BMJ

Question 1

What is visceral leishmaniasis

Answer 1

• Visceral leishmaniasis (kala-azar) is an endemic disease in several regions of India and sub-Saharan Africa.
• It is caused by the parasite Leishmania donovani and spread by Phlebotomus sandflies.
• It causes SPLENOMEGALY + FEVER

Leishmaniasis is common in immune-suppressed patients, particularly those infected with HIV. in 2011 there was a substantial increase of cases in the Mediterranean region. It has been estimated that 15% of HIV positive drug users in Spain are infected with Leishmania donovani infantum.

Question 2

What does giardiasis and tropical sprue cause?

Answer 2

Giardiasis and tropical sprue present with gastrointestinal symptoms and malabsorption.

Question 3

Giardiasis

Answer 3

• Giardiasis is an infection in your small intestine.
• It’s caused by a microscopic parasite called Giardia lamblia.
• Acquired by faecal-oral route
• Many individuals excreting cysts are asymptomatic and are thus carriers. Others have diarrhoea, steatorrhoea, abdominal pain, and nausea.

Diagnosis:

• It is diagnosed by stool microscopy; if negative, the parasite is found in duodenal aspirates or biopsy.
• Testing of serum antibodies against G. lamblia trophozoites is not useful in diagnosing current infection.

Treatment

• It is eradicated with metronidazole (or quinacrine, tinidazole, ornidazole, furazolidone, paromomycin).
• Mebendazole is used in treating hookworm infections

Question 4

What would be a confirmatory test for anaphylaxis?

Answer 4

• Tryptase is a neutral protease stored in mast cell secretory granules.
• Elevated serum levels demonstrate that mast cell activation with mediator release has occurred whether triggered by IgE-mediated anaphylaxis or non-IgE-mediated anaphylactoid reactions.
• The greater the severity of anaphylaxis, the more likely that serum tryptase levels will be elevated.

Question 5

Pelvic inflammatory disease

Answer 5

IX
Investigate suspected cases of pelvic inflammatory disease or postprocedural pelvic infection with an endocervical swab for:
- nucleic acid amplification testing (NAAT) (eg polymerase chain reaction [PCR]) for C. trachomatis, N. gonorrhoeae, and M. genitalium
- Gram stain and culture of N. gonorrhoeae for susceptibility testing.

TX
IV ceftriaxone as a single dose + PO metronidazole for 14 days + either PO doxycycine/PO azithromycin

COMPLICATIONS
Prompt treatment of pelvic inflammatory disease (PID) reduces the risk of tubal damage and, consequently, infertility, ectopic pregnancy and chronic pelvic pain.

Question 6

Bacterial vaginosis

Answer 6

• Clear, fishy smelling discharge with no hx of itching or irritation
• It typically features a reduction in the number of the normal hydrogen peroxide-producing Lactobacilli in the vagina.
• Tx: metronidazole

Question 7

What is quinupristin and dalfoprisin?

Answer 7

• Quinupristin and dalfopristin are a synergistic combination of a streptogramin A and B respectively.
• They are effective against Gram positive aerobes and are particularly useful against resistant Strep. pneumoniae and Staph. aureus.
• They can only be administered via a central line.