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ID Module 2/2

PA Module Infectious Disease Week 2 of 2

Clinical DiseaseVirus/Parasite/FungusPresentationLaboratory Tests/FindingsMost Common In: TreatmentComplicationsPrognosisPrevention
Chicken Pox Varicella (HHV - 3) Primary Infection Rash, fever, malaise, maculopapular vesicles. centripetal distribution, lesions appear and disappear in "crops" Usually diagnosed clinically Children Vaccination available; treatment of symptoms Good Vaccination
Shingles Herpes Zoster (HHV - 3) Recurrence Unilateral vesicular eruptions on single dermatome,severe pain Usually diagnosed clinically Adults age 60+ Vaccination available; Acyclovir, Famcyclovir; analgesics Postherpetic Neuralgia Good, although there may be long term neuralgias Vaccination
Infectious Mononucleosis Epstein-Barr Virus (EBV) (HHV - 4) Fever; chills; lymphadenopathy; splenomegaly; severe pharyngitis Throat culture, Monospot test; antibody titers Adolescents acetominophen; rest; warm salt water gargles; avoid contact sports for 6-8 weeks Maculopapularrash sometimes appears with administration of amoxicillin; bacterial strep pharyngitis may occur; splenic rupture; Bell's Palsy Disease is usually self limiting Usually transmitted in saliva ("kissing diease"); shed from oropharynx for up to 18 months; patients should avoid physical sports to prevent splenic rupture
Roseola infantum (Sixth Disease) HHV - 6 Irritability; fever; rash (faint, small, maculopapular rash on neck and truck extending to thighs and buttocks) Children; in adults it is associated with several illnesses Symptomatic Generally benign; major cause of infantile febrile seizures
Fifth Disease (Erythema infectiosum) a.k.a. "Slap face Disease" Parvovirus mild fever; exanthemous rash; cough; conjuctivitis; nausea; diarrhea; blue lips Elevated IgM anti-parvovirus titer; PCR Children Symptomatic, NSAIDS Respiratory tract is probably route
Measles Rubeola Koplik's spots; acute febrile eruption (brick red), conjunctivitis, edema of eyelids; photophobia; hacking cough; rhinorrhea Diagnosis usually made clinically; Leukopenia; proteinuria Children (age 12ish) Symptomatic; antipyretics and fluid CNS involvement; Respiratory tract disease; Strep throat; fatality rate is approx. 3/1000. Good prognosis Vaccine available; Highly contagious (nasopharyngeal secretions); isolation of afflicted individuals
German Measles Rubella (Togavirus) examthematous rash (usually milder than measles); lymphadenopathy; splenomegaly; Forchheimer's spots on soft palate In adults: malaise, headache, fever Virus isolation; elevated IgM antibodies any age; fetal infection is usually devastating Symptomatic; acetominophen Postinfectious encephalopathy Good (except in fetal cases) Vaccine available; should be given to girls before menarche
Hand Foot and Mouth Disease Cocksackievirus
Cold Sores HSV - 1 "Dewdrop on a rose petal" papules; fever; malaise; myalgias; anorexia PCR, Tzanck Preparation; varies with presentation Children and young people Acyclovir Associated with Bell's Palsy; Associated with Bell's Palsy;
Genital Herpes HSV - 2 Vesicular lesions on genital area w/ pain, itching, dysuria, vaginal/urethral discharge; headache, fever, malaise, myalgia PCR, Tzanck Preparation; varies with presentation Children and young people Acyclovir Can be transmitted vertically; assoc. with Bell's Palsy; Recurrences often involve fewer lesions and are induced by stress, fever, infection and chemo.
