+INFECTIOUS DISEASE UWORLD ROUND 1+

common antibiotics used for anaerobic coverage include?`

metronidazole with amoxicullin amoxicillin-calvulanate, clindamycin

Toxoplasma encephalitis treated with ?

sulfadiazine and pyrimethamine

what are the 2 most common high risk opportunistic infections for solid organ transplantation?

PCP (prophylax with TMP-SMX) and CMV (prophylax with ganciclovir or valganciclovir)

bright red, firm, exophytic nodules in patient with HIV Gram (-) bacillus are most likely what diagnosis? antibiotic or choice?

Bacillary angiomatosis

bacillary angiomatosis in immunocompromised individuals (advanced HIV) vascular cutaneous lesions, systemic symptoms, and sometimes organ involvement (liver, CNS, bone) several purple, pedunculated lesions on face and extremities that are friable and bleed easily with palpation ddx? treatment?

Bartonella henselae and Bartonella quintana treat with doxycycline, erythromycin and antiretroviral initiation (2-4 weeks later)

fungal infection endemic to central US. mild pulmonary illness, but disseminated infection may occur even in immunocompromised individuals in bone, prostate and the CNS involved manifests as well-circumscribed verrucous nodules and plaques that progress to microabscesses ddx?

Blastomycosis

Disseminated histoplasmosis treatment?

CD4 <100 Amphotericin B first in patient with HIV then - after 1-2 weeks of clinical improvement--> patient transitioned to oral itraconazole for > 1 year maintenance therapy - patients with HIV should be put on antiretrovirals usually after 2 weeks of antifungal treatment

CD 4 under what value cannot receive live attenuated vaccines?

CD4< 200

patient with HIV with subacute onset of low-grade fever, headache, and sings of increased intracranial pressure should be evaluated for what?

Cryptococcal meningitis detection of the cryptococcal antigen or isolation of organism in the CSF

tenosynovitis, polyarthralgia, and pustular lesions blood, synovial, skin cultures are often negative due to the dastidious nature urogenital mucosa testing (nucleic acid amplification) is typically positive even in the absence of urogenital symptoms ddx?

Disseminated gonococcal infection

what is the treatment of choice for Lyme disease?

Doxycycline

a superficial skin infection that manifets with acute onset of systemic symptoms (fever, chills), regional lymphadenitis, and a warm, tender erythematous rash with raised, sharply demarcated borders ddx? most common cause?

Erysipelas Group A strep (step pyogenes)

acute febrile illness with malaise and altered mental status not often associated with a rash and is described as "Rocky Mountain Spotted Fever without the spots" confusion, mental status changes, clonus, and neck stiffness Leukopenia and/or thrombocytopenia with elevated aminotransferases and lactate dehydrogenase difinitive diagnosis made through visualization of intracytoplasmic morulae in white blood cells or through polymerase chain reaction testing ddx? treatment?

Ehrlichia doxycycline

Patient with low-grade fever, generalized weakness, a new holosystolic murmur, and several tender erythematous lesions affecting the finger tips (Osler's nodes) prior rheumatic fever nosocomial aquired urinary tract infection history of pyelonephritis and persistent dysuria recent manipulation from the cystoscopy leading to IE ddx?

Enterococci endocarditis

what are the 2 most common causes of genital ulcers in the US? what about in developing countries? in syphillis when do you have multiple chancres?

Herpes and syphillis developing countries due to chancroid or lyphogranuloma venerum in patients with HIV

what is given with isoniazid as a supplement?

INH-induced peripheral neuropathy can be prevented with pyridoxine

chronic granulomatous disease of the skin and peripheral nerves that is found primarily in developing regions chronic, anesthetic, hypopigmented lesions with peripheral nerve involvement (nodular/painful nerve deformations with diminished sensory/motor activity ddx? diagnosis with?

Leprosy diagnosis usually requires a biopsy from the active edge of the lesion

Legionella pneumonia treatment

Levofloxacin

individuals in endemic areas who develop flat, annular rash with or without central clearing diagnosis made clinically because serology is negative in early disease ddx? treatment?

Lyme disease doxycycline is curative

secondary bacterial pneumonia is the most common influenza complication and should be suspected when fever and pulm symptoms worsen after initial improvement patients age >65 most common predilection for young patients with recent influenza--> which bug?

