Bacteria

Question 1

Organism cause of Typhoid

Answer 1

Salmonella typhi and salmonella paratyphoid A

Gram negative

Question 2

How is typhoid transmitted?

Answer 2

Faecal-oral

Water/food - think ice cream stand
Flooding conditions

No animal reservoir, exclusive human to human

Question 3

What is the clinical timeline of typhoid disease?

Answer 3

Question 4

Who does typhoid tend to affect?

Answer 4

Children - 40-80% children
In <5y can be non specific fever and a mild bacteraemia

Many patients can be treated as OP

Question 5

Diagnosis and investigations for Typhoid?

Answer 5

WCC - normal/low (different to pyogenic infections)
Transaminases 2-3x (not herpatitis picture)

Blood culture - 60% sens
Widal Test - cheap not reliable
RDT - antibody test

Question 6

Where is the global burden of typhoid?

Answer 6

SEA and Central Asia - Typhi, paratyphi A
Africa - Typhi, non typhoidal salmonella
SA

Question 7

Pathopyhsiology of typhoid?

Answer 7

Ingest bacteria
Taken up by monocytes and macrophages (survives this) - passes to reticular endothelial system (liver and spleen) - multiplies and spills out into blodostream (SYMPTOMS)

7-14 days incubation period

Question 8

Treatment Typhoid

Answer 8

Ceftriaxone - slow treatment, little resistance
Cipro - some resistance
Azithro - good for mild severity disease

Question 10

What are the features of severe and complicated disease of typhoid?

Answer 10

GI bleed/perforation
Shock

Relapse
Chronic carriage >1y (continue to shed bacteria in stool for over a year)
Carcinoma of gall bladder

Question 11

Brucellosis

Answer 11

Gram -ve coccobaccili
Global Zoonosis

Most common - Brucellosis Melientis
Ingestion unpasteurised milk

Insidious fever + joint involvment
Children - unilateral joint

blood culture - slow
SAT - less good

Doxy 6 weeks, 1-2 week aminoglycoside

Question 12

Plague

Answer 12

Yestinia perstis
Plague - bubonic and pneumonic (septicaemic)

Gram -ve coccobacilli

Classic plague symptoms

Tx Fluroqunilone

Question 13

Anthrax

Answer 13

Bacillus Anthracis
Gram +ve rod

Africa/Turkey - farmers

Cutenouos
GI
Resp

Fast progressing

Penicillin or doxy or cipro

Question 14

Q fever

Answer 14

Coxiella Bureti
Gram -ve rod

Acute - severe flu, can get hepatitis/pmneumonia
Helmand fever

Chronic - concern is endocarditis

Tx: Doxy and hydroxychoroquine

Question 15

Tularamiea

Answer 15

Francisella Tulerensis

Rabbit fever

Multipel forms
Ulceroglandular

Gent best
Doxy or cipro

Tx: Gent best
Doxy or cipro

Question 16

Diptheria

Answer 16

Corynebacterium Diptheriae
Short incubation 2-5 days
Droplet spread - most prominent in children

membranous pharyngitis with fever
anterior cervical nodes
Can get bull neck - combo cervical adenopathy and swollen mucosa

myocarditis and heart block - major complication
demyleinanting peripheral neuritis - can get palatal palsy, CN abnormalities, respiratory paralysis

Tx:
Anti toxin (diphtheria anti toxin)
Penicillin is good
Treat contacts
CV support if required and have facilities to do so

Vaccine

Question 17

Tetanus

Answer 17

Clostridium tetani
Mediated by tetanus toxin

In soil - entry by wound

Tx:
Wound cleaning/debridement
Anti toxin
Metronidazole or penicillin
Supportive treatment as needed

Vaccination!!

in 3rd trimester pregnant women to prevent