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Infectious Disease AB > General ID AB > Flashcards

General ID AB Flashcards

1
Q

What is the incubation period of P. falciparum?

A

7-28 days

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2
Q

What are the features on blood film of P falciparum?

A

Multiple infected RBC
No enlargement of RBC
Crescent-shaped gametocytes
Ring-forms (chromatin)

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3
Q

What are the features on blood film of P vivax?

A

Few infected RBC
Swollen infected RBC
Fine eosinophilic dots (Schuffner’s dotsS)
Round/oval gametocytes

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4
Q

Give an example of the genetic basis of drug resistance in malaria.

A

Mefloquine & lumefantrine
- Pfmdr1 gene

Chloroquine

  • Pfmdr1 gene
  • Pfctr transporter
  • K76T

Antifolate drugs
- point mutations in DHFR and DHTS

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5
Q

Give two common effects of malaria in pregnancy

A

Spontaneous abortions

IUGR

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6
Q

What are the severe manifestations of malaria?

A 
Unable to tolerate oral intake
Altered consciousness
>5% parasitaemia
Jaundice
Oligura
Hypoglycaemia
Severe anaemia
Acidosis 
ARDS
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7
Q

How long from illness onset does severe disease manifest?

A

3-7 days after illness onset

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8
Q

What is the mortality rate of severe malaria?

A

15-25%

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9
Q

What findings may you see on CBE in malaria?

A

Haemolytic anaemia
WCC normal/low
- No eosinophilia
Thrombocytopaenia (95%)

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10
Q

What is the management of severe P. falciparum?

A

IV Artesunate

IV quinine second line

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11
Q

What are some adverse drug reactions of IV Artesunate?

A

Cerebellar ataxia
Abdominal pain
Diarrhoea
ALT elevation

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12
Q

What comorbidity do you need to exclude prior to commencing quinine therapy?

A

G6PD deficiency (haemolysis)

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13
Q

How do you treat uncomplicated P falciparum?

A

First line: Artemether-Lumefantrine (Riamet)
- >95% cure rate in P falciparum

Second line: atovaquone-proguanil (Malarone)
- Slower parasite clearance

Third line: quinine + doxy/clindamycin

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14
Q

How do you treat P vivax/malariae/ovale?

A

Chloroquine

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15
Q

What are the options for chemoprophylaxis in malaria?

A

Chloroquine
- 1 week prior to 4 weeks after

Atovaquone + proguanil (malarone)
- 1-2 days prior, 7 days after

Doxycycline

  • 2 days prior to 4 weeks after
  • Can use in Mefloquine-resistant malaria (SEA)
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16
Q

What are the contraindications for Mefloquine?

A

Neuropsychiatric disorders
Epilepsy
Cardiac conduction defects

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17
Q

How do you treat Amoebiasis?

A

Metronidazole

Paromomycin or diloxanide fuorate (prevents continued luminal infection)

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18
Q

What family of viruses does Ebola belong to?

A

Filovirus family

Zaire - current outbreak

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19
Q

What is Ebola’s incubation period?

A

11 days (6-12)

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20
Q

How to you test for Ebola?

A

Viral PCR

- positive 1 day prior to symptoms

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21
Q

What is the pathophysiology of ebola?

A
  1. Binds to surface receptors
  2. Internalised by macropinocytosis
  3. Moved to Endosomal compartments
  4. Viral GP2 interacts with NPC1
  5. Fusion of viral and endosomal membrane
  6. Viral nucleocapsid released into cytoplasm
  7. Genome is replicated
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22
Q

What is the incubation period of Influenza?

A

1-3 days

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23
Q

Antigenic shift - what does this cause in a population?

A

Pandemic

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24
Q

Antigenic drift - what does this cause in a population?

A

Annual epidemic

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25
Q

What are some extra-pulmonary sequelae of influenza?

A 
Myositis
GBS
Encephalitis
Reye syndrome
- mostly influenza B + aspirin
26
Q

Meningococcal meningitis - what is the treatment?

A

IV Benpen 1.8g 4 hourly (short course)

Cipro if type 1 penicillin hypersensitivity

27
Q

Meningococcal meningitis - what is the mortality?

A

7% (on treatment)

28
Q

N meningitidis - what is the microbiology?

A

Gram negative diplococci

neiserria = negative

29
Q

Meningococcal meningitis - what is the incubation period?

A

2-10 days

30
Q

Pneumococcal meningitis - what is the treatment?

A

Empiric - Ceph + Vanc

31
Q

L monocytogenes meningitis - what is the incubation?

