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394 Cards in this Set
- Front
- Back
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What are the 4 common gram stain results? |
Gram + Cocci
Gram + Rods Gram - Cocci Gram - Rods |
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List the Gram + cocci
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Staphylococcus
Streptococcus Peptostreptococcus |
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List the Gram + rods
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Cornyebacterium
Listeria Lactobacillus Bacillus Propionibacterium Erysipelothrix |
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List the Gram - cocci
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Nisseria
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List the Gram - rods
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Escherichia
Klebsiella Enterobacter Serratia Pseudomonas Proteus Salmonella Shigella Moraxella Haemophilus |
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What are the main fungal diseases?
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Candidiasis (yeast)
Cryptococcosis Histoplasmosis Pneumocystis |
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List the main bacterial diseases?
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Botulism
Chlamydia Cholera Diphtheria Gonococcal Infection Salmonellosis Shigellosis Tetanus |
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List the mycobacterial diseases
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Tuberculosis
Atypical mycobacterial disease |
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List the Parasitic diseases
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AmebiasisAscariasis
Giardiasis Hookworms Malaria Pinworms Tapeworms Toxoplasmosis |
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List the Spirochetal Disease
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Lyme disease
Rocky Mountain Spotted Fever Syphilis |
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List the main viral diseases
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CMV
EVB erythema infectiosum herpes simplex HIV infection HPV Influenza Rubeola (Measles) Mumps Rubella Rabies Roseola VZV Herpangina hand-foot-mouth disease |
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What is the most common opportunistic fungal infection?
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Candidiasis
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What is the most common organism causing candidiasis?
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candida albicans (others include glabrata, parapsilosis, tropicalis)
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How do candida species reproduce?
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through budding
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How are candida species spread?
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they are found in the normal flora in the GI and GU tract and on the skin
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List the 4 bodily manifestations of candida
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1. Oropharyngeal/esophageal (thrush)
2. Vulvovaginitis (yeast infection) 3. Skin 4. Disseminated |
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Describe the appearance of lesions involved in oropharyngeal/esopohageal (thrush)
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white plaques on the buccal mucosa, palate, oropharynx or tongue
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What happens when you scrape thrush?
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reveals an erythematous, non-ulcerated mucosa
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If the patient is a healthy person, what should you expect when you so oropharyngeal thrush?
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HIV
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When does vulvovaginitis (yeast/candidiasis) most commonly effect people
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women of child-bearing age
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List the risk factors for vulvovaginitis
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increased estrogen levels, DM, corticosteroid therapy, antibiotics and HIV
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What are the symptoms of vulvovaginitis?
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vaginal discomfort
curd-like discharge pruritis |
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Would would you expect to see on PE for a pt with vulvovaginitis?
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vaginal walls are erythematous and show white plaques, labia are erythematous and swollen
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Where do cutaneous candida infections most commonly occur?
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in the intertriginous areas or under large breasts or pannus
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What do cutaneous candida lesions look like?
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erythematous with a distinct border and SATELLITE LESIONS
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What is the most common disseminated candida infection?
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candidemia
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What are the risk factors for candidemia?
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broad spectrum abx
central IV catheters renal failure corticosteroid therapy |
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What is a complication of candidemia?
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endocarditis and hepatosplenic infxn
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How do you diagnose a candida infxn?
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***KOH prep/Gram Stain -->budding yeast and PSEUDOHYPHAE***
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How do you diagnose disseminated disease?
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blood culture
(imaging such as CT to determine extent) |
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How do you treat thrush?
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clotrimazole trouches
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How do you treat esophagitis?
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fluconazole OR intraconazole
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How do you treat vaginitis?
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miconazole (monistat/nystatin) OR clotrimazole
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How do you treat disseminated candida disease?
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amphotericin B or fluconazole
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Why should a patient with renal disease take fluconazole rather than amphotericin B?
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Amphotericin B is nephrotoxic
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What organism causes cryptococcosis?
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a yeast called cryptococcus neofromans
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What population usually acquires this disease? (cryptococcosis)
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immunosuppressed (CD 4 <50)
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What is the most common clinical manifestation of cryptococcosis?
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meningitis (often with pulmonary infxn)
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How is this organism (cryptococcus) spread?
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inhaled (often pigeon excreta) causing pulmonary infection. Without adequate immunity, infxn disseminates
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What are the clinical manifestations of cryptococcus?
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*CNS infxn (HA, nuchal rigidity, lethargy, confusion, photophobia, papilledema, N/V)
-fever in 50% of cases *Pulmonary Infxn (usually w/underlying COPD): fever, cough and dyspnea |
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What tests are used to diagnosis cryptoccocosis infxn?
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1. Culture
2. Mucicarmine stain/ INDIAN INK PREP 3. Latex agglutination testing |
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What will a pt with cryptococcosis show in the CSF?
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increased WBC's (predominantly lymphocytes)
increased protein decreased glucose |
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How do you treat cryptococcosis?
pulmonary vs CNS |
Pulmonary: fluconazole or itraconazole
CNS: amphotericin B + flucytosin x 6wks |
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What organism is histoplasmosis caused by?
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histoplasmosis capsulatum
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What type of organism is histoplasmosis capsulatum?
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a dimorphic fungus
(mold at <35C, yeast at 35-37C) |
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What part of the world is histoplasmosis most often seen?
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Mississippi and Ohio River valleys
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Histoplasmosis capsulatum is often found hiding in what?
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bird or bat guano in caves, soil and abandoned buildings
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How does a person contract histoplasmosis?
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inhale organism, localized pulmonary infxn, phagocytized organisms survive and travel within macrophages to hilar and mediastinal lymph nodes
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What are the 3 categories in which histoplasmosis can be manifest?
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Acute Pulmonary
Chronic Pulmonary Disseminated |
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What are the symptoms of acute pulmonary histoplasmosis?
