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FM: Infectious Disease 2
Terms in this set (98)
What is the eponym for erythema infectiosum?
What organism causes erythema infectiosum?
HPV B19: Aplastic crisis w/ hemolytic anemia
Erythema infectiosum is due to person-to-person spread by ______ _____. What time of year does this most commonly occur and patients of what age?
Late winter/early spring
Patient presents with erythematous, maculopapular rash on the trunk, butt, and extremities with LG fever, sore throat, nasal stuffiness, arthralgia, and arthritis. You also see a "slapped-cheek" looking presentation. What do you suspect, how do you confirm diagnosis, and what tx?
Primarily a clinical diagnosis, can test IgG and IgM Antibody
No antiviral tx or immunization, let it run its course or use OTC medication
a. Causative agent?
b. When do epidemics occur?
c. Mild flu-like illness may occur at ___ days; rash occurs at ____ days
d. When is the patient contagious?
a. parvovirus B19
c. 7-10; 10-17
d. before but not after the onest of the rash
a. First sign of illness?
b. Describe the rash
a. usually the rash
b. raised, fiery med maculopapular lesions on cheecks that coalesce to give "slapped-cheek" appearance; lesions are warm, nontender, sometimes pruritic; circumoral region is spread; within 1-2 days, spreads to proximal extensor surfaces of extremities and spreads distally in symmetrical fashion; trunk, neck, buttocks often involves
A spectrum of illness from stomatitis and urogenital lesions to facial nerve paralysis and encephalitis with variable intervals b/w exposure and clinical disease.
Herpes simplex - HSV causes both primary and reactivation disease
Which type of HSV affects the head and neck? Which one affects below the waist?
Patient presents with vesicles that develops ulcers over several days that look like grouped vesicles on an erythematous base. What do you suspect?
Epithelialize over 1-2 weeks
Which type of virus causes genital ulcers, latent in presacral ganglia that can cause aseptic menigitis, urinary retention, and asymptomatic shedding?
HSV can infect the eyes. _____ is unilateral impaired vision with dentritic ulcers. _____ affects the eyelids and _____ has frequent recurrences.
Patient presents with flu-like prodrome, HA, fever, behavioral changes, seizures, and hearing/speech problems. What do you suspect?
Encephalitis and meningitis HSV infection
HIGH mortality - can present with coma!
The hearing/speech problems are d/t temporal lobe damage.
What is the DOC for HSV? How is it prevented?
Acyclovir prevents recurrent mucocutaneous disease, but does not CURE it
What is the MC cause of visible genital ulcers?
HSV-1 infxns are frequently estbalished in children by age ___. HSV-2 is an STI.
a. SSx of initial infxn
b. What is comon as a prodrome before recurrence?
c. gold standard for Dx?
a. vesicles of vulva, vagina, cervix, rectum, urethra, quickly followed by shallow, painful ulcerations; can have fever and LAD
b. genital, buttock, or pelvic region pain
c. viral culture - unroof an active vesicle and swab the base of the lesion
How is HSV treated?
antiviral drugs within first 5 days of primary infxn decreases duration and severity
for recurrent, start therapy with prodrome or during first day of attack
a. Describe the primary infxn.
b. Gold standard for Fx?
a. Start w/ flu-like Sxs (malaise, myalgias, nausea, diarrhea, fever). Next vulvar burning & pruritis, then multiple vesicles appear & remain for 24-36 hrs before evolving into painful genital ulcers.
b. Viral cultures
c. No cure, but for primary infxns can use acyclovir, valacyclovir, or famiciclovir
a. 1/2 of new cases occur in what age group?
b. What is highest risk group?
c. All sexually active individuals older than __ should be offered HIV testing at least once.
a. 13-24 years
b. men who have sex with men
What disease?: Prominent systemic complaints such as sweats, diarrhea, weight loss and wasting caused by sexual contact w/ an infected person, parenteral exposure to infected blood by transfusion or needle sharing, perinatal exposure.
What are the neurologic manifestations of an HIV infection?
dementia, aseptic meningitis, and neuropathy
What is the definition of AIDS?
AIDS is defined as being HIV positive, symptomatic and having a CD4 lymphocyte count < 200/ul.
______ treatment has improved the prognosis of an individual with HIV/AIDS
Antiretroviral treatments (HAART)
- nucleoside reverse transcriptase inhibitors: didanosine, zidovudine
- protease inhibitors: indinavir
What is the normal CD4 count in a healthy patient? What is considered a "normal" count in an HIV-infected patient?
Most HIV patients are asymptomatic for 10 years and when they present they are identical to symptoms of other diseases. What are 2 clinical findings that are highly suggestive of HIV?
