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Infectious Disease
A Practically
Painless Review
Christine M. Houser
123
Pediatric Infectious Disease
Christine M. Houser
Medical knowledge and the accepted standards of care change frequently. Conflicts
are also found regularly in the information provided by various recognized sources
in the medical field. Every effort has been made to ensure that the information con-
tained in this publication is as up to date and accurate as possible. However, the
parties involved in the publication of this book and its component parts, including
the author, the content reviewers, and the publisher, do not guarantee that the infor-
mation provided is in every case complete, accurate, or representative of the entire
body of knowledge for a topic. We recommend that all readers review the current
academic medical literature for any decisions regarding patient care.
vii
Preface
Keeping all of the relevant information at your fingertips in a field as broad as pedi-
atrics is both an important task and quite a lot to manage. Add to that the busy
schedule most physicians and physicians-to-be carry of a practice or medical stud-
ies, family life, and sundry other personal and professional obligations, and it can be
daunting. Whether you would like to keep your knowledge base up to date for your
practice, are preparing for the general pediatric board examination or recertification,
or are just doing your best to be well prepared for a ward rotation, Practically
Painless Pediatric Infectious Disease can be an invaluable asset.
This book brings together the information from several major pediatric board
review study guides, and more review conferences than any one physician would
ever have time to personally attend, for you to review at your own pace. It’s impor-
tant, especially if there isn’t a lot of uninterrupted study time available, to find mate-
rials that make the study process as efficient and flexible as possible. What makes
this book additionally unusual among medical study guides is its design using “bite-
sized” chunks of information that can be quickly read and processed. Most informa-
tion is presented in a question and answer format that improves attention and focus
and ultimately learning. Critically important for most in medicine, it also enhances
the speed with which the information can be learned.
Because the majority of information is in question and answer (Q & A) format,
it is also much easier to use the information in a few minutes of downtime at the
hospital or office. You don’t need to get deeply into the material to understand what
you are reading. Each question and answer is brief – not paragraphs long as is often
the case in medical review books – which means that the material can be moved
through rapidly, keeping the focus on the most critical information.
At the same time, the items have been written to ensure that they contain the nec-
essary information. Very often, information provided in review books raises as many
questions as it answers. This interferes with the study process, because the learner
either has to look up the additional information (time loss and hassle) or skip the
information entirely – which means not really understanding and learning it. This
book keeps answers self-contained, meaning that any needed information is provided
either directly in the answer or immediately following it – all without lengthy text.
ix
x Preface
Items which appear in bold indicate topics known to be frequent board examination
content. On occasion, an item’s content is known to be very specific to previous
board questions. In that case, the item will have “popular exam item” or “item of
interest” beneath it.
At times, you will encounter a Q & A item that covers the same content as a
previous item. These items are worded differently and often require you to process
the information in a somewhat different way, compared to the previous version.
This variation in the way questions from particularly challenging or important con-
tent areas are asked is not an error or an oversight. It is simply a way to easily and
automatically practice the information again. These occasional repeat items are
designed to increase the probability that the reader will be able to retrieve the infor-
mation when it is needed – regardless of how the vignette is presented on the exam
or how the patient presents in a clinical setting.
Preface xi
Dr. Houser completed her medical degree at the Johns Hopkins University School
of Medicine, after spending 4 years in graduate training and research in Cognitive
Neuropsychology at George Washington University and the National Institutes of
Health. Her Master of Philosophy degree work focused on the processes involved
in learning and memory, and during this time she was a four-time recipient of train-
ing awards from the National Institutes of Health (NIH). Dr. Houser’s dual inter-
ests in cognition and medicine led her naturally toward teaching and “translational
cognitive science”—finding ways to apply the many years of cognitive research
findings about learning and memory to how physicians and physicians-in-training
might more easily learn and recall the vast quantities of information required for
medical studies and practice.
xiii
Content Reviewers
xv
Contents
xvii
Chapter 1
Infectious Disease Prevention Question
and Answer Items
Why is acellular pertussis a better Fewer side effects, but close to the
vaccine than whole cell? same efficacy
Which children get the vaccine >2 years old & high risk
for the 23 types of pneumococcus?
Which kids qualify for an extra dose Kids with high-risk medical
of pneumococcal vaccine in the conditions who have not previously
“low-risk” ages from 6 to 18 years? received the PCV13 vaccine – even
if they did previously receive PCV7
or PPSV23
What is the protocol for immunizing First immunization after 2nd birthday –
children with the polysaccharide One more 5 years later for children
pneumococcal vaccine? with splenic dysfunction &
immunocompromise
Generally, oral polio vaccine should not 1. Outbreaks – useful for mass
be used. What are the rare circumstances immunization
in which you might choose it? 2. Incompletely immunized child
(2) traveling to an epidemic area
What are the two big problems 1. GI shedding can produce disease
with oral polio vaccination? in non-immune household contacts
2. Occasionally causes paralytic polio
In children less than 9 years old, the Two doses 1 month apart – just the
influenza vaccine is not as effective as first year they receive it
it is in older individuals. How should
these young children be vaccinated?
1 Infectious Disease Prevention Question and Answer Items 5
Which kids are at high risk for bad Asthma & chronic pulmonary
influenza for pulmonary reasons? problems
What is the link between adoption & Children arriving from countries
hepatitis A? where Hep A is common frequently
bring it to their new home – best to
immunize close contacts of newly
arrived children
Can you catch rabies when the nice Yes – if there is an area of broken
doggie licks you? skin (abrasions that you might not
notice do count!)
If you think you might have been Very thorough soap & water wash
exposed to rabies, what should you (reduces infection rate dramatically)
do before you go to the ER?
Why must you avoid giving vaccines & They are likely to bind each other,
immunoglobulin in the same area making both useless to the patient
of the body, at the same time?
What is the best way to determine Sacrifice the animal & check its brain
whether the exposure animal has rabies
or not?
When are children at highest risk When they’ve just started in daycare
for developing infections in the
childcare setting?
Why are children at increased risk Contact with many children receiving
of acquiring antibiotic-resistant antibiotics (especially in the winter)
infections in daycare?
It is much more common for infections The organism is in droplets which can’t
to be spread in droplets, rather than stay in the air for more than three feet
airborne. What does droplet
transmission mean?
How long is airborne transmission Until 4 days after the rash develops
of measles a concern?
How long do you need to maintain 5 days after you start treatment
droplet precautions for pertussis?
10 1 Infectious Disease Prevention Question and Answer Items
Which children with TB infection are Only those with the cavitary or the
contagious? laryngeal form
(laryngeal is fairly rare – develops
either by direct infection from
sputum, or hematogenous spread)
If you have started a DTaP series, Give the one you have
and the correct line of vaccine is not (it’s better to have a nonmatching
currently available, what should you do? vaccine than not to have it at all)
What is the National Childhood Vaccine Legislation that mandates what you
Injury Act? must do each time you give an
immunization
What are the four core items a 1. Give the vaccine “information
physician must do, according to the sheet”
National Childhood Vaccine Injury 2. Discuss risks/benefits
Act? 3. Document vaccine & lot given in
med record
4. Report adverse events
As you learn the recommended Use the same ages for their
vaccination protocols, what should immunizations
you remember about how they apply
(unless they are medically unstable
to babies born prematurely?
or <1,500 g when you would normally
give the vaccine)
14 1 Infectious Disease Prevention Question and Answer Items
MMR and varicella are both live Yes – they’re not communicable
vaccines, like oral polio. Is it okay to give or shed in any way (with oral polio
those vaccines if the child lives with vaccine, viable virus is shed
someone who is immunocompromised? in the stool)
If you miss a shot in the Hep B series, Doesn’t matter – still works even if
how long do you have before you need it’s given years late
to start the series all over?