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fever, chills, fatigue, nonproductive cough, myalgias
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What is seen on X-ray with acute pulmonary histoplasmosis?
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patchy lobar or multilobe infiltrate
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What is chronic pulmonary histoplasmosis often seen?
What are the symptoms seen? What will be seen on CXR? |
pt's with hx of COPD
--fever, fatigue, anorexia, weight loss, productive cough w/purulent sputum and hemoptysis ----upper love infiltrates w/multiple cavities |
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When do you most commonly see disseminated histoplasmosis?
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immunocompromised, post-transplant, corticosteroid tx
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What are the symptoms of disseminated histoplasmosis?
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fever, chills, anorexia, weight loss, hypotension, dyspnea and hepatosplenomegaly
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What would a blood test reveal in disseminated histoplasmosis? What about CXR?
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pancytopenia
-diffuse pulmonary infiltrates |
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How do you diagnose histoplasmosis?
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Culture (takes 6wks to grow)
Bx stained w/methenamine silver Wright's stain of peripheral blood Complement fixation or immunodiffusion testing (M precipitin band on ID testing) *Disseminated disease: enzyme immunoassay on urine or serum |
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How do you treat mild to moderate histoplasmosis?
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itraconazole
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How do you treat severe histoplasmosis?
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amphotericin B
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What is the most frequent case-defining infxn of AIDS?
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Pneumocystis
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What organism is pneumocystis caused by and what type of organism is it?
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PNEUMOCYSTIS CARINII
eukaryotic microbe with fungal characteristics |
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When is a person exposed to pneumocystis and when does it become activated?
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exposed early in life and activated during severe immune system depression
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What are the symptoms of pneumocystis?
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hacking, nonproductive cough, fever and dyspnea
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What will a pt with pneumocystis reveal have on lung PE?
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typically normal but may have rales and wheezing
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What is the most useful marker and predictor of out come in pneumocystis
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hypoxemia
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What will a CXR reveal in a pt with pneumocystis?
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interstitial infiltrates beginning in the perihilar region and spreading lower in a butterfly pattern
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What 4 things are used for diagnosis of pneumocystis?
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1. CXR
2. bronchoalveolar lavage w/stains 3. Increased uptake on gallium scan 4. CD4 <200 |
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How do you treat acute pneumocystis?
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1. Trimethoprim-sulfamethoxazole
2. Parenteral pentamidine 3. Clincamycin plus primaquine |
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What criteria is needed for prophylactic treatment of patients who want to prevent pneumocystis?
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Prior pneumocystis infxn
CD <200 |
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What is the prophylactic treatment of pneumocystis?
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Dapsone
Aerosolized pentamidine |
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What is botulism produced by?
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a toxin produced by clostridium botulinum
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What type of organism is clostridium botulinum and where is it found
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--Gram - spore forming obligate anaerobe
-----Found in soil, marine environments and agricultural products |
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How does botulism toxin work/reproduce?
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absorbed from gut, lung or wound (does not penetrate intact skin)
-->binds to receptors and blocks acetylcholine |
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What is the most severe complication of clostridium botulinum
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severe neuroparalytic disease
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What are the 4 clinical forms of botulinum toxin?
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1. food-borne (MC: inadequate food prep- in outbreaks)
2. Wound (unusual: traumatic w/soil contamination 3. Infant (GI tract from soil/honey) "floppy baby syndrome" 4. Inhalation |
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What are the symptoms of "floppy baby syndrome"
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a. lethargy
b. diminished suck c constipation d weakness e diminished spontaneous activity w/loss of head control |
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List the clinical manifestations of botulism
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1 bulbar musculature (1st affected: diplopia, dysphonia, dysarthria, dsyphagia)
2. Cholinergic ANS decreased salivation, ileus, urinary retention 3. Neurologic ***AFEBRILE |
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What are the neurologic manifestations of botulism
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*b/l CN 6 palsy
*ptosis *dilated pupils *dec. gag reflex *respiratory failure *n/v |
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What are the 2 steps in diagnosing botulism?
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1-examine food, serum, stool and gastric contents for toxin
2. Stool or food culture |
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What is the tx for botulism?
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SUPPORTIVE
Passive immunization with toxin Abx only in wound infxn |
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How can botulism be prevented?
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1. Destroy spores w/heat or irradiation
2. Inhibit germination (dec. pH) by refrigeration, freezing, or drying 3. Don't give honey to infants under age 1 |
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What type of organism is chlamydia?
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obligate intracellular bacteria
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What are the 3 organisms of chlamydia?
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Chlamydia trachomatis
Chlamydia pneumoniae Chlamydia psittaci |
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What are the 5 disease caused by chlamydia?
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1. Trachoma
2. Urethritis/Cervicitis 3. Epididymitis/Salpingitis 4. Atypical Pneumonia 5. Psittacosis |
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What is the most common cause of preventable blindness?
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trachoma (chlamydia)
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What is trachoma
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a chronic follicular conjunctivitis
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How do you treat trachoma?
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topical tetracycyline and erythromycin x21-60 days
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How does urethritis/cervicitis (caused by chlamydia) present?
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mild, clear or cloudy urethral discharge, urethral discomfort, mild dysuria
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How do you treat urethritis/cervicitis (caused by chlamydia)?
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tetracycline or azithromycin
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What causes epididymitis/salpingitis?
