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PM3A > BACTERIAL INFECTIONS IN CORE SYSTEMS > Flashcards

BACTERIAL INFECTIONS IN CORE SYSTEMS Flashcards

1
Q

LOWER UTI, CAUSES RISK FACTORS AND SYMPTOMS

A

CAUSES: Commonly bacteria
- Usually E. coli in bladder/ urethra from GIT.
RISK FACTORS:
(1) Females - urinary system + GIT in close proximity
(2) Sexual activity
(3) Pregnancy
(4) Genetic predisposition
(5) Post-menopausal
(6) Diabetes
SYMPTOMS:
(1) Increased urination frequency - polyuria
(2) Burning in urination - dysuria
(3) Cloudy urine
(4) Strong-smelling urine
(5) Lower abdominal discomfort

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2
Q

UTI: 1ST LINE TREATMENT FOR WOMEN THAT AREN’T PREGNANT AND 2ND LINE TREATMENT

A
  • Nitrofurantoin
  • 100 mg M/R
  • BD
  • 3 day course (increase duration if pregnant)
    2ND
    Fosfomycin/ pivmecillinam
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3
Q

CAUSES, SYMPTOMS OF PNEUMONIA

A

Strep.pneumoniae pneumococal, typically ‘at risk’ groups.
fever, loss of appetite, unwell, shivering, chest pain, others

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4
Q

TREATMENT FOR PENUMONIA and PREVENTION

A

Depends on severity, organism and type, e.g. CA vs HA oral antibiotics, e.g. amoxicillin, IV antibiotics (hospital/severe).
Vaccine, PPV against pneumococcal

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5
Q

PATHOPHYSIOLOGY and SYMPTOMS OF H PYLORI

A

Causes damage to the stomach and duodenal epithelial lining via multiple mechanisms. Can cause gastritis (inflammation). Can lead to damage and later ulcers. Inflammation and other effects of H.pylori can also lead to gastric cancer in chronic infection.
Abdominal pain (burning), nausea, bloating, belching.

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6
Q

TREATMENT FOR H PYLORI

A

PPI + 2 antibiotics: amoxicillin (1000mg/BD) + either clarithromycin (500mg BD) or metronidazole (400mg BD) for 7 days

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7
Q

INFECTIVE ENDOCARDITIS: CAUSES AND SYMPTOMS

A

Usually bacterial and in pt. with heart valve replacement or damage (rare) caused by commonly s.aureus or strep.
Symptoms: fever, chills, heart murmurs, tiredness/fatigue, cough, headache, shortness of breath, night sweats & others

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8
Q

TREATMENT FOR INFECTIVE ENDOCARDITIS

A

Depends on no. factoirs, e.g. a penicillin (+gentamicin, s.pyogenes) flucloxacillin (s.aureus). if serious, empiric treatmewnt e.g. ampicillin or (vancomycin, MRSA) duration 2-6 weeks. surgery.

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9
Q

IMPETIGO CAUSES AND DIAGNOSIS

A

Break in skin, infection with s.aureus or s.pyogenes.
Lesions start, e.g. pustules that release exudate forming a crust (non bullous) or blisters that burst forming crust (bullous)
symptoms: swollen glands, fever, diarrhoea (esp. bullous)

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10
Q

WHAT IS THE MOST COMMON CAUSE OF INFECTION IN THE GIT and treatment for most GIT infections

A

Faecal oral transmission, No treatment - normally self-limiting
Stay hydrated

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11
Q

What are the causes and symptoms for BV?

A

Overgrowth of anaerobic bacteria in the vagina, symptoms: Discharge:
- White/ pale grey discharge
- Milky discharge
- Fishy-smelling

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12
Q

What is the treatment for BV?

A

Oral metronidazole 400mg BD, 5-7 day treatment, alternatively
2g single dose of metronidazole gel

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13
Q

similarities and differences in symptoms between BV and Thrush

A

S: increased vaginal discharge, white discharge
D: BV discharge can be grey, discharge in BV is smooth, thrush is curdled, thrush has no odor, thrush itches and burns

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14
Q

Which skin layer does acne, impetigo & cellulitis affect

A

acne - epidermis hair follicle
impetigo - epidermis
cellulitis - dermis, subcutaneous fat

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15
Q

treatment for impetigo? localised vs systemic

A

good hygiene
LOCALISED
- Topical fusidic acid for 5 days
- Topical mupirocin 2% for 5 days if MRSA
SYSTEMIC:
- Oral flucloxacillin 250-500mg QDS for 7 days
- Clarithromycin 250-500mg BD for 7 days (if allergic)

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16
Q

Cellulitis? causes and symptoms?