What is special about when you give Must be 2 months after 2nd dose,
the third dose of Hep B vaccine, in and 4 months after the 1st dose
relation to the other two doses?
What is the rule for when you can give 6 months after the third one is given
the final dose of DTaP? (anytime after 12 months, if the first
three were given on schedule)
Is HPV vaccine only for females? No, the quadrivalent vaccine is also
useful to decrease anogenital cancers
in males & can be offered
What is the significance of calling the Vaccines listed as DT have 10 times the
tetanus immunization for older people amount of diphtheria toxoid as do the
Td, and the one for younger people Td vaccines
DT (DTaP)? (same stuff, just different proportions)
It is not okay to give a vaccine The last time the child had it →
if _________? anaphylaxis
(the sole general reason)
First, to briefly review, bacteria come in three general groups: cocci, bacilli, and
spirochetes. Bacteria usually have both a cell wall and a cell membrane.
Orientation to Bacteria
Spirochetes are strange, spiral bacteria. The thinnest bacteria are the spirochetes –
often they cannot be seen with a regular microscope at all. (That is why “dark-field
microscopy” is needed to make them show up.)
Some bacteria are variable in shape, and those are called pleiomorphic.
Mycoplasma is the smallest bacteria, and is about the same size as the largest viruses.
Mycoplasma is also unusual because it lacks a cell wall – these bacteria only have a
cell membrane. It is the smallest independently living organism we know of.
Gram-positive bacteria have a much thicker cell wall than gram negatives do.
Gram negatives have a different composition for the outer portion of their mem-
brane, and a space between the inner and outer layer where their resistance enzymes
often live. Gram negatives also have endotoxin on their cell wall.
Mycobacteria are acid-fast. They will not gram stain, because their cell wall con-
tains special lipids called mycolic acids.
Outside the cell wall, many bacteria have other specialized structures. One
important structure shared by many bacteria is the glycocalyx coat (slime layer)
which allows the bacteria to adhere to various surfaces. Other bacteria have
capsules of polysaccharide which make it hard for phagocytes to eat them. This
makes them much more virulent than the same bacteria without a capsule. Typical
examples of encapsulated bacteria are Streptococcus pneumoniae and Neisseria
species.
In addition to the enzymes contained in the periplasmic space between the cell wall
layers of gram-negative bacteria, bacteria often have plasmids of double-stranded
DNA in their cytoplasm. These plasmids replicate independently, and often provide
resistance to various drugs or environmental situations.
Transposons, or genes that jump about on various bits of DNA in the cell, some-
times also provide coding for important resistance mechanisms. Transposons do not
replicate independently – they are replicated whenever the DNA to which they are
attached at that moment decides to replicate.
Mycoplasma
Very small bacteria with a cell membrane only (no wall). The lack of a wall explains
why beta-lactams and cephalosporins can’t touch them! Their shape is variable, due
to their flexible cell membrane.
The cold agglutinin test is often positive (although not diagnostic) for mycoplasma
infection. A positive cold agglutinin test means that the patient has IgM antibodies
to type O blood, which will agglutinate the RBCs at cold temperatures (4 °C), but
not at body temperature. Official diagnosis is via serology or PCR from nasopha-
ryngeal swabs (now available at many centers).
Which rickettsial illness is mainly associated with wars & poverty, and is nearly
always spread human to human (humans are the main reservoir)?
Epidemic or louse-borne typhus – R. prowazekii
Spread by the human louse Pediculus humanus humanus.
(Despite the name, it does not have to occur in large numbers of people at the
same time. It is generally a quite severe & sometimes fatal illness.)
. . . but is also seen in the USA due to contact with flying squirrels???
Yes, flying squirrels. They are the only other known vertebrate reservoir.
Contact usually involves close contact with the squirrel itself, or with squirrel
nests.
(There are other typhus forms like endemic and scrub typhus, not common in
the USA, which are usually due to contact with animal vectors.)
Rickettsiae normally inhabit endothelial cells of blood vessels. Which one targets a
different tissue?
Q fever – lungs
Funny Bacteria Overview 23
Rickettsiae are very short rods – they can be seen with light microscopy, but just
barely. Like Chlamydia they don’t have enough energy to reproduce unless they are
in a host cell. This makes them obligate intracellular parasites (and still bacteria).
The Weil-Felix test helps to identify patients suffering from rickettsial diseases. It is
an agglutination test based on the existence of rickettsial antibodies in the patient’s
serum. It is not used now in the USA (because it is not very reliable), but can still
appear on boards exams. Serological tests of immunofluorescence or ELISA testing
are usually used for diagnosis.
Rickettsiae like to live in the endothelium of vessels. That is why you find them
causing vasculitis, in most cases.
Typhus should not be confused with typhoid! Typhoid is infection with Salmonella
typhi. Typhoid is mainly a GI infection. Typhus, on the other hand, is caused by
several rickettsial species (Rickettsia typhi, prowazekii, and tsutsugamushi – the
main type in the USA is prowazekii). Typhus begins like a bad case of influenza
(fever, chills, headache, etc.). It then develops into a maculopapular rash, with
accompanying meningoencephalitis. If untreated, peripheral vascular collapse or
bacterial pneumonia often causes death after a few weeks.
Epidemic typhus is transmitted by the bite of the human body louse, and humans are
the typical reservoir for the rickettsial organism. In the USA, flying squirrels are
also a reservoir, and contact with them is sometimes implicated.
Endemic typhus is transmitted to humans by fleas, and has a rodent reservoir.
Treatment:
All rickettsial diseases are treated with tetracyclines, but chloramphenicol is a
backup (not really available anymore, but good to know for board exams).
Prevention:
Vaccines are available for typhus, when needed, and also for Q fever (although the Q
fever vaccine is not available in the USA). Q fever vaccine is recommended for peo-
ple who are routinely exposed to the animals most likely to transmit it (shepherds,
farm workers, veterinarians, lab personnel, and slaughterhouse workers). Remember
that the highest concentration of Coxiella burnetii is found in the placentas of infected
animals. A typical history is a farmer tending to the births of his or her livestock, or a
family visiting the very recent birth of some livestock or domestic animals, or spread-
ing of manure (containing the decaying material loaded with bacteria).
24 2 Selected Infectious Disease Topics
Parasite Classification
Protozoa, roundworms, and flat worms are the types of parasites. (Of course, being
a parasite also means they live in, or on, a host – and do harm to the host.)
Protozoa
Amebas, Flagellates, Sporozoans Ciliates
Amebas: Entamoeba histolytica & Naegleria fowleri
Flagellates: Giardia, Trichomonas, Trypanosomes, Leishmania
Sporozoans: Plasmodium, Cryptosporidium, Toxoplasma
Ciliates: Balantidium coli
Roundworms = Nematodes
Ascaris and Enterobius (enterobius = pin worms), trichuris (whip worm),
Trichinella, Strongyloides, Ancylostoma & Necator (hook worm), Wuchereria,
Loa loa, Onchocerca, Dracunculus
Flatworms
Trematodes: Schistosomes, Clonorchis, Paragonimus
(Trematode = fluke)
Cestodes: Taenia, Echinococcus, Diphyllobothrium
(Cestode = tapeworm)
Helminth means worm – roundworms and flat worms are both helminthes.
