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2193 Pediatrics Infectious Diseases

in Children: Grp A Strep Pharyngitis should always be Confirmed by Rapid Ag Testing; if -ve
then do Throat Culture
-Rx w Penicillin & Amoxicillin
-Abrupt onset of Sore Throat, Fever, dec Oral Intake, Malaise; Tonsilar Erythema, Exudates,
Tender Ant Cervical L Nodes
-if they have Conjunctivitis, Rhinorrhea, Cough then it's Viral= dont do Strep Test
ASO peaks 1mo later; not helpful in Dx
Adults: w Centor Criteria can receive Antibiotics w/o Culture

2236 Medicine Infectious Diseases


if mucopueulent discharge but no bacteria seen on culture or gram stain and patient is sexually
active then it's Chlamydia; Culture -ve Urethritis
Dx Nuc Acid Amplification
Rx: Azithro or Doxy
Niesseria is visible on Gram Stain
Pyuria = WBC >10
Cystitis = Suprapubic Discomfort; has Pyuria but no Discharge
PyeloNephritis = CostoVert Tenderness

2239 Medicine Infectious Diseases


Epididymitis is due to Sexually Transmitted is in young Adults Age <35 by Neisseria and
Chlamydia causes Urethritis
Non STD Epididymitis is in older men is due to Bladder OutLet Obstruction and is by
E coli or Pseudomonas

2262 Medicine Infectious Diseases


INH binds B6 and causes its Excretion; B6 is needed for NeuroTransmitters; its Deficiency causes
Neuropathy= Numbness, Tingling in Stocking Glove Distribution
-inc Risk of Neuropathy in Pregnancy and DM
-Isoniazid: give 10mg Pyridoxine to prevent and 100mg Pyridoxine to treat Neuropathy

2264 Medicine Infectious Diseases


ToxoPlasma= Remains Dormant; Reactivated in AIDs
Toxoplasma Encephalitis = Headache, Confusion, Focal Signs = CN7 Palsy, Seizures
Multiple Rings near Basal Ganglia
SulfaDiaZine & Pyrimethamine + Leucovorin
Prevent w TMP-SMX
Patients not on anti HIV treatment should wait 2 weeks w Toxoplasma Treatment then start HIV

NeuroCystiCercosis= Mixture of Enhancing, NonEnhancing, Calcified Lesions


Treat MAC (GI & Pulm Infections) w ClarithroMycin & Ethambutol

2265 Medicine Infectious Diseases


Dx Primary syphilis w Florescent Treponemal Antibody Absorption FTA Abs
Dx Secondary is w RPR and VDRL = dec after treatment
Behcet Syndrome = recurrent Oral ulcers multiple painful Genital ulcers
-Dx w Pathergy Test; insert needle into skin --> papule

2267 Medicine Infectious Diseases


Strep Pneumonia: Fever, Pleuritic Pain, Dyspnea, Productive Cough, Lobar Infiltrate
Aspergilosis: Triad= Fever, Pleuritic Pain, Hemoptysis; Pulm Nodules
Mycoplasma occurs over days or weeks w Headache, Malaise, Dry Cough, Low Fever

2268 Medicine Infectious Diseases


MAC= nonspecific symptoms = Fever, Cough, Abd Pain, Diarrhea, Night Sweats, Wt Loss
+ SplenoMegaly & inc ALP = Disseminated MAC
BCG is a live Vaccine; avoid in AIDs

2269 Medicine Infectious Diseases


Diarrhea in AIDS = Cryptosporidium, MAC, Microspodida, Giardia, IsoSpora
Examine stool for culture, ova, parasitess, C Diff Antigen, Acid Fast Stain for Cryptosporidium
if Collitis = Bloody then Colonoscopy w biopsy to find the cause or also when stool study is
negative
if Diarrhea is Infectious= Bloody then antiDiarrheals cause organisms or toxins to remain in
intestine causing toxic megacolon

2270 Medicine Infectious Diseases


CMV less Frequently has Pharyngitis, L nodes or Megaly than EBV; heterophile Antibody is also
-ve
Absolute Lymphocytosis: inc Lymphocytes than neuts
Fatigue, Fever; Atypical Vacuolated Lymphocytes
+ve CMV IgM serology; resolves on its own

2273 Medicine Infectious Diseases


PCP = Diffuse Bilateral Interstitial Infiltrates
Oral Thrush= HIV w Pneumonia = PCP
HIV PCP develops in few weeks
Give Steroids w TMP/SMX in severe PCP because Lysed bacteria can cause inflammation and
worsen the condition
Community Pneumonia is treated w CefTri and Azithro
Hospital Pneumonia is treated w Vancomycin and Piperacillin-Tazobactam
2274 Medicine Infectious Diseases
Candida Esophagitis = white oral thrush w OdynoPhagia MCC Esophagitis in HIV
Empiric Fluconazole for 5 days if not resolved then do Endoscopy w biopsy
-HSV and CMV are less common; not Treated Empirically

Pill Induced Esophagitis= K supplements; TetraCyclines; BisPhosphonates


2277 Medicine Infectious Diseases
PMN = Focal Neuro Signs like Aphasia, hyperReflexia, HyperTonia, Babinski, ParaLysis
+ Hypodense Non Enhancing Lesions w no mass effect on MRI = deMyelination
-JC Virus Lyses OligoDendrocytes
-Defects in speech, vision and gait
-Dx w PCR of CSF after LP
Toxoplasmosis is Ring Enhancing(opposite) Mass lesion; Multiple;
Enhancement means Edema
Primary CNS Lymphonma = single; EBV
HIV Dementia MRI= Cerebral Atrophy

2292 Medicine Infectious Diseases


Aspiration Pneumonia: inc Risk w Poor Dentition= means more Bacteria; NG & ET Tubes, GERD,
LOC
Rx= Anerobic Coverage = Metro+Amox or Amox+Clavilunate or Clindamycin
-Anerobes produce Beta Lactamase
-Cipro covers Gram -ve

2295 Medicine Infectious Diseases


Substance Abuse=> Risk of TB
Cough more in Morning due to Pooled secretions

2296 Medicine Infectious Diseases


Mycoplasma Interstitial Pneumonia --> Non Exudative Pharyngitis, Dry Cough, Macular Rash;
Hemolytic Anemia due to Cold Agglutinins; Rx w Azithro
Strep Pneumonia is Abrupt, Mycoplasma is slow;
Strep has Productive Cough, not Dry and Lobar Infiltrate not Interstitial
Ebv --> Exudative pharyngitis, L notes, Megaly
Legionella: High Fever, GI Vomiting Diarrhea, Systemic= Headache, Confusion,
Pulmonary Cough Dyspnea after days

2304 Medicine Infectious Diseases


PCP = bilateral Diffuse Interstitial Infiltrates on Xray
Ground Glass opacities on CT
Pts on ImmunoSuppressive Medication after Solid Organ Transplant have Acute Resp Failure;
HIV Pts have Slower Course

2424 Pediatrics Infectious Diseases


Croup= SubGlottic Edema & Narrowing=> Barky cough w Insp Stridor
-Rx w Steroids, Nebulized Epi to dec Resp Obstruction; Constricts Mucosal Arterioles & dec
Secretions
-Avoid IV Line Placement= Painful=> Agitation=> Worsen Airway Obstruction
-AMS or Poor Resp Effort= Resp Failure=> Intubate
Albuterol=> Lower Resp Tract ie Bronchial Dilation; not SubGlotis

2428 Pediatrics Infectious Diseases


Neonatal Sepsis= Fever or HyPOThermia; Lethargy= dec Activity, Poor Feeding, dec Alertness
-Culture Blood, Urine & CSF First then Rx w EmpiriC Antibiotics= Gentamicin or Ampicillin &
Cefotaxime
-if Septic Shock or Status Epi then give A/Biotics ASAP w/o Cultures
it is Difficult to Differentiate Sepsis vs Meningitis in Neonates; they dont have Neck Rigiidty,
Kernig or Brudzinski Signs
-Neonate Meningitis= Irritable, Lethargic, HypoTonic; Dx w LP
Neonates do not Herniate after LP as their Open Fontanelles Relieve ICP; Head CT is not
required before LP
Galactosemia= Jaundice

2431 Pediatrics Infectious Diseases


boy had no vaccinations
Measles: Cough, Coryza, Conj, Blue Koplik; Red Brown Rash after Day 3-> spreads from Head
to Body; Coalesces & Darkens to Brown Color; goes away after 1wk
-Resp Secretions can remain AirBorne for Hours even after the Affected Person has Left the
Waiting Room or Day Care
Rubella= German or 3 Day Measles= Shorter & Milder; Rash doesn't Darken like Measles does
Roseaola Rash after Fever Goes Away
Rocky Mountain: Rash starts @ Extremities & Spreads Centripetally

2447 Pediatrics Infectious Diseases


Septic Arthritis= inc ESR, refuse to bear wt
-Pathogens= S Aureus, GAS, S Pneumo
-often preceeded by Skin or URInfections
-can lead to permanent joint destruction
-if it fails to improve after A/Biotic & Arthrocentesis-> do MRI & BoneScan to check
for Concomitant OM

2616 Medicine Infectious Diseases


Febrile Neutropenia: obtain Blood Cultures then start Broad Spectrum Antibiotics ASAP
-Anti Pseudomonal agents are used CeFepime, Meropenem, Pipera-Tazo to prevent
Progression to Sepsis they also provide Gram +ve & -ve coverage
Neutropenia <1500; Severe <500
His wbc were 690 w 20% Neuts= Neutropenia
PseudoMonas is MCC
Vancomycin has no gram -ve coverage

2749 Surgery Infectious Diseases


Necrotizing Fascitis= S Pyogenes; Rapid Spread; Bullae; Swelling, Redness; CT shows Gas in
Deep Tissues, Crepitus, Tissue Necrosis, Purulent Drainage + Systemic Signs= Hypotn
-Resect Necrotic Tissue
Cellulitis is less severe; only Tenderness, Swelling & Warmth; no Necrosis, Crepitus or Systemic
Signs
Toxic Shock Synd= Diffuse Rash, Hypotn, Multi Organ DysFn
ThromboPhlebitis= Cord like Vein
PyoMyositis= Muscle Abscess, Fever, Swelling, Limited to one Muscle, doesnt Spread Rapidly

2768 Pediatrics Infectious Diseases


Primary Varicella= 2wk Incubation after Exposure then Fever, Malaise then Rash in 24hrs=
Intensely Pruritic & Vesicular
Varicella Zoster=> Chicken Pox=> Virus lies Dormant in Sensory Ganglia= Latent Infection=>
Reactivation in ImmSuppression or Old Age=> Pain for 2days then Dermatomal Vesicles
Poison Ivy= Linear Vesicles after Brushing w the Plant; Pruritic

Coxsackie Hand Foot vesicles are Painless


Rubella & Measles= MaculoPapular

2781 Pediatrics Infectious Diseases


Impetigo starts w Papules=> become Painful Pustules=> Rupture into Honey Colored Crusts;
No Fever
-MCC= S Aureus & S Pyogenes
HSV is limited to OroLabial Region
Eczema Herpeticum= Severe Eczema which gets Infected w HSV; has Fever
ErySipelas= Red Patch=> Indurated, Shiny Plaque w Raised Demarcated Margin; Fever &
Shaking Chills
Hand Foot Mouth Disease= Post OroPharynx
Chicken Pox= Vesicular Rash=> Ruptures to leave Scabs

2782 Pediatrics Infectious Diseases


Passive Immunization Post Exposure is for Varicella & Rabies
Droplet Precautions= Surgical Mask prevents Influenza, RSV
-Droplets are Large, Short Ranged
Small Airborne Particles= Measles, Varicella, TB not blocked by Surgical Masks; use N95 Mask,
Negative P Rooms
-Measles starts 3wks after Inhalation
Contact Precautions= Gown, Gloves prevent Spread by Contact= MRSA, Rota
Hand Hygiene prevents Fecal Oral= C Dif

2845 Medicine Infectious Diseases


Epiglotitis: High Fever >102; severe sore throat w odynophagia and drooling, Airway
obstruction= Stridor; Muffled Voice; Hoarseness
=Rapidly Progressing Cellulitis w SupraGlottic Edema
MCC is Strep Pyogenes and H Influenza
Rx w CefTriAxone + VancoMycin
RetroPhar Abscess; Ludwig Angina & EpiGlititis all have Muffled= Hot Potato Voice
2869 Medicine Infectious Diseases
Inf Mononucleosis: HeteroPhile Abs may be -ve early in the disease; Repeat after 1wk
Atypical Lymphocytes w Large Vacuolated Cytoplasm; Convoluted nuclei
-ve MonoSpot test does not exclude IM
-Extreme Fatigue; Splenic Rupture
HL= normal blood smear; RS cells on L Node Biopsy; Months of B Symptoms