Cytomegalovirus (CMV) (HHV - 5)
T-lymphotropic Virus (HHV - 7)
Kaposi's Sarcoma HHV - 8
Congenital CMV Cytomegalovirus (CMV) Petechiae, hepatosplenomegaly, jaundice (common); microcephaly; growth retardation;prematurity Viral culture; PCR; Antigen Assay; Tissue confirmation Ganciclovir Lifelong infection once infected; Infant can be infected by mother; "blueberry muffin" lesions
Perinatal CMV Cytomegalovirus (CMV) poor weight gain, adenopathy, rash, hepatitis, lymphocytosis Viral culture; PCR; Antigen Assay; Tissue confirmation Ganciclovir
CMV Mononucleiosis Cytomegalovirus (CMV) Prolonged high fever, fatigue and malaise; myalgia, headache; splenomegaly; rubelliform rash (occasionally) Viral culture; PCR; Antigen Assay; Tissue confirmation Ganciclovir
Mumps Paramyxovirus swollen salivary glands (sometimes unilateral); facial edema leukopenia; renal function abnormalities; swab of parotid duct Children Bed rest while febrile; warm/cold compressesfor parotid tenderness;ice packs for swollen scrotum if present Swollen testicles; Meningitis; Pancreatitis Usually last about 2 weeks; fatalities are rare Vaccine available; spread by respiratory droplets
Congenital Rubella Syndrome Rubella (Togavirus) heart malformation; eye lesions; microcephaly; mental retardation;deafness; TTP; hepatosplenomegaly; intrauterinegrowth retardation Virus isolation in the mother Infants whose mother have been infected with Rubella during pregnancy PREVENTION! (Not much can be done after birth) Lifelong treatments - the earlier in development that the infection occurs, the worse the sequelae Poor - high mortality rate Women should be vaccinated against Rubella before menarche, or at least 3 months before becoming pregnant
Common Cold Rhinovirus; Coronavirus; Adenovirus
Bronchiolitis Respiratory Syncytial Virus (RSV) (Paramyxovirus) low grade fever, tachypnea and wheezing; dyspnea ELISA; immunofluorescent assay; culture of nasopharyngeal secretions children under 6 months; male; daycare exposure; premature infants have higher mortality Ribavirin; hydration; humidification of inspired air; ventilary support (if needed) Recurrent Otitis Media; Upper Respiratory Infection Usually good, but depends on severity of illness Prevention of nosocomial infections with isolation, handwashing and possible passive immunization
Croup Parainfluenza virus low grade fever, hacking cough which is usually worse at night Can be made clinically; ELISA Young children Aerosolized Racemic Epinephrine; Prednisone; avoid cough medicine; hydration; humidification of inspired air (croup tent); cool air seems to ease cough; Recurrent Otitis Media; Pneumonia Good for most patients Isolation; Ribavirin may be useful
Influenza Orthomyxovirus Influenza A and B fever, chills, malaise, myalgias, substernal soreness; coryza; nausea; vomiting; flushed face; conjunctivalredness leukopenia; proteinuria; nasal or throat swab cultures any age; mortality increased in children and elderly Tamiflu or Relenza if symptoms have been present <2 days; Ribavirin; bed rest; hydration Otitis media; sinusitis; bronchitis; pneumonia;Reye's syndrome in children Good except in children and the elderly Vaccine is available
Rabies Rhabdovirus Pain at site of animal bite; fever; malaise; headache; fever; vomiting; Foaming at the mouth, delirium and coma in advanced disease direct fluorescent antibody technique; RT-PCR; Viral isolation from CSF People in contact with animals (veterinarians, vet techs, etc) and anyone who comes into contact with a rabid animal Immunoglobulin; inactivated Human Diploid cell Rabies Vaccine (5 Injections) Death Good if caught early; If not caught early it is almost always fatal Rabies vaccinations in domestic animals; Vaccinations for people in occupationsinvolving animals; immediate medical care if bitten by an animal
Smallpox Variola (poxvirus) severe headache; fever; prostration;lesions all appear at same stage; rash begins on face; affects palms/soles; centrifugal rash; back> abdomen Diagnosis can usually be made clinically Can affect any age Vaccination has virtually eliminated smallpox Death Poor Vaccination
Tuberculosis Mycobacterium tuberculosis chronic cough, positive PPD (sometimes negative in severe infection though) acid fast bacilli staining; mycobacterium culturing; Tubercles present in CXR; if involved in lymph system indicates a Ghon complex; Milliary small white nodules may be present in active disease; reactivationTB usually visible in upper lobes; any age; common among minority groups; healthcare workers are often exposed Isoniazid (INH) for 9 months or Rifampin for 4 months in latent infection; For active infection Isoniazid (INH), Rifampin (RIF) pyrazinamide (PZA) and Ethambutol (EMB) Latent disease can be reactivated with immunosuppression; Treatment is very hepatotoxic; Optic neuritis can occur with Ethambutol;Extrapulmonary manifestations Caused by inhalation and deposition of the organism; frequent screening of healthcare workers; vaccine is available
Ring Worm FUNGUS -Tinea Corporis scaling, circular plaques, rash and mild pruritis Diagnosis made clinically; KOH prep warm climates; associated with dogs, cats and other domestic animals Topical antifungals Good Avoid contaminated soils; education about pets
Tinea Cruris "Jock Itch" FUNGUS - Microsporum, Trichophyton, Epidermophyton erythematous half-moon shaped plaques in crural folds; pruritic; Diagnosis can be made clinically; KOH prep; fungal cultures Obese patients; athletes; more common in summer topical antifungals without steroids; avoid tight clothing; keep area as dry as possible Good avoid tight clothing; keep area as dry as possible