Miliary Tuberculosis
weeks, the lungs usually fill with foci of tubercular infection, called “tubers.” This
can result in respiratory distress and pneumothoraces.
The CXR will be normal in the early phases of miliary tuberculosis. Elderly patients
often die of the disease before the chest X-ray shows any related abnormalities.
The most important factor in diagnosing miliary TB in children is a history of expo-
sure to a tuberculosis infected adult. Thirty percent of children with miliary tuber-
culosis will not test positive for TB. Alternatively, if an affected area, such as a
lymph node, can be identified it can be biopsied for a definitive diagnosis.
Children respond well to treatment for miliary TB. Full recovery may take months,
but they feel better within 2 weeks. The prognosis is less good for adults with mili-
ary disease but improves if diagnosis and administration of the appropriate treat-
ment are rapid.
Lymphocytic Choriomeningitis
On the pediatric boards, tends to be presented as a zoonosis from pet hamsters. Mice
are also a source. It is an arenavirus.
Main point – In humans, it causes aseptic meningitis (rare cause).
Spread by – mice (and sometimes hamster) urine or feces.
Human-to-human spread? – No.
Main reason scientists are interested in this virus – because it is a good example of
“immunopathogenesis.” In other words, it is the immune system response that
determines whether this virus makes the animal sick.
If a mouse has incompetent (ineffective) humoral & cellular immunity, and catches
the virus, the virus can replicate like crazy, and the mouse does fine.
On the other hand, if the mouse has competent humoral immunity (antibody pro-
duction) but not cellular immunity, and catches the virus, the mouse will be fine
except that over time it will develop glomerulonephritis due to immune-complex
deposition.
If the mouse is fully immunocompetent, though, it gets very sick very fast and often
dies. Transplacentally infected mice have chronic lifelong infection, and pass the
virus along to other mice.
Chapter 3
General Infectious Disease Question
and Answer Items
In addition to cat feces, where else might 1. Undercooked meat (especially pork)
someone encounter toxoplasmosis? and eggs
2. Unpasteurized milk
3. Transfusions (of blood products
including WBCs)
What is a good way to remember the If you were rock climbing in the
rash pattern for RMSF? Rockies, you would probably get
some petechiae on your hands & feet
If a pregnant mother contracts CMV, is Usually noticed, but not always reported
she likely to notice the infection? (nonspecific malaise-type illness)
What is toxocara canis (in very general A dog parasite (worm) that sometimes
terms)? accidentally ends up in a person
(wrong host)
How do you identify scabies as the cause Look for long, narrow burrows at edges
of a patient’s itching? of clothing and intertriginous areas
How can you differentiate CMV from Both cause calcifications but CMV is
toxoplasmosis on head CT? periventricular (toxo is diffusely spread
throughout)
If a patient is found to have trichomonas, The patient & all sexual contacts
how many people need to be treated?
How would you know that a patient’s cat Significant lymphadenopathy (large &
scratch fever is unusually severe? painful)
(2 items)
&
Hepatosplenomegaly
How aggressive are H. flu infections in Very aggressive (jump on them! With
general? Ceftriaxone)
H. flu is one significant cause of otitis No – the vaccine does not prevent the
media. Do immunized children avoid OM infection
this infection?
(It is non-typeable H. flu, not covered
by the vaccine)
Does antibiotic treatment help with the It may decrease the coughing if started
coughing of whooping cough? early, before coughing fits begin
If an infant is born whose mother’s HIV HIV testing after counseling + consent of
status is unknown, what should you mother (some states allow testing without
recommend? consent, but the above is preferred)
3 General Infectious Disease Question and Answer Items 37
“Preauricular Adenovirus
lymphadenopathy” + conjunctivitis Keratoconjunctivitis (also sometimes
(bilateral) = responsible for corneal opacities –
self-resolving)
What is the main buzzword for Gray *pseudomembrane* (in the throat)
diphtheria infection?
During which season do most diphtheria Winter (possibly due to more indoor
cases occur? crowding)
What are the four main factors that 1. Prior immunization (less severe)
determine how severe a particular 2. Virulence (toxigenic form is worse)
case of diphtheria is likely to be? 3. Time to antitoxin (less is better)
4. Location of membrane (laryngeal)
What two factors determine the 1. interval between symptom onset and
likelihood of diphtheria complications? antitoxin administration
2. quantity of membranes
How does nasal diphtheria present? Like a nasal foreign body except
bilateral
(initially clear discharge,
then serosanguinous, then smelly
mucopurulent)
What special finding in the vital signs Heart rate unexpectedly high for
suggests diphtheria? temperature
What does the lower-case “d” vs. the The lower-case “d” indicates a reduced
capital “D” indicate, in the vaccine dosage diphtheria used in older patients
name?
The life cycle of ascaris is 2 months 1. Eggs to gut then to portal venous
long. Where do the worms travel in system
the body? 2. Pulmonary vessels into alveoli
(4 phases) 3. Coughed up & swallowed
4. Grow to adults in small intestine
In what ways does aspergillosis affect Ear & sinus infections in warm, wet
healthy people? regions
(2)
&
Allergic bronchopulmonary
aspergillosis
Which patients are at risk for allergic Those with chronic respiratory
bronchopulmonary aspergillosis? disorders
Why are the infiltrates seen with Because they develop in areas where
allergic aspergillosis “transient?” mucous plugs cause obstruction (if
the plug is coughed up, they disappear)
How does “otomycosis” appear on Black spores begin at the TM, & may
physical exam? fill the EAM!
(yuck!)
How does sinusitis from aspergillus Chronic sinusitis that doesn’t respond
present? to Abx
How do people encounter atypical Air, water, meat, & egg products
mycobacteria?
What are atypical mycobacterial Any that are not the three typical
infections? infections
(Those three are tuberculosis, bovis, &
leprae)
Fever, malaise, and hemolytic anemia go Babesiosis (although most people are
with what tick-borne illness? actually asymptomatic)
What blood test should you send if you Thick & thin smear (same as
are hoping to identify babesiosis malaria)
infection?
What types of skin lesions might you see Nodules, abscesses, ulcerations
with cutaneous blastomycosis?
48 3 General Infectious Disease Question and Answer Items
Where in the USA are you most likely to Central & Southeastern USA
develop blastomycosis?
(Blastomyces is present in a variety of
other countries, also)
Which three sets of preemies require • Born ≤ 28 weeks & ≤12 months old
palivizumab prophylaxis? at RSV season start
• Born 29–32 weeks & ≤ 6 months old
at RSV season start
• Born 32–35 weeks & ≤ 3 months old
at RSV season start
Which children require RSV prophylaxis Those with difficulty handling airway
at any age? secretions
What type of bacterium is brucellosis? Gram negative (there are four types of
brucellosis)
Campylobacter is estimated to be 40 %
responsible for what percentage of the
US Guillain-Barre cases?
Are the animals infected with the various No – they are asymptomatic
types of campylobacter ill?
What is the gold standard for Gastric mucosa biopsy & culture (from
identification of campylobacter pylori the biopsy)
(the gastritis bug)?
