fever

flank pain
costovertebral tenderness
Symptoms
Dysuria
Leukocytosis
Pyuria
E. Coli (80%) Not urease-producing
Proteus mirabilis Urease-producing
Microorganisms
Klebsiella pneumoniae
Staphylococcus saprophyticus
OP Trimethoprim-
sulfamethoxazole
uncomplicated infection Mild to moderate
OP Fluoroquinolones
(Ciprofloxacin)
IV Ceftriaxone
Ciprofloxacine
Severe IV Fluoroquinolones
Levofloxacin
IV Tremethoprim-sulfamethoxazole
Pseudomonas aeroginosa
Enterococcus faecalis
Microorganisms Citrobacter freundii
Urine culture
Candida
Positive blood culture
Staph. aureus
Proteus mirabilis (most
common) Renal corticomedullary abscess
Urease-producing bacterium
Klebsiella pneumoniae Urinary Alkalization pH>8 Perinephric abcess

Struvite stone (magnesium Reduce the solubility of Acute Pyelonephritis in Symptom Emphyseamatous pyelonephritis
Diagnosis
ammonia phosphate) phosphate adults Papillary necrosis
Patients with persistent clinical symptoms sepsis
despite 48-72 hours of therapy
Indwelling urinary catheter
Pt with history of nephrolitiasis Imaging
Urinary obstruction or retention
Gross hematuria
Pt with unusual urinary findings Recent urologic procedure
Urinary obstruction
^ risk of drug-resistant
Hospital acquired infection Gentamicin
organisms
Complicated infection Risk factor fever, painful enlargement of testes, irritative voiding symptoms Neisseria gonorrhoeae (most
Underlying renal impairment Gram stain gram-negative cocci
common)
with azotemia Adults
Culture-negative urethritis
Immunosuppression pain at the tip of the penis and
+ urethritis nucleic acid amplification without pre-cleansing the
Sexually transmitted urethral discharge Dysuria Chlamydia trachomatis
IV antibiotic 48-72 => oral testing of first catch urine genital area
Comorbid DM Chlamydia trachomatic Urinary frequency
antibiotic 10-14 days Acute epididymitis Etiology Etiology Azithromycin or doxycyline
Etiology Gonococcus (N. gonorrhea) Acute bacterial cystitis Symptoms Suprapubic discomfort
Ceftriaxone Mycoplasma genitalium
Older persons bacteriuria
Cefepime asymptomatic in men
+ UTI Pyuria
Mild to moderate non-sexually transmitted uncommon cause of urethritis
Ciprofloxacin Vaccinations against each of these Trichomonas (rare)
E. Coli (more common)
Fluoroquinolone etilogy organisms should be administered insensitive microscopy on wet
Levofloxacin Pseudomonas either 14 days before scheduled Motile trichomonad in women
mount prep
Ampicillin-sulbactam splenectomy or >1 4 days after
splenectomy Urethritis in men Dysuria
Ticracillin-clavulanate
S pneumonia is the most common cause pyuria (WBC10/hpf)
Piperacillin-tazobactam of sepsis in post splenectomy patients
Severe Clinical features Discharge
Meropenem PCV13 PPSV23 8 weeks later
Pneumococcus Urgency
Imipenem 5 years later
Recommended vaccines for ^ voiding frequency
Revaccination with PPSV23
Aztreonam (+/- gentamicin) At age 65
asplenic adult patients Urinalysis
48-72 hours IV Antibiotics Oral Ab. should be continued to H influenzae type B (Hib) 1 dose Hib vaccine
followed by oral antibiotic 10-14 days Gram stain & culture
Diagnosis
Meningococcal quadrivalent vaccine Nucleic acid amplification
Ceftriaxone +/- gentamicin Meningococcus
Pregnancy Hospitalized for IV antibiotics Revaccinate every 5 years testing
Aztreonam
Purulent arthritis without skin lesion Influenza Infected influenza annually Azithromycin OR doxycyline
Prophylaxis recommended
Tenosynovitis wrist, ankle, finger, knees HBV Treatment Plus ceftriaxone if gonococcus
Mucous membrane
according to standard guidelines suspected or not ruled out
Exposure of non-tact skin Clinical presentation Generally pustular rash Other vaccines HAV
OR triad of Dermatitis Pustules, macules, papules, bulle for nonsplenectomized patients
percutaneous exposure Extremities and torso Tdap then Td every 10 years

Blood Migratory asymmetric polyarthralgia without purulent arthritis Age 65 PCV13 + PPSV23 8 weeks later

Semen Synovial fluid analysis up to 50,000 cells/mm3 Cerebrospinal fluid leak

Vaginal secretions Urethral sickle cell disease

High risk contact Any body fluid with visible blood Cervical cochlear implants
Age <65 PCV 13 + PPSV23 8 weeks later +
Exposure to CSF Culture Blood culture (2X) maybe negative congenital or acquired asplenia

