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146 Cards in this Set
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MC organism of Community Acquired Pneumonia (CAP)
|
Streptococcus pneumonia
*Also, H. flu, Klebsiella, S. aureus |
|
MC organism of Hospital Acquired Pneumonia (HAP)
|
1) Gram-negative rods
2) Staphlococcus aureus |
|
Organisms common to Atypical CAP
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1) Mycoplasma
2) Legionella 3) Chlamydia (pneumoniae, psittaci) 4) Coxiella burnetti (Q fever) 5) Influenza virus, adenovirus, parainfluenza virus RSV *Non-productive cough |
|
Treatment of Pneumonia
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1) Macrolides
2) Doxycycline 3) Fluroquinolones 4) Ceftriaxone *Levofloxacin, Moxifloxacin |
|
Main risk factor for Lung Abscess
|
Aspiration of oropharyngeal contents
*Alcoholism, drug-addiction, CVA, seizures, general anesthesia, nasogastric or endotracheal tube, poor dental hygiene |
|
Treatment of Lung Abscess
|
1) Postural drainage
2) Antibiotics: augmentin, vancomycin (S. aureus), clindamycin, metronidazole (anaerobes), fluoroquinolone or ceftazidime (gram-negatives) |
|
MCC of death due to infection worldwide
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Tuberculosis
*Caused by Myocbacteria tuberculosis |
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Clinical features of Secondary Tuberculosis (TB)
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1) Fever, night sweats, weight loss, malaise
2) Cough (from dry to productive) 3) Hemoptysis (advanced TB) |
|
Classic CXR findings of TB
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Upper lobe infiltrates with cavitations
*Ghon complex, Ranke's complex |
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First-line therapy for TB
|
Four-drug regimen:
1) Isoniazid (INH) 2) Rifampin 3) Pyrazinamide 4) Ethambutol or Streptomycin |
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Cause of The Flu
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Orthomyxoviruses A and B
|
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Common causes of Chronic Meningitis
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1) Mycobacteria
2) Fungi 3) Lyme disease 4) Parasites |
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MCC of Bacterial Meningitis in Neonates
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1) GBS
2) E. coli 3) Listeria monocytogenes |
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MCC of Bacterial Meningitis in Children >3 months
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1) N. meningitidis
2) S. pneumoniae 3) H. influenzae |
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MCC of Bacterial Meningitis in Adults
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1) S. pneumoniae
2) N. meningitidis 3) H. influenzae |
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MCC of Bacterial Meningitis in Elderly
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1) S. pneumoniae
2) N. meningitidis 3) L. monocytogenes |
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MCC of Bacterial Meningitis in Immunocompromised pts
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1) L. monocytogenes
2) Gram-negative bacilli 3) S. pneumoniae |
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Clinical features of Meningitis
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1) HA
2) Fever 3) Stiff, painful neck 4) Malaise, n/v, photophobia, AMS |
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Signs of Meningitis
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1) Nuchal rigidity
2) Rashes (maculopapular with petechiae, vesicular lesions) 3) Increased ICP 4) CN palsies 5) Kerning's sign 6) Brudzinski's sign |
|
Diagnosis of Meningitis
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1) Lumbar puncture
2) CT head (before LP) 3) Blood cultures (before LP) |
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Treatment of Bacterial Meningitis
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1) Empiric antibiotic therapy (IV)
2) Steroids (for cerebral edema) 3) Vaccination (S. pneumoniae, H. influenzae, N. meningitidis) *Give prophylaxis to close contacts: Rifampin or Ceftriaxone |
