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INFECTIONS TiKi TaKa

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. Isoniazid side effect:
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. Peripheral neuropathy .. Tx: Vit. B 6 (Pyridoxine)
. CEREBRAL TOXOPLASMOSIS:
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. Multiple ring enhancing lesions causing headache & hemiparesis.
. Prohphylaxis = TMP-SMX = Trimethoprim - Sulfamethoxazole.
. Treatment = SDZ-PMT = Sulfadiazine - Pyrimethamine.
. MYCO-BACTERIAL AVIUM "MAV" complex:
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. HIV pt with un-explained fever & cough with CD 4 count < 50.
. AZITHROMYCIN is the best prophylaxis for HIV with MAV.
. FEBRILE NEUTROPENIA:
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. Fever > 38.3 + Neutrophils < 1500.
. Management: Admission + CEFEPIME I.V.
. Mucormycosis:
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. caused by fungus RHIZOPUS.
. require aggressive surgical debridement + I.V. AMPHOTERICIN B.
. ASPERGILLOSIS:
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. Immunocompromized pt. with pulmonary symptoms.
. CXR: consolidation in the upper lobe.
. CT: HALO sign.
. HISTOPLASMOSIS:
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. Pulm. symps.
. CXR: Hilar adenopathy.
. Triad of palatal ulcers + splenomegaly + Thrombocytopenia.
. COCCIDIODIOMYCOSIS:
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. Pulm. symps.
. erythema multiforme or erythema nodosum.
. BLASTOMYCOSIS:
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. Immunodefecient pt. with pulm. symps.
. YEAST :)
. COCCIDIOMYCOSIS:
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. ARIZONA.
. Non specific lung syms + erythema multiforme + erythema nodosum + Arthralgia.
. Any dog bite .. An attempt to capture the dog is tried 1st.
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. If the dog is not captyred .. It is assumed RABID .
. Give post-exposure prophylaxis.
. If the dog is captured .. but doesn't show any features of Rabies .
. Observe for 10 days .
. If it developed any Rabies features.
. Give post-exp. prophylaxis.
. If the bite involves the head & neck.
. Post exposure prophylaxis is indicated IMMEDIATELY.
. Viral (HSV) Encephalitis:
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. Fever + confusion.
. Hemiparesis + Hyperreflexia.
. Cranial n. palsies + focal deficits.
. CSF: ++ ptn , ++ WBCS , ++ Lymphocytes.
. Normal glucose.
. Dx: PCR.
. Tx: I.V. ACYCLOVIR.
. Rt. sided endocarditis:
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. should be considered in pts. with H/O of I.V. drug abuse.
. Tx ----------------> VANCOMYCIN.
. directed against MRSA & Streptococci.
. BABESIOSIS:
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. Tick borne disease.
. Parasite enters the RBC causing hemolysis.
. Symptoms: JAUNDICE .. HEMOGLOBINURIA .. RENAL FAILURE .. DEATH.
. Typical pt: > 40 ys .. without a spleen or immunocompromized.
. LABS: INTRAVASCULAR HEMOLYSIS:
................................ * -- RBCs,--WBCs,--Platelets.
................................ * -- Serum complement.
................................ * ++ ESR, ++ Lymphocytes.
. Dx: GIEMSA stain.
. Tx: ATOVAQUONE - AZITHROMYCIN.
. Any transplant pt. should have TMP-SMX for prophylaxis against (PCP) pnemo-cys
tis carinii pneumonia.
. "AIHI" Auto-immune Hemolytic Anemia is one of the complications of INFECTIOUS
MONONUCLEOSIS.
. Empiric antibiotics for bacterial meningitis:
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. VANCOMYCIN + AMPICILLIN + CEFEPIME + CORTICOSTEROIDS.
. HIV +ve pts are at high risk for T.B.
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. A pt with +ve PPD Tuberculin test i.e. > 5mm induration:
. should have INH (Isoniazid) & Vit.B6 (Pyridoxine) for 9 months as a prophylax
is.
. EHRILICHIOSIS:
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. SPOTLESS RMSF.
. TICK BITE.
. Sysytemic symptoms.
. LEUKOPENIA & THROMBOCYTOPENIA.
. ++ ALT & AST.
. Tx: DOXYCYCLINE.
. ENTERO-HEMORRHAGIC E-COLI:
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. Bloody diarrhea.
. Abd. pain.
. NO FEVER.
. No travel H/O.
. E-Coli = TRAVELER's diarrhea.
. Whenever a health care worker is exposed to HIV:
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. Draw his blood for HIV serology.
. Start anti-retro-viral therapy with 3 drugs without delay
. while awaiting the results of HIV serology.
. HIV pts with CD 4 cell count < 50:
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. require prophylaxis against MAV complex with AZITHROMYCIN.
. CRYPTO-COCCAL meningitis:
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. caused by encapsulated yeast
. HIV pt. with meningitis
. Tx: IV Amphotericin + FLUCYTOSINE.
. Tx of primary syphilis:
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. Single I.M. BENZATHINE PENICILLIN.
. If the pt is allergic to penicillin.
. Give either single dose of AZITHROMYCIN or 2 weeks course of DOXYCYCLINE.
. Lyme dis. pt. if pregnant , lactating or child < 8ys:
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. Don't give DOXYCYCLINE but give AMOXICILLIN.
. Malignant Otitis externa:
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. D.M. pt. with ear pain & granulation tissue at the auditory canal.
. caused by pseudomonas Aeruginosa.
. Recall of a tick bite is not the main stay of the diagnosis of LYME disease ca
used by BORRELIA BURGDORFERI !
. UTI INFECTION:
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. Acidic urine = E-Coli.