Pleural/pericardial fluid Pharyngeal immunocompromised status HIV, malignancy

Pneumococcal
Uncertain risk Synovial fluid rectal chronic renal failure
Diagnosis
Peritoneal fluid Syphilis screen Smoking
Recommend
amniotic fluid HIV screen Heart or lung disease
Adult vaccination
HIV should tested immediately, followed Age <65 PPSV23 + Diabetes
Recurrent DGI Check terminal complement activity
by 6 weeks, 3 months, 6 months Chronic renal disease
Occupational HIV post- No prophylaxis recommended Genital tract Alcoholics
Nucleic acid amplification test
exposure prophylaxis urine Mucosal sites Influenza Intramuscular inactivated annually
feces 1g/day Tetanus diphtheria toxoid booster (Td) every 10 years
IV ceftriaxone
7-14 days
Low-risk contact Exposure to . with no nasal secretions Disseminated Mensturation (tampon use) once instead of Td
visible blood saliva gonococcal infection PO cefixime after clinically improved surgical wound infection Tetanus Age 18 Pregnant women
Etiology Tetanus diphtheria pertussis (Tdap)
sweat Treatment Purulent arthritis Joint drainage sinusitis adults who are expected to be
tears Azithromycine single 1 gr dose septorhinoplasty close contact with small children
Concomitant chlamydial infection
Initiate urgently (first few hours) Doxycyline 7 days Diffuse myalgias
Timing
continue for 28 days Treat sexual partner vomiting
Tenofovir fever, arthritis, pustular rash profuse diarrhea
2 nucleotide/nucleoside reverse Infective endocarditis 2-3 days after the onset of
transcriptase inhibitors Emtricitabine Should complete duke criteria Fever >38.5
menstruation
fever, rash, arthritis Symptoms
Integrase strand Hypotension with systolic
Raltegravir Paravirus B19
3 (or more)-drug regimen 4 weeks of transfer inhibitor Rash is malar rash on the face BP 90 mmHg
PEP Regimen
+ 3rd drug Protease inhibitor fever, rash Diffuse macular erhthroderma similar to sunburn
non-nucleoside reverse trunk Skin desquamation, including
1-2 weeks after illness onset
transcriptase inhibitor plasma and soles
extremitis
Must be initiated ASAP Differential Secondary syphilis GI vomiting/diarrhea
Generalized maculopapular rash lymphadenopathy
AIDS defining illness CD4<200/mm^3 Pneumocystis jirovecii severe myalgias
Palms Muscular
Solid organ transplantation elevated creatine kinase
Soles
Pneumocystis pneumonia Risk factor
Immunocompromised state fever, rash, hypotension Toxic Shock Syndrome Hematologic Platelets < 100,000/uL
CMV
(TSS)
throughout body Multisystem involvement (3 or more system) Mucose membrane hyperemia
indolent HIV Toxic shock syndrome
Course Diffuse erythematous rash palms
Acute respiratory failure Immunocompromised All HIV pt with CD4>200/mm^3 Renal BUN or serum cr>1-2X upper
should receive all vaccines that soles ALT,AST & total bilirubin > 2x
Exertional dyspnea Liver
a healthy person requires upper limit of normal
Tachypnea
Symptoms Chronic liver disease (e.g. HBV, altered mentation without focal
Out of proportion to HCV) Central nervous system
Hypoxia neurologic sign
radiographic findings HAV
Men sex with men supportive therapy IV fluids CD4 < 200 cells/uL
Risk factor
nonproductive Dry couph IV drug users removal of foreign materials Pneumocystitis jirovecii Oropharyngeal candidiasis
Women All pt age 11-26 Treatment from surgery Prophylaxis TMP-SMX
fever Epidemiology 2-4 weeks after exposure
HPV without HIV age 11-21 Broad spectrum anti- CD4 < 100 cell/uL
Fever
LDH elevated Men staphylococcal antibiotics
withHIV age 11-26 Risk factor Postitive toxoplasma IgG
Mononucleosis-like syndrome Lymphadenopathy Toxoplasma gondii
The rash is petechial, starts in antibody
All pt without documented Rocky mountain spotted fever the extremities and occurs few (within the first 6 months of infection) Sore throat
Normal WBC count Lab HBV
immunity to HBV days after fever onset Prophylaxis TMP-SMX
Arthralgias
Serogroups A,C, W, Y Petechial rash that progress to ecchymosis, bullae, M avian & M intracellulare
CD4<200 Differentials Meningococcemia Generalized macular rash
All pt age 11-18 vesicles, and ultimately gangrenous necrosis Clinical features Mycobacterium avid complex Risk factor CD4< 50 cells/uL
Diarrhea
College students Prodrome of fever and influenza-like syndrome, followed Prophylaxis Azithromycin
Large groups living in close Stevens-Johnson syndrome by mucocutaneoux erythematous and purpuric macule GI symptoms Abdominal distension
Meningococcus military recruits that progress to necrosis and sloughing of epidermis CD4<150 cell/uL
HIV is not an indication for proximity Flatulence
meningococcus vaccination; incarcerated individuals Age 15-65 (+ younger/older if at risk) Risk factor Ohio
Night sweats Opportunistic Histoplasma capsulatum Endemic area
would only be recommended if
Asplenia Initial screening Treatment for TB infection in HIV Mississippi river valleys
Bilateral, diffuse infiltrate CXR Acute HIV infection Weight loss
Complement deficiency Treatment for another STD Prophylaxis Itraconazole
HIV vaccines Elevated viral load >100,000 copies/mL
Diagnosis PCV 13 once IVDI + sexpartners No prophylaxis is recommended
Diagnosis HIV Ab testing may be negative Candidiasis
8 weeks later MSM Fluconazole for treatment
Pneumococcus CD4 count may be normal
PPSV 23 5 years later Sex for money/drugs Not recommended in US due to
Combination antiretroviral therapy Prophylaxis Fluconazole cost, low incidence and
at age 65 Partners of HIV positive Cryptococcal
Chest cavity Management Partner notification concern for drug resistance
CT scan Annual
Annually Patient or partner had >1
ground-glass opacities Influenza Secondary prophylaxis Treatment Flucytosine
partner since last HIV test
inactivated form
P Jirovecii can not be cultures IBD Pt with severe or frequent recurrences
Homeless shelter living Risk factor
Once repeat with each pregnancy
Dog Ancylostoma caninum Connective tissue disease Regardless of CD4 count
Require of PCP diagnosis Correctional facility
Hookworm larvae Tdap Td every 10 years HIV screening Differential diagnosis HSV
Cat Ancylostoma braziliense incarceration Lymphoma Acyclovir or valacyclovir
Induced sputum Td after 5 years in high risk trauma indications Secondary prophylaxis
Larve unable to penetrate the staining of respiratory samples regardless of normal results in Whipples disease Prevent HSV recurrences
Epidemiology Humans are incidental hosts Pneumocystis each Pregnancy regardless of CD4 count
dermal basement membrane Bronchoalveolar lavage MMR, zoster, varicella previous screening
pneumonia Cruise
Barefoot contact with contaminated useful for viral Contraindicated CD4+ cell count <200/mm^3 Occupational exposure to blood/body fluids
NOT nasopharyngeal swab Additional screening Within the previous 2 weeks
sand (beaches) and soil respiratory infection Varicella vaccine for adults with Any new STD symptoms Travel associated hotels
Papular lesion at the site of entry Oral Mild to moderate Live vaccines HIV born after 1979 legionnaires disease
Varicella vaccination is given to Prior to any new sexual ships CD4 <200/mm^3
Suggested
Primary lower extremity 70% Large arterial-alveolar gradient children ag 12-15 months relationship
Aerosols or droplets from Contaminated portable water in Most common etiology
Cutaneous (deeper infection rare) Low PaO2 IV severe age 4-6 years HIV p24 antigen contaminated water supplies hospitals/nursing homes
4th generation assay Streptococcus pneumonia due to increased colonization
Cutaneous larva migrans Erythematous, pruritic at the Tachypnea Zoster Adults age60 HIV antibodies nonproductive couph and impaired immunity against
site of injury encapsulated bacteria
Pulse oximetry <92% No benefits for HIV patients Preferred HIV screening test confirmatory test: HIV-1/HIV-2 shortness of breath
Clinical H influenza type B (Hib) positive results
Intensely pruritic antibody differentiation immunoassay Staphylococcus aureus rapidly progressive necrotizing pneumonia
Good for patients with splenectomy Community acquired
PaO270 mmHg watery diarrhea abdominal pain fever
Migrating Pt with impaired oxygenation + Corticosteroid Trimethoprium-sulfamethoxazile 21 days Negative results but high pneumonia (CAP)
Plasma HIV RNA test
Chronic lung disease clinical suspicion
within few days: Serpinginous confusion pleuritic pain
arterial-alveolar gradient 35 mmHg similar to uninfected individuals
Legionella pneumophila cigarette smoker Neurologic symptoms headache dyspnea
Reddish-brown cutaneous tracks
from larval migration HIV pt who developed PCP are usually immunosuppressed pt. Clinical features Distinguish from community productive couph
ataxia
not on ART and should be initiates 2 (Atypical pneumonia) acquired pneumonia
History + clinical findings malaise lobar, interstitial,
Diagnosis weeks of PCP teatment Profilaxis Bradycardia with Diagnosis CXR
Eosinophils usually normal anorexia cavitary infiltrate
Rash, neutropenia, hyperkalemia, relative to high fever
Side effect Community acquired fever
Treatment Antihelmintic Ivermectin elevated transaminases Steptococcus pneumoniae Lobar pneumonia Cavitary lesion Tuberculosis Slowly progressive symptom of weight loss
