ID Flashcards
Gram +ve cocci
Staphylococcus
Streptococcus
Enterococcus
Gram +ve rods
Use the mnemonic “corney Mike’s list of basic cars”:
Corney – Corneybacteria
Mike’s – Mycobacteria
List of – Listeria
Basic – Bacillus
Cars – Nocardia
Gram +ve anaerobes
Use the mnemonic “CLAP”:
C – Clostridium
L – Lactobacillus
A – Actinomyces
P – Propionibacterium
Gram -ve
Neisseria meningitis
Neisseria gonorrhoea
Haemophilia influenza
E. coli
Klebsiella
Pseudomonas aeruginosa
Moraxella catarrhalis
Atypical bacteria
The definition of atypical bacteria is that they cannot be cultured in the normal way or detected using a gram stain. Atypical bacteria are most often implicated in pneumonia.
The atypical bacteria that cause atypical pneumonia can be remembered using the mnemonic “legions of psittaci MCQs”:
Legions – Legionella pneumophila
Psittaci – Chlamydia psittaci
M – Mycoplasma pneumoniae
C – Chlamydydophila pneumoniae
Qs – Q fever (coxiella burneti)
Management- Macrolides such as clarithromycin
Quinolones such as levofloxacin
Tetracyclines such as doxycycline
Atypical bacteria
The definition of atypical bacteria is that they cannot be cultured in the normal way or detected using a gram stain. Atypical bacteria are most often implicated in pneumonia.
The atypical bacteria that cause atypical pneumonia can be remembered using the mnemonic “legions of psittaci MCQs”:
Legions – Legionella pneumophila
Psittaci – Chlamydia psittaci
M – Mycoplasma pneumoniae
C – Chlamydydophila pneumoniae
Qs – Q fever (coxiella burneti)
MRSA
Resistant to penicillins, cephalosporins and carbapenems.
People are often colonised with MRSA bacteria (skin and respiratory tract)
If these bacteria become part of an infection they can be difficult to treat.
Patients being admitted for surgery or treatment are screened for MRSA infection by taking nasal and groin swabs- eradication (when on the skin surface and not part of an infection)- chlorhexidine body washes and mupirocin (antibacterial) nasal creams.
Antibiotic treatment options for MRSA infection are:
1st line: vancomycin/ teicoplanin
2nd line: linezolid (inc. allergy)
Extended Spectrum Beta Lactamase bacteria (ESBLs)
bacteria that have developed resistance to beta-lactam antibiotics
usually e. coli or klebsiella and typically cause urinary tract infections (or pneumonia)
NB- sensitive to carbapenems eg. meropenem
Local resistance and guidelines
In your OSCEs questions about treating infections can always be answered with “treat with antibiotics as per the local antibiotic policy”.
Chest infection
Either bacterial pneumonia or viral bronchitis (no ABX)
Bacterial causes;
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis (immunocompromised or pulmonary disease)
Pseudomonas aeruginosa (CF/bronchiectasis)
Staphylococcus aureus (CF)
ABX- Amoxicillin, Erythromycin / clarithromycin, or Doxycycline
Cellulitis
Deeper skin infection caused by staph aureus and strep pyogenes
Erythema (red discolouration)
Warm or hot to touch
Tense
Thickened
Oedematous
Edges are NOT well-demarcated
Bullae (fluid-filled blisters)
A golden-yellow crust can be present and indicate a staphylococcus aureus infection
Eron Classification
Class 1 – no systemic toxicity or comorbidity
Class 2 – systemic toxicity or comorbidity
Class 3 – significant systemic toxicity or significant comorbidity
Class 4 – sepsis or life-threatening
Admit the patient for intravenous antibiotics if they are class 3 or 4. Also consider admission for frail, very young or immunocompromised patients.
Flucloxacillin is first line for mild-moderate
Clarithromycin, erythromycin (in pregnancy) or doxycyline is recommended in patients allergic to penicillin.