Tinea Pedis "Athlete's Foot" FUNGUS - Tricophyton strong odor; itching; scaling; macerations; ulcerations;often in interdigital spaces between 4th and 5th toes Diagnosis usually made clinically In males age 20-50 Try to keep feet dry in hot humid weather; avoid occlusive footwear; dry well between toes; avoid walking barefoot in public places
Tinea Versicolo FUNGUS - superficial mycosis discolored patches on skin; otherwise asymptomatic; patches are white on sun exposed areas; brown on covered areas; patches on chest, shoulders and neck, very fine scaling on lesions; 3-4 mm diamter Diagnosis made clinically; KOH Prep Common in US, especially in the summer; affects males and females equally; more common in teens and young adults Application of selenium sulfide (Selsun Blue) shampoo to area, allowed to dry before shower Good
Nail Fungus (Onchomycosis) FUNGUS - dermatophytes; candida; molds; Trichophyton (Rubrum most common species) Usually affects toes, especially the hallux; hyperkeratosis; nail dystrophy; yellow brown nails candidal infection sometimes present in middle finger of dominant hand Diagnosis often made clinically; KOH prep; Histology samples Molds common in patients > 60 years of age Systemic antifungal therable Pain with exposure to water; if green it may be a pseudomonal infection; treatment is sometimes hepato/renal toxic Fair - 20 to 40% of cases don't respond to aggressive therapy If not causing problems most people can just live with "ugly feet"
Candidiasis FUNGUS - Candida Albicans Substernal odynophagia (mucosal); asymptomatic (funguria); multiple organ system involvement(disseminated candidiasis) Biopsy and Cultures Prolonged neutropenia; recent abdominal surgery; broad spectrum antibiotic therapy; renal failure; presence of IV catheters; IV drug use Often fluconazole or amphotericin B; removal of IV or bladder catheters; removal of infected heart valves Nervous system involvementin disseminated disease Fair - overall mortality around 30% Catheter care; prevention of infection during cardiac surgery
Histoplasmosis FUNGUS - histoplasmosis capsulatum mild, influenza-like illness Pulmonary and splenic calcifications; anemia of chronic disease; elevations in alkaline phosphatase, LDH and ferritin levels Endemic along major river valleys in the US Itraconazole Acute is rarely fatal, Progressive disseminated is often fatal; Avoid soils contaminated with bird and bat droppings
Coccidiomycosis FUNGUS - Coccidioides immitis or Coccidioides posadassi URI; fever; chills; pleuritic pain; althralgia and swelling of knees and ankles; CBC may show leukocytosis and eosinophilia; serologic testing; radiology soil of SW US, Mexico, South and Central America; Filipinos and Blacks affected most Amphotericin B; sometimes thoracic surgery for nodules Meningitis in 30-50% of cases Usually asymptomatic in immunocompetent patients; often fatal in those that do show symptoms Avoid exposure to soil if in endemic areas
Cryptococcosis FUNGUS - Cryptococcus neoformans(encapsulated budding yeast) Headache (often indicative of meningitis) Lumbar puncture (increased opening pressure and protein, decreased glucose) Found worldwide in soil and pigeon dung; more common in people with hematologic cancer under treatment, Hodgkins disease, corticosteroid therapy and HIV infection Amphotericin B; maintenance antifungals Infection can sometimes disseminate- Most common cause of fungal meningitis Depends on predisposing conditions Avoid exposure to pigeon dung
Aspergillosis FUNGUS - Aspergillus fumigatus Worsening asthma symptoms in patients with pre-existing asthma; waxing and waning of symptoms High levels of IgE and IgG Aspergillus precipitins in blood Burn eschar and external ear debris often contain this fungus Voriconazole, high doses of amphotericin B; caspofungin May result in saccular bronchiectasis and fibrotic lung disease
Tick-Borne Rickettsial Diseases (TBRD) (Rocky Mountain Spotted Fever, Rickettsial Pox, Murine Typhus) Bacterial parasites in Arthropods Arthropod (Tick) bite; vasculitis surrounding bite area; fevers; arthralgia; rashes; headaches; petechiae, purpura Quick lab diagnosis is possible Common in children (tick bites) and people whose occupation puts them at risk for tick bites (outdoors) Doxycycline Death; Tissue Necrosis Avoid tick bites Prevention of Tick bites
Q Fever Coxiella burnetti (gram-negative bacteria) sudden onset of fever, severe headache, cough and influenza-like symptoms Elevated liver function tests; People who are exposed to cattle (dairy - spread during milking), sheep and goats; spread when animal tissue is aerosolized or with ingestion of contaminated milk; veterinarians, shepherds and lab personnel at high risk Doxycylcine; Pasteurization of milk prevents infection; Pneumonia develops in 50% of those infected; hepatitis is often associated Patients usually recover even without therapy Avoidance of cattle sheep and goats; avoiding aerosolized animal tissues and contaminated milk
HIV/AIDS VIRUS - HIV Weight Loss, Infections that won't heal (immunosuppression) Rapid Test, Western Blot, Elisa HIV becomes AIDS once the CD4 count is < 200 cells/mcl or percentages below 14%. HAART often is initiated once CD4 count is < 350 cells/mcl or viral load is >100,000/mcl Men who have sex with men (MSM) and injection drug users, increasing incidence among people age 19-24 Highly Active AntiRetroviral Therapy (HAART), AZT, Combination therapy (Protease inhibitors (PI), NRTI's and NNRTI's) Pneumocystis Pneumonia, Kaposi's Sarcoma, Toxoplasmosis, Cryptococcal Meningitis, Opportunistic infections, Retinitis, Hairy Leukoplakia, Candidiasis infections, Wasting Most patients respond well with HAART, but early death is likely. Avoid unprotected sex, IV drug use and minimize occupational hazards in the medical setting
Created by: kacycee15