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64 Cards in this Set

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How long does a tick need to be engorged before it can transmit the disease and why?
48-72 hrs. b/c this is the amount of time required for Borrelia Burgdorferi to crawl from the gut of the tick to the salivary gland
What are the chances of acuiring lyme disease from a tick bite?
1%
What type of insect is a tick and how is it attracted?
Exophilic and are attracted by feet hitting the ground or by CO2 emitted by a car stopped in the bush
How large can a tick get during engorgement?
Increase its wieght up to 120 fold
What is Borrelia Burgdorferi?
A two membrane spiral shaped bacterium that lives primarily as an extracellular pathogen
Flagella to stay motile
What ticks come from the Midwest/East and which from the West and how long do they live?
Ixodes Scapularis= East/Midwest
Ixodes Pacificus=West
2 year life cycle
What are the symptoms of LD?
Erythema Migrans=68%
Arthritis=33%
Facial Palsy=8%
Radiculopathy=4%
Meningitis/encephalitis/heart block= 1%
What allows you to become reinfected after intial LD?
The Spirochetes phenotype switches from OspA to OspC
What is the difference between OspA and OspC?
OspA is uniform across different isolates
OspC is highly variable hence no protection against previous infection
What Immunoglobin must you test for in LD?
Test for IgG
IgM tells nothing
How long is the incubation period?
7-10 days after the bite
What is the hallmark of early localized LD?
Erythema Migrans
What is early disseminated LD characterized by?
Multiple EM's
What is late peristent LD characterized by?
Arthritis, memory deficit, irritability
>8 Weeks
What can be caused by unterated LD?
Muscoskeletal polyarthritis (60%)
Aseptic lymphocytic meningitis, palsy, vertigo (15%)
A.V. conduction block (5%)
What is the surveilence criteria for LD?
Rash must exceed >5 cm
Show expansion
Persist >1 week
How would Dx LD?
Clinical
ELISA or IFA; followed by
Western Blot; followed by
Serologic
What is the most fatal tick borne disease, what causes it and how to you treat it?
Rocky Mountain Spotted Fever from Rickettsia Rickettsii; a gram (-)
Responds to Doxycycline
Nationally notifiable disease
What are some common first sympotoms of RMSF?
Rash starts at wrist and ankles, can lead to genital necrosis and ARDS
What is the vector and main reservoir for R. Rickettsii
The Tick
What is the Triad features of RMSF?
Fever, headache and rash with a history of tick exposure
How do you Dx RMSF?
Direct imminofluorescence
Serology (IFA)
Lab results with raised LDH
What causes Ehrlichiosis (HME)?
E. Chaffeenis by the lone star tick
What causes Anaplasmosis (HGE)?
E. phagocytophila or E. ewingii
Is life threatening
How might HGE and HME present?
Rash, fever and conjunctivitis
What is vector and what is the reservoir for HME and HGE?
Tick is the vector and the white tailed deer is the reservoir
What is the treatment for HME and HGE?
Doxycycline or tetracycline
Rifampin can be used during pregnancy
How do you get Babesiosis?
Natural host is the white footed mouse or deer from ticks.
May coexist with Lyme Borreliosis
What increase your chances of contracting Babesiosis?
Having no spleen and immunosupression
What are the clinical features of Babesiosis?
Fever and Cold Shakes (rigors)
Same tick vector as lyme disease
No spleen more suscitable
What should physicians consider when diagnosing Babesiosis?
Pts with Lyme disese who experience prolonged symptoms after treatment need to be tested
Physicians should consider this differential when diagnosing Hemolytic Anemia of neonates, particulary among transfusion pts.
What causes Babesiosis?
Babesia Microti
What causes Rat Bite Fever, what are the symptoms and how do you treat it?
Steptobacillus Moniliformis
Abrupt fever, chills, rash, asthritis and headache
IV penicillin G followed by oral penicillin
What can cause Sepsis after a dog bite?
Capnocytophaga Canimorsus, a Gram (-) bacteria
In pts that are asplenic or with heaptic disease
What is a common bacteria form Dog/Cat bites?
