Step Up: infectious diseases II

• Fever, night sweats, weight loss
• Lethargy, headache, myalgias
• Diarrhea
• Sore throat
• Lymphadenopathy
• Maculopapular rash on the trunk

• Two nucleoside reverse transcriptase inhibitors, plus-
• Either a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor
• Test viral load to monitor response to treatment

• Seen in AIDS, or other IC patients
• Presents with signs of a mass lesion (headache, focal deficits) plus signs of encephalitis (fever, altered mental status)
• CT scan shows at least 3 contrast-enhanced lesions in the basal ganglia and subcortical white matter

When the CD4 count drops below 200 or if the patient has a history of oropharyngeal candidiasis`

HSV-1

• HSV infection of the finger, caused by direct inoculation into open skin surface
• More common in health care workers
• Manifests with painful, vesicular lesions at the fingertip, plus fever and axillary lymphadenopathy
• Treat with acyclovir, NOT incision and drainage

• Maculopapular rash, 4-8 weeks after chancre heals
• May also involve flu-like illness, aseptic meningitis, and hepatitis

In SLE patients

Chancroid, H. ducreyi

Damage to lymphatics

• Group A strep
• Staph aureus

• Venous stasis
• Lymphedema
• Diabetic ulcer

• Cellulitis confined to the dermis and lymphatics, usually caused by group A strep (e.g. strep pyogenes)
• Manifests with red, painful, well-demarcated lesions on the legs and face
• May involve chills and fever

• Strep pyogenes
• Clostridium perfringens

• Gram positive anaerobic bacillus
• Produces an exotoxin that blocks inhibitory NTs at the NMJ
• A classic early symptom is trismus (contraction of the masseter, lockjaw)

• Respiratory support, diazepam for tetany
• IM tetanus Ig to neutralize free toxin
• Tetanus/diphtheria toxoid
• Metronidazole or penicillin G

Pseudomonas or fungi

Salmonella

• Staph aureus
• Staph epidermidis

• Osteomyelitis of the vertebral bodies
• Caused by TB

Used to monitor response to therapy

• Needle aspiration or bone biopsy (X-ray isn't enough because changes aren't visible until about 10 days)
• MRI

• Staph aureus
• N. gonorrhea
• P. aeruginosa or salmonella in IVDA, sickle cell, or immunodeficiency

• Swelling, heat, and pain in the affected joint
• Severely limited range of motion
• Systemic symptoms such as fever and chills

• Erythema migrans, Lyme disease
• Multiple lesions indicate hematogenous spread

• Flu-like symptoms, headache, fever, neck stiffness, etc
• After several weeks, 15% of patients develop-
• Meningitis (with negative Brudzinski's and Kernig's signs)
• Encephalitis
• Cranial neuritis (bilateral Bell's palsy)
• Peripheral radiculoneuropathy
• Some patients develop cardiac manifestations (AV block, pericarditis)

• Sudden onset of fever, chills, nausea/vomiting, photophobia
• Papular rash after 4-5 days of fever that begins peripherally, spreads centrally, and includes the palms and soles
• Interstitial pneumonitis is a possible manifestation

• Constant fever--falciparum
• Fever spikes ever 48 hours--vivax or ovale
• Fever spikes every 72 hours--malariae

• Chloroquine or quinine and tetracycline if chloroquine resistance is suspected
• Two weeks of primaquine if infection is vivax or ovale, which have dormant hypnozoites in the liver

Amphotericin B or fluconazole

• A type I hypersensitivity reaction to to aspergillus
• Presents with asthma and eosinophilia
• Recurrent exacerbations are common

• Caused by inhalation of spores into the lung
• Presents with chronic cough and possibly hemoptysis
• Increased risk with sarcoidosis, histo, TB, and bronchiectasis

• Occurs when fungal hyphae invade lung vasculature
• Causes thrombosis and infarction
• Presents with acute onset of cough, fever, and diffuse bilateral pulmonary infiltrates
• Seen in IC patients (leukemia, transplant recipients, AIDS)

• Definitive diagnosis with tissue biopsy, but positive sputum sample in a patient with symptoms is good enough
• Blood cultures are not useful because they are rarely positive

IV amphotericin B, voriconazole, or caspofungin

Ohio and Mississippi river valleys

• Severe, watery diarrhea in an IC host
• Diagnose by oocytes on stool sample

• Fecal-oral route
• Bloody diarrhea with tenesmus, abdo pain, and maybe liver abscess
• Diagnose by trophozoites on stool sample
• Treat with indoquinol or paromomycin (metronidazole for liver abscess)

• Chronic, water diarrhea
• Seen in daycare children or campers

• Trematode, causes urinary tract granulomas
• Bladder polyps, dibrosis, and dysuria

Fever over 38.3 for at least 3 weeks with no working diagnosis, despite at least 1 week of inpatient workup/three outpatient visits

• Infectious (most common--TB, abscess, UTI, endocarditis, sinusitis, HIV, viral, malaria)
• Neoplastic (especially Hodgkin's)
• Collagen vascular disease
• Sarcoidosis, Crohn's
• Drugs PE
• Hemolytic anemia
• FMF
• Gout
• Subacute thyroiditis

• Sulfonamides
• Penicillin
• Quinidine
• Barbiturates
• diet pills with phenolophthalein

• Chills--sensation of cold, often with shivering
• Rigors--severe form of chills with pronounced shivering and teeth chatterin

• CBC
• Urinalysis
• Cultures (blood, sputum, urine, CSF, stool)
• Complement assay
• PPD (if TB is on the DD)
• LFTs, ESR, ANA, rheumatoid factor, TSH
• Imaging

Staph aureus enterotoxin or group A strep exotoxin

Drugs, toxins, hematologic malignancy/bone mets, hypersplenism, SLE, AIDS

• Septicemia
• Pneumonia
• Cellulitis

Posterior cervical

Lymphocytic leukocytosis with atypical lymphocytes

To rule out secondary infection with beta-hemolytic streptococci

CMV (EBV mono does have a positive monospot test)

• Hepatitis
• Neuro complications (Guillain-Barre, meningoencephalitis, Bell's palsy)
• Splenic rupture (avoid contact sports)
• Thrombocytopenia/hemolytic anemia
• Upper airway obstruction, due to lymphadenopathy