Common Infections In Primary Care Flashcards
First to seventh disease in children
First disease - measles
2nd - scarlet fever - group A strep, sore throat, fever, rash
3rd - rubella
4th - dukes-filatov
5th - Slapped cheek - erythema infectiosum - parovirus B19
6th - roseola infantum
7th - Kawasaki
Neurobiology infections
Head and brain - meningitis / viral
Eyes - conjunctivitis by adenoviruses and bacteria, stye by staph aureus, orbital cellulitis by streptococcus and staph aureus
Urinary system infections
UTI due to E.coli
proteus, pseudonomas- 50% cases structural abnormalities so do imaging
Cystitis
Pyelonephritis
Men - non-specific urethritis
Cardio
Endocarditis
Rheumatic fever
Resp 1
Viral due to RSV causing croup and bronchiolitis
Tonsilitis - viral or due to strep (group A beta-haemolytic eg strep pyogenes)
Bacterial - fever, lymphadenopathy, exudate
Penicillin V or G. Macrolide if allergic.
Resp LRTIs
LRTIs - asthma, pneumonia, COPD, empyema
Viral, S.pneumoniae, HI, rare = mycoplasma or legionella pneumoniae
Investigation - sputum culture, FBC, CXR, vaccines - influenza and pneumococcal
Chest infections
Acute bronchitis - LRTI - inflammation of bronchial airways
History - cough, might have sputum/wheeze/breathlessness
Chest wall pain may be present when coughing
Exam - wheeze
Investigation - normal CXR
Management - smoking cessation, fluids, analgesia - don’t need antibiotics unless systemically unwell
Pneumonia- bacteria, inflammatory cells and fluid fills alveoli
History - cough, dyspnoea, sputum production, pleural pain, sweating, fever
Exam - decreased or asymmetric breath sounds, bronchial breath sounds, dullness to percussion, crepitations
Tachypnoea, tachycardia, Temperature >/=38°C
Investigation- abnormal CXR
Management - 1st - oral amoxicillin 500 mg three times a day for 5 days.
If there is a penicillin allergy - oral doxycycline 200 mg on the first day then 100 mg once a day for 4 days (total course of 5 days)
Oral erythromycin (in pregnancy) 500 mg four times a day for 5 days.
CRB 65 score > 3 for hospital admission. C = confusion. R = resp rate > 30/min. B = systolic BP < 90 and diastolic < 60.
uti women
Uncomplicated UTI = typical uropathogens (eg E.coli) in a non-pregnant woman with no abnormalities of the urinary tract.
Usually self-limiting and resolves within a few days.
Diagnosis - Aged under 65 years if there are one or more of key symptoms of dysuria, nocturia, cloudy urine. Other urinary symptoms = frequency, urgency, suprapubic pain, haematuria.
History - onset, severity, and evolution of symptoms
Sexual history
Family history eg PKD
Possibility of pregnancy and contraception used
Symptoms suggesting complicated UTI - fever, oliguria, loin pain, vomiting
Any treatments used
Examination - vital signs
Palpate abdomen for flank or suprapubic tenderness or an abdominal mass.
Consider performing a vulval and pelvic examination (with a chaperone) to assess for an alternative cause such as urogenital atrophy, vulval rash, pelvic mass, or pelvic organ prolapse.
Management- Do pregnancy test
Don’t arrange dipstick if woman has 2 of 3 key symptoms - it is UTI
Arrange dipstick if 1 key symptom or other symptoms
Results - if nitrite/leucocyte +ve AND RBCs then UTI
If leucocyte +ve but not nitrite then send MSU for culture and sensitivities
If dipstick -ve for all then alternative cause
Mid-stream urine sample if: woman if over 65, pregnant, recurrent UTI, complicated, haematuria, catheter, persistent
Treatment - if mild UTI then delayed antibiotics (unresolved in 48hrs) and advice on analgesia and hydration.