2905 Medicine Infectious Diseases


Hep A: Aversion to Smoking
-Prodromal= N,V, Abd Pain, Icteric =Pruritis & Jaundice; Convalescent Phases; Resolves in 6wks;
Tender Magaly
-AST and ALT inc first then ALP and Bili
-Acute HBV & HCV are Asymptomatic
-2% HBV Adults --> Chronic Hep; 90% Infants=> Chronic Hepatitis
-80% HCV Adult --> Chronic
2906 Pediatrics Infectious Diseases
Infants of HBV Mothers should be Passively Immunized @ Birth w HBIG & Active
Immunization w Recombinant Vaccine
if HBeAg -ve then Risk of Transmission is 20%; if +ve then Risk= 95%
90% of HBV in Newborns progress to Chronic Hepatitis; 10% in Adults
Acute Schistosoma= Katayama Fever= Urticaria, AngioEdema, Eosinophilia, Dry Cough

2916 Medicine Infectious Diseases


Test all pregnant women for HIV
Transfusion before 1992= test for HCV

2927 Medicine Infectious Diseases


Post Exposure Prophylaxis after known needle stick injury: Hep B Ig and Vaccine
Within 12hrs; if previously vaccinated then do nothing
diagram

2961 Medicine Infectious Diseases


Treat HBV: if HBV DNA >20000, ALT 2x normal to prevent cirrhosis or cancer; HBeAg +ve or
patients with Cirrhosis or Liver Failure
Pts w Normal ALT do not Respond to Rx
Entecavir***: used in HBV Decompensated Cirrhosis; less resistance
Tenofovir***: Most potent for HBV; less resistance
Interferon: short term treatment in compensated liver failure
Lamivudine: not used; HBV is resistant to this; its used in HIV
HBC Rx = Peg IFN + Ribavarine

2968 Medicine Infectious Diseases


Entameba: Colitis (Bloody Diarrhea) + ExtraIntestinal = Liver (Megaly, Cyst= Abscess, RUQ
Pain), [Pleura (dec Breath Sounds), Brain (Headache)]]= Rare
-EntAmeba Liver Abscess= Fever, RUQ Pain, inc Liver Enzymes, Recent Diarrhea; SubCapsular
Cyst on Imaging
Dx w Entemeba Serology
Rx w Metro or ParomoMycin
EchinoCoccus Hydatid Cyst= no Fever; no Diarrhea; only RUQ Pain or Asymptomatic

2970 Medicine Infectious Diseases


Hydatid Cysts = Echinococcus; Egg Shell Calcification on CT; can occur in Lung, Liver, Bone;
Transmitted by Dogs
Pt has no Fever but Large Cyst can cause Abd Tenderness
Rx= Surgical Resection w Albendazole; Cyst Spillage causes Anaphylaxis

Cysticercosis goes to Brain or Muscle

2981 Medicine Infectious Diseases


with INH if Hepatitis develops then stop it immediately; switch to 2nd Lind Drugs
-occurs in pts w Existing Liver Disease or Daily Alcohol Intake
if minor elevations in Aminotransferases <100 then follow up and Monitor LFTs
Steroids are given in Miliary TB

2993 Medicine Infectious Diseases


Mucormycosis=Rhino-Orbital-Cerebral Disease Dx = Sinus Endoscopy w Tissue Sampling
-in DKA or Leukemia or Transplant
pt had double vision; Purulent Nasal Discharge; Sinus Pain; Necrosis
-Liposomal Amphoterecin B; 60% pts die
Clostridium Septicum --> Gas Gangrene w Fever, severe Muscle Pain, Bullous skin lesions in
Extremities
ActinoMyces= Painless Slow Growing Mass
Sinus= Aerobic Place; Anerobes dont cause Infections there
2994 Surgical Debridement is required in MucorMycosis

2995 Medicine Infectious Diseases


Histo resembles Sarcoidosis but deteriorates w immunosuppressive therapy
Hilar L Nodes, Erythema Nodosum; Caseating Granuloma more common, can be non
caseating; Megaly; PanCytopenia
Urine Antigen Testing
Mississipi, Ohio
Blastomyses, blasts bones; Disseminated= Lytic Bone Lesions, Prostate; Skin
Coccidioides is seen in SW USA; Histo is in Middle, Blasto is in East
Aspergilosis= occurs in NeutroPenia

2998 Medicine Infectious Diseases


CoccidiodoMycosis: Arizona or California: Community Acquired Pneumonia= Fever, Chest Pain,
Cough, Lobar InFiltrate; Arthralgias,
Erythema Nodosum & MultiForme; Incubation Period 14 days
Dissemination to Bones, CNS, Skin in Diabetics, HIV
Rx Keto or Fluconazole
BlastoMyces: Incubation= 6wks; Pneumonia + Skin Lesions
Chlamydia Psitaci: abrupt fever, dry cough headache
Legionella: Pneumonia= Dyspnea, Cough; GI= N,V,D; High Fever >102
Nocardia= always in Imm Comp; taking Steroids

2999 Medicine Infectious Diseases


BlastoMycosis: Wisconsin; Ohio, Mississippi, Great Lakes
-Pneumonia, Wartlike Lesions & Ulcers on Skin, OsteoMyelitis, Prostatitis, Meningitis
-Culture Blood, Sputum; Antigen in Urine
Histoplasma: Mississippi and Ohio; Papules in Skin
CoccidioidoMycosis: in California; Erythema Nodosum, Multiforme

3000 Medicine Infectious Diseases


Sporothrix: decaying plant matter and soil; Lanscapers and Gardeners
a Papule forms which Ulcerates and drains non Purulent Odorless fluid
additional Papular Lesions develop along Lymphatics; L Nodes are Spared
-treat w Itraconazole for several Months
Cat Scratch: Prominent Tender Lymph Nodes; Skin Lesions and systemic spread
Filariasis: causes Lymphangitis and Edema

3002 Medicine Infectious Diseases


Rabies Prophylaxis start immediately if animal is symptomatic or unavailable
if Animal is available then observe for 10 days
incubation period of rabies is 1-3 months and animals become symptomatic within 5-10 Days
so we can afford to observe them
Start Prophylaxis after Exposure to Bats; ay not notice bites
Rabies= Encephalitis=> Coma

3003 Medicine Infectious Diseases


Viral Encephalitis: Altered Mental Status; Seizures; Coma
-Focal Neuro: Hemiparesis, Cranial Nerve Palsies; inc DTReflexes
Dx: Viral DNA in CSF
Rx: IV Acyclovir
Encephalitis does not have photophobia, nuchal rigidity
Delirium Tremens: Treat w Chlordiazepoxide; Teremulousness, Anxiety, Headhache,
Palpitations
Meningitis Rx= Ceftriax + VancoMycin + Ampicilin in pts >50yrs old
3005 Pediatrics Infectious Diseases
S Aureus= mcc of OsteoMyelitis in Children; GBS & E Coli in Infants; S Pyogenes in Children
S Epidermidis OsteoMyelitis in pts w Prosthetic Devices
Gram -ve Rods cause OM in pts w UTI or UT Instrumentation

3007 Medicine Infectious Diseases


Significant Fatigue and low Energy; Exhaustion in MonoNucleosis
-also Fever, L Nodes, Pharyngitis w Exudates
-Check SplenoMegaly w Ultrasound; Palpation is not Sensitive
-Avoid Sports atleast 3 weeks to prevent splenic rupture
-Viral so we dont give AntiBiotics

3009 Pediatrics Infectious Diseases


Mumps=> Meningitis, Parotitis, Orchitis in Post Pubertal Males
Measles, Varicella=> maybe complicated by Pneumonia
Otitis Media=> CN7 Palsy & Mastoiditis
Rubella= Fever, Arthritis, MaculoPapular Rash

3011 Medicine Infectious Diseases


bite wounds = polymicrobial; do blood cultures; Debridement; Tetanus Toxoid
Amoxi- Clav for Gram +ve, Gram -ve and beta Lactamase producing Anerobes
Cipro is for Gram -ve and some Gram +ve but not Strep; Used for GI & UTI
ClindaMycin is for Gram +ve and Anerobes but not for Gram -ve
Erythromycin: for Atypicals

3012 Medicine Infectious Diseases


Infective Endocarditis: a minimum of 3 blood cultures from different venipuncture sites B4
Starting A/Biotics; then do Echocardiogram= to see Vegetation, PeriValvular Abscess
GlomeruloNephritis/ Hematuria= Immune Mediated; Splinter Hemorrhages, Roth Spots=
Embolic?
Pt had a Root Canal a Month Ago

3013 Medicine Infectious Diseases


Needle Marks on Arm then Fever Chills = Infective Endocarditis.
Holosystolic Murmur increases w Inspiration = Tricuspid Regurg
Fewer Embolic Phenomenon in Right Sided
Heart Failure occurs in Aortic Valve IE
If Valves are Native then we Treat w Vancomysin for MRSA & MSSA
Ampicillin-Sulbactam for HACEK and Enterococcus

3014 Medicine Infectious Diseases


S Aureus = Hospital acquired IE see table
Strep = Community acquired IE
Viridans: Gingival Perforation and Respiratory Tract Biopsy/Incision
-Sanguinis, Sobrinus, Milleri, Mitis, Mutans
Strep Bovis: Colon Cancer or IBD
3037 Medicine Infectious Diseases
Blasto = Blasts Bones and Skin + Pulmonary
Skin: Ulcerated; Verrucous, Crusted lesions
Bone Lytic Lesions; Wt Loss, Night Sweats
give Itraconazole or Amphoterecin
near great lakes, Mississippi, Ohio, Wisconsin** has highest rate
Coccidioidomycosis also affects Meninges; cough, night sweats; SW USA
Sarcoidosis also has Erythema Nodosum

3054 Medicine Infectious Diseases


Legionella: High Fever w Relative Brady; inc Liver Enzymes
-Headache, Confusion, Ataxia, Diarrhea; Cough comes Later
-Low Sodium; Ag in Urine; many Neuts but few organisms = Intracellular
-water supplies, cruise ships, hotels
-Rx: Quinolones or Macrolides
Amoxicillin used for Sinus or Ear Infections

3068 Medicine Infectious Diseases


Enterococcus Endocarditis after Cystoscopy or UTI; pt had PyeloNephritis, Persistent DysUria=>
CystoScopy=> Bacteremia --> Rh Affected Diseased Valves Endocarditis
Look for a history of Rheumatic Fever = Risk Factor for IE

3077 Pediatrics Infectious Diseases


Vit A reduces Morbidity in Severe Measles in Hospitalized pts= promotes Ab Producing Cells &
ReGen of Epithelial Cells in Gut, Lungs, Retina
-Prodrome of Cough, Conj, Coryza then MorbilliForm Rash lasts <1wk
-Complications= Pneumonia, Encephalitits, Blindness occur in Imm Comp ppl

Vit E Def=> HemoLytic Anemia + Neuro Defects eg Ataxia


B6 Def=> Neuro= Confusion, Irritability + Mucus Memb= Stomatitis, Cheilosis

3103 Medicine Infectious Diseases


Treat Odynophagia + Thrush w Empiric Fluconazole
if persist after 2 weeks then biopsy
-Herpes = small Round ulcers= Deep
-CMV = Large Linear ulcers= Shallow
if No Thrush or severe disease then do Biopsy right away b4 treating
Recurrent Aphthous Ulcers: Rx= Prednisone

3104 Medicine Infectious Diseases


Babesia: Flu like symptoms eg Fever, Chills, Malaise + IV Hemolysis (Dark Urine; LDH; Jaundice;
inc Indirect Bili) and Thrombocytopenia
Severe Disease in Imm Comp; Age >50; Asplenics
Dx: Blood Smear --> Maltese Cross
inc Bili, LFTs, LDH
Rx: Atovaquone + AzithroMycin or [Quinine + ClindaMycin] if Severe
Dengue= Headache, Fever + Severe Myalgia= BreakBone Fever; dec WBC & Platelets
Rocky Mountain= Fever Headache, Myalgias + Rash**