Do you need to get rid of your cat if No – the cat is not likely to carry the
someone in the family develops cat bacteria chronically
scratch disease?
Which cats are most likely to transmit Those less than 1 year old
cat scratch disease?
Where will you see lymphadenopathy The lymph nodes draining that area
following cat scratch disease exposure? (unilateral)
How long will it take for all symptoms Weeks to months (nodes resolve last)
of cat scratch disease to disappear?
What infections put patients at special Any facial infection (including dental,
risk for developing cavernous sinus sinus, & significant acne)
syndrome?
54 3 General Infectious Disease Question and Answer Items
What is the usual long-term outcome for Long-term cranial nerve defects
patients who recover from infectious
cavernous sinus syndrome?
What is the trouble with treating 1. Costs the same as other regimens
vaginal yeast infections with the 2. No symptom relief for at least
one-time dose of fluconazole? 1–2 days
(2)
3 General Infectious Disease Question and Answer Items 55
What is the problem with treating 1. Poor compliance due to BID dosing
adolescents with the doxycycline STD 2. 7 days of treatment
regimen? 3. Need to fill prescription
(4) 4. High stakes for future fertility
How are the ulcers of chancroid Chancroid ulcers are deep with
different from those seen in HSV? undermined edges
(HSV ulcers are very shallow, not
undermined, & multiple)
How do infants generally acquire Via vaginal delivery (although C/S does
chlamydial pneumonia? not fully prevent it)
In addition to the typical rash stages, 1. Rash in various stages over body
what other buzzwords describe the 2. “Dewdrop on a rose petal”
varicella rash? appearance
(2)
What type of isolation is needed for Contact and respiratory (while vesicles
hospitalized varicella patients? present)
How long should an exposed, varicella From days 8–21 after rash develops in
susceptible individual be isolated? the index case
(if hospitalized)
During what portion of pregnancy can Between the 8th and 20th weeks
varicella cause birth defects?
What is the pattern of the rash seen in Centripetal but sparing extremities
congenital varicella infection?
(centripetal = going toward the center of
the body)
What is the common name for the illness San Joaquin Valley fever or Desert
it causes? Rheumatism (because it often causes
joint pain & myalgias)
What is the usual course of HPV Like herpes, the immune system
infection? eventually keeps the virus from
manifesting & may eliminate it
A vaccine for HPV infection is now It is given to patients between the ages
available. What is the main restriction on of 9 and 26 years old (target age for
who can get the vaccine? vaccination is 11–12 years old)
What is the typical age & gender for a <3 years (usually 2) and male
croup patient?
What makes the two Ehrlichia bacterial They live within the phagosomes of
species so unusual? immune cells
Which TWO types of immune cells are Granulocytes with Anaplasma infection
affected in Ehrlichiosis?
&
Monocytes with E. chaffeensis infection
Geographically, where does the other Southeast, South central, & Midatlantic
form of Ehrlichiosis mainly occur? USA –
Lone Star tick vector (Amblyomma
americanum)
68 3 General Infectious Disease Question and Answer Items
What makes the two Ehrlichia They live within the phagosomes of
bacterial species so unusual? immune cells
(Gram-negative, intracellular coccobacilli)
Which patients are at special risk for Asplenic & immunocompromised patients
more severe Ehrlichiosis?
(RMSF-type presentation)
Where, specifically, does herpes hide Sensory neural ganglia (hence the
when it’s latent (not active)? paresthesias that often precede an
outbreak when it starts “creeping out”)
What will the CSF profile of a patient 1. WBC pleocytosis – mainly lymphs
with herpes encephalitis usually look 2. High protein
like? 3. High RBCs (even without trauma,
due to hemorrhagic necrosis)
Are CSF viral cultures for HSV useful? Usually not – Often negative even with
clear HSV infection
What age groups are most commonly Children & healthy young adults
affected by Hanta pulmonary syndrome,
& Hanta infection generally?
Are the rodents that carry Hantavirus ill No – they have a chronic infection
appearing?
Is cough common in the early stages of No – it comes just before the very
Hanta infection? serious phase (pulmonary edema and
cardiac suppression)
Which lab values can be a clue to the 1. The platelet count (it falls during the
presence of Hanta, if followed over prodrome)
time? 2. Immature WBC forms are seen in
(3) the peripheral blood
3. IgM to Hanta will be present
How does impetigo cause infection? Bacteria invade the skin at points of
minor trauma
“Early” infection with Group B Strep Sepsis in the first week of life
produces what sort of neonatal infection?
Since botulism is caused by a bacterium, 1. The toxin is the problem, not the
why don’t we treat it with antibiotics? bacteria
(3 reasons) 2. Killing the spores may result in
increased toxin release in the gut
(infant botulism)
3. Some antibiotics actually make the
effects of the toxin worse
3 General Infectious Disease Question and Answer Items 75
How does botulism cause problems for Preformed toxin is ingested (usually
children & adults? from canned goods)
How is infant botulism different from Spores are ingested, these grow in the
the disorder seen in children and gut, then release toxin
adults?
(Doesn’t happen in older children,
because gut flora prevent significant
growth by the botulinum spores)
If a child has a “clean” wound, how do >10 years since last immunization
you know whether a tetanus booster is
required?
What is one simple way to Staph scalded skin should not involve
differentiate staph scalded skin the mucosa
syndrome from the erythema
multiforme group of disorders?
What is the formal name for the type of Rubella – also known as German
measles associated with birth defects? measles
Mnemonic:
Imagine an infant speaking German
wearing a “bell” that hangs over her
heart. The bell is to warn others when
she’s coming, because she often bumps
into things, due to poor vision (cataracts)
What two defects are seen most PDA (& other heart issues)
commonly in infants affected by rubella?
&
Cataracts
Regular measles (rubeola) has an 5 days before until 5 days after the
average incubation period of one to rash first appears
one-and-a-half weeks. When are
patients most likely to be contagious?
Should HIV patients receive the MMR Yes – the risk of the diseases is worse
(live) vaccine? than the risk of the immunization
Which animals are most likely to carry Bats, fox, skunks, raccoons
rabies in North America?
(local patterns vary)
Why are unprovoked animal bites more Unprovoked = higher probability the
worrisome for rabies, than those that animal is rabid
occur when the patient was interacting
with the animal?
Why are bites that occurred in areas The virus migrates along the nerves to
closer to the brain more likely to cause the brain – the shorter the distance, the
problems, in terms of rabies? faster it arrives!
Are travelers at increased risk for rabies, YES – dogs are the most common
if they are not specifically working with source for rabies amongst travelers &
animals? contact with animals in public areas is
enough to contract the disease!
Aside from the patient’s discomfort, Spread to the adjacent tissue planes
what is the most concerning aspect of producing
a peritonsillar abscess? 1. serious infection &
2. airway compromise
What is the typical organism seen with Staph aureus brain abscesses
the abscesses of congenital heart disease
patients?
Can Staph epidermidis ever be safely Yes – well-appearing child and one
considered a contaminant? culture bottle positive only
84 3 General Infectious Disease Question and Answer Items
Why is Strep pneumo such an important It is the most common bacterial cause
bug? of most of the important peds infectious
diseases
(OM, pneumonia, meningitis,
bacteremia)
In an occult bacteremia case, if a blood Call to check on the child – if sick, call
culture comes back positive for Strep in Abx, if not sick, do nothing
pneumo, what should you do?