A

inflammation of the skin and subcutaneous tissues caused by s.pyogenes most common, or s.aureus in damaged skin
symptoms:(1) Red
(2) Hot
(3) Swelling/ inflammation
(4) Painful

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17
Q

treatment for mild cellulitis vs gram negative cellulitis

A

mild: flucloxacillin (clarithomycin if penicillin allergy), 500mg QDS for 7 days
gram -ve, broad spectrum antibiotic e.g. amoxicillin

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18
Q

Bacterial conjunctivitis: causes and its symptoms

A

(1) S. aureus
(2) H. influenzae
(3) S. pneumoniae
symptoms: (1) Thick + yellow discharge (mucopurulent)
(2) Gritty feeling in eye
(3) Pink/ red eye

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19
Q

First line treatment for bacterial conjunctivitis and second line treatment

A

1st: (1) Self-care
(2) Bathe + Clean

2nd: A
(1) OTC Topical Antibiotics
- Chloramphenicol 0.5% drops
- Chloramphenicol 1% ointment
(2) Self-care

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20
Q

Otitis externa, causes and symptoms?

A

infection of the outer ear,
causes: mainly bacterial
s.aureus, p.aeruginosa - can also be fungal

symptoms:
pain, itchiness, discharge, temporary/slight hearing loss, feeling of pressure

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21
Q

treatment for otitis externa?

A

(1) Self-care
- Pain relief
- Localised heat
(2) Clotrimazole if fungal
(3) If bacterial:
- Topical acetic acid 2%
- Topical antibiotic - neomycin
- Corticosteroid - betamethasone

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22
Q

Otitis media? causes and symptoms

A

Infection of the middle region of the ear, most common cause of ear pain in children
causes:
(1) Usually viral
(2) Can be bacterial:
- S. pneumoniae
- H. influenzae

symptoms:
(1) Ear ache
(2) Fever
(3) Vomiting
(4) Fatigue
(5) Slight hearing loss

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23
Q

Treatment for otitis media?

A

(1) Self-care
- Pain relief
(2) If severe
- Antibiotics (amoxicillin)

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24
Q

What are the similarities and differences between the symptoms of otitis externa and otitis media?

A

(1) Similiarities:
- Pain/ ear ache
- Slight hearing loss
(2) Differences:
- externa is itchy, with discharge + feeling of pressure
- media gives fatigue, fever + vomiting

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25
Q

What is the causes and symptoms of a sore throat?

A

Usually viral, can be bacterial. Strep throat is caused by airborne droplets.
(1) Pharyngitis - throat inflammation
(2) Tonsillitis - tonsil inflammation

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26
Q

What is the treatment for a sore throat?

A

at home
-salt gargle
-increased fluids
-painkillers

Phenoxymethylpenicillin - severe bacterial infections
- Covers group A streptococcus (GAS)

27
Q

What is septic arthritis and it’s treatment?

A

Infection of the joints, flucloxacillin for 4-6weeks

28
Q

What is osteomyelitis and its treatment?

A

Infection of the bone marrow
1st-flucloxacillin for 6 weeks
sometimes with the addition of fusidic acid/rifampicin for first 2 weeks

29
Q

What is the role of the pancreas?

A

Blood glucose regulation

30
Q

What is bacterial meningitis?

A

Infection of the CNS

31
Q

What is the cause of bacterial meningitis?How does this differ for old/young patients?

A

Older children/adults: s.pneumoniae, N. meningitidis

young children
h.influenzae

32
Q

What are the symptoms of bacterial meningitis?

A

headache, stiff neck, fever, non-blanching rash-N. meningitidis, photophobia, altered consciousness

33
Q

What is the treatment for bacterial meningitis?

A

If meningococcal (N. meningitidis): iv benzylpenicillin

in hosp: IV ceftriaxone/cefotaxime

can also use corticosteroid - dexamethasone

34
Q

What are the preventative measures for bacterial meningitis?

A

vaccination

35
Q

what does the bacterial meningitis vaccination include?

A

(1) HiB
(2) MenB
(3) MenC
(4) MenACWY

36
Q

What is sepsis and how does it affect the body?

A

An inflammatory immune response to infection, endo and exotoxins damage tissues and organs

37
Q

How do the 3 types of endo/exotoxins damage the body’s tissues and organs?

A

type1-disrupt host cell
type2-destroy host cell membranes to invade and interrupt host defence
type3-disrupt host cell defence to allow spreading of infection

38
Q

what are the underlying infections that can cause sepsis? and the most common infection sites leading to sepsis?

A

usually bacterial:gram+ (s.aureus)
gram-(e.coli)

less commonly fungal/viral

(1) Lungs (50%)
(2) Urinary tract (20-25%)
(3) Abdominal (15-20%)
(4) Skin/ soft tissue (10-15%)

39
Q

what are the symptoms of sepsis?

A

(1) Fever/ low body temperature
(2) Elevated HR
(3) Elevated RR
(4) Low BP
(5) Confusion
(6) Pale blotchy skin & non-blanching rash
(7) Significantly reduced urination

40
Q

what is the treatment for sepsis?

A

(1) Antibiotics PRN

(2) IV fluids PRN

(3) Oxygen PRN

41
Q

What is a nosocomial infection/HCAI?