3105 Medicine Infectious Diseases


Solid Organ Transplant --> give PCP and CMV Prophylaxis w TMP-SMX and Acyclovir
give Pneumococcus and Hep B Vaccines before Transplant

3107 Medicine Infectious Diseases


Bacillary Angiomatosis: Friable Nodules w Fever and Malaise
Rx Oral Erythromycin
Kaposi= Nodule; Color changes from Pink to Violet

3131 Medicine Infectious Diseases


Infectious MonoNucleosis: sore throat w Exudates, fever, malaise, Megaly--> Traumatic
Rupture, L Nodes (Post Cervical, Inguinal, Axillary); Large Tonsils
--> Block airway
--> Autoimmune HemoLytic Anemia and Thrombocytopenia=> inc Bili & Reticulocytes
Ig M Cold Agglutinins
Diphtheria --> Dilated CardioMyopathy; pseudomembrane
Malaria=> Megaly

3172 Medicine Infectious Diseases


Parvo Virus = Symmetric Arthritis; Fever, Fatigue, Diarrhea
-Freq Contact w Children= Teachers, Daycare Workers
Dx= antiParvo IgM antibodies; NAAT
ParvoVirus = no joint destruction or swelling; Stiffness <15 mins; acute onset in Days
Other Viral Arthritis = Hep B & C, HIV, Rubella
Rh Arthritis = Stiffness >1hr; swelling; same Location as Parvo
Cryoglobinemia= Palpable Purpura; Arthralgia; NephroPathy; NeuroPathy; L Nodes

3243 Medicine Infectious Diseases


Lyme Early Localized: headache, lethargy myalgia; EM Rash is not Itchy or Painful
give Doxycycline=> Teeth Discoloration in Children
give Amoxicillin in Preg women and children <8 yrs
Early Disseminated: AV Block, Cranial N, Arthralgias, Conjunctivitis, L nodes
Late Disseminated: Arthritis, Encephalomyelitis and periph neuropathy
give IV Ceftriaxone for Disseminated; also perform Serology for Ig

3245 Medicine Infectious Diseases


Bacterial Meningitis in Immm Comp: Empirc Rx= Ampicillin (for Listeria) + Cefepime
(PseudpMonas, Strep Pneumo, Neisseria, Group B Strep, H Influenza) + Vanco (for Cef
Resistant PneumoCocci)
-Start DexaMethaSone but stop if its not Strep Pneumo =dec Risk of Deafness & Focal Defs
Cefepime is given to Imm Compromised; CefTriAxe given to Imm Competent
if Hemophilus or Neisseria then only CefTriaxone alone is enough
Risk Factors for IntraCranial Mass: AMS, Seizures, Papilledema, Focal Signs then do CT First

3246 Medicine Infectious Diseases


if PPD is +ve but no symptoms and normal chest xray it is Latent TB
Rx= give Isoniazid and Pyridoxine= B6 for 9 months
-33% ppl in World have Latent TB; inc Risk of Activation in HIV; they should undergo PPD
Testing and get Rx if +ve
CD4 <200 gives False -ve PPD; Repeat after CD4 Levels increase
Active TB= +ve PPD + X Ray Findings

3247 Medicine Infectious Diseases


Ehrlichiosis: Amblyoma Tick bite, Flue like; Fever, Confusion; Leukopenia, Thrombocytopenia;
inc ALT AST, LDH; Rash is not common= Rocky Mountain Spotted Fever w/o the Spots
-intracytoplasmic Morulae in Monocytes
-High Fever, Neck Stiffness, Confusion; Clonus
-Doxycycline
Rocky Mountain Spotted Fever has Same Symptoms but has Rash
Rx= Doxy or Chloramphenicol
Lyme Disease: give Doxycycline for initial Lyme; or Amoxi if Preg
Ceftriaxone for Cardiac and Neuro

3248 Medicine Infectious Diseases


EHEC = MCC Bloody Diarrhea w/o Fever; can be Initially Watery; Exposure to Beef
Dx w Shiga Toxin Assay on Stool
Avoid Antibiotics --> HUS
Give Supportive Treatment
C Diff is not bloody

3249 Medicine Infectious Diseases


CryptoSporidium = Traveller's Diarrhea; resolves in 10days
Persistent nonbloody, watery diarrhea for >2 weeks in AIDs

Chronic Diarrhea = Giardia and CystoIsoSpora, MicroSporidia


Strongyloides = Skin + GI (N,V not D) + Pulmonary

3251 Medicine Infectious Diseases


Post Exposure Prophylaxis of HIV is w 3 drugs immediately for 4 weeks
Tenofovir + Emtricitabine = NRTI + Raltegravir
Blood or Semen or Any ssecretion w visible BLOOD or contact w non intact skin
Test for HIV @ once then 6 wks, 3 months, 6 months

3252 Medicine Infectious Diseases


besides prophylaxis from Step 1 for AIDs
Histoplasma Proph is also given in Ohio or Mississippi w ItraConaZole
give Pneumococcal Vaccine
Secondary Prophylaxis prevents Recurrences

3253 Medicine Infectious Diseases


Kaposi sarcoma= Papules/ Macules. Raise CD4 count >200 to regress
Bacillary Angiomatosis Friable Papules**; has Fever and other Systemic Symptoms?
Confirm w Biopsy

3254 Medicine Infectious Diseases


Cryptococcus: Induction Therapy = Amphoterecin B + FluCytosine 2 weeks
Maintenance Therapy = FluconAzole 1 yr
-Serial Lumbar Punctures to dec ICP=> dec Mortality
-Defer AntiRetroviral therapy for 2-8 weeks after Antifungals are started
(Immune Reconstitution Syndrome)
SulfaDiazine + PyriMethamine is given for ToxoPlasma

3256 Medicine Infectious Diseases


Patient w Syphilis: give IM Benzathine Penicillin
-if allergic then give Doxycycline for 2 weeks; inc Risk of Rx Failure
do RPR before treatment and after 6 months; if decreased 4 times then treatment is succesful
-Desensitize to Penicillin in Pregnancy; CNS eg Ocular or NeuroSyphilis or Multiple Treatment
Failures
-Penicillin is most effective and safest in pregnancy

3257 Medicine Infectious Diseases


For Early Lyme Disease: Give Amoxicillin to Pregnant, Lactating Patients or less than 8yrs old
instead of Doxy

3259 Medicine Infectious Diseases


ChemoProphylaxis for Malairia = Mefloquine, AtrovaQuone-Proguanil and Doxycycline
Start 2wks B4 Travel, Continue during the Stay until 4wks after Returning
India has both Vivax & Falciparum
Primaquine is used where Falciparum is not present; Korea. G6PD; Hypnozoites

3261 Medicine Infectious Diseases


Ramsay Hunt Synd: Herpes Zoster Oticus = triad of CN7 Paralysis, Ear Pain and Vesicles in
Auditory Canal and External Auricle
Lyme Effect in Heart=> AV Block is mcc=> Dyspnea, Chest Pain, LightHeaded; Syncope
3262 Medicine Infectious Di seases
Pt had Kidney Stone and Urine pH was Alkaline= 8.2; its a Urease Producing Organism=
Proteus= Mg-NH4-PO4 Struvide Stones
-PeriNephric Fat Stranding on Imagine= PyeloNephritis

3263 Medicine Infectious Diseases


Erysipelas = superficial skin infection: Acute onset= 1 Day of Fever, Chills, Regional L Nodes,
warm tender Erythematous Rash w Raised Demarcated Borders
-MCC is S Pyogenes
Rx: IV Ceftriaxone, Cefazolin or oral Amoxicillin
External Ear has no lower Dermis so Cellulitis is not possible
Cellulitis= Deep Dermis & Adipose; Flat Edges, Poor Demarcation, Slow Onset= over Days;
Localized= no Fever Initially
Perfringens= bullas, Crepitus

3264 Medicine Infectious Diseases


Bacillus Cereus: after eating Rice; preformed toxin; Nausea and Vomiting
S Aureus after Dairy, Salad, Mayonese, Meat, Eggs
Ingestion of Bacteria=> Diarrhea
C Diff=> Diarrhea

3266 Pediatrics Infectious Diseases


Rubella= BlanchingMaculoPapular Rash w Cephalo Caudal Spread in 24hrs; Post Auricular &
Sub Occipital L Nodes
-Arthralgia persists a month after Rash
Measles= Cervical L Nodes; Fever >104; Rash Spreads in Days; no Arthritis
Varicella= ChickenPox, Vesicular Rash, Crusts after few days; Crops in Several Stages
Rocky Mountain= Macular Rash
Gonococcal= VesiculoPustular Rash

3267 Medicine Infectious Diseases


Trichinellosis: from Undercooked Meat, Pork
Intestinal Stage: Abdominal Pain, N,V,D
Larva Migrate to Muscles: Pain, Tenderness, Swelling, Weakness; inc Creat kinase
-Splinter Hemorrhages, Orbital Edema; Eosinophilia >20% is Hallmark of Disease;
Chemosis = Red Eyes, Retinal and Conj Hemorrhages
**Triad of Periorbital Edema, Myositis, Eosinophilia
Dengue has no Eosinophilia; has RetroOrbital Pain, Myalgia, Arthralgia; Nose & Skin Bleeds
Typhoid Fever= 1st wk Fever, 2nd wk Rash & Abd Pain, 3rd wk Megaly, Intestine Perforation
Ascariasis= Dry Cough, Intestinal Obstruction

3286 Pediatrics Infectious Diseases


Acute Bacterial Rhinosinusitis: 30% by Strep Pneumo; 30% by H Inf; 10% by Moraxella
-Rx w Amoxci-Clav
-Pts w Asthma may have Exacerbations= Wheezing triggered by the URI
-Fungal Pathogens in DM or HIV=> Epistaxis, Turbinate Destruction, Palatal Eschars, Maxillary
Cyanosis
Chronic Sinusitis >12wks= S Aureus
Acute >10days

3288 Pediatrics Infectious Diseases


Coup= Rhinorrhea Fever First; then Hoarseness, Insp Stridor; Barky Cough Later means Gradual
Onset
-AP X Ray shows SubGlottic Edema= Steeple Sign; Rx= DexaMethaSone, Epi
RSV=> Bronchiolitis= Lower Resp Tract= Wheezing
RetroPh Abscess= Limited rotation of Neck; Age <4
LaryngoMalacia= collapse of SupraGlottic Structures during Insp; Worse in Supine

3320 Medicine Infectious Diseases


Disseminated Gonococcal Infection = High Fever, chills; Purulent MonoArthritis or
**Triad of Tenosynovitis + Dermatitis= Pustular Lesions on Trunk and Limbs + Migratory
Asymmetric PolyArthralgia eg Wrist, Ankles, Fingers
**Screen for Syphilis and HIV
Dx: Blood cultures are usually -ve so do Naat of Genital Tract eg Vaginal or Rectal Swab
Rx: IV Ceftriaxone for 2 weeks then Oral Cefixime
-Azithromycin or Doxycycline for 7 days for Chlamydia
Syphilis= MaculoPapular Rash + L Nodes
TSS= Erythematous Rash including Palms & Soles

3325 Medicine Infectious Diseases


Tetanus Prophylaxis: Give Tetanus Toxoid Vaccine only if its a clean or minor wound; and pt
was vaccinate >5yrs ago
Also give Tetanus IG if Dirty Severe wound = Burn or Crush; and Person is unimmunized
Or Active Tetanus
-Children are immunized at 2,4,6, 18 months; 6yrs
Tetanus Spasm can last 4-6 weeks

3326 Pediatrics Infectious Diseases


Orbital Cellulitis= Pain w Eye Movement, dec Vision, OphthalmoPlegia; no Headache**
-Proptosis, Lid Edema; Dx w CT
-Complications= Orbital Abscess, IntraCranial Infection
PreSeptal= Mild, Ant to Orbital Septum
Cavernous Thrombosis: **Headache= mcc early Symptom, Eye Edema, Proptosis, PapillEdema,
Dilated Retinal Veins; Chemosis= Swollen Conjunctiva
-starts UniLat but involves the other Eye in 2days
Ant Uveitis= Corneal Ppt, Pupil Signs; Eye Pain, Blurry Vision
Optic Neuritis= DeMyelination=> UniLat Vision Loss & Pupillary Defects
Conjunctivitis= no Pain w Movement, no Vision Loss