pneumonia
Nephrotoxicity, hypotension, hypoglycemia, fever fever > 39C Classic triad pleuritic chest pain
HIV+ with CD4<200/uL Chest Imaging
cardiac arrhythmia, pancreatitis, elevated Side effect Pentamidine IV hemoptysis
Moderate to severe disease night sweat Legionella Pneumonia Invasive aspergillosis
transaminases Subacute symptom Pneumocystitis pneumonia Diffuse infiltrate unresponsive to beta-lactam &
Septic pulmonary emboli amino glycoside antibiotics focal lesions (nodules with or
Clindamycin IV + Primaquine OP increase alveolar-arterial gradient Staph aureus without cavitation)
Diagnosis
IV drug users with IE
Dapsone: Hemolytic anemia Hyponatremia CD4 > 50/mm^3
Side effect Trimethoprim Op + Dapsone Op Alternate agent
(G6PD deficiency) Nocardia Pneumonia in HIV fungal infection, desert southwest U.S.
GI distress, rash Side effect Atovaquone OP Colonizer of URT Hepatic dysfunction Coccidioidomycosis
Mild to moderate disease CAP + hilar lymphadenopathy
Primaquine: Non cavitating infiltrate Haemophilus influenzae Bronchitis primary in COPD pt
Methemoglobinemia, hemolytic Side effect Clindamycin OP + Primaquine OP Hematuria & proteinuria nosocomial (Hospital acquired) pneumonia
Pneumonia Klebsiella and Pseudomonas
anemia (G6PD deficiency) acute illness (<2 weeks) Laboratory findings Pt at risk of aspiration
Risk factor Systemic lupus erythematosus many neutrophils
Pulmonary disease in Symptom Productive couph Legionella is intracellular subacute fever
couph Sputum gram stain
immunocompromised Community-acquired gram negative rod
focal infiltrate on CXR few or no organisms couph
fever Diffuse alveolar fever pneumonia (CAP) Tuberculosis
Symptoms Doxycyline
hemorrhage (DAH) hemoptysis weight loss
chest pain Symptom Treatment CXR Bilateral interstitial infiltrates
Aspergillosis Ceftriaxone + azithromycin
dyspnea apical pulmonary disease not lower lobe pneumonia
Dimorphic Fungal infection hemoptysis Chest Rales bilaterally
acute illness (<2 weeks) presents over days or weeks not acute
Differential CXR intestinal infiltrate Legionella urine antigen test
exposure to decaying vegetation when Pulmonary nodules
CXR Hospital-acquired Symptom Productive couph Diagnosis headache
gardening or landscaping culture in buffered charcoal yeast extract
segmental infiltrate
pneumonia (HAP) focal infiltrate on CXR Mycoplasma pneumoniae malaise
Subacute/chronic Similar CXR and ABG with PCP
Treatment Vancomycin + piperacillin-tazobactam Respiratory fluoroquinolones
odorless nonproductive cough
A nodule ulcerates and drains fluid occur over weeks or months SLE induced pulmonary fibrosis Treatment
Klebsiella pneumonia low grade fever
non purulent Does not cause fever Etiology Macrolides
Mixed anaerobes pt with CD4<200
Sporotrichosis Symptoms Additional nodular lesion along About 75% of patients with IE have previously damaged Methicillin-susceptible/resistant
lymphatic chain heart valves, with mitral valvular disease being the most Empiric Antibiotic Native valve Vancomycin
staphylococci/streptococci/enterococci Fever dyspnea
common. Patients with mitral valve prolapse and associated Pneumocystis pneumonia
mild or absent pruritus regurgitation have a 5-8 times higher risk of IE than those Prosthetic valves Symptoms Malaise nonproductive couph
upper arm, thorax, inner thighs with a normal valve.
NO LAD, deeper spread & Pacemakers Foul-smelling sputum bilateral diffuse interstitial infiltrate
systemic symptoms Brown recluse spider Red plaque or papule The aortic valve is the second most common cardiac valve
Implanted devices
with central clearing
involved in IE, usually in 24 patients with prior history of
Health care associated IE Defibrillators Clindamycin
Vesicular bites Bites are characterized by congenital bicuspid aortic valve with associated aortic
Diagnosis Cultures (aspirate fluid or biopsy)
Necrotic eschar
stenosis.
Staphylococcus aureus Injection drug users Amoxicillin
Cutaneous lesion Erythematous Treatment
Treatment 3-6 months oral itraconazole Poison ivy
Tricuspid regurgitation is more commonly associated with IE Risk factor IV catheters Metronidazole plus Amoxicillin-clavulanate
Papular in intravenous illicit drug users
Cat scratch fever Symptoms
Irritant component of Poison oak Anarobic coverage high risk pt with dental procedure Carbapenem
prominent Poor dentation
Clindamycin
Lymphadenopathy tender Poison sumac congenital heart disease cellulitis due to methicillin-resistant S aureus Aspiration Pneumonia Poor dentition
Urushiol Cardiac causes Endotracheal tube
regional Intensely pruritic valvular abnormalities/repair Strep. mitis
Upper airway instrumentation
nematode Strap. sanguid NG tube
Etiology HIV infection increase the risk Symptoms Linear lesions Hemodialysis catheters Intravascular catheters Risk factor
africa, asia, latin america Strep. mutans Gastroesophageal reflux
vesicular/plaque/bullous lesions Intravenous drug use
fever Staph. aureus is the most
T>38 C G(+) cocci Strep. salivarius Dysphagia
Lymphatic filariasis common organism
Acute painful lymphadenopathy S. oralis Impaired consciousness
symptoms glomerulonephritis Immunologic phenomena
lymphangitis Arm cellulitis in adults with track marks
IV drug use Minor S. sorbinus Posterior / Upper lobe
Holosystolic murmur increases with Viridans group Supine
Chronic Disfiguring edema S milleri Superior / Lower lobe
inspiration => Tricuspid involvement (TR) Embolic phenomena streptococci Location Gravity dependent
Predisposing cardiac lesion manipulation of gingival tissue Base of lower lobe
Staph. aureus Dental procedures Erect
Blood culture positive for perforation of oral mucosa Right middle lobe
Pleuritic chest pain Duke criteria
typical microorganism Major Procedures incision & biopsy of
Dyspnea
Symptom Echo shows valvular vegetation respiratory tract Staphylococcus
Fever, chills
2 major native-valve IE + penicillin-
Cough Diagnosis IE Aqueous penicillin G Etiology Streptococcus
Infective endocarditis in susceptible Viridans streptococci
1 major + 3 minor criteria
pulmonary infiltrates Intravenous drug users IV catheters Salmonella
1 major + 1 minor
Infarction Septic pulmonary emboli is Possible IE Prosthetic valves
common (75%) Tricuspid valve (right sided) 3 minor Coagulase-negative
10-20% incidence
Pulmonary gangrene more common than aortic valve staphylococci Pacemakers
Painful Infection (e.g. infective endocarditis) hematogenous spread
Abscess Immunologic phenomena Oslers nodes defibrillators Mechanism
Located in lung periphery Imaging Finger tips and toes Violaceous nodules septic emboli
Nasocomial urinary tract infections
subungual hemorrhage Hemoglobinopathy sickle cell disease
Enterococci (enterococcus older men after genitourinary manipulation Risk factor
Cavities Macular Skin Immunosuppression HIV
faecalis) younger women after obstetric procedure
erythematous Vascular phenomena Janeway lesion IV drug use
Ampicillin-sulbactam Penicilin resistant enterococcus
Palms and soles nontender lesion Trauma
Responsible for 3% of infective endocarditis
Heart failure more common in aortic valve involvement Petechiae NOT lung cancer
Haemophilus aphrophilus
Splenic abscess
Splinter hemorrhage fever
Fewer peripheral IE manifestation Vascular phenomena Mycotic aneyrysm Infective endocarditis microorganism Aggregatibacter (Actinobacillus)
Janeway lesion Classic triad Leukocytosis
actnomycetemcomitans
DIC Swollen interphalangeal joints Cardiobacterium hominis LUQ abdominal pain
Clinical presentation
Cerebral Physical examination G(-) anaerobe Left sided pleuritic chest pain
HACEK group of normal human oral flora with pleural effusion
Pulmonary Vascular phenomena Systemic emboli
organisms poor dentation
Splenic infarct Eikenella corrodens Possible splenomegaly
periodontal infection Diagnosis CT scan
Dark and cloudy urine Renal Infective endocarditiis
dental procedure with Antibiotic alone have 50%
gingival manipulation Combination of broad-spectrum antibiotics
Heart murmurs Cardiac mortality rate
Pharyngitis Splenomegaly GI Kingella kingae Treatment
Splenectomy Recommendate for all its
Causes pyoderme Edematous & hemorrhagic Ampicillin-sulbactam HACEK organisms
Cutaneous infections Immunologic phenomena Roths spots Ocular
Group A streptococcus lesions of retina Rapidly progressive cellulitis of poor surgical candidate Percutaneous drainage
cellulitis submandibular and sublingual space
(Streptococcus pyogens) embolic stroke Colon carcinoma
Acute rheumatic fever Dental infections spread contiguously down the root into the
Complications mennigitis Neurologic Inflammatory bowel disease
glomerulonephritis Strep. bovis (S gallolyticus) (mandibular molars) submaxillary (and then sublingual) space
brain abscess Colonoscopy should be Etiology
performed Oral aerobic viridians streptococcus
Major Duke criteria Positive blood cultures Polimicrobial
Immunocompromised host anaerobic
Glomerulonephritis fever
Hematuria/proteinuria
Fungi Chronic indwelling catheters
Immunologic phenomena Prolonged antibiotic therapy systemic chills

