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Disease

Mononucleosis-like
Syndromes

Bug

Infectious Mononucleosis
(EBV)

EBV

Acute CMV Mononucleosis

largest virus to infect humans

Primary/Acute HIV (Acute


retroviral syndrome)

Acute Toxoplasmosis
-also see
toxoplasma encephalitis

Toxoplasma gondii (protozoa)

Cat-Scratch Disease

bartonella henselae - BART


THE CAT

Geographic Outside US
Hepatitis A

typhoid fever

Salmonella Typhi

Malaria

Plasmodium species:
-P. Vivax
-P. Ovale
-P. Malariae
-P.
Falciparum

Dengue virus

Dengue Virus
4 serotypes, infection with
each one gives immunity to
only that serotype, so at most
4x you can get infected with
dengue. After first infection
higher risk of dengue
hemorrhagic fever (DHF)

Chikungunya virus

king kong grabbing his painful


joints

Yellow Fever

flavivirus

Rickettsia Africae
Leptospirosis

spirochete

Leishmania
Chagas (american
tripanozomiasis)

trypanozoma cruzi

African Trypanosomiasis
Rabies

rabies virus

Ebola

ebola virus

Zoonosis
cat scratch Dz / Bartonella
see above
Henselae
Plague / Yersenia Pestis
Brucellosis
Tularemia
Rickettsiae Ricketsii
Ricketssiae Typhi
Ricketssiae Prowazekii
Q-Fever / coxiella Burnetti
Hantavirus
Human LCM
(lymphochorionic
meningitis)

Brucela; G(-); facultative


intracellular
Francisella Tularensis
R. Ricketsii (RMSF)
R. typhi (endemic)
R. Prowazekii (epidemic)
"atypical Rickettia" but not
actually rickettsia

ssRNA virus

West Nile Virus


Psittacosis
Geographic US Infections

chlamydophila psittaci

Rickettsia Rickettsii
Ehrlichia Chaffeensis

weakly G(-)
G(-)

Anaplasma phagocytophilim G(-)

Lyme / Borrelia Burgdorferi spirochete


blood protozoa
Babesia
Mycosis: Histoplasma
Capsulatum
Mycosis: Blastomyces
Dermatitidis
Mycosis: Coccidiodes immitis
Paracoccidiomycosis

opportunistic HIV I/II


strep pneumo

PCP

pneumocystis Jeroveci

MTB

MAC (Mycobacterium Avium


Complex Intracellulare /
Avium)
Candida
Diarrhea in HIV

Cryptosporidium; Isospora,
cyclospora ,microsporidiosis

CMV

cryptococcal Meningitis

cryptococcal neoformans; a
yeast
-Has capsule

toxoplasma encephalitis

toxoplasma gondii (protozoa)

EBV
primary CNS Lymphoma
PML
(progressive
JC Virus
multifocal
lymphadenopathy)
HHV-8
Kaposi's Sarcoma

Bacillary Angiomatosis
HPV

bartonella hensalae

Influenza Lecture

8 RNA segments,
hemaglutinin, neuraminidase,
protein M2;

Influenza A
Influenza B
Influenza C
H1N1

spanish flu (8 million died)

H5N1

avian flu;

swine flu
SARS
MERS
Opportunistic in NON-AIDS

H1N1
coronavirus
coronavirus

humoral immunodeficiency
Primary immunodeficiencies (Immunoglobulin
deficiency)

T-cell/combined
immunodeficiency

Secondary
immunodeficiencies

chronic

Immunomodulators
Infection

Skin Manifestations from


infectious diseases
Maculopapular

Erysipelas is upper dermis


and superficial lymphatics
-cellulitis:
deeper dermis and subcut fat

Crusty Lesions
Faruncle
Caruncle

Impetigo: superficial bacterial


infection; staph A., topical
therapy
one follicle
multiple follicles and multiple
drainage sites

Vesiculo-bullous lesions
HSV

acyclovir gets phosphorylated


by thymidine kinase, but if
patient has mutation then
drug doesnt work on them.