3 General Infectious Disease Question and Answer Items 85
What is scarlet fever? Strep throat with a rash (yes, that’s all it
is)
Why do some patients get a rash with It comes from an exotoxin, & only
strep throat, & others do not? certain streps make it
86 3 General Infectious Disease Question and Answer Items
Why is the heart affected in rheumatic “M” proteins of certain Strep bacteria
fever? generate a strong antibody response –
and those antibodies are cross-reactive
against (all sorts of) cardiac tissues
If you suspect rheumatic fever, and Cultures are usually negative by the
obtain a throat culture, what is the likely time rheumatic fever has developed
outcome?
When does ASO titer peak, & how 2–3 weeks after rheumatic fever onset
sensitive is it? Sensitivity about 85 %
Which infants typically develop late- Preemies who have, or used to have, IV
late-onset GBS? lines
Which body fluid must not be used to Urine (not at all reliable)
diagnose GBS infection?
(based on antigens)
90 3 General Infectious Disease Question and Answer Items
How is the treatment regimen different Same drugs, but meningitis is 14 days
for GBS sepsis and GBS meningitis, (minimum), sepsis is 10 days,
compared to GBS septic arthritis or arthritis is 4 weeks
osteomyelitis?
In the environment, where might your Sheep, goats, poultry, & contaminated
patients contact Listeria? milk products
What are the two infectious diseases for Diphtheria + tetanus (patient will not
which treatment with antitoxin is get better without it!)
crucial?
Why is the treatment length so long, Because spores stuck in the lung
when inhalational anthrax is possible? sometimes don’t start growing for a
long time after they are inhaled –
The 60 days is to try to be sure
antibiotic is present if they do!
What is the issue, currently, with The vaccine is not yet (as of 2014) FDA
immunizing children following an approved for children – informed
aerosol anthrax exposure? consent required to administer it
3 General Infectious Disease Question and Answer Items 95
What is the unusual shape of the anthrax They look like “boxcars” from a train,
organism, if micro information is all lined up!
provided?
If you’re eating rice infested with – if the bacteria hasn’t had time to
B. cereus, how do you know whether make toxin yet, you get diarrhea
you’ll get vomiting vs. diarrhea? because it makes the toxin in your
gut (8–16-h incubation time)
– if toxin was already made and in the
food, you start vomiting within a
few hours
Will cooking the food better protect you No – the toxin is heat stable
from the emetic form of B. cereus
toxicity?
Which patients do not need any <5 years since last tetanus
treatment after possible tetanus
exposure?
How should you conclusively diagnose Culture (but treat anyway if suspicion is
N. gonorrhoeae in a female patient? high)
What clue from the microbiology lab It only grows with “sorbitol-enhanced
tells you that you are dealing with agar”
EHEC? (a clue you would never
Mnemonic: Imagine bloody sugar
normally know!)
cubes sitting on an agar plate
With H. flu meningitis, should you give Yes – it reduces hearing loss & other
steroids automatically? neuro sequelae
Do contacts of a patient with a Yes, if <4 years old & not fully
significant (meaning not OM) H. flu immunized OR immunocompromised
infection require chemoprophylaxis?
(Rifampin × 4 days for household
contacts)
Why might a patient with H. flu also Therapeutic antibiotics do not always
require “chemoprophylaxis”? eradicate carriage of H. flu, so if
susceptible household members are
present they would still be at risk from
the patient
Where can patients contract RMSF? Not in the Rocky Mountains – New
England to Texas (skipping Florida &
Louisiana)
There are two forms of Ehrlichiosis- One lives in monocytes, the other
what’s the difference? lives in neutrophils
(Popular test item!)
What usually happens after the primary It goes into a latent phase – May
TB infection resolves? reactivate later in the upper lobe
What is the problem with placing a Not reliable for infants <6 months old
PPD on a 4-month-old infant?
(Popular test item!)
Patients in what age group have a Kids <4 years old are considered
lesser requirement for judging their positive at 10 mms
PPD to be positive?
If a patient is PPD positive, what should Get a CXR and sputum to check for
you do about it? active disease
Why are TB bugs called “red snappers?” They are acid-fast on stain, so they look
bright red
What is the name of the stuff used for Mantoux 5 Todd units
the PPD?
(Popular test item!)
There is a certain patient group for Children too young to be tested for
whom you should not prescribe color vision
ethambutol. What group is it?
Why is color vision testing important Its main side effect is decreasing visual
for patients taking ethambutol? acuity, and loss of color vision is the first
sign that this side effect is developing
What is the connection between the Leptospirosis from the animal’s urine
animals, water, and leptospirosis infection? gets into the water
If the organism is in the urine, why It is in the urine, but not until very
can’t I just culture the urine? late in the course
(Known question of interest)
What are the important predisposing Sweating & high cortisol levels
factors for development of Tinea
(That’s why it so often develops in
versicolor?
adolescents – they tend to be sweaty
with high cortisol levels)
What is the giveaway that your patient Olive oil overlay is needed to grow
has a Malassezia furfur infection, in out the blood culture
terms of the micro info? (in addition to Sabouraud’s medium)
Known question of interest
On the peds boards, if they show a P. falciparum (it’s the main one they
malaria blood smear & you’re not want you to know about)
sure what it shows, what should you
guess?
(Popular test item!)
3 General Infectious Disease Question and Answer Items 113
Why don’t the other meds kill the forms The other meds only kill free organisms –
living in the liver? if it’s hidden inside a cell (including
RBCs) they can’t get to it
Although the string test only occurs on A string is swallowed – long enough
the boards, you should know how it is to end up in the duodenum – while
done. What is the procedure? the remainder stays exterior. Giardia
adhere to the string, which is
microscopically inspected after is it
taken out.
What are the three main differences Protozoa: Single celled, replicate in
between protozoa and helminths (aka human, no eosinophilia
“worms”)?
Worms: Multicellular, replicate
elsewhere, + eosinophilia
How will you know that a patient has The lesions show up on head CT
cysticercosis?
For patients at risk of severe Varicella Give oral or IV acyclovir, even if not
zoster problems, what is the best very ill
management if they don’t seem to be
(just prophylactic)
very ill?
Valacyclovir is also used
(popular test item!)
Which neonates are at risk for severe Those whose moms developed
varicella zoster infection? chicken pox in a 7-day window –
5 days before delivery to 2 days after
(Mom didn’t have a chance to make
IgG antibodies & transmit them)
If a “normal” child develops chicken 2nd (or 3rd or 4th) case in one
pox, and is not unusually ill, when would household
you still consider giving acyclovir?
There are several lab tests that are The patient is convalescent or done
specific for EBV. What does a positive with EBV infection (EBV is Not
EBNA mean? Active!)
Which serology is NOT positive with EBNA (nuclear antigen – not yet
acute, primary, EBV infection? making antigens to the deep viral
structures in acute phase)
When does IgM to VCA (viral capsid About the same time
antigen) appear, relative to when
(IgG production begins shortly after,
symptoms appear?
peaks 2–3 months later, then persists at
a lower level for life)
If a patient has positive EBNA & IgG for Long-term (old) EBV infection – >12
VCA, but is EA negative, what is the months
likely EBV diagnosis?