Intravascular shunts malaise

Extraluminal ascent of
microorganism
Etiology
impaired urinary catheter
drainage
Intraluminal infection
contamination of a urinary
collection bag
avoiding unnecessary catheter use
Catheter associated
minimizing the duration of
urinary tract infection
cathererization
(CA-UTI)
clean intermittent
catheterization (CIC)
Prevention
Indwelling catheters
Suprapubic tube placement
No prophylactic antibiotic use
No bladder irrigation with
antibacterial solutions
Increase Laboratory/imaging
Enterococcus spp WBC mouth pain
Subacute endocarditis Normal uncommon cause of native
Pseudomonas aeruginosa valve endocarditis drooling
microorganism Septic emboli
E.Coli Prosthetic valve Local compressive dysphagia
100% specific Staphylococcus Coagulase negative
Transesophageal Health care associated IE
Candida spp Gold standard for diagnosis staphylococci Hospital acquired endocarditis muffled voice
Major Duke criteria Valvular vegation echocardiogram epidermidis Symptoms
associated with IV catheters
Biofilm (slime-enclosed bacterial Along the catheter wall airway compromise
Fever + general weakness + tricuspid regurgitation + Infants with infective endocarditis secondary
aggregates) Stories Submandibular area is tender and indurated
allows them to reach bladder IVDU = Right sided infective endocarditis to umbilical venous catheter in NICU
Vancomycin Initial treatmnet Floor of the mouth is elevated,
Prosthetic joints
Treatment displacing the tongue
based on culture Subsequent treatment Diabetes mellitus
Anaerobic
recurrent high fever (39) Carcinoma Crepitus
Ludwing angina Gas-producing bacteria
maculopapular Alchoholism
rash inflammatory disorder No lymphadenopathy
nonpruritic Adult Stills disease Differential
Group B streptococcal
Hepatic failure
Diagnosis CT scan of neck
arthritis elective abortion
Ampicillin-sulbactam
Periodic insertion and removal No renal disease and painful skin nodules IV drug use
(4-6 hours) IV antibiotics Clindamycin
Candida likely
Periodic insertion and removal treatment prevent airway compromise
Empiric treatment Fluconazole
(changed monthly) Mild symptoms, oral thrush removal of inciting tooth
Endoscopy with biopsy if no
if pt or caregivers cannot impaired respiratory status Mechanical airway
Rhizopus species improvement with treatment
perform CIC
Etiology Candida sore throat, fever, muffled voice, drooling
increased risk of UTI, stricture, Spores are inhaled and
converted to hyphae Epiglottitis swelling in supraglottic structure
bladder spasm Treat Fluconazole
or laryngeal tracheal area
DM (ketoacidosis) White plaques Voriconazole
Tuberculosis lymphadenitis
Hematologic malignancy if resistant to fluconazole Echinocandin (caspofungin) airway obstruction with lymph nodes
Risk factors (scrofula)
Solid organ or stem cell Amphotericin Differential Airway obstruction with
transplant Tonsillitis
Focal susternal burning pain hoarseness and stridor
Acute/aggressive
Odynophagia located on lateral face superficial to master muscle
Fever Esophagitits in HIV Dysphagia and odynophagia + CMV
Large linear ulcer Intranuclear and intracytoplasmic mumps
patients CD4<50-100/mm^3 Parotid gland edema
nasal congestion inclusion on biopsy
Sever odynophagia (pain with swallowing), secondary to bacterial infection
purulent nasal discharge foul-smelling no dysphagia (difficulty swallowing), no endoscopy Ganciclovir G(+) partially acid-fast, aerobic, after parotid duct obstruction
thrush filamentous, branching rods
headache multiple, small, well
sinus pain circumscribed
Manifestation
volcano-like (small and deep)
palate HSV
Vesicles & round/ovoid ulcer Ballooning degeneration
Eosinophilic intranuclear inclusion inhation(most common)
Necrotic invasion orbit transmission
Ulcerated lesion Cutaneous penetration during gardening