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the spread of chlamydia from urethra to epididymis or fallopian tubes
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What is the presentation of epididymitis/salpingitis (caused by chlamydia)
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MEN:
unilateral testicular pain scrotal erythema and tenderness swelling over the epididymis Women: low abdominal pain and dyspareunia |
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How do you treat salpingitis/epididymitis (caused by chlamydia)
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tetracycline or azithromycin
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How does atypical pneumonia, caused by chlamydia, present?
on PE? |
nonproductive cough, sore throat and hoarseness
PE: crackles |
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What does CXR or atypical pneumonia (from chlamydia) show
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pneumonitis
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How do you treat atypical pneumonia caused by chlamydia
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tetracycline or erythromycin
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What is psittacosis
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systemic infxn of the reticuloendothelial system
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How does psittacosis (caused by chlamydia) present
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abrupt febrile illness w/shaking chills and fever, HA, myalgia, arthralgias, and nonproductive cough
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What will be seen on CXR for person with psittacosis caused by chlamydia
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single or multiple localized bronchopneumonic patches
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How do you treat psittacosis causes by chlamydia?
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tetracycline or doxycycline
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Describe cholera
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acute watery "rice water" diarrhea
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What is cholera caused by
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an exotoxin produced by vibrio cholerae
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How is cholera spread
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via comtaminated water and food
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What are the signs and symptoms of cholera?
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similar to those with severe water loss
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How is cholera diagnosed
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stool culture and serology
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How is cholera treated
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1. rehydration via oral route with WHO/UNICEF solution, pedialyte or rice solution
2. Abx: tetracycline, fluoroquinolones and macrolides |
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What is diphtheria
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tonsillopharyngitis and/or laryngitis due to corynebacterium diphtheriae
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How is diphtheria spread
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humans: close-contact setting through respiratory droplets
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How does diphtheria begin
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incubation 1-7days followed by sore throat, malaise and fever
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What are the PE finding for diphtheria
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whitish exudate appears on the tonsils and later becomes a grayish membrane
(membrane is very adherent and bleeds easily on attempted removal) |
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What are complications of diphtheria
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myocarditis, conduction disturbances and neurologic impairment
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What is the tx for diphtheria?
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1. Equine diphtheria antitoxin
2. Parenteral penicillin (prevent transmission & limit local infxn) 3. Prophylactic abx for close contacts |
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How and when can diphtheria be prevented?
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Immunization
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How is a gonococcal infxn transmitted and what is it caused by
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sexually transmitted
Neisseria gonorrhoeae |
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What 3 disease does gonococcal infxn cause
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1. urethritis
2. Endocervicitis 3. Neonatal conjunctivitis (ophthalmia neonatorum) |
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How does gonococcal urethritis present
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dysuria and purulent urethral discharge
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How does an endocervcial gonococcal infxn present
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1. vaginal discharge and abnormal vaginal bleeding
2. Cervicitis w/mucopurulent discharge 3. easily induced bleeding with gentle swabbing of the cervix |
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How does gonococcal conjunctivitis present
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Mucopurulent discharge on conjunctivae
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How do you treat gonococcal conjunctivitis
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topical abx OR 1%silver nitrate
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How is a gonococcal infxn diagnosed
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MALE
gram stain: intracellular gram - diplococci FEMALE: culture |
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What is important to remember in the work-up and treatment of a patient with a gonococcal infxn?
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**Tx sexual partner
**Consider HIV and syphilis testing |
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What does disseminated gonococcal disease present with
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polyarticular tenosynovitis, dermatitis and/or septic arthritis
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What is PID caused by
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chlamydia or gonorrhea
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How does PID present
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lower abdominal pain, fever, malaiseand anorexia
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what is seen on PE of PID
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lower abdominal tenderness, cervical motion tenderness (CMT), b/l adnexal tenderness and signs of cervicitis or vaginal infection
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What is a complication of PID
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fallopian scarring --> infertility or ectopic pregnancy
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How do you treat PID
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IV: cefoxitin OR cefotetan + doxycycline OR clindamycin + gentamycin
ORAL: ofloxacin OR levofloxacin + metronidazole OR single dose ceftriaxone + doxycline + metronidaole x 14 days |
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How do you treat gonococcal endocervical and urethral infections
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Single dose
ceftriaxone 125mg IM cefpodoxime 400mg PO Ciprofloxacin 500mg PO Follow-up tx: Azithromycin 1g PO single dose OR Doxycycline 100mg PO BID x7days |
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What is typhoid fever caused by
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salmonella typhi
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how is salmonella typhi transmitted
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fecal-oral route through contaminated water or food
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What are the symptoms of typhoid fever
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1. increasing fever, chills, malaise, dry cough, anorexia, HA, abdominal tenderness
2. (week 2) erythematous macule or papules (rose spots) on shoulders, thorax and abdomen 3. Intestinal bleeding or perforation |
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What should be ordered in a pt suspected of having typhoid fever
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CBC (normal-low WBC, increased bands)
Blood cultures Widal test for agglutinating antibodies against the O and H antigens of S. typhi |
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How do you treat typhoid fever
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fluoroquinolones
chloramphenicol, amoxicillin, or trimethoprim-sulfamethoxazole |
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What other organizms cause salmonella infections
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salmonella enteritidis
salmonella typhimurium |
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How can a person contract a salmonella infxn (excluding typhoid fever)
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food products: poultry, reptiles and amphibians
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What are the clinical manifestations of a salmonella infxn (excluding typhoid fever)
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1. asymptomatic carrier
2. enterocolitis 3. crampy abdominal pain and diarrhea 4. prolonged, sustained fever 5. WBC in stool w/mucus 6. enteric fever 7. similar to typhoid fever 8. bacteremia |
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People with what disease are most likely to show symptoms of salmonella infection
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those with hemolytic diseases such as sickle cell
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How do you diagnose salmonella infxn (excluding typhoid fever)
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stool culture
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How do you treat a salmonella infxn (excluding typhoid fever)
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Enterocolitis: no abx
Bacteremai and enteric fever: fluoroquinolones, 3rd generation cephalosporins |
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What is shigellosis
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infxn due to shigella resulting in colitis (affecting mainly the sigmoid colon)
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How is shigella transmitted
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fecal-oral route, person-to-person through contaminated hands
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How long is shigella secreted in the stool
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6weeks
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What is the clinical manifestation of shigellosis
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1. intial: nonspecific prodrome and intestinal symptoms (cramps, loose stools, water diarrhea)
2. bloody, mucus stool, tenesmus and rectal pain 3. LLQ pain |
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How do you treat shigellosis
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***Always ABX
Adult: cipro Child: trimethoprim-sulfamethoxazole, ampicillin or azithromycin Do NOT give agens that decrease intestinal motility |
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What are 2 things that result from post-dysenteric syndromes
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Arthritis
Reiters triad (arthritis, urethritis, conjunctivitis) |
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What is tetanus?
