Infectious disease

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jstaylor
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237570
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Infectious disease
Updated:
2013-10-27 23:01:41
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medicine
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medicine shelf - infectious disease
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  1. Common variable immunodeficiency
    • aka acquired hypogammaglobulinemia
    • suspected in patients with recurrent gastrointestinal infections (especially giardiasis) and respiratory infections
    • Dx: decreased serum IgG levels
    • Sx: malabsorption, small bowel bacterial overgrowth
    • Risks: autoimmune or neoplastic diesase
  2. Sx of bacterial vaginosis
    • malodorous discharge w/o irritation or pain
    • homogeneous, white discharge, without vaginal erythema
    • Clue cells: squamous epithelial cells with obscured edges
    • vaginal pH >4.5
    • fishy odor either before or after addition of 10% potassium hydroxide
    • Tx: metronidazole or clindamycin (orally or vaginally)
  3. Candidal vaginitis
    • "cottage cheese-like" vaginal discharge
    • moderate to significatn vaginal irritation, inflammation
    • lack of odor
    • high pH
    • stained specimens show pseudohyphae and budding yeast
  4. Trichomonas vaginalis
    • yellow-green discharge
    • pruritic
    • "frothy" discharge
    • high pH
  5. Drug fever
    • Abx can cause or prolong fever
    • Common cause: beta-lactam antibiotics
    • Eosinophilia and rash accompany drug fever in 25% of cases
  6. SIRS
    • 2 or more of the following:
    • temp > 100.4
    • HR > 90
    • RR > 20 (or  Pco2 <32)
    • leukocyte count >12 or <4 or >10% band forms
  7. Sepsis
    SIRS + confirmed infectious process
  8. Severe sepsis
    Sepsis with organ dysfunction, hypoperfusion, or hypotesion
  9. Septic shock
    Sepsis-induced hypotension or hypoperfusion abnormalities despite adequate fluid resuscitation
  10. Severe sepsis
    tx, improves survival
    Aggressive fluid resuscitation with resolution of lactic acidosis within 6 hours
  11. influenza postexposure prophylaxis in immunosuppressed
    • Zanamivir (relenza) or oseltamivir (tamiflu)
    • trivalent, inactivated influenza vaccine (intramuscular)
  12. Oseltamivir
    • neuraminidase inhibitor
    • treats influenza A and B
  13. Zanamivir
    • neurominidase inhibitor
    • treats influenza A and B
    • inhaled, associated with bronchospasm in 5 to 10% of patients with asthma
  14. Amantadine, rimantadine
    • only active against influenza A
    • >90% of circulating influenza A virus were resistant to amantadine and rimantadine
  15. nasal degongestant spray overuse
    • rhinitis medicamentosa
    • persistent rhinitis symptoms in setting of chronic use
    • tx: withdrawal vasoconstrictor and initiate treatment with nasal corticosteroid spray
  16. bacterial rhinosinusitis
    • duration of symptoms >1 week
    • worsening after initial improvement
    • maxillary tenderness
    • purulent drainage
    • poor response to decongestants
  17. Bacterial rhinosinusitis
    pathogens, treatments
    • Streptococcus pneumoniae
    • Haemophilus influenca
    • Tx: 3- to 10-day course of narrow-spectrum antibiotics (amoxicillin, TMP-SMZ, doxycycline)
  18. acute rhinosinusitis
    • most caused by viral infection
    • tx: symptomatic
    • Sx: URI > 7 days, facial pain, purulent nasal discharge (1 of 3 fives <25% probability of bacterial sinusitis)
    • 2-3 of these sx, antibiotic therapy may be warranted
  19. Pyelonephritis
    • UTI ± flank pain ± fever ± naus/vom
    • Tx: oral (when appropriate)
    • Empiric tx: oral levofloxacin x 7 days (some say 7 to 14 days)
    • alternatives: 3rd gen cephalosporin, extended-spectrum penicillins or aminoglycosides, monobactams, carbapenems
  20. Uncomplicated UTI
    • Tx: 3-day course of trimethoprim-sulfamethoxazole
    • must do pregnancy test first
    • ciprofloxacin if unrelieved dysuria and bacteriuria after TMP-SMZ
  21. genital herpes simplex virus
    • painful vesicles progressing to pustules and then to ulcers or erosions
    • tender inguinal LAD
    • incubation period: 3 to 5 days
    • Tx: oral valacyclovir
