GNRS 5669 Exam 4
Endocarditis: - ✔️✔️-weeks or months of symptoms
-S. Virdans and Strep Bovis
-DX: Echo, blood cultures, CXR, EKG
-Tx: IV abx 4-6 weeks
Pericarditis: - ✔️✔️Inflammation of visceral and parietal pericardium
Dx: two of the following
-chest pain
-pericardial friction rub
-ECG changes (ST elevation)
-Pericardial effusion
Tx: hospitalize if high risk
-NSAIDS, Colchine for 3 months (not if bacterial), no strenuous activity
Myocarditis: - ✔️✔️Dx: elevated troponin, CXR (cardiomegaly), BNP, Echo, MRI
-ST elevation or T wave inversion
Tx: same as pericarditis
-bed rest- rest cardio system
Meningitis: - ✔️✔️Sx: fever, nuchal rigidity, change in mental status
Dx: CBC, blood cultures, *LUMBAR PUNCTURE*, CT (if unable to do LP)
Tx: Dexamethasone + abx therapy
Norwalk: - ✔️✔️primary cause of gastroenteritis in the U.S
foodborne and waterborne
Tx: supportive
Vaccine: edible norwalk virus in transgenic spuds
Cryptospordium: - ✔️✔️tx:
-healthy: spontaneous recovery
-Immunocompromised: Nitazoxanide
-If severe diarrhea: Nitazoxanide and Azithromycin
-Supportive: fluids
Giardia: - ✔️✔️-water and food borne
, -common in day cares
Dx: multiple stool samples, 3 every other day.
Fecal immunoassays
PCR to identify subtypes
Tx: only if symptomatic, immocompromised, or in high risk for spreading conditions
3 yrs+: Tinidazole 2g PO once
1-3 yrs: Nitazoxanide 500mg BID x 3 days
<1 yrs: Metronidazole 500mg BID 5-7 days OR 250mg TID 5-7 days
Travelers Diarrhea: - ✔️✔️Prevention: pepto bismole
*do not use antidiarrheals*
Tx: *best to culture prior to tx*
Azythromycin 1000 mg once OR 500 mg 3 days (ok to use in febrile diarrhea and
pregnant women)
Rifazimin 200 mg TID x 3 days
Rifamycin 2 tablets BID x3 days
Quinolone abx- levofloxacin, ciprofloxacin, ofloxacin
Rocky moutain spotted fever: - ✔️✔️Transmitted by a tick
Sx: rash, fever, chills, muscle aches, vomiting, photo-phobia, lethargy
Dx: indirect immunofluorescence assay- can take up to 4 wks, ok to treat based on H&P
Tx: Doxycycline 100 mg PO Q 12 hrs x 7-10 days
Lyme disease: - ✔️✔️Sx:
Stage 1- erythema migrans, lesion starts as a red macule or papule at site of tick bite
Stage 2- rash-annular erthematous lesion
Stage 3- recurrent arthritis
Tx: Doxycycline 200 mg
Lyme meningitis and Neuro manifestations: Ceftriaxone 2 g IV QD for 14-28 days
HIV: - ✔️✔️Sx:
initial presentation- flu like symptoms, dark purple colored spots (kaposis sarcoma), non
productive cough, shortness of breath, fever, weight loss, night sweats, diarrhea
acute presentation- fever, headache, myalgias, pharyngitis, cervical lymphadenopathy,
night sweats
Dx: initial- ELISA
if positive ELISA, do the western blot test
Endocarditis: - ✔️✔️-weeks or months of symptoms
-S. Virdans and Strep Bovis
-DX: Echo, blood cultures, CXR, EKG
-Tx: IV abx 4-6 weeks
Pericarditis: - ✔️✔️Inflammation of visceral and parietal pericardium
Dx: two of the following
-chest pain
-pericardial friction rub
-ECG changes (ST elevation)
-Pericardial effusion
Tx: hospitalize if high risk
-NSAIDS, Colchine for 3 months (not if bacterial), no strenuous activity
Myocarditis: - ✔️✔️Dx: elevated troponin, CXR (cardiomegaly), BNP, Echo, MRI
-ST elevation or T wave inversion
Tx: same as pericarditis
-bed rest- rest cardio system
Meningitis: - ✔️✔️Sx: fever, nuchal rigidity, change in mental status
Dx: CBC, blood cultures, *LUMBAR PUNCTURE*, CT (if unable to do LP)
Tx: Dexamethasone + abx therapy
Norwalk: - ✔️✔️primary cause of gastroenteritis in the U.S
foodborne and waterborne
Tx: supportive
Vaccine: edible norwalk virus in transgenic spuds
Cryptospordium: - ✔️✔️tx:
-healthy: spontaneous recovery
-Immunocompromised: Nitazoxanide
-If severe diarrhea: Nitazoxanide and Azithromycin
-Supportive: fluids
Giardia: - ✔️✔️-water and food borne
, -common in day cares
Dx: multiple stool samples, 3 every other day.
Fecal immunoassays
PCR to identify subtypes
Tx: only if symptomatic, immocompromised, or in high risk for spreading conditions
3 yrs+: Tinidazole 2g PO once
1-3 yrs: Nitazoxanide 500mg BID x 3 days
<1 yrs: Metronidazole 500mg BID 5-7 days OR 250mg TID 5-7 days
Travelers Diarrhea: - ✔️✔️Prevention: pepto bismole
*do not use antidiarrheals*
Tx: *best to culture prior to tx*
Azythromycin 1000 mg once OR 500 mg 3 days (ok to use in febrile diarrhea and
pregnant women)
Rifazimin 200 mg TID x 3 days
Rifamycin 2 tablets BID x3 days
Quinolone abx- levofloxacin, ciprofloxacin, ofloxacin
Rocky moutain spotted fever: - ✔️✔️Transmitted by a tick
Sx: rash, fever, chills, muscle aches, vomiting, photo-phobia, lethargy
Dx: indirect immunofluorescence assay- can take up to 4 wks, ok to treat based on H&P
Tx: Doxycycline 100 mg PO Q 12 hrs x 7-10 days
Lyme disease: - ✔️✔️Sx:
Stage 1- erythema migrans, lesion starts as a red macule or papule at site of tick bite
Stage 2- rash-annular erthematous lesion
Stage 3- recurrent arthritis
Tx: Doxycycline 200 mg
Lyme meningitis and Neuro manifestations: Ceftriaxone 2 g IV QD for 14-28 days
HIV: - ✔️✔️Sx:
initial presentation- flu like symptoms, dark purple colored spots (kaposis sarcoma), non
productive cough, shortness of breath, fever, weight loss, night sweats, diarrhea
acute presentation- fever, headache, myalgias, pharyngitis, cervical lymphadenopathy,
night sweats
Dx: initial- ELISA
if positive ELISA, do the western blot test
