29. Infections 2 Flashcards
What is infective endocarditis and what are the main causative organisms?
Infection of endocardial structures
Staphylococci
Streptococci (likes prosthetic valves)
Enterococci
Signs and symptoms of infective endocarditis?
Fever
Malaise
Arthralgia, myalgia, confusion
Pyrexia, tachy, anaemia Clubbing New murmur Splenomegaly Vasculitic lesions
Investigations for infective endocarditis?
Bloods - FBC for anaemia, ESR, CRP, U&Es, rheumatoid factor positive
3 blood cultures an hour apart
Urgent echo
Dukes classification
How do we manage infective endocarditis?
Empirical ABx
Targeted ABx after sensitivity results (2-6 weeks)
Anticoagulation may be needed in prosthetic valve endocarditis to prevent stroke/pe
What are the main three UTIs?
Cystitis - bladder
Pyelonephritis - kidney
Prostate - prostatitis
What are the signs and symptoms of pyelonephritis?
Rigors Flank and back pain Pyrexia N&V Confusion (elderly)
Signs and symptoms of cystitis?
Frequency Urgency Dysuria Haematuria Foul-smelling cloudy urine Suprapubic/loin pain
How do we investigate UTIs?
Assess RF (complicated or no) Dipstick urinalysis (positive nitrites, leukocytes, blood) Urine MC&S Abdo USS to exclude urinary tract obstruction/renal stones
How do we manage UTIs?
Cefalexin first like for pyelonephritis
Trimethoprim/nitrofurantoin
What is malaria?
Infection with protozoan plasmodium
Signs and symptoms of malaria?
Headache Weakness Myalgia Fevers Splenomegaly Anaemia DIC
Investigations and management for malaria?
Giemsa-stained thick and thin blood smears
Artesunate
Symptoms of viral hepatitis?
Initial flu-like symptoms, malaise, joint pain etc.
Icteric phase - jaundice, pale stools, dark urine, pruritus
Recovery - up to 6 months (or not at all if in chronic, B, C, D)
How do we manage viral hepatitis?
Supportive - rest, avoid alcohol, paracetamol, anti-emetics etc.
Minimise risk to others - not sharing toothbrushes, razors, sex, needles
What is gastroenteritis and what are the common pathogens?
Inflammation of the GI tract Norovirus Rotavirus Campylobacter E.coli
Symptoms of gastroenteritis?
Sudden onset diarrhoea Blood or mucus in the stool Faecal urgency N&V Fever/malaise Abdo pain/cramps
Gastroenteritis investigations?
Assess fluid status
HR, BP, temp for shock
Bloods (deranged K in severe dehy)
Stool MC&S - bacteria, ova, parasites
Management of gastroenteritis?
Supportive therapy (bed rest, fluids)
If systemic illness then admit with oral fluids
ABx
Main causes of meningitis?
Neisseria meningitidis
Strep pneumoniae
Sign and symptoms of meningitis?
Classic triad -
Fever
Tachy
Hypotension
Altered mental state Skin rash N&V Focal neurological signs Brudzinski's and kernig's sign
Investigations for meningitis?
Two sets blood culture
CT scan to exclude raised ICP
Lumbar puncture for CSF and gram staining
How do we treat meningitis?
Non-blanching rash or septicaemia - call an ambulance and give IV benzylpenicillin
Bacterial meningitis - IV ceftriaxone
Consider corticosteroids
Consider IV acyclovir for encephalitis
Rifampicin for prophylaxis of close contacts
