infectious disease final 2
Terms
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- major risk factors for HIV in American females
-
unprotected sex
IV drugs
multiple partners - AIDS leads to _________; must register w/ CDC
- Kaposi's Sarcoma
- AIDS pt w/ mx wasting TX =
- testosterone
- PCP, AIDS have ________ on CXR
- atypical infiltrates (patchy)
- pt with altered mental status w/ HIV can get
- MAC (Mycobacterium avium complex)
- ________ is caused by direct infection of the renal cells with the HIV-1 virus and leads to renal damage through the viral gene products.
- HIVAN
- _________ shows as multiple lesions on MRI
- Toxoplasmosis
- Tx Peripheral neuropathy (sensory) in HIV-infected persons
- amitriptyline
- ___________ is commonly seen as a white lesion on the lateral aspect of the tongue. It may be flat or slightly raised, is usually corrugated, and has vertical parallel lines with fine or thick ("hairy") projections
- Hairy leukoplakia
- Hairy leukoplakia is caused by the ___________ and tx is __________
-
Epstein-Barr virus
oral acyclovir -
CD4 < 500
<200
<100 -
start retrovirals
tx PCP prophylaxis
TX MAC -
_________are nucleoside reverse transcriptase inhibitors with activity against human Immunodeficiency virus
(HIV).
TX 4-6 WKS -
lamivudine
zidovudine
Indinavir- protease inhibitor -
odds of converting from needle stick ________
tx dec. odds by _____ -
1/300
80% - __________was also approved for primary prophylaxis of CMV retinitis in HIV-positive patients
- ganciclovir
- HIV TESTS
- ELISA with Western blot confirmation
- PEOPLE TRAVELING TO AFRICA NEED ________ VAC.
-
YELLOW FEVER
(+ MALARIA) -
SE:
INDINAVIR
DIDANOSINE (DDI)
DELAVIRDINE
NELFINAVIR
STAUVIDINE -
INDINAVIR - kidney stones
DIDANOSINE (DDI)- dry mouth, Hepatic failure; check CBC for anemia and thrompocytopenia, amylase, K+, TGL
DELAVIRDINE - rash
NELFINAVIR - diarrhea
STAUVIDINE - pancreatitis, peripheral neuropathy - CD4 < 500: tx with nucleosidase analogues
- DDI and indinavir
- G6PD _______ is CI b/c of hemolytic anemia
- dapsone
- adults have more persistant _________ than children
- diarrhea
- most common opportunistic infection
- PCP
-
newborn w/ HIV+ mom; test of choice = ____________
___% chance of mother passing HIV to infant -
HIV DNA PCR
8% - <1 yo start anteretroviral b/c dz progresses _________ than in adults
- faster
- _______ is a live vaccine CI in children < _________
-
varicella
<12 mo - _________ is not infectious unless contains gross blood
- saliva
-
_____% convert to HIV
_____% convert to HBV -
0.3-0.5%
6-30% - _____ has inc risk of complications with pregnancy
- HIV
- Chorionic villi sampling 12-16 wks b/c < ______ wks there is no chance of verrtical transmission to fetus
- <20 wks
- Only ________ vaccination may be required by law for international travel
- yellow fever
-
Yellow Fever
This live, attenuated virus vaccine is highly effective and recommended for those traveling to areas in _________ where yellow fever is endemic. - South America and Africa
- _________ is endemic in parts of Asia and Africa, and has returned to South and Central America, where it is a major concern to travelers
- Cholera
- Up to 20% of first-year college students have no serologic evidence of prior measles infection or immunization and must be presumed to be susceptible. Individuals born after 1956 with no physician-documented record of immunization are at greatest risk fo
- measles
- _________ is a ubiquitous problem and is most prevalent in tropical countries. A booster within the past 5 years is recommended
- Tetanus
- ________ remains endemic in some regions of Asia and Africa, and a small, geographically restricted, vaccine-associated outbreak recently occurred in the Dominican Republic and the adjacent area of Haiti. Most young adults have been immunized with at lea
- Polio
- _________ is the most frequent and important vaccine-preventable infection for travelers due to poor sanitation
- hepatitis A
-
____________ is a worldwide disease, but cases in international travelers are infrequent except with prolonged contact with the local population.
Vaccination is recommended for travel to:
northern India, Nepal, and Saudi Arabia during th - Meningococcal meningitis
-
Indian subcontinent,
Mexico,
western South America,
sub-Saharan Africa.
Vaccination is recommended for travel to endemic areas where exposure to contaminated food and water is likely.
Vaccination is also strongly - typhoid
- Special considerations for some should be given to immunization with __________, Japanese B encephalitis, ________, and ________ vaccines
-
hepatitis B
plague
rabies -
Traveler's Diarrhea
The risk is highest when traveling to _______, Latin America, _______, the Middle East, and South Asia.
The average duration of an episode of traveler's diarrhea is 3 to 6 days.