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a neurologic syndrome due to neurotoxin
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What organism causes tetanus and where is it found?
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Clostridium tetani found in soil
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What is the incubation period of clostridium tetani
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7-21 days
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What are the symptoms of tetanus
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generalized tetanus
MC complaint: trismus (lockjaw) -irritability, diaphoresis, dysphagia, hydrophobia, back muscle spasms |
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How is do you diagnose tetanus
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clinical findings
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How do you treat tetanus
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SUPPORTIVE
benzo's for back spasms passive immunization w/human tetanus immunoglobulin 500units IM active immunization abx: metronidazole OR penicillin |
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When is tetanus given
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2 months, 4 months, 6 months, 15 months, and 4-6yrs
Td ever 10 yrs |
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What is tuberculosis causes by and what type of organism is it?
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Mycobacterium tuberculosis
(acid-fast bacillus) |
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What is the only natural reservoir for m.tuberculosis
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humans
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What are the symptoms of TB
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cough w/ hemoptysis, fever and sweating
malaise, fatigue, wt loss, chest pain and dyspnea |
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Where can extrapulmonary disease occur
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lymphatic
pleural GU bone or joine disseminated meninges and CNS GI pericardial |
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How do you diagnose TB
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CXR:lesions in upper lung fields
Acid-fast smears **CULTURE is the gold standard |
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What is the treatment for TB
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1. Isoniazid: 9months
2. Rifampin: 4months 3. Rifambutin 4. Pyrazinamide 5. Ethambutol 6. Streptomycin |
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What is the name of the atypical atypical mycobacterial disease
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Mycobacterium-avium intracellulare
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What is Mycobacterium-avium intracellulare
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pulmonary infection typically in pts with underlying lung dz
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What are the symptoms of Mycobacterium-avium intracellulare
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fever, wt loss, anorexia, abdomina pain, diarrhea
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How do you diagnose Mycobacterium-avium intracellulare
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culture from blood, bone, marrow or tissue
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How do you treat Mycobacterium-avium intracellulare
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a. azithromycin OR clarithromycin, rifambutin OR rifampin & ethambutol
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What is the prophylactic tx for Mycobacterium-avium intracellulare
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azithromycin or clarithromycin at CD4<50
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Where is the hightest prevalence of amebiasis
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developing countries (poor sanitation)
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What organism causes amebiasis
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entamoeba histolytica
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What can amebiasis lead to
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liver abscess
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How does amebiasis present
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-Asymptomatic
-bloody,mucus diarrhea, pain, urgency and tenesmus -LLQ tenderness in colitis -Liver abscess: RUQ radiating to back (diarrhea uncommon) |
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How do you diagnose amebiasis
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identification of trophozoites or cysts in stool or involved tissue
(no fecal leukocytes) hepatic ultrasound for liver abscess |
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How do you treat amebiasis
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metronidazole followed by paromomycin
drain liver abscess |
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What is ascarias?
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common helminithic infection
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Where is ascariasis found most often
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southeastern U.S.
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What organism is ascariasis casued by? Where is it found?
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ascaris lumbricoides
contaminated soil |
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How does ascaris lumbricoides form disease
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onces ingested, largae emerge in the small intestine and migrate to the lung and then back to the intestine
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What are the symptoms of ascariasis
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ASYMPTOMATIC
heavy exposure: cough, dyspnea, asthma with eisonophilia intestinal infxn: abdominal pain, distention nausea, anorexia, intermittent diarrhea (possible obstruction) |
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How do you diagnose ascariasis
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AXR: "whirlpool pattern of intraluminal worms
large, brown, tri-layered eggs in the stool |
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What is the treatment for ascariasis
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mebendazole or albendazole
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What is giardiasis caused by and what is it?
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giardia lamblia
(flagellated protozoan) |
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How is giardiasis acquired
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lake or stream water, contaminated food, personal contact (day-care centers)
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What is the most commonly identified cause of waterborne outbreaks of diarrhea?
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Giardiasis
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What is the incubation period for giardiasis
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1-2weeks
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What are the symptoms of giardiasis
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bloating, cramping and flatulence followed by foul-smelling diarrhea (possibly develop malabsorption syndrome)
fever uncommon after first few days |
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How do you diagnose giardiasis
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examine stool for presence of cysts
enzyme immunoassay antigen tests |
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How do you treat giardiasis
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metronidazole and albendazole (paromomycin in pregnant women)
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How can you kill the cysts of giardiasis
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boiling or filitration - NOT chlorination
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Where is hookworm most commonly seen
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worldwide BUT in U.S. - southeastern U.S.
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What is hookworm caused by?
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One of two nematodes
ancylostomaa duodenale Necator americanus |
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How is hookworm acquired
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skin exposure to larvae in soil contaminated by human feces
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How do hookworms form disease in humans
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once in the skin, larva move to the lung and break into the alveoli, larvae are coughed up and swallowed then live in the jejunum
(4week time period) |
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How does hookworm present?
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pruritic rash at site of entry
asymptomatic pulmonary (possibly cough, patchy infiltrates and eosinophilia abdominal pain, nausea and bloating anemia due to blood loss |
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How do you diagnose hookworm
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noting eggs in stool sample
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How do you treat hookworm
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albendazole or mebendazole
iron |
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What is the general rule for malaria?
