Bacteria Flashcards
1
Q
Melioidosis - name of causative bacteria and bacteria description
A
Burkholderia Pseudomallei
Gram neg rod
Oxidase positive
environmental pathogen
multiple morphotypes
growth is always significant –> never a contaminant
2
Q
Distribution of Melioidosis
A
Australia, SE asia, South america
3
Q
Methods of contraction of Melioidosis
A
soil + water contact
ingestion
subcut innoculation
4
Q
Symptoms of melioidosis
A
Fever + pneumonia + abscesses
parotid abscess
spleen and liver abscess
lymphadenopathy
pneumonia
skin vesicles
brain abscess
5
Q
Investigations and findings of melioidosis
A
CXR - patchy non-specific opacities
Micro - various patterns of growth
Sputum culture
Throat swab
Urine culture
6
Q
Treatment of melioidosis
A
Ceftaz or meropenem - at least 2 weeks
then Bactrim for atleast 3 months
fevers can take weeks to improve
7
Q
Anthrax - name of causative bacteria and its description
A
Bacillus Anthracis
gram positive
Spore forming bacteria
Anaerobic (but can be aerobic)
Non-motile
Non-haemolytic
8
Q
Zoonosis animals for anthrax
A
Sheep
Cows
- causes haemorrhage in animals (at higher infection levels)
9
Q
Method of inoculation
A
Inhalation
Infected meat
IVDU
Skin (cutaneous anthrax)
10
Q
Reason for anthrax virulence
A
Encapsulated
Has endotoxins
11
Q
Symptoms of anthrax
A
Oedema
Haemorrhage
Cutaneous anthrax - painless ulcer with eschar (can also occur in GIT and cause ulcers and peritonitis/perforation)
mediasteinal lymphadenopathy
pulmonary haemorrhage
Anthrax meningitis - bloody CSF
12
Q
Treatment of anthrax
A
PEP
Vaccination
doxycycline or ciprofloxacin (add clinda if severe)
13
Q
Plague bacteria and description
A
Yersinia Pestis
Gram neg
non-motile
Cocco bacilli - safety pin appearance
Aerobic non-lactose fermenter
14
Q
Zoonotic host of plague
A
Rats - humans are an accidental host
Increasing incidence with deforestation and movement of forest rats into urban environments
15
Q
Symptoms of plague
A
Fever
Pustules (Bubonic)
Pneumonia (Pneumonic)
Malaise
Shock
DIC
16
Q
Investigation findings in plague
A
Neutrophillia
Lymphocytosis
Thrombocytopenia
DIC
Hepatorenal failure
Blue on Waysons stain (methelyene blue)
17
Q
Treatment for plague
A
Streptomycin, Gentamicin, Bactrim, Ciprofloxacin, doxycycline
(gram neg cover)
18
Q
What are the two types of rickettsial disease
A
Typhus group
Spotted fever group
19
Q
What are the Typhus group rickettsial diseases and their vectors
A
Epidemic - Louse
Marine (Endemic) - Flea
Scrub - Mite
20
Q
What are the Spotted fever group rickettsial diseases and their vectors
A
Rocky spotted mountain fever
African tick fever
Mediterranean spotted fever
Rickettsial pox
All caused by ticks except rickettsial pox (mites)
21
Q
Rickettsial bacteria description
A
obligate intracellular gram negative organisms
22
Q
Symptoms of rickettsial infection
A
Headache
Fever
Rash
Myalgia
Arthralgia
Eschar at bite sites
Pneumonia - ARDS
AKI
Rare - CNS disease, myocarditis
23
Q
Rickettsia treatment
A
Doxycycline 7-10 days
24
Q
Q fever organism and description
A
Coxiella Burnetti
obligate intracellular coccobacillus
25
Hosts and vector for Q fever
Farm animals
Sylvatic animals
Vector --> Ticks
26
Issue with Q fever diagnosis
Can change its antigenic composition in lab conditions --> very difficult to grow
27
Q fever symptoms
Subclinical flu-like prodrome
Acute --> fever, hepatitis, atypical pneumonia.
