PA Module Infectious Disease Week 2 of 2
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| 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
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| 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
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| 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
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| 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 |
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| 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
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| 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
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| 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
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| Hand Foot and Mouth Disease | Cocksackievirus |
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| Echovirus |
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| 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;
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| 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.
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| Cytomegalovirus (CMV) (HHV - 5) |
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| T-lymphotropic Virus (HHV - 7) |
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| Kaposi's Sarcoma | HHV - 8 |
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| 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 |
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| Perinatal CMV | Cytomegalovirus (CMV) | poor weight gain, adenopathy, rash, hepatitis, lymphocytosis | Viral culture; PCR; Antigen Assay; Tissue confirmation | Ganciclovir |
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| CMV Mononucleiosis | Cytomegalovirus (CMV) | Prolonged high fever, fatigue and malaise; myalgia, headache; splenomegaly; rubelliform rash (occasionally) | Viral culture; PCR; Antigen Assay; Tissue confirmation | Ganciclovir |
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| 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
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| 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
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| Common Cold | Rhinovirus; Coronavirus; Adenovirus |
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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 |
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| 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"
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| 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
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| 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
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| 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
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| 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
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| 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 |
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| 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
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| 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
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| 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
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