. Alkaline urine = Proteus.
. Rash of measles & Rubella r za same ... BUT:
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. Measles is accompanied by KOPLIK's spots.
. Rubella is associated with ARTHRITIS.
. TRICHINELLOSIS:
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. GIT complaints.
. + Triad of ---> Peri-orbital edema + Myositis + Eosinophilia.
. other clues .. Splinter or sub-ungal hemorrhages.
. Actinomycosis:
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. Infection at the neck in a diabetic pt.
. Serosanguinous fluid draining from a defect in the center of the lesion.
. Culture : Gram +ve branching bacteria.
. Tx: I.V. Penicillin.
. Actinomycosis is a bacteria not a fungus so don't ttt it with Amphotericin !!
. Lesion: Slowly progressive non tender indurated mass
. evolving into multiple abscesses with draining sinus tracts.
. with sulfur yellowish granules !
. CMV Pneumonitis !!!!
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. 45 days post Bone Marrow transplant recepients.
. CXR: Multi-focal diffuse patch infiltrates.
. Oral thrush.
. CMV colitis: Abdominal tenderness
. Toxic scock $yndrome:
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. H/O of NASAL PACKING or MENSTRUATION TAMPOONS.
. Fever < 38.9 c.
. Hypotension < 90/60 mmHg.
. Rash & thrombocytopenia.
. Multisystem involvemet (Vomiting & Diarrhea & Myalgia).
. PCP = PNEUMOCYSTIS CARINII PNEUMONIA:
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. HIV pt. with CD4 < 200.
. Non prod. cough, dyspnea, fever, hypoxia.
. Bilateral interstitial infiltrates on CXR.
. Tx: TMP-SMX.
. Use steroids if: PaO2 < 70 mmHg or A-a gradient > 35 mmHg.
. NOCARDIOSIS:
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. Crooked , branching , beaded , gram +ve partially acid fast filaments on micr
oscopy.
. Tx: TMP-SMX.
. Symptomatic CAT scratch disease:
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. Lymphadenopathy & Systemic symptoms.
. Tx: AZITHROMYCIN.
. PSEUDOMONAS AERUGINOSA:
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. Gram -ve bacilli in the sputum of an intubated ICU pt. + fever + leukocytosis
.
. Tx: CEFEPIME (4th g. cephalosporin) or PIPERACILLIN - TAZOBACTAM !
. Ceftriaxone is not effective against Pseudomonas.
. U should STOP it !
. Valvular diseases:
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. MR is the most common valvular abnormality not related to IV drug abuse.
. If IV drug abuser .. TR is the the most common.
. D.M. pts with foot ulcer who developed osteo-myelitis:
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. The route of infection is CONTAGIOUS SPREAD.
. A nail puncture wound resulting in Osteomyelitis in an adult:
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. is due to Pseudomonas Aeruginosa.
. Bacterial Meningitis with meningococcemia:
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. Sudden onset fever + Neck stiffness + Nause + Headache + Myalgias.
. Hypotension + Tachycardia + Myalgia + Purpuric skin lesions.
. CSF findings of BACTERIAL cause:
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** ++ WBCs .. 2000 (N: 0-5).
** Glucose .. 20 (N: 40-70).
** ++ Protein .. 175 (N: <40).
. Lyme disease:
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. is not associated with purpura.
. but associated with erythema migrans.
. with characteristic bull's eye appearance !
. INFLUENZA MANAGEMENT:
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. Most pts with INFLUENZA r ttt with BED REST & SIMPLE ANALGESIA e.g. ACETAMINO
PHEN.
. Anti-viral medications reduce the duration of influenza,
. but they r only effective if administered within 48 hours of the onset of ill
ness. . Amantadine & Rimantadine r only effective against type A.
. Zanamivir & Oseltamivir r only effective against both type A & B.
. INDINAVIR (Protease inhibitor):
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. Anti-retroviral therapy.
. causing high creatinine & hematuria.
. Needle shaped crystals in sediment : causing crystal induced nephropathy!
. BACILLARY ANGIOMATOSIS:
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. caused by BARTONELLA HENSELAE.
. Manifest as several cutaneous & visceral angioma like blood vessels.
. EXOPHYTIC PURPLE SKIN LESIONS.
. I.V. drug abusers r more prone to developing tricuspid endocarditis:
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. caused by STAPHYLOCOCCAL AUREUS.
. Fragments of the vgetation can embolize to the lungs,
. causing the characteristic nodular infiltrate with cavitation.
. PID PELVIC INFLAMMATORY DISEASE :
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. Any PID .. Give .. Chlamydia (Azithromycin) + Gonorrhea (Ceftriazone).
. Any PID pt sh'd be routinely screened for $yphilis .. HIV .. HBV .. PAP smear
.
. 2ry SYPHILIS:
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. Maculo-papular rash involving the palms & soles + Generalized lymphadenopathy
. . Spirochete infection.
. PNEUMONIAS:
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. POST-INFLUENZA ---------------> STAPH. AUREUS.
. HIV---------------------------> PCP.
. D.M. & Alcoholics-------------> KLEBSIELLA.
. C.F. & Bronchiectasis---------> PSEUDOMONAS.
. Atypical $ dry cough----------> MYCOPLASMA.
. Aspiration--------------------> ANAEROBES.
. o"H"io----> "H"ISTOPLASMOSIS:
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. HIV pt with CD 4 cell count <100.
. T.B. like pulm. syms with FHMA & weight loss.
. HEPATOSPLENOMEGOLY + Palatal ulcers.
. CXR: Bilateral reticulonodular opacities.
. Dx: URINE ANTIGEN.
. Tx: ITRACONAZOLE.
Dr. Wael Tawfic Mohamed
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