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Infectious Disease > General ID > Flashcards

General ID Flashcards

1
Q

What factors affect Abx choice?

A

Patient- immunocompromised, allergies, drug interactions, compliance
Disease- Type of infection, previous M/C/S, known local pathogens and resistance, severity (ie PO vs IV), community vs hospital acquired
Hospital- Local protocols and guidelines

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2
Q

Which disease typically show pulse-temperature dissociation (ie relative bradycardia with raised temp)

A

Enteric fever
- Typhoid and Paratyphoid
Ebola virus disease

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3
Q

What is the stereotypical test for S. typhi in suspected typhoid fever?

A

Widal test
Immunoassay for Anti-S. typhi antibodies

Good in returned travellers, limited utility in endemic regions as cannot distinguish between current and previous infections

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4
Q

What are the typical tests to assess for Malaria?

A
  • Thick/Thin blood smear (assess presence of parasite and what type)
  • Blood film (assess for schistocytes)
  • Malarial PCR
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5
Q

What is the empiric therapy for severe malaria?

A

Artesunate 2.4mg/kg IV or IM

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6
Q

What is the most common cause of diarrhoea in AIDS patients?

A

Cryptosporidium
However typical and very atypical organisms can also be the cause, need stool and blood cultures

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7
Q

What are the relevant points on history with occupational needle exposure?

A
  • Was the skin breeched
  • Was there visible bleeding
  • Had the needle been used on a patient? was it visibly contaminated?
  • Was the area immediately washed with soap and water
  • Is the staff member vaccinated against Hep B and do they have appropriate antibody titres
  • Is the source known to have HIV, Hep B or Hep C? are they likely to have it (sex worker, IVDU etc)?
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8
Q

What are the risk factors for an epidural abscess?

A
  • IVDU
  • Anything procedure causing bacteraemia (dental procedures, infected catheters, tatooing, acupuncture etc)
  • Infective IE
  • Lumbar puncture/epidurals or paraspinal steroid/anaesthetic injections
  • Recent spinal surgery
  • Diabetes
  • Alcoholism
  • HIV infection and any form of systemic immunocompromisation
  • Trauma to the spine
  • Infection near the site ie spine osteomyelitis, cellulitis over spine
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9
Q

What are the most common bacterial causes of epidural abscess

A

Staph aurea (63%)
Mycobacteria in resource poor areas
strep species
Gram -ve bacilli

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10
Q

What is the cross reactivity between penicillins, cephalosporins, carbapenems and monobactams?

A
  • The cross reactivity is related to similar side chains and not a class effect (ie beta lactam core)
  • For penicillins/cephalosporins with no similar side chains the cross reactivity is approx 1%, but closer to 40% if the side chains are similar.
  • 3rd/4th/5th generation cephalosporins have the least cross reactivity with penicillins and vice versa
  • Carbapenems as a group have <1% to close to 0% cross reactivity with other beta lactams
  • Monobactams have no cross reactivity with other beta lactams
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11
Q

When should cephalosporins and carbapenems be completely disregarded as an option with a history of penicillin allergy?

A
  • If the patient has a history of a serious Typle II/III/IV reaction

Serious type II (IgG mediated cell destruction)
- Haemolytic anaemia, neutropaenia, thrombocytopaenia

Serious type III (immune complex deposition, complement activation)
- serum sickness, drug induced vasculitis/nephritis

Serious type IV (T cell mediated)
- SJS/TEN, DRESS

Type I (IgE mediated)
- Anaphylaxis has less cross reactivity and wanes over the years (80% allergy resolved within 10yrs)

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12
Q

What is the typical adult regime for HIV PEP in Australia?

A

Tenofovir/Emtricitabine (Truvada) 300/200mg
PO daily
+/-
Dolutegravir 50mg PO daily

Continue for 28 days until GP/ID review

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13
Q

What is the dosing of Hep B immunoglobulin for PEP?

A

<30kg = 100 IU via IM route
or
>30kg = 400 IU IM

within 14 days of exposure

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14
Q

What is the indication for Hep B immunoglobulin in occupational exposure?

A

Known to be unimmunised
or
Hep B surface antibody titre <10IU

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15
Q

What are the most common causes of fever in a returned traveller?