  22. Valacyclovir
    • ester of acyclovir
    • converted to acyclovir in the liver
    • better absorption, higher drug levels than oral acyclovir
  23. secondary syphilis
    • generalized rash (palms and soles, included)
    • low grade fever
    • generalized LAD
    • Dx: RPR test (screen)
  24. oral thrush
    • associated with HIV infection and odynophagia
    • tx: fluconazole
    • may need upper endoscopy (esophageal candidiasis)
  25. Antibodies to HIV
    • not detectable until about 6 weeks after infection
    • test HIV viral load
  26. guidelines for HIV treatment
    • Initiate ART for treatment-naive patient when CD4 count <200
    • Regimen: three or more agents (i.e., zidovudine, didanosine, nelfinavir)
  27. Polyomavirus JC
    ...in HIV pt
    progressive multifocal leukoencephalopathy
  28. PML
    • opportunistic infection caused by polyomavirus JC
    • Demyelination of the central nervous system that causes gradually progressive neurologic deficits
    • Radiograph: no mass effect
    • Approx 50% of pts with AIDS and PML will survive the latter disease if they start HAART
  29. Chlorhexidine vs povidone-iodine for cleaning skin
    Chlorhexidine is superior skin cleanser and has residual activity for at least 30 minutes
  30. indwelling catheters
    • remove whenever possible
    • 90% of UTIs are related to indwelling catheters
  31. ventilator-associated pneumonia
    risk factors
    • risk factors: chest trauma, low glasgow coma scale, need for mechanical ventilators
    • Prevention: keep bed at 45-degree angle, maintain gastric acidity, maximizing nutrition, preventing colonization or cross-contamination
    • Equipment needs to be changed every 2 weeks in adults
  32. HCAP
    tx
    • nosocomial, health-care acquired pneumonia
    • must cover for resistant organisms including MRSA/pseudomonas
    • risk: prior hospitalization within 90 days
    • Initial tx: (broad spectrum) vancomycin, cefepime, ciprofloxacin
  33. Infliximab
    • anti-tumor necrosis factor-α
    • increases risk for reactivation of tuberculosis, often extrapulmonic disease
  34. methotrexate pneumonitis
    sx: fever, dypsnea, diffuse pulmonary infiltrates
  35. Tx of active tuberculosis
    • 1. isoniazid, rifampin, pyrazinamide
    • 2. isoniazid, rifampin, pyrazinamide, ethambutol
    • 3. isoniazid, rifampin, pyrazinamide, streptomycin
  36. Tx of latent TB
    • isonizid for 9 months
    • 88% reduction of reactivation tuberculosis in the first year, 68% reduction over the next 10 years
  37. BCG vaccine
    affects on screening
    BCG vaccination does NOT change the interpretation of TB skin test in most adults
  38. prophylactic isoniazid therapy
    • immunosuppressed patients have an increased risk for developing primary or reactivation tuberculosis
    • PPD testing before starting dose of prednisone
  39. Aspiration pneumonia
    organisms, coverage, risk factors
    • anaerobic organisms (often from the mouth)
    • coverage: clindamycin
    • Risk factors: difficulty swallowing, episodes of depressed consciousness, mechanical factors (esophageal obstruction)
  40. CAP
    community-acquired pneumonia
    • empiric therapy for ward:
    • 1. IV fluoroquinolone alone (i.e. ceftriaxone)
    • 2. IV beta-lactam + IV/oral macrolide or doxycycline

    • Empiric tx for ICU:
    • 1. IV beta-lactam (ceftriaxone or cefotaxime) + IV macrolide (azithromycin) or IV fluoroquinolone

    Risk for pseudomonas: anti-pseudomonal beta-lactam
  41. CAP
    switching to orals
    • improvement in fever, cough, dyspnea
    • decrease in the leukocyte count
    • Most patients, oral therapy can be instituted within 3 days
    • do NOT need to wait for change in radiograph findings
  42. CAP associated with mild lung disease
    (i.e. outpatient therapy)
    • Tx: azithromycin, or clarithromycin (advanced-generation macrolides) or doxycycline
    • pathogens: streptococcus pneumoniae, atypical organisms (mycoplama pneumoniae, chlamydophila pneumoniae, legionella pneumophila)
    • Empiric treatment without waiting for gram-stain or cultures
  43. kaposi's sarcoma
    • cutaneous lesions: asymptomatic
    • cause is human herpesvirus 8
  44. clenched fist injury
    "fight bite"
    • Tx: amoxicillin-clavulanate (Augmentin)
    • polymicrobial: cover for GP, GN, anaerobes