Chronic --> endocarditis, arthritis, GBS, CNS.
28
Treatment for Q fever
Doxycycline 2-3 weeks (12 months if endocarditis)
29
Name and description of bacteria causing trachoma
Chlamydia Trachomatis
30
Routes of trachoma transmission
4Fs
Food
Fomites/Fingers
Flies
Family
31
Symptoms of trachoma
Repeated cycles of eye infection
red, watery, discharging eyes.
Causes eyelashes to grow inwards
Over time can have entropion from scarring
32
Stages of trachoma
1. Normal
2. Inflammation
3. Intense inflammation
4. Scarring
5. Trichiasis (eyelashes inwards)
6. Corneal opacification
33
Types of spirochete infections
1. Treponema- Pallidium (Syphillis),Yaws, Bejel, Pinta.
2. Leptospirosis
3. Borrelial disease - Relapsing epidemic borrelia (Louse borrelia), Relapsing endemic borrelia (Tick borrelia), Lyme disease.
34
Description of spirochetes
spiral structure, gram negative anaerobic rods
35
Diagnosis of spirochetes
Serology only - very difficult to culture
36
Epidemiology and transmission of Yaws
Is a disease in children
From skin-skin contact
increased in humid environments and around equator
37
Symptoms and stages of Yaws
Primary: Mother lesion at site of innoculation - can then develop satellite daughter lesions.
Secondary: Widely disseminated lesions via lymphatic spread, hyper keratotic. Affects palms and soles (causing crab walk)
Latent: symptoms resolve
Tertiary: Bone, joint and tissue involvement (classic nose disfigurement)
(think yams and crab)
38
Epidemiology and transmission of Bejel
In children
North Africa and middle east only
Skin-skin or mucous-mucous contact
Long latency - 3 months
39
Treatment of Treponemal diseases
IM injection of Benzethine Penicillin
40
Symptoms and stages of Bejel
Primary: Painless chancre, common around nipples.
Secondary: Involvement of mucous membranes and genital lesions (condylomata lata), lymphadenopathy, osteoperiostitis.
Latent:
Tertiary: Destructive skin/bone gummas, skin depigmentation, neuro and cardiac involvement.
(bejewelled nipples and genitals)
41
Epidemiology and transmission of Pinta
Occurs in young adults in South America
Skin-skin contact
Most benign - skin ONLY
42
Symptoms and stages of Pinta
Primary: Plaque on arms/legs/hands - slowly enlarges
lymphadenopathy
Secondary: Disseminated lesions
Tertiary: Atrophic lesions and depigmentation
43
Treponemal disease diagnostics
RPR/VDRL
Treponemal tests
PCR
Dark field microscopy
44
Borrelia types and vectors
Relapsing fever epidemic - louse
Relapsing fever endemic - soft tick (intended hosts are rodents and lizards)
Lyme disease - Hard tick
45
Epidemiology of epidemic relapsing fever (borrelia)
high mortality associated with over-crowding and poor hygiene
Incubation - 1 week
More severe than tick borne borrelia - 70% mortality
46
Epidemiology of endemic (tick born) relapsing fever (borrelia)
found in the tropics
ticks live in roofs
passed down verically through tick generations
multiple relapses (10+)
10% mortality
47
Symptoms of borrelial disease
relapsing fevers lasting 3-6 days with each episode.
high grade fever, chills, myalgia.
Headache, confusion.
Hepatomegaly, jaundice.
Bleeding, petichiae
Myocarditis
DIC, thrombocytopenia
48
Diagnosis, management and complications of borrelial disease
Diagnosis - PCR
Management - Penicillin/Tetracycline
Complication - Jarisch - Herxheimer reaction (occurs in 2%) - exacerbation of fever and rash sometimes with hypotension, can also have other organ dysfunction.