Severe cellulitis- co-amoxiclav, cefuroxime, clindamycin or ceftriaxone. (3 C’s)
NB- diagnosis of cellulitis is clinical
Influenza (flu) features
Fever
Coryzal symptoms
Lethargy and fatigue
Anorexia (loss of appetite)
Muscle and joint aches
Headache
Dry cough
Sore throat
NB- secondary pneumonia: usually caused by Staphylococcus aureus
NB- viral nose and throat PCR swabs
Management of influenza
Conservative- notify public health England, rest, fluids, limit contact with other people
Medical- antivirals if the person it as risk of developing severe complications
NB- post exposure prophylaxis, PPE to be worn by hospital staff etc.
HIV seroconversion
HIV seroconversion typically presents as a glandular fever type illness. It usually occurs 3-12 weeks after infection;
sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
rarely meningoencephalitis
AIDS defining illnesses
AIDS-defining illnesses are associated with end-stage HIV infection where the CD4 count has dropped to a level that allows for unusual opportunistic infections and malignancies to appear;
Kaposi’s sarcoma
Pneumocystis jirovecii pneumonia (PCP)
Cytomegalovirus infection
Candidiasis (oesophageal or bronchial)
Lymphomas
Tuberculosis
Toxoplasmosis
HIV transmission
Unprotected anal, vaginal or oral sexual activity.
Mother to child at any stage of pregnancy, birth or breastfeeding. This is referred to as vertical transmission.
Mucous membrane, blood or open wound exposure to infected blood or bodily fluids such as through sharing needles, needle-stick injuries or blood splashed in an eye.
HIV Investigations
Combination test- HIV p24 antigen and HIV antibody
PCR for HIV RNA (viral load)
NB- testing should be done 4 weeks after possible exposure in asymptomatic patients
HIV Management
Conservative- refer to GUM/ID, regular monitoring, annual cervical smears for women
Medical- ARV (x3), prophylactic antifungals of necessary , CVD therapy
Specialist- reproductive health, PEP etc.
HIV Monitoring
CD4 count (500-1200, below 200= AIDS)
Viral load
NB- aim is to have a normal CD4 count with undetectable viral load
Reproductive health
Can engage in protective sex (barrier method)
Caesarean section unless undetectable viral load
Children born to HIV+ve mothers get ART for 4 weeks after birth
Can breast feed if undetectable load, but there is still a risk of transmission
Oesophageal candidiasis
the most common cause of oesophagitis in patients with HIV. It is generally seen in patients with a CD4 count of less than 100. Typical symptoms include dysphagia and odynophagia. Fluconazole and itraconazole are first-line treatments.
Kaposi’s sarcoma
caused by HHV-8 (human herpes virus 8)
presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)
skin lesions may later ulcerate
respiratory involvement may cause massive haemoptysis and pleural effusion
radiotherapy + resection
Pneumocystis jirovecii
the most common opportunistic infection in AIDS
all patients with a CD4 count < 200/mm³ should receive PCP prophylaxis
Management- co-trimoxazole, IV pentamidine in severe cases
Pneumocystis jirovecii
the most common opportunistic infection in AIDS
all patients with a CD4 count < 200/mm³ should receive PCP prophylaxis
Management- co-trimoxazole, IV pentamidine in severe cases
Features (PJ pneumonia);
dyspnoea
dry cough
fever
causes desaturation on exercise
clear chest on examination/ few chest signs
Management of animal and human bites
Cleanse wound (puncture wounds should not be sutured closed unless cosmesis is at risk)
Co-amoxiclav
Anthrax
causes painless black eschar (cutaneous ‘malignant pustule’, but no pus)
typically painless and non-tender
may cause marked oedema
anthrax can cause gastrointestinal bleeding
Antibiotic guidelines pass medicine
print out (maybe I already have them printed?)
Aspergilloma
a mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to tuberculosis, lung cancer or cystic fibrosis).