If acute and serious hospital admission
If giving antibiotics then Nitrofurantoin 100 mg twice a day for 3 days +
Trimethoprim 200 mg twice a day for 3 days
Diarrhoea
Diarrhoea is the passage of three or more loose stools per day (or more frequently than is normal for the individual).
Acute diarrhoea - lasting less than 14 days.
Persistent diarrhoea - lasting more than 14 days.
Chronic diarrhoea - lasting for more than 4 weeks.
Acute diarrhoea is usually caused by a bacterial or viral infection.
Other causes - medication, anxiety, food allergy, and acute appendicitis.
Chronic diarrhoea - irritable bowel syndrome, diet, inflammatory bowel disease, coeliac disease, and bowel cancer.
Assessment:
Determining onset, duration, frequency, and severity of symptoms.
Identifying red flag symptoms.
Ascertaining the underlying cause.
Looking for complications, such as dehydration.
Investigations - Acute diarrhoea should be investigated with a stool specimen for routine microbiology investigation if:
The person is systemically unwell
Blood or pus in the stool.
Immunocompromised.
The person has recently received antibiotics, a PPI or been in hospital (specific testing for Clostridium difficile should also be requested).
Diarrhoea occurs after foreign travel (tests for ova, cysts, and parasites should also be requested).
Amoebae, Giardia, or cryptosporidium are suspected, particularly if diarrhoea is persistent (14 days or more) or the person has travelled to an at-risk area.
There is a need to exclude infectious diarrhoea.
Chronic diarrhoea - blood tests should be requested in all people presenting with this problem. FBC, urea and electrolytes, liver function tests, calcium, vitamin B12 and red blood cell folate, ferritin, thyroid function tests, ESR and CRP, and testing for coeliac disease.
Bacterial vaginosis
Definition- overgrowth of anaerobic organisms and a loss of lactobacilli. The vagina loses its normal acidity, and its pH increases to greater than 4.5. Not a STI
Symptoms- 50% asymptomatic. Characterised by fishy-smelling vaginal discharge. Not usually associated with soreness, itching, or irritation.
Risk factors:
Being sexually active
The use of douches, deodorant, and vaginal washes.
Factors linked to an alkaline vaginal pH (menstruation, semen.)
Copper intrauterine devices.
Smoking.
Factors that reduce risk:
Hormonal contraception.
Consistent condom use.
Examination - may reveal a thin, white discharge coating the walls of the vagina and vestibule.
Investigations:
In women with characteristic symptoms of BV, examination and further tests may be omitted and empirical treatment started if all the following apply:
Low risk of an STI.
No symptoms of other conditions.
Not developed pre or post a gynaecological procedure.
The woman is not postnatal or post miscarriage.
Not recurrent
The woman is not pregnant.
Otherwise - checking the pH of the vaginal discharge, and/or sending a sample of the discharge to the lab for Gram-stain and microscopy.
Management- Oral metronidazole
All women with BV should be advised to avoid exposure to contributing factors.
If symptoms persist or recur:
Check adherence, reconsider diagnosis, check exposure to contributing factors.
Candida
Definition- Vulvovaginal candidiasis is a symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection, usually Candida albicans.
Symptoms- vulval or vaginal itch and irritation, a non-offensive vaginal discharge, superficial dyspareunia, and dysuria.
Risk factors - recent antibiotic use; local irritants; uncontrolled diabetes or other causes of immunosuppression; and increases in endogenous and exogenous oestrogen such as pregnancy and use of the combined oral contraceptive pill.
Assessment - duration, frequency, and severity of symptoms
any risk factors for candidiasis or STIs
treatments tried
risk of pregnancy and contraceptive use.
Exam - external genitalia (esp if treatment failure or recurrent) for vulvovaginal inflammation and erythema, fissuring, or excoriations.
Arranging a high vaginal swab (HVS) for culture, particularly if there is diagnostic uncertainty, or persistent or recurrent symptoms.