brain Acyclovir Branching filamentous growth helps the

Symptomatic therapy immunocompromised hosts organism prevent phagocytosis => host defense
Angioinvasive and fatal Aphthous ulcer largely dependent on cell-mediate immunity
Topical corticosteroids if not Prednisone
Rhino-orbital-cerebral sinus endoscopy with Any patient with significant Infection by direct extension Cavitary lesion
Diagnosis Anaerobic bacterium
biopsy and culture immunocompromised and sinusitis Upper lobes
mucormycosis filamentous, gram positive bacteria lung nodules
surgical debridement Dental infection fever

Liposomal amphotericin B Dental trauma extraction malaise

Treatment Risk factor Immunosuppreccion dyspnea
^ glucose Pulmonary nordiosis
Elimination of risk factors Diabetes mellitus Symptoms couph
acidosis
Malnutrition pleurisy
+ draining sinus tract
painless, slow growing mass upper/lower jaw weight loss
+ sulfur granules
Actinomyces may be confused with TB night sweat
Immunocompromised (DM) Slowly progressive Nocardia
after dental procedure fever
Non tender
acute fever brain abscess causing seizure
Manifestations
severe muscle pain Non painful
brain Patients from Mississippi who are initially thought
Cervicofacial Disseminate from lungs to TB
Clostridium septicum spontaneous gas gangrene bulls indurated mass to have sarcoidosis (couch, hilar aden-patchy,
Actinomyces skin erythema nodosum, non-caseating granulomas in => untreated infection Histoplasmosis
Differential taut skin lesion Sinus tracts with sulfur granules African American individual) but deteriorated TB-mimicking disease
Sputum culture is usually negative Blastomycosis
extremities NO Fever/lymphadenopathy following high dose corticosteroid therapy.
Brochoscopy with bronchoalveolar
aerobic gram neg organism sensitivity >85% soil
Fine needle aspiration lavage adequate sample
Diagnosis
Acute ocular pain Culture often take >14 days Gram stain filamentous gram-positive rods weekly acid fast Mold in bird
Diagnosis
decrease visual acuity Alveolar infiltrate and nodules Epidemiology bat dropping
Pseudomonas aeroginosa mild cases (no fistula) OP Penicillin G 2-6 months
Endophthalmitis CXR Ohio river
after eye trauma or surgery cavitation
Treatment Midwest & central U.S.
No palate/turbinate necrosis or IV Penicillin Mississipi river
sever disease culture require > 4 weeks of incubation upper midwest staet
nasal discharge Surgery mediastinal or hilar lymph
Tick-borne protozoal South/south central state
Trimethoprium-sulfamethoxazole nodes
Chronic, non painful subcutaneous
Babesia microti Pulmonary histoplasmosis pulmonary symptoms + Great lake state
lesion with draining sinus tract arthralgias Region
Anaplasma phagocytophilum => Human granulocytic anaplasmosis Treatment in severe disease + Amikacin
Epidemiology Mississippi and ohio river
reservoir for Differential Nocardia Skin inoculation during gardening or farming Central valley of california Erythema nodosum
Borrelia burgdorferi => Lyme disease If brain is involved + carbapenem valleys
Infection arise on feet, legs or back Desert southwest Pancytopenia
Anaplasmosis and babesiosis transmit soon after tick bite Duration of therapy 6-12 months epidemiology Canadian provines
immunocompromised patients organism targets histiocytes Central and south america caribbean island
Treatment Trimethoprim-sulfamethoxazole infection of single arthroconidium is Lymphadenopathy
transmission require 48-72 Tuberculosis Acid fast rods that do not gram stain 7-14 days after inoculation (advanced HIV <100/mm3) and reticuloendothelial system Disseminated disease may occur even in
sufficient to cause infection immunocompetent patients tropical regions of africa
resides in the gut of the tick Hepatosplenomegaly Epidemiology
Organisms pass from salivary hours acid fast negative hyphae (not
Ixodes scapulars tick bite Aspergillus upper lobe cavitary lesion subclinical Primary infection through inhalation and pulmonary infection. south asia
Epidemiology glands of tick bite B burgdorferi extremely unlikely for disease filamentous, weakly acid fast rods) fever, chills, malaise extra pulmonary disease due to hematogenous spread
Differential fevr vector Aedes mosquito Same as Dengue fever
attachment <36 hours days-1 month after tick bite Sporulating (not branching) Weight loss & cachexia
DO NOT require antimicrobial mild to moderate
chest pain Lung acute & chronic pneumonia incubation period 3-7 days
prophylaxis Serology is insensitive and Bacillus anthracis fever, myalgia, dyspnea, Pulmonary (cough, dyspnea) but may be severe
would be seronegative hypoxemia, shock productive couph High fever
Should be removed with tweezers Symptoms papules wartlike lesions heaped-up skin lesion
Pathogonomic for Lyme symptom lobar infiltrate Mucocutaneous lesion virtually always present
Surrounding erythema is due to skin irritation community-acquired nodules violaceous hue
Round or oval macule initially pneumonia (CAP) Erythema nodosum sever symmetric polyarthralgias swelling and tenderness of
Northeastern USA Hepatosplenomegaly Sharply demarcated border
uniformly red and can develop a bilateral hand, wrist, ankle
zone of central clearing CAP + Arthralgias Reticuloendothelial
Peak prevalence in July and Lymphadenopathy Skin Lesion can be crusted and has
Valley fever Headache
August No pain Erythema multiforme small peripheral ulcer
Symptoms Pancytopenia Bone Marrow infiltration Clinical symptoms
scrapings shows yeast Flu like illness Myalgia
Human transmission occurs 48-72 No itch symptoms last weeks or months
hours after tick attachement Progressive Disseminated histoplasmosis (PDH) Laboratory ^ Aminotransferase conjunctivitis
Erythema migrans (80% of patients) As large as 20 cm Lower respiratory ilness lasting Verrucous nodules and plaques could
Early localized pt traveling to Arizona/California ^ LDH & ferritin Symptoms
fever >1 week progress to microabscesses
Diagnosis maculopapular rash limbs and trunk
fatigue Oral Doxycycline Histoplasmosis reticulonodular Bone Osteomyelitis
Confirmation serologic testing Diagnosis CXR
Flu like symtom interstitial infiltrate
Chikungunya fever
myalgia mild or moderate disease regular follow up Prostatitis Cervical Lymphadenopathy
Treatment Pregnant women Amoxicillin coccidioides Blastomycosis Genitourinary
headache urine/serum Histoplasma antigen Epididymo-orchitis
(coccidioidomycosis) ketoconazole
Anti fungal treatment Serology Lymphopenia
Jaundice fluconazole meningitis
Children age<8 years Amoxicillin CNS
Dark urine culture takes 4-6 weeks epidural or brain abscesses
Fatigue, malaise, lethargy Treatment bones Thrombocytopenia
Indirect hyperbii sever disease or certain risk IV Amphotericin B (liposomal) moderate-severe disease blood
Babesiosis Anemia Intravascular hemolysis Mild headache & neck stiffness factors (HIV, DM)
mild disease/maintenance ^ liver enzymes
Manifestation reticulocytosis Develop dissemination CNS Culture sputum
Myalgias & arthralgias Treatment OP Itraconazole 1-2 weeks after Amphotricine Management Supportive care resolves within 7-10 days
^ aminotranferase tissue
Weeks-months after tick bite Skin 1 year maintenance therapy maculopapular,
^ LDH Wet preparation of skin
reactivation of varicella-zoster yeast urticarial, petechial rash
Mild hepatosplenomegaly
Lyme IgM antibodies 1-2 weeks HIV Antiretroviral treatment 2 weeks after Diagnosis scrapings Mononucleosis
virus central and midwestern
AV block body fluids no arthritis
Thrombocytopenia Blastomyces Caseating granulomas /
Carditis (5% of untreated pt) Typical unilateral, dermatomal longer incubation time (3-6 Microscopy
Cardiomyopathy noncaseating granulomas tissue specimens Differential 1-4 weeks after GI or GU infection
^ bilirubin/LDH/LFT distribution of pain and rash weeks)
symptom fungal tissue stain and culture asymmetric oligoarthritis
unilateral/bilateral CN defects (VII) T3 to L3 most frequent Histoplasma Central and midwestern urine
ARDS Diagnosis Antigen testing Reactive arthritis
Neurologic (15% untreated) meningitis dermatome Histoplasma urinary antigen testing blood conjunctivitis
CHF abrupt onset of fever, dry
if sever Chlamydia psittaci Mississippi oral lesion
encephalitis Drug of choice Valacyclovir Differential cough, headache Mild pulmonary disease in
DIC Early disseminated no treatment
Shingles less expensive and effective high fever >39 C, GI symptom, skin lesions, osteolytic bone immunocompetent pt
Muscular (60%) Migratory arthralgia Legionella pneumophila
Splenic rupture pulmonary symptom Blastomyces lesions, prostate involvement
Acyclovir + oral steroids if the initial Mild to moderate pulmonary disease Oral itraconazole
Conjunctivitis (10%)
Intraerythrocytic rings symptoms are severe its almost always Hilaradenopathy is suggestive
Diagnosis Thin blood smear mild disseminated disease Oral itraconazole
(Maltese cross) Skin Multiple erythema migrans immunocompromised of histoplasmosis Treatment
Treatment Reduce the rash and pain Nocardia Sever pulmonary disease IV amphotericin B
Atovaquone + Azithromycin 7-10 days Regional or generalized infection frequently involves CNS pulmonary infiltrate
Treatment lymphadenopathy Reduce the likelihood of Immunocompromised patients Moderately severe to severe
Quinine + clindamycin Sever illness postherpetic neuralgia mediastinal adenopathy IV amphotericin B
Differential disseminated disease
No hemolytic anemia Treatment IV ceftriaxone TCA (amitriptyline or Aspergillosis pneumonia in pt. with
Postherpetic neuralgia Immunocompromised patients IV amphotericin B
Rocky mountain spotted fever centripetally nortriptyline) prolonged neutropenia
macular/petechial rash Months-years after tick bite
palms and soles Treatment Caspofungin
IgG antibodies 2-6 weeks
Lyme No hemolytic anemia could cause non-caseating
Muscular (60%) Arthritis granulomas
Differential Leukopenia Late or chronic Hypersensitivity pneumonitis
Ehrlichiosis Encephalomyelitis symptoms should improve with
Thrombocytopenia Neurologic
Peripheral neuropathy corticosteroids
Leukopenia
Treatment IV ceftriaxone
Dengue fever Thrombocytopenia
No hemolytic anemia sexual contact
Ehrliche chaffeensis
Hepatitis B immunoglobulin
E ewingii Transmission Passive immunity
exposure to infected blood (HBIG) within 24 hours bat
Transmitted by tick vector lone star tick (Amblyomma americanum) Active immunity Hepatitis B vaccine raccoon
Epidemiology
Principal reservoir white tail deer positive HBsAg i.e. skunk
seen in southeastern & south Chronic hepatitis B positive HBeAg fox
central U.S Elevated ALT High risk wild animal
positive anti-HBcAg IgG coyote
high fever HIV positive status
Acute liver failure unavailable: start PEEP
headache Sexual contact of HCV positive
Flue like illness Clinical complications of cirrhosis animal availability start PEEP if the
myalgias Children born to HCV patient available: euthanize and test
test was positive
Advanced cirrhosis with high
chills serum HBV DNA Health care worker after squirrel
confusion needle stick exposure
positive HBeAg chipmunk
Clinical manifestation Patients to treat Screening History of IV drug use i.e.
mental status change HBV DNA >20,000 IU/mL Low risk wild animal mouse/rat
Neurologic symptoms Pt without cirrhosis but Mammalian bite with possible
clonus received clotting factors before Rabies PEP rabies exposure
Pt with NL ALT less likely to 1987 rabbit
Serum ALT >2x upper limit normal
Human monocytic neck stiffness respond to therapy
over days HCV risk factors received blood transfusion No PEP
ehrlichiosis uncommon <30% fever Hepatitis B Prevent HBV reactivation during Hepatitis C before 1992 dog
Rash chemotherapy or immunosuppression
Rocky mountain spotted fever Symtoms headache Chronic hemodyialysis cat
without spots Rocky mountain spotted young pt with compensated i.e.
spreads towards the center, liver disease Born in US between 1945-1965 gerbil
Leukopenia fever petechial rash Interferon
palms and soles
Short term treatment Pet ferret
Thrombocytopenia CSF findings Viral meningitis Leukocytes <500/mm^3
Laboratory findings High drug resistance injection drug use observe for 10 days
Elevated liver enzyme Lamivudine Exposure to infected blood Yes
Treatment second line Chloramphenicol Workplace exposure
good in HIV pt available for quarantine No PEP if animal is healthy
Elevated LDH
Decompensated cirrhosis Blood transfusions before 1992 No Start PEP
Intracytoplasmic morale in Transmitted
Entecavir
monocytes lower rate drug resistance Due to micro abrasions or trauma Livestock or unknown wild Contact public health
Diagnosis Treatments Sexual transmission leading to blood exposure animal department
E chaffeensis Most potent
PCR for Not infected genital secretions
E ewingii Tenofovir Limited drug resistance
Preferred drug
Empiric doxycycline
Treatment antiretroviral use to teat HIV
side effect of Efavirenz
second line treatment option Chloramphenicol no effect against HBV
blood dycrasias Other drugs
Hepatitis C Native americans
Interferon + ribavirin
+ Telaprevir Genotype 1 chronic hepatitis C Morbid obesity
Immunosuppression
Streptococcus pneumoniae
sudden onset with rapid severe Common organisms Nursing home or chronic care facility residents
progression Neisseria meningitidis
Age 2-50 Chronic pulmonary
fever vancomycin + 3rd generation
Empiric antibiotics Risk factor cardiovascular
symtoms cephalosporin
headache underlying chronic medical illness
S pneumoniae renal
Age 11-12 nausea/vomiting
common organisms N meningitidis hepatic
if not previously vaccinated Age 13-18 sever myalgias
Age >50 Listeri Women who are pregnant & up
Optional if not previously neck stifness to 2 weeks postpartum
vaccinated Primary vaccination Vancomycin + ampicillin + 3rd
within 12-15 hours altered mental status Empric antibiotic Age 65
High risk patients Age 19-21 cephalosporin
Clinical presentation Signs petechial/purpuric rash S pneumoniae worsening fever and pulmonary symptoms
First year college students in Symptoms
Kernig after initial symptomatic improvement
residential housing N meningitidis
meningeal sign organisms
if primary vaccination was Brudzinski influenza complications sever, necrotizing, rapidly
Age 16-21 Booster vaccination Meningococcal Immunocompromised
Listeria
progressive
before 16th Bday vaccination multiorgan failure Bacterial meningitis
G (-) rods
hemoptysis
Complement deficiency DIC
Meningococcal Vancomycin + ampicillin +
Empiric antibiotic symptom confusion
asplenia adrenal hemorrhage cefepime
meningitis Complications hypotension
HIV shock Shortly after onset of symptoms MRSA
Consider if at high risk Age>21 dyspnea
exposure to community outbreak Mortality >15% even with G (-) rods
Neurosurgery/ organisms Staph. aureus high fever
travel to hyperendemic/ treatment coagulase negative
penetrating skull trauma Etiology
epidemic countries Blood culture Staphylococci lobar or multi lobar infiltrate
Imaging CXR
with/without cavitation
military recruits Glucose <45 mg/dL Empiric antibiotics vancomycin + cefepime
Diagnosis ICU admission
High protein >500 mg/dL 3rd cephalosporins ceftriaxone or cefotaxime
Lumbar puncture Vancomycin
Neutrophilic leukocytosis ceftazidime Treatment multiple broad spectrum,
>1000/mm^3 Treatments alternate to cefepime Piperacillin-tazobactam
meropenem empiric antibiotic
3rd generation cephalosporin + vancomycin Levofloxacin
Alternate to ampicillin TMS-MTX for listeria
No Glucocorticoids Strep. pneumoniae
Treatment Rifampin
Chemoprophylaxis Ciprofloxacin
Ceftriaxone

New onset diarrhea

fever
Symptoms ^ WBC
recent antibiotic use
Mild abdominal tenderness
recent hospitalization
advanced age
Fluoroquinolones
penicilins
antibiotic use
Risk factors cephalosporins
clindamycin

