Board Review

Infectious Disease
July 2018
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Name That Bug: $100

A child with cyanotic heart disease presents with new onset headache and
seizure. MRI demonstrates a brain abscess.

What is the likely organism?

Answer
Answer:
Staphylococcus Aureus

Children with cyanotic heart disease are at increased risk of brain abscesses due
to S. Aureus, especially if there is endocarditis with septic emboli.
Name That Bug : $200
Which organism is associated with the following:
- Occurs in infants <1 month of age
- Maternal amnionitis
- Brown staining of the amniotic fluid
- Pre-term birth
- Pneumonia and septicemia
- Erythematous rash with papules
- Also known as “Granulomatosis Infantisepticum”

Answer
Answer:
Listeria Monocytogenes

- Infection with Listeria Monocytogenes occurs in the neonates, solid organ

transplants, immunodeficiency, lymphoma/leukemia, and pregnant women.
- It is acquired via direct contact with goat cheese, uncooked hot dogs, tofu, or
contaminated vegetables.
Name That Bug : $300
A previously healthy 2 year old day care attendee presents with:
- Fever
- Vomiting
- Bloody diarrhea, rectal prolapse
- New onset tonic-clonic seizure activity
- Leukocytosis with bandemia

What is the most likely etiology for the diarrhea and other findings?

Answer
Answer:
Shigella

Shigella is a common cause of diarrhea, especially in day care centers. Children

ages 1-4 year have the highest incidence. Bloody diarrhea and seizures
commonly occur. Rectal prolapse occurs in 5-8% of cases. Most illnesses are
self-limited, but antibiotics are recommended in severe cases and can shorten
the disease course and limit spread to others.
Name That Bug: $400

A neonate is diagnosed with bacteremia and meningitis. Head CT

demonstrates large brain abscesses.

What organism is most likely?

Answer
Answer:
Citrobacter

Citrobacter Meningitis has a high incidence of brain abcesses

Name That Bug: $500
A healthy 17 year old girl presents with:
- Pneumonia
- Diarrhea
- CNS Symptoms (headache, delirium, confusion)

What is the most likely etiology of her symptoms?

Answer
Answer:
Legionella pneumophila.

Legionella causes a triad of pneumonia, diarrhea, and CNS manifestations

(headache, delirium, confusion). It is commonly associated with outbreaks related
to contaminated water towers or air-conditioning water units in buildings, hotels,
cruise ships, and hospitals.
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A 9 year old boy with recent history of camping in the Rocky Mountains
presents with watery, smelly diarrhea for the last week with multiple episodes
of flatulence. His mother complains that he is burping a lot and that is smells
horrible, “like sulfur”.

What is the most likely diagnosis?

Answer
Answer:

Giardiasis.
Giardia is the most common disease-causing parasite in the US. Acute symptoms
include watery, smelly diarheea, and flatulence. “Sulfuric belching” is very common
with the infection. Diagnosis is by checking a Giardia specific antigen in the stool.
Travel to the Rocky Mountains is a common hint on the board examination.
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A 12 year old boy from Arizona loves to hunt prairie dogs and skins them with his old
hunting knife. He presents with a 3 day history of fever, chills, headache, and painful,
swollen right inguinal lymph node.

What organism do you expect?

Answer
Answer:
Yersinia pestis

Yersinia pestis is a zoonotic infection of rodents, carnivores, and their fleas. It may
occur in the bubonic form (acute onset fever and painful, swollen lymph nodes
(buboes)) or, less commonly, as pneumonic plague.
Most human cases occur in New Mexico, Arizona, Colorado, or California
Found in squirrels, prarie dogs, and other wild rodents.
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A patient from North Carolina presents with:
- Fever
- Headache
- Arthralgia
- Maculopapular rash on the extremities
- LAB: Serum sodium 128mg/dL, Platelet count 110K

What is the most likely diagnosis?

Answer
Answer:
Rocky Mountain Spotted Fever (RMSF).