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Treatment of Viral Meningitis
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No treatment necessary - self-limited
|
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Exams to send CSF for when Meningitis is suspected
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1) Cell count
2) Cytology 3) Protein, glucose 4) Gram stain and culture (including AFB) 5) Cryptococcal antigen |
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Empiric treatment of Meningitis in Neonate
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1) Cefotaxime +
2) Ampicillin + 3) Vancomycin *Aminoglycoside instead of Vanc if less than 4 weeks old |
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Empiric treatment of Meningitis in pt 3 months to 50 years
|
1) Ceftriaxone or Ceftaxime +
2) Vancomycin |
|
Encephalitis
|
Diffuse inflammation of brain parenchyma
Often associated with meningitis |
|
Major causes of Encephalitis
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1) Herpes (HSV-1)
2) Arboviruses (Eastern/western equine viruses, West Nile virus) 3) Enterovirus (polio) 4) Toxoplasmosis 5) Cerebral aspergillosis 6) Metabolic encephalopathies 7) T-cell lymphoma |
|
Risk factors for Encephalitis
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1) AIDS (toxo w/CD4 <200)
2) Immunocompromise 3) Travel to underdeveloped areas 4) Mosquito bites 5) Bat bites |
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Clinical features of Encephalitis
|
1) HA, malaise, myalgias
2) Signs of meningitis 3) AMS, confusion, delirium 4) FOCAL NEUROLOGIC DEFICITS |
|
Diagnosis of Encephalitis
|
1) LP
2) MRI brain 3) EEG 4) Brain biopsy |
|
Treatment of Encephalitis
|
1) Antiviral therapy
2) Anticonvulsant therapy 3) Treatment of cerebral edema |
|
Common causes of Encephalitis in the Immunocompromised
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AIDS: Toxoplasmosis, Fungi
Neutropenic: Aspergillus, Candida, Zygomycosis |
|
Sequelae of the following may lead to Brain Abscess
|
1) Ear, nose, throat infection
2) Cranial trauma, brain surgery 3) Pyogenic lung infection (hematogenous spread) 4) Dental infection |
|
Clinical features of Brain Abscess
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1) HEADACHE
2) AMS 3) Seizures, n/v |
|
Vasculitis associated with Hepatitis B
|
Polyarteritis nodosa (PAN)
*Hep C associated with Cryoglobulinemia |
|
Clinical features of Hepatitis
|
1) Jaundice
2) Dark-colored urine (conjugated hyperbilirubinemia) 3) RUQ pain 4) Nausea/vomiting 5) Fever and malaise 6) Hepatomegaly |
|
Diagnosis of Hepatitis
|
1) Viral serology
2) PCR 3) Liver function tests |
|
Liver Function Tests in Hepatitis
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ALT > AST except in alcoholic hepatitis
ALT > 1000 in acute hepatitis |
|
Treatment of Hepatitis B
|
1) Interferon- alpha
2) Lamivudine |
|
Treatment of Hepatitis C
|
1) Interferon- alpha
2) Ribavirin |
|
Hepatitis B Surface Antigen
|
Present acute or chronic infection
**Persists in chronic hepatitis regardless of symptomatology; if virus is cleared, HBsAg is undetectable** |
|
Hepatitis B e Antigen
|
1) Reflects ACTIVE viral replication
2) Presence indicates INFECTIVITY |
|
Anti- HBsAg Antibody
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Present after vaccination or clearance of HBsAg
*Indicates immunity in most cases |
|
Hepatitis B Core Antibody (anti-HBc)
|
1) Assay of IgM and IgG combined
2) Positive during WINDOW period 3) Presence does not indicate immunitiy |
|
Botulism
|
Symmetric, descending flaccid paralysis caused by ingestion of preformed toxins of Clostridium botulinum (or wound contamination)
|
|
Diagnosis of Botulism
|
Identification of toxin in serum, stool, or gastric contents
|
|
Treatment of Botulism
|
1) Administration of antitoxin (toxoid)
2) Wound cleansing and penicillin |
|
Causes of Intra-Abdominal Abscess
|
1) Spontaneous bacterial peritonitis (SBP)
2) Pelvic infection 3) Pancreatitis 4) GI perforation 5) Osteomyelitis of vertebral bodies with extension *Treat with abscess drainage and broad spectrum coverage (anaerobes, enterococci, gram-negatives) |
|
Common organisms of UTI
|
1) E. coli