MRSA --> rapidly progressive, enctotizing pneumonia with high fever, productive cough ( often with hemoptysis), leukopenia, and multilobar cavitary infultrates

atypical pneumonia with indolent symptoms of headache, malaise, low grade fever, incessant cough, nonexudative pharyngitis x-ray shows interstitial infiltrates with or without small, serous pleural effusion empiric oral antibiotics usually resolve ddx? treatment?

Mycoplasma pneumonia azithromycin

immunocompromised patient has systemic symptoms, lung nodules, and brain abscess (causing seizures) the cultures grow filamentous, aerobic, gram-positive, particullarly acid-fast, filamentous, branching rods can be initially confused with TB symptoms such as weight loss, fever, and night sweats are common cxr: alveolar infiltrates and nodules, often with cavitation can disseminate from the lungs to affect other organs such as the brain and skin ddx? treatment?

Nocardia treat with TAMP-SMX - when the brain is involved then we add Carbapenems for better coverage - when possible, surgically grain abscess - therapy depends on clinical response but is generally long (6-12 months)

patient with AIDS (CD4 <200)or severe deficits in cell-mediated immunity or individuals on chronic glucocorticoid therapy (particularly when combined with other immunosuppressive medications) indolent manifestations usually develop in patients with AIDS, those recieving immunosuppressive meds have acute resp failure dry cough, fever, elevated lactate dehydrogenase levels usually present x-ray have bilateral, diffuse interstitial infiltrates ddx? treatment? prophylaxis?

Pneumocystis Jirovecii treatment is 21 day course of TMP-SMX to prevent patient recieve prolonged glucocorticoid therapy are presecribed primary prophylaxis with TMP-SMX

patients who receive solid organ transplant are at risk for opportunistic infections most notably with?

Pneumocystis pneumonia and cytomegalovirus

Patient with HIV with CD4 count >200 are at incresed risk of community-aquired pnemonia what is the most commonly implicated organism?

Strep pneumoniae

what is the most common cause of community- aquired bacterial meningitis? what can be present concurrently or not?

Strep pneumoniae Pneumococcal pneumonia

presenting with gi complications followed by the characteristic triad of periorbital edema, myositis, and eiosinophilia, fever, subungual splinter hemorrhages, and conjunctiveal or retinal hemorrhages ddx?

Trichinellosis

right sided endocarditis should be considered in patients with presumed history of intravenous drug use empiric antibiotic treatment of native valve endocarditis should ve geared towards MRSA, streptococci, and enterococci what is the treatment?

Vancomycin

when should kids get meningococcal vaccination?

age 11-12 --> primary vaccination age 16--> booster

pregnant patient with early localized lyme disease are typically treated with what?

amoxicillin

Patients with Neisseria gonorrhoeae infection are at risk for coinfection with other sexually transmitted pathogens including what?

chlamydia trachomatis, HIV, and Treponema pallidum (syphilis)

Patients taking isoniazid develop mild aminotransferase elevation within the first few weeks of treatment hepatic injury is typically self-limited and will resolve without intervention what to do next?

continue medication and observe

HIV associated diarrhea has many potential causes CD4, chronicity, and the presense and absence of symptoms of colitis help narrow the differential diagnoses (CD4 < 50 MAC) work up typically involves sending the stool for several tests including?

culture, ova and parasites, acid-fast stain, and clostridium difficile antigen

meningococcal meningitis is a potentially fatal infection that presents with rapidly progressive symptoms (fever, headache, nuchal rigidity, petechiae) over 12-24 hrs what is the empiric treatment if high clinical suspicion ?

empiric vancomycin and ceftriaxone

considered in patients with a liver abscess who have lived of traveled in a developing country liver abscess in those who lived or traveled to developing countries (can occur after ameobic colitis) develop fever, right upper quadrant pain, anorexia, elevated liver enzymes, and leukocytosis ddx? treatment?

entamoeba histolytica infection treat with metronidazole or tinidazole followed by paromomycin to eradicate intestinal colonization

urease producing bacterium that commonly causes urinary tract infections urease generates ammonium, resulting in urine alkalinization (pH>8) this decreased the solubility of phosphate, dramatically increasing the risk of urinary calculi with struvite stones (magnesium ammonium phosphate) ddx?

proteus mirabilis

When patient has syphillis and allergic to penicillin what do you do?

treat with oral doxycycline or IV/IM Ceftriaxone 4-fold decrease in antibody titers at 6-12 months indicates treatment success