Usually asymptomatic but features may include
-cough
-haemoptysis (may be severe)
Can be seen on CXR/ CT scan
Bed bugs
Intensely itchy bumps on arms legs and torso
Management- wash bed linin, mattress cover, fumigate house
Botulism (clostridium botulinum)
produces botulinum toxin, a neurotoxin which irreversibly blocks the release of acetylcholine
may result from eating contaminated food (e.g. tinned) or intravenous drug use
neurotoxin often affects bulbar muscles and autonomic nervous system
Features;
patient usually fully conscious with no sensory disturbance
flaccid paralysis
diplopia
ataxia
bulbar palsy
NB- antitoxin is the only effective management
Catch scratch disease
Bartonella henselae
Features
fever
history of a cat scratch
regional lymphadenopathy
headache, malaise
Chickenpox exposure
Patients who are immunocompromised should receive chicken pox antibodies if they are exposed and have no antibodies to varicella
Cryptospiridosis
The commonest protozoal cause of diarrhoea in the UK. Common in the immunocompromised eg. HIV
watery diarrhoea
abdominal cramps
fever
in immunocompromised patients the entire gastrointestinal tract may be affected resulting in complications such as sclerosing cholangitis and pancreatitis
Management;
Immunocompetent- supportive (fluids)
Immunocompromised- nitazoxanide (and start ART if necessary)
Dengue fever
fever
headache (often retro-orbital)
myalgia, bone pain and arthralgia (‘break-bone fever’)
pleuritic pain
facial flushing (dengue)
maculopapular rash
haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis
NB- treatment is symptomatic
Enteric fever (typhoid/paratyphoid)
initially systemic upset as above
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
Epstein-Barr virus: associated conditions
Malignancies associated with EBV infection;
Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas
The non-malignant condition hairy leucoplakia is also associated with EBV infection.
Specific features of gastroenteritis
see pass medicine page
Herpes simplex virus
Features;
primary infection: may present with a severe gingivostomatitis
cold sores
painful genital ulceration
Management;
gingivostomatitis: oral aciclovir, chlorhexidine mouthwash
cold sores: topical aciclovir
genital herpes: oral aciclovir.
HSV and pregnancy
Pregnancy;
-elective caesarean section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation
-women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low
Invasive aspergillosis
a systemic Aspergillus infection
Risk factors include;
HIV
Leukaemia
Following broad-spectrum antibiotics
Legionnaires disease
Legionella pneumophilia (typically colonizes water tanks and hence questions may hint at air-conditioning systems or foreign holidays. Person-to-person transmission is not seen).
Features;
flu-like symptoms including fever (present in > 95% of patients)
dry cough
relative bradycardia
confusion
lymphopaenia
hyponatraemia
deranged liver function tests
pleural effusion: seen in around 30% of patients
Diagnosis
urinary antigen
Management
treat with erythromycin/clarithromycin
Leprosy
Mycobacterium leprae/lepromatosis
patches of hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
sensory loss
Management- triple therapy (rifampicin, dapsone and clofazimine)
Leptospirosis
classically spread by contact with infected rat urine
Features;
the early phase is due to bacteraemia and lasts around a week;
-may be mild or subclinical
-fever
-flu-like symptoms
-subconjunctival suffusion (redness)/haemorrhage
second immune phase may lead to more severe disease (Weil’s disease);
-acute kidney injury (seen in 50% of patients)
-hepatitis: jaundice, hepatomegaly
-aseptic meningitis
Investigations- serology (antibodies), PCR
Management- benzylpenicillin or doxycycline
Lyme disease
caused by the spirochaete Borrelia burgdorferi and is spread by ticks.