What sort of cells are the atypicals, Polyclonal activated CD8 cytotoxic-
generally? suppressor T cells
Which patients often do not make Young ones <4 years old – & especially
heterophile antibodies with primary common in patients <2 years old
EBV infection?
(about 80 % of those <2 years old will
not have heterophile antibodies)
What are the hallmarks of a German Red rash + lymph nodes in a ring
measles infection? from ear to ear (postauricular-
suboccipital LAD)
How does the risk of acquiring It’s a “U” – highest in first and third
congenital rubella infection vary trimester
according to the trimester the
infection starts?
(popular test item!)
Although the risk of acquiring a The earlier the infection, the more
congenital rubella infection is high in severe the consequences
both the first and last trimesters, what
determines how severe the effects of
the infection will be?
(popular test item!)
3 General Infectious Disease Question and Answer Items 127
What sort of infection does parainfluenza Same as RSV, but occurs all year
virus usually cause?
What does herpangina look like? Little vesicles on pharynx, tonsils, uvula
How is rabies definitively diagnosed? Nerve biopsy from the “nape of neck”
(back of neck) shows “Negri bodies”
What is the risk of rabies from bites of High – assume they’re rabid (unless
fox, skunk or bats in the USA? you catch them and check their brains)
What are the two patterns of paralysis Spinal – proximal strength most affected
in polio paralytic disease?
Bulbar – swallowing, respiration, &
brain-stem affected
Why is Babesiosis associated with the Because there are usually multiple
“maltese cross” buzzword? organisms in the cell, & sometimes they
arrange themselves like a cross
How do you make the diagnosis of IgM (or IgG) to the virus, or PCR
parvovirus B19 infection, based on
(most cases are diagnosed clinically)
labs?
What are the standard screening tests ELISA, then if positive confirm with
for HIV? Western blot
Mnemonic:
Think of “Elisa” as the receptionist—
she does the initial screening
In children 0–18 months old, how can PCR testing for HIV DNA or RNA
you check for HIV infection?
(96 % sensitive & 99 % specific at
1 month old)
What do you need to confirm that the Requires two negative HIV PCRs, at
infant is not HIV infected? least 1 month apart, in an infant
6 months of age or older
OR
At least two negative PCR results in an
infant 4 months or older, who is not
breast feeding (first test must be from
after 1 month old)
Infants of HIV positive mothers should Hep C (along with Hep B, of course)
also be serologically screened for what
Syphilis
additional disorders?
(3) Toxoplasmosis
A child is referred to you because HIV Whether the PCR test was done
screening has come up positive. Mom
(The ELISA & Western blot rely on
is known to have HIV. The child is
IgG, which is always positive in infants
6 months old. What do you want to
of infected moms due to transplacental
know about the testing?
IgG transfer)
134 3 General Infectious Disease Question and Answer Items
At what age should you start PCP Most sources recommend 6 weeks
prophylaxis?
Should infants at risk for HIV infection Yes! Start zidovudine as soon as
be started on treatment before the HIV possible after birth!
infection is confirmed?
Begin cART (combined antiretroviral
therapy) when the infant is older, even
if initial testing is negative
136 3 General Infectious Disease Question and Answer Items
After the age of 1 year, what should CD4 criteria for severe
guide your decision as to whether PCP immunosuppression
prophylaxis is needed or not? (<500 aged 1 thru 5 years)
(<200 older than 5 years)
The children aged 1–5 years must keep
their count at or above 500 for
3 months to discontinue prophylaxis
Aside from the CD4 count, how do you Symptoms – The patient becomes
know when you should start symptomatic (AIDS defining illness or
antiretroviral therapy? significant symptoms)
(3 ways)
Age – infant < 12 months old
RNA level – >100,000
plasma HIV RNA level
How can you prevent the abacavir It occurs only in patients with a
reaction? particular HLA type: HLA-B*5701 –
screen for the HLA type before
starting the med
In what circumstances will you need to If the mother has NOT been taking
give newborn HIV prophylactic combination antiretroviral therapy –
treatment with two different drugs? Baby must then receive 6 weeks of
zidovudine
+
3 doses of nevirapine in the first week
of life
Should premature infants at risk for Yes, the same regimen as for term
HIV also be started on a prophylactic infants
medication regimen?
What is the main use for inhaled Prophylaxis for PCP in those >5 years
pentamidine? old
(for treatment, use IV)
How does HIV infection affect CNS The majority have some level of
development in very young children? encephalopathy (directly caused by
HIV)
What is the gold standard for diagnosing Silver staining of samples from
PCP? bronchoscopy or bronchoalveolar
lavage
What are Janeway spots, and what do • non-tender spots on hands and feet
they indicate? • acute bacterial endocarditis
Where are Roth spots found, and what • white spots on the retina
do they signify? • subacute bacterial endocarditis (they
develop late in the course)
For AIDS patients, or others with severe India ink or cryptococcal antigen (both
immunocompromise, be sure to ask for for possible cryptococcus)
what unusual lab evaluation of CSF, if
meningitis is suspected?
Diarrhea occurring with antibiotic use is A side effect due to change in gut flora
usually due to _______?
What are the four most common causes Norovirus is the main cause
of diarrhea in US children? (especially in children ≤18 months old)
Rotavirus (dropping due to vaccination)
Adenoviruses
(types 40 & 41 mainly)
Astroviruses
Which aspect of a child’s history can History of prior antibiotic use (e.g., for
give you a clue as to whether he or she is otitis media) –
likely to have an antibiotic resistant Kids with frequent prior antibiotic use
UTI? are more likely to develop UTIs
resistant to those antibiotics
What is the story with Bactrim® (TMP/ Linked to kernicterus in late pregnancy
SMX) in pregnancy? and in young infants who are breastfeeding
How should you identify the causative Bone biopsy/scraping or fluid for
organism in osteomyelitis? culture & Gram stain
If “line salvage” is attempted, what is They must be given via the “antibiotic
special about the way the antibiotics are lock technique” – if that is not possible,
administered? then the antibiotics must be
administered through the catheter
suspected to be infected
Which HIV infected mothers may not Those on cART with viral RNA levels
need IV zidovudine during labor & consistently ≤1,000, and good
delivery? continued adherence to the cART
regimen at time of delivery
What do you expect to see in the CSF Basically very similar to bacterial,
of a patient with TB meningits? except more monocytes than
neutrophils
3 General Infectious Disease Question and Answer Items 153
In aseptic meningitis, what should the Some WBCs – more lymphs than
CSF profile look like? PMNs
Glucose – nl
(popular test item!)
Protein – nl
What is the most cost-effective way to Send stool for fecal WBCs
evaluate a patient for an invasive
diarrhea?
(popular test item!)
How can you remember the unusual Think of standing in a “queue” to give
source for some cases of Q fever? birth – this reminds you of the placenta
Why would a boards vignette mention Because they want you to give rabies
that an animal attack (big or small) prophylaxis
was “unprovoked?”
(popular test item!)
3 General Infectious Disease Question and Answer Items 159
When during pregnancy is a fetus Mom infected (for the first time) late
most likely to become toxoplasmosis in pregnancy
infected, if mom catches the infection?
(the later in pregnancy, the more likely
(popular test item!) infection is)
A vignette tells you that a child has a Visceral larva migrans – Toxocara
history of pica. The child is now (↑eos, ↑IgG, migratory pneumonia)
febrile, wheezing, and has developed
hepatomegaly. What is the causative
organism?
