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45 Cards in this Set
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- Back
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Lyme Disease - Information
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- Borrelia burgdorferi - bacterial spirochete
- Transmitted to humans through the bite of infected deer ticks - Most commonly reported vector-borne illness in the US - Most prevalent in June and July |
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Lyme Disease - Clinical Presentation
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- Clinical Presentation: ERYTHEMA MIGRANS, stiff neck, fever, malaise, fatigue, headache, myalgia, arthralgia, other manifestations of the musculoskeltal, cardiovascular, and neurologic
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Lyme Disease - Diagnostic Test
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Two-Tiered Testing
Enzyme Immunoassay or Immunofluorescence assay - Positive then IgM, IgG and Western blot (with signs and symptoms) or Western blot (without signs and symptoms) Other options - skin biopsy, PCR testing, the lyme Urine Antigen Test, VIsE C6 Peptide Assay |
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Lyme Disease - Management
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- Safety and Prevention
- Tick removal - Prophylaxis - doxycycline single dose 200 mg if deer tick, attached >36 hours, within 72 hours of tick removal, endemic lyme disease, and no contraindications to doxycycline - Early Localized Disease - Doxycycline 100 mg BID for 14 days (not for use in children under 8 or pregnant women), Amoxicillin 500 mg tid for 14 days, - Early Disseminated with Neurological symptoms - PO doxycycline 100 mg PO BID x 14 or IV ceftriaxone 2 mg once daily for 28 days - Early Disseminated with Carditis - IV or PO antibiotics - Late Persistent - Neurological symptoms - 28 days IV therapy, Arthritis - 4 week course of PO doxycycline or amoxicillin, or IV depending on severity |
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West Nile Virus
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- Flavivirus that is spread when a mosquito bites an infected bird and then a human
- Most prevalent increasingly from July to September |
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West Nile Virus - Clinical Presentation
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Early phase: 1-2 weeks post infection for 3-6 days - abdominal pain, diarrhea, fever, headache, lack of appetite, nausea, rash, sore throat, swollen lymph nodes, vomiting
Late signs & neurological involvement - high fever, severe headache, stiff neck, disorientation or confusion, stupor or coma, tremors or muscle jerking, lack of coordination, convulsions, pain, paralysis *Maculopapular rash on chest, back, and arms < 1 week PE - febrile, splenomegaly, adenopathy, arthralgias, nuchal rigidity (brudziniki's sign & kernig's sign), decrease DTR, encephalitis, extrapyramidal symptoms, myoclonus, parkinsonian features |
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West Nile Virus - Diagnostic Tests
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Lumbar Puncture - differentiate between WNV and aseptic meningitis, increase WBC with neutrophils dominant, growth of bacteria
MRI - leptomeningeal enhancement IgM - detected in serum 6-14 days after symptom onset, or in CSF within 8 days, indicates recent infection Hyponatremia, elevated transaminases, increase creatine kinase & myoglobin |
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West Nile Virus - Management
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Treatment = supportive care
Monitored in primary care setting but if a Neuroinvasive Disease is suspected - admit to hopsital for lumbar puncture and MRI Encephalitis - need ICU Investigational Treatments - Interferon, Ribavirin, IV Immunoglobulin PREVENT |
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Malaria
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- Risk Factors - living or visiting tropical areas
- Immunity - residents of endemic areas can acquire partial immunity that lessens the severity of symptoms - Plasmodium sporozoites -- vector 1 -- human host -- liver infection -- blood infection -- vector 2 -- human host |
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Malaria - Clinical Presentation
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Symptomatic a few weeks after infection - headache, cough, fatigue, malaise, shaking chills, arthralgia, myalgia, paroxysm if fever, shaking chills, and sweats every 48-72 hours - classic
may have splenomegaly, anemia, respiratory abnormalities, renal failure |
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Malaria - Diagnostic Tests
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Blood cultures, CBC, BMP, liver function, etc.