Could be avoided with TNFa blockade (though not largely available)
49
Control measures for borrelia
Delousing
DDT, Permethrin, Malathion
Heat sterilisation of clothing
Mass PrEP
50
Lyme disease bacteria
Borrelia Burgdorferri
51
Symptoms of Lyme disease
Erythema chronicum migrans (target like lesions)
Meningitis
Rediculopathy
Myocarditis
AV block
Late symptoms:
Arthritis/dermatitis/chronic fatigue
Encephalopathy/myelopathy
52
Treatment for Lyme disease
doxycycline 3 weeks
53
Leptospirosis epidemiology
Is a zoonotic disease - many hosts and serotypes
Shed by animals through urine - contaminates soil and water
54
Phases of leptospirosis
Leptospiremic phase - blood and CNS
Leptospiuric phase - in urine and organs
55
Symptoms of leptospirosis
Hepatitis/jaundice
Muscle necrosis
renal failure
Uveitis and subconjunctival haemorrhage
Aseptic meningitis
56
What is Weil syndrome
Complication of leptospirosis
End organ damage + haemorrhage
57
Treatment of leptospirosis
doxycycline (Penicillin if severe)
58
Brucellosis epidemiology and transmission
gram negative cocco-bacillus, commonly intracellular
found in Mediterranean and the Middle east
comes from animals (animals are well besides foetal loss)
Inhalation, dairy products (can be treated with pasteurisation)
59
Symptoms of brucella
Undulating fever (rising and falling)
Anorexia, lethargy, fever, headache, lymphadenopathy
splenomegaly, hepatomegaly
Septic arthritis
Spinal disease
Orchitis
Hypersensitivity
60
Brucella diagnostics
Culture - with Castaneda medium
Serology --> note can be paradoxically negative in high titres (due to lack of agglutination)
16S
Direct brucella PCR
61
Treatment of brucella
Doxycycline + second agent for 6-12 weeks
2nd agent - streptomycin, gentamicin, bactrim, rifampicin, fluroquinolones.
3 weeks doxy as PEP
62
Tuberculosis bacteria description
Weakly gram positive, Acid fast bacilli
Fungus-like
Very slow growing - generation time - 17hrs
Has a cell wall
63
Immune evasion methods of TB
lives intracellularly (primarily in macrophages)
hides in vacuole to evade immune detection
Has immunomodulatory surface proteins
64
Cause of TB granulomas
Caused by the body trying to wall off the infection.
less likely to see granulomas in immunocompromise (HIV)
65
Life time risk of TB activation in latent persons
10%
66
Latent TB tests
Tuberculin skin test - intradermal injection of TB antigens to see if there is immune reaction (delayed hypersensitivity reaction) - can have cross-reactivity with other types of mycobacterium. - Sensitivity 56%
Quant gold - ELISA based interferon gamma release assay - Sensitivity 78%
Elispot test - cytotoxic t-cells producing interferon gamma.
67
TB diagnostic tests
Zeihl-Neelson stain
Fluorescent microscopy with auramine
Mycobacterial culture
Gene Xpert - NAAT
Gene Xpert ULTRA
CXR
Urine LAM - used in HIV+ cases
68
Relationship between TB and HIV
HIV increases TB risk 20-40 fold
TB risk increases prior to CD4 count dropping - Early loss of pulmonary CD4 cells and altered innate responses of macrophages.
69
Best timing of 3x AFB (sputum smear) collection
Spot/Spot/Morning
70
Standard TB treat
HRZE (2 months) + HR(4 months)
71
Standard TB treatment side effects
Rifampicin - orange secretions, liver injury, drug interactions, itch, flu-like symptoms,
Isoniazid - liver injury, peripheral neuropathy (give B6), psychosis
Pyrazinamide - arthralgia, gout, hepatotoxicity, GI upset, itch
Ethambutol - optic neuritis
72
Treatment for CNS TB
HRZE 2 months + HR 10 months (12 months total)
Could consider adding steroids if HIV negative ONLY
73
Issues with pleural TB diagnosis
pleural TB is considered extra-pulmonary (though often also have pulmonary disease)
AFB smear negative 98% of the time.
