ID Flