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Septic arthritis
Bacteremia of one joint
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S/s septic arthritis
- Swelling, loss of ROM, joint warmth, tenderness
- Fever
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Dx septic arthritis
Sample synovial fluid
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To septic arthritis
Treat with abx IV 2 weeks, then oral
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Osteomyelitis
- Infection in the bone
- WBC may be elevated
-
Most common cause of osteomyelitis
Usually staph aureus (MSSA or MRSA)
-
Dx septic arthritis
U/S or MRI, bone biopsy
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S/s Acute osteomyelitis
pain, loss of ROM, soft tissue swelling. Weeks of abx
-
S/s Chronic osteomyelitis
malaise, night sweats, anorexia, fever, bone necrosis and instability. Months of abx
-
Trichomoniasis infects
Vaginal / lower urinary tract infection in females, GU tract in males
-
S/s trichomoniasis
- Malodorous frothy yellow or green discharge,
- vaginal erythema, red macular lesions on cervix
-
Dx trichomoniasis
wet mount
-
Treat trichomoniasis
One dose of metronidazole
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HPV
- 77 types, there?s a vaccine for most common ones
- Causes warts: palmar, plantar, genital
- Histology & DNA
-
Herpes simplex
Lesions on mouth (type 1) or genitals (type 2)
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HSV Can reactivate when
- Stress
- UV exposure
- Menses
- Fever
-
S/s HSV
Fever, anorexia, gingivitis
-
Dx HSV
culture vesicular fluid
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Chlamydia
Intracellular parasite
-
Chlamydia Causes
- Women: PID, cervical inflammation, infertility
- In men, urethritis, proctatitis, rectal stricture.
-
s/s chlamydia
Evanescent genital lesion, lymph node enlargement
-
Dx chlamydia
Negative gram stain, confirmed by DNA amplification
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To chlamydia
- Azithromycin
- Erythromycin
- DCN
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Syphilis
- Spirochete
- Sexually transmitted or via placenta
-
s/s syphilis
- Painless ulcers
- Can have secondary lesions in kidneys, liver, eyes, bone
- Late stage: CNS
-
Dx syphilis
Immunofluorescence, serology
-
Tx syphilis
Benzathine PCN one IM dose
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Gonorrhea
15-29 year olds primarily
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s/s gonorrhea
- Men: burning on urination, milky/creamy/bloody discharge
- Women: if symptomatic, disurea w/urinary urgency, urethral discharge, vaginitis
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Dx gonorrhea
Negative gram stain, Need to get cultures
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Tx gonorrhea
DCN or azithromycin, oral cefixime or IM ceftriaxone
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Influenza
- 3 strains, can be epidemic or pandemic
- Droplet nuclei, worst Dec-Mar
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Influenza incubation
8-72 hr, usually two days
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Influenza Contagious
from day before until 5 days after symptoms resolve
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s/s influenza
Fever, chills, myalgia, malaise, Cough, wheezing in bronchi, substernal chest pain
-
Dx influenza
Viral cultures, rapid antigen test, CXR
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Tx influenza
neuraminidase inhibitors, symptomatic relief
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Histoplasmosis
Soil fungus, bat/bird droppings
-
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Histoplasmosis s/s
- Mild: fever, cough, dyspnea, weight loss
- Possible ulcers in mouth, pharynx, liver, spleen
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Lab results histoplasmosis
Blood work could show pancytopenia, anemia, ^LDH, ^ferritin
-
Tx histoplasmosis
Itraconazole or amphotericin B
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Rhinovirus
- Common cold, 4-9 days
- myalgia, sneezing, congestion, sore throat
- No testing needed
- Symptomatic relief
- Can exacerbate COPD, asthma
- Can develop sinusitis, otitis medi
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Tuberculosis
- Aerosolized transmission
- Common in large confined populations
-
Progression of TB
Dry cough, progresses to productive, progresses to hemoptysis
-
TB s/s
Pleuritic chest pain, tachycardia, weight loss, night sweats
-
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Treat TB
/RIPE, isolation
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Haemophilus influenzae
Causes secondary bacterial PNA
-
s/s h. Influenzae
Fever/chills, SOB, typically with OM, sinusitis, epiglottitis
-
-
Tx h. Influenzae
amoxicillin
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Coccidioidomycosis
Valley fever, southwestern states and Mexico, soil dwelling fungus
-
High risk coccidioidomycosis
HIV pt, Filipinos, blacks
-
s/s coccidioidomycosis
Fever/chills, cough, night sweats, fatigue
-
Blood work coccidioidomycosis
leukocytosis, eosinophilia
-
Dx coccidioidomycosis
- CXR: mediastinal lymph node enlargement, patchy nodular upper lobe infiltrates
- Tx coccidioidomycosis
- Fluconazole, Amphotricin
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What is used to treat syphilis?
- Benzathine penicillin, one IM dose
- Three weekly injections for latent or tertiary
-
Jarisch - Herxheimer
- Reaction to treatment of spirochetal infections
- Fever, headache, myalgia
- Give antipyretic and caution pt
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How to test for syphilis?
- Doesn?t grow on culture
- Nontreptonemal antigen test,
- Possible False positives tested with treptonemal antibody test
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How to know when syphilis is cured
Four-fold decline in non-treptonemal test
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Causes of false positive on syphilis nontreptonemal test
- Lyme dz
- Autoimmune disorder/Lupus
- Pregnancy
- Viral infection
- Malaria
- Leprosy
-
Chancre
- Painless ulcer
- Rolled edges
- Ulcerated
- Punched out
-
Rash suggestive of syphilis
- Macular, copper-colored
- Followed by red papular rash on palms and soles
-
Argyll Robertson pupil
- Accommodate to near
- Non-reactive to bright light
-
Ocular indications of syphilis
- Argyll Robertson pupil
- Uveitis
- Neuroretinitis
- Interstitial keratitis
- CSF normal ~ 50%
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When to screen pregnant women for syphilis
- 1st visit
- 28-32 weeks
- @delivery
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Chlamydia symptoms women
- Often asymptomatic
- Transient vesicular lesion
- Cervicitis, abnormal bleeding
- Change in vaginal discharge
- PID
- Cervical motion tenderness
- Tenderness on abdominal palpation
-
Complications of chlamydia
- Risk of future ectopic pregnancy
- Can cause infertility
-
Chlamydia s/s men
- Watery penile discharge
- Transient vesicular lesion
-
Fitzhugh-Curtis Syndrome
- Inflammation of liver capsule
- RUQ or pleuritic pain
- Liver function tests usually normal
-
How to diagnose chlamydia
- Clinically
- DNA amplification if confirmation needed
-
Treatment for chlamydia
- Erythromycin - esp for pregnant women
- DCN
- Azithromycin
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Complications of chlamydia in men
- Epididymitis
- Prostatitis
- Dysuria, painful ejaculation, pelvic pain
- Rectal pain, discharge, pressure
- Conjunctivitis
- Reactive arthritis
-
Reiter syndrome
- ?Can?t pee, can?t see, can?t climb a tree?
- Arthritis
- Uveitis
- Urethritis
-
Trichomonas infects
- Females: Skene gland, vagina, lower urinary tract
- Males: genitourinary tract
-
Symptoms of trichomonas in women
Malodorous frothy green/yellow vaginal discharge
-
How to diagnose trichomonas
Wet mount - motile flagellates
-
Treatment for trichomonas
Metronidazole
-
Lymphogranuloma venereum
- Vesicular or ulcerative lesion
- Spreads to lymph nodes
- Inguinal buboes
- Breakdown of buboes cause draining sinuses and scarring
-
Anorectal disease from lymphogranuloma venereum causes
fistula, discharge and tenesmus
-
Diagnosis of lymphogranuloma venereum
nucleic acid amplification test
-
How to treat lymphogranuloma venereum
- One gram azithromycin
- Or DCN bid x 7 days
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Gonorrhea incubation period
2-8 days
-
Complications of gonorrhea in women
- Urethritis
- Cervicitis
- Chronic pelvic pain
- PID
- Infertility
- Ectopic pregnancy
-
Symptoms of gonorrhea in men
- Urethral pain
- Milky/bloody penile discharge
- Can spread to prostate and epididymis, causing urethral strictures and prostatitis
-
Symptoms of gonorrhea in women
- Usually asymptomatic
- Purulent urethral discharge
- Dysuria, urinary frequency/urgency
-
Best way to diagnose gonorrhea
Nucleic acid amplification test
-
How to treat gonorrhea
- Multi drug resistant
- One dose of IM ceftriaxone 250 mg
- Treat for chlamydia as well
-
Erythema marginosum: rheumatic fever, carditis, polyarthritis
-
Erythema migrans: Lyme disease
-
Exam signs of trichomonas
Diffuse erythema on vagina and red macular lesion on cervix
-
Endocarditis signs/symptoms
- Febrile
- Pallor
- Regurgitation murmur, stable
- Osler nodes
- Roth spots
- Janeway lesions
- Petechiae: palate, conjunctiva, subungual
- Splinter hemorrhage
- Splenomegaly
- Symptoms can be nonspecific
-
Tests for endocarditis
- echocardiography
- 3 sets of blood work, 1 hr between each, before abx
- CXR might show diffuse infiltrates
-
Osler nodes
Painful papular Purple polka dots on the phalanges
-
Janeway lesions
Painless red lesions on the palms and soles
-
Roth spots
Exudative retinal lesions
-
Transmission risks for endocarditis
- ?Teeth and tubes?
- Dental surgery
- Invasive procedure of
- upper respiratory
- GI
- Urologic
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Minor signs of endocarditis
- Immunologic response
- Vascular issue
-
Causes of endocarditis
- Staph aureus - IVDU, prosthetic heart valve
- Strep viridans
- Enterocci
-
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-
-
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Janeway lesions: endocarditis
-
Osler’s nodes: endocarditis
-
Complications of measles
- Encephalitis
- pneumonia
- death
-
s/s of measles
- Fever, dry cough,
- spreading rash,
- runny nose, conjunctivitis
-
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s/s of mumps
- Fever, fatigue
- headache, myalgias
- swollen salivary glands
-
S/s of pertussis
- Runny nose
- severe cough
- apnea
-
complications of pertussis
PNA, death
-
-
S/s tetanus
- Fever
- muscle spasms
- difficulty swallowing
- neck and abdominal muscles
-
-
Ddx EBV vs CMV
- EBV:
- longer fever, exudative pharyngitis, heterophile +
- CMV: profound fatigue, rash, night sweats
-
mumps w/o parotitis
dx w/buccal swab and blood specimen
-
three C's of measles
- Cough
- Coryza
- Conjunctivitis
-
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Epstein-Barre Triad
- lymphadenopathy
- fever
- pharyngitis w/ exudate
-
risk factor for measles
Vitamin A deficiency
-
CMV rash vs measles
- measles: rash followed by very high fever
- CMV: fever throughout
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Rubella lymphadenopathy vs CMV
- rubella: occipital
- CMV: cervical
-
roseola fever vs measles fever
- roseola: fever is before rash,
- measles: rash is before fever
-
lymphoma sign
fixed, nontender lymph nodes
-
-
CMV s/s
- Profound fatigue
- nonspecific rash
- cervical lymphadenopathy
- night sweats
-
rubella s/s
- occipital lymphadenopathy
- arthralgia
- eye pain on movement
- petichial lesions on uvula
-
Fordyce spots
peticheal lesions on uvula
-
aftercare for EBV
avoid contact sports for 6-8 weeks
-
EBV management
- self-limited
- give supportive care/antipyretic
-
which rashes are pruritic?
varicella, measles, roseola, fifth
-
which heart valve is most often affected by rheumatic heart disease
mitral valve
-
purulent vs pruritic
- purulent: pus
- pruritis: itching
-
risk factor for rubella
foreign born
-
contagion period of measles
5 days before rash -> 4 days after
-
name of the measles virus
morabilli virus
-
Koplik's spots
- 48 hours prior to rash
- white lesions clustered opposite the molars
-
measles rash and fever
very high fever, then 2-4 days later rash
-
measles rash begins on the
face and spreads to the trunk and extremities
-
measles rash and cough
cough lasts 1-2 weeks after measles
-
Rubella communicable
one week before and one week after rash onset
-
rubella lymphadenopathy
occipital
-
measles rash vs rubella rash
- measles: coalesces
- Rubella: remains distinct
-
rubella is caused by what
virus B19
-
third vs fifth disease
- Third: Rubella, German measles
- Fifth: slapped cheek
-
roseola rash vs rubella rash
roseola: nonpruritic, high fever, coalesces
patchy itchy
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