Early features (within 30 days);
-erythema migrans (bulls eye rash)
-systemic features (headache, lethargy, fever, arthralgia)
Later features (after 30 days);
-heart block
-peri/myocarditis
-facial nerve palsy
-radicular pain
-meningitis
NB- can be diagnosed clinically if erythema migrans is present (otherwise, ELISA to B. burgdorferi antibodies)
Management- doxycyline is first line (when erythema migrans is present). Amoxicillin for pregnant women. No need for prophylaxis in asymptomatic tick bites
Lymphogranuloma venereum
Caused by Chlamydia trachomatis
Typically infection comprises of three stages:
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
may occasionally form fistulating buboes
stage 3: proctocolitis
NB- treated using doxycycline
Mantoux Test
0.1 ml of PPD injected intradermally
result read 48-72 hours later
erythema & induration > 10mm = positive result - this implies previous exposure including BCG
if strongly positive TB likely (response to previous BCG decreases with time), needs further investigation including e.g. CXR
Causes of false-negative Mantoux test;
-immunosuppression (miliary TB, AIDS, steroid therapy)
-sarcoidosis
-lymphoma
-extremes of age
-fever
-hypoalbuminaemia, anaemia
SOME CARDS ARE IN
CASE 4 YEAR 3 OSCE
Pyrexia of unknown origin
Defined as a prolonged fever of > 3 weeks which resists diagnosis after a week in hospital
Neoplasia
lymphoma
atrial myxoma
Infections
abscess
TB
Connective tissue disorders
Rabies
a viral disease that causes an acute encephalitis.
Features;
prodrome: headache, fever, agitation
hydrophobia: water-provoking muscle spasms
hypersalivation
Negri bodies: cytoplasmic inclusion bodies found in infected neurons
Following an animal bite in at-risk countries:
-the wound should be washed
-if an individual is already immunised then 2 further doses of vaccine should be given
-if not previously immunised then human rabies immunoglobulin (HRIG) should be given along with a full course of vaccination
Respiratory pathogens
Pass medicine page
Spinal epidural abscess
a collection of pus that is superficial to the dura mater (of the meninges) that cover the spinal cord. Usually caused by S. aureus
bacteria enters the spinal epidural space by contiguous spread from adjacent structures (e.g. discitis), haematogenous spread from concomitant infection (e.g. bacteraemia from IVDU), or by direct infection (e.g. spinal surgery).
NB- same symptoms as discitis, but also focal neurological deficits (that is what separates discitis and a spinal epidural abscess)
Management- IV ABX and maybe surgical drainage
Post-splenectomy changes
Platelets will rise first (therefore in ITP should be given after splenic artery clamped)
Blood film will change over following weeks, Howell-Jolly bodies will appear
Other blood film changes include target cells and Pappenheimer bodies
Increased risk of post-splenectomy sepsis, therefore prophylactic antibiotics and pneumococcal vaccine should be given.
Staphylococcal toxic shock syndrome
a severe systemic reaction to staphylococcal exotoxins, the TSST-1 superantigen toxin (tampons are risk factors)
Diagnostic criteria;
fever: temperature > 38.9ºC
hypotension: systolic blood pressure < 90 mmHg
diffuse erythematous rash
desquamation of rash, especially of the palms and soles
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
Management;
removal of infection focus (e.g. retained tampon)
IV fluids
IV antibiotics
Staphylococcus epidermidis
Coagulase-negative
Cause of central line infections
Tetanus
caused by the tetanospasmin exotoxin released from Clostridium tetani.
Features;
prodrome fever, lethargy, headache
trismus (lockjaw)
risus sardonicus
opisthotonus (arched back, hyperextended neck)
spasms (e.g. dysphagia)
Management;
supportive therapy including ventilatory support and muscle relaxants
intramuscular human tetanus immunoglobulin for high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue)
metronidazole is now preferred to benzylpenicillin as the antibiotic of choice
Wounds and tetanus prophylaxis
Full course of vaccines (last one <10 years ago)- clean wound
More than 10/never had- clean wound, tetanus vaccination, tetanus immunoglobulin
Adverse effects of tetracyclines
eg. doxycycline, tetracycline
discolouration of teeth: therefore should not be used in children < 12 years of age
photosensitivity
angioedema
black hairy tongue
NB- should not be given to women who are pregnant or breastfeeding due to the risk of discolouration of the infant’s teeth.
Toxoplasmosis
Toxoplasma gondii (rats and cats are carriers)
Most infections are asymptomatic. Symptomatic patients usually have a self-limiting infection, often having clinical features resembling infectious mononucleosis (fever, malaise, lymphadenopathy). Other less common manifestations include meningoencephalitis and myocarditis.
Serology is the investigation of choice.
No treatment is usually required unless the patient has a severe infection or is immunosuppressed.
