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IMS- Strand 7 > Diagnosis, treatment & prevention of infection > Flashcards

Diagnosis, treatment & prevention of infection Flashcards

(46 cards)

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1
Q

What is the history?

A

What a patient tells you

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2
Q

What are non- specific symptoms

A

Fever
- Sweats, chills, shivers
- Rigors
Loss of appetite +/- weight
Aching muscles (myaligia) or joints (arthralgia)

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3
Q

What are specific symptoms

A

According to source
- Pneumonia- cough, breathless, sputum
- Meningitis- headache, neck stiffness, photophobia

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4
Q

What conditions make people more susceptible to infection?

A
  • Past medical history: diabetes, immunodeficiency e.g. HIV
  • Drug history: steroids, chemo
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5
Q

Lifestyle activities that bring people in to contact with infection

A
  • Occupation (healthcare, vet, farmer, sex worker)
  • Travel
  • Recreation: hobbies, food, injecting drugs
  • Contacts: people, animals, insects
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6
Q

What is the significance of signs?

A

Infections often produce signs that give away the diagnosis

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7
Q

3 types of WBC

A
  • Neutrophil
  • Lymphocyte
  • Eosinophil
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8
Q

What are neutrophils elevated in?

A

Bacterial infections
e.g. Pneumonia

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9
Q

What are lymphocytes elevated in?

A

Viral infections
e.g.Glandular fever

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10
Q

What are Eosinophils elevated in?

A

Parasitic infections
Schistosomiasis (Bilharzia)

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11
Q

Other basic tests

A

C- reactive protein (CRP)- marker of inflammation
U&E- urea and electrolyte levels (kidney function)
LFT- liver function test

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12
Q

What sampling should be done?

A
  • Any body fluid/ tissue can be sent to microbiology for testing
  • Hospitalised patients with suspected infection should have blood ± urine sent for culture
  • Choose and send other samples related to the body system (s) affected
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13
Q

Rules about taking samples

A

Samples for culture should be sent before antibiotic treatment starts if at all possible
Use aseptic technique to avoid contaminating the blood with them

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14
Q

Rules about sending samples

A

Provide background clinical information to help the lab
Inform the lab if important samples are on the way

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15
Q

Lumbar puncture

A

examination of cerebrospinal fluid for signs of meningitis

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16
Q

What tests do microbiologists do?

A

Antibody detection
Culture
Antibiotic sensitivity testing
Microscopy
Antigen detection
PCR

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17
Q

Identify part of the organism

A

Proteins (often called antigens)
DNA/RNA (by polymerase chain reaction)

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18
Q

Identify the body’s immune response to the infection

A

Antibodies (proteins made to neutralise a specific infection
- IgM
- IgG

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19
Q

Examples of antigen testing

Study These Flashcards
A
  • Legionnaire’s disease= urine test
  • SARS COV-2 antigen detection
20
Q

DNA/RNA identification by PCR

Study These Flashcards
A
  • Method of detecting genetic “fingerprints”
  • Identifies unique genetic code sequence for specific infection
    e.g.
  • Meningitis
  • HIV
  • Hep B & C
  • Respiratory viruses
21
Q

IgM

Study These Flashcards
A

Initial antibody response
Appears within a week usually disappears after a few months

22
Q

IgG

Study These Flashcards
A

Later antibody response
Appears 10-14 days
Test for rising levels in consecutive samples
Persists throughout life
Also useful to test whether you are immune to an infection

23
Q

Why is TB different from other bacteria

Study These Flashcards
A

Waxy cell wall and different component (mycolic acid) so needs different kind of stains

24
Q

2 staining methods in TB

Study These Flashcards
A
  • zeihl neelsen stain
  • auramine stain
25
Why is TB different from other bacteria
Multiple mimics (chronic symptoms) Different treatment Public health Risk factors
26
Culture
- Done on special solid medium and liquid medium - Needs culturing for up to 6-8 weeks as bacilli are slow growing - Lowenstein- jensen medium- solid medium used in TB culture
27
Tuberculin skin tests
- The test is done by putting a small amount of TB protein (antigens) under the top layer of skin - If exposed to TB, the skin reacts to the antigens by developing a firm red bump at the site within 2 or 3 days - Cannot tell if infection is active or latent
28
TB blood tests
- Quantiferon is an ELISA based interferon gamma release assay. Whole blood is stimulated overnight with Mycobacteria Tuberculosis (TB) specific antigens, positive control or a nil control T- SPOT= this is a T cell based assay for the detection of infection with mycobacterium tuberculosis. TB assay cannot distinguish between latent and active TB infection
29
PCR
- Allows a target DNA sequence to be selectively amplified - Rapid molecular test for detection of M. tuberculosis complex and rifampicin resistance - Can be performed on a range of samples, both pulmonary and non- pulmonary - A negative result does not exclude the clinical possibility of TB infection or infection with other Mycobacteria
30
Supportive therapy
- Symptomatic e.g. paracetamol for fever/ aches - Dehydration/ low BP
31
Specific therapy
- Antimicrobials - An antibiotic - For many viral infections there is no specific treatment
32
What do you ideally want an antimicrobial to do?
- Selective toxicity (effective against microbe without harming host) - Bacteriocidal (kills the organism) - No resistance - Good pharmacokinetics - No side effects - Not inactivated by enzymes secreted by microbes, or by the host
33
Where does penicillin come from?
- Derived from a mould (fungus)
34
Where does Mupirocin come from?
produced by Pseudomonas fluroscens (bacterium)
35
Problems with antimicrobials
- Variable spectrum of activity (broad spectrum= kills lots of different organisms, Narrow spectrum= kills few organisms) - Some cannot be given orally - Many cause side effects which can be serious (allergic) - Bacterial resistance (some antibiotics are now effective against very few organisms, some organisms are not resistant to many antibiotics)
36
8 goals of antimicrobial stewardship programs
- Educate healthcare workers - Limit antimicrobial resistance - Decrease adverse antibiotic events - Reduce healthcare costs - Decrease C.difficile infections - Reduce inappropriate antibiotics use - Improve patients outcome - Increase adherence to guidelines
37
preventing infection
Prevention involves interrupting the chain of transmission at one or more part
38
Reducing environmental pathogens in general
- Clean drinking water - Improving sanitation - Hygienic food preparation
39
Reducing environmental pathogens in hospital
- Cleaning wards, rooms and equipment - Filtered air in operating theatres - Using sterile instruments when operating, taking blood etc
40
Preventing transmission via food/ water borne
Sanitation, clean water supplies, food preparation hygiene
41
preventing transmission via contact e.g. MRSA
Handwashing Wearing gloves, gowns, masks
42
preventing transmission via airborne (TB)
Isolate infected patient in a negative pressure room (that filters out- going air)
43
preventing transmission via vector borne (e.g. malaria)
Avoid mosquito bites: insect repellent, bed nets, long sleeves
44
Prophylactic treatment (protecting the potential host)
- Antimalarials - Antibiotics given to immunosuppressed patients e.g. bone marrow transplant recipients
45
Immunisation (protecting the potential host)
- Passive (with antibodies), e.g. chickenpox immunoglobulin - Active (by stimulating the immune system with something which mimics the infection e.g. Hep B virus surface antigen
46
Notification of communicable disease
Health protection (notification) regulations 2010 Information on infection Information on patient with infection or suspected infection Used to identify and prevent outbreaks e.g. food poisoning Coordinated by UK HSA

IMS- Strand 7 (3 decks)

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