Hairy leukoplakia or Kaposi's sarcoma
What are some risk factors for sexual transmission of HIV?
Receptive anal intercouse
Ulcerative inflammatory STDs
Lack of male circumcision
Which has a higher risk of transmission of HIV - drugs or needle stick? What about vaginal vs cesarean delivery?
What is the pathogenesis seen with HIV?
CD4 - helper T cells unable to call for help
Depressed B cells
Fever, night sweats, weight loss, and nausea are _____ type symptoms associated with HIV.
Acute viral-like illness
Pneumocystis pneumonia, Kaposi's sarcoma, NHL, and sinusitis all cause _____ type symptoms associated with HIV.
Opportunistic infection - recurrent oral candiasis
What can happen to a patient with HIV if their CD 4 count is <200 that affects the CNS?
Cryptococcal meningitis - HIV myelopathy or PML-viral infection
What are some effects on the PNS due to HIV?
What is the eye problem associated with HIV?
Inflammatory polyneuropathies: Guillain-Barre syndrome
What are some rheumatologic effects due to HIV?
What are some myopathy effects due to HIV?
What are some gastroenterology effects due to HIV?
What are some endocrine effects due to HIV?
Candidal esophagitis; Hepatic disease; Cholecystitis; Enterocolitis
**Cryptosporidium causes self-limited diarrhea in healthy normals; if it persists, think HIV
Adrenal gland - Salt wasting
What are some skin effects due to HIV?
Herpes simplex and zoster
Bacillary angiomatosis: Bartonella
What are the malignancies associated with HIV?
Anal dysplasia and squamous cell carcinoma
Cervical dysplasia and neoplasm
What is the screening test for HIV? What is the confirmation test?
Screening - ELISA if positive, retest to make sure not a false positive
Confirmation - Western blot
What are the lab findings associated with HIV?
What type of therapy is indicated in a HIV patient with a CD4 <350?
Nucleoside reverse transcriptase inhibitors: AZT, DDI
Protease inhibitors: Indiavir
What is the treatment for opportunistic infections for herpes and pneumocystis infections that are associated with HIV?
** Begin CMV suppression when CD4 < 150
AIDS is defined as being ___ positive, symptomatic, and having a CD4 lymphocyte count < _ /microliter.
A normal CD4 count is 600-1200 CD4 cells/mmcubed. HIV infected individuals are considered to have "normal" counts if the number is greater than __.
Most HIV-infected individuals remain Asx for how long?
several years, 10 years being the mean
In HIV, as the CD4 number decreases, opportunistic infections occur. List some.
• Pneumocystis pneumonia
• Kaposi's sarcoma
• NHL; sinusitis; HIV myelopathy; PML-viral infection
• CNS: toxoplasmosis (CD4 < 100), lymphoma, dementia, cryptococcal meningitis
On PE of an HIV infected individual, what are 2 findings that are suggestive of AIDS?
hairy leukoplakia - white deposits on tongue and throat that can't be scraped off
HIV screening is done with _____ and confirmed with ______.
Western blot test
At what point do you begin treating HIV?
- when CD4 count is < 350
- earlier if there is rapid CD4 decline or a high viral load
a. How many strains cause genital infxns?
b. Low-risk strains cause what?
c. High-risk strains cause what?
b. 6 & 11 - condyloma and low grade lesions (CIN I)
c. 16, 18, 31, 33 - high grade lesions and invasive cancer (16 & 18 account for 2/3 of cervical cancer cases)
HPV is present in __% of cervical neoplastic lesions.
It is present in 99.7% of invasive cervical cancers.
80% - essentially you can't get cervical cancer w/o HPV
Why do condoms offer poor protection against HPV?
transmission can occur from labial-scrotal contact
When a woman is infected with HPV...
a. ___% will have a spontaneous resolution over a 2 year period
b. Only __% will have a cytologically detectable CIN
Infection with HPV alone is insufficient for development of CIN or cervical cancer. Cofactors such as what are involved?
smoking (associated w/ 2-4 fold increase in risk of developing cervical cancer; pack-years is directly proportional to risk)
HPV occurs in up to __% of sexually active women by age __.
HPV types 6 and 11 cause...
