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general infection Flashcards

1
Q

what is the treatment of systemic fusariosis ?

A

amphotericin B iv and
Intravitreal ( or voriconazole intravitreal) if associated Endophthalmitis

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2
Q

Echthyma gangrenosum ?

A

PSA

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3
Q

What are the Poor prognostic factors in cryptococcal meningitis ?

A
  1. Cryptococcus spp isolated from blood or other extraneural site
  2. Low CSF white cell count (< 20 cells/mm3)
  3. High CSF antigen titre (>1:1024)
  4. Cryptococci seen in CSF microscopy
  5. Altered mental status.
  6. Raised opening pressure
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4
Q

Recommended diphtheria antitoxin
antibody levels are:

A
  • 0.01 IU/mL for those in routine diagnostic laboratories
  • 0.1 IU/mL for those handling or regularly exposed to toxigenic strains
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5
Q

C Diphtheriaea contacts management?

A

1-isolation
2-swabs
3- chemoprophylaxis: Clarithromycin
500mg twice a day 7
or : Azithromycin 500mg once a day 6
or: Alternative
Benzathine benzylpenicillin IM

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6
Q

Common effects of congenital rubella syndrome (CRS) before 16 w?

A

cataracts
congenital heart disease
hearing impairment
developmental delay
miscarriage if early infection

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7
Q

Single most common effect of congenital rubella Before 16w?

A

Bilateral SNHL

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8
Q

most common cause of congenital syndromes:
Fetal hydrops
Rhinitis
Limb hypoplasia
Microcephaly

A

Fetal hydrops : maternal parvovirus.

Rhinitis : congenital syphilis

Limb hypoplasia : congenital varicella

Microcephaly : Zika virus

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9
Q

what is the cause and the vector of African Tick-Bite Fever (ATBF) ?

A

Caused by Rickettsia africae.
Transmitted by Amblyomma hebraeum and Amblyomma variegatum.

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10
Q

What is the triad of African Tick-Bite Fever (ATBF) ?

A

1- multiple eschars and tick bites
2- regional LN
3- diffuse skin rash
very commonly associated: fever , headache and myalgia

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11
Q

Amplifying hosts for:
1- JEV
2- West Nile virus
3- Nipah virus
4- Ebola
5- Lassa

A

1- JEV: pigs and aquatic birds
2- WNV: birds e.g crows (transmits by Culex)
3- Nipah virus : fruit bats (but can transmits by contaminated date palm sap or infected pigs)
4- Ebola: fruit bats
5- Lassa: multi-mammals rats

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12
Q

Transmission of Hendra virus?

A

Usually found in fruit bats and horses
Transmits to humans by exposure to body fluids.

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13
Q

Symptoms of West Nile virus?

A

rash
arthralgia
lymphadenopathy
sever disease : hepatitis , myelitis , pancreatitis

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14
Q

Indications for HNIG as PEP for infants with measles contact ?

A

1- All infant contacts under 6 months
2- All household infant contacts under 9 months without any testing.

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15
Q

Infectious period?
1- measles
2- VZV

A

1- measles: four days before to four days after rash onset
2- 2 days before the onset of rash and until all rash has crusted over

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16
Q

Treatment of Cutaneous larva migrans

A
  • Ivermectin single 12mg PO.
  • Albendazole single 400mg PO
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17
Q

cause of vesceral larva migrans VLM?

A

Toxocara catis and cannis

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17
Q

Types of typhoid vaccines?

A

1- Vi vaccine- injectable purified capsular polysaccharide - one dose 2 weeks before travel and every 3 years

2- Ty21a oral vaccine - live attenuated : total 4 capsules to be taken on alternative days - should complete 7 days before travel.

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18
Q

Neisseria meningitidis vaccination timing in UK?

A

1- MenB vaccination at 2,4 and 12 months.

2- Hib/MenC at 12 months.

3- MenACWY at 14 years of age.

