Virus
Management of inactive carrier phase of hepatitis B?
No treatment required
A 28 yr old male presents to the hospital after 10 days of persistent fevers, muscle pains, malaise and lower extremity weakness after swimming in a lake in southern Illinois. Initial evaluation reveals an elevated alkaline phosphatase, total bilirubin in addition to temperature-pulse dissociation.
Leptospirosis (Weil's disease)
Leptospirosis is a worldwide zoonotic infection due to Leptospira spp. Animals, specifically rodents, are the primary vectors of disease. Human infection results from exposure to the urine of infected animals or through contact with contaminated soil or water.
A reactive HIV-1/2 antigen/antibody combination immunoassay followed by negative result on confirmatory testing indicates
Initial result was a false positive.
A reactive HIV-1/2 antigen/antibody combination immunoassay followed by negative result on confirmatory testing indicates that the initial combination assay result was a false positive
Serum immunoassay with high specificity and sensitivity for invasive Aspergillus infection
Galactomannan Antigen Immunoassay
Empiric abx coverage for nosocomial meningitis
Meropenem and vancomycin
Empiric antimicrobial therapy for nosocomial meningitis must cover a broad spectrum of pathogens, including gram-negative organisms and Staphylococcus aureus, particularly methicillin-resistant S. aureus
The most common cause of acute gastroenteritis in the US
Norovirus
Type of isolation indicated in Patients with pulmonary tuberculosis, or infections with other organisms transmitted by small droplet nuclei.
Airborne isolation
Effect of Cobicistat- (HIV medication ) on renal function.
No effect in GFR
Cobicistat can inhibit tubular secretion of creatinine but does not actually affect glomerular filtration rate, so an increase in the creatinine level is expected when this agent is used.
Diagnostic study indicated in all patients with non- Central nervous system Cryptococcus infection
Lumbar puncture
In patients with pulmonary cryptococcosis, lumbar puncture should be performed to determine if central nervous system (CNS) infection is also present, even in the absence of CNS symptoms.
Preferred antibiotic therapy in patients presenting with for erythema migrans
PICTURE
Doxycycline
Early localized Lyme disease and southern tick–associated rash illness present with erythema migrans and are clinically indistinguishable; therefore, patients with erythema migrans should be treated with doxycycline, which is effective in both conditions.
Diagnostic CSF finding in Sporadic Creutzfeldt-Jakob disease
Elevated 14-3-3 protein
Patients with sporadic Creutzfeldt-Jakob disease usually present in the seventh decade of life and have disordered cognition, ataxia or spasticity, myoclonus, and elevated 14-3-3 protein in the cerebrospinal fluid.
Water-borne gram-negative bacillus associated with necrotizing skin infections in immunocompromised patients.
Vibrio vulnificas
Antiretroviral therapy for preexposure prophylaxis to prevent HIV infection in all persons considered at ongoing risk of infection.
Combination tenofovir-emtricitabine should be considered as preexposure prophylaxis
Treatment of choice for Coccidiodal meningitis
Fluconazole
Fluconazole is the treatment of choice for coccidioidal meningitis, because it offers a good response rate and a favorable safety profile.
Cause of dysentery associated with ingestion of contaminated seafood particularly shell fish
Vibrio parahemolyticus
Gastrointestinal infections caused by Vibrio species are associated with ingestion of contaminated seafood, particularly shellfish, and can be severe in patients with liver dysfunction.
Major risk factor for post transplant lymphoproliferative disease
Organ from donor seropositive for Epstein-bar virus
PTLD is related to B-cell proliferation induced by infection with EBV in the setting of chronic immunosuppression and resulting decreased T-cell immune surveillance.
Progressively rising fever accompanied by abdominal pain, initial constipation followed by diarrhea, and relative bradycardia; tender hepatosplenomegaly is common in
Typhoid fever ( Salmonella enterica serotype Typhi)
Administration sequence and timing of Pneumococcal immunization in a patient with HIV infection.
13-valent pneumococcal conjugate vaccine first, followed 8 weeks later by the 23-valent pneumococcal polysaccharide vaccine
Immunocompromised persons, including those with HIV, should receive the 13-valent pneumococcal conjugate vaccine first, followed 8 weeks later by the 23-valent pneumococcal polysaccharide vaccine. This recommendation applies regardless of the patient's CD4 cell count.
Most likely diagnosis in a patient with fever, hemolytic anemia, and the peripheral blood smear shown following a tick bite
PICTURE
Babesiosis
this peripheral blood smear shows an intracellular inclusion. Babesiosis and malaria should be considered in patients with intracellular erythrocyte inclusions, fever, and hemolytic anemia.
Diagnostic criteria for FUO ( FEVER OF UNKNOWN ORIGIN)
Temperature greater than 38.3 °C (100.9 °F) for at least 3 weeks that remains undiagnosed after two visits in the ambulatory setting or 3 days of in-hospital assessment
Diagnostic test in Fever, headache, and focal limb weakness following outdoor activities
CSF analysis
Erythrocyte count-17/µL (17 × 106/L)
Leukocyte count- 256/µL (256 × 106/L)
Glucose- 55 mg/dL (3.1 mmol/L)
Protein- 299 mg/dL (2990 mg/L)
West Nile virus antibody test in CSF
Fever, headache, and focal limb weakness following outdoor activities suggest West Nile neuroinvasive disease, and the most appropriate diagnostic test is for West Nile virus antibodies within cerebrospinal fluid.
Tick-borne bacterial co infection that may accompany lyme disease
Anaplasma phagocytophillum
Anaplasma phagocytophilum, a bacterium spread by the Ixodes tick (the same vector associated with Lyme disease). The constellation of fever, leukopenia, thrombocytopenia, and mild elevation in liver enzymes in a patient with recent Lyme disease is highly suggestive of co infection with anaplasmosis.
Bacteremia of which organism could cause this finding
PICTURE
Neisseria meningitides
Purpura fulminans is a severe complication of meningococcal disease. Meningococcal-induced microvascular thrombosis and disseminated intravascular coagulation lead to widespread hemorrhage into the skin, which can evolve into painful purple papules
Hx: 3-day history of fever, removal of several embedded ticks from her skin in the last month. One day before admission, she noted onset of a bilateral temporal headache. On the day of admission, she noted neck stiffness, photophobia, and a new skin eruption.
Question: Treatment of choice
PICTURE
Doxycycline
Following a tick bite, symptoms of fever, petechial rash, and lymphocytic meningitis suggest Rocky Mountain spotted fever and should be treated with doxycycline.
Treatment for erythematous macular and papular rash that began on the chest and spread to involve the extremities. The rash is not pruritic. The patient is sexually active with men
PICTURE
Benzathine penicillin.
A high-risk sexual history and erythematous macules and papules on the palms and soles indicate secondary syphilis, which should be treated with benzathine penicillin