Arranging a HVS for culture with full speciation and sensitivity testing, if there is a poor or partial response to maintenance treatment for recurrent infection.
Management - Advising on self-management, management of risk factors.
Antifungal drug treatment - oral azoles or topical imidazoles
Arranging follow-up if there is treatment failure or suspected recurrent infection.
Arranging specialist referral if there is diagnostic uncertainty, persistent symptoms, a young person is affected, or a non-albicans Candida species or azole resistant Candida is identified.
Oral candida
Oral candidiasis is most commonly caused by Candida albicans.
There are different types of oral candidiasis, including pseudomembranous candidiasis, denture stomatitis and chronic plaque-like candidiasis.
Comorbidities which increase risk - diabetes mellitus, severe anaemia, and immunocompromise.
Other risk factors - poor dental hygiene; local trauma; smoking; use of broad spectrum antibiotics, inhaled or oral corticosteroids; and malnutrition.
Immunocompetent person - topical antifungal for 14 days.
Miconazole oral gel is recommended first-line for children aged 4 months and over.
If topical treatment is ineffective, infection is severe, or the person is immunocompromised:
For people aged 16 years and older, oral fluconazole should be prescribed for at least 14 days and then review.
Referral should be arranged if:
Recurrent episodes of oral candidiasis.
There is doubt about the diagnosis.
Resistance
Referral for biopsy should be considered for people with chronic plaque-like candidiasis which is unresponsive to treatment, as it carries a risk of malignancy.
Recurrent UTI
Mid-stream urine sample
Gout
Symptoms and signs:
rapid onset of severe pain with redness and swelling, in 1 or both first metatarsophalangeal (MTP) joints
Tophi
Also if symptoms in joints other than the first MTP joints (for example, midfoot, ankle, etc).
Diagnosis - Measure the serum urate level in people with symptoms (serum urate level of 360 micromol/litre or more).
If serum urate level is below 360 micromol/litre repeat the serum urate level at least 2 weeks after the flare has settled.
Consider joint aspiration and microscopy of synovial fluid if a diagnosis remains unconfirmed.
Then consider imaging the affected joints with X-ray, ultrasound or dual-energy CT.
Treatment for gout flares - Offer NSAID, colchicine or a short course of an oral corticosteroid for first-line treatment.
Consider adding a PPI for people who are taking an NSAID.
Apply ice packs to the affected joint in addition to meds to help pain.
Check uric acid levels. If raised treat. After 4-6 weeks check levels again and if still raised it’s gout.
Differentials - Assess the possibility of septic arthritis, calcium pyrophosphate crystal deposition and inflammatory arthritis in people presenting with a painful, red, swollen joint.
Diet and lifestyle - Advise people with gout that excess body weight, or excessive alcohol consumption, may exacerbate gout flares and symptoms.
Long-term management of gout - Offer ULT, using a treat-to-target strategy, to people who have:
multiple or troublesome flares
CKD stages 3 to 5
diuretic therapy
tophi
chronic gouty arthritis.
Start ULT at least 2 to 4 weeks after a gout flare has settled. Offer either allopurinol or febuxostat as first-line treatment.
Why do we immunize against Rubella (German Measles)? What is Congenital Rubella Syndrome?
Symptom - main = spotty rash that starts on the face or behind the ears and spreads to the neck and body.
Harder to seen on darker skin but might feel rough or bumpy.
Other - fever, cough, runny nose, sore throat, aching joints, headaches, red eyes
Management - gets better in a week.
Get rest, fluids, paracetamol or ibuprofen.
Avoid spread - stay off school for 5 days after rash.
Vaccine - 2 doses of MMR. Helps protect people who cannot be vaccinated, such as unborn babies, newborn babies and anyone with a weakened immune system.
Congenital rubella syndrome - illness in infants that results from maternal infection with rubella virus during pregnancy.
Common congenital defects include cataracts, congenital heart disease, hearing impairment, and developmental delay.
May present with a single defect, most commonly hearing impairment.