(popular test item!)
What is the natural course for toxocara The worms are in the wrong host, so
infection? they die
(spontaneous resolution)
Why would the boards tell you that a That’s how the child picked up the
child with toxocara has a history of eggs
pica?
Do tapeworms cause problems for Other than “anal pruritis,” not really
humans?
3 General Infectious Disease Question and Answer Items 161
What is the drug of choice for Strep PCN or Amoxicillin always – there is
infection? no resistance
(Group A)
(popular test item!)
If your vancomycin patient turns red It’s “red man syndrome” not allergy –
shortly after you begin infusing
(the whole patient turns red due to
vancomycin, what should you
histamine dumping by most cells)
conclude?
(popular test item!)
If you are treating a C. diff infection Vanc will only work if given orally
with vancomycin, what must you
(Metronidazole works both ways)
remember?
(popular test item!)
Which has better absorption and Equivalent (unless the gut is messed
distribution, PO or IV quinolones? up)
How do humans contract the short By ingesting infected dog or cat fleas
(only a few inches) type of tapeworm?
What are Osler nodes and what do • Painful nodules on palms & soles
they indicate? • Subacute bacterial endocarditis
Fishy odor and “clue cells” = what Gardnerella aka bacterial vaginosis
diagnosis?
(Treatment: metronidazole or
clindamycin)
If a pregnant syphilis patient is PCN PCN – you will need to desensitize the
allergic, what should you use to treat patient
her? Or
Azithromycin (single dose) may be
used, but resistance exists, efficacy is
lower, & this treatment is not
universally accepted (also not by the
CDC)
If a syphilis patient does not have any Yes – at least in the first year after
symptoms and the chancre has healed, is infection
s/he likely to be infections?
3 General Infectious Disease Question and Answer Items 173
If a patient has been treated for syphilis, Depends – the screening tests usually
will the blood tests for syphilis go back do, the treponemal tests usually don’t
to normal?
What kind of PCN, specifically, is used Benzathine PCN 2.4 million units
to treat syphilis? IM × 1
Does neurosyphilis only occur with No – it can actually occur at any point
tertiary syphilis? in the disease
What is the simplest & cheapest way Check urine for WBCs –
to screen for urethritis? >5/hpf is sensitive and specific for
urethritis in males
If you prescribe metronidazole (or other Drinking alcohol will make them feel
drugs in this class) to an adolescent very bad!
patient, what do you need to remember
(Disulfiram-like reaction)
to tell the patient?
Which therapies for genital warts cannot • The patient applied types, regardless
be used during pregnancy? of who applies them
(1 group & 2 specific meds) • Interferon & 5-FU
How should you monitor a patient for HCV RNA & liver panel –
development of acute hepatitis C The RNA will turn positive
infection? significantly earlier than antibody tests!
(“window period” in which infection is
present but antibody is not yet
measurable)
Which patients are most likely to Those who engage in receptive anal
develop (infectious) proctitis? intercourse
How are the symptoms of proctocolitis The colon is involved, so they have
different from those of proctitis? diarrhea and cramps
Which patient group is most often Young males (15–35 years old)
affected in hepatitis E outbreak?
3 General Infectious Disease Question and Answer Items 183
What is the best management of hepatitis Monitor for signs of impending liver
D, in a patient already infected with failure & need for transplant
hepatitis B?
Interferon treatment for 1 year safe in
children, but not very successful in
clearing chronic infection
What is the difficulty with a positive It tells you whether the patient was
serological test for Lyme disease? exposed, but not whether she or he is
currently infected (antibodies are
present for a long time)
&
Antibody tests are often negative in
early acute infection!
How do small pox patients present? Ill appearing (severe flu-like illness),
with diffuse blistering on mucous
membranes & external skin
Lesions are all in the same stage &
diffusely present on the body
How easily does small pox spread? Will Fairly easily, but it usually requires
everyone in a crowd get it, if an infected close face-to-face or bodily fluid
person walks through? contact
Contact with contaminated items like
bedding can spread the disease
Only rarely spread via air in enclosed
spaces
Contagious small pox patients are also
usually quite ill & not likely to be
walking far!
What are the most common & well- Coxsackie A & B viruses
known infectious causes of (especially Coxsackie B)
myocarditis?
(Coxsackie viruses are enteroviruses)
A PCN, 90
Abacavir, 138, 139 sulbactam, 163
Acellular pertussis, 2 Anaphylaxes, 1, 17, 170
Acquired immunodeficiency syndrome Anaplasmosis, 67
(AIDS) Angular cheilosis, 62
CMV retinitis, 122 Anthrax
and HIV, 42 bioterrorism, 96
meningitis, 111 meningitis, 93
Actinomyces, 20, 108, 155 penicillin/amoxicillin, 93
Actinomycetes, 20 pneumonia, 94
Acute otitis media, 7 skin lesions, 93
Adenovirus vaccination, 94
GI symptoms, 38 Antibiotics
GU effects, 38 bacterial ribosomes, 167
infection, 37 children, 7
keratoconjunctivitis, 37 diphtheria, 39
meningitis, 37 gram-negative bacteria, 168
transmission, 37 line salvage, 149
upper/lower respiratory symptoms, 38 lock technique, 149
URI, 127 meningitis, 145
AIDS. See Acquired immunodeficiency syn- mycobacterium cervical adenitis, 45
drome (AIDS) pediatric endocarditis, 145
Allergic bronchopulmonary aspergillosis, 43 pertussis infection, 35
Amebas, 24 pneumonia and brain abscess, 167
Amebiasis, 115 resistant infections, 7
Amebic meningitis, 145, 165 salmonella, 36
Amoxicillin Strep pharyngitis, 87
clavulanate, 163 vaccination, 13
clindamycin, 95 whooping cough, 35
doxycycline, 21 Anti-inflammatory
PCN, 162 neuraminidase, 128
penicillin, 93 steroids, 49
Ampicillin symptomatic toxoplasmosis, 29
and amoxicillin, 170 Appendicitis
enterococcal infection, 91 intussusception, 52
gentamicin, 145 postsurgical bleeding, 169
E. coli (cont.) G
and group B Strep, 143 Gardnerella, 34, 171