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any traveler with fever has malaria until proven otherwise
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What 4 organisms can cause malaria
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Plasmodium
P. falciparum P. vivax P. ovale P. malariae |
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What is the life cycle of organisms causing malaria
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female anopheline mospito bites and infects hume with sporozoites
evolve from sporozoites to shizonts to merozites in the liver merozoites are released from the liver and invade the red blood cells, where they multiply |
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What are the clinical manifestations of malaria
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1. Cold stage: chills lasting up to several hours
2. Hot stage: high fever lasting several hours (fever responds to lysis of RBC's 3. Drenching sweats HA, back ache, abdomina pain, n/v, hypotension, AMS during hot stage |
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What complication can P. falciparum cause
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coma (cerebral malaria) or renal failure w/himoglobinuria (blackwater fever)
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How do you diagnose malaria?
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High degree of suspicion
Examine thick and thin blood smears for parasite |
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How do you treat malaria
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CONTROL VECTOR
chemoprophylaxis with chloriquine chlorquine resistance: mefloquine, doxy, chloroquine plus proguanil |
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What is the most prevalent helminithic infection in the U.S.
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pinworm
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Who is typically affected by pinworm
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children in dcay care center, institutionalized individuals and crowded spaces
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What organism is pinworm caused by
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enterobius vermicularis
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How do pinworms create infection
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take up residence in cecum
at night, females migrate to periana region and lay eggs |
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How long are pinworm eggs infectious
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up to 20 days
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What are the symptoms of pinworms
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perineal itching and insomnia
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How is pinworm transmitted
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by patient's hands
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How do you diagnose pinworm
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cullophane tape test showing ovoid eggs under microscope
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How do you treat pinworm
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single dose mebendazole or albendazole, repeat in 2 weeks
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What organism is toxoplasmosis caused by and what is it?
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toxoplasma gondii ( a protozoan) a zoonosis (host is cat)
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What are the 2 routes of infection of toxoplasmosis
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Oral: undercooked or raw meat
Transplacental: to fetus |
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What are the clinical manifestations of toxoplasmosis
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Primary: asymptomatic, lymphadenopathy and fatigue w/o fever
Immunocompromised: encephalitis, chorioretinitis, pneumonitis, systemic disease |
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How do you diagnose toxoplasmosis
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Serology IgG to establish exposure
identify parasite in the tissue CT or MRI to check for toxoplasmosis in brain (multiple ring-enhancing lesions) |
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How do you treat toxoplasmosis in an immunocompetent patient
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none for lymphadenitis
Systemic: pyrimethamin, sulfadiazine, folinic acid |
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How do you treat toxoplasmosis in an immunocompromised pt
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pyrimethamine, sulfadiazine and folinic acid
trimethoprim/sulfamethoxazole or dapsone + pyrimethamine for prophylaxis for the full life |
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List the 3 organisms causing tapeworm
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taenia solium
taenia saginata diphylloborthrium latum |
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What does taenia solium/saginata, diphyllobbothrium cause
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solium pork tapeworm
saginata: beef tapeworm Diphyllobothrium: fish tapeworm |
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Where is taenia solium most often found
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Mexico, South and Central America, Africa, Southeast asia and India
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What lab result will be found with tapeworm
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eosinophilia for all + B12 deficiency in diphyllobothrium latum
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How do you diagnose tapeworm
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stool O&P
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How do you treat tapeworm
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Praziquantel or Niclosamid
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How do you prevent tapeworm
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adequate cooking
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What are signs and symptoms for tapeworm
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Asymptomatic for solium and saginata
Diphyllobothrium latum: bloating, abdominal pain and diarrhea |
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Where is taenia saginata most commonly seen
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worldwide, but common in central Asia and eastern Africa
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Where is diphyllobothrium latum found
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Europe, Canada, Alaska, and Japan
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What is the most common vector-borne disease in the U.S.
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Lyme disease
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what is lyme disease caused by
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Borelia burgdorferi (a spirochete)
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How is Lyme disease transmitted
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by ticks of the Ixodes family
Life cycle: rodents: white footed mouse larger mammals: deer |
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What is entailed in the first stage of lyme disease
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1. acute onset of fever, rash, fatigue, HA and lymphadenopathy
2. ***SKin lesion: erythema chronicum migrans (1 wk after bite) Large, red outer border with indurated center |
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What is entailed in the second stage of lyme disease
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-Days to weeks after initial infxn
-Spirochete spreads Multiple erythema migrans lesions **Lesions are annular, smaller, w/o indurated centers *****Anywhere on body except feet and hands facial nerve palsy, lymphocytic meningitis, arthritis, radiculopathy or heart block |
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What is entailed in the third stage of lyme disease
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+1 year after infxn: chronic oligoarticular arthritis
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How do you diagnose lyme dz
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based on hx
If unclear Serology: IgM appear at 3-4wks peak 6-8wks IgG appear at 6-8 wks peak 4-6 months Polymerase chain reaction PCR |
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What is the problem with serologic testing for lyme disease
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patients with autoimmuni disorders will have false-positives
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What complications occur if Lyme disease is treated
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cardiac involvement, chronic arthritis, or neurologic disease
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How do you treat pt with early localized lyme disease
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doxycycline, amoxicillin, cefuroxime
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How do you treat a patient with symptomatic lyme disease
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ceftriaxone, penicillin G
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How do you treat arthritis caused by lyme disease
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doxycycline, amoxicillin, ceftriaxone, penicillin G
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What is rocky mountain spotted fever
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a generalized infection of the vascular endothelium, leading to wide spread tissue injury
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What is rocky mountain spotted fever caused by
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rickettsia rickettsii (intracellular bacteria)
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How is rocky mountain spotted fever transmitted
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ticks in the dermacentor family
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Where and when is rocky mountain spotted fever most often seen
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the western U.S. and South Atlantic west central regions during the late spring and summer months
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What is the incubation period of rocky mountain spotted fever
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2-14 days
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How does rocky mountain spotted fever initially present
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nonspecific flu-like illness with fever, severe HA, and myalgias, n/v, abdominal pain, diarrhea
