Influenza
sudden onset, myalgias, HA, fever, chills, malaise. Rapid Influenza nasal swab or cultures to test. Treatment: Oseltamivir in high risk and severe disease, symptom management in mild disease and healthy. Best within 48 hrs. Long term care facility w/ 2+ c
URIs
Viral is mostly symptomatic, and differentiating factors between the viruses are few.Can always use PCR but when treatment is almost always supportive (except influenza, then oseltamivir) PCR would be expensive and unwarranted. Influenza is dx using Rapid
RSV
Depending on severity, URI sxs, cough, fever, wheezing, crackles. Sxs of resp distress. Dx: Clinical suspicion, RSV test only done in severely immunocompromised. Treatment: Treat ssx unless severely immunocompromised, then give ribavirin and RSV immunoglo
SARs
Coronavirus, TRAVEL TO ENDEMIC AREA last 10 days, Fever, HA, cough, SOB, myalgias, Patchy Pneumonia on x ray (atypical).
Dx: Clinical picture, low O2 sats, Health Dept tests.
Treatment: Supportive Care 10% mortality, highly contagious
Pertussis
Bordatella pertussis-Catarrhal phase: URI symptoms, most contagious now.
Paroxysmal Phase: severe paroxysmal coughing fits with inspiratory whooping sound after fit.
Convalescent Phase: Resolution of cough
Dx: Throat culture and PCR. Lymphocytosis. Treatm
Chlamydia/LGV (Lymphogranuloma Venereum)
C Trachomatis, Painless singular ulcer, +nodes that ARE tender. DX: NAAT testing on lymph drainage Treatment: Azithromycin, Doxycycline is second line, STD testing and needle drainage of nodes for management (+DOXY FOR LGV)
Gonnorhea
Neisseria Gonorrhoeae Discharge, dysuria, frequency, urgency Dx: NAAT is fastest and most accurate, but culture is gold standard. Treatment: Ceftriaxone + Azithromycin (for chlamydia) Erythromycin is treatment for conjunctivitis.
Syphilis
T. Pallidum, Painless singular ulcer, + nodes that ARE NOT tender. Understand the 3 stages. Dx: 1st stage: Dark Field Microscopy, 2nd and 3rd: RPR with Fta-Abs to confirm. Condyloma Lata in secondary may appear like HPV warts Treatment: All three stages g
HPV
Genital Warts, Dx: appearance, but biopsy if treatment is not effective. Treatment: Self limiting disease- but can also cryo, TCA, surgical excision. Prevention: Gardasil vaccine by age 11-12 female, 9-26 male bc incr. Risk of cervical cancer. Regular pap
Trichomoniasis
Trichomonas vaginalis yellow/green frothy discharge, cervical petechiae "strawberry cervix", Dx: saline prep slide, organisms that are motile (flagella) Treatment: Metronidazole for BOTH partners
Chancroid
Haemophilus Ducreyi PainFUL singular ulcer, + nodes that are tender, difficult to culture so Dx is usually clinical. Treatment: Azithromycin first line, Ciprofloxacin as second line.
Cholera
Vibrio Cholerae. Rice water stool leading to hypotension/shock. Dx: stool culture. Tx: fluid replacement, Aztihromycin for severe cases (Cipro, Doxy second choice).
Tetanus
TOXIN from tetanospasmin and elaborated by clostridium tetani. Early pain, tingling, spasticity leading to hyperreflexia, gross muscle spasm, then to convulsions and asphyxia.Trismus and local spasms are early sxs. Tx: supportive/respiratory support, anti
Malaria
Plamodium (P. vivax and P. falcipaurum most common). Can be dormant for months to years in liver (hypnozoites). Liver stage: replication in liver cells then rupture releases merozoites. Blood stage: merozoites develop into trophozoites in RBC and perpetua
Rabies
Rabies lyssavirus. Fever, HA, fatigue, pain, confusion, seizure, paralysis, violent agitation, hypersalivation, hydrophobia. If asleep in room with bat, prophylaxis DX: Negri bodies in brain tissue, isolate virus in body fluid, detect AB, IFA on skin bx.
Amebiasis
Entamoeba dispar or histolytica. Asx to diarrhea, pain, bloody stool, leading to abscess, hepatomegaly, hemmorrhage, death. DX: O&P, colonoscopy. Tx: Tnidazole or metronidazole plus diloxanide furate.
Hookworms
Ancylostoma duodenatle and Necator americanus (but variable). Skin penetration phase: pruritic dermatitis. Pulmonary phase: dry cough w/ blood tinge. Sputum-Intestinal phase: diarrhea, abd pain, malabsorption. DX: Ova and parasites in stool sample, elevat
Pinworms
Enerobius vermicularis. Pruritic anus, Scotch tape test. Tx: albendazole/Mebendazole. Treat whole family and repeat in 2-3 weeks to prevent reinfection.