Varicella Zoster virus

Vibrio Vulnificus

G(-) Rod

Petechiae-Purpura
Necrotizing Faciitis
Meningococcemia
Disseminated gonnococcal
nisseria gonnorrheae
Dz.
Rocky mountain spotted
fever
infective endocarditis
Capnocytophaga
canimorusus
Macular Rash

Strep, enteroocci, S Aureus

DOG BITES

Eschar

skin falls of thats dead.

syphilis

spirochete treponema pallidum

Infectious Diarhheal Illness


Traveler's diarrhea

Bacterial causes

parasitic

viruses

Invasive Diarrhea
Non-invasive
viral Enteritis
Food-Poisoning
S. Aureus
Clostridium Perfringens
bacillus cereus
Diarrhea
Noninvasive

Entamoeba Histolytica
(anaerobic protozoa)
giardia
Norovirus
Rotavirus
short incubation
incubation 6-14, preformed
toxin, watery diarrhea, no
vomiting
reheated rice, short incubation
Enterotoxigenic E. Coli
Enteroaggregate E. coli
Diffusely adherent E. Coli

Dysentary/Invasive
Shigella
Salmonella
Shiga-Toxin E. Coli (EHEC)
Campylobacter
C. Difficile\

epi

Methods of Spread

90-95% of adults have


serology, and 50% get it by
age 5.
-Usually
higher class people

Usually don't know. Saliva?


Lives in B-cells. 10-20%
Shed virus in throat

60-70% of US cities have it.


-most
common cause of
heterophile-negative mono

unclear (kissing/sex, blood


transfusions)

CATS poop oocysts that


sporylate/become
infectious in 1-5 days and
you eat spores. No need to
touch the cats

global

domestic/ wild CATS from


cat flea vector. "Kitten
scratches you"

fecal-oral route or
contaminated food/water

South asia (India, Pakistan)

Anopheles mosquitos
(nocturnal)

everywhere

africa/asia/mediterranean
basin

Aedes Aegypti
mosquito (during the
day)

Aedes Aegypti
mosquito (during the
day)
Aedes Aegypti
mosquito (during the
day)
TICKS saliva in AFRICA
urine of dogs and other
animals

SAND FLY

Kissing Bug (riduviig bug)


Tse Tse fly
saliva/brain
WEST AFRICA

infected blood/body fluids,


needles, infected
bats/primates

flea bite from prairie dogs


MOST WIDESPREAD,

farm animals and


unpasteurized milk
RABBITS-->tick bite

endemic
epidemic

Tick
Lice
Fleas
Aerosol; livestock and pets
and parturient animals
cotton wool mice
rodents to lab workers or
transplant recipients.
Inhaling poop

LATE SUMMER
pigeons

southeast (NC)
North carolina

lone-star tick, American


dog tick

north carolina, rare rash

deer tick (ixodes),


american dog tick

most common pneumonia in


AIDS

premature/malnourished
children WWII

kills 1/2 of HIV pt's

Its EVERYWHERE.

virus is in 80% of adults

antigenic drift = still


recognized by body but
changes (what happens
H(1,2,3,5,7,9) and N(1,2)
yearly)
affect humans
-Antigenic Shift:
completely different and
causes outbreaks/pandemics
EPIDEMICS

infects humans, horses,


pigs, birds, etc; SEASONAL

slow mutation rate

Humans only

humans and swine; local


epidemics but no pandemics
no human-human
transmission, just chicken
to human
in pigs

protein-losing states
meds that cause
hypogammaglobulinemia

spreads person-to-person
not from pigs to human, so
its a misnomer

(nephrotic syn,
gastroenteropathies)
anticonvulsants,
sulfazalasine, rituximab

males, defect in "bruton's


x-linked gammaglobulinemia tyrosine kinase" causing
decreased all Ig's.

hype-IgM Syndrome

a misnomer bc IgM is
normal but IgA,G,E are all
deficient.
-its b/c CD40Ligand
deficiency

Common variable
Immunodeficiency

decreased all Ig's, no


defects

Severe Comined
Immunodeficiency (SCID)

B and T cell defect

wiskott aldrich

eczema and
thrombocytopenia

ataxia-telangectasia
di-george syndrome

diabetes, chronic kidney dz,


elderly, malnutrition
splenectomy

lose 25% of phagocytosis

malignancy

from lymphoid tumors:

cytotoxic chemo malignancy

chemo therapy gives you


profound neutropenia

transplant patients
strep pneumo
Rhino-cerebral
mucormycosis

mucorales fungi like


Mucor, rhizopus

Otitis externa

psedomonas aeruginosa

vibrio vulnificus

G(-) rod,

Staph Scalded skin


syndrome: superficial
blistering; rash then
blistering

humans the only reservoir;


spread by droplets;

Raw Shellfish/oysters

patients without spleen

give amox+Clav

burns, brown recluse spider


bite, pseudomona,
cutaneous anthrax, invasive
fugus

Test primary infection using


dark field microscopy.
After Treatment VDRL will
screen using VDRL test,
go down, but FTA-ABS will
which has high false positive
stay (+) for life
rate. If positive, confirm
Dxusing FTL-ABS.