    • Augmentin is also used for dog bites
  45. Clindamycin
    • effective against GP and anaerobes
    • treatment of lung abscesses and female genital tract
  46. Erythromycin
    • treatment of choice for legionnaire disease
    • outpatient treatment of CAP
  47. pulmonary nodule with "halo sign"
    • invasive aspergillosis: occurs in immunocompromised patients
    • disease: fever, cough, dyspnea, hemoptysis
    • CXR: cavitary lesion
    • CT: halo sign or lesions with an air crescent
  48. subacute bacterial endocarditis
    s/p tooth extraction
    viridans group streptococci
  49. Acute infective endocarditis
    • Staphylococcus aureus 
    • IV drug users
    • tricuspid valve involvement > aortic valve
    • increasing with inspiration: tricuspid involvement
    • Tx: iv vancomycin (emperic)
  50. Mucormycosis
    • caused by fungus Rhizopus
    • Presentation: diabetics, fever, dull facial pain, bloody nasal discharge
    • diplopia, headache
    • Tx: surgical debridement + IV amphotericin
  51. hepatomegaly with smooth round big cyst with daughter cysts within
    • Echinococcosis
    • tapeworm echinococcus
    • Source: sheep
  52. Sheep breeder
    • echinococcus
    • liver, lungs
    • hydatid cyst
  53. Pig farmers
    neurocysticercosis
  54. Infective endocarditis
    HACEK organism
    • Haemophilus aphrophilus
    • Aggregatibacter actinomycetemcomitans
    • Cardiobacterium
    • Eikenella: GN anaerobe, human oral flora
    • Kingella
    • 3% of infective endocarditis
  55. streptococcus bovis
    • colonoscopy
    • GI malignancy
  56. Seafood injestion
    • Vibrio parahaemolyticus
    • diarrhea, bloody, mucus
    • incubation: 4hr - 4days
  57. Shigella
    • dysentery
    • daycare centers or institutional settings
  58. EHEC
    • colitis
    • transmission: improperly cooked ground beef
  59. under cooked pork
    yersiniosis
  60. isoniazid 
    side effects
    • peripheral neuropathy, numbness, ataxia
    • Tx: pyridoxine increased to 100mg/day
    • other side effect: hepatitis
  61. Pulmonary cavitation in HIV patient
    • Mycobacterium tuberculosis
    • atypical mycobacteria
    • Nocardia
    • GNRs
    • anaerobes
  62. Nocardia
    • GP, weakly acid-fast, filamentous branching rod
    • found in soil and water
    • Primarily involve lungs
    • Tx: trimethoprim-sulfamethoxazole
  63. histoplasmosis
    • CD4 <100/microL
    • fever, weight loss, night sweats, n/v, cough with SOB
    • HSM
    • Dx: urine antigens
    • Tx: itraconazole
  64. Bacillary angiomatosis
    • Bartonella, GN bacillus
    • Tx: oral erythromycin
  65. CD4 <50
    prophylaxis
    • Start azithromycin for mycobacterium avium complex MAC
    • azithromycin or clarithromycin
  66. lyme disease
    • early stage: erythema migrans, fatigue, malaise lethargy, myalgias, arthralgias
    • Early disseminated: carditis, neurologic, muscular, conjunctivitis, skin
    • Late or chronic: muscular, neurologic
    • Cause: borrelia burgdorferi
    • Tx: doxycycline
  67. osteomyelitis
    • most common: staphylococcus aureus
    • nail puncture: pseudomonas aeruginosa
  68. hemochromatosis
    • increase risk of infection with listeria monocytogenes 
    • Iron overload also a risk for yersinia enterocolitica and septicemia from vibrio vulnificus
  69. pneumocystis pneumonia
    • fever, dry cough, exertional dyspnea
    • CD4 <200
    • Tx: trimethoprim-sulfamethoxazole
    • Prednisolone in combination when PaO2 is <70
  70. Rubella
    • erythematous and maculopapular rash
    • starts on face, progresses to trunk and extremities
    • fever, lymphadenopathy, malaise
    • mild coryza and conjunctivitis
  71. Bronchiectasis
    pneumonia
    pseudomonas aeruginosa
  72. dental procedure prophylaxis
    • high-risk cardiac conditions: prosthetic valves, previoius bacterial endocarditis, complex cyanotic congenital heart diseases
    • Moderate risk: most congenital cardiac malformations, acquired valve dysfunction, hypertrophic cardiomyopathy, mitral valve prolapse
    • Ppx: amoxacillin 2G PO 1hr prior; or amp 2G IV 30min prior
  73. osteomyelitis in sickle cell disease
    • staphylococci, streptococci, salmonella species
    • Tx: vancomycin plus ceftriaxone

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