3422 Medicine Infectious Diseases


Shingles following Stressful Situations like Surgery, Old Age, Immune Suppression w Drugs or
AIDs; Cell Mediated Immunity
-Prodrome of Itching, Tingling, Burning
-Rash: Vesicles=> Ulcers & Crusting; 10 Days
-PostHerpetic Neuralgia= Pain Persisting >4mo After Rash Onset
Valacyclovir if Given within 3 Days: Reduces Duration of Rash And Pain; we can add TCA

3423 Pediatrics Infectious Diseases


Febrile Paroxysms= Periodic/ Cyclic Fever= waves of RBC Invasion when Parasites are
Released from Liver into Blood in Malaria
-Young Children= inc Risk of Cerebral Malaria= Seizures, Delirium, Coma
-Past History of Malarial Infection=> lower Risk of Severe Disease
-Giemsa Stain= Thick & Thin Films
Traveler's Diarrhea= E Coli, CampyloBacter, Shigella, Salmonella; Rx w CiproFloxacin; Resolves
in 5days
Bacterial Meningitis=> precipitous Neuro Decline within Hours of OnSet

3425 Medicine Infectious Diseases


Leprosy: Nerves around the Lesion become Nodular, Thick and Tender then Segmental
Demyelination --> Loss of Sensation and Motor f'n
>1 Anesthetic, HypoPigmented Macular Lesions w Raised Borders
Full Thickness Biopsy from Active Regions

Lyme can also cause Motor or Sensory Neuropathy but Not Nodular Tender Nerves
Syphilis Gummas= Soft Ulcerative Masses w Necrotic Centers

3441 Pediatrics Infectious Diseases


Neisseria= mcc Meningitis=> Petechial Purpuric Rash** only seen w Neisseria
-high Mortality =15% even w Treatment; BrudZinski Sign
-10x more Risk in Children <2yrs
-Rx= CefTri + Vanco
Listeria Meningitis in NewBorns; no Rash,
-Adults= ingestion of Milk or Cheese from Infected Cows
Herpes=> Temporal Lobe Encephalitis= Seizures in Infants
CMV= Fever, Fatigue, Malaise, Megaly, Pharyngitis

3442 Pediatrics Infectious Diseases


WaterHouse Friderichsen= Sudden VasoMotor Collapse & Purpuric Skin Rash on Flanks due to
Adrenal Hemorrhage
-100% Mortality
ARDS=> requires Mech Vent

3443 Pediatrics Infectious Diseases


UnTreated Strep Pharyngitis=> Rh Fever= Sore Throat, Fever, PeriCarditis= ST Elevation,
Erythema Marginatum, Arthritis, Chorea= Rapid Irregular Jerks, Skin Nodules; inc ESR
-10 Day Oral Penicillin prevents RhFever
-Rh Fever pts should be Rx w Long Acting IM Benzathine Pen G until Adulthood to prevent
Worsening of Disease and ReInfection
Rx Chorea w Steroids; Rx Arthritis & PeriCarditis w NSAIDs
ParvoVirus= Arthritis, Myocarditis
HerpAngina= Vesicular Pharyngitis; CoxSackie; Myocarditis; High Fever

3444 Pediatrics Infectious Diseases


Infectious MonoNuc= Exudative Pharyngitis, MaculoPapular Rash after taking Amoxicillin or
Ampicilin; is not a Drug Allergy as pts can take these Drugs after or before IM and no Rash
Develops
Erythema Infectiosum= Slapped Cheeks
SJS= Erythema Multiforme Major= Necrosis & Lysis of Epidermis
Scarlet Fever: Rash occurs Early in course of Infection

3458 Pediatrics Infectious Diseases


Delayed Vaccination Schedule
Pertussis= Highly Contageous
3 Phases= Catarrhal= like common Cold= Rhinorrhea, Congestion, mild cough
-Paroxysmal= Severe Coughing Bouts can last upto 30mins; postTussive Emesis
-Whoop= forced Inspiration
-Worsens @ Night or w Laughing, Exercise, Exposure to Smoke or Steam= Shower
-Infants <6mo= Life threatening Apnea
-Convalescent= Resolves slowly
Rx: Macrolides dec Severity
Chlamydia, Mycoplasma= Mild Cough, Low Fever
RSV=> causes Bronchitis in Children <2yrs Old

3475 Medicine Infectious Diseases


Uncomplicated Pyelonephritis: Symptoms of Cystitis = Dysuria, freq, urgency, suprapubic pain,
hematuria
+Flank pain, N,V, Fever >38 or CV Tenderness
Get Urine Cultures & Rx w Eppiric A/Biotics= Quinolones; Do imaging if persistent symptoms
after 48-72 hours of treatment or history of nephrolithiasis or unusual urinary Findings like
gross hematuria or suspicion of obstruction
-also do Blood Culture if Hypotn because it could be Sepsis
Complications= Renal CorticoMedullary or Perinephric Abscess, Emphysematous Pyeloneph,
Papillary Necrosis --> Sepsis, Multi Organ Failure, Shock
3530 Medicine Infectious Diseases
Ludwig Angina: infection of SubMandibular and SubLingual Glands; source = 2nd or 3rd lower
Molar
is a rapidly progressive bilateral cellulitis; Fever Chills Mouth Pain; Muffled Voice from Edema
Dysphagia, Drooling, Odynophagia, Swelling, Crepitis due to Gas from Anerobes
Intubate as asphyxiation is common; remove tooth
Mumps affects Parotids
S Pyogens affects Tonsils

3561 Medicine Infectious Diseases


Actinomysis dx by FNA; Culture treat for 2-6 months w penicillin
-submandibular lesion after dental procedure, yellow sulfur like granules
-NonTender, Indurated Mass w Sinus Tracts

Nocardia while farming/ Gardening on feet, legs, back; treat w SMX-TMP

3571 Pediatrics Infectious Diseases


Sickle Cell=> MicroInfarctions in Bone=> inc Risk of OsteoMyelitis= Nidus for Infection
-Salmonella= 2/3 Cases of OM in SCD; S Aureus= 1/4 cases of OM in SCD
-Take Cultures & Rx Empirically w CephTriAxe + Oxacillin/ Vancomycin for Staph
High Risk of Strep Pneumo Sepsis in SCD before Age 5yrs

Neisseria=> MonoArticular Septic Arthritis in sexually active

3577 Pediatrics Infectious Diseases


Septic Arthritis= Acute Fever, Joint Pain, Turbid Synovial Fluid, 100k WBCs w >90% Neuts; inc
ESR
-obtain Blood + Synovial Fluid Cultures
-Emergent Surgical Drainage + IV VancoMycin to prevent Joint Destruction
-maybe caused by Hematogenous Spread from Cellulitis=> Bacteremic Showers=> Joints
Intra Articular Steroids not given in Septic Arthritis & OsteoNecrosis; given for Rh Arthritis
-pain is worse @ Night in ALL infiltration

3583 Medicine Infectious Diseases


Acute HIV Infection in First 6mo presents like Mononucleosis =Fever, Night Sweats, L Nodes,
Arthralgias, Diarrhea, Flatulence, Distention
-Mucocutaneous Ulcers, Prolonged Diarrhea (30%), Rash (50%), Headache, Dry Cough
Differential = Whipple, IBD (Diagnosis is more Invasive so test for HIV First as its Easiest), SLE
=Arthralgia, Ulcers but (no Diarrhea)
(50%)
3590 Medicine Infectious Diseases
CryptoSporidium = low fever, acid fast; CD4 <180 ; Horse Breeders
CMV: Freq Small Vol bloody Stools; CD4<50
MicroSpora: No Fever
MAC: Cough, High Fever, watery diarrhea (102/39)
Strongyloidis: Pulmonary, GI, Skin Pruritis, Urticaria

3611 Pediatrics Infectious Diseases


IM may cause Acute Airway Obstruction= Throat Tightness, Diff Swallowing, Severe
Tonsilar Enlargement, Labored/ Mouth Breathing, Tachypnea
-Rx w IV Steroids
SubGlottic Stenosis can occur due to Trauma eg ETT insertion
GAS Pharyngitis resolves in 5days
RetroPh Abscess= UniLat Pharyngeal Wall Swelling; not common after Age 4; Difficulty
Swallowing & Labored Breathing
IM causes PeriTonsillar Abscess
Ludwig Angina= SubLingual or Mandibular Space Cellulitis from Dental Abscess

3612 Pediatrics Infectious Diseases


Enterobius= highly Contageous
-Lives in Cecum & Appendix; Abd Pain, N,V, VulvoVaginitis
-Rx w Albendazole & Pyrantel Pamoate if Pregnant; Treat all Family
Quinine used for Chloroquine Resistant Malaria
MetroNidaZole: Rx of Anerobic IntraAbd Infection: Diverticulitis, Peritonitis, Cholangitis
BenzNidaZole for Trypanosoma Cruzi= Chagas Disease=> RBBB
StrongyLoidis: Urticatia, Abd Pain, Cough, Dyspnea, Wheezing
-Rx w IverMectin; also used for OnchoCercia River Blindness

3613 Medicine Infectious Diseases


CMV affects Multiple Organ Systems like Pneumonitis (dry cough, dyspnea, lung
crackles), Hepatits (inc Enzymes), GastroEnteritis (bloody Diarrhea)
Dx: CMV DNA in PCR
Rx: Discontinue Mycophenolate and start Ganciclovir=> causes Pancytopenia
PCP only affects the Lungs
Legionella also causes Lung, GI symptoms like CMV but not Bloody Diarrhea; Fever >102
Aspergilosis=> Hemoptysis, Lung Nodules
3633 Pediatrics Infectious Diseases
Meningitis in Critically Ill Infants= Status Epi or Septic Shock=> Require AntiBiotics before LP
-Stable Infants w Meningitis: do LP first for Culture then start Empiric A/Biotics
-Infants have Lethargy, Fever, Nuchal Rigidity; Heniation does not occur in InFants because
Fontanelles are Open; we dont need CT to rule out Mass Lesion before LP
-Rx w CeftriAxone or CefoTaxime=> for S Pneumo or Neisseria; Vancomycin added for
Resistant Strains
-Give DexaMethasone if H Influenza=> to dec Risk of Deafness
-Avoid CeftriAxone in Neonates= Displaces Bili from Albumen=> Kernicterus
-Head CT done in Comatose Infants or w Focal Neuro Signs or History of Brain Surgery

3636 Pediatrics Infectious Diseases


early localized: E Migrans, Headache, Malaise Fatigue, Fever
-Rx w DoxyCycline also Treats CoExisting Anaplasma; but it's not given in Preg pts or
Children <8yrs old=> Enamel HypoPlasia, Teeth Stains
-Rx Children w Amoxi or Cefuroxi
early disseminated= heart block, meningitis; Rx w IV Cef 3-Axone
late disseminated

3639 Gynecology Infectious Diseases


Cervicitis= Purulent Discharge + Friable Cervix= Bleeds on Examination
-Rx= Azithro for Chlamydia & Azithro + CefTriAxone for Neisseria
-Both are needed for Neisseria due to Resistance
PID= Tenderness of Uterus, Adnexa & Cervical Motion
-Rx= Cefoxitin + Doxycycline
OligoHydramnios Risk= Htn & Placental Insuf
PreEclampsia Risk= Htn, DM, Renal Disease, Extremes of Maternal Age

3640 Pediatrics Infectious Diseases


Sickle Cell=> Asplenia=> Vaccinate against SHiN
-Strep Pneumo can still Commonly cause Sepsis via non Vaccinated Strains=> Penicillin
Prophylaxis till Age 5

3642 Pediatrics Infectious Diseases


pt had Small Red Bumps on Arm; Painful; filled w Yellow Fluid; no Fever=
Non Bullous Impetigo= Painful Pustules=> Rupture & Harden into Honey Crusted Lesions; inc
Risk w Skin Trauma= Insect Bite, Eczema
-Rx w Topical Mupirocin
Bullous Impetigo= Flaccid Bullae, w Yellow Fluid; caused by S Aureus; Rx w Oral AntiBiotics
Atopic Dermatitis= Red, Dry, Thick Skin in Flexural Areas= AnteCubital & Popliteal Fossa; Rx w
Topical Steroids

3655 Gynecology Infectious Diseases


Trichomonas= Sexually Transmitted so we Treat the Partner as well
-Avoid Sex until both Partners have Completed Treatment to Avoid ReInfection
-Rx= Metro or Tinida Zole; dont Drink Alcohol= Disulfiram

Gardenerella & Candida= due to Imbalance of Vaginal Flora; not STD so don't Rx Partner