2) Staphlococcus saprophyticus 3) Enterococcus 4) Klebsiella 5) Proteus spp. 6) Pseudomonas 7) Enterobacter 8) Candida spp |
|
Host-dependent risk factors for UTI
|
1) Diabetes - risk for upper UTI
2) Impeding urinary flow (BPH, neurogenic bladder, vesicourethral reflux) 3) Spinal cord injury 4) Immunocompromised state |
|
Clinical features of UTI
|
1) Dysuria - burning on urination
2) Frequency 3) Urgency 4) Suprapubic tenderness 5) Gross hematuria 6) NO FEVER W/ lower UTI |
|
Diagnosis of UTI
|
1) Urine dipstick (leukocyte esterase, nitrite)
2) Urinalysis 3) Urine gram stain 4) Urine culture 5) Blood culture (w/ suspicion for urosepsis) |
|
Complicated UTI
|
Any UTI that spreads beyond the bladder
1) Pyelonephritis (Urosepsis) 2) Prostatitis *Risks: Diabetes, pregnancy, vesicoureteral reflux |
|
Treatment of uncomplicated Cystitis
|
Empiric treatment with Bactrim for 3 days
*Fluoroquinolone (Cipro) for 3 days appropriate if patient has sulfa allergy |
|
Treatment of UTI in Pregnancy
|
1) Ampicillin OR
2) Amoxicillin OR 3) PO Cephalosporin for 7 - 10 days *AVOID FLUOROQUINOLONES --> fetal arthropathy |
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Pyelonephritis
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Infection of upper urinary tract caused by ascending spread from bladder to kidneys
|
|
Complications of Pyelonephritis
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1) Sepsis - 10-20% of patients
2) Emphysematous pyelonephritis - DIABETES: gas-producing bacteria 3) Chronic pyelonephritis and renal scarring (rare) |
|
Clinical features of Pyelonephritis
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1) Fever, chills
2) Flank pain, CVA tenderness 3) Nausea/vomiting |
|
Treatment of UTI in men
|
Bactrim for 7 days (not 3 days)
|
|
Diagnosis of Pyelonephritis
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1) Urinalysis: pyuria, bacteriuria, leukocyte casts
2) Urine and blood cultures 3) CBC - leukocytosis 4) Imaging studies |
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MC organism causing Pyelonephritis
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E. coli
*Proteus, Klebsiella, Enterobacter, Pseudomonas |
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Treatment of uncomplicated Pyelonephritis
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Gram-Negative Rods: Bactrim or Cipro for 10-14 days
Gram-Positive Cocci: Amoxicillin *Single dose of Ceftriaxone or Gentamicin often given before PO treatment |
|
Treatment of inpatient Pyelonephritis
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Broad-spectrum: Ampicillin + Gentamicin or Cipro
Negative blood cultures: Treat until afebrile for 24 hrs, then complete 14-21 day course PO Positive blood cultures: Treat with IV antibiotics for 2-3 weeks |
|
Organisms common to Prostatitis
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Gram-negative organisms: E. coli, Klebsiella, Proteus, Pseudomonas, Enterobacter Serratia
|
|
Clinical features of Acute Prostatitis
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1) Fever, chills
2) Dysuria, frequency, urgency 3) Perineal pain, low back pain, urinary retention |
|
Diagnosis of Prostatitis
|
1) DRE - boggy, exquisitely tender prostate
2) UA 3) Urine cultures |
|
Treatment of Prostatitis
|
Acute: Bactrim or Cipro and Doxy for 4-6 weeks
Chronic: Cipro *Often related to UTI, so treated similarly* |
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Treatment of Chlamydia
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1) Azithromycin PO x 1 dose
2) Doxycycline PO for 7 days |
|
Findings of Disseminated Gonococcal Infection
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1) Fever, arthralgias, tenosynovitis
2) Migratory polyarthritis/septic arthritis, endocarditis, meningitis 3) Skin rash (distal extremities) |
|
Treatment of Gonorrhea
|
1) Ceftriaxone IM x 1 dose
2) Oral Cefixime, Cipro, Ofloxacin *Treat Chlamydia as well |
|
Clinical features of HIV primary infection
|
Mononucleosis-like
Fever, sweats, malaise, lethargy, HA, arthralgia/myalgia, diarrhea, sore throat, lymphadenopathy, truncal maculopapular rash |
|
Indications for Antiretroviral therapy in HIV patient
|
1) Any symptomatic patient
2) Asymptomatic patient with CD4 <500 |