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When happens in rocky mountain spotted fever after the initial flu-like symptoms
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3 days into illness, rash appears
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Describe the rash of rocky mountain spotted fever
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maculopapular and/or petechial
First on wrists or ankles then later on palms and soles |
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What 3 things are used to diagnose rocky mountain spotted fever
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WBC count normal w/left shift
Thrombocytopenia Rash + retrospective serologic tests |
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When should you start treating rocky mountain spotted fever
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no need to confirm, just start with onset of rash
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How do you treat rocky mountain spotted fever
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doxycycline (chloramphenicol in pregnant women)
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What does death in rocky mountain spotted fever occur due to
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organ failure
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What organism is syphilis caused by and what type is it
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treponema pallidum (a spirochete)
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How is syphilis contracted
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after inoculation through abraded skin or mucous membranes it attaches to the host cells and spreads in hours to regional lymph nodes
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Describe symptoms seen in primary syphilis
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Incubation 2-6 weeks after exposure
Papule develops at site of infection and ulcerates into chancre |
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Describe the chancre of primary syphilis
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**painless, indurated with well-defined borders and a clean base (heals in 3-6 weeks w/o treatment)
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Describe the symptoms in secondary syphilis
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3-10 weeks after chancre disappears
-Systemic disease w/generalized lymphadenopathy, fever, HA, sore throat, and arthralgias -**Rash: macules and papules on the head, neck, trunk and extremities INCLUDING palms and soles |
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What is latent syphilis
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defined as a patient having reactive serology in the absence of clinical signs or symptoms
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What is the presentation of tertiary syphilis
|
Cardiovascular disorders (aortic aneurysms, aortic insufficiency, coronary stenosis
GUMMATION LESIONS (bones and skin) CNS disorder (general paresis and tabes dorsalis) |
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When is neurosyphilis present
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any time during the course of the disease
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How does neurosyphilis present?
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meningitis w/HA, n/v/, stiff neck, cranial nerve palsies, hearing loss and tinnitus
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What can meningovascular meningitis associated with syphilis lead to
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hemiparesis, hemiplegia, aphasia, and seizures
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How is primary syphilis diagnosed
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treponemes on dark-field miscroscopic exam
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What treponemal serologic tests are used to diagnosesyphilis
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1. fluorescent treponemal antibody absorption test (FTA-ABS)
2. Microhemagglutination assay- Treponemal pallidum (MHA-TP) |
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What non-treponemal serologic tests are used to diagnosesyphilis
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CONFIRMATORY TESTS
1. RPR 2. VDRL |
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What is the treatment for syphilis
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penicillin G
(doxycycline or tetracycline if penicillin allergy) |
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What family is cytomegaolvirus part of
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herpesviridae
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How can CMV be acquired
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congenitally, perinatally, close contact/sexual transmission
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What is the leading cause of blindness in patients with AIDS
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CMV
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What are CMV symptoms in immunocompetent patient
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usually non, sometime mono-like
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What are the symptoms of congenital CMV
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typically asymptomatic at birth but develop sensory nerve hearing loss and/or psychomotor mental retardation
If symptomatic: hepatosplenomegaly, jaundice, anemia, thrombocytopnie, low birth weight, and microencephaly |
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How do you diagnose CMV
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CMV cytopoahtology: "OWL EYE" cells
cell culture antibody detection |
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How do you treat CMV infection
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Children: Ganciclovir
Adults: Gancicolvir or foscarnet HIV +: prophylactic tx |
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What family is epstein-barr virus part of
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herpesviridae
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What does EBV infection cause
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infectious mononuclosis and lymphoproliferative disease
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How is EBC transmitted
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repeated close contact with infected secretions such as saliva
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How is EBV manifes
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Infectious mononucleosis: fever, malaise, pharyngitis, lymphadenopathy and splenomegaly (persisting 1-2 weeks)
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What 4 tests help diagnose EBV infection
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CBC: lymphycytosis w/many atypical lymphocytes
elevated LFT's +heterophile antibodies (+monospot) +EBV serology findings |
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How do you treat EBV infection
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SUPPORTIVE
w/CNS complications: corticosteroids |
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What are the complications associated with EBV infection
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splenic rupture (contact sports)
laryngeal obstructioin aseptic meningitis encephalitis |
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What is another namem for erythema infectiosum
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5th disease
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What is the cause of erythema infectiosum
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parvovirus B19
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How is erythema infectiosum spread
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respiratory transmission (moderately infectious)
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What are the symptoms of erythema infectiosum
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Asymptomatic often
Usually in children under age 10 nonspecific prodrome, nonspecific febrile illness: HA, coryza, diarrhea followed by "SLAP CHEEK" facial rash maculopapular rash on trunk and extremities |
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How is erythema infectiosum diagnosed
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clinical finding OR presence of IgM antibodies
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How do you treat erythema infectiosum
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Usually self-limited
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Complications of erythema infectiosum
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Increased risk of miscarriage during pregnancy
Aplastic crisis in patients infected with the virus (give IV immunoglobulin) |
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What family does herpes simplex fall under
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herpesviridae
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What is the major mode of transmission for herpes simplex
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direct contact w/infected secretions
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What is the major feature of acute herpes simplex infection
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multinucleated giant cells
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What can latent herpes simplex be triggered by
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fever, trauma, and exposure to UV light
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What is herpes whitlow
|
HSV involving the finger or nail area
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Describe the clinical manifestations of HSV1
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1. grouped or singles vesicular lesions that become pustular and form single or multiple ulcers
2. involve mucosal surface 3. Lesions are painful and last 5-10days 4. latent in sensory nerve root ganglion 5. recurrences are unilateral, lasting 7 days |
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What is the cause of genital herpes
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HSV2
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What is the incubaiton period from secual contact to onset of lesions in HSV2
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5 days
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Describe lesions of HSV2
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small erythematous papules that form into vesicles and then pustules
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What is the difference between primary and recurrent HSV2 infections?