3660 Pediatrics Infectious Diseases


Universal Screening of Chlamydia in Pregnant pts @ 1st Visit & in 3rd Trimester to Prevent
Neonatal Infection
-50% Exposted Infants develop Conj; 30% develop Pneumonia= Paroxysmal Staccato
Cough @ 4-12wks
-Oral Erythromycin Treats Chlamydia = @ 5-14 Days; Corneal Ulcer, Scar, Blindness if UnRx
-Topical Erythro Prevents Neisseria =applied to all Newborns Regardless of Infectiion** within
1hr After Birth; Rx Active Neisseria w IM CefTriAxe
All Newborns are screened for CF, HypoT4
GBS Prevented w IntraPartum Ampicillin; Sepsis or Pneumonia in First 2 Days of Life
3663 Pediatrics Infectious Diseases
Congenital Rubella= White Pupil Reflex= Leukocoria, Machine Like Systolic Murmur
Congenital Syphilis= Megaly, Nasal Discharge= Snuffles; OsteoArticular Destruction;
MaculoPapular Rash; Hearing Loss occurs Later
Congenital Varicella= Limb Hypoplasia, Cataracts, Skin Scarring
Congenital CMV= ChorioRetinitis & PeriVentricular Calcifications
Congenital Herpes presents after 1wk; not @ Birth

3670 Pediatrics Infectious Diseases


HIV Infants= Failure to Thrive, L Nodes, Diarrhea
-Maternal Abs present in HIV -ve Infant until 18mo; Confirm w DNA PCR; or Persistence of
AntiBody after Age 18mo

Kartagener= Recurrent Ear, Nasal, Sinus Infections, Pneumonia


Bruton= Absent Lymphoid Tissue

3671 Pediatrics Infectious Diseases


Group B Strep, E Coli= Mcc Neonatal Sepsis; Prevent w Maternal Testing & IV Penicillin
-pts have Poor Oral Intake, Irritability, Hyper OR Hypo Thermia**; Resp Distress, Vomiting,
Jaundice
-Meningitis= Bulging Fontanelles; Apnea; Seizures; HypoTonia
-Rx w Ampicillin + GentaMicin
-Bands >700 means Bacterial Infection; WBC count can be High or Low
**Get Blood, Urine & CSF Cultures
Early Onset GBS Sepsis is due to TransVaginal Transmission during Delivery
Late Onset GBS Sepsis is due to Horizontal Transmission due to UnWashed Hands

MeningoCoccus & PneumoCoccus Sepsis in Age >3mo


ToxoPlasmosis= Rash, Megaly, Hydrocephalus
Meningococcal Meningitis= Rash
Listeria= Neonatal Meningitis; Mother has Flu like Symp= Body Ache, Fatigue
Herpes Encephalitis= Seizures

3674 Medicine Infectious Diseases


Cutaneous Larva Migrans = Ancylostoma Caninum and Braziliense. Hookworm Larvae;
Walking Barefoot on Sand
Papule First then Tracks= Pruritic SerPiginous Red Brown Tracks due to Larva Moving
Rx: Ivermectin

Uroshiol is Pruritic but Linear not Serpiginous


SporoTrix= Nodule that Ulcerates

3675 Medicine Infectious Diseases


Typhoid: Headache, GI, Salmon Rose Spots, Relative Bradycardia
Malaria: Cyclic fever, GI, Anemia, Thronmbocytopenia
-Cyclic fever = Rbc Lysis
-cold phase = chills and shivering, then fever then sweating
-Headache, Myalgia, Vomiting, Diarrhea
Dengue = Leukopenia, Muscle and Joint pain; RetroOrbital Pain
Hep A = Pruritis; Dark Urine

3676 Pediatrics Infectious Diseases


CMV= Transmitted via Saliva; PeriVentricular Calcifications
ToxoPlasma= ChorioRetinitis, HydroCeph= Large Head, Diffuse Cerebral Calcifications
-Megaly, MicroOphThalmia, MacroCephaly, Diffuse L Nodes & Petechiae, Jaundice
-Cat Feces, Infected Meat, Goat Milk
-ChoreoRetinitis in Adulthood due to ReActivation of ToxoPlasma
-Dx= Infant IgA or IgM; Rx= PyriMethamine, SulfaDiaZine, Folate for 1yr

Congenital Syphilis in Infants= Persistent Rhinitis, Intermittent Fever, OsteoChondritis, L


Nodes, Megaly, MucoCutaneous Lesions
Rubella= Small Eyes & Head; Cataracts, Glaucoma, ASD, MeningoEncephalitis
HSV= acquired during Birth when Development is Complete=> no Congenital Anomalies; just
Infection
Rubella & ParvoVirus Acquired through Resp Droplets
Zika Virus= Severe MicroCephaly

3678 Obstetrics Infectious Diseases


HIV in Preg: Most Important Prevention of Transmission= HAART Therapy beginning ASAP;
Regardless of CD4 Count or Viral Load; Makes Risk <1%
-Zidovudine to Neonate for 6wks
-if Mom didn't take HAART then we also give Nevirapine to Neonate
if Viral Load >1000 then C Section + Zidovudin to Mom dec Transfer
Avoid Forceps or Vaccum=> can Tear Baby Skin=> inc Transmission
Neonatal Sepsis if S Pyogenes Colonization, ChorioAmnionitis or Prolonged Rupture of
Membranes

3679 Gynecology Infectious Diseases


Candida is the odd one; other 2 have inc pH and Rx is Metro for both
Candida Discharge is Odorless & pH is Normal
Adding KOH to Gardenerella increases the Fishy Odor= Whiff Test
Vaginitis= Vulvar Erythema, Burning & Pruritis; DysUria & Pareunia= not seen in Garden
Trichomonas= Pear Shaped Organism w Flagella; also Treat the Partner
MNG Giant Cells are seen in Herpes
BreastFeeding should only be Stopped if Nipple is Bleeding

3707 Obstetrics Infectious Diseases


Bacterial Vaginosis Rx= MetroNidaZole 500mg twice a day for 7days
DoxyCycline deposits in Fetal Bones & Teeth
Azithro & FluconAzole= Safe in Preg
-Erythro causes Cholestatic Hepatitis

3743 Medicine Infectious Diseases


Toxic Shock: Diffuse Macular ErythroDerma; Skin Desquamation including Palms and Soles
GI: V, ProFound Diarrhea
Diffues Myalgias, inc Creatine Kinase
Renal BUN and Creatinine inc
Hem: Platelets dec
Liver ALT AST Bilirubin
BP <90
Recent Nasal Packing or Tampons; Rash, Fever, Hypotension, Diarrhea, Thrombocytopenia

Scarlet Fever after a Prodrome of Fever Headache Vomiting Sore Throat then Rough
Sandpaper Rash= Papules

RMSF Rash= Papular; Starts in Hands


MeningoCoccemia= Petechial Rash

3758 Pediatrics Infectious Diseases


Neonatal Chlamydial Conj= 5-14 days of Life= Watery or MucoPurulent Blood Stained Eye
Discharge
-Rx w Oral Erythromycin=> Pyloric Stenosis in Infants
-oral is given in Chlamydia to Eliminate NasoPharyngeal Carriage
GonoCoccal Conj is most Destructive=> Corneal Perforation & Blindness
-Topical Erythro used for Neisseria Conj Prophylaxis; CefoTaxime used for Rx
Silver Nitrate= Prophylaxis against Neisseria but it causes Chemical Conj

3788 Pediatrics Infectious Diseases


Neonatal Tetanus= due to Umbilical Stump Infection in Infants of UnImmunized moms
-Presents in 1st 2wks w Poor Suckling & Fatigue first; then Rigidity & Spasms
-Apnea=> v High Mortality in 1st Wk; Septicemia in 2nd wk
-Inhibits NT Release @ Junction of UMN & LMN
-Airway Muscles Contract=> Stridor, Resp Failure
-Rx= Penicillin + Tetanus Ig

3789 Medicine Infectious Diseases


Echinococcus = Hydatid Cyst = close contact w dogs feces or sheep farmers.
Pain, N,V,Megaly; No Fever vs Ameba; Ultrasound = Septated Cyst= Daughter Cysts11
Can be in Liver Cyst or Lung Cyst, may Rupture --> Eosinophilia, Fever
Dx: IgE Antibodies
Rx: Albendazole if <5cm; Percutaneous Aspiration if >10cm
Tenia Solium --> Seizures, Intracranial Htn
Fish --> Diphyllobothrium or Clonorchis Sinensis

3791 Pediatrics Infectious Diseases


Pinworm Infection= Nocturnal PeriAnal Pruritis; Vulvar & PeriAnal Erythema @ Night
Rx whole Family to Prevent ReInfection w Albenda or Pyrantal
Lichen Sclerosus= PeriAnal & Vulvar Pruritus, Vaginal Discharge, Bleeding due to Thin White
Skin
Sexual Abuse= Abrasions, Bleeding, Vaginal Discharge
Atopic Dermatitis= Dry, Red, Thick Plaques on Popliteal & Antecubiral Areas
Candida after Recent AntiBiotic Use
3808 Medicine Infectious Diseases
Tenia Solium = Pork Tapeworm; eggs in contaminated water or food?
Seizures; inc ICP = vomiting, headache, papilledema
Cysts on MRI w enhancement/edema or calcifications;
Edema & Inflammation when cysts degenerate
give Albendazole + Steroids; Phenytoin for Seizures
Toxoplasma caused by cysts in Feline (cats) feces; CD4 <100; MulTiple Ring Enhancing
Lesions; Headache; Seizures
Cereblral Malaria: fever, delirium, Seizures
Naegleria= MeningoEncephalitis =Fever, Seizures

3819 Medicine Infectious Diseases


Amebic Dysentery: bloody diarrhea then Amebic Liver Abscess= Tenderness; fever
-inc ALP; Entemeba Antibodies present
-Rx w Metronidazole for Abscess + ParomoMycin to Eradicate Intestine Colonization
Hydatid Cyst has no fever; Contact w Dogs, Sheep; Rx= Aspirate + give Albendazole
Bacterial Abscess in DM or HepatoBiliaryDisease

3825 Medicine Infectious Diseases


Bovis Biotype 1 =GalloLytiCus= is associated w Colon Cancer
Not Biotype 2

3830 Pediatrics Infectious Diseases


Cystic Fibrosis: Mcc Organism in Children= S Aureus
-Mcc Organism in Adults= Pseudomonas
Recurrent Pneumonias in CF=> Bronchiectasis, Chronic Hypoxia, Barrel Chest
-inc Chance of Resistant Bacteria due to so much AntiBiotic use
Listeria= Sepsis + Meningitis

3873 Medicine Infectious Diseases


Live vaccinations like BCG, Anthrax, Oral Typhoid, Oral Polio are Contraindicated in HIV
MMR can be given if CD4 >200 if no history of AIDs defining illness eg PCP, MAC
HIV patients have inc risk of measles so should be vaccinated

3888 Medicine Infectious Diseases


Hep A vaccine is given to HIV men who have sex w men,
-or with chronic Liver Disease like HBV HCV
Starting in 2006 HAV Vaccine is given to all kids
HPV is given 11-26 yrs old
MMR Zoster, Varicella not given CD4<200
-Meningococcus Vaccine given to Asplenics or Complement Deficiency; Hajj
-TdaP is given at each Pregnancy to give Antibodies to the Fetus
***HIV ppl should get all normal vaccines, plus Pneumococcal Conjugate 13 then Polysaccaride
23 at 8 weeks then 5 years then again at age 65 yrs

3900 Pediatrics Infectious Diseases


New England= Lyme Endemic Area
-Prevent w Tick Repellant= DEET, PerMethrin, Clotting, Tick Checks
-only 25% ppl recall being bitten
-give Doxy if tick Attached for >36hrs
-Erythema Migrans arises 2wks after Bite
-Flu Symptoms= Fatigue, Headache, Myalgias, Arthralgias
Vibrio Vulnificus=> Cellulitis, Sepsis, Hypotn; Brakish Water= less Salty than Sea

3905 Pediatrics Infectious Diseases


Pertussis: Dx confirmed by PCR of Nasopharynx
-Vaccine Immunity is not LifeLong but useful via Herd Immunity; also dec Severity
-SubConj Hemorrhages due to inc Intra Orbital P
-Rx w Macrolides w/o confirmation
-Give TDaP booster @ each Pregnancy

3906 Pediatrics Infectious Diseases


All Close Contacts of Pertussus should be given Macrolides regardless of Age, Imm Status or
Symptoms to Reduce Transmission & Shorten the Duration
-Resp Isolation= keep pt @ home only in First 5days of Therapy
-DTaP given @ 2,4,6,15,18 mo & 4-6yrs
Erythromycin assoc w Pyloric Stenosis in Neonates; give Azithro for Pertusis
Hospitalize Infancts <3mo Old

3917 Medicine Infectious Diseases


CMV Collitis = Abd Pain and Bloody Diarrhea; also see Retina***
-Freq Low Volume Bloody Stools**
-Dx w Biopsy on Colonoscopy; Eosinophilic Intranuclear and Basophilic Intracytoplasmic
MAC, Cryptospo, Microsporidium Isospo all cause Watery Diarrhea

3928 Medicine Infectious Diseases


S Epidermidis Endocarditis in infants following umb vein catheter infection
Enterococci IE after GU Manipulation in elderly or Obstetric Procedure in Women
SubAcute= Several Weeks of Fatigue & Low Fever; Anemia of Chronic Disease; Proteiuria in
50% pts
GalloLyticus= Ulcerative Lesions of Colon in IBD or Colon Cancer

3938 Medicine Infectious Diseases


PCP Pneumonia = non productive (Dry) cough, exertional dyspnea, fever, SEVERE HYPOXIA;
BILATERAL Interstitial Infiltrates; CD4<200
LDH is Frequently Elevated
Treat w TMP-SMX for 21 days
Give steroids: if PO2<70; Aa Gradient >35
Immune Reconstitution Syndrome?

