Mcphs Mmd Ii Final Exam Vector Diseases

Front 1

This disease is a systemic infection caused by the spirochete Borrelia burgdorferi. The tick that spreads this is almost always of the genus Ixodes.

Back 1

Lyme Disease

Front 2

Lyme disease is classically divided into three different stages, what are they?

Back 2

Early localized - Early localized Lyme disease refers to isolated EM and patients with an undifferentiated febrile illness.

Early disseminated -Early disseminated disease refers to the extracutaneous manifestations and secondary skin lesions that occur during the first weeks to months after infection.

Late -refers to later manifestations (usually in the nervous system and joints) that occur months to years later.

Front 3

What are the systemic manifestations of Lyme Disease?

Back 3

Low Grade Fever

Fatigue

Myalgias and Arthralgias

Frank Arthritis

Front 4

What are the diagnostic clues for Lyme Disease?

Back 4

The season of onset

Epidemiologic likelihood of a tick bite

Lack of respiratory and GI symptoms

Prompt response to antiborrelial therapy

Front 5

Headache is a neurological symptom associated with Lyme Disease. How is it described with Lyme?

Back 5

Waxing and waning

From Mild to Severe

Front 6

The following are associated with what?

Paresthesias
Pain due to peripheral neuropathy
Personality, cognitive, and sleep disturbances from chronic encephalopathy
Lyme disease may produce numerous symptoms in every part of the CNS and peripheral nervous system.

Back 6

Late Lyme Disease

Front 7

What is a dermatological sign of Lyme Disease?

Back 7

Classic Erythema Migrans is an erythematous papule or macule that occurs at the site of the tick bite

Front 8

This is usually flat, round, or oval and monocyclic.

Generally nonpruritic and nonpainful
The rash enlarges a few centimeters per day and fades, even if untreated, after a few weeks.

The rash can be triangular or linear and is sometimes fleeting in duration.

Back 8

Erythema Migrans associated with Lyme Disease

Front 9

Erythema migrans is rarely found where?

Back 9

On the hands or the feet.

Front 10

Where are typical locations for the erythema migrans rash?

Back 10

The Thorax and Torso

Front 11

What are two tests that the CDC recommends as a part of a 2 step procedure for diagnosing Lyme Disease?

Back 11

The CDC recommends a 2-step procedure consisting of a screening enzyme-linked immunoassay (ELISA) (or immunofluorescent assay [IFA]) and a confirmatory Western blot for specimens that have positive or equivocal results with the ELISA.

Patients with a high likelihood of having Lyme disease (eg, classic EM in an endemic area), no serologic test should be ordered.

Front 12

How do you TX a patient who presents with a solitary erythema migrans?

Back 12

Oral antibiotics (eg, amoxicillin, doxycycline, cefuroxime axetil, erythromycin, azithromycin, amoxicillin-clavulanate) should be administered for 10-30 days.

Front 13

The following are signs of what?

Isolated facial palsy
Secondary skin lesions (not meningitis)
Disease with first-degree heart block (not a high-degree heart block)
May be treated with oral antibiotics for 21-30 days

Back 13

Early disseminated Lyme disease

Front 14

How do you TX early disseminated disease with meningitis?

Back 14

Early disseminated disease with meningitis: (or a high-degree heart block) may be treated with intravenous ceftriaxone for 2-4 weeks.

Front 15

This is a tick borne disease caused by the organism Rickettsia rickettsii

Back 15

Rocky Mountain Spotted Fever

Front 16

The hallmark of RMSF is what?

Back 16

Petechial rash beginning on the palms of the hands and soles of the feet

Front 17

This is the most common cause of fatal tick borne disease in the US?

Back 17

RMSF

Front 18

In RMSF the tick needs to be attached to the host for how long?

Back 18

Six to Ten days

Front 19

T or F? RMSF can infect people who remove ticks from other people?

Back 19

True

Front 20

The following is a clinical presentation of what?

Chills, fever, bradycardia
Severe headache
Conjunctival redness and Photophobia
Cough
Myalgias and Malaise
Gastrointestinal disturbances
Insomnia

Back 20

RMSF

Front 21

The rash begins as a maculopapular eruption on the wrists and ankles and spreads centripetally to involve the trunk and extremities. The rash involves the palms of the hands and soles of the feet.

Back 21

The rash in RMSF

Front 22

What presents in the HEENT with RMSF?

Back 22

Bilateral edema is present. Periorbital edema is a key diagnostic finding, especially in children

Front 23

This is the only tick borne disease that can cause congestive heart failure.

Back 23

RMSF

Front 24

Edema on the dorsum of the hands and feet is a key sign of this?

Back 24

RMSF

Front 25

The following may show up in what?

Cranial neuropathies may be present.
Patients may have urinary or fecal incontinence.
Paralysis may develop.
Ataxia is present in 5-18% of cases.
Meningismus develops in 18% of patients.