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Primary: lesions are painful, multiple and extensive (w/systemic symptoms such as fevers and myalgias)
Recurrent: shorter in duration, localized to genital region, no systemic symptoms (possibly prodromal symptoms 12-24hrs prior to onset) |
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How do you diagnose HSV1
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Tzanck smear showing multinucleated giant cells
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What is the test of choice to diagnose HSV encephalitis
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PCR
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How do you treat HSV
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acyclovir, valacyclovir or famciclovir
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How do you treat HSV encephalitis
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IV acyclovir
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What prophylactic measures should be taken in a pt with HSV
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daily acyclovir
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What should be done to prevent neonatal HSV infection
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c-section
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What is HIV due to? What organism? What family?
|
infection with the human immunodeficiency virus-1
lentivirus, which is a member of the retroviruses |
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Describe the mechanism of action of HIV
|
uses reverse transcriptase to produce DNA copy from viral RNA, which is incorporated into the host nucleus to produce more viral RNA, which is incorporated into the host nucleus to produce more viral RNA
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What types of cells does HIV infect
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those with a CD4 receptor (macrophages, T cell, and astrocytes)
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How is HIV spread
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parenteral and sexual contact
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What is the first symptom of HIV
|
acute retroviral syndrome with symptoms similar to mononucleosis, influenzae-like illness, or aseptic meningitis
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What causes an HIV infected patient to become symptomatic
|
development of opportunistic infections, tumors, or wasting syndrome
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What is occurring during the asymptomatic time frame of HIV
|
a patients' CD4 count declines and viral load increases, making them more susceptible to opportunistic infection
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How long does it take to detect antibodies to HIV
|
weeks to months
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What is the first test to be done in suspected HIV
|
ELISA detects anti-HIV within 3-6months of infection
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What is positive ELISA screening confirmed with and how does it work
|
Western blot test: it detects antibodies in the core and envelope of HIV
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How is staging for HIV performed
|
monitoring CD4 cell count and nucleic acid tests for HIV DNA or RNA with the PCR
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When should HIV treatment begin
|
initially, 3 drugs should begin before patient develops substantial immunocompromise
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What is necessary when changing HIV medicaitons and why?
|
2 drugs should be added or substituted to prevent resistance
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What should be monitored during treatment?
|
viral load: to keep the level below the level of detection
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What are the common malignancies of HIV
|
Kapopsi's sarcoma and non-hodgkins lymphoma
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|
What member is HPV infection
|
papovavirus family
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What does HPV infection
|
warts and genital lesions
|
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When are skin warts common
|
children and young adults
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How are genital warts transmitted
|
sexually
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what are genital warts due to HPV associated with
|
cervical dysplasia and/or neoplasia
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What are the clinical manifestations of skin warts- 2 types, types what, where do they infect, how do you treat
|
2 types: flat and plantar
HPV types 1-4 Infect keratinized surfaces (hands and feet) will regress spontaneously |
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What is another name for genital warts
|
condyloma acuminata
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Where do genital warts occur
|
squamous epithelium of the external genitalia and perianal areas
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What types are associated with HPV in genital warts
|
types 6 and 11
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What types of HPV are associated with cervical dysplasia, neoplasia and cancer
|
16 and 18
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How do you diagnose HPV1 and 2
|
bx w/hyperplasia of prickle cells and production of keratin
DNA probes for HPV: w/koilocytotic squamous epithelia cells on smear |
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How do you treat HPV
|
spontaneous disappearance
electrocautery, crytherapy and chemical injection with interferon avoid contact |
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How many types of influenzae are there and what are they
|
2 - A and B
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What type of influenza is the cause of epidemic or pandemic influenza
|
a
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What is influenza A characterized by
|
envelope glycoproteins known as hemagglutinin H and neuramidase N
highly infectious: increased rates in institutionalized settings |
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Where is influenza B mostly seen
|
schools and military camps
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What are the clinical manifestations of influenza
|
-abrupt
-2-4 day incubation -high fever, HA, photophobia, myalgia, pharyngitis, nonproductive cough and malaise |
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How long does it take for influenza to resolve
|
2-5days
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How is influenza diagnosed
|
viral culture and antigen detection are available
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How do you treat influenza
|
fluids, rest and acetominophen
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What are the 3 classes of agents used in treatment of influenza
|
tricyclic amines, nucleoside analog, neuraminidase inhibitors
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What are tricyclic amines used for in regards to influenza? What are the side effects
|
prevent influenza A in institutional settings
insomnia, anxiety, confusion, seizures |
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What is nucleoside analog for
|
active against both influenza a and b
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What are neuraminidase inhibitors used for
|
shorten duration of disease if given within 48hrs of symptoms