3969 Pediatrics Infectious Diseases


Scarlet Fever= can occur after Strep Skin or Throat Infection withing 7days
-Fever, Chills; Exudative Pharyngitis, Red Cheeks=> Lips look Pale= CircumOral Pallor,
Strawberry Tongue; Abd Pain
-Sanpaper Rash= Finely Papular Texture; Starts on Neck & Axilla Later Generalizes in 2days
-Then Desquamation begins After 1wk, includes Palms & Soles
-Pharynx covered w Grey Exudates
-GAS Erythrogenic Toxin
-Rx w Penicillin V
Scalded Skin Synd= ExfoliaToxin, Flaccid Bullae then Exfoliation of Skin; Age <5yrs
Herpangina= Ulcers on Palate, Tonsils, Pharynx, High Fever; Severe OdynoPhagia
SJS= Severe Variant of E MultiForme= Target Lesions 1st; Bullae in GI, Resp or GU Mucous
Membranes Later; Shedding of Nails
-can be caused by NSAIDs
4012 Medicine Infectious Diseases
Nocardia in Immunocompromised hosts eg HIV or Transplant patients= Cavitary or Nodular
Lesions in Upper Lung Lobes
Disseminated= CNS Abscess, or Skin Lesions
-inhalation or skin inoculation
-Dx: Bronchoscopy w Lavage--> Gram Stain= Filamentous weakly Acid Fast Branching

ActinoMyces= nonpainful Mandibular Mass


Anthrax=> Myalgia, Dyspnea, Shock

4071 Medicine Infectious Diseases


Ventilator Associated Pneumonia >48 hours after EndoTracheal Intubation;
MCC = Pseudomonas, Ecoli, Klebsiella; MRSA; Strep
First Step = X Ray; if abnormal = Alveolar Infiltrates, Air Bronchograms --> do Lower Resp Tract
Sampling = TracheoBronchial Aspiration for Gram Stain and Culture
Then Start Empiric Antibiotics including Anti Pseudomonals

4092 Medicine Infectious Diseases


C Dif Pseudomembranous Collitis = watery diarrhea, low fever, abd pain, inc leukocytes
or Fulminant colitis w Toxic MegaColon
-Dx= Toxin in Stool PCR or Enzyme ImmunoAssay
Drugs that cause it: Quinolones, Penicillins, Cephalosporins, Clindamycin; PPI
Treat w Metronidazole or Vancomycin
Diverticulitis Dx w CT; Diarrhea, fever left lower pain
Do Stool Culture if Bloody Diarrhea
Laproscopy if rebound tenderness, guarding, toxic megacolon, severe illness

4102 Surgery Infectious Diseases


Necrotizing Surgical Infection= inc Pain in Wound, dec Sensitivity @ Wound Edges, Cloudy
Discharge & Crepitus; Emergency
-common in DM; pain & Edema beyond Surgical Site, Systemic Signs= Fever, Hypotn
-IV Antibiotics alone if just Cellulitis
-Debridement if Deep Skin Layers Infected
-ve Pressure Wound Therapy, Vacuum Assisted Wound Closure= Rapid Healing

4115 Medicine Infectious Diseases


PCP Pneuomnia is not only in HIV but also in immunosuppressive drugs eg SLE patients
Resp Failure (dec PO2, resp Alkalosis dec PCO2), fever, dry cough, inc LDH
BILATERAL DIFFUSE Interstitial Infiltrates on X Ray
Resp Failure in HIV is slower; in Steroids it is faster
SLE without treatment --> Diffuse Alveolar Hemorrhage = cough, fever, hemoptysis,
dyspnea
SLE Myocarditis = volume overlad eg JVD, Edema
Aspergilosis= Pulm Nodules

4120 Medicine Infectious Diseases


Vertebral OsteoMyelitis = bone tenderness;
Dx: inc ESR, CRP; Blood cultures
- MRI (also detects cord compression) then CT guided bone biopsy
-alternate to MRI is RadioNucleotide bone scanning
can be due to Hematogenous Spread of recent UTI
-50% cases are due to S Aureus
Epidural Abscess= Motor & Sensory Loss

4156 Obstetrics Infectious Diseases


Syphilis: if pt has Penicillin Allergy then use DoxyCycline= not used in Pregnancy as it
decreases Fetal Bone Growth
-Macrolides are not Effective against Syph
-So we Must use Penicillin in Pregnant Syphilis; Allergy= IgE= should be Confirmed w Skin Test
and pt has to be Desensitized to Penicillin
-Rx w IM Benzathine G
All Preg pts are Screened for Syphilis

4163 Medicine Infectious Diseases


Mitral valve prolapse is MCC valvular abnormality in Infective Endocarditis; Increases IE Risk=>
MR
Bicuspid Aortic Valve w AS is 2nd MCC
Tricuspid Regurg in IVDU
Dx: TransEsophageal Echocardiogram is gold standard
-Blood Cultures
Rx: Vancomycin

4167: Medicine Infections:


Catheter Assoc UTI: ExtraLuminal due to Ascent of Bacteria; IntraLuminal due to Obstruction of
Lumen
-Long Term Use=> Infeciton; Prevented by Clean Intermittent Catheterization every 6hrs
-using Prophylactic A/Biotics=> Emergance of Resistant Organisms

4168 Medicine Infectious Diseases


Diabetic Wound Deep Infections are Polymicrobial Strep + Staph + Pseudomonas
-Localized= Skin Redness, Warmth, Edema then Systemic= Fever & Chills; inc ESR
-OM due to Contiguous Spread after 2wks of Infection; Cortical Erosion on X Ray
-Rx w Debridement; Piperacillin-TazoBactam + Vanco
Hematogenous OsteoMyelitis is in Children

4169 Medicine Infectious Diseases


DM , Sepsis, Elderly patients w Pyelonephritis or w Obstruction are treated w IV Ceftriaone=
Hospitalize for 3 days then oral Quinolones and TMP-SMX =Narrower Spectrum for 14 days
Gentamycin used in Resistant cases and Severe infections
CiptoFloxacin is given in UnComplicated, Non DMUTI

4186 Pediatrics Infectious Diseases


Varicella Immunity= 2 doses of Vaccine; @ Age 1 & 4yrs or Prior Infection
-NonImmune Child >1yr Old w Exposure to another Child w Varicella should be given VZV
Vaccine if Immuno Competent or Varicella IG if Imm Suppressed or Pregnant or Neonates=
Post Exposure Proph to prevent Pneumonia, Cerebellar Ataxia
-Dont give Live Vaccine to Neonates; Give them Varicella IG; Infants >1mo Old are not given
anything due to low Risk
-90% of pts develop VZV after Exposure to an Infected Person

4233 Medicine Infectious Diseases


Legionella: Relative Bradycardia; CNS: Confusion; GI: Diarrhea; dec Na; Hematuria;
Pneumonia; Sputum Gram Stain = Neuts but no orgamism as its intracellular
Urine Antigen
Treat w Quinolone or Macrolide

4257 Medicine Infectious Diseases


Pseudomonas Osteomylitis = after puncture of sole of shoe due to warm moist environment
Dx= Xray, Blood cultures, Bone Biopsy
Rx Cipro, Piperacillin-Tazobactam
Non Aureus Staph & Strep rarely cause OM

4265 Medicine Infectious Diseases


Meningococcal Meningitis: Sudden Symptoms; Rapid Progression
Fever, Headache Vomiting; Petechiae (Specific to Neisseria) develop in <15hrs
Petechial Rash and Shock (BP< 90/60); Severe Myalgias; AMS (difficulty waking the pt up)
CSF Glucose <45, Protein >500
Dx: Blood Cultures, CSF Analysis
Treat w Vancomycin and Ceftriaxone

Pneumococcus Meningitis is Slower than Nisseria and has no Rash


Henoch Schonlein = Purpura, Arthralgia, GI and Renal
Viral Meningitis CSF: WBC <500; Bacterial Meningitis CSF: WBC >1000
4272 Obstetrics Infectious Diseases
HCV is Transmitted by *Blood; Sexual Transmission <0.1% in monogamous
SeroDiscordant Couples
-inc Sexual Risk w MicroTrauma & *Blood* Exposure= Gay Men, Many Partners, HIV
Chronic HCV= inc Risk of Gest DM, Cholestasis, PreMaturity
-Acute Viral Hep= Life Threatening in PreExisting Chronic Hep pts; they Must get Hep A & B
Vaccines
-5% Risk of Vertical Transmission; inc if HIV coInfection or High Viral Load; not dec by C
Section= Transmited b4 Birth
-Ribavarin= Teratogen

4284 Medicine Infectious Diseases


Influenza peaks in Jan-Feb; abrupt Fever, Myalgias, Headache, Rhinorrhea, Sore Throat w No
Exudates, dry Cough
-Give Oseltamivir if age >65yrs
-or within 2 days to dec duration
-give vaccine after symptoms abate
Strep Pharyngitis has Exudate, L Nodes but No Cough (Centor Criterion)

4317 Pediatrics Infectious Diseases


Cat Bites= Inoculation of Bacteria into Deep Puncture Wounds= into Nerves, Tendon Sheaths
-Give Prophylaxis= Amox & Clav against Pasteurella & Oral Anerobes Respectively
-Give Tetanus if last Vaccine >5yrs Ago
-Human or Dog Bites can be Observed= Lower Risk of Infection
ClindaMycin: Rx Cellulitis & Abscesses unrelated to Bites; Treats Anerobes, SA, GAS
Azithro: for Bartonella= Cat Scratch Disease in Imm Comp

4351 Pediatrics Infectious Diseases


Cervical L Nodes: Dangerous if >2cm, Firm, Immobile, Fever, Wt Loss, Night Sweats
-Biopsy + Chest Ray for Lymphpma
-Absence of Above Features= Soft, NonTender, smaller than 1cm=> Observe for Weeks then
CBC, Viral Titers, Inflam Markers
Cervical LymphAdenitis= Staph or Strep; Large, Red, Tender L Nodes; Rx w Clinda

4353 Pediatrics Infectious Diseases


Bacterial L Adenitis most commonly Affects SubMandibular Nodes; it's UniLat
-Rx= ClindaMycin= Covers MRSA & GAS
-Acute= few days
-SubAcute > Weeks; MycoBacteria Avium
CMV & EBV= Bilateral L Adenitis; Cervical, Axillary, Inguinal
AdenoVirus=> BiLat L Nodes, Fever, Pharyngitis, Conjunctivitis

4354 Medicine Infectious Diseases


EBV: Fever, Exudative Pharyngitis, Symmetric Cervical L Nodes, Splenomagaly and Rupture;
HeteroPhile Antibody is not present in 1st Wk
HIV: Generalized L Nodes; Sore throat w No Exudates, GI [Diarrhea, Rash = not in EBV]
Tender L nodes is less likely to be cancer; Do Biopsy in Cancer
SLE has Rash, Arthritis and Serositis