A

Healthcare associated infection

42
Q

What is Clostridium difficile? what is CDI

A

Gram positive, anaerobic, spore-forming rod
Clostridium (clostridioides) difficile infection

43
Q

What is the effect of broad-spectrum antibiotics on CDIs?

A

Increases the infection

Proportional to the duration of exposure to the antibiotic

44
Q

Which two conditions is a CDI significantly implicated in?

A

A
(1) AAD - Antibiotic-associated diarrhoea

(2) AAC - Antibiotic-associated colitis

45
Q

What are the common symptoms of a CDI?

What are the rare symptoms of a CDI?

A

(1) Mild-moderate diarrhoea
(2) Mild-severe abdominal cramping/ pain
(3) Yellow-white plaques on the intestinal mucosa (only if SEVERE)

RARE:
(1) Fulminant life-threatening colitis (severe + sudden)
(2) Low-severe fever
(3) Dehydration

46
Q

(1) What are the different categories for CDI severity?

(2) How is the severity determined?

A

(1) MILD:
ø Normal WCC
ø <3 loose stools in a day
ø 5-7 on Bristol Stool Chart

(2) MODERATE:
ø Increased WCC - >15x10^9/ L
ø 3-5 loose stools in a day

(3) SEVERE:
ø Increased WCC - >15x10^9/ L
ø Acutely increased serum creatinine (+>50%)
ø Temperature >38.5ºC
ø Evidence of severe colitis
ø Stools are no longer relevant in determining severity

(4) LIFE-THREATENING:
ø Hypotension
ø Partial-complete ileus (obstruction of the ileum)
ø Toxic megacolon (rapid widening of the colon)
ø CT evidence of severe disease

47
Q

What are common risk factors for CDIs?

A

(1) Increased age
(2) Proximity to infected patients - e.g. hospital staff
(3) Nasogastric tube
(4) Gastric surgery
(5) PPIs
(6) Increased hospital stay
(7) Underlying disease - e.g. IBS
(8) Chemotherapy
(9) Increased exposure to antibiotics
(10) Courses of multiple antibiotics

48
Q

What antibiotic can cause a CDI?

A

Any antibiotic

Traditionally: clindamycin

49
Q

Why can antibiotic therapy increase risk of CDI?

A

Can affect the healthy flora of the colon

50
Q

What is the pathogenicity of C. diff? and it’s progression

A

(1) Antibiotic therapy affecting healthy colon flora
(2) Toxicogenic stains producing A + B toxins
ø Some strains also produce binary toxin (CDT)

(1) Uncolonised
(2) Asymptomatic colonisation
(3) Toxin production
(4) CDI

51
Q

What does toxin A do in C. diff infections?

A

(1) Causes fluid secretion
(2) Causes intestinal inflammation
(3) Activates cytokine release

52
Q

How does the severity of CDI change when binary toxins (CDT) is present?

A

Increased severity

53
Q

How is a CDI diagnosed based on clinical symptoms and risk factors?

A

(1) Diarrhoea
(2) ABx exposure
(3) History - can lead to recurrent CDI

54
Q

How is a CDI differentially diagnosed?

A

(1) Cytotoxic assay
(2) Toxigenic culture
(3) ELISA for toxins A + B
(4) PCR for toxin genes
- Presence of the gene does NOT mean presence of the toxin

55
Q

How is a suspected CDI managed?

A

(1) Cessation of offending antibiotic
(2) Symptomatic treatment
ø Fluid + electrolyte replacement
ø NOT antidiarrhoeals
(3) Specific ABx therapy usually indicated

56
Q

What is the first line therapy for treatment of a mild-moderate CDI?

A

A
(1)
ø Metronidazole
ø 400 mg
ø TDS
ø Oral
ø 10-14 day duration

(2) Switch to 500mg TDS IV if oral FAILS

(3) Switch to VANCOMYCIN if treatment FAILS

57
Q

What is the first line therapy for treatment of a severe CDI?

A

(1)
ø Vancomycin
ø 125-500 mg
ø QDS
ø 10-14 days

(2) ORAL vancomycin is ineffective as it is poorly absorbed

58
Q

Which antibiotic is potentially superior to vancomycin for preventing recurrent CDI?

A

Fidaxomicin

59
Q

What is the rarity of recurrent CDI?

A

Up to 1/3 cases

60
Q

How does treatment differ for recurrent CDI?

A

(1) Same treatment as before
(2) Often switched to oral vancomycin or fidaxomicin

61
Q

What treatment is gaining importance as a possible treatment for recurrent CDI?

A

Faecal transplantation

62
Q

What treatment can be administered in recurrent CDI, in addition to antibiotic therapy? Give an example.

A

Bezlotoxumab
It is a monoclonal antibody
Selective against toxin B

63
Q

How are CDI controlled in hospitals?

A

(1) Good infection control - thorough hand washing
(2) Cohorting/ isolation of infected patients
(3) PPE
(4) Increased monitoring
(5) Improved education on ABx use

PM3A (36 decks)

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