Suggested by the triad of: thrombocyptopenia, elevated lactase dehydrogenase levels, and atypical lymphocytes Micro-hemacrit centrifugation, fluorescent dyes/uv indicator tests, thin or thick blood smears or quantitative buffy coat |
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Malaria - Management
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chloroquine
Atovaquone-proquanil Artemether-lumefantrine Meflorquine Quinine Quinidine Doxycycline (used in combination with quinine) Cindamycin (used in combination with quinine) Artesunate Prevent! Prophylaxis!! |
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Mononucleosis
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Viral infection, acute, self-limited
Risk Factors - close contact with EBV infected individual - respiratory droplet, saliva, sexual contact, urine |
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Mononucleosis - Clinical Presentation
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Preceding symptoms - malaise, anorexia, fatigue
Classic Triad - Fever, Pharyngitis, Lymphadenopathy (anterior and Posterior cervical chain) Other symptoms - palatal petechiae, splenomegaly, rash |
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Mononucleosis - Diagnostic Tests
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CBC w/ diff, LFTs, Heterophile antibodies (Monospot), Viral Capsid Antigen (VCA) IgG and IgM, Epstein-Barr Virus Nuclear Antigen (EBVA)
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Mononucleosis - Management
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Adequate hydration, bedrest
NSAIDs, Acetaminophen, throat lozenges, corticosteroids Patient Education - Transmission through oropharyngeal secretion, refrain from strenuous activity for 3-4 weeks, importance of rest Hospitalization if indicated by peritonsillar abscess, respiratory compromise, dysphagia |
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Chronic Fatigue Syndrome
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A real illness - chronic fatigue
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Chronic Fatigue Syndrome - Clinical Presentation
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Fatigue - incapacitating, not improved by rest, worsened by mental or physical exertion
6 months or more: increased malaise, sleep problems, difficulty with cognitive activities, joint pain, myopathy, tender lymph nodes, headache, sore throat Brain fog, vertigo, hypersensitivity to foods, smells, noise, chemicals, bowel changes, chills and sweats, depression |
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Chronic Fatigue Syndrome - Diagnostic Tests
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Rule out all other options
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Chronic Fatigue Syndrome - Management
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Cognitive Behavioral Therapy - series of one hour sessions designed to alter beliefs & behaviors that might delay recovery such as planning and pacing activities to reduce fatigue
Graded Exercise Therapy: Physical activity that starts slowly and gradually increases over time Antidepressants: phenelzine, a MAOI, showed significant improvement in treatment group - depression, insomnia, or myalgia Methylphenidate for fatigue and concentration Glucocorticoids Patient Education - reaffirm it is a real illness, refer to psychiatry, physical therapy, alternative therapies |
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Pertussis - The Whooping Cough
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risk factors - younger than 6 months that aren't vaccinated, waning immunity
Highly contagious respiratory illness caused by Bordetella pertussis bacterium |
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Pertussis - The Whooping Cough - Clinical Presentation
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Characterized by 3 Phases: Catarrhal, Paroxysmal, Convalescent
Catarrhal - lasts 1-2 weeks, malaise, mild cough, rhinorrhea, mild fever, ** excessive lacrimation and conjunctival injection Paroxysmal - lasts 1-6 weeks - ** Paroxysmal Cough (succession of severe coughs occurring during one exhalation), cough may be followed by post-tussive vomiting or syncope, triggers laughing, exercise, shouting, yawning, typically worse at night Convalescent Phase - lasts 2-3 weeks, slow decrease in the intensity and frequency of the cough paroxysms |
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Pertussis - The Whooping Cough - Diagnostic Tests
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Obtain culture by using deep nasopharyngeal aspiration or by holding a flexible swab (Dacron or calcium alginate) in the patient's posterior nasopharynx until a cough is produced
PCR or ELISA Usually a clinical diagnosis - paroxysm of coughing, the whoop, and known exposure |
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Pertussis - The Whooping Cough - Management
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Comfort measures - increase fluid intake, eat small, frequent meals to avoid vomiting with coughing episodes, cool mist vaporizer
Azithromycin, Clarithromycin, and Erythromycin, Trimethoprim-sulfamethoxasole Vaccination!! Tdap booster every 10 years - pregnant women, adults who have contact with infants |
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Meningitis
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Disease caused by inflammation of protective membranes covering the brain and spinal cord (meninges)
Inflammation usually caused by infection of CSF: bacterial or viral, parasitic, fungal - may be secondary to other diseases |
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Meningitis - Clinical Presentation
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s/sx may develop over several hours or 1-2 days
In adults and patients over age 2: sudden high fever, severe headache, accompanied by vomiting or nausea, stiff neck, confusion or difficulty concentrating, sleepiness or difficulty waking up, sensitivity to light, lack of interest in drinking or eating, skin rash, seizures PE - Kernig's sign - patient cannot extend leg at knee when thigh flexed d/t stiffness in neck, Brudzinski's sign - when the patient's neck is flexed, hip and knees flex d/t stiffness in neck, skin inspection and tumbler test - purpura and petechiae - rash doesnt change color under pressure decreased respiratory rate, hypotension, bradycardia, sluggish reactive pupils or dilated pupils, papilledema, focal deficits, posturing, hyperreflexia, spasticity |
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Meningitis - Diagnostic Tests
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Blood cultures
CRP Lumbar Puncture - CSF protein, glucose, WBC w/diff, gram stain, culture - contraindications: signs of ICP |