Clostridium difficile Unexplained leukocytosis in

colitis hospitalized pt. should rise
suspicion for C. difficile even
without diarrhea
PCR
Enzyme immunoassay
Drug should discontinue Diagnosis stool studies for C difficile toxin
INH hepatitis do sigmoidoscopy/colonoscopy
immediately Both are highly sensitive and
Neg results are not repeated
Mild elevation of ALT/AST <100 IU/L specific biopsy to document
M avium
Excellent prognosis type Metronidazole
M intracellulare
Mild hepatotoxicity Self limited Oral vancomycin
Isoniazid Risk factor HIV + CD4<50/mm3
Maintaine INH therapy with rebound tenderness
fever Treatment Pt with acute peritoneal sign
Mycobacterium close follow-up guarding DNA virus herpes virus
Treatment couph
tuberculosis drink alcohol daily Laporscopy
Toxic megacolon Same-sex partners have higher
abdominal pain
Ominouse hepatotoxicity who Already have liver disease non specific rates of CMV seroconversion
severe ileus
diarrhea
Age 50 years or older symptoms Mild pharynigitis
night sweats
Rifampin mild lymphadenopathy
weight loss
Ethambutol mild splenomegaly
Opportunistic infection in immunocompromised
Splenomegaly
Pyrazinamide patients with focal neurologic deficit (FND) Fever
^ Alk.p
Etiology JC virus Human polyomavirus Disseminated Mycobacterium Malaise
avid complex (MAC) Blood cultures
cerebellum Fatigue
Diagnosis Lymph node biopsy
brainsetem Mild elevation of ALT/AST
location
Bone marrow biopsy
Predominantly involves the
cortical white matter Clarithromycin Symproms
Treatment Mononucleosis like initial illness
no mass effect Azithromycin (<10%)
Symptom
Hemiparesis Prophylaxis Azithromycin
Absolute lymphocytosis
speech history of exposure to TB
Disturbances vision CXR
M. tuberculosis >10% atypical lymphocytes:
gait
Differential diagnosis
Tuberculin skin test >5 mm Cytomegalovirus (CMV) Lager basophilic cells with a
induration vacuolated appearance
Cranial nerve deficit
Prophylaxis: Isoniazide
multiple demyelination Pharyngeal erythema
Cytomegalovirus
Diagnosis MRI non-enhancing lesion
Primary Painless chancre shallow, non purulent ulcer rise, well-demarcated border Neg heterophiles antibody test
Progressive multifocal no mass effect
Diagnosis (mono spot)
Leukoencephalopathy Generalized lymphadenopathy
no effective treatment
Treatment Positive CMV IgM serology
Diffuse mucocutaneoux lesions
survival 6 months
Secondary Slf limited
Symptoms systemic symptoms beginning Treatment
multiple, spherical, located in
1-3 month after the initial some patients Valganciclovir
basal ganglia
Cerebral toxoplasmosis infection
Lymphadenopathy, anemia, bruising, bleeding, fatigue,
unlikely in patient receiving
years after initial infection ALL thrombocytopenia, neutropenia infection
TMP-SMX Tertiary Gummatous syphilis
nodular or ulcerating lesion with necrotic center scaring Peripheral smear; Blasts
many years after measles
Subacute sclerosis infection Higher false-negative rates mononucleosis-like illness
panencephalitis (20%-30%) Acute toxoplasmosis
CT shows scaring and atrophy Differential CMV is more common
Antibody to cardioliptin-
Differential ring enhancing lesion on MRI High fever, malaise, throat pain
cholesterol-lecithin antigen
fever solitary Nontreponemal (RPR, VDRL) Herpangina
Quantitative Titers Hyperemic yellow/grayish-
malaise Primary CNS lymphoma Throat examination
weakly enhancing and white papulovesicles
Symptoms Cryptococcal meningitis Possible negative results in
headache periventricular
early infection
NO ring enhancing lesions on MRI EBV DNA in CSF
Decrease in titers confirm treatment
CD4 <50/mm3 cortical and subcortical atrophy
Diagnostic serology Highest diagnostic sensitivity
AIDS dementia secondary ventricular (>97%)
GI and pulmonary symptoms Infectious mononucleosis
enlargement
NO CNS infection Mycobacterium avid complex Antibody to treponemal antigens
fresh water amoeba fever
Treponemal (FTA-ABS, TP-EIA)
Clarithromycin + ethambutol Qualitative reactive/nonreactive
fever malaise
Azithromycin Prophylaxis Greater sensitivity in early infection
headache pharyngitis Tonsillitis tonsillar exudate
Naegleria fowleri Syphilis Positive even after treatment
vomiting Acute meningoencephalitis confusion Deep to the sternocleid o matoid
symptoms NOT useful (Treponema palladium cannot be cultures) posterior cervical
altered mental status focal neurologic deficit symmetric
Lymph node aspiration lymphadenopathy
Useful for diagnosing Klebsiella Progressive ulcers without
seizure multifocal micronodules posterior more than anterior
fevr granulomatosis lymphadenopathy
Intracellular protozoan Symptoms Inguinal lymphadenopathy
chills CMV encephalitis Risk factor Pregnant women at first Generalized lymphadenopathy
Prodromal ventricular enhancement Diagnosis HIV with CD4<100/mm3 prenatal visit Axillary lymphadenopathy
malaise RPR, VDRL
Headache Pt with another STD, MSM,
headache ring enhancing lesions are Tender lymphadenopathy
Screening commercial sex worker
uncommon Confusion
hydrophobia Symptoms Rabies Differential Toxoplasma encephalitis All patient should have pretreatment seen in streptococcal
Ganciclovir Treatment Clinical Fever 4-fold decrease at 6-12 months Mild palatal petechiae non-specific sign
pharyngeal spasm serology with non-treponema test to pharyngitis
indicates treatment success
Focal neurologic findings Focal neurologic deficit quantitate antibody titers
hyperactivity followed by Symptoms Tonsilar enlargement airway compression
Confusion Seizure Primary (chancre) First line Penicillin (IM) x 1
under cooked contaminated pork coma Hepatosplenomegaly
Unilateral temporal lobe HSV encephalitis HIV with CD4<100/mm3 Secondary (diffuse rash) Alternate Doxycycline x 14 days
Taenia sodium (pork tapeworm) eggs death Atypical lymphocytosis
NOT widespread, multiple, ring MRI Diagnosis Positive Toxoplasma gondii IgG First line Penicillin (IM) x 3
Fecal-oral human transmission enhance Latent (asymptomatic) both sensitive and specific
Epidemiology Multiple ring enhancing brain lesions MRI Preference for basal ganglia Alternate Doxycycline x 28 days Anti Heterophiles antibody test
Central & south america Pork consumption Diagnosis rise within one week
Prophylaxis TMP-SMX CD4<100/mm3 (monospot)
Risk factor First line Penicilin G (IV) x 14 days
Subsaharan africa Central and south america Travel to endemic area Tertiary (i.e. CV, gummas) persist for up to one year
Treatmnet
Sulfadiazine & pyrimethamin
+ leucovorin (prevent Alternate Ceftriaxone x 14 days Epstein-Barr virus (EBV)
asia Seizure Symptoms hematologic side effects) Testing anti-EBV antibodies
Treatment Neurocyphilis, ocular syphilis
months to years Prolonged incubation Antiretroviral initiation 2 weeks after No splenic infarction
enhancing lesion in pregnancy risk of Splenomegaly with splenic rupture
Adult onset seizure beginning of toxoplasmosis treatment Patients who are pregnant Avoid contact sports for 3-4 weeks
Penicillin G IV desensitization if penicillin allergy transmission is high
headache Symptoms Neurocysticercosis Thrombocytopenia
nonenhancing lesion patients who had multiple
vomiting ICH obstruction of CSF otflow MRI Diagnosis treatment failure Autoimmune hemolytic anemia
Neurocysticercosis
Altered mental status calcified lesion fever Complications IgM cold-agglutinin antibodies
Cross reactivity of EBV-induced
headache (anti-i-antibodies)
normal Laboratory antibodies against RBC and
depending on the stage of cyst mixture of 3 Symptoms altered mental status with platelets complement destruction of
Cysts at various stage of RBC (Coombs-test positive)
development confusion and agitation
Albendazole Treatment 2-3 weeks after the onset of
Diagnosis Risk of seizure and coma
Hypodense 1 Cystic lesion CT/MRI South america symptoms
Enhancement/edema Often asymptomatic Hemiparesis
middle east Rural, developing countries Epidemiology Primary HIV infection causes a febrile illness that can
closely resemble infectious mononucleosis. Most
Calcified First; Dysentry/colitis Examination Cranial nerve palsies signs of FND frequently, patients with acute HIV have fever,
Sheep farm malaise, generalized lymphadenopathy, sore throat,
headache, rash, and Gl symptoms
Phenytoin Seizure/ICH management Hyperreflexia
Echinococcus granulosus HIV
Albendazole Antiparasitic therapy Treatment ^ WBC Lymphocyte predominant The key distinctions between HIV and EBV are that
Dog tapeworm etiology rash (unless antibiotics have been administered) and
diarrhea are LESS common in infectious
Human contact with dog Smooth, cystic, sub capsular CSF analysis normal glucose Differential mononucleosis and tonsillar exudates are uncommon
Corticosteroids Sheep intermediate host
Ingestion of undercooked meat mass (Solitary lesion) in primary HIV.