4371 Medicine Infectious Diseases


Tenderness to percussion over Spinous Process of vertebra = Spinal OsteoMyelitis
Pain Even at Rest; usually Chronic >6wks; Half pts have No Fever
MRI is most sensitive; inc ESR
Risk: IV Drug Use**; UTI; Sickle Cell
MCC is Staph
Platelets are high due to inflammation
spinal Stenosis: pain Improves w lumbar Flexion
Prostate cancer: Night vertebral Pain and Urinary symptoms

4373 Medicine Infectious Diseases


Bartonella Quintana Lice Bites
Hensalae Cat Scratch; Dermal Infection --> Vascular Endothelium--> RBC Destruction
Friable Papules Nodules; can be Pedunculated
Systemic: Fever, Night Sweats, Fatigue
Dx = Biopsy; Rx = Doxycycline
Disseminated MAC = high Fever, Night Sweats, Fatigue Malaise, Wt Loss, Diarrhea, Abd Pain;
CD4 <50

4388 Medicine Infectious Diseases


IVDU --> S Aureus Tricuspid Endocarditis --> Vegetation can embolize to the Lungs in 75% pts --
> nodular infiltrate w cavitation
-lacks audible murmur (low pressure gradient in Tricuspid) and lacks splinter hemorrhages or
Heart Failure = Aortic Valve
Fever, Chills, Pleuritic Chest Pain, Dyspnea, Cough
Needle Track Marks = IVDU
TB=> Chronic Cough
H Influenza=> Bronchitis & Pneumonia in COPD
PCP=> inc A-a Gradient
4417 Medicine Infectious Diseases
SNAP
SMX Nocardia, Actinomycis Penicillin
Nocardia: Pulmonary Disease (cavitations and nodules, Cavitation) and Brain Abscess
(Seizures) ; Wt loss, night sweats
Aztreonam for Gram -ve eg Pseudomonas
Clindamycin for aspirated anerobes

4418 Medicine Infectious Diseases


Influenza: Abrupt Fever, Malaise, Myalgias, Headache; Rhinorrhea, Dry Cough; winter season;
Red Throat w No Exudates; Recover in 1wk
-complication= Influenza Pneumonia =acute worsening dyspnea, cough, hypoxia;
Bilateral Diffuse Reticular Infiltrates
-2ndary Bacterial Pneumonia= Worsening after Initial Improvement
Strep Pyogenes has Exudates
-Hospitalize w Oxygen, Oseltamivir
RSV: similar symptoms + Wheezing

4470 Medicine Infectious Diseases


Tuberculin Test =PPD Identifies Latent TB w High Risk of Reactivation
if +ve (InDuration >15mm) then do X Ray to Rule Out Active TB
-Rx w INH + Rifa + PyriZina + Ethamb for 2mo then INH + Rifa for 4mo
if X Ray is -ve then its Latent TB, Treat w INH 9 mo + B6

4472 Obstetrics Infectious Diseases


Asymptomatic BacteriUria: inc Risk in DM, MultiParity
Rx w Co Amoxi Clav or NitroFurantoin or Cephalexin or Fosfomycin
Complications= PyeloNephritis, PreTerm Birth; Low Birth Wt
DoxyCycline=> Grey Color Teeth
TMP-SMX: 1st Trimester=> Neural Tube; 3rd Trimester=> Kernicterus
4475 Medicine Infectious Diseases
All adults >65 Give both Pneumococcal Vaccine 13 and PPSV23 After 6 to 12 months
if <65 but have Heart or Lung or DM or Liver Disease or Smoker then Give PPSV23 Alone
if <65 but have CSF Leaks, Sickle disease, Cochlear Implants, Asplenia then give Both 13
and 23
if Vaccination History is Unknown then give Tetanus, Diphtheria and Pertusus followed by TD
Booster every 10 years
Give Influenza every year

4476 Medicine Infectious Diseases


Chronic Liver Disease: give Hep A & B and Pneumococcal 23 Vaccine
Pneumococcal 13 is given before 65 to very high risk patients
23 is given to Less High Risk patients eg Heart or Lung or DM or Liver or Smoking
13 and 23 are given to all patients above 65 yrs old

4478 Medicine Infectious Diseases


All adults should get anual Influenza vaccine,
Tetanus Diphtheria every 10 years
HIV patients should get HBV, Strep Pneumo 13 valent then after 8weeks 23 valent then again
after 5 yrs then at 65 yrs old
-also give Varicella if CD4 >200
Asplenic Patients get Hemophilus and Meningococcus vaccines
HPV vaccine in Females from 11-26 and 11-21 in Males; and from 11-26 in HIV
Zoster Vaccine given >50

4488 Medicine Infectious Diseases


Patient w Any one STD should also be Screened for Neisseria, Chlamydia, Syphilis, HIV, HBV
-inc Risk of STD if New Partner
-Counsel on Safe Sex Practices
-Herpes Screening not Recommended if pt Asymptomatic
IVDU ppl should be Screened for HCV and HIV

4517 Medicine Infectious Diseases


Viral URI --> Superimposed Secondary Bacterial Pneumonia in Elderly; Hemophilus or Strep
Pneumo; S Aureus
Viral URI Symptoms Worsen After Initial Improvement= Secondary Bacterial Infection
-S Aureus --> Acute Necrotizing Pneumonia in Young pts w Recent InFluenza= Rapidly
Progressive, Fatal Infection; Blood Streaked Sputum + MultiLobe Lung Cavities (Abscess) =
Pneumatocelle = Air Filled Cavity
Rx w Vanco or LineZoLid

AsPerGillus= Triad of Fever+ Pleuritic Pain + HemopTysis


LeGionella= GI First then Pulm Symptoms
4526 Surgery Infectious Diseases
Fever in few hours of Surgery= Prior Infection, Trauma;
Malignant HyperThermia= Anesthetics; = Met Acidosis, HemoDynamic Instability
Febrile Transfusion Rxn due to Cytokines; Give AntiPyretics but Avoid Aspirin if Low Plts
Surgical Site Infection= Acute: <1wk or: SubAcute >1wk; not immediate: Hours
Acute= Nosocomial= UTI, Pneumonia
Nosocomial Pneumonia= after 2days of Admission; Community Pneumo <2days
SubAcute = PEmb, Drug Fever, Surgical Site Infection
Drug Fever has Rash & Eosinophilia

4544 Surgery Infectious Diseases


Post Op Acute Bacterial Parotitis= S Aureus; Pain Aggravated by Chewing; Purulent Saliva; High
Fever; Red Parotic Gland (when seen inside Mouth)
-Prevent w Hydration & Oral Hygiene
-more common in Elderly pts
Early Ambulation prevents DVT; B Blockers prevents MI
PeriOperative AntiBiotics should be given to pts having Abd Surgery
Incentive SpiroMetry: dec Lung Complications

4611 Medicine Infectious Diseases


Toxoplasmosis = Headache, Confusion + Focal Deficits = Hemiparesis, Ataxia, Behavior =
Aggression, suspicion
CD Count <100; give Prophylaxis if +ve Ig G Antibody means pt has LifeLong Latent Infection=>
will become Activated as CD Count Drops
Albendazole Treats NeuroCysticercosis; doesnt Prevent it

4634 Medicine Infectious Diseases


Splenectomy: Give Vaccines either 14 days
befoer or 14 days after
**this period increases function of the antibodies
formed due to vaccine
-Pneumococcus: give 13 PCV =Conjugated first
then 23 Polysaccharide 8 weeks later then at
65yrs old

4654 Medicine Infectious Diseases


Chronic Hep C= Asymtomatic or Fatigue + Arthralgias, Myalgias, MembranoProlif GN
-Essential Mixed Cryoglobulinemia Synd= Purpura, Arthralgia, GN, dec Complement
-intermittent Transient elevations of TransAminases
-Circulating Immune Complexes deposite in Vessels; low Conmplement levels
-Porphyria Cutanea Tarda= Fragile, Photosensitive Skin, Erosions, Vesicles & Scarring; Strong
Assoc w HCV***; Rx w Phlebotomy or OH Chloroquine
Lambert Eaton w Hodgkin; has dry mouth
PolyArteritis Nodosa w HBV
Erythema Nodosum= painful Nodules; Sarcoidosis
A1AT Def= Panniculitis= Inflam of Subcutaneous Adipose tissue= Painful Nodules on Thighs or
Butt
Wilson has Acanthosis Nigricans
Dermatitis HerpitiFormis= Intensely Pruritic Papules
4656 Medicine Infectious Diseases
2ndary Syphilis = widespread L Nodes esp EpiTrochlear (Elbow); Diffuse maculopapular
rash beginning on Trunk; spreading outward
-also fever, malaise, sore throat, headache, chondyloma lata= Raised Warty Velvety Cutaneous
Papules
Grey Mucosal Patches in Mouth
Disseminated Gonococcus rash = few pustules but no sore throat
Rocky Mountain Fever spreads from Hands to Central Trunk

4662 Medicine Infectious Diseases


remove Attached Ixodes tick asap w tweezers
give DoxyCyline if tick attached more than 36 hours
dont give doxycycline in <8yrs old, pregnant or lactating

4668 Medicine Infectious Diseases


Adult Still's Disease = Recurrent High Fevers, Maculo-Papular Rash, Arthritis; inc ESR
IE: Non Specific= Myalgia, Arthralgia
Heart Failure= Cough, Dyspnea, Edema
Immuno= Osler Nodes; GN= Hematuria, RBC Casts
Infectious Mets= to Brain, Spleen, Lungs
Rh Factor can be +ve
PSGN= Red Brown Urine, Htn, Edema, inc Creat

4669 Medicine Infectious Diseases


Milliary TB: Diffuse ReticuloNodular Pattern = Millet Seed on X Ray
-Fatigue, Fever, WtLoss, IVDU, Prison, Group Living, Travel
-Hematogenous Spread of TB; Liver, Bones, CNS, L Nodes
-Mycoplasma has same symptoms but is limited to 3 weeks
Hodgkin's Disease has a Mediastinal Mass; Painless L Nodes

4714 Medicine Infectious Diseases


Splenic Abscess: Triad of Fever, Leukocytosis, Left Upper Abd Pain. Left Chest Pain = Pleural
Effusion, Splenomegaly
Infective endocarditis commonly --> splenic abscess; Hematogenous spread
Dx w Abdominal CT
Treat w Splenectomy or Percutaneous Dranage; 50% pts die

Malaria has jaundice and anemia


Lung Cancer Mets to Liver Bone Brain and Adrenals
GI TB in Liver Intestines and Peritoneum

4727 Medicine Infectious Diseases


Pt had punch on the Face and Developed IE; blood cultures were taken and He was Started on
Vancomycin for MRSA
-Cultures reveal Viridans Sensitive to Penicilin so switch to Ceftriaxone
Dont give oral antibiotics in Infective Endocarditis; give IV Penicillin or Ceftriaxone for
Viridans for 4 weeks

4734 Pediatrics Infectious Diseases


Rubella prevented by Vaccination before Conception
-Live Vaccine= C/Ind in Pregnancy due to Risk of Infecting the Fetus
-1st Trimester Screening includes Testing for IgG to Rubella
Because +ve Rubella Serology after 1st Trimester can be due to Previous Infection or 1st
Trimester Infection so we Screen in 1st Trimester where +ve means Previous Infection and no
Risk to Fetus
Maternal Rubella= Fever, Cough, Conjunctivitis, Rash
Do Cesarean Delivery if Maternal HIV w High Viral Load or Active Genital Herpes

4806 Obstetrics Infectious Diseases


HSV= Painful Vesicles on Red Base=> become Shallow Punched out Ulcers & Erosions
Women w Active Genital Lesions @ Time of Delivery=> do C Section
-TocoLysis after Rupture of Membranes increases Risk of Transmission
-placing Scalp Electrodes creates a Port of Entry=> inc Transmission
Women w a History of HSV Infection should get Acyclovir @ 36wks to Prevent Infection @
Time of Delivery
-Acyclovir @ time of Delivery is not Effective

4814 Pediatrics Infectious Diseases


Bat bites are Painless and may go UnNoticed so any Exposure to Bats even w/o bites warrants
PostExposur Proph for Rabies
-Rabies IG + Vaccine
-AeroPhobia, HydroPhobia: Feeling of Water or Air triggers Pharyngeal Spasm
- Incubation is 1-3mo; all pts die in Weeks of Developing Symptoms

4833 Pediatrics Infectious Diseases


Viral Meningitis= Echo, Coxsackie= NonPolio Enteroviruses
-starts w Fever, URI Symptoms; Pharyngitis, Rash, HerpAngina
-CSF Glucose is Normal
-Rx is Supportive, Resolves in 1wk
TB Meningitis= v High Protein, v Low Glucose; Gradual Onset; inc CSF Lymphocytes