Types 8, 16, 31, 33, 35 cause...
external genital warts
a. What are the SSx of HPV?
b. What is Tx?
a. condyloma acuminatum, itching, burning, or pain - Dx w/ colposcopy w/ acetic acid stain
b. laser/electrocautery, surgical, cryotherapy, imiquimod, podifilox, vaccine
a. What virus causes condyloma acuminata?
b. What else can be caused by this virus?
c. Which strains of the virus cause 90% of genital warts
d. Which strains cause more than 70% of cervical dysplasia and CA?
b. cervical dysplasia, cervical CA
c. 6 and 11
d. 16 and 18
What is the MC cause of an abn ormal Pap smear?
a. How does influenza spread?
b. What is incubation period?
a. airborne resp. secretions
b. 2-7 days
c. sudden onset high fever, severe myalgia, HA, chills, coryza, pharyngitis, cough; diarrhea, vomiting, & abd pain may occur in young children
a. What age has highest hospitalization rates?
b. Where do 2ndary bacterial infections occur MC?
c. During a flu outbreak, ill children who develop protracted vomiting or irrational behavior should be evaluated for what?
a. under age 2
b. middle ear, sinuses, lungs (Staphylococcal)
c. Reye syndrome
a. Where does the flu cause inflammation?
b. Name the 3 antigenic types & which ones almost exclusively infect humans.
c. Which antigenic type usually causes disease (the others cause minor illness)?
a. the lungs - lung lining infiltrated with fluid
b. A, B, C; B and C in humans
c. Dz usually caused by A
How does influenza transmission occur: fomites, droplets, or direct contact?
primarily through droplet nuclei
incubation period 1-4 days
Pt presents with abrupt onset of fever, chills, malaise, myalgias, substernal soreness, HA, nasal stuffiness, nausea, cough, and pharyngeal injection and soreness. Prob Dx? Tx?
supportive - analgesics, cough mixture.
Antivirals can reduce attack if begun within 48 hrs of exposure: Ribavirin, osltemavir, zanamivir (A & B); amantadine, rimantadine have high resistance and are ineffective against B and avian
Who should receive a flu vaccine?
age > 50 (or > 65...diff recommendations)
children & teens with chronic ASA therapy
nursing home residents
pregnant women 2-3 trimester
What dz?: Painful swollen salivary glands, usually parotid. Facial edema. Frequent involvement of other tissues, including testes, pancrease, and meninges, in unvaccinated individuals.
Mumps are most common in ______. Transmitted through ____ and _____.
Saliva and urine
What dz?: decreased leukocytes with increased lymphocytes, trismus, complications include meningitis, orchitis (inflammtion of testes) and pancreatitis.
TX of mumps?
symptomatic Tx - bed rest and isolation
Orchitis: scrotal support, codeine or meperidine for pain
a. SSx of salivary gland dz?
b. Other manifestations?
a. tender swelling of salivary gland(s) - MC parotid and usually bilateral; fever; facial lymphedema; ear displaced up and outward; mandibular angle obliterated; parotid stimulation with sour foods is painful
b. meningoencephalitis (rare; mild HA); pancreatitis; orchitis, oophoritis (fever, local tenderness, swellling; sterility is RARE); thyroiditis, mastitis, arthritis
Which dz?: Parasthesia, hydrophobia, rage alternating with calm. Convulsions, paralysis, thick tenacious saliva.
Rabies - average incubation 3-7 weeks
Which dz?: prodrome of pain at site of bite with fever, malaise, headache, N/V, skin temperature sensitive, after 10 days, CNS symptoms appear
Tx of rabies?
clean wound thoroughly
RIG (rabies immune globulin) 20 units/kg locally inject as much as possible.
Inject remainder IM HDCV (human diploid cell vaccine) 1mL (IM deltoid) on day 0,3,7,14, 28
a. What is rabies?
b. What is the most important cause of human rabies in US? ARound the world?
c. In what other animals is it common?
a. Viral (rhabdovirus) encephalitis via saliva of infected animal
b. bats; dogs
c. skunks, raccoons, foxes
a. Incubation period?
b. Describe SSx?
c. Once a pt develops Sxs, what is his prognosis?
a. 3-7 wks; can be 10 days to several years
b. prodrome of pain @ bit site; fever, malaise, HA, N/V; skin is temp sensitive; paresthesias, hydrophobia, rage alternating w/ calm; convulsions, paralysis, thick salvia
c. FATAL within 7 days
How to treat an animal bite that may be rabid?
