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UWorld Internal Medicine: Infectious Disease

Terms in this set (146)

Primary Syphilis
- painless genital ulcer (chancre)
- Tx = PCN G (IM) x1 dose; if PCN allergic, Doxycycline x14 days

Secondary Syphilis
- diffuse rash (MACULOPAPULAR RASH starts ON TRUNK, EXTENDS TO PERIPHERY ON PALMS + SOLES), generalized lymphadenopathy, condyloma lata (painless, mucosal, warty lesions on penis), oral lesions, hepatitis
- initial testing - RPR + VDRL; confirm with FTA-ABS (more specific)
- Tx = PCN G (IM) x1; if PCN allergic, Doxycycline x14 days
I. possible SE: Jarisch-Herxheimer reaction - acute febrile reaction with headaches + myalgias)

Latent Syphilis
- Asx
- Tx = PCN G (IM) x3 doses; if PCN allergic, Doxycycline x 28 days

Tertiary Syphilis
- CNS sx [tabes dorsalis (dorsal column destroyed so impaired proprioception, ataxia at night, absence of DTR, pos Romberg), Argyll Robertson pupil (*A*ccomodation *R*eflex *P*resent but *P*upillary *R*eflex ARNS sx [tabes dorsalis (dorsal column destroyed so impaired proprioception, ataxia at night, absence of DTR, pos Romberg), Argyll Robertson pupil (*A*ccomodation *R*eflex *P*resent but PPNS sx [tabes dorsalis (dorsal column destroyed so impaired proprioception, ataxia at night, absence of DTR, pos Romberg), Argyll Robertson pupil (*A*ccomodation *R*eflex *P*resent but *P*upillary Reflex Absent), dementia]; CV sx - aortic aneurysm, aortic insufficiency; Cutaneous - gummas (granulomas that are most common in liver)
- Tx = PCN G (IV) x 14 days; if PCN allergic, Ceftriaxone x14 days

Pregnancy
- Intrapartum transmission + congenital disease
- PCN - desensitize if allergic + finish course
Bacillus cereus
- diarrhea, abd cramping
- ingestion of preformed toxin in starchy food such as rice

Staphylococcus aureus
- vomiting, abdominal pain
- diarrhea not typical but may occur
- caused by preformed toxin with RAPID ONSET symptoms

Clostridium Dificile
- Abd pain, watery diarrhea, possible fever
- bloody stools unusual
- associated with antibiotic exposure

Clostridium Perfringens
- brief illness with watery diarrhea, cramps, fever
- associated with undercooked or refrigerated food

Salmonella
- watery diarrhea, fever, abd pain, and vomiting
- associated with undercooked foods, especially poultry + eggs
- antibiotic treatment needed only for severe disease or immunocompromised patients

Vibrio vulnificus
- vomiting, diarrhea, and bad pain
- raw or undercooked shellfish
- may cause invasive life threatening disease of immunocompromised patients or those with liver disease

E. coli
- watery diarrhea, may be BLOODY if associated with EHEC (shiga toxin producing)
- associated with undercooked beef or food w/bovine feces
- EHEC - inflammatory diarrhea syndrome with BLOODY stools due to making SHIGA TOXIN from BEEF PRODUCTS confirmed for with STOOL ASSAY FOR SHIGA TOXIN
I. if EHEC suspected, avoid empiric antibiotic therapy b/c inc risk of HEMOLYTIC UREMIC SYNDROME

Shigella
- bloody diarrhea with fever and often bacteremia
- associated with contaminated food or water especially during travel outside of US

Campylobacter species
- abdominal pain, bloody diarrhea
- highest incidence in children + young adults
- associated with raw or undercooked meats
Endocarditis in general
Inflammation of the heart valve, usually secondary to infection
- usually left-sided
- unless patient has hx of IVDU - think right-sided due to infected venous blood returning first to the right-heart + involving tricuspid valve


•Types
- Acute endocarditis
i. associated with fever and rapid degradation of heart tissue
ii. caused by: Staphylococcus aureus (IVDU)
iii. can infect healthy or damaged valves (e.g. from mitral valve prolapse or rheumatic heart disease)
iv. mitral valve prolapse = most common predisposing cardiac condition acute form


- Subacute bacterial endocarditis
i. slower onset of symptoms with less severe symptoms
ii. caused by: Enterococcus (bacteremia most commonly caused by GI/GU interventions) (growth in 6.5% NaCl differentiates it from S. viridans); strep viridans (oral interventions); staph epidermidis (prosthetic valves); Strep bovis (secondary to UC or colorectal cancer); Eikenella corrodens (dental manipulation)



- Marantic endocarditis = paraneoplastic syndrome (sterile vegetations on the valves as a result of ↑ coagulability secondary to ↑ mucin production - same process underlying Trousseau's sign)
i. primary cancers in GI tract
ii. may produce emboli to periphery

◾note: "marantic" derives from "marasumus" wasting associated with cancer

- Libman-Sacks endocarditis
i. caused by systemic lupus erythematous (SLE)
ii. remember: SLE : LSE
iii. usually asymptomatic but mitral regurgitation murmur can be heard


•Complications
◦chordae tendineae rupture
◦emboli
◦glomerulonephritis
◦suppurative pericarditis