(, , )

Virus
HSV, VZV, CMV, EBV

HSV encephalitis
MRI .
: acute onset fever, focal neurologic sx.( temporal lobe)
: -> CSF HSV DNA PCR
: iv acyclovir, oral valacyclovir, famciclovir
 Antiherpetic agent

Drug Target Indication Toxicity

HSV
Acyclovir dGTP kidney
VZV

Famciclovir dGTP HSV,VZV,HBV

Ganciclovir dGTP CMV(retinitis) BM,CNS

Antiinfluenza agent

Amantadine
M2 protein Influenza A mild GI, CNS
Rimantidine

Oseltamivir
Neuraminidase Influenza A GI, airway
Zanamivir

Quiz
1. 60 3 , .
. ? ()
2. 53 3 .
. ? ()

3. 33
. . 38.9 ,
. . () . ?

280mmH20, 13/mm3, 350/mm3( 100%)

123 mg/dL, 64 mg/dL( 113)

4. EBV
()Hodgikin;s disease
()Burkitt's lymphoma
()Infectious mononucleosis
()Nasopharyngeal carcinoma
5. 19 5 . 110/75 mmHg, 110/, 38 ,
. . . ?

22,000/mm3( 25% , 70%, 2%), 11.5g/dL, 160X103/mm3

6. CMV(cytomegalovirus) virus ?

7. 61 , . 39.2 1, 3
, 30 . 9
, cyclosporin . leukocytosis, CMV(+) .
?

8. 65 40 . 3 ,
. .
?

*Influenza vaccination
-50
-
-
-(DM, CKD, Cancer, LC...)
-,
-
-50~64
- 6~23

* : 10~12 : cover !

* : 12 ~ 4
9. Influenza vaccination ?
()
() 50
()
()

Streptococcus Pyogenes
acute pharyngitis in adults - : -
* Diagnosis

2
History of fever
Lack of cough
Tonsillar exudates
Tender anterior cervical adenopathy

* ?
peniciliin : , .
Amoxicillin .
Marcrolide( ~ thromycin) . penicillin allergy
.

Quiz
1. 3 17 . 37.5
. . ?

2. 18 2 . . ,
. 38.2 , . (streptococcus pyogenes)
. ?

3. 37 3 1 . , , .
. . 37.6 ,
. . ?
Rabies

Quiz
1. 12 . ?

2.
()
()
()
()
()

3. 2 , 42 .
. ?
1) 2) 3) 4) 5)

:
:
- virus Hantaan virus(severe Sx.) Seoul virus(mild Sx.)
- (rodent) , (aerosolized)

(5) (2) (4) (-)

fever, chill, ,
Sx. , , , , delirium, , CNS GFR
uremia

face, neck flushing flushing

Sign conjunctiva HR/BT/BP petechiae
petechiae() BP

WBC BUN/Cr < 1.010

, ,
Lab atypical lymphocyte Na K P BUN
, BUN/Cr , DIC
eosinophil ,

Rivabirin

Quiz
1. 28 3 , , . 1
. 130/85mmHg, HR 110/min, 24/min 39.1 .
. 85/45 .
.
: WBC 19,000 Hb 17.0 Plt 30.000
: 1.010 3+ RBC 10~15/HPF WBC 0~1/HPF

- ?
- ?
- ?
- ?
- rale BUN/Cr -> ?
Dengue Fever

**!
** sign!
26 , , . 15 3 ,
. 130/80 104 23 39.5 .
.
. .
- ?
- ?

AIDS

HIV ElISA(anti-HIV) ?

< >
HARRT
Highly Active Antiretrovial Therapy
3
-2NRTIs + 1NNRTI
-2NRTIs + 1PI

CD4
HIV

HIV
- HIV ART
-
-

Quiz
1. 31 AIDS . 1
. . . HIV
. ?

2. AIDS .
?
() HIV
()
()
() 3

3. AIDS .
?

HIV post-exposure prophylaxis

* zidovudine + Lamivudine

4. 44 . CT hemoperitoneum
. anti-HIV antibody (+) ?

Pneumocystis
people at risk for disease
- HIV ( CD4+ cell <200 )
-
- organ TPL
-
- premature malnourished infants

: sputum or BAL
 : TMP-SMX

Fungus
Aspergillus vs Mucormyces

Narrow hype, septated, Y shape Broad hypae, rarely septated



Cryptococcus
C.albicans A.fumigatus Mocormycosis
neoformans

fluconazole S S R R

Itraconazole S S S R

voriconazole S S S R

caspofungin S R S R

Ampho B S S S S

Quiz
1. 20 DM 50 ,
.

- ?
- ?
2. 70 . 400( 30%,
120, 50) . ?

ampgotericin B + flucytosine

3. 15
- ?
- ?

4. 58 . nerogenic bladder foley keep state. V/S 36

. . .
no pyuria, no hematuria, Candida albicans 100,000

- ?

Malaria
Genus Plasmodium
(protozoa)
1. plasmodium falciparum
2. plasmodium vivax
3. plasmodium ovale
4. plasmodium malariae

Vector
Anopheles mosquitoes
( : Anopheles sinensis )

Diagnosis
Thick smear & Thin smear < RBC >
Giemsa stain
1. RBC
2. RIng
3. : schuffner's dots

1. RBC
2. Ring
3. Double Dotted Ring
4. Gametocyte
Malaria Endemic Countries

treatment

DOC Pregnancy

chloroquine- sensitive malaria Chloroquine chloroquine

Radical Tx
primaquine(14days)
for chlroquine
CIx for G6PD def.
P.vivax or P. ovale

Quinine+clindamycin
Atovaquone+proguanil
Chloroquine resistant malaria quinine+clindamycin
Mefloquine
Artemisine derivative
prophylaxis

DOC pregnancy

Chloroquine-senstive malaria chloroquine chloroquine

Mefloquine
chloroquine-resistant malaria Doxycycline Mefloquine
Atovaquone/proguanil

Doxycycline
Mefloquine-resistant marlaria
Atovaquone/proguanil

Quiz
1. 1

2. 45 2 .
. ?

Parasite Infection
- ~