HUS, 76 GBS. See Guillain–Barre syndrome (GBS)
Egg allergy, 12, 17 Genital herpes, 118
Ehrlichiosis Genital warts, 179, 180
babesiosis, 114 German measles, 77, 125
granulocytes, 104 Giardia
Rickettsiae, 22–23 lamblia, 33
TWO types, 67 STD, 182
Encephalitis treatment, 116
cat scratch disease, 53 in USA, 115
HSV, 71 Glycocalyx coat, 19
skin/mucous membrane, 71 Gonococcus, 177
transient cerebella ataxia, 119 Gonorrhea
Endocarditis infection, 142 chlamydia, 55
Endotoxin, 19 gram-negative diplococci, 55
Entamoeba histolytica, 24, 33, 115, 116 pregnant woman, 176
Enterococcus septic arthritis, 149
infections, 90 Gram-negatives
and Listeria, 164 endotoxin, 19
medication, 165 plasmids, 20
neonatal sepsis, 90 post-antibiotic effect, 168
Enterohaemorrhagic Escherichia coli resistance enzymes, 19
(EHEC), 70, 100 Gram-positive bacteria, 19
Enterotoxigenic Escherichia coli Granuloma inguinale, 174, 175
(ETEC), 100, 147 Group B Strep, 73, 87, 88, 143
Enterovirus, 77, 128, 129, 155, 186 Guillain–Barre syndrome (GBS)
Enzyme-linked immunosorbent assay and arthritis, 52
(ELISA), 22, 23, 133, 160, 184 meningitis, 89
Eosinophilia, 33, 42–44, 116, 160 postinfectious autoimmune complications, 51
Epididymitis, 179 in pregnant mothers, 88
Epiglottitis, 65, 101 serotype, 89
Epstein–Barr virus (EBV)
and adenoviruses, 186
infections, 122, 123 H
serological marker, 123 HACEK organisms, 144, 145
Erysipelas, 86 Hand-foot-mouth, 70, 128, 129
Erythromycin Hantavirus, 72, 131, 132, 134
azithromycin, 35 HAV. See Hepatitis A virus (HAV)
doxycycline, 175 HDV. See Hepatitis D virus (HDV)
PCN, 39 Helminths, 116, 117
prophylaxis, 36 Hematuria, 38, 117
Ethambutol, 107 Hemolytic uremic syndrome (HUS), 76, 100
Hemophilus influenza
gram-negative pleiomorphic organisms, 35
F immunization, 34
Fatigue, 24 meningitis, 154
Febrile illness, 13, 123 Hemoptysis, 43, 63, 66, 106
Fifth disease (5th disease), 131 Hepatitis A virus (HAV), 1, 10, 180
Fitz-Hugh-Curtis Syndrome, 73, 74, 177 Hepatitis C infection, 181
Flagellates, 24 Hepatitis D virus (HDV), 183, 184
Flat worms, 24 Hepatitis E infections, 183
Flukes, 24, 117 Hepatosplenomegaly, 24, 34, 46, 51, 75, 134
Frontal sinusitis, 48 Hep A vaccine, 5, 16
Index 193
L interference, 12
Laryngeal papillomatosis, 180 rubeola immunoglobulin, 78
Laryngotracheo-bronchitis, 65 varicella vaccine, 10
Latex agglutination test, 29 Menactra, 4
Legionella pneumonia, 103 Meningitis
Lemierre’s syndrome, 81 adenovirus, 37
Leptospira, 21 anthrax, 95
Leptospirosis, 21, 109, 159, 165 Bell’s palsy, 155
Listeria brackish water, 145
ampicillin, 164 brain abscess, 48
ceftriaxone, 168 chemoprophylaxis, 155
enterococcus, 164 cryptococcal, 66
infections, 91 GBS, 89, 90
monocytogenes, 73 and peritonitis, 24
Loffler’s syndrome (eosinophilic pneumonia), Strep pneumo, 153
116 systemic anthrax, 93
Lyme disease TB, 106
babesiosis, 47 Meningococcal vaccine (MCV4), 3, 4
Borrelia, 21 Meningococcus, 3, 4, 8, 11, 16
Ehrlichiosis, 68 Meningoencephalitis, 23
and viral myocarditis, 185 Menveo, 4
Lymphadenopathy, 24, 28, 34, 37, 51, 56, 134 Methicillin-resistant Staphylococcus aureus
Lymphangitis, 54 (MRSA), 82, 83, 166
Lymphocytic choriomeningitis, 25, 156 Microabscesses, 73
Lymphogranuloma venerum (LGV), 175, 182 Miliary tuberculosis, 24
M. marinum infection, 105
Molluscum contagiosum, 137
M Monoclonal antibody, 1, 50, 96
MAC/MAI, 136, 142 Mononucleosis, 29, 122
Macrolides, 22, 35, 57, 150, 162, 167, 174 Moraxella catarrhalis, 98
Maculopapular rash, 23, 75, 77, 125 Mumps, 77, 130, 131
Mad Cow Disease, 161 Mycobacteria
Malaise, 24, 31, 45 actinomycetes, 20
Malaria adenitis, 105
and babesiosis, 152 atypical, 20
blood test, 46 chlamydophila, 22
chloroquine, 113 cold abscess, 45
P. falciparum, 112 immunocompetent, 44
treatment/prophylaxis, 113 infections, 44, 45
types, 113, 114 mycolic acids, 19
Malassezia furfur, 109, 110 mycoplasma, 20
Maltese crosses, 46, 112, 114, 131 Rickettsiae, 22–23
MCV4. See Meningococcal vaccine (MCV4) spirochetes, 21
MCV4-CRM, 4 Mycolic acids, 19, 20
MCV4-D, 4 Mycoplasma
Measles bacteria, 19
airborne transmission, 9 cell membrane, 21
German, 125 cold agglutinin test, 21
immunoglobulin, 13
incubation period, 78
rubella, 77 N
unimmunized patient, 125 National Childhood Vaccine Injury Act, 12
Measles, Mumps, Rubella (MMR) Necrotizing fasciitis, 86, 120
egg allergy, 12 Neisseria meningitidis, 97, 154, 155
HIV patients, 78 Nematodes, 24
Index 195
Trichomonas Varicella
flagellates, 24 buzzwords, 59
gardnerella/bacterial vaginosis, 171 childhood immunizations, 14
infections, 171 disseminated zoster, 9
metronidazole/clindamycin, 171 gestation, 9
strawberry cervix, 34 humoral immunity, 58
vaginal infections, 177 infection, 59
Trichomonas vaginalis, 36 maternal antibodies, 61
Tuberculosis (TB) and MMR, 12
adolescents, 135 organ systems, 58
BCG, 13 pertussis, 9
children, 105 rash, 14
HIV infection, 134 zig-zag scarring, 121
immunocompromise, 30 zoster IG, 120
infection, 10, 24, 105, 129 Varicella pneumonia, 120
internal organs, 24 Varicella vaccine, 10, 12, 60, 120
meningitis, 105, 106 Varicella zoster
miliary, 24–25 cicatricial skin, 122
M.tuberculosis, 20 immunoglobulin, 120
mycobacterial infections, 44 neonates, 120
pulmonary infection, 105 organ systems, 58
red snappers, 107 pregnant adolescent, 119
Tuboovarian abscess, 179 Vibrio Vulnificus, 146, 148
Tularemia, 76, 103, 163 Viral myocarditis, 185, 186
Typhoid, 14, 23, 99 Viremia, 139
Typhus, 22–23 Vulnificus. See Vibrio Vulnificus
U W
Ulcer of chancroid, 55 Weil-Felix test, 23
Urethritis, 175, 176, 179, 182 West Nile virus, 145, 161
UTI Whipworm, 100, 117
asymptomatic colonization, 88 Whooping cough, 8, 35
ciprofloxacin, 147
E.coli, 143
enteroccocal infections, 90 Y
klebsiella, 103 Yeast (Candida) infection, 54
nitrofurantoin, 165 Yellow fever, 14
pregnant diabetic transplant, 146 Yersinia enterocolitica
campylobacter, 52
infection, 102
V malassezia furfur, 110
Vaginal candidiasis, 62 pseudoappendicitis presentation, 155
Vancomycin
C.diff infection, 168
ceftriaxone, 153 Z
endocarditis, 145 Zidovudine
3rd-generation cephalosporin, 84 abacavir, 139
β-lactams, 83 antiretroviral therapy, 141
MRSA bacteremia, 82 cART, 151
renal function, 166 labor/delivery, 150