This is the classic scenario for RMSF. RMSF is due to Rickettsia Ricksettsii, a tick-
bourne disease mainly found in the mid-Atlantic states. The rash begins at the
wrists and ankles and spreads toward the trunk. The disease is treated with
Doxycycline.
Where --> what?: $400
A 14 year old boy from Hawaii presents with the following:
- History of swimming in fresh-water lagoons
- Fever
- Myalgia
- Headache
- Jaundice

- His bilirubin is disproportionately high compared to his AST/ALT, which are mildly
elevated
- Creatinine 1.9 Answer
Answer:
Leptospirosis

Leptospirosis is a spirochetal disease transferred by contact with contaminated

water or infected animals. Rat and dog urine are the most common vectors.
This is a disease that is biphasic with an initial systemic febrile illness followed
(7 days later) with hepatic and renal insufficiency. Leptospirosis is diagnosed
with urine studies after 4-7 days of illness.
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A 13 year old from Missouri presents with:
- Interstitial pneumonia
- Palatal ulcers
- Splenomegaly

What is the most likely diagnosis?

Answer
Answer:
Histoplasmosis

Common triad of pneumonia, splenomegaly, and palatal ulceration.

Seen in the Ohio and Mississippi river valleys.
Associated with bird and bat droppings
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A 6 year old with MRSA Osteomyelitis is given his first dose of antibiotic. He
develops the following:
- Tachycardia
- Flushing
- Generalized pruritis

What antibiotic was he likely given?

Answer
Answer:
Vancomycin

This reaction is caused by rapid infusion of IV vancomycin. It is not a true

allergy, but rather a degranulation of mast cells and releasing of
histamine in the setting of rapid infusion.
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The use of Erythromycin ointment in a newborn’s eyes is useful for preventing

which infection:

a. Gonorrhea
b. Chlamydia
c. Both
d. Neither

Answer
Answer:
Gonorrhea

Contrary to popular belief, the use of eye prophylaxis is only beneficial in

preventing Gonorrheal conjunctivitis. It does NOT prevent Chlamydial infection.
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A Caucasian adolescent boy presents with hyperpigmented scaling lesions on his

chest and back which worsen when he plays football in the hot sun.

What is the most appropriate treatment?

Answer
Answer:
Topical Selenium Sulfide or oral Itraconazole

Tinea Versicolor is due to Malassezia furfur infection. Skin Scraping will

demonstrate “spaghetti and meatballs” organisms. The most appropriate
treatment is topical selenium sulfide or oral itraconazole
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A 17 year old girl with HIV learns that she is pregnant. Her most recent
CD4 count was 780. She has not been on anti-retroviral medications. A
repeat CD4 count is now 820.

Should she be started on anti-HIV medications?

Answer
Answer:
Yes
Current HIV therapy guidelines list pregnancy as a “definite” for
starting anti-HIV medications. On the board examination, be sure to
refer the HIV-infected patient who becomes pregnant immediately for
anti-HIV therapy.
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Amphotericin B causes renal losses of which 2 electrolytes?

Answer
Answer:
Magnesium and Potassium

Amphotericin B causes a renal tubular acidosis, and thus the renal losses of
Potassium and Magnesium.
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An unimmunized 3 year old presents with:
- Fever (Tmax 104F)
- Dysphagia
- Drooling
- She is leaning forward with her neck hyperextended and chin thrust forward.

What is vaccination might have prevented her illness?

Answer
Answer:

Hib: Haemophilus Influenza Type B was previously a common cause of epiglottitis.

Today, the disease is rare, but there continue to be sporadic infections in
underimmunized children.
Prevention: $200

A 5 year old presents for her first influenza vaccination.

How many should she receive?

Answer
Answer:

2 Doses, spaced 1 month apart.

For children <9 years of age who have never been vaccinated, 2 doses of
Influenza vaccination are indicated. Thereafter, they receive 1 vaccination
annually.
Prevention: $300

A bat is found in the room of a 2 year old boy where he was

sleeping. His parents like to keep the windows cracked open to allow
the cool Hawaiian breeze to come in.

Should he be given rabies prophylaxis?

Answer
Answer:
No

In areas where rabies is found, you WOULD provide rabies prophylaxis

to a child found sleeping in the same room as a bat.

However, Hawaii is the only US state which is rabies-free!

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Marla, a 13 year old girl, has a staple injury (clean, minor wound).
She has had 7 immunizations for tetanus. Her last immunization for
tetanus was 7 years ago.

What do you recommend for her in regards to immunization for

tetanus?

Answer
Answer:
No immunization

Immunize for tetanus if:

- Wound is “dirty”
- Fewer than 3 immunizations in the past
- More than 10 years since last immunization
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What time frame determines which newborns should be given

VariZIG (Varicella Immune Globulin) if their mothers develop
chicken pox in the perinatal period?

Answer
Answer:

Newborns whose mothers had Varicella within 5 days BEFORE and

2 days AFTER delivery should be prophylaxed with Varicella IG