A

Long - up to 6 weeks

32
Q

L monocytogenes meningitis - what is the treatment?

A

Benpen (resistant to Ceph)

Resistant: TMP/SMX

33
Q

Cryptococcal meningitis - what is the treatment?

A

Induction: Amphoterecin B + Flucytosine
Consolidation: Fluconazole
Minimum 10 weeks therapy

34
Q

Hib meningitis - what is the treatment?

A

Ceftriaxone for 7 days

+ Benpen for 7 days if susceptible

35
Q

Steroids - what is the proven efficacy in meningitis?

A

Hib - hearing loss in children
S pneumo - mortality benefit

No benefit in meningococcal.

36
Q

Diffuse erythematous rash - what are some infective causes?

A 
Scarlet fever (strep)
Toxic shock syndrome (staph or strep)
Staph scalded skin syndrome
Dengue
Enterovirus
37
Q

Purpuric rash - what are some infective causes?

A 
Meningococcus
Gonococcus
Staph sepsis
Dengue
HBV
Enterovirus
Rickettsial infection
38
Q

Cellulitis - what are the associated exposures with:

  • Dog/cat bite
  • Fresh water
  • Sea water
  • Immunocompromised
  • Shell fish
  • Other water exposure
A
  • Dog/cat bite - pasturella
  • Fresh water - aeromonas (esp males with cirrosis/cancer)
  • Sea water - vibrio
  • Immunocompromised - clostridia
  • Shell fish - erisepelothrix
  • Other water exposure - mycobacterium marinum
39
Q

Necrotising fasciitis - what is empiric therapy?

A

Meropenem
Penicillin
Clindamycin

40
Q

Hyposplenism - name some causes

A 
Haematologic disorders
- CLL, sickle cell, lymphoma
Splenic irradiation
high dose steroids
Coeliac disease
Bone marrow transplant
- Especially if GvHD
41
Q

Name 4 encapsulated organisms

A

St pneumoniae
N meningitidis
H influenzae
Capnocytophaga carimorus

42
Q

Toxoplasmosis - what is the treatment?

A

Pyrimethamine/folinic acid and sulfadiazine or clindamycinc

43
Q

Zygomycosis - what is the treatment?

A

Debridement and amphotericin (lipid formulations)

44
Q

Varicella - what is the incubation period?

A

10-21 days

45
Q

Schistosomiasis - which organism infects the urinary tract?

A

S haematobium

46
Q

Schistosomiasis - which organisms infect the bowel?

A

S masonii, S japonicum, S intercalatum

47
Q

Schistosomiasis - what is the typical clinical picture?

A

Days: pruritic rash
Weeks later: febrile illness
Months/years later: fibrotic response in urinary tract or gut
Chronic infection: colitis, portal HT, urolithiasis, SCC bladder

48
Q

Schistosomiasis - what is the management?

A

Praziquantel

49
Q

Ascariasis - what sort of organism?

A

Helminthic (most common human)

50
Q

Ascariasis - what is the management?

A

Mebendazole, pyrantel pamoate

51
Q

Melioidosis - what is the organism?

A

Burkholderia pseudomallei

52
Q

Melioidosis - what are the risk factors for infection?

A

DM

EtOH

53
Q

Melioidosis - what are the clinical manifestations?

A 
Pneumonia
Abscesses (spleen, prostate)
Osteomyelitis, septic arthritis
Skin and soft tissue infection
High mortality if sepsis
54
Q

Melioidosis - what is the management?

A

Ceftazadime, Carbapenem

GCSF in sepsis

55
Q

H pylori and gastric adenocarcinoma - which molecules/genes are involved?

A 
CagA gene
Vacuolating cytotoxin (vacA)
56
Q

HPV - which strains are most likely to cause cervical cancer?

A

16 and 18

57
Q

EBV and Burkitt’s lymphoma - which chromosome is affected?

A

Chromosome 8 translocation - deregulation of c-MYC oncogene

58
Q

EBV - what are the associated malignancies?

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
NHL in immunocompromised
Nasopharyngeal carcinoma

59
Q

HHV-8 - what are the associated malignancies?

A

Kaposi sarcoma
Primary effusion lymphoma
Multi-centric Castleman’s disease

60
Q

Schistosomiasis - what is the associated malignancy?

A

SCC of the bladder

61
Q

What is the Jarish-Herxheimer reaction?

A

Fever and transient exacerbation of constitutional symptoms from sudden release of bacterial products from injured or killed bacteria

Seen with tertiary syphilis, brucellosis, enteric fever, schistosomiasis.

Infectious Disease AB (11 decks)

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