A

Malaria
Dengue fever
Enteric fever (typhoid/paratyphoid)
Mononucleosis
HIV
Rickettsial infection
- Sub-Saharan Africa
Melioidosis
- North australia, southeast asia
Trypanosomiasis
- Africa
Leptospirosis
Japanese encephalitis
Influenza
Covid 19
CAP
MERS-Cov
- Arabian peninsula
Tuberculosis
- At least 3 month incubation

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16
Q

What are the key elements in a travel history?

A
17
Q

When are children with measles considered to be infection from?

A

4 days prior to rash to 4 days after the onset of the rash

18
Q

What are the features an specifics of VZV primary infection?

A
  • Transmission via resp droplets and direct contact
  • Incubation is 10-21 days
  • Patient is infectious from 1-2 days prior to rash until all lesions are crusted over (usually day 5-6)
  • Complications include pneumonia, shingles, neurological sequelae, secondary bacterial/HSV infection
19
Q

When is VZV immunoglobulin recommended for primary infection?

A
  • Up to 10 days post exposure
  • special groups ie immunocompromised, pregnant women, neonates and premature infants
20
Q

What is the initial management of a staff member with a needle stick injury?

A
21
Q

What is the management and investigations for staff with needle stick injuries who aren’t immunised against Hep B?

A
22
Q

What is the estimated risk of transmission of HepB/C and HIV with needle stick injuries?

A
23
Q

What are the Duke Criteria for infective endocarditis?

A

Major
- Blood cultures x2 positive for typical endocarditis MO’s
- Evidence of endocardial involvement ie new murmur, +ve TOE or TTE

Minor
- Fever
- Predisposing heart conditions or injection drug use
- Vascular phenomena (strokes, bleeds, mycotic anuerysms, janeway lesions, petechiae, splinter Hx etc)
- Immunological phenomena (oslers nodes, Roth’s spots, GN, RF +ve)
- Evidence of infection (+ve inflammatory markers, +ve blood cultures but not major criteria etc)

24
Q

What are the RF’s for IE?

A
  • Age >60
  • Male sex (3:2)
  • IVDU
  • Poor dentition/Dental infection
  • Any structural heart disease
  • Rheumatic heart disease
  • Previous IE
  • Indwelling vascular device
  • PPM/ICD in situ
  • Long term haemodialysis
  • Cardiac bypass surgery
  • HIV infection
25
Q

What are the most common MO’s for IE?

A
  • Staph aureus (31%)
  • Strep Viridans (19%)
  • Staph epidermidis (11%)
  • Enterococci (11%)
  • Strep Bovis (7%)
  • HACEK (2%)

HACEK organisms
- Haemophilus aprophilus
- Actinobacilus sp
- Cardiobacterium hominis
- Eikenella corrodens
- Kingella Kingae

26
Q

What is the typical dosing of meningitis prophylaxis for close contacts?

A

Confirmed N. meningitidis
- Ciprofloxacin 500mg PO daily

Confirmed H. influenzae
- RIfampicin 20mg/kg (max 600mg) PO daily

27
Q

What is the empiric therapy for Infective Endocarditis before M/C/S is back?

A

Native Valve
- Benpen QID 60mg/kg (max 2gm)
- Fluclox Q4-6 50mg/kg (max 2gm)
- Gentamicin 7.5mg/kg

Artificial valve, post surgery, MRSA and IVDU
- Vancomycin 20-30mg/kg IV as loading dose
- Fluclox Q4-6hr 50mg/kg IV
- Gentamicin 7mg/kg IV, 4-5mg/kg IV if patient has renal failure

28
Q

What are the risk factors for Listeria monocytogenes infection (ie meningitis)?

A
  • Neonates
  • > 50yo
  • Immunocompromised
  • Pregnant
  • Debilitated
  • Hazardous alcohol consumption

Treatment is with benzylpenicillin 1st line
2nd live if allergy is Bactrim

29
Q

What are the different categories of severity for covid 19?

A

Mild
- Not requiring 02
- No lower respiratory tract disease
- Overall mild symptoms

Moderate
- LRTI symptoms BUT no 02 requirement (>92% RA)
- Mild to moderate symptoms

Severe
- Requires 02 (sats <92% RA) BUT no mechanical ventilation
- Infiltrate >50%, RR >30

Critical
- Requiring invasive ventilation
- May have multi-organ failure, ARDS, ECMO etc

30
Q

What are the specific issues with overprescribing of antibiotics?

A
  • Side effects
  • Resistance
  • Drug interactions (ie warfarin)
  • Overall cost
  • 2ndary infections ie C. difficile
  • Alteration of persons microbiome

Infectious Disease (4 decks)

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