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Stain for Crytococcal Meningitis
|
India ink
|
|
CD4 count at which esophageal candidiasis is seen
|
CD4 <100
|
|
CD4 count at which PCP is seen
|
CD4 </ 200
|
|
HAART Therapy
|
1) Two nucleoside reverse transcriptase inhibitors and EITHER
2) Non-nucleoside reverse transcriptase inhibitor 3) Protease inhibitor |
|
Prophylaxis for Opportunistic Infections in HIV/AIDS
|
PCP: Bactrim
MAC: Biaxin or Azithromycin TB: Annual PPD (give INH and Pyridoxine if positive) Toxo: Bactrim |
|
Stain used to diagnosis Herpes Simplex
|
Wright's Stain
*Done in association with Tzanck smear *Culture of HSV is gold standard for diagnosis |
|
Treatment of HSV
|
Acyclovir (Valacyclovir and Famciclovir have better bioavailability)
*Foscarnet in immunocompromised patients |
|
Herpetic Whitlow
|
HSV infection of the finger caused by inoculation into open skin surface
Tx: Acyclovir |
|
Treatment of Syphilis in patients with Penicillin allergy
|
PO Doxycycline or Tetracycline for 2 weeks
|
|
Causative agent of Chancroid
|
Haemphilus ducreyi - gram-negative rod
|
|
Treatment of Chancroid
|
Azithromycin PO x 1 dose OR
Ceftriaxone IM x 1 dose *Painful ulcer distinguishes from syphilis |
|
Lymphogranuloma venerum
|
Painless sexually-transmitted ulcer caused by CHLAMYDIA TRACHOMATIS
Leads to obstruction of lymphatics and elephantiasis of genitalia *Treat with PO doxycycline for 21 days |
|
Causative agent of Pubic Lice
|
Phthirus pubis
*Transmitted via clothing, towels, sex *Treat with Permethrin 1% shampoo (Elimite) |
|
Cellulitis
|
Inflammation of skin and subcutaneous tissue often caused by GAS or S. aureus
*Can lead to life-threatening bacteremia |
|
Clinical features of Cellulitis
|
1) Erythema
2) Warmth 3) Pain 4) Swelling |
|
Treatment of Cellulitis
|
IV meds until signs of infection improve -
Staphylococcal penicillin (Oxacillin, nafcillin) Cephalosporin (cefazolin) |
|
Erysipelas
|
Cellulitis located in the dermis and lymphatics often caused by group A streptococcus
|
|
Predisposing factors of Erysipelas
|
1) Lymphatic obstruction (radical mastectomy)
2) Fungal infections 3) Diabetes mellitus 4) Alcoholism |
|
Necrotizing Fasciitis (Nec Fasc)
|
Life-threatening infection of deep soft tissues that tracks along fascial planes
*Leads to sepsis, TSS, and multi-organ failure |
|
Common organisms of Nec Fasc
|
1) Streptococcus pyogenes
2) Clostridium perfringens |
|
Treatment of Nec Fasc
|
Surgical debridement and broad-spectrum parenteral antimicrobial therapy
|
|
Lymphadenitis
|
Inflammation of a lymph node
Fever, tender LNPathy, red streaking of skin from wound Tx: antibiotics and wound drainage |
|
Cause of Tetanus
|
Neurotoxin produced by Clostridium tetani, a GRAM-NEGATIVE ANAEROBE
|
|
Clinical features of Tetanus
|
1) Hypertonicity and contractions of masseter muscles "Lock-jaw"
2) Risus sardonicus - grin due to contraction of facial muscles 3) Opisthotonos - arched back due to contraction of back muscles |
|
Most common organisms of Osteomyelitis
|
1) S. aureus
2) Coagulase-negative Staph |
|
Plain radiograph of Osteomyelitis
|
Earliest changes (periosteal thickening or elevation) not evident for at least 10 days
Lytic lesions only apparent in advanced disease |
|
Treatment of Osteomyelitis
|
IV antibiotics for 4-6 weeks (or longer)
Surgical debridement |
|
Acute Infectious Arthritis
|
Organisms invade joint space and release ENDOtoxins that trigger cytokine release and neutrophil infiltration --> erosion of the joint
|
|
Most common agent of Acute Infectious Arthritis
|
S. aureus
*N. gonorrheae in young, sexually active adults |
|
Clinical features of Acute Infectious Arthritis
|
1) Swollen, warm, painful joint
2) Very limited active and passive range of motion 3) Palpable effusion 4) Constitutional symptoms |
|
Diagnosis of Acute Infectious Arthritis
|
1) Joint aspiration (culture, stain, crystal analysis)
2) Blood cultures 3) CBC, ESR, CRP 4) CT or MRI |
|
Treatment of Acute Infectious Arthritis
|
1) Prompt antimicrobial therapy
2) Drainage of joint as long as effusion persists |
|
Signs of disseminated gonococcal infection
|
1) Fever
2) Chills 3) Rash (macules, papules, and/or pustules) |
|
Where are the 3 endemic Lyme Disease areas in the US?
