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Review Study Session Infectious Diseases

01/17/08

Food Poisoning

            Botulism C. botulinum

                        Infant --> spores in honey

                        Food--> canning

                        Wound --> IVDA

                        18-36 hrs incubation

                        Rx:  Supportive care. Watch for resp failure due to ascending paralysis

             Ciguatera Snapper, grouper, tuna

                        15 min- 24 hr incubation

                        Sxs:  Abd pain, vomiting, profuse watery diarrhea, temperature reversal

             Scrombroid Mahi mahi, tuna, mackerel

                        Due to improper preparation

                        Onset 1-2 hrs

                        Sxs:  Abd pain, N/V/D, Skin rash

                        Rx:  Supportive, antihistamines

Rashes

            Palms & Soles

                        Secondary syphilis, RMSF, Cocksackie, Meningiococcemia, disseminated gonorrhea

STDs

            C. trachomonas cervicitis

                        Rx:  1gm Azithromycin; If allergic, Doxy x 7 days

            Cervicitis w/PID, salpingitis or endometritis

                        Rx:  Doxy x 14 days

            Syphilis

                        T. pallidum                             

                        Primary

                                    Onset 10d-12wks

                                    Rash presentation

                                    Rx:  Penicillin-Benzathine

                        Secondary

                                    Incubation 6-20wks

                                    Presentation: rash (palm & sole), fever, chills, lethargy

                                    Pathognomic lesions--> condylomata lata

                        Tertiary

                                    Gummas (bone, skin)

                                    Develops over years

                                    Presentation:  CNS-->tabes dorsalis, dementia

                                                            Cardio-->ascending thoracic aneurysm

                                    Rx:  IV Pen x 10-14 days

                        Latent

                                    Rx:  IM Pen-Benzathine

                                    Use RPR / VDRL, if pos, then treponemal antibodies

Jaresh-Herkheimer reaction

                        Antigen release after abx

                        <24 hrs fever, myalgia, headache

                        Rx: salycilates

Meningococcemia

                        Rash (palms & soles), AMS

                        Rx:  Infants-->rocephin; high risk contacts are defined as those exposed to resp secretions

Toxic Shock Syndrome

                        S. aureus

                        Tampon use & post-partum infections, also nasal packings

TB

            M. tuberculosisacid fast bacillus

            Transmitted via respiratory droplets

            Primary

                        Cough, fever, night sweats

                        Gohn complex (scarring)

            Reactivation

                        Weight loss, hemoptysis, fever

                        Upper lobe infiltrates

            Extrapulmonary

                        Potts disease, brain, GI, liver

            Use sputum & PPD

            Rx:  INH, rifampin (careful they both cause hepatitis) AND pyrizanimide OR ethambutol (use B6 with INH to prevent neuropathy)

            If PPD +, dont get another PPD, follow w/CXRs

M. avium

            Wt loss, cough

            Dx-->sputum, blood

            Rx-->Azithromycin, clarithromycin, levofloxacin, amikacin

 

Plague-->Y. pestis

Smallpox-->variola

Anthrax-->B. anthrax

Typhoid-->Salmonella typhi

Tularemia-->ransciella

TetanusC. Tetani

 

Malaria

            Female anopheles mosquito

            Plasmodium vivax, ovale or falciparium

            Sporocytes reproduce, cycle continues after RBCs lyse

            Vivax or ovale-->dormancy in liver

            Presents with generalized aches

            Dx:  CBC (hemolytic anemia)

            P. malariae-->chloroquinine

            P. vivax/ovale-->Chloroquin, premaquin

 

Cats-->cat scratch (bartonella), toxoplasmosis

RMSF-->Rash, fevers, headache

            Rx: Doxy or chlorenphenocol

Lyme-->Borellia burgdorfi, deer tick

            Target lesions (erythema chronicum migrans)

            Rx:  doxy; If preggo? Amox; If heard Dz: Rocephin, Pen-G

Mono

            Malaise

            Rash w/PCN

            Monospot

            Atypical lymphs on CBC (earlier indicator)

            No contact sports

Influenza

            Tamiflu first 48 hours

Rabies

            Mostly fatal

            Vaccine and IVIG (infiltrate at site and IM)

            OK to Rx if preggo

            #1:  raccoons & skunks in US; dogs worldwide

            No rodents (rat, squirrel, etc)