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19
Q

Treatment of strongyloidiasis

A

1- first line: Ivermectin 200 mcg/kg single oral dose
2-Albendazole 400 mg once daily for 7 days

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20
Q

Indication for Men ACWY in UK ?

A

1- part of the current routine vaccination at age of 14
2- patients with asplenia and splenic dysfunction
3- complement disorders
4- Travellers

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21
Q

Indications for Rabies vaccine in UK?

A

1- Handlers of high-risk animals - bats
2- travellers to high risk countries

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22
Q

Hepatitis A:
Indication of PEP Vaccination?

A

Vaccine only:
1- pregnant and BF if not immune
2- MSM
3- IVDU
4- Sewage workers
5- haemophilia
——–
HNIG(within 14 d) in addition to vaccine:
1- Aged 60 and over
2- HIV and a CD4 count of <200
3- Chronic hepatitis B or C infection
4- Chronic liver disease
5- Immunosuppressed

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23
Q

how to treat neonate with maternal chickenpox 5 days before delivery?

A

prophylactic VZIG for neonates whose mothers develop chickenpox in the period 7 days before to 7 days after delivery .

also: IV Acyclovir if maternal infection occurs 4 days pre and 2 days post delivery

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24
Q

Dosing of dexamethasone in CNS TB?

A

1- If No focal neurological deficit and GCS 15: 0.3mg/kg reducing to 1mg/day over 6 weeks
2- If focal neurology :
0.4mg/kg for 8 weeks.

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25
Q

Category A biological warfare agents?

A

Bacillus anthracis
Yersinia pestis
Variola major (smallpox)
Franciscella tularensis
Viral haemorrhagic fevers (e.g. Ebola)
C. botulinum toxin.

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26
Q

Classical presentation of Histoplasmosis?

A

1- Travel to the Mississippi 2- Pulmonary symptoms
3-Erythema nodosum
4 - lymphopenia
5- Hepatosplenomegaly
6- LN

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27
Q

what are the types of pneumococcal vaccines in UK?

A

1- 23 valent polysaccharide vaccine - Pneumovax
- Not effective <2 years old
- No immune memory
- No protection against non-invasive disease
- No reduction in pharyngeal carriage

2- 13 valent conjugate vaccine - Prevenar13:
- effective from 2 m age
- part of UK routine V
- long term memory
- protect against non-invasive disease
- reduce carriage
- induce herd immunity
- indicated for HIV regardless CD4

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28
Q

What vaccine should be given to pt with new diagnosis of asplenia ?
(adults and children >10y age )

A

1 X PPV23
1x MenACWY
2x MenB
yearly influenza vaccine

29
Q

indications of Chemoprophylaxis for iGAS close contacts ?

A

1- mother and baby if either develops iGAS in the first 28 days of life
2- for close contacts if developed symptoms of localised Group A streptococcal infection i.e. sore throat, fever, skin infection
3- he entire household if 2 or more cases of iGAS within a 30-day

30
Q

what is the recommended chemoprophylaxis for iGAS?

A

Oral penicillin V 500mg QDS x 10 days or azithromycin 500 mg od for 5 days

31
Q

First line to treat uncomplicated malaria in pregnancy ?

A

1- 1st trimester: quinine and clindamycin for 7 day

2- 2nd and 3rd trimester: artemether-lumefantrine

32
Q

Unwell pt with sever neutropenia , multiple ulcerative skin lesions and endophthalmitis . what organism and how to treat?

A

1-Fusarium salonii
2- high dose IV and intravitreal amphotericin B

33
Q

What is the mechanism of action of azole antifungals ?

A

inhibit cytochrome P450 and 14a demethylase in the ergosterol synthesis process

34
Q

Griseofulvin

A

interferes with mitosis by disrupting microtubules.

35
Q

Flucytosine

A

It is a precursor of cytotoxic drug 5-fluorouracil, but is converted to the active agent selectively in fungal cells( inhibit DNA synthesis)

36
Q

Echinocandins (e.g. caspofungin)

A

prevent synthesis of the fungal cell wall agent β1-3 D-glucan

37
Q

Terbinafine

A

inhibits squalene epoxidase

38
Q

Mechanism of Amphotericin B?