(pork) often years Initially asymptomatic Symptoms Viral (HSV) encephalitis Laboratory/imaging
^ protein
Few months later; Sore throat with
Mexico MRI temporal lobe abnormalities pseudomembrane formation Bartonella henselae Cat scratch
smaller daughter cyst unilocular cystic lesion Liver abscess
CSF analysis shows viral DNA Corynebacterium
china any organ (liver, muscle, bone) fever Diagnosis Dilated cardiomyopathy as body/head lice bite in
on PCR Epidemiology Bartonella quintana
Endemic complication homeless people
thailand Couph, chest pain, hemoptysis Lung cyst symptoms RUQ pain start immediately after obtaining sever immunocompromise advanced HIV (CD4<100/mm3)
part of central europe and Treatment IV acyclovir
RUQ pain, nausea, vomiting, Leukocytosis CSF
Epidemiology argentina Mass effect 1-2 cm round
hepatomegaly Liver cyst (most common) Elevated Ak.p, ALT, AST subacute and patients present
within 1st week of ingestion fever, eosinophilia Rupture after weeks of symptoms Bright red
Serologic testing of E histolytic
invade small intestine and Large, smooth hepatic cyst often with antibioticsodies immunocompromised patients exophytic
95% sensitivity Ultrasound Cryptococcal meningitis/
develop into worms daughter cysts (internal sepatation) Differential
Gastric acid release larvae Diagnosis in early disease meningoencephalitis firm
symptoms elevated opening pressure Nodules
up to 4 weeks later Eggshell calcification of hepatic cyst Diagnosis Stool microscopy insensitive by the time liver
Female worms release larvae CT scan co infection of HIV and HHV8 Vascular cutaneous lesion friable
Migrate and encyst in striated with internal septation Large, smooth hydatid cyst access has formed IV amphotericin + flucytosine Vascular tumor
muscle Elliptical violaceous skin lesion
IgG E granulosus serology Metronidazole (>90% cure with vascular
Can be asymptomatic oral therapy) advanced HIV with CD4<200/mm3
Initial stage (within 1 week of Albendazole small cyst <5 cm Definition Symptoms non-tender
ingestion) abdominal pain, nausea, mass effect
Larger or complex cyst Treatment Entamoeba Histolytica AIDS defining illness Pupular
vomiting, diarrhea Percutaneous therapy + surgery
(>5 cm or septation) Hydatid cyst Amebic liver abscess imminent rupture
Drainage is not recommended Peduncular
Myositis Men who have sex with men
Anaphylactic shock during cyst aspiration Complications Treatment uncertain diagnosis
and reserved for
fever legs Fever night sweat fatique
multiple lesion Echinococcus multilocularis patient not improving with
subungual splinter hemorrhage therapy face
most common extra manifestation of amebiasis Liver
Conjunctival and retinal To eradicate intestinal oral cavity
hemorrhage Fever + RUQ pain within weeks Luminal agent (i.e. paromomycin) involve mucosa and visceral organ Bone
Amebic liver access colonization commonly involve region
of intestinal amebiasis genitalia CNS
Symptoms Periorbital edema Chemosis No fever Bacillary angiomatosis
metronidazole Treatment symptom GI tract Lesional biopsy with
Muscle stage (up to 4 weeks pain Diagnosis
asymptomatic microscopy/histopathology
after ingestion) Taenia solium lung
Larvae entering the tenderness Cysticercosis Eosinophilia if there is antigenic
Trichinellosis Cysts in brain or muscle develop plaques or nodules Oral erythromycin / doxycyline
muscle cause swelling material leakage lesion begin as papules Treatment
due to surgery, GI infection, Hydatid cyst (Echinococcus ) multiple lesion Antiretroviral therapy 2-4 weeks later
weakness (neck, arm, should) dog
acute appendicitis require contact with animals extremities
Pyogenic liver abscess Kaposi Sarcoma color light brown to violet
Eosinophilia >20% Hallmark of disease Sheep
extreme pain, high fever, Differential Papules trunk
Clinical
Laboratory Elevated creatinine kinase leukocytosis Differential Diagnosis
Large cysts can be treated with Kaposi sarcoma Symptoms face
biopsy for confirmation
Leukocytosis Congenital aspiration + albendazole
Highly active papule become color from light brown to
intestinal symptoms and eosinophilia Fluid secretion by epithelial lining will regress with treating underlying HIV plaques or nodules pink/dark violet
Old patients with underlying DM antiretroviral therapy
dull RUQ pain, abdominal Simple hepatic cysts
Lung phase with medical conditions Hepatobiliary disease systemic/intralesional nodular
asymptomatic intestinal phase bloating, early satiety Treatment Sever KS
Ascariasis nonproductive couph chemotherapy
Pyogenic bacterial abscess Following peritonitis cutaneous lesion papular
worms obstructing the small No calcification on CT scan Pneumocystis
systemic/intralesional External auditory meatus in HIV pt.
bowel or bile duct IV antibiotic and drainage for Refractory KS Differential
Undercooked fish may transmit liver flukes (eg, Clonorchis sinensis) or chemotherapy
fish tapeworm (eg, Diphyllobothrium /alum) Liver flukes typically cause treatment Prophylaxis TMP-SMX
fever, headache, retro-orbital pain,
biliary disease (not hepatic cysts) Fish tapeworm rarely causes symptoms
rash, myalgia and arthralgias Poxvirus
but may cause megaloblastic anemia due to vitamin 812 deficiency
Dengue fever
Hemorrhagic dengue fever hemorrhage in skin or nose Centrally-umbilicated
Molluscum contagiosum
Does not cause marked eosinophilia dome-shaped
Differential Steatorrhea non-pruritic
Acute giardiasis Flatulence painful
Mycobacterium leprae acid fast bacillus HSV
Abdominal cramps vesicular
Asia, africa, south america
1st week fever Primarily developing world infection is rare in US and occur
abdominal pain Epidemiology in immigrants
2nd week
salmon colored rash Respiratory droplets
Typhoid fever
Hepatosplenomegaly nine-banded armadillo
3rd week Intestinal bleeding low infectivity
Perforation raised border
Neutropenia Absolute neutrophil count (ANC) <1500/uL Macular anesthetic skin lesion 1
Leprosy
Symtoms Chronic
Sever neutropenia ANC<500/uL Staph. aureus
Definition
higher risk of overwhelming loss of sensory/motor function Etiology
ANC<1000 nodular, painful nearby nerves puncture wound of the sole of
bacterial infection due to segmental demyelination Pseudomonas aeroginosa
foot
Disruption of skin and mucosal Full thickness biopsy of skin
Chemotherapy active edge asymptomatic
barrier of mouth and GI tract Diagnosis lesion
Etiology
M leprae is not culturable edema
G(-) organisms Pseudomonas aeruginosa Differential : Strep agalactiae
warmth Streptococcus pyogenes
Blood culture Minimal lesion (paucibacillary) Dapson + rifampin Plasmodium falciparum (Group B Streptococcus)
superficial cellulitis (Group A Streptococcus)
>50% develop erythema peripartum infection
Urine culture Treatment if sever multibacillary +Clofazimine P vivax symptoms
Infected Anopheles mosquito tenderness Superficial dermis & lymphatics
immediate IV antibiotic tx took months or years to heal Pathogenesis P ovale
Febrile Neutropenia Deeper infection osteomyelitis warm, tender erythematous rash
P malariae
Cefepime Leukocutosis Raised, sharply demarcated edges
Travel to subsaharan africa
Manifestation Rapid spread & onset
fever
meropenem Cold phase (chills, shivering)
Radiographs Fever early in course
Treatment Medical emergency Anti-pseudomonal beta-lactam Periodic febrile paroxysms Hot phase (high-grade fevers)
bone changes of osteomyelitis involvement of external ear is skin lacks a lower
piperacillin-tazobactam Sweating stage (diaphoresis, fever resolution)
takes 2 weeks to form particularly suggestive of erysipelas dermis level
Diagnosis
Anemia Eryispelas minor trauma
Aztreonam Puncture wounds Blood culture
Thrombocytopenia inflammation
Bone biopsy with culture
High risk pt. with persistent etiology skin disruption due to
Antifungal medications malaise concurrent infection
fever 4-7 days after initial tx. Ciprofloxacin
headache IV antibiotics
Treatment Piperacillin-tazobactam edema
Low risk pt. Ciprofloxacin + amoxicillin-clavulanic acid
nausea clinical
Southern Asia Clinical features Surgical debridement
vomiting Diagnosis pt with extensive rash, systemic toxicity,
Southeast Asia Candidia osteomyelitis injection drug user blood culture