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Meningitis - Management
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Bacterial - immediate empirical antimicrobial therapy - vancomycin, cefotaxime and adjunctive dexamethasone therapy
Viral - supportive |
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Meningitis - Education
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Spread via airborne droplets from infected person BUT not via casual contact - late winter/early spring
20% have longterm disabilities Quick recognition of alarm symptoms is key - high fever, severe headache, stiff neck, confusion, N/V, exhaustion, rash Vaccination is single best way to prevent disease - at 11 yrs, booster at 16 Antibiotic prophylaxis if exposed |
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Pneumococcal Disease
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An infection caused by streptococcus pneumoniae bacterium
Spreads from perso to person through respiratory droplets A healthy person's immune system will prevent the bacteria from causing symptoms in most cases but a person who is immune compromised can develop a serious infection |
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Pneumococcal Disease - Clinical Presentation
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Abrupt onset of symptoms, fever, shaking chills, malaise, weakness, headache
Pneumococcal Sepsis - fever, headache, muscular aches and pains, tachycardia, tachypnea Pneumococcal meningitis - fever, headache, N/V, sleepiness, irritability, stiff neck, seizures, coma Pneumococcal pneumonia - productive cough with mucopurulent rusty-colored sputum, fever, SOB, pleuritic chest pain, N/V, headache, fatigue, muscle aches, hypoxia Pneumococcal acute otitis media - earache, an elevated body temperature, vomiting, diarrhea, temporary hearing loss, ear discharge |
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Pneumococcal Disease - diagnostics
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Specimen tests - gram stain and culture tests can be performed using blood, cerebrospinal fluid, sputum or pleural fluid/lung aspirate for example
For otitis media: weber test, rinnie test, pneumatic otoscopy |
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Pneumococcal Disease - Management
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Warm showers and teas to loosen up mucus in the lungs, use of cool mist humidifier, rest, adequate fluid intake
Penicillins, second generation cephalosporins, treat for 10 to 14 days Immunization - all individuals over 65, others at risk |
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Parvovirus B19
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Erythemainfectiosum
Causes mild rash illness called 5th Disease Spread through respiratory secretions, blood, or blood products & from mother to fetus - most contagious when cold-like symptoms present and before rash or joint swelling Symptoms arise within 4-14 days |
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Parvovirus B19 - Clinical Presentation
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First symptoms mild and nonspecific - fever, runy nose, headache
Rash on face and body, may be pruritic, usually disappears in 7-10 days, lacy appearance of rash as it goes away Polyarthropathy Syndrome - pain and swelling in joints, lasts 1-3 weeks |
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Parvovirus B19 - Diagnostics
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Slapped cheek rash on face
Parvovirus B19 specific antibodies Nucleic Acid Amplification Testing - test of choice for diagnosing acute infection in immunocompromised |
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Parvovirus B19 - Management
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Will go away on its own
Treatment revolved around symptom management No vaccine or medication to prevent it May need IV immunoglobulin treatment with chronic infection with anemia or HIV patients |
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Varicella
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Vaccine - possible herd immunity
Contagious 1-2 days before the rash appears, may take between 5-10 days until all the blisters have formed scabs, it can take 10-21 days after contact to develop chickenpox |
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Varicella - clinical Presentation
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1. Macule - develop within hours over the trunk spreading to the face and extremities.
2. Vesicle - develop from the macules, with classic umbilicated centers 3. Granular scab: form after the vesicle breaks open and begins to crust over crops of lesions occur successively all three forms are visible on the 3rd day pruritus accompanies the lesions Adults may have prodromal symptoms of nausea, loss of appetite, aching muscles, headache, cold-like symptoms |
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Varicella- Diagnostics
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PCR to confirm varicella - collect within 5 days of rash onset, sample 2 lesions of vesicle and crusts
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Varicella - Management
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See slides
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Herpes Zoster
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Shingles
A reactivation of dormant varicella-zoster virus in a sensory ganglion Prevent with Zostavax - one dose regardless of chickenpox history Postherpetic Neuralgia after |
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Herpes Zoster - Clinical Presentation
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Pain - stabbing, burning, aching
Itching Tingling Unilateral, painful rash on the face, and or body - one dermatone or 2-3 close dermatomes Swollen/enlarged lymph nodes Single stripe of erythematous papules or grouped vesicles, 3-4 days may progress to pustular vesicular lesions, 7-10 days lesions crust, no longer infectious Symptoms - low-grade fever, nausea, chills, headache |
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Herpes Zoster- Diagnostics
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Tzanck test - allows rapid confirmation of diagnosis in outpatient setting
Direct fluorescent antibody (DFA) test PCR Viral culture |
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Herpes Zoster - Management
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Symptomatic treatment of lesions and prevention of secondary infection - corticosteriods, analgesics and narcotics, calamine and domeboro soaks
Antivirals - started within 72 hours of rash onset - decreases duration and severity of rash and pain while reducing the risk of postherpetic neuralgia (PHN) Acyclovir, famciclovir, and valacyclovir |