enterotoxigenic E. coli,
campylobacter, shigella,
salmonella

most common when


traveling

giarda intestinalis,
cryptosporidium parvum,
cyclospora cayetanensis,
entomoeba histolytica,

subacute presentation

rotavirus, norovirus

most common when at


home
contaminated water

cruise ships
children

sketchy
sketchy
mild dz, hemorrhagic colitis, DONT GIVE
HUS
ABX/ANTIMOTILITY

Pathogenesis

4 serotypes, infection with each one


gives immunity to only that serotype,
so at most 4x you can get infected with
dengue. After first infection higher risk
of dengue hemorrhagic fever (DHF)

inhale poop

infects MACROPHAGES

infects GRANULOCYTES

Capsule causes it to get trapped in


CSF = hydrocephalus

REACTIVATION not primary


high-grade B-cell lymphoma.
infection of oligodendrocytes;
demyelinating syndrome
infection of vascular endothelium

Needed for spreading:


(1) animal to human
(2) Human to human
(3) severe enough
to kill but kill slowly to allow spreading

Diagnose by seeing that there's no


response to vaccines. Babies with it get
recurrent sinopulmonary infections;

Sx = Lymph node hyperplasia

Dx b/c no response to vaccines

Sx = chronic diarrhea, severe infections

pneumococcus, N. meningitidis,
babesia, malaria, capnocytophaga
canimorusus, Strep Pneumo
Hodgkin's lymphoma (t-cell deficiency)
chronic lymphocytic leukemia (B-cell
deficiency)
this can lead to aspergillus and
Pseudomona

non-septate mold branching 90


swelling/pain/erythema of auricle,
purulent discharge, can cause basilar
skull osteomyelitis
from food or warm ocean water

replicates in nasopharynx

sepsis leads to disseminated


intravascular coaguation, so clots are
forming in all your vessels.
arthritis, dermatitis, tenosynovitis
syndrome, with some hemorrhagic
pustules
janeway lesions = PAINLESS
hemorrhagic macules
-osler's nodes = PAINFUL
purpuric nodules;
-splinter
hemmorhages

Symptoms
Fever, lymphadenopathy, pharyngitis, Fatigue

Fever-76, Sore throat-84, Lyphadenopathy


(94%), splenomegaly-52, hepatomegaly-12,
jaundice-10, rash-10
-complications: autoimmune hemolytic
anemia, splenic rupture, encephalitis, death
rare.

host can be normal (no disease, congenital is


frequently fatal, young adults with CMV
mononucleosis)
-Immunocopromised host
(transplant),.
- Primary Infection Looks
like IM but no abnormal L
-AIDS pt's get retinitis
and encephalitis and esophagitis or colitis
Onset of illness 1-6wks after exposure
-fever-96, adenopathy74,pharyngitis-70,rash-70,myalgia54, etc
5 clinical situations:
1. normal host,
2. primary/reactivation in
immunocompromised
3. ocular dz,
4. pregnant,
5. congenital dz
10-20%
have symptomes but usually benign cervical
lymphadenopathy no pharyngitis fever ,
-mono-like syndrome (fever malaise
pharyngitis splenomegaly), can have
chorioretinitis,
-rarely disseminated dz (heart,liver,
brain)
-congenital ONLY IF MOTHER HAS
PRIMARY infection during pregnancy.
Intracerebral calcifications, hydrocephalus,
chorioretinitis

Big enlarged Lymph node; low grade feverm


malaise, sore throat
-Atypical CSD: perinaud's oculoglandular
syndrome = conjunctivitis, ; granuloatus
hepatitis, atypical pneumonitis,
encephalopathy, FUO5

abrupt onset of fever malaise, anorexia,


nausia, vomiting. Followed by dark urine +
jaundice. Never becomes chronic
acute, life-threatening febrile illness (103-104),
headache, malaise, anorexia, splenomegaly,
rash (faint/transient),fever-heart rate
association
FEVER, headache, malaise; incubation 7d to
months.
-complications: anemia, renal
failure, siezures, death
-P. ovali/vivax has
liver hypnozoites (primaquine)
-P.
Falciparum severe life-threatening cerebral
edema
Viremia phase: 1wk, FEVER flushing of
face/neck, goes away.
-Critical Phase: fever GOES AWAY, HCT
GOES UP, ascites, liver enlarges, severe
abdominal pai.
-If Recovery phase:
confluent rash rash with islands of normal
color on lower extremities -If Convalescent
phase: improvement
fever, arthralgia, similar to dengue. Self
limited
early phase: fever, headache, chills, back pain,
anorexia, nausea vomiting
Toxic phase: liver
failure/jaundice
rash, but benign condition

visceral vs. cutaneous


Visceral look
for a kid with a ton of ascites. Cutaneous look
for a big pizza lesion or face falling off.
Acute self limited
-chronic = dilated
cardiomyopathy, megaesophagus,
megacolon
encephalitis
hemorrhagic fever