Poor sensitivity (around 50%) of culture and Gene Xpert
74
effect of TB treatment on granulomas
Initial paradoxical enlargement - then improves
75
Management of DILI from HRZE
Cease all drugs then re-introduce one by one slowly. Consider keeping off Pyrazinamide.
76
CNS TB probability score
Marais score
77
CSF findings in CNS TB
Appearance - slightly cloudy
Cell count - 100-500 (high but not as high as bacterial
High protein
Low glucose
78
Group where TB diagnosis is commonly missed
Children <5
79
What is gibbus deformity
bending of the spine due to spinal TB
80
Paediatric TB symptoms
non-tender lymphadenopathy
Hard, painless abdominal swelling
Slowly arisen swollen joint
Wheeze not reactive to bronchodilators
Meningitis
Angular deformity of the spine
81
Diagnosis of TB in paediatrics
Same methods as adults
Lower yield, more false negatives (smaller volumes of CSF etc)
Highly dependant on scoring systems --> CHILD TB LP and Keith Edward system
82
Management of newborns in TB positive mothers
Give BCG at 3-6 months if baby has not contracted TB
Give isoniazid preventative therapy 10mg/kg for 6 months
If baby gets TB then treat with HRZE
83
Breastfeeding advice for mothers with TB
Should breast feed UNLESS MDR
84
Paediatric TB treatment durations
Pulmonary TB - 6 months
Non-severe TB - 4 months
CNS/miliary/spine/joint TB - 12months
85
Categories of drug resistant TB
Rif resistant TB - RRTB
Multi drug resistant TB (rif + isoniazid) - MDRTB
Pre- XDRTB - (rif + isoniazid + fluroquinolone)
Extensively DRTB = XDRTB (rif + isoniazid + fluroquinolone + Grp A drug)
86
Group A drugs in TB
Fluroquinolones (Moxiflox, levoflox)
Linezolid
Bedaquiline
87
Regimen for Isoniazid resistant TB
HRZE + Levofloxacin
Once Isonazid resistance confirmed --> it can be dropped to RZE + Levofloxacin
88
Regimen for RR-TB or MDR-TB
Short (all oral) (9 months), if uncomplicated TB with no previous second line exposure.
4-6 months: bedaquiline + levofloxacin + clofazimine + ethionamide (AABC) + high dose isoniazid + pyrazinamide + ethambutol (hHZE)
followed by
5 months: levofloxacin + clofazimine + pyrazinamide + ethambutol
(ABZE)
Bedaquiline use in this regimen is always for 6 months.
Long course (18 months) - AAA + BB
Bedaquiline (6m) + Linezolid + Levofloxacin + Clofazamine + Clycoserine
89
Who should you screen for TB
High risk populations - HIV, malnutrition
Not household contacts - No change in health outcomes with household screening - likely due to the amount of TB caught outside the house.
90
TB prevention options
BCG vaccine - only useful in children
Isoniazid prevention therapy - for at risk groups/children/household contacts - 6 or 9 months isoniazid, 4 months rif, 3 months combo.
91
Social effects of TB in low-income settings
Catastrophic costs in 20% of households
- further poverty and its consequences
- malnutrition
- loss of work and education opportunities
- stigma
92
Leprosy bacteria description
Obligate intracellular bacteria - lives within macrophages
Acid fast bacilli
Slow generation time (12.5 days)
93
Leprosy epidemiology
Asia, South America, Nigeria
1-20 year latency
only 5% develop disease
94
Leprosy transmission
Droplet
Close contact
skin-skin contact
95
What parts of the body are most affected by leprosy
Cool areas where temp <33
96
Classification of leprosy
Tuberculoid (TT) leprosy = paucibacillary form.