A

binds to ergosterol containing membranes and disrupts them by forming pores

39
Q

What is the recommended HBV Vaccine schedule for high risk ppl?

A

HBV Vaccine (Engerix B®) can be given at 0, 7
and 21 with a fourth dose at 12 months for longer term protection.
Any adults over 18 years of age at immediate risk e.g:
1- travellers to high endemicity
2- PWIDs
3- prisoners

40
Q

What is the recommended PEP for HBV for sexual partner with acute Hepatitis B or new chronic HepB ?

A

1- accelerated vaccine
2- HBIG if within 7 days

41
Q
A
41
Q
A
41
Q

What isPEP plan for HBV after needle stick and eye splash from Known HBV infected person (both in healthcare or community)?

A

1- hep B vaccine given at zero, one and two months.
No need for reinforcing dose at 12 m unless continues risk (e,g: HCW or renal dialysis )
2- HBIG If within 7 days
ideally within 24 hours of the first dose of vaccine

41
Q

what is the recommended plan for hep B vaccine non responder ( An antibody level below 10mIU/ml 2 months after 1ry vaccination) ?

A

1- check for markers of current or past infection.
2- repeat course of vaccine followed by retesting 1-2 months later
3- if still have anti-HBs < 10 mIU/ml: HBIG if exposed to the virus

41
Q

What are the poor prognostic factors for JC infection and PML ?

A

1- longer duration of treatment with natalizumab
2- peripheral JCV IgG positive
3- previous exposure to immunosuppressants

42
Q

What is the commonest cause of dermatophyte scalp infection in UK?

A

Trichophyton tonsurans

43
Q

what are the commonest cause endothrix and exothrix tinea capitis ?

A

1- Both Trichophyton tonsurans and Trichophyton violaceum cause endothrix infections
2- Microsporum canis causes ectothrix infections.
3- Trichophyton rubrum is rarely associated with cases of tinea capitis and normally only the skin is infected.
————
oral griseofulvin and terbinafine

44
Q

what is current recommendation for secondary prophylaxis of
SBP ??

A

oral norfloxacin or ciprofloxacin prophylaxis

45
Q

Invasive aspergillosis
what is first line in primary infection ? secondary infection (salvage therapy ) ? prophylaxis?

A

1- Voriconazole 6 mg /kg bd iv for 6-12weeks
2- caspofungin 70mg/day
3-Posaconazole 200 mg 3 times per day with food during neutropenia until Neutrophils> 500

46
Q

What is the first line treatment for uncomplicated malaria in UK ?

A

1- Artemether + lumefantrine (Coartem)
2- Atovaquone proguanil: (malarone)

47
Q

First line treatment for uncomplicated malaria in pregnancy?

A

1-In 1st trimester: Oral quinine 600 mg Q8h for 5 - 7d + clindamycin 450 mg
8 h for 7 days.

2- Artemether-lumefantrine is the treatment of choice in the 2nd and 3rd trimester

48
Q

Severe / complicated malaria in pregnancy ?

A

1- artesunate is
preferred first option

2- IV quinine (with clindamycin) is an alternative.

49
Q

Treatment of non-falciparum malaria?

A

1- Chloroquine for vivax, ovale, malariae and knowlesi malaria in adult and children
2- Artemether-lumefantrine
3- Parenteral artesunate
(or quinine)

50
Q

Meningococcal Chemoprophylaxis for close contact??

A

1- single dose azithromycin
2- rifampicin is alternative 600 mg bd for 2 days
—-
should be given with in 7 days of contact regardless of vaccination status

51
Q

invasive meningococcal disease : vaccination of index case ?