4843 Pediatrics Infectious Diseases


Acute UniLat L-Adenitis occurs in Children <5yrls Old= S Aureus or Pyogenes; L Nodes= Warm,
Red & Tender; 3-6cm
NonTB MycoBacteria=> NonTender L Adenopathy
Tularemia: L Nodes + Headache, Fever, Chills, Malaise; Rabbits, Hamsters
PeptiStreptoCoccus L Node: in Dental Infection

4845 Pediatrics Infectious Diseases


Orbital Cellulitis= Posterior to Orbital Septum; OphthalmoPlegia, Blindness; Cavernous
Thrombosis, IntraCranial Infection
-Rx w IV AntiBiotics
PreSeptal Cellulitis= Eyelid Edema, Tenderness; No dec Visual Acuity, Diplopia, No
OphthalmoPlegia
-Rx w Oral AntiBiotics

4850 Pediatrics Infectious Diseases


MCC Predisposing Factor for Bacterial Sinusitis= Viral URI= Mucosal Edema interferes
w Clearance of Bacteria
-lasts 10-30days; Fever >102; Purulent Nasal Discharge for @least 3days
-X Ray= Sinus Opacification, Mucosal Thickening, Air/Fluid Levels
-Complications= Orbital Cellulitis, IntraCranial Extension
-Rx= Amoxi-Clav

4852 Pediatrics Infectious Diseases


Congenital Syphilis= Jaundice, Megaly= due to ReticuloEndoThelial Activation, BlueBerry
Muffin Spots= due to ExtraMed HematoPoiesis, Snuffles= Profuse Rhinorrhea
-MaculoPap Rash; may DesQuamate
-Penicilin Therapy prevents Saddle Nose, Hutchinson Teeth, Frontal Bossing
**No Infant should be Discharged from Nursery until Mother's Serologic Testing is Complete

Congenital CMV= PeriVent Calcifications & MicroCephaly

4867 Medicine Infectious Diseases


MCC Pneumonia after Influenza = Strep Pneumo and Staph Aureus
-worsening fever, Pulmonary Symptoms eg Dyspnea, productive cough after initial
improvemnt
-inc Risk in Age >65; Lung Disease; Imm Comp
-S Aureus --> Severe Necrotizing rapidly progressive. Hemoptysis, Confusion; Death
-Rx= Vanco, Pippera-TazoBactam; LevoFloxacin

MycoPlasma has Headache & Dry Cough


-Legionella has GI Symptoms like vomiting, diarrhea

4891 Pediatrics Infectious Diseases


RetroPharyngeal Abscess= Fever, Dysphagia, inAbility to Extend Neck, Muffled Voice;
Trismus= mouth not opening
-Infection can be Life Threatening due to Proximity to Airway, Spine, Major Vessels=>
Carotid Art Rupture; Jugular Vein Thrombus
-Infection Spreads from Pharyngitis, Tonsilitis, Otitis, Sinusitis; pts have PreExisting Rhinorrhea;
common age 6mo to 6yrs
-Widened PreVert Space on X Ray: should be Narrower than Vert Bodies

Meningitis= PhotoPhobia, Neck Stiffness can not Flex

4938 Medicine Infectious Diseases


Histoplasa in MidWest & Central USA like Missouri
-Febrile Wasting Illness= Fevers, Chills, Malaise, Wt Loss,
-Skin= Papules, Nodules
-Pulmonary= Cough Dyspnea, ReticuloNodular Infiltrates on X ray, interstitial
-ReticuloEndothelial= Megaly, L Nodes; PanCytoPenia due to BM InFiltration
LDH, Ferritin; Rapid Serum or Urine Antigen; Culture takes weeks
inc risk in CD4 <100***
Pneumocystis = no L Nodes or Megaly or Pancytopenia; do BronchoAlveolar Lavage
Disseminated TB is diagnosed by L Node Biopsy

4939 Medicine Infectious Diseases


Treat HIV pts w Histoplasmosis w 2 weeks of Amphoterecin B then transition to 1 year of
Itroconazole
Flucytosine for Cryptococcus

8880 Medicine Infectious Diseases


Eikenella Endocarditis = Gram -ve Anaerobe in Oral Mucosa; Poor Dentition
In IVDU --> Staph Endocarditis= mcc
UTI--> Enterococcus Endocarditis
IBD= Ulcers in Colon=> GalloLyticus IE

8959 Medicine Infectious Diseases


if Severe Odynophagia then Viral Esophagitis; Confirm b4 Treating
if Oral Thrush then Less Pain and Candida which is More Common >60%; Treat w Fluconazole
Empirically w/o Confirming
Pill Esophagitis is due to K-Cl; Tetracyclines, Bisphosphonates, NSAIDs
EosinoPhlic EsoPhagitis= pt has Asthma or Allergy; GERD & Dysphagia

9111 Surgery Infectious Diseases


SubAcute Prosthetic Joint Infection= Staph Epidermidis >3 Months after Implant; Less Virulent;
Chronic Pain, Joint Loosening; Sinus Tracts
Acute= Early Onset= S Aureus, Pseudomonas <3 Months after; more Virulent; Signs of
Infection= Redness, Swelling
Neisseria= Disseminated Gonococcal Triad= Migratory PolyArthritis, Tenosynovitis, Rash
Native Joint Septic Arthritis: Synoveal WBC >50K
Prosthetic Joint Arthritis: Synoveal WBC >1000

9849 Pediatrics Infectious Diseases


Coxsackie= Herpangina= Grey Vesicles & Fibrin Coated Ulcers on Tonsilar Pillars & Post
OroPharynx, Fever, Pharyngitis; occurs in Summer, Fall
-Rx= Hydration and Pain Control; Resolves in 1wk
Herpetic GingivoStomatitis= Fever, Pharyngitis, Oral Lesions & Ant Pharynx
Strep Pyogenes= Ant Cervical L Nodes, Tonsillar Exudates
EBV= Post Cervical L Nodes, Tonsillar Exudates

9885 Medicine Infectious Diseases


HIV patients w fever, headache and signs of inc ICP (vomiting, papilledema) should be tested
for Cryptococcal Meningitis; do CT to Exclude Mass Lesion=> then LP to lower ICP
CD4 <100
Dx w india ink on CSF
Rx: Amphoterecin + Fluuconazole
JC Virus MRI= Patchy Areas of White Matter= DeMyelination
Herpes Encephalitis --> Cognitive and Personality changes, Focal Neuro Signs, Seizures
10068 Obstetrics Infectious Diseases
Painful Genital Ulcers + mild L Nodes= Genital Herpes=> DysUria, Malaise
-Urine Culture is -ve; WBC & RBC present in UrinaLysis due to InFlam
-Vesicles are often Absent
Chlamydia=> LymphoGranuloma Venereum= Large Painful L Nodes=Buboes + Small PainLess
Ulcers
Hemophylis ducriiye= Deep ulcers w Severe L Nodes; may suppurate
Herpes Zoster= Shingles= ReActivated Varicella
Neisseria Urethritis= no Ulcers
Untreated Genital Warts progress to Squamous Cell Carc
Trichomonas= Frothy Discharge

10301 Medicine Infectious Diseases


HIV screening age 15-65; also Screen w Each Preg
Anual screening in IVDI, Gay ppl, >1 partners, homeless, Prostitutes
**HIV p24 antigen and HIV antibodies = screening
**Confirm w HIV Antibody Differentiation Immunoassay
Hep C Screening if IVDU, inc ALT; Clotting Factor before 1987, Blood Transfusion before 1992,
Born b4 1965
Syphilis: screen pregnant women, if another STD, prostitutes etc
10904 Medicine Infectious Diseases
Meningococcal Vaccine given at 11 yrs then booster at age 16-21 esp those ppl Travelling for
Hajj or going to Africa or living in Dorms eg college students or Army Recruits or Asplenics or
Complement Def
Patients taking TNF antagonists; Steroids or Transplant or HIV pts should not be given live
vaccines MMR is live

11108 Medicine Infectious Diseases


Kaposi = multiple violaceous papules= pink, red, brown due to inc vascularity
-Lymphedema due to vascular obstruction or cytokines
-Biopsy to rule out Bacillary Angiomatosis due to Bartonella
LeukoCytoClastic Vasculitis: due to infections, medications, inflammation, malignancy
=HyperSensitivity Vasculitis= Vascular Damage from Infiltrating Neuts= Palpable Purpura;
Papules; Plaques

11228 Medicine Infectious Diseases


ChikunGunya Fever: high Fevers, Severe PolyArthralgias**, MaculoPapular Rash
-L Nodes
-Lymphopenia, Thrombocytopenia, inc LFT
-Resolves in 10 days
-Aedes Mosquito
Acute Hep B = Rash, Flu like symptoms
Rh Arthritis has PeriCarditis & Episcleritis
Reactive Arthritis has Asymmetric OligoArthritis

11984 Pediatrics Infectious Diseases


Cat Scratch= Bartonella= Papular/ Nodular Skin Lesion + Ipsilateral L Adenitis= Large, Tender,
Red; Slow Infection; Develops over 2wks; Resolves in 2mo
-most pts do not remember a Cat Scratch or Bite
Salmonella causes Mesenteric Adenitis
Pasteurella=> Acute Cellulitis after Dog or Cat Bite; develops in 2days
TB=> Cervical L Nodes
12168 Medicine Infectious Diseases
Vibrio Vulnificus: after Eating Oyesters
-Wound Infection while Surfing; Ocean Water=> Rapid Onset< 12hrs, Severe Necrotizing
Fascitis w Hemorrhagic Bullous Lesions; Septic SHOCK
-inc Risk in pts w Cirrhosis, Hepatitis, DM, Hemochromatosis: Fe= inc Growth
-Rx w IV CefTri + Doxy even b4 Confirming; it is Highly Fatal
S Aureus or Pyogenes Infections Develop over Days; not hrs
Pasteurella= also Rapid Onset; but after Dog/Cat Bites
PseudoMonas= Folliculitis & Cellulitis

12240 Medicine Infectious Diseases


Strep Meningitis: Treat w CefTriaxone, VancoMycin and DexaMethasone
Add Ampicillin for Listeria in Imm Comp and >50 yrs old
Pt had Pneumonia --> Sepsis --> Meningitis

12260 Pediatrics Infectious Diseases


Varicella= Live Vaccine= can cause Mild
MaculoPap Rash: <10 Lesions vs >100
Vesicular Lesions in nonAttenuated Wild Type
Infection
-Incubation Period= 1-3wks
Allergy to Vaccine Components= NeoMycin or
Gelatin; Type1= Immediate Hives or Anaphylaxix
or Type4= Redness & Swelling @ Injection Site
2days Later
Measles= MaculoPapular Rash

12267 Pediatrics Infectious Diseases


Varicella & MMR= Live Vaccine= given @ Age 1 & 4; can cause mild Infection w Fever &
MaculoPapular Rash within 3wks that Resolve w/o Rx
-Avoid Contact w Imm Comp ppl= ALL pt receiving ChemoTherapy; Pregnant
AirBorne Isolation w N95 Mask used for Primary Measles Infection= AeroSolized Droplets=
Contagious
-Vaccine Strain Measles is less Contagious
Varicella= Fever & Vesicular Rash in Successive Crops
Eczema= Dry, Scaly, Erythematous, Pruritic

12470 Medicine Infectious Diseases


H DuCreyi= STD; >1 Painful Papules=> become Pustules=> then Ulcers w Painful, Red Base &
Well Demarcated Borders + Purulent Exudate
-Painful Inguinal L Nodes are common
-Rx w Azithro
HIV=> PainLess L Nodes, Rash, Painful MucoCutaneous Ulcers w White Base
Staph Ecthyma= Deep Impetigo; Vesicle/ Pustule=> Purulent Ulcer on Buttocks, Legs;
Erodes into Dermis

12471 Medicine Infectious Diseases


Jarisch Herxheimer: <12hrs after Rx of Syphilis, Boriella, Bartonella; Resolves in 48hrs
-Fever, Myalgias, Rigors, Sweating, Hypotn, Worsening Syphilis Rash (Macular)

Anaphylaxis= Urticarial; not Macular Rash; Occur Immediately; not in hours


Immune Reconstitution Inflam Synd= pt on HAART; Worsening of Infectious Symptoms due to
Immune System Improvement

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