Body Systems, rashes and anything else

Question 1

What are the signs of Trachoma?

Answer 1

Trachomatous inflammation with follicles (TF)

Intense trachomatous inflammation (TI)

Trachomatous conjunctival scarring (TS)

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Trachomatous trichiasis (TT) and

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Corneal opacity because of trachoma (CO).

Question 2

What causes Trachoma?

Answer 2

Chlamydia trachomatis,

Question 3

What is the WHO SAFE strategy for elimination of Trachoma?

Answer 3

S Surgery for advanced cases.

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A Antibiotic treatment. (azithromycin)

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F Facial cleanliness to reduce transmission.

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E Environmental improvement.

** WHO recommends 3 years of annual azithromycin as part of a trachoma control programme in communities where active trachoma is present in > 10% of children

Question 4

3 causes of a purpuric rash

Answer 4

• Bacteria
  – Neisseria meningitidis
  – Staphylococcus aureus
  – Pseudomonas aeruginosa
• Other septicaemias
• Infective endocarditis
• Rickettsiae
• Dengue
• Enterovirus, parvovirus etc
• Drugs
• Vasculitis
• Henoch Schonlein purpura

Question 5

What is Pellagra?

Answer 5

Vit B3 deficinecy –> diarrhoea, dementia, dermatitis

Rx with Niacine

Question 6

What bacteria causes Buruli Ulcer?

Answer 6

Mycobacterium Ulcerans

Question 7

Is buruli ulcer painful or painless?

Answer 7

painless –> likely due to local immunosuppression at ulcer site

Question 8

How do people get Buruli ulcers?

Answer 8

Penetrating injury (may be minor) that causes inocculation of Mycobacterium ulcerans OR following infection of bugs

Person to person transmission is pretty unlikely

Question 9

How does Buruli ulcer present?

Answer 9

Non ulceration –> ulceration

Can start as a papule, nodule, plaque or oedema

Usually a PAINLESS ulcer (causes delays in seeking healthcare )
Deeply undermined skin at the edge of the ulcer
Satellite lesions around the area

**adenitis and systemic symptoms are unusual unless other co-infection

Question 10

What are complications of Buruli ulcer?

Answer 10

Tetanus
Osteomyeltis
Contractures
Nerve damage

Question 11

How do you diagnose Buruli ulcer?

Answer 11

Micrscopy –> ZN stain might show AFB
PCR

Culture NOT worthwhile

Question 12

How do you manage Buruli Ulcer?

Answer 12

Rifampicin + Streptomycin for at least 8/52

±surgical management

Question 13

What are three causes of acute flaccid paralysis?

Answer 13

ACUTE HORN CELL DAMAGE
- Polio
- Enterovirus
- Japanese Encephalitis

IMMUNE MEDIATED
- Guillain Barre
- Chinese Paralytic Syndrome (Acute motor axonal neuropathy)

OTHER
- Tick paralysis (removal of tick eliminates symptoms)
- Botox consumption
- toxin exposure
- diptheria neuropathy
- rabies exposure

Question 14

What is Polio?

Answer 14

Enterovirus which can cause CNS invasion leading to acute flaccid paralysis from destruction of anterior horn cell

Question 15

Compara Polio presentation to GBS

Answer 15

Polio:
Paralysis is during or almost immediately after febrile illness
Symmetrical paralysis
2-3 days to reach max. weakness
No sensory involvement
CSF has raised lymphocytes
Limb pain

GBS:
Paralysis several weeks after illness
Symmetrical paralysis
Long duration to develop weakness (7-14 days)
Often sensory invovlemetn
CSF has high PROTEIN
Back pain

Question 16

An outbreak of meningitis/septicaemia has occurred in the neonatal unit of a district hospital.

What is the possible diagnosis?

Answer 16

Escherichia coli; (common in neonatal units)

Gram –ve bacilli
(big and chunky rods) tends to have bipolar staining where ends stain better than middle.

Question 17

An isolated case of neonatal sepsis in a patient from a
nomadic community

What is the likely diagnosis?

Answer 17

Listeria monocytogenes; (one of top 3 causes of neonatal
infection)

Gram +ve bacilli (small rods) a contaminant of soft cheeses, meat etc and an important zoonosis in herd animals.

Question 18

What are the organisms that stain as Gram +ve Bacilli?

Answer 18

ABCD - L

Actinomyocytes
Bacillus Anthracus
Clostridium
Diptheria
Listeria

Question 19

A case of bacterial meningitis in an HIV infected adult

What is the probable diagnosis?

Answer 19

Streptococcus (pneumococcus) pneumoniae;

Gram +ve diplococci (paired organisms) these patients are
more susceptible to invasive pneumococcus.

Question 20

An isolated case of meningitis in a 4 year old child in West
Africa.

Could it have been prevented by immunisation?

Answer 20

Yes

Haemophilus influenzae; Gram –ve coccobacilli, a small and
delicate organism, some may appear as rods others as cocci.

Question 21

A case of meningitis from an epidemic in Western Sudan

What is the probable diagnosis?

Answer 21

Neisseria meningiditis; (meningococcal meningitis) Gram -ve
diplococci (2 kidney-like organisms joined at centre)
What further bacteriological information would you want to
investigate the epidemic?
Need to know the serotype by growing the cells in central
reference lab

Question 22

A 27yr old man with a 3 week history of headache and fever.

CSF examination shows lymphocytic meningitis.

What is the probable diagnosis?

Answer 22

Cryptococcal Meningitis