Case Studies Flashcards

1
Q

Tx of meningitis in LIC?

A

LP immediately unless CIs
Start abx within 2hrs
Do not necessarily wait for LP or CT

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2
Q

What abx do you avoid in bacterial Meningitis?

A

pipercillin Tazobactam
Macrolides
TCNs
1st and 2nd gen cephalosporins

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3
Q

Tx of bacterial meningitis?

A

Avoid steroids
Ceftriaxone ± Ampicillin ±Vancomyc

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4
Q

What is the main causative organism in bacterial meningitis?

A

Streptococcus Suis
Typically in pig raising areas of India and SE Asia

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5
Q

What vaccines are used in LMIC to prevent bacterial Meningitis

A

Monovalent A or C
Combine HIB
Quadravalent A, C, Y and W135
MenAfrVac

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6
Q

What is Listeria Meningitis?

A

Seen in immunocompromised
Assoc with contaminated milk products and processed meat

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7
Q

What are the main causes of subacute meningitis?

A

TB
Crypto
Syphilis

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8
Q

Most common causes of bacterial meningitis?

A

Used to be men A
Now other serotype and S Pneumonia

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9
Q

46y/o male with fever/joint pain, headache and myalgia in India in rainy season
Reduced GCS, thrombocytopenia, raised lactate

A

Orientia Tsutsugamushi

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10
Q

Clinical presentation of scrub typhus? Gold standard diagnosis? Tx?

A

Incubate for 6-21 days
55% Painless eschar
Fever, fatigue, frontal headache
Generalised maculopapular rash

IgG antibody assay

Doxycycline

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11
Q

54y/o farmer, diabetic, hypertension, CKD. Presents with 2/52 of right facial pain and frozen right eye

A

Mucormycosis 90 degree branching hyphae

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12
Q

Where is mucor found?

A

Worldwide, endemic particularly in India
Rhizopus spp/ Mucor Spp

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13
Q

What are main risk factors for mucor?

A

Diabetes
Prolonged neutropenia
Haematological malignancy
Iron overload
Steroid use

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14
Q

How does rhino-orbital mucormycosis present?

A

Facial pain and soft tissue swelling
Periorbital oedema, pain, proptosis, blurring
Can cause osteomyeltitis, multiple cranial nerve involvement, Periorbital destruction

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15
Q

Management of mucor?

A

Debridement
Anti fungal–ampho B can use Isavuconazole or Posaconazole
Reduce Immunosuppression

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