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|
What is reye's syndrome
|
a complication of using aspiring during treatment for influenza (can't see, can't pee, can't climb a tree)
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|
What type of virus is mumps
|
paramyxovirus
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How is mumps spread
|
droplets
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What is the incubation period of mumps
|
12-25days
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When is a pt infectious with mumps to others
|
2 days before to 9 days after parotid swelling
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What are the clinical manifestations of mumps
|
parotid pain and swelling
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how do you diagnose mumps
|
physical findings and culture or serology results
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How do you treat mumps
|
analgesics and fluids
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At what age are pt's vaccinated for mumps
|
12-15 months and 4-5 years
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What are complications of mumps
|
orchitis
meningeoencephalitis deafness arthritis pancreatitis |
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What virus causes rubella? what family does it belong to
|
rubivirus in the togaviridae family
|
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How is rubella transmitted
|
respiratory droplets
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|
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What are the clinical manifestations of rubella
|
sore throat, conjunctivitis, low-grade fever
on day 2 or 3 a fine macular rash appears on the face and moves downward fever disappears 24 hrs after rash petechial lesions (***FORCHHEIMER'S SPOTS) on soft palate posterior cervical and occipital lymphadenopathy |
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How can the diagnosis of rubella be confirmed
|
IgM antibodies
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When are pt's vaccinated for rubella
|
12-15months of age
4-6years of age |
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Why is it important to check rubella status in pregnant women
|
to prevent congenital rubella
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what happens to a child with congenital rubella
|
transient, permanent, and developmental problems
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|
What type of virus is rubeola (measles)
|
paramyxovirus
highly contagious! |
|
|
how is rubeola (measles) transmitted
|
droplets, person-to-person contact, or airborne spread
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What are the clinical manifestations of rubeola (measles)
|
fever, irritability, malaise, conjunctivitis, respiratory infxn
several days later KOPLIK'S SPOTS day 3/4: nonpruritic maculopapular rash begins, starting at the hairline and descending to the trunk and extremities |
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|
What are koplik spots and what disease are they seen in
|
Measles
small, raised white or blue-gray lesions on an erythematous base on the buccal mucosa opposite the upper molar |
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How can rubeola (measles) be confirmed
|
IgM antibodies
|
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How do you treat rubeola (measles)
|
Supportive
Large dose vit A reduce severity |
|
|
When is child immunized for rubeola (measles)
|
12-15months
4-6yrs of age |
|
|
Describe what type of virus rabies is
|
rhabdovirus group: bullet shaped virus
|
|
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How is rabies transmitted
|
infected secretions between mammals
|
|
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What animals carry rabies
|
dogs, cats, skunks, foxes, wolves, raccoons, bats and mongooses
|
|
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Describe the pathogenesis of rabies virus
|
1. virus enter epidermis through bite
2. virus replicated in striated muscle 3. virus enters peripheral nerve and spreads to CNS 4. repllicated in gray matter and passes centrifugally along autonomic nerves to other tissues |
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|
Describe symptoms of rabies
|
fever, HA, malaise, n/v
encephalitis (excess motor activity and agitation) hallucinations, combativeness, muscle spasms, menigeal irritaion, seizures and focal paralysis increased salivation due to ANS involvement |
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|
How long can one live once onset of symptoms for rabies
|
4 days
|
|
|
How is rabies diagnosed
|
virus in brain tissue at autopsy
***NEGRI BODIES |
|
|
How do you treat rabies
|
vaccine and rabies immune globulin
|
|
|
What is roseola caused by
|
herpesvirus 6 and 7
|
|
|
When does roseola most often occur
|
infancy
|
|
|
Describe what type of virus rabies is
|
rhabdovirus group: bullet shaped virus
|
|
|
How is rabies transmitted
|
infected secretions between mammals
|
|
|
What animals carry rabies
|
dogs, cats, skunks, foxes, wolves, raccoons, bats and mongooses
|
|
|
Describe the pathogenesis of rabies virus
|
1. virus enter epidermis through bite
2. virus replicated in striated muscle 3. virus enters peripheral nerve and spreads to CNS 4. repllicated in gray matter and passes centrifugally along autonomic nerves to other tissues |
|
|
Describe symptoms of rabies
|
fever, HA, malaise, n/v
encephalitis (excess motor activity and agitation) hallucinations, combativeness, muscle spasms, menigeal irritaion, seizures and focal paralysis increased salivation due to ANS involvement |
|
|
How long can one live once onset of symptoms for rabies
|
4 days
|
|
|
How is rabies diagnosed
|
virus in brain tissue at autopsy
***NEGRI BODIES |
|
|
How do you treat rabies
|
vaccine and rabies immune globulin
|
|
|
What is roseola caused by
|
herpesvirus 6 and 7
|
|
|
When does roseola most often occur
|
infancy
|
|
|
What is the incubation period for roseola
|
10 days
|
|
|
Clinical manifestation of roseola
|
high fever for 1-4 days
during febrile period patient is listless and may have cough, diarrhea or lymphadenopathy fever resolves, MACULOPAPULAR RASH ON FACE AND TRUNK SPREADS TO REST OF BODY rash lasts 2-5 days |
|
|
How do you treat roseola
|
symptomatic
|
|
|
What condition does varicella zoster virus infection cause?
|
chicken pox
|
|
|
What are the clinical manifestations of varicella zoster virus infection
|
1. erythematous macules-->vesicles-->pustules-->crust over
***Hallmark is lesions in various stages (in small pox, all lesions are at same stage) lesions are on mucous membranes pruritic |
|
|
What is the treatment of varicella zoster virus infection
|
symptomatic
(acyclovir in immunocompromised) |
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When is varicella zoster virus vaccine given
|
12-18months
|
|
|
What are complications of varicella zoster virus infection
|
herpes zoster (shingles) - reactivation of latent VZV
varicella encephalitis, cerebellar ataxia, pneumonia, bacterial superinfection |
|
|
What is herpangina caused by
|
coxsackie A virus
|
|
|
How does herpangina present
|
1-4mm vesicles on uvula and soft palate
fever sore throat |
|
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How do you treat herpangina
|
supportive - resolves in 1 week
|
|
|
What is hand-foot-mouth disease caused by
|
coxsackie A16
|
|
|
Clinical manifestations of hand-foot-mouth disease
|
small vesicles on anterior part of mouth and on palms and soles
fever, sore throat |
|
|
How do you treat hand-foot-mouth disease
|
supportive - resolves in 1 week
|
