Infectious Disease

Missed Concepts

• Catscratch disease is the most common cause of chronic unilateral cervical adenitis in children. Complications include lymph node suppuration.
• Acute LE or facial rash that is elevated, edematous, sharply demarcated, red, painful, and associated with fever/chills/malaise: erysipelas caused by GAS.
• Varicella vaccine can still be administered to close contacts of immunocompromised people, but they should be monitored for a rash.
• Acute HIV infection has fever, fatigue, weight loss, lymphadenopathy, abdominal pain, diarrhea, and rash. Exudative pharyngitis and hepatosplenomegaly are not a common features.
• EBV infectious mononucleosis (IM) is diagnosed with the monospot (heterophiles antibody) test. Treatment is supportive, and avoid contact sports for 4-6 weeks.
• Management of a needlestick that is high-risk for HIV includes PEP for 4 weeks; HIV testing immediately, at 4 weeks, and 6 months; testing of the source patient (often legally mandatory).
• A resident who intubates someone with N. meningitidis needs prophylactic treatment.
• Meningitis that is slower onset and less severe may be early neurosyphilis.
• Lyme does not grow on standard cultures, get an ELISA instead.
• For prevention of vertical transmission of HepB, give IVIG and vaccine within 12 hrs of birth then follow the routine vaccination schedule of 0, 2, 6 months.
• Oral pharyngeal thrush is an AIDS defining illness in the absence of inhaled steroids or chemo.
• Bacterial conjunctivitis has thick, unilateral discharge that crusts over. Viral and allergic are more watery and more likely to be bilateral. Allergic is itchy. Certain patients with bacterial conjunctivitis (e.g. contact lens wearers) should be treated with fluoroquinolone for Pseudomonas coverage. These patients also have an increased risk of bacterial keratitis
• Measles complications can be minimized in children by giving vitamin A
• Giardia transmission prevention: symptomatic shedders shouldn't swim.