|
1) Northeastern seaboard
2) Midwest 3) West coast |
|
Transmission of Lyme Disease
|
Caused by Borrelia burgdorferi, which is transmitted by the deer tick, Ixodidae scapularis
|
|
Clinical features of Lyme Disease
|
Stage 1: Erythema migrans
Stage 2: Early disseminated infection (flu-like symptoms, meningitis/encephalitis, cardiac manifestations) Stage 3: Arthritis, Chronic CNS disease, Acrodermatitis Chronica Atrophicans |
|
Most important tests to confirm suspicion of Lyme Disease
|
Serologic studies
*ELISA used to detect IgM and IgG; Western blot used to confirm |
|
Treatment of early Lyme Disease
|
Oral doxycycline for 21 days
*Contraindicated in pregnancy and in children less than or equal to 12 years of age **Amoxicillin, Cefuroxime, and Erythromycin are alternatives |
|
Treatment of the complications of Lyme Disease
|
Prolonged antibiotic therapy
|
|
Pathophysiology of Rocky Mountain Spotted Fever
|
1) Organisms enter host cells, multiply in the vascular endothelium, and spread to different layers of vaculature
2) Damage to vascular endothelium results in increased permeability, activation of complement, microhemorrhages, and microinfarcts |
|
Clinical features of Rocky Mountain Spotted Fever
|
1) Sudden onset of fever, chills, malaise, n/v, myalgias, photophobia, and HA 1 week after tick bite
2) Papular rash appears 4-5 days after the fever *Rash starts on wrist, forearms, palms, ankles, and soles and then spreads centrally 3) May lead to INTERSTITIAL PNEUMONITIS |
|
Lab abnormalities seen in Rocky Mountain Spotted Fever
|
1) Elevated liver enzymes
2) Thrombocytopenia |
|
Treatment of Rocky Mountain Spotted Fever
|
Doxycycline for 7 days (IV if pt is vomiting)
*CNS manifestations or pregnant pts: Chloramphenicol |
|
4 organisms of Malaria
|
1) Plasmodium falciparum
2) Plasmodium ovale 3) Plasmodium vivax 4) Plasmodium malariae *Plasmodium falciparum most serious and life-threatening form |
|
Clinical features of Malaria
|
Fever, chills, myalgias, HA, n/v, and diarrhea
|
|
Fever patterns of Malaria
|
Plasmodium falciparum: constant fever
Plasmodium ovale and Plasmodium vivax: fever spikes every 48 hrs Plasmodium malariae: fever spikes every 72 hrs |
|
Diagnosis of Malaria
|
Peripheral blood smear with GIEMSA STAIN
|
|
Treatment of Malaria
|
Chloroquine Phosphate
*Quinine Sulfate and Tetracycline if chloroquine resistance *Atovaquone-proguanil and Mefloquine are alternatives |
|
Malaria Prophylaxis
|
Mefloquine is agent of choice in chloroquine-resistant areas
|
|
Rabies
|
Devastating, deadly viral encephalitis
From bite or scratch of infected animal |
|
Clinical features of Rabies
|
Incubation period 30 - 90 days
1) Pain at bite site 2) Prodromal symptoms (sore throat, fatigue, HA, n/v) 3) Encephalitis (confusion, hyperactivity, fever, seizures) 4) Hydrophobia (inability to drink, laryngeal spasm, hypersalivation) 5) Ascending paralysis *Once symptoms are present, rabies is almost invariably fatal |
|
Diagnosis of Rabies
|
1) Virus or viral antigen may be identified in infected tissue and saliva
2) Four-fold increase in serum antibodies 3) NEGRI BODIES in tissue 4) PCR detection of RNA virus |
|
Treatment of Rabies
|
1) Thorough cleaning of wound
2) Passive immunization (human rabies IgG in wound and glutes) 3) Active immunization (anti-rabies vaccine in 3 IM doses) over 28 day period |
|
Which bacteria causes Rocky Mountain Spotted Fever?