Pasteurella Multocida
What are common pathogens from human bites?
Eikenella Corrodens
S. Aureus
Sterptococci
What does Bacillus Anthracis cause, what are the virulence factors, how does it work, and what is the incubation period?
Causes Anthrax with its spores which can remain viable for 60 yrs "box car" apperance.
Is pathogenic b/c of the 2 extra DNA molecules, incubates for 2 D - 8 W
Virulence factors are the PROTECTIVE ANTIGEN and lethal factor which causes the release of TNF-A and IL-1B
What is Cutaneuos Anthrax?
Malignant pustule with a Eschar "cigareete burn" lesion which is painless, depressed, small crusted nectrotic, center is black
What is characteristic of Gastrointestinal Anthrax?
Abdominal pain, rebound tenderness and bloody diarrhea
From insufficiently cooked meat from infected animals
What is characteristic of Inhalational Anthrax?
Spores are transfered to lings and then mediastinal lympth nodes
Then turn into vegitative cells and release their deadly cargo
What type of disesae is Inhalational Anthrax?
Biphastic illness
Initial phase: fever, malaise, chest tightness, comiting, chills, ab pain
Fulminant Phase: Sudden fever, hemorrage, pleural effusion, cyanisis, necrosis and septic shock
What is the pathogenic evidence in Advanced Inhalational Anthrax?
Mediastinal Widening in a previously healthy pt. due to massive lymphadenopathy with overwhemling "flu like" sympotoms
What is the primary complication in Inhalational Anthrax?
50% develop hemorrhagic meningitis "cardinal cap"
What is the treatment for Anthrax?
Ciprofloxacin IV or BID orally.
Amoxicillin can be used in children
How does the Vaccine for Anthrax work?
Recommened for ages 18-65 and is administered at 0,2,4,6,12,18 weeks followed by yearly boosters
PEP vaccine can be given on day zero with treatment
How is infection control done for Anthrax?
NO person to person transmission
Standard barrier precautions requires bisafety level II
What causes the plague?
Yersinia Pestis bacteria
Gram (-) rods with a "safety pin" apperance
Uses fleas as their vector
What are the clinical features of the plague?
Necrotizing rash, purpuric skin lesions and gangrene
Mortality is 100% in untreated septicemic form
How can you Dx the plague?
Made from lymph hode aspirate, sputum, broncial washes and blood
Y. Pestis has a "safety pin" appearance
How is the plague treated?
Streptomycin, gentamicin, tetracycline, doxycycline, and fluoroquinolones
What is the common most zoonotic infection worlwide?
Human Brucellosis
Transmitted by ingestion of undercooked delicacies, liver and spleen, and unpasteurized dairy products
What are the clinical features of Brucellosis?
Intermittent spiking fever, rigor and perfuse sweating
What is the most common reported lab-associated infection?
Brucellosis
What is the Dx for Brucellosis?
Bone marrow culture is the gold standard
What is the treatment for Brucellosis?
Tetracycline, Doxycycline, rifampin, streptomcin
What is most commonly related to Q fever?
Most frequent organism in blood-culture-negative endocarditis
How does Q fever transmit and what are the reservoir hosts?
By inhalation, contact with infected blood/placenta of animals and ingestion of raw milk
Reservoir hosts: carrle, goats or sheep
What is the prominant clinical feature of Q fever?
Infective endocarditis
What is a key Dx feature for Q fever?
Unexplained elevated hepatic enzymes
What is the treatment for Q fever?
Doxycycline and FQ if pt. developes meningitis
How is Bartonellosis most commonly transmitted?
"Cat Scratch Fever" hence is usually caused by a cat scratch, children are the most suscitable
What is the treatment for Bartonellosis?
Macrolides
What is a hallmark diagnostic sign for Leptospirosis?
Flu like sympotoms and Conjunctivitis, followed by meningitis
Patients with a H/O recreational freshwater sports, occurs often after street flooding
What is the treatment for Leptospirosis?
Penicillin or tetracycline/doxycycline