A

1- Fully immunised cases do not require additional
vaccination.
if not should complete appropriate vaccination
——–
2- At-risk index cases (e.g. asplenia, complement-deficiency) if unimmunised or partially immunised:
- MenACWY conjugate vaccine (2 doses one month apart if aged <1 year; 1 dose after first birthday)
- MenB vaccine (2 doses two months apart with a booster at
12 months for <1 year-olds, 2 doses 2 months apart for 1-10 year-olds and 2 doses 1
month apart for older children and adults)

52
Q

Meningococcal disease
Vaccination of close contacts??
for confirmed MenACWY and MenB ?

A

1- MenACWY
contacts should receive MenACWY conjugate vaccine, unless immunised within the last 12 months (2 doses one month
apart if aged <1 year; 1 dose after first birthday). For MenC : another
MenC-containing conjugate vaccine should be given
—-
Men B contact :
vaccination is not recommended unless at risk group

53
Q

treatment of african trypanosomiasis?

A

Suramin for first stage Melarsoprol for 2nd stage

54
Q

treatment of paragonimiasis, - P. westermani??

A

triclabendazole or praziquantel

55
Q

what are the commonest Sandfly viruses?

A

1- Toscana : Southern Europe and the Mediterranean - mainly in summer months
2- Naples virus.in Italy , Serbia and Egypt
3- Siciliana virus in the Mediterranean through to central Asia.

56
Q

PVL toxin mechanism of action

A

pore-forming toxin
induces polymorphonuclear cell death by necrosis or by apoptosis by disruption of mitochondrial homeostasis and activation of caspase-9 and caspase-3

57
Q

VZV Contact PEP in immunocompromised pt ?

A

Oral aciclovir (or valaciclovir) is first choice of PEP for susceptible immunosuppressed
individuals, all susceptible pregnant women ‘
start from day 7 until day 14

58
Q

Cidofovir mechanism of action and resistance ??

A

Cidofovir: inhibits viral DNA polymerase pUL54 and incorporates itself into the viral DNA which interrupts further elongation of the virus
Cidofovir resistance is caused only by DNA polymerase mutations, mainly by a UL54 mutation which also results in cross-resistance to ganciclovir.

59
Q

What is mutation H275Y has been detected in influenza A/H1N1?

A

-Is a single base pair change in the influenza neuraminidase
- it result in oseltamivir and peramivir resistance.
- It does not affect zanamivir and laninamivir both remain active.

60
Q

T/F Amantadine act by binding the viral M2 ion channel and disrupting viral uncoating. Influenza B viruses are intrinsically resistant to amantadine

A

T

61
Q

if HBsAg positive HCW ? what advice to give re EPP?

A

restart EPPs if their VL is adequately suppressed <200 (on 2 tests, at least 4 weeks apart). They would require retesting every 6 months while on treatment.

62
Q

Mother with VZV symptoms 5 days before to 2 days after birth:
???

A

Keep mother and infant hospitalised and isolated for at least 3 days
Treat newborn with either VZIG or, if unavailable, IVIG 400 mg/kg as soon as possible within the first 48 - 96 hours after birth.
————-
If the newborn does not have any other comorbidity, mother and baby can leave the hospital between administration of immune globulins and start of acyclovir therapy.
———
intravenous acyclovir from day 7 after the onset of maternal rash and administer for 10 days. Alternatively, give oral acyclovir in case of no peripheral venous access

63
Q

What is the cause and treatment of rhino-orbital-cerebral mucormycosis?

A

Mucorales:
Rhizopus, Mucor, Lichtheimia spp
—-
Tx:
Liposomal amphotericin B (AmBisome) given at high dose (10 mg/kg) is the preferred first-line agent, isavuconazole and posaconazole are secondary options

64
Q

what is the Sterilization ? antisepsis ? Cleaning ?
Disinfection?

A

Sterilization: complete destruction of all microorganisms present including bacterial spores.
An antiseptic agent which safely disinfects skin or living tissues.
Cleaning is the physical removal of microorganisms and debris
Disinfection is a process which destroys microorganisms by chemical or heat methods and reduces them to a level not harmful to health.

65
Q
A

revision (4 decks)

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