Bubonic Plague = Lymph nodes, Pulmonic


plague = rapid pneumonia, Septicemic Plague
= blood

centripetal; Rocky Mountain Spotted Fever


centiriphugal; Endemic typhus
centriphugal

NO RASH

fever, myalgia, cough, SOB

ENCEPHALITIS; fever confusion, disorientation,


seizures ataxia, coma, paralysis

fever, headache, malaise, myalgia, rigor,


nausea/vomiing, RARE RASH but if so its
MACULOPAPULAR (not petechial like RMSF)
fever, headache, malaise, myalgia, rigor,
nausea/vomiing, RARE RASH but if so its
MACULOPAPULAR (not petechial like RMSF)
Stage 1: (Localized) erythema migrans ,
TARGET LESION;
-Stage 2: (disseminated) fever, AV-NODAL
Block, mononeuritis, hepaititis,
ophtlamus

fever, nonproductive cough, progressive


dyspnea, fever chills

wt loss, fever, night sweats


-Primary TB: pleural effusion,
Lymphadenopathy, lower lobe consolidation,
no cavitation
-post primary TB: cavitation
in upper lobe
- Miliary pattern
CXR = disseminated suggests PCP; normal
CXR or can be "reticular bilateral infiltrate"
-extrapulmonary = other LN's, marrow, CNS,
fistula, Pott's disease = TB osteomyelitis

scrapable off tongue;


thrush and esophagitis

Esophagitis (dysphagia, odynophagia, ulcers);


Colitis (ab pain, tenesmus, bloody stools,
friable mucosa)
hydrocephalis, headache, nuchal
tenderness, fever. headache, fever,
meningismus, cranial nerve abnormalities (IV
palsey),
focal neurological deficits, seizures, brain's not
working, personality changes

focal neuro deficits

vascular proliferation

Often causes 2 staph A. pneumo

60% chance you die from it

Tx: immuneglobulin replacement

Tx: immuneglobulin replacement

Tx: hematopoietic stem cell transplant

strep neumo also meningitis, otitis media,


pneumonia, sepsis, splenectomy

EMERGENCY SURGERY
Treatments for Pseudomona: Aztreonam,
carbapenem, ceftazadim, cefepime, levo
aminoglycosides, paparicillin, vanco
rapid cellulitis but no diarrhea

primary: chickenpox
reactivation = herpes zoster (usually
elderly/immunosuppressed)
-unusual manif: disseminated, herpes
zoster opthalmicus can make you blind,
Ramsay hunt syndrome (geniculate ganglion
and vesicles in external auditory meatus, loss
of taste in ant 2/3 )
fever, hypotension, SEVERE CELLULITIS ,
infection of subcut tissue
type 1 = mixed aerobic/anaerobic, Type II Strep
pyogenes

acute presentation

nausea vomiting;

Dx
Hematologic labs: Atypical lymphocytes
-serology: Ab's to EBV
-liver
enzymes mildly elevated
-heterophile antibodies (heterophile test)
o -VCA-IgM (Viral Capsid Antigen) only
with Primary infection
-VCA-IgG positive for life
-EBNA (EB nuclear
Antigen): only post-primary
-Anti-EA
(Early Antigen): ???

Serology. PCR in thousands

Monospot - look for abnormal


HIV Serology using ELIZA: negative in 50%,
HIV RNA PCR is positive

Parasite detection using pathology +


serology

liver enzymes in 1000's, jaundice

Culture blood/BM/stool

Blood smear + PCR


P. Falciparum has
banana-shape cells; ring inside cell =
parasite

Pain control for joints

If it comes from Africa and its not malaria,


assume rickettsiae

culture, serology, PCR

serology (IgM/IgG) and PCR

CD4 <200, high lactate Dehydrogenase


(b/c cell breakdown from lungs) .CXR Patchy
infiltrates (if patchy in HIV, Assume PCP), but
can have normal CXR but NEVER a normal
CT. test oxygen levels

CD4<50, fever night sweats weightloss.