abdominal pain underlying comorbidities (DM)
Sub-saharan Africa Clostridium tetani does not cause osteomyelitis
Nonspecific diarrhea ceftriaxone
Amazon Beta hemolytic streptococci IV antibiotics
myalgia Treatment cefazolin
Expensive Coagulase negative
pallor staphylococco those without systemic symptoms oral medication amoxicillin
Osteomyelitis in DM
abdominal pain GI disturbance Atovaquone-proguanil Differential Common cause of skin
jaundice E. Coli S. Pyogenes
^ Liver function tests infections
Areas with Chloroquine- petechiae Klebsiella pneumoniae MSSA (methicillin-sensitive Staph aureus)
Inexpensive resistant P falciparum
hepatosplenomegaly rare in US Deep dermis & subcutaneous fat
GI disturbance
Doxycycline Diagnosis Thin and thick peripheral blood smears Mycobacterium tuberculosis Spine osteomyelitis (Post Flat edges with poor demarcation
Cellulitis (nonpurulent)
sun sensitivity disease)
Seizure Indolent (over days)
Manifestation
teratogenic
coma Localized
Neuropsychiatric effect Children
hypoglycemia Less initial systemic symptoms Fever later in course
Agent of choice in pregnancy Mefloquine Complications metabolic acidosis
Antimalaria MSSA
weekly dosing Chemoprophylaxis for Malaria Jaundice
MRSA
short term travelers Adults Acute renal failure
All above
Purulent drainage
Need to be started 1-2 weeks Acute pulmonary edema Cellulitis (purulent)
Folliculitis infected hair follicle
in advance Areas with chloroquine- Hgb S Manifestation
Chloroquine, susceptible P falciparum Blood cultures Furuncles Folliculitis dermis abscess
Potential exacerbation of some Hemoglobinopathies Hgb C
hydroxychloroquine
skin conditions Protection Evaluation of vertebral Fever, back pain & focal spinal CT-guided needle Carbuncle multiple furuncles
Thalassemia ESR/CRP Increase with normal X-ray MRI
weekly dosing osteomyelitis tenderness aspiration/biopsy Clostridium perfringens
Partial immunity from previous malarial illness
parts of south america Plain spinal x-rays severe pain
Atovaquone-proguanil
mexico bullae
Doxycycline Gas gangrene
korean peninsula Streptococci Manifestation soft tissue crepitus
Antimalarial drugs Mefloquine
Potential teratogenicity Staphylococcus aureus shock
Areas without P falciparum Prevention Chloroquine systemic toxicity
Hemolysis in G6PD deficiency Eikenella corrodens multiorgan failure
Hydroxychloroquine Polymicrobial infection aerobic and anaerobic oral flora
weekly dosing Primaquine Haemophilus influenzae
Insecticide-treated nets
effective on P oval and P vivax Beta-lactamase-producing
household insecticide residual spraying anaerobic bacteria
No effect on schizont of P falciparum Human bite wounds
Tick transmitted RBC parasite Amoxicillin-clavulanate
Bebesiosis seen in northeastern and Tetanus vaccination (if not
midwest ed U.S. uptodate)
Treatment
symptoms develop 4-7 days after wounds left open to drain and heal by
mosquito bite (never >2 weeks) surgical debridement secondary intension (high risk of infection
Muscle and joint pain with closure)
Denge fever
Retroorbital pain
Differential
rash
leukopenia
Human african trypanosomiasis Prominent abdominal pain
(tsetse flies)
Campylobacter Pseudoappendicitis
Sleeping sickness skin lesion (trypanosomes chancre)
Bloody diarrhea
acute febrile illness + myocarditis
Enterotoxigenic E coli, contaminated food &
progress to CNS Enteropathogenic E Coli drinking water
Sever watery diarrhea Brief illness
Short term illness
Low grade fever CD4 < 180/mm^3 Diarrhea Rotavirous & norovirus
vomiting common
Weight loss Abdominal cramping
Bacillus cereus Salmonella Frequent fever
drinking water ingestion of performed toxin in
starch foods (i.e. rice) Travel associated Fever
Horse breeding animal contact Etiology Diarrhea Shigella Bloody diarrhea
Cryptospordium Vomiting
person-to-person contact abdominal pain
abdominal pain
cryptosporidium oocytes stool examination with modified common in wilderness & rural
Diagnosis Diarrhea not typical but may
(4-6 um) acid-fast stain Staph aureus areas of U.S.
accur
supportive care Giardia Asymptomatic patients may
Treatment performed toxin with rapid
Anti retroviral therapy onset of symptoms continue to shed organism for
Long term illness (>2 weeks) months
Watery diarrhea abdominal pain
acute onset, non bloody HIV positive patients Cyclospora Prolonged, relapsing infection
High fever >39C Common infectious watery diarrhea
CD4<50/mm^3 Mycobacterium avid complex diarrhea with low grade fever Recent contact of known TB case Cryptosporidium, Cytoisospora, Chronic illness in
Weight loss Clostridium difficile fever Microsporidia immunosuppressed patients
PPD induration 5mm Nodular or fibrotic changes on CXR
cough bloody stool unusual
Organ transplant recipient
Watery diarrhea associate with antibiotic use
Immunosuppressed patients
Crampy abdominal pain brief illness
CD4 < 100/mm^3 Microspordium Injection drug users
Weight loss watery diarrhea
prisons, nursing homes,
Fever is rare cramps High risk settings
Clostridium perfingens hospital, homeless shelters
Giardia fever mycobacteriology lab personnel
Watery diarrhea undercooked or DM
Crampy abdominal pain unrefrigerated food
Isospora belli (Isospordium)/ Prolonged corticosteroid therapy
CD4 < 100/mm^3
Weight loss microsporidium Abdominal pain, bloody diarrhea
Leukemia
Fever is rare highest incidence in children
AIDS-related diarrhea Campylobacter speccies
and young adults PPD induration 10mm
Salmonella Higher risk of reactivation TB
raw or undercooked meats
Campylobacter
non-opportunistic pathogen Bacterial cause of watery diarrhea
Entamoeba TB to treat
Diarrhea fever
Shigella End stage renal disease
abdominal pain
Frequent, small volume diarrhea Chronic malabsorption syndrome
vomiting
Hematochezia Salmonella Children< 4 years of age
poultry
Abdominal pain undercooked foods Children exposed to adults in
Bloody diarrhea (colitis) eggs high-risk categories
Low grade fever
severe disease All of the above
Weight loss Antibiotic treatment needed only for PPD induration 15 mm
CD4<50/mm^3 CMV colitis immunocompromised patients Healthy individuals
eosinophilic intranuclear
inclusion vomiting PPD or Interferon gamma release assay
Colonoscopy + biopsy
Basophilic intracytopasmic diarrhea CXR infiltrate + lymphadenopathy
Diagnosis
inclusion abdominal pain if + Symptom night sweat, fever, couph
Vibrio vulnificus
An ocular examination to rule raw or undercooked shellfish All new HIV pt. should receive latent TB testing No CT scan
out concurrent retinitis
immunocompromised patients 9 months Isoniazid + Pyridoxine
Culture invasive, life-threatening disease in No manifestation of active TB Should be treated for latent TB
those with liver disease
ova/parasites Active TB Rifampin, isoniazid, pyrazinamide, ethambutol Bacillus cereus
Stool examination First step watery diarrhea
Clostridium difficile antigen Staphylococcus aureus
shiva-toxin producing HIV+ pt with CD4 < 200 may initiate antiretroviral therapy until Enterotoxin ingested
Cryptosporidium Acid fast stain bloody diarrhea if associated have false-negative PPD CD4 > 200 and test for PPD Quick onset : 1-6 hours
diagnosis with enterohemorrhagic strain Diagnosis with stool assay for
Colonoscopy and biopsy of mucosa Negative work up Vomiting predominant
shiga toxin
In a patient whose diarrhea is likely infectious, use of Clostridium perfringens
E. Coli undercooked beef or foods
an antidiarrheal agent may cause more organisms or contaminated with bovine feces ETEC (Entrotoxigenic E. coli)
toxin to remain in the intestine, which could lead to
toxic megacolon STEC (Shiga toxin-producing E coli)
in EHEC empiric antibiotic therapy Enterotoxin made in intestine
should be avoided as it may increase Vibrio cholerae
the risk of hemolytic uremic syndrome Major pathologic mechanism
Delayed onset >1 day
of food borne illness
Bloody diarrhea with fever and Watery/bloody diarrhea
Shigella bactetermia Campylobacter jejuni
contaminated food and water travel outside the united states Nontyphoidal salmonella
Listeria monocytogenes
Bacterial epithelial invasion Variable onset
Watery/bloody diarrhea
Fever
Systemic illness (Listeria)