Asymmetric
1-2 lesions, sharply defined red patches or hypopigmented patch
<10 cm.
Sensory loss and hair loss over lesion
nerves are thickened and tender on palpation over lesion
Borderline tuberculoid (BT) leprosy.
More lesions (5-20) + larger in size.
Asymmetrical
Satellite lesions
Sensory loss and hair loss over lesion
Borderline borderline (BB) leprosy
Asymmetric
Multiple lesions of varying size, shape, and distribution
Skin-coloured or erythematous.
Swiss cheese lesions
Sensory loss and hair loss over lesion
Borderline lepromatous (BL) leprosy
Widespread bilaterally symmetrical lesions
Macules, papules, and nodules of variable size and shape
Sensation and hair growth remain normal within a lesion
Characteristic glove and stocking numbness
Widespread peripheral nerve involvement.
Lepromatous (LL) leprosy = multibacillary form
Early symptoms of nasal stuffiness, discharge, and bleeding
Swelling and thickening of limbs with subsequent ulceration
Symmetric widespread poorly defined hypopigmented and erythematous macules with normal sensation + nodules and plaques
Widespread peripheral nerve involvement.
Characteristic leonine facies with thickening of the forehead, loss of eyebrows and eyelashes (madarosis), distortion of the nose, and thickening of the earlobes
Involvement of other systems
97
Systemic symptoms of lepromatous leprosy
Eyes — corneal anaesthesia, keratitis, corneal ulceration, uveitis, glaucoma, irreversible blindness
Testes — orchitis, testicular atrophy, sterility
Liver — hepatitis, hepatic amyloidosis
Kidneys — glomerulonephritis, renal amyloidosis
Bones — osteoporosis, resorption of digits.
98
Immunological difference between tuberculous leprosy and lepromatous leprosy
Tuberculous - lower bacterial load, cell mediated response
Lepromatous - higher bacterial load, antibody response
99
Which gene increases risk of active leprosy
NOD2 variant
100
Symptoms of leprosy
Hypopigmented or erythematous skin patches
Thickened nerves with neuropathy and sensory loss
Sensory disturbance
Motor loss
Ophthalmic disease - weakening of eye nerves/muscles (Lagopthalmos) - eyes unable to close leading to Iritis.
Immunologic reactions - fatigue, malaise, fever, neuritis, arthritis, iritis, and nasopharyngeal symptoms.
Collapsed nose
Perforated nasal septum
Lucio phenomenon (necrotizing vasculitis)
101
What are lepra reactions
Lepra reactions are immunologic reactions in leprosy that may be induced by treatment
Type 1 reaction 'reversal reaction' : Delayed hypersensitivity to M.leprae antigens and increase in cellular immunity.
- lesions become more red/ulcerated/indurated
- nerves become painful/paralysis
- occurs mostly in borderline disease
Type 2 'erythema nodosum leprosum': Acute immune complex vasculitis
- eruption of AFB positive nodules
- swollen nodes, joints and eyes
- headache
- occurs mostly in lepromatous disease
102
Treatment for each Lepra reaction type
Type 1 reaction 'reversal reaction' : Prednisolone + reduce rifampicin
Type 2 'erythema nodosum leprosum': Pred + MTX + Thalidomide
103
Diagnostics for Leprosy
Skin biopsy + AFB
PCR
Serology (not reliable)
104
Treatment for Leprosy
Rifampicin triple therapy: Dapsone + Rifampicin (monthly) + Clofazimine
Paucibacillary → 6 months
Multibacillary → 12 months
Single lesion → Rifampicin + Ofloxacin + Minocycline
105
Side effects of Leprosy drugs
Dapsone SE → Methaemaglobinemia. Dapsone hypersensitivity syndrome (10% mortality).
Clofazamine SE → photosensitivity, hyperpigmentation.