In immunocompromised (HIV) patients;
constitutional symptoms, headache, confusion, drowsiness
CT: usually single or multiple ring-enhancing lesions, mass effect may be seen
management: pyrimethamine plus sulphadiazine for at least 6 weeks
Trimethoprim
-myelosuppression
-transient rise in creatinine (competitively inhibits the tubular secretion of creatinine)
-hyperkalaemia
-avoid in 1st trimester of pregnancy
Live/attenuated vaccines
see passmedicine page
Vancomycin adverse effects
nephrotoxicity
ototoxicity
thrombophlebitis
red man syndrome; occurs on rapid infusion of vancomycin
Viral meningitis
Causes;
non-polio enteroviruses e.g. coxsackie virus, echovirus
mumps
herpes simplex virus (HSV), cytomegalovirus (CMV), herpes zoster viruses
HIV
measles
Viral polymerase chain reaction (PCR) may demonstrate an underlying organism.
Management;
whilst awaiting the results of the lumbar puncture, treatment should be supportive and if there is any question of bacterial meningitis or of encephalitis, the patient should be commenced on broad-spectrum antibiotics with CNS penetration e.g. ceftriaxone and aciclovir intravenously. This is particularly the case if the patient has risk factors e.g. elderly, immunocompromised
HIV and diarrhoea
Cryptosporidium + other protozoa (most common)
Cytomegalovirus
Mycobacterium avium intracellulare
Giardia
HIV enteritis
Indicator illnesses
Illnesses linked to HIV and so a HIV test should be carried out (different from AIDS defining)
Entamoeba histolytica
may cause dysentery, liver abscesses, colonic abscesses, or inflammatory masses in the colon
Giardiasis
Caused by protozoan giardia lamblia. Faeco-oral route
Risk factors;
foreign travel
swimming/drinking water from a river or lake
male-male sexual contact
Features;
often asymptomatic
lethargy, bloating, abdominal pain
flatulence
non-bloody diarrhoea
steatorrhoea
chronic diarrhoea, malabsorption and lactose intolerance can occur
Investigations;
stool microscopy for trophozoite and cysts: sensitivity of around 65%
stool antigen detection assay: greater sensitivity and faster turn-around time than conventional stool microscopy methods
PCR assays are also being developed
Treatment- metronidazole.
Gas gangrene
caused by C. perfringens
features include tender, oedematous skin with haemorrhagic blebs and bullae. Crepitus may present on palpation
HIV Medications
Nucleoside analogue reverse transcriptase inhibitors (NRTI)
examples: zidovudine (AZT), abacavir, emtricitabine, didanosine, lamivudine, stavudine, zalcitabine, tenofovir
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
examples: nevirapine, efavirenz
Protease inhibitors (PI)
examples: indinavir, nelfinavir, ritonavir, saquinavir
Integrase inhibitors
examples: raltegravir, elvitegravir, dolutegravir
Adverse effects- hypersensitivity, mood/behaviour/sleep changes, hyperlipidaemia, lipodystrophy, renal impairment, hepatic toxicity, peripheral neuropathy, bone marrow suppression and pancreatitis.
Hepatitis A vaccination
people travelling to or going to reside in areas of high or intermediate prevalence, if aged > 1 year old
people with chronic liver disease
patients with haemophilia
men who have sex with men
injecting drug users
individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates
Schistosomiasis
Acute manifestations may include:
swimmers’ itch
acute schistosomiasis syndrome (Katayama fever)
-fever
-urticaria/angioedema
-arthralgia/myalgia
-cough
-diarrhoea
-eosinophilia
Schistosoma haematobium
These worms deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation. The calcification seen on x-ray is actually calcification of the egg clusters, not the bladder itself.
Features
frequency
haematuria
bladder calcification
Investigation
for asymptomatic patients serum schistosome antibodies are generally preferred
for symptomatic patients the gold standard for diagnosis is urine or stool microscopy looking for eggs
Management
single oral dose of praziquantel
Schistosoma mansoni and Schistosoma japonicum
These worms mature in the liver and then travel through the portal system to inhabit the distal colon. Their presence in the portal system can lead to progressive hepatomegaly and splenomegaly due to portal vein congestion.
