Bacteria Flashcards
Leprosy PB Treatment (first line)
6/12 Rif monthly Dapsone daily (Clofazamine also given to simplify, but this is contentious as causes darkened skin)
Leprosy MB Treatment (first line)
12/12 Rif monthly, Dapsone and Clofazamine daily
Leprosy Facts
M leprae are found in nasal droplets of highly infected individuals and thought to enter th ebody through URT
Leprosy Facts
Affinity for cooler sites of body, peripheral nerves and skin, rarely eyes, mucus membranes, testes, bones and viscera
Leprosy Incubation
Long, 3-5 years, to >20 years
Leprosy TT
High CMI Low bacteria = PB
Leprosy LL
Low CMI High bacteria = MB
Leprosy Borderline
At highest risk for reactions
Leprosy Skin
> 95% of patients with leprosy will have a skin lesion
Leprosy Symptoms
Numbness in hands and feet, deformities, painless ulcers or burns, nasal stuffiness, ptosis
Leprosy TT Skin
Well defined, asymmetrical, not many, may mimic ringworm, anaesthesia, often affecting buttocks, face and extensor surfaces of limbs (cooler parts of body)
Leprosy BT Skin
Ill defined, satellite lesions
Leprosy BB Skin
Central healing area, looks more like ring
Leprosy BL Skin
Symmetrical and more diffuse
Leprosy LL Skin
Nodules and infiltration, associated nasal stuffiness, discharge, epistaxis, oral lesions, hoarseness
Leprosy Nerve signs
Thickening, hand burns, muscle wasting, claw hand, foot ulcers
Leprosy Eye signs
Lagophthalmitis (inability to close eyes causes dryness), reduced corneal sensation - abrasions, acute or chronic iritis, cataract
Leprosy WHO Disabiity grading Eyes
2 = reduced vision (unable to count fingers at 6m) or lagophthalmos
Leprosy WHO Disability grading Hands
1 = palmar sensory loss, 2= wounds, claw hand, or loss of tissue
Leprosy WHO Disability grading Feet
1 = sole sensory loss, 2= wounds, loss of tissue, foot drop
Leprosy Split skin
Forehead, eyebrows, ear lobes - ZN staining
Leprosy Three cardinal signs
Definite loss of sensation in hypopigmented or reddish skin patch; thickened peripheral nerve with loss of sensation/motor fx supplied by nerve; or presence of AFB on slit smear
Leprosy Diagnosis
At least one cardinal sign
Leprosy WHO PB Definition
5 lesions or less
Leprosy WHO MB Definition
6 lesions or more
Leprosy AE Dapsone
Hypersensitivity more common in Asia and G6PD deficiency
Leprosy AE Clofazamine
Hyperpigmentation, ichythyosis (fish scale skin)
Leprosy AE Rifampicin
Orange body fluids
Leprosy PB Treatment endpoints
30% will still have active skin lesions afer 6 months
Leprosy MB Treatment endpoints
BI falls 1 unit per year - look at appearances of AFBs (how broken do they look?)
Leprosy Treatment (second line)
Mino/Oflox/Clari OR monthly Rif/Moxi/Mino - newer agents Bedaquiline and Telacebec
Leprosy Chemoprophylaxis for household
Single dose Rifampicin
Syphilis Screening
Unless testing and treatment of syphilis in pregnancy are universally available, over half of pregnancies in women with syphilis will result in an adverse outcome
Syphilis RPR testing
Sens 85-95% Spec 95-98%
Syphilis MTCT
Primary 60%, Secondary 90%, Early latent 40%, Late latent <10%, causes 7.7% of avoidable stillbirths, although risk lower with late latent, most women are late latent, therefore most transmissions occur in asymptomatic women
Syphilis Treatment
Primary, Secondary, Early latent IM Benzathine penicillin 2.4m units stat; Late latent x3 (no evidence to support this)
Syphilis WHO elimination congenital syphilis
> 95% antenatal ateenders screened, >95% seropositive treated, incidence of congenital syphilis <50 per 100,000 births
Brucella Diagnosis
GNCB intracellular on any sample inc BC, PCR, Serum agglutination ELISA >1:160 (>1:320 endemic), Rose Bengal (total Ab agglutination, not B canis)
Brucella Transmission
Low infective dose 10-100 bacteria, inhale or ingest. Commonest bacterial zoonosis worldwide - unpasteurised dairy, undercooked meat, contact with mucus membranes, aerosolisation during butchery, Lab-acquired
Brucella Epidemiology B melitensis
SE Europe, ME, Sth America, SE Asia, dairly products
Brucella Pathogenesis
Circulates in reticuloendothelial system (similar to dimorphic fungi) go to LN, bone marrow, liver/spleen
Brucella Treatment
Difficult (intracellular) Doxy 45d and Streptomycin 10d (or Gent) (relapse 5%) - second line Doxy and Rif 45d (relapse 16%)
Brucella Symptoms
Nonspecific, undulent fever (over weeks), migratory arthralgia, hepatosplenomegaly, thrombocytopaenia, elevated LFTs
Brucella Complications
Endocarditis, sacroilitis, epididymoorchitis, OM, spondylodiscitis (Pedro Pons’ sign - erosion anterosuperior vertebrae)
Brucella Prevention
Animal vaccines, wear PPE, adequately cook meat, pasteurise dairy