Haemolytic anaemia in G6DP. Agranulocytosis
106
PEP for leprosy
Single dose Rifampicin
107
Chlamydia - symptoms, testing, complications and treatment
Symptoms - clear discharge, cervical motion tenderness, rectal infection, pharyngeal infection, conjunctivitis.
Testing - gram stain
Complications - PID, ectopic, infertility, reactive arthritis
Treatment - 1 week doxy
108
Gonorrhoea - symptoms, testing, complications and treatment
Symptoms - green discharge, urethral pain
Testing - Gram stain (GNC)
Complications - PID, prostatitis, skin lesions, tenosynovitis
Treatment - Ceft + Azithro STAT
109
Trichmonas Vaginalis - symptoms, testing, complications and treatment
Symptoms - strawberry cervix, clear DC
Testing - microscopy, NAAT
Complications -
Treatment - Metronidazole
110
Mycoplasma genitalium - symptoms, testing, complications and treatment
Symptoms - Majority asymptomatic, PID, cervicitis
Testing - NAAT
Complications -
Treatment - doxycycline then azithromycin if not improved
111
Bacterial Vaginosis - symptoms, testing, complications and treatment
Symptoms - Grey thin discharge
Testing -
Complications -
Treatment - Metronidazole
112
Empirical therapy for PID
IM Ceftriaxone stat + doxy 100mg BD + metronidazole 400mg BD
113
Treatment of Syphilis
Benzathine Penicillin + Doxycycline
Can get an acute Jarisch-Herxheimer reaction with treatment
Prednisolone if neurosyphillis
114
Tropical ulcer STIs - symptoms, testing, complications and treatment
Chancroid - painful + buboe + Phimosis
LGV (chlamydia subtype) - multiple ulcers, anorectal involvement, lymphatic obstruction.
Donovanosis - painless, granulomas
Diagnosis - NAAT
Treatment - Azithromycin
115
Features and causes of small bowel diarrhoea
watery, low frequency large volumes.
causes: viruses, giardia, cholera, cryptosporidium
116
Features and causes of large bowel diarrhoea
bloody, mucous, high frequency small volumes.
causes - campylobacter, shigella, salmonella, amoeba, schisto, strongyloidiasis
117
Most common cause of diarrhoea in Africa in children <5
Shigella
118
Shigella bacteria type, infectious dose and species
gram negative bacilli
10 bacteria required for infection
1 week incubation
Sonnei - most common in high income countries
Flexneri - most common in low income countries
Boydii
Dysenteriae - type 1 shiga toxin
119
Treatment for Shigella
Ciprofloxacin, Azithromycin
Zinc!
Can be prevented with chlorination
120
Shigella investigations
microscopy, culture, PCR (no serology)
121
Entamoeba histolytica incubation, infectious dose and investigations
Incubation - 1 week
infectious dose - 1000 bacteria
Ix - microscopy, faecal antigen, serology
122
cholera bacteria and infectious dose
gram negative bacilli
comma shaped
infectious dose - 100 million
123
Incubation and symptoms of cholera
incubation - hours - 5 days
symptoms - severe watery diarrhoea, Rice water stools, bloating, vomiting, ileus, muscle cramps.
75% asymptomatic
124
What is cholera sicca?
fluids pooling within the gut (third spacing) - severe dehydration without major vomiting or diarrhoea. Rapid deterioration.
125
How does cholera cause disease
via cholera toxin - affects Nacl/K/HCO3 exchange
mediated by Tox R gene
126
cholera investigations
Dark field microscopy - darting vibrios
Dipstick
Confirmation by culture
127
Management of cholera
- cholera vaccine - 2 types, toxin sub unit B vaccine and whole bacteria vaccine.
