ID Flashcards
What is seen on CSF analysis in bacterial meningitis?
Cloudy appearance
Low glucose (50% plasma)
High protein
10-5000 PMNs
What is seen on CSF analysis in viral meningitis?
Glucose 60-80% plasma
Normal/high protein
15-1000 lymphocytes
What is seen on CSF analysis in tuberculous meningitis?
Slightly cloudy, fibrin web
Low glucose (50% plasma)
High protein
30-300 lymphocytes
What is the treatment of TB meningitis?
Usual therapy + prednisolone
12 months
What is the most common cause of viral meningitis?
Enterovirus e.g. Coxsackie
Which lobes does HSV-1 encephalitis affect?
Temporal and frontal
How is HSV encephalitis diagnosed?
LP - viral CSF picture
PCR for HSV
CT: medial temporal and inferior frontal petechial haemorrhages
EEG: lateralised periodic discharges at 2Hz
What is the cause of Japanese encephalitis and how is it transmitted?
Flavivirus
Transmitted by culex mosquitos which breed in rice paddy fields
Reservoir hosts - aquatic birds
Amplification hosts - pigs
What are the symptoms of Japanese encephalitis that differentiate it from other forms of encephalitis?
Parkinsonian features
Acute flaccid paralysis
What type of virus is hepatitis B?
dsDNA hepadnavirus
Which is the first serological marker to appear in hepatitis B and indicates ongoing infection?
HBsAg
What are the characteristics of anti-HBs?
Implies immunity - exposure or immunisation
Negative in chronic disease
What are the characteristics of anti-HBc?
Present for around 6 months; implies previous or current infection
Negative if immunised (c=caught)
What hepatitis serology is expected to be seen in patients who have only been immunised against hepatitis B?
Anti-HBs
What are the complications of hepatitis B?
Chronic hepatitis and fulminant liver failure
Glomerulonephritis
Polyarteritis nodosa
Cryoglobulinaemia
What level of anti-HBs shows adequate response to vaccination?
> 100
What are the features of chronic hepatitis B?
Transaminitis
Ground glass appearance of liver
HBsAg and anti-HBc
What is the treatment of chronic hepatitis B?
48 weeks pegylated IFN-a
Synthetic thymidine nucleoside analogue e.g. tenofovir, entecavir
What type of virus is hepatitis C?
RNA flavivirus
What is the serology of hepatitis C?
HCV RNA detected
anti-HCV antibodies (remain if patients clear the virus)
What percentage of patients clear hepatitis C?
33%
66% develop chronic hepatitis C, 50% of these develop end stage liver disease
What are the risk factors for developing chronic hepatitis C?
Asymptomatic in acute stage
Co-existing hepatic pathology
HIV
African American
What are the complications of chronic hepatitis C?
Arthritis Sjogren's syndrome Cirrhosis and HCC Type 2 cryoglobulinaemia PCT Membranoproliferative GN Autoimmune thyroid disease
What does management of hepatitis C depend on?
Viral genotype
What is the treatment of hepatitis C?
2DAAS +/- ribavarin
E.g. Harvoni (ledipasvir (NS5A inhibitor) and sofosbuvir (NS5B inhibitor)
What is HCC screening in hepatitis C?
6 monthly AFP, liver USS
In which patients does hepatitis E carry risk of significant mortality?
Pregnancy
What is the mechanism of action of rifampicin?
Inhibits bacterial DNA dependent RNA polymerase, preventing transcription of DNA into mRNA
What are the side effects of rifampicin?
Hepatitis
Orange/pink secretions
Flu like
P450 inducer
What is the mechanism of action of isoniazid?
Inhibits mycolic acid synthesis
What are the side effects of isoniazid?
Peripheral neuropathy (prevent with pyridoxine)
Hepatitis
Agranulocytosis
P450 inhibitor
What is the mechanism of action of pyrazinamide?
Converted into pyrazinoic acid which inhibits fatty acid synthase
What are the side effects of pyrazinamide?
Hyperuricaemia
Arthralgia/myalgia
Hepatitis
What is the mechanism of action of ethambutol?
Inhibits arabinosyl transferase which polymerises arabinose into arabian
What are the side effects of ethambutol?
Retrobulbar optic neuritis
Needs dose adjustment in renal impairment
Name 5 skin disorders associated with TB.
Lupus vulgaris Erythema nodosum Scarring alopecia Scrofuloderma Verrucosa cutis Gumma
What is the general treatment of HIV?
2NRTIs + PI/NRTI
Give some examples of NRTIs and their side effects.
Zidovudine: anaemia, myopathy, black nails
Tenofovir: renal impairment, osteoporosis
General: peripheral neuropathy
Give some examples of NNRTIs and their side effects.
Nevirapine, efavirenz
P450 induction, rashes
Give some examples of protease inhibitors and their side effects.
Ritonavir: P450 inhibitor
Indinavir: renal stones, high bilirubin
General: diabetes, hyperlipidaemia, buffalo hump and central obesity
Give some examples of integrase inhibitors.
Raltegravir, elvitegravir
What is the cause of progressive multifocal leukoencephalopathy?
Infection of oligodendrocytes by JC virus
What is seen on CT or MRI in PML?
Widespread demyelination, single/multiple lesions
What is seen on CT in cerebral toxoplasmosis?
Single or multiple ring enhancing lesions
What is the treatment of cerebral toxoplasmosis?
Sulfadiazine and pyrimethamine
Which virus is primary CNS lymphoma associated with?
EBV
Which imaging modality is positive in primary CNS lymphoma?
Thallium SPECT
How is cryptococcal meningitis diagnosed?
High opening pressure CSF, India ink test positive
What is the cause of AIDs dementia?
HIV virus itself
What is post exposure prophylaxis?
Combo PO antiretrovirals for 4 weeks
Serological testing at 12 weeks post completion
What are the symptoms of HIV seroconversion illness?
Glandular fever type
1-4 weeks after infection
Maculopapular rash
Suggests the beginning of HIV antibody production
What is tested in suspected HIV seroconversion illness?
P24 antigen
HIV PCR
Antibodies negative up to 3 months
Which HIV patients should have prophylaxis against PCP pneumonia?
CD4 count <200
How is PCP pneumonia diagnosed?
CXR: bilateral interstitial pulmonary infiltrates
BAL silver staining: cysts
Sputum culture
What is the treatment of PCP pneumonia?
Co-trimaxazole
IV pentamidine if severe
If PCP patients are hypoxic <9.3kPa, what is added to treatment?
Steroids
What type of virus is HIV?
RNA retrovirus
Which cells does HIV virus infect?
CD4 T cells, macrophages, dendritic cells
How does HIV virus replicate?
After entering a cell, reverse transcriptase creates dsDNA from RNA for integration into the host cell’s genome
Which vaccines are contraindicated in HIV?
Cholera
Intranasal influenza
Oral polio
BCG