- flush copiously w/ soap & water
- passive immunization: inject rabies Ig near wound; 20 IU/kg on day of exp, infiltrated into & around wound
- active immunization: rabies vaccine (stimulates immunity after 7-10 days); give on 0, 3, 7, 14 (and also 28 if immunosuppressed)
Which virus causes...
b. rubella (german measles)
c. rubeola (measles)
a. human herpes virus 6
b. "german measles" Togavirus
Roseola, caused by human herpes virus 6, is the most common _____ _____ in the first 2 years of life. When does it most often occur?
late spring, early fall
A 12 month old child develops fever, malaise, a mild cough, vomiting, and diarrhea. Soon after his fever subsides, a rash develops. Dx and Tx?
a. Causative agent?
b. typical age group?
c. Describe SSx?
a. HHV-6 or HHV-7
b. 6-36 months
c. abrupt onset of fever (105 degrees) up to 8 days in an otherwise mildly ill child; fever ceases abruptly then characteristic rash appears; mild lethargy & irritability; pharynx, tonsils, TMs may be injected; diarrhea & vom may occur
Describe the rash of Roseola infantum.
coincides with lysis of fever; begins on trunk, spreads to face, neck, extremities; rose-pink macules or maculopapules, 2-3 mm in diameter, nonpruritic, tend to coalesce, disappear in 1-2 days
a. What is rueblla a.k.a.?
b. What is measles a.k.a.?
a. german measles
Most common infectious exanthem in first 2 years of life that is caused by HHV6 causes fever (abrupt onset), malaise, mild cough, vomitting/ diarrhea, and a rash that appears after fever is gone. PE is unhelpful.
Measles - Rubeola
Postcervical and postauricular lymphadenopathy. Athralgia in young women. Mild in adults- fever, malaise, coryza, coincidence with eruption. Fine maculopapular rash of 3 days duration, face to trunk to extremities.
Fine maculopapular rash that moves from face to trunk to extremities caused by togavirus
Rubella - "german measles"
Transmitted from 1week before to 15 days after
What is CI treatment for rubella?
Pregnancy - avoid 1 month after receiving vaccination
Prodrome of fever, coryza, conjunctivitis, cough, malaise, iriitability, photophobia, Koplik's spots.
Measles - rubeola
Rash: brick red, irregular, maculopapular, onset 3-4 days after onset of prodrome, begins on face "downward and outward"
Measles - rubeola
Paramyxovirus causes ______.
Measles - rubeola
Cough, Coryza, Conjunctivitis, Caudal progression of rash? TX?
Measles - rubeola
a. How is it transmitted?
b. How long are pts infectious?
c. Congenital rubella usually follows maternal infxn in the ___ trimester.
a. aerosolized respiratory secretions
b. 5 days before and until 5 days after rash
a. Describe the prodrome.
b. Describe the rash.
c. When is the rash gone?
a. nonspecific; low-grade fever, ocular pain, ST, myalgia; postauricular and suboccipital adenopathy is characteristic; often precedes the rash
b. erythematous discrete maculopapules beginning on face (can have slapped-cheek appearance); spreads to trunk & extremities after fading from face
c. is gone by 4th day
What are the complications of congenital rubella infection?
cardiac anomalies (pulm artery stenosis, PDA, VSD)
ocular anomalies (cataracts, microphthalmia, glaucoma, retinitis)
thrombocytopenia; bluberry muffin rash; lymphopenia
hepatitis; osteomyelitis; immune disorders; malabsorption; diabetes
What are "blueberry-muffin babies"?
those infected with congenital rubella (dermal nests of extramedullary hematopoiesis or purpura)
a. A.K.A. ____
b. SSx during prodrome?
c. Describe the rash
b. High fever, lethargy, sneezing, eyelid edema, tearing, coryza, photophobia, harsh cough;Koplik spots (few to many small white papules on a diffusely red base on the buccal mucosa) 1-2 days prior to and after onset of rash
c. discrete maculopapular rash spreads quickly over face and trunk, coalescing to a bright red; fades from the face as it extends to extremities
Measles (rubeola)... How to Tx an exposed person for prophylaxis?
vaccination within 72 hours prevents dz
immune globulin will preventor modify if given within 6 days
Rash: pruritic, centrifugal, papular, changing to vesicular ('dewdrops on rose petal') pustular, and finally crusting
Varicella and Herpes Zoster
Varicella-zoster is caused by ______.
Treatment for varicella and herpes zoster
Treatment for varicella and herpes zoster
Varicella Zoster (HHV 3)...
a. How is it spread?
b. When is the host infectious?
a. by direct contact or exposure to airborne infection
b. 48 hrs before to 4 days after exanthem (once crusting begins)
Varicella Zoster (HHV 3)...
a. Describe the prodrome
b. Describe the rash
a. malaise, pharyngitis, rhinitis; Fever and malaise may occur just before or with eruption
b. pruritic, centrifugal, papular to pustular - all stages of exanthems are present; vesicles look like dewdrops on rose petals; papules --> vesicles --> pustules --> crusts --> slightly depressed scars
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