These species can also lead to complications of liver cirrhosis, variceal disease and cor pulmonale.
TB
Causes of reactivation;
immunosuppressive drugs including steroids
HIV
malnutrition
Screening;
Latent TB- Mantoux test or interferon gamma
Active TB- CXR/ sputum smear (Ziehl Nielsen stain, acid fast bacilli, all mycobacterium stain the same eg. leprosy, decreased sensitivity in HIV patients) /sputum culture (gold standard, assess sensitivities)/ NAAT
Causes of Mantoux test false negatives;
miliary TB
sarcoidosis
HIV
lymphoma
very young age (e.g. < 6 months)
Management
Rifampicin
Isoniazid (+pyridoxine)
Pyrazinamide (gout)
Ethambutol
NB- only rifampicin and isoniazid are continued for the next 4 months of 6 month treatment (they are at the start of the RIPE, so they continue)
NB- direct observed therapy may be necessary in those who are likely to have reduced medication concordance eg. homeless, drug addicts
Management of latent TB
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)
Lemierre’s syndrome
Lemierre’s syndrome is an infectious thrombophlebitis of the internal jugular vein.
It most often occurs secondary to a bacterial sore throat caused by Fusobacterium necrophorum leading to a peritonsillar abscess. A combination of spread of the infection laterally from the abscess and compression lead to thrombosis of the IJV.
Patients will present with a history of bacterial sore throat followed by neck pain, stiffness and tenderness (may be mistaken for meningitis) and systemic involvement (fevers, rigors, etc). Septic pulmonary emboli may also occur.
Chlamydia trachomatis
Can cause chlamydia, trachoma, PID, or LGV
Malaria
The most common cause of non-falciparum malaria is Plasmodium vivax
Features
general features of malaria: fever, headache, splenomegaly
Plasmodium vivax/ovale: cyclical fever every 48 hours.
Falciparum malaria is the commonest, and most severe, type of malaria.
Feature of severe malaria;
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
Complications
cerebral malaria: seizures, coma
acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown
acute respiratory distress syndrome (ARDS)
hypoglycaemia
disseminated intravascular coagulation (DIC)
Treatment
in areas which are known to be chloroquine-sensitive then WHO recommend either an artemisinin-based combination therapy (ACT) or chloroquine
in areas which are known to be chloroquine-resistant an ACT should be used
ACTs should be avoided in pregnant women
in p falciparum- if parasite count > 10% then exchange transfusion should be considered
Erysipelas
Superficial version of cellulitis
Has a very well-demarcated border
Caused by strep pyogenes
Main cause of central line infections
Staph epidermidis
Trypanosomiasis
African trypanosomiasis (sleeping sickness) and American trypanosomiasis (Chagas’ disease).
African (gambiense/rhodesiae)
Trypanosoma chancre - painless subcutaneous nodule at site of infection
intermittent fever
enlargement of posterior cervical lymph nodes
later: central nervous system involvement e.g. somnolence, headaches, mood changes, meningoencephalitis
Management
early disease: IV pentamidine or suramin
later disease or central nervous system involvement: IV melarsoprol
American (Cruzi)
The vast majority of patients (95%) are asymptomatic in the acute phase although a chagoma (an erythematous nodule at site of infection) and periorbital oedema are sometimes seen. Chronic Chagas’ disease mainly affects the heart and gastrointestinal tract
myocarditis may lead to dilated cardiomyopathy (with apical atophy) and arrhythmias
gastrointestinal features includes megaoesophagus and megacolon causing dysphagia and constipation
Management
treatment is most effective in the acute phase using azole or nitroderivatives such as benznidazole or nifurtimox
chronic disease management involves treating the complications e.g., heart failure
Inflammatory processes
Inflammation can be driven by infection or autoimmunity- can see raised WCC and CRP in things like coeliac (inflammatory, but not infective)
Hepatitis envelope antigen
HbeAg results from breakdown of core antigen from infected liver cells as is, therefore, a marker of infectivity. Marker of HBV replication and infectivity (“carrier”)