|
Rickettsia rickettsii
|
|
Treatment of Candidiasis
|
1) Clotrimazole lozenge (oral)
2) Nystatin swish and swallow (oral) 3) Oral ketoconazole or fluconazole (esophagitis) 4) Miconazole or clotrimazole cream (vaginal) 5) Amphotericin B or Fluconazole (systemic disease) |
|
3 Main Clinical syndromes associated with Aspergillus
|
1) Pulmonary aspergilloma
2) Allergic bronchopulmonary aspergillosis 3) Invasive aspergillosis |
|
Allergic Bronchopulmonary Aspergillosis
|
Type 1 hypersensitivity reaction
Presents with ASTHMA and EOSINOPHILIA *Tx: avoid exposure |
|
Pulmonary Aspergilloma
|
Chronic cough, hemoptysis in pts with sarcoidosis, histoplasmosis, TB, and bronchiectasis
*May resolve spontaneously or invade locally *Tx: lobectomy if massive hemoptysis |
|
Invasive Aspergillosis
|
Hyphae invade lung vasculature and cause thrombosis and infarction in immunocompromised patients
*May invade sinuses, orbits, and brain *Tx: IV Amphotericin B, voriconazole, or caspofungin |
|
Diagnosis of Aspergillus infection
|
1) CXR - fungus ball
2) Tissue biopsy *Blood cultures rarely positive |
|
Cryptococcosis
|
Infection caused by Cryptococcus neoformans inhalation into lungs
Associated with pigeon droppings Seen in advanced AIDS as meningitis Fever, HA, irritability, dizziness, confusion, seizures *Always on differential in HIV pt with fever and HA |
|
Diagnosis of Cryptococcosis
|
1) LP - INDIA INK shows encapsulated yeast
2) Tissue biopsy - lack of inflammatory response 3) Urine and blood cultures |
|
Treatment of Cryptococcosis
|
1) Amphotericin B with flucytosine for 2 weeks
2) PO fluconazole afterwards |
|
Definition of Fever of Unknown Origin (FUO)
|
1) Fever > 101
2) Occurs on several occasions for at least 3 weeks 3) No dx despite 1 week of work-up or 3 outpatient visits |
|
Causes of Fever of Unknown Origin
|
1) Infection (MCC)
2) Occult neoplasms (lymphoma, leukemia) 3) Collagen vascular disease |
|
True or False: It is the bacteria, not the toxin, that causes Toxic Shock Syndrome (TSS)
|
False; it's the toxin
|
|
True or False: TSS must involve at least 3 organ systems
|
True:
1) GI - n/v, diarrhea 2) Renal - elevated BUN/Cr, transaminitis 3) Hematologic - thrombocytopenia 4) Musculoskeletal - elevated creatinine kinase 5) CNS - confusion in absence of fever |
|
Treatment of TSS
|
1) Hemodynamic stability
2) Anti-staphylococcal therapy (nafcillin, oxacillin, vancomycin) |
|
Most common organisms of Catheter-Related Sepsis
|
S. aureus and S. epidermidis
|
|
Most common infections seen in Neutropenic Individuals
|
1) Septicemia
2) Cellulitis 3) Pneumonia |
|
Clinical features of Infectious Mononucleosis
|
1) High fever, sore throat, malaise, myalgias, weakness
2) LNPathy - >90% of pts 3) Pharyngeal erythema or exudate 4) Splenomegaly 5) Maculopapular rash (related to AMPICILLIN!) 6) Hepatomegaly 7) Palatal petechiae and periorbital edema |
|
Diagnosis of Infectious Mononucleosis
|
1) Serology - Monospot test for heterophile antibody
2) Peripheral blood smear - lymphocytic leukocytosis with large atypical lymphocytes 3) Throat culture - r/o secondary infection (B-hemolytic strept) |
|
Complications of Infectious Mononucleosis
|
1) Hepatitis
2) Meningoencephalitis, Guillian-Barre, Bell's palsy 3) Splenic rupture 4) Thrombocytopenia, hemolytic anemia 5) Upper airway obstruction 2/2 LNPathy |
|
Currant Jelly Sputum is seen with which gram-negative PNA?
|
Klebsiella
|