About 10% of episodes last -
India
Africa
low-grade -
Traveler's Diarrhea TX
Bismuth subsalicylate (Pepto-Bismol) prophylactic or Diphenoxylate (Lomotil) loperamide (Imodium)
________, doxycycline, or one of the newer fluoroquinolones reduce the duration of symptoms and are effective against -
Bactrim
Shigella and Salmonella
Prophylactic - activities overseas include exposure to _______(rabies), swimming in _______ water (schistosomiasis or leptospirosis), ________ (hookworm or strongyloidiasis), and insect bites
-
dogs and cats
fresh
walking barefoot - Live virus vaccines are contraindicated in pregnant women, which greatly complicates pretravel preparations. _________ probably can be used safely
- Chloroquine
-
The clinical problems that most often arise in travelers soon after return are _________, whereas ___________is the most common cause for later referral. Fever is most important because delay in the diagnosis of_________is often fatal
Traveler -
fever and diarrhea
eosinophilia
P. falciparum malaria
giardiasis - Giardiasis is a common cause of ____________in returning travelers. Giardia lamblia is prevalent throughout much of the developing world. _________, reflecting the relative frequency of American travelers, is the most common site of Giardia acquisition
-
persistent, nonbloody diarrhea
Latin America -
Like Giardia, _______ is transmitted by the fecal-oral route; the vast majority of infected individuals are asymptomatic.
When causes acute illness, it is generally manifested by bloody diarrhea - Entamoeba histolytica
-
Cutaneous and mucocutaneous _________ (Table 109-1) should be considered in any traveler returning from the Middle East or endemic areas of Latin America who has a persistent skin or mucous membrane lesion.
Diagnosis is made by tissue biopsy. - leishmaniasis
-
This protozoal infection, endemic in Africa, causes sleeping sickness. Rarely imported into developed countries, it should be suspected in systemically ill patients from Africa presenting with fever, headache, and confusion (Table 109-1).
Man -
African Trypanosomiasis
insect bite -
most common cause of heart failure in Brazil. *Transmission:feces from infected reduviid bugs (kissing bugs)
*transfusion-associated in the United States
*Most cases are asymptomatic for decades and then manifest as _________, megaesophagus, or -
Chagas' Disease (American Trypanosomiasis)
cardiomegaly
nitrofuran -
___________is common in the United States (Table 109-2), particularly among children.
________ pruritus is the major clinical presentation.
Infection is maintained by _______ contamination.
Diagnosis is made by the appl -
Pinworm
Enterobiasis
Perianal
fecal-oral
mebendazole - _________(giant roundworm), __________and _________ (hookworm), and __________(whipworms), still endemic in the United States, are extremely common in immigrants and are ubiquitous in the developing world (Table 109-2). Most individuals are asymptomatic.
-
Ascaris
Ancylostoma duodenale
Necator americanus
Trichuris - _____________is a common cause of eosinophilia in returning long-term travelers and immigrants, particularly those from Southeast Asia (Table 109-2). Infection can persist for years; many men who served in the Pacific theater during World War II or in Vi
- Strongyloides stercoralis
- Schistosoma mansoni (Africa, South America, and the Caribbean), S. japonicum (Philippines, China, and Indonesia), and S. mekongi (Cambodia, Laos, and Vietnam) are the most common causes of ________ in the world
- hepatosplenic enlargement
- Wuchereria bancrofti and Brugia malayi cause __________ throughout the tropics (Table 109-2). Patients may present with acute lymphadenitis or asymptomatic eosinophilia. Occasional patients have pulmonary symptoms, infiltrates, and marked eosinophilia (t
-
elephantiasis
ivermectin - _________is endemic in West and Central Africa (Table 109-2). Patients present with transient pruritic subcutaneous swellings. ________ is universal. In the United States, cases are often misdiagnosed for years as chronic urticaria. In rare patients, the
-
Loa Loa
Eyeworm
Eosinophilia
diethylcarbamazine -
____________
Infection with ________ occurs in West and Central Africa as well as in South and Central America (Table 109-2). Although the most severe manifestations occur in the ___, the most common clinical presentation in the United States is rec -
River Blindness
Onchocerca volvulus
eye
pruritic dermatitis
Ivermectin -
______________
The Chinese liver fluke, Clonorchis sinensis, is important to diagnose in ________immigrants.
Symptoms may be confused with those of biliary tract disease. If untreated, infection can lead to ___________.
_____ -
Clonorchiasis
Asian
cholangiocarcinoma
Praziquantel -
______________
The invasive larval form of pork tapeworm is the most common cause of __________ throughout the world, as well as in young adults in Los Angeles, chiefly among immigrants from Mexico. Typically, patients present with new onset of seiz -
Cysticercosis
seizures
ring-enhancing
Praziquantel
albendazole -
Intestinal Tapeworms
Three intestinal tapeworms commonly infect humans: Taenia saginata from raw _______, Taenia solium from raw ______, and Diphyllobothrium latum from raw _______. Most individuals are asymptomatic, but T. solium can cause invasiv -
beef
pork
fish
cysticercosis
vitamin B12
praziquantel -
___________
Commonly manifests as a cystic liver mass in emigrants from sheep-raising parts of the world. Early diagnosis is important, because rupture of the cyst can lead to dissemination. Diagnosis is often suspected from the appearance of the c -
Hydatid Disease
sand