Alkaline phosphatase elevated because
invades liver (cells that produce are liver,
bone, placenta)
-Isolate in Blood culture/biopsy

micro<crypto<cyclo for size of spores

high CSF pressure (>20); stain of INDIA INK


NOT TAKEN UP; -do PCR, IgM on CSF
Peripheral ring-enhancing regions on
MRI; serology IgG!!! Not IgM b/c its
REACTIVATION
Periventricular ring-enhancing regions
-LP shows high protein, EBV
MRI: diffuse (non-ring enhancing) lestions
-PCR, viral load (corresponds to survival)

rapid antigen (poor sensitivity so if neg it


doesnt mean anything)
-PCR: takes days
-culture:
takes days
-who gets tested?
hospitalized, pregnent,young/old, pt's who's
dx will be affected by it

tenderness in eye and necrotic ulcer in


nostril.

Tx: Abx + debridement

Treatment / Management

none (antivirals ineffective).


NSAIDS/tylenol for sore throat. Dont
play contact sports b/c of splenic
rupture. Don't take Abx because rash is
common esp amoxacillin rash.

Gancyclovir/acyclovir

self-limited. If severe, give sulfadiazine


or clindamycin PLUS pyrimethamine

self-limited and benign, no treatment;


avoid cats and treat cats for fleas

Hep A vaccine available


-if traveling or cant do
vaccine then give Hep-A immune
globulin
vaccine only 70% effective
Primaquine: for vivax and ovale to kill
hypnozoites Check if G6PD)
-Cloroquine:
only works in certain countries so use
Mefloquine instead (also prophylactic
for traveling)
-Artheusunate
(severe), IV Quinidine (severe)

No vaccine. Prevention.

supportive. Give vaccine but major


complications from vaccine: YEL-AVD
(60% mortality) and YEL-AND (5%
mortality)
doxycycline
doxy

supportive care. Can give prophylaxix


vaccine or immunoglobulin.

AMINOGLYCOSIDES

Doxy!
Doxy!
Doxy!

supportive

Bactrim, (or if allergic clindamycin)


PLUS primaquine. Can also give
Pentamidine
-Also Corticosteroids
b/c killing bugs releases cytokines.
-Give HAART 2wks after Tx
but not until immune system is under
control b/c immune system is
hypersensitive and will overreact
-Prophylaxis:
give if CD4<200 or oropharyngeal
candidiasis: Bactrim or dapsone if
allergic (but check for G6PD

RIPE: rifampin/ (Rifabutin if taking


ritonifir HAART), Isoniazid,
Pyrazinamide, Ethambutol,
-Prophylaxis:if >5mm PPD give INH for
9mo (regardless of CD4 count);
Quantiferon GOLD test +
Azithromycin + Ethambutol +
Rifabutin
-prophylaxis azithromycin
fluconazole

LP to lower pressure repeatedly

sulfadiazine or clindamycin if
allergic PLUS Pyrimethamine

Do ARV's IMMEDIATELY

Neuraminidase inhibitor = oseltamivir,


zanamivir, amantidine has become
resistant. If you dont start <48hrs it
doesnt work but still give >48hrs if
HIGH RISK PATIENTS

Cipro + ceftazadime,
-debridement, apmutation,

oral rehydration, Fluroquinolones,


Azithromycin, Bismuth, antimotility
(loperamide + diphenoxylate)
-Prophylaxis = rifaximin (poor oral
bioavailability so stays in GI)

compare Mono infections:


MI
= fever, pharyngitis, abnormal L
CMV = FEVER but no abnormal L
HIV = skin rash + others
Toxo = cervical LAD, no
pharyngitis, fever

CSD = giant LN

; has cat + conjunctivitis


Toxo =
fever/disseminated diffuse or cervical LAD;
has cat + retinitis

ITS CALLED YELLOW FEVER FOR A REASON


If it comes from Africa and its not malaria,
assume rickettsiae

big fly towing two Leashes one that is


pulling out a kids belly, one that is pulling
a pizza
picmonic

sketchy

sketchy
sketchy: rabbits, coccobaccli, facultative
intracellular, tick bite, painful ulcer. Carried
by M to LN causing granulomoa,
aminoglycosides

Sketchy: G(-) obligate intracellular,


contracted from farm animals; spores in
poop get aerosolized for transmission;
don't cause a rash, cause fever, headache,
pneumonia, possibly hepatic,

sketchy

sketchy
sketchy

Recurrent bacterial Pneumonia = think HIV

<200

<50

oral = <500

<100

<100

kaposi's

<200
<100
<200
<500
<500

bacilary angiomatosis

Amox Rash

HIV Rash

kaposi's

Bacillary angiomatosis