- Azithromycin
- glucose containing fluid replacement
128
Cholera serotypes
01 - classical (more symptomatic), El Tor (more prevelant)
0139
129
Types of enteric fever
Salmonella Typhi
Salmonella paratyphi
130
Typhoidal salmonella presentation
usually bacteremic
10% mortality without treatment
relapse is common
step-wise fever
vomiting
diarrhoea OR constipation
cough
hepatosplenomegaly
Rose spots
CAN BE BRADYCARDIC
131
Complications of typhoid
delirium
intestinal perforation
pneumonia
DIC
bone and joint infections
gallbladder cancer
132
typhoid incubation and number of bacteria needed to cause infection
1-2 weeks
10 million
133
Typhoid pathogenesis
Salmonella typhi and paratyphi can go through the gut wall silently via M-cells past peyers patches without causing diarrhoea/inflammation
Is an intracellular pathogen in macrophages and lymphnodes
→ after 1-2 weeks the bacterial load is so high that it spills out into the bloodstream causing fever and illness.
Can return to the GIT when expelled into the bowel from the gallbladder bile. Salmonella then re-interacts with the GIT peyers patches, which now recognise the pathogen and cause inflammation causing diarrhoea.
134
Diagnostic tests for typhoid
Blood culture (54% sensitivity)
Faecal culture (25% sensitivity. Cannot differentiate chronic carriers)
Transaminitis (mild)
Widal test - agglutination of antibodies (high false negatives)
Rapid diagnostics tests
135
Treatment of typhoid
Ciprofloxacin/Ceftriaxone, Azithromycin
In Pakistan - need meropenem due to drug resistance
136
management of asymptomatic typhoid carriers
need a prolonged course of treatment - can readily pass infection to others (think typhoid mary)
137
Vaccines for Typhoid
2 available
- TY21a
- Vi vaccine (for multi-resistant strains)
138
Non-typhoidal salmonella species
Typhimurium
Enteritidis
139
How does non-typhoidal salmonella differ from salmonella
Non-typhoidal salmonella can have non-human hosts
More commonly does not cause bacteraemia (except in HIV and in African variant!!)
low mortality
self limiting and does not require treatment
140
Symptoms of non-typhoidal salmonella
Fever
Pneumonia
Diarrhoea
anaemia
hepatosplenomegaly
141
what is the non-typhoidal salmonella African variant
A variant found across Africa (except South Africa which has global variant)
is invasive and causes bacteremia, without enteritis
142
Common causes of meningitis
N.Meningitidis - globally, serogroups A, B, C, W and Y most commonly cause disease. (Men B vaccine - new)
Strep pneumo / Strep suis
H. influenzae
(SNH)
143
proportion of people who have meningococcal rash
33%
144
What are Kernig and Brudzinsky sign
Kernig - pain on passive extension of the knee with flexed hip
Brudinski - hips and knees flex when neck is flexed
145
Treatment of meningococcal disease
Cefalosporin
Penicillin + Cefalosporin in >60
Vanc + Cefalosporin if risk of resistance
Chloramphenicol + Bactrim if immunocompromised
No significant improvement with steroids
146
Management of meningococcal close contacts
Ciprofloxacin STAT
147
Diptheria incubation, transmission and pathogenesis
Exo-toxin producing
A subunit and B subunit
Incubation 2-5 days
Droplet spread
Most common in children
147
Diptheria incubation, transmission and pathogenesis
Exo-toxin producing
A subunit and B subunit
Incubation 2-5 days
Droplet spread
Most common in children
148
Diptheria symptoms
Causes tonsillar plaque (dirty white membrane) and lymphadenopathy
149
Diptheria investigations
ELEK test - to see if toxin producing
Black dots on agar
Toxin can be diagnosed by PCR
150
Management of diptheria
- anti toxin
- ben pen + azithromycin
- give immunisation
- ecg monitoring for toxin induced heart block
151
Tetanus management
Ben Pen/ Metronidazole
Anti-toxin
152
Characteristics of Noma
Age 2-5
Occurs on face
Well demarcated perimeter
Odour
Short time frame
Comorbidity