Back 25

Central Nervous Symptoms in RMSF

Front 26

What laboratory studies are used in RMSF?

Back 26

Rocky Mountain spotted fever (RMSF) diagnosis relies on clinical (fever, rash, myalgia) and epidemiologic (tick exposure) criteria.

After exposure to vector ticks, patients who develop fever, petechial rash, and vomiting require antibiotic therapy.

Front 27

Diagnosis, in serology, of RMSF is confirmed based on?

Back 27

Indirect immunofluorescent antibody (IFA) test

latex agglutination

enzyme immunoassay

Front 28

What is the preferred drug of choice for treating RMSF in adults?

Back 28

Doxycycline

Front 29

If a patient is in vitro and in ovo R. rickettsii is susceptible to what?

Back 29

Rifampin

Front 30

predominantly occurs in tropical areas, is a potentially life-threatening disease caused by infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito vector.

Back 30

Malaria

Front 31

is responsible for nearly all severe disease.
It is endemic in most malarious areas and is by far the predominant species in Africa.

Back 31

Plasmodium falciparum

Front 32

is about as common as P falciparum, except in Africa, but seldom causes severe disease.

Back 32

Plasmodium vivax

Front 33

Most patients with malaria have no physical findings, but this may be present.

Back 33

splenomegaly

Front 34

P falciparum malaria can present with what physical findings?

Back 34

Cerebral malaria and severe anemia

Front 35

A diagnosis of malaria should be supported by the identification of?

Back 35

the parasites on a thin or thick blood smear.

Front 36

Uncomplicated malaria can have diagnostic findings such as?

Back 36

thrombocytopenia
anemia
leukocytosis
leukopenia
liver function abnormalities
hepatosplenomegaly

Front 37

How do you TX P falciparum malaria

Back 37

Quinine-based therapy - Quinine (or quinidine) sulfate plus doxycycline or clindamycin or pyrimethamine-sulfadoxine

Alternative therapy - Atovaquone-proguanil or mefloquine

Front 38

Patients diagnosed with uncomplicated malaria can be effectively treated with?

Back 38

oral antimalarials.

Front 39

obligate intracytoplasmic bacteria that infect mononuclear cells and granulocytes.

Back 39

Ehrlichia

Front 40

inclusion bodies, such as morulae, are visible in the cytoplasm of infected mononuclear phagocytic cells after 5-7 days.

Back 40

Ehrlichia

Front 41

Clinical manifestationsbegin 5-14 days after the tick bite.
Patients present with severe headache, myalgias, and fever. Shaking chills are often present.
Nausea and vomiting are common.
Abdominal pain is uncommon
Skin rash is rare, in contrast to RMSF

Back 41

Erlichiosis

Front 42

manifests as an acute undifferentiated febrile RMSF-like illness with few to no physical findings.

Back 42

Erlichiosis

Front 43

What lab tests do you use to diagnose erlichiosis?

Back 43

(1) a single elevated immunoglobulin G (IgG) immunofluorescent antibody (IFA) Ehrlichia titer

or

(2) demonstration of a 4-fold or greater increase between acute and convalescent IFA Ehrlichia titers.

Front 44

Ehrlichiosis may also be diagnosed by?

Back 44

demonstrating characteristic morulae in the cytoplasm of leukocytes.

Front 45

How do you TX erlichiosis?

Back 45

The preferred drug is doxycycline.

Adult
100-200 mg IV/PO q12h
Pediatric
<8 years: Not recommended>8 years: Administer as in adults

Although experience is limited, in vivo data suggest that rifampin may be useful in patients who are unable to take doxycycline (eg, children <8 y, pregnant females).
Fluoroquinolones may be useful against Ehrlichia, but experience is limited

Front 46

This is endemic to New England

a tick-borne malaria-like illness caused by species of the intraerythrocytic protozoan Babesia. Humans are opportunistic hosts for Babesia when bitten by nymph or adult ticks.

Back 46

Babesiosis

Front 47

Patients who are ? have a more fulminant and prolonged clinical babesiosis course and may have overwhelming infection and a fatal outcome.

Back 47

asplenic

Front 48

The following is the clinical presentation for what?

The history includes fever and chills
Patients have symptoms similar to those of malaria
Symptoms are related to the degree of RBC parasitemia

Back 48

Babesiosis

Front 49

What laboratory studies are used in babesiosis?

Back 49

Lactate dehydrogenase (LDH)

A properly stained peripheral blood smear - Wright or Giemsa stain on thin blood smears reveals the ring forms of babesiosis.

Front 50

What medication is used with Babesiosis?

Back 50

Clindamycin (Cleocin) plus quinine (Formula Q)
Anti-Babesia agents
Quinine inhibits growth of parasite by increasing the pH within intracellular organelles and possibly by intercalating into DNA of the parasites.
Quinine alone is ineffective, and clindamycin must be used in conjunction.