Toxoplasmosis
Toxoplasma gondii from cat feces. Resembles mono w/ retinochoroditis, yellow/white patches on macula. Dx: serological and staining. Tx: treat immunocompromised with pyrimethamine plus sulfadizine plus folic acid. Send to OBGYN if pregnant. TMP-SMX prophyl
Ebola
ebolavirus. Fever, pharyngitis, malaise, arhtragia/myalgia, rash, leading to expressionless face, bleeding, myocarditis, pulm edema, tachpnea, hypotension...DX: CBC, CMP, PCR, ELISA, Ab TX: call your neighborhood friendly ID specialist
MAC
Most common in HIV pts, and may be a cause of FUO. Presents like TB in pulmonary pts. Dx: Acid fast staining (no cell wall so gram wont work). Treatment: Clarithromycin + Ethambutol + Rifampin, Prophylaxis in AIDS: Macrolide of choice
Leprosy
Mycobacterium Leprae 2 types:
Tuberculoid: In immunocompetent pts, hypopigmented lesions, numb to touch, asymmetric nerve involved Lepromatous: lesions with poorly defined borders, in immunocompromised, SYMMETRIC nerve involvement with tingling/numbness.
HIV and related opportunistic infections
Pt without known exposure will present with flu-like symptoms if they have any. Be on lookout for opportunistic infections, such as oral/vaginal candidiasis, CMV, PCP pneumonia or cryptosporidiosis.MAC and toxoplasmosis infections signal severe disease. D
HSV, types 1 and 2
Both cause lesions that turn into painful ulcers. Lesions described as grouped vesicles on an erythematous base.Dx: PCR is the test of choice. Treatment: Valacyclovir/Acyclovir
VZV (Varicella, Zoster, Shingles)
Varicella causes chickenpox, Zoster causes shingles. Vesicles for varicella are on an erythematous base like "dew drops on a rose petal", and can have a clinical diagnosis. PCR for a test if one feels warranted Treatment for varicella: supportive unless 1
EBV
Fever, posterior cervical lymphadenopathy, fatigue, splenomegaly. Dx: monospot, peripheral smear with atypical lymphocytes. Treatment: Supportive. Avoid contact sports. Burkitts lymphoma is a potential complication, as well as splenic rupture.
CMV
MOST COMMON VIRAL CONGENITAL DISEASE Most commonly seen in immunocompromised pts. Retinitis with pizza pie retinopathy. Similar to EBV but less pharyngitis. Treatment: Gancyclovir.
Candidiasis
Candida Albicans is causative agent and is normally found on skin, likes regions that are warm and moist, infection is due to overgrowth which can be caused by steroids and antibiotics, beefy red, defined border, satellites, immunocompromised pts will see
Cryptococcosis
yeast, common, opportunistic, sx: cough and SOB, but in immunocompromised meningitis can occur Treatment: Amphotericin B, Fluconazole, Flucytosine
Histoplasmosis
Ohio-Mississippi river valley, soil with bird or bat droppings, infections occurs by inhalation of spores, presents with flu-like sx but most are asymptomatic. Treatment: Amphotericin B or Fluconazole
Pneumocystis
Severely Immunocompromised pts, spread person to person through air, sx: cough, fever, fatigue, associated pneumonia leads to morbidity, Treatment: TMP-SMX or Pentamidine
Lyme
Borrelia burgdorferi Bullseye rash (erythema migrans) and HA, fatigue, fever, malaise arthralgias. As it progresses neurological and cardiac problems may occur, accompanied by arthritis. Dx: clinical symptoms for early dx, serologic (elisa, western blot)
RMSF
Rickettsia Rickettsii Tick borne disease, HA, fever , blanching erythematous rash on wrist and ankles. Dx: serologies take too long, history of ticks + rash + fever = they have it Treatment: Doxycycline for everyone but pregnant women. They get chloramphe
Erlichiosis and Anaplasmosis
Ehrlichia chaffeensis intercellular bacteria that work like a virus and destroy WBCs. Fever, chills, HA, myalgia. If untreated will result in more severe symptoms such as DIC meningitis or encephalopathy.Anaplasmosis will appear the same way and cannot be
Babesiosis
Babesia SppCalled the American Malaria because symptoms are similar. Parasite will lyse RBCs leading to anemia. Dx: Giesma stained peripheral blood smear initially, PCR to confirm. Treatment: Atovaquone + Azithromycin
Tularemia
Francisella tularensis Rabbits/Rodents are reservoir. Single papule at site of inoculation, which will ulcerate with a central eschar and regional lymphadenopathy. Dx: Serology Treatment: Streptomyocin
Colorado Tick Fever
Viral. Carried by wood tick. Saddle-back fever, may be confused for RMSF or relapsing fever Dx: Left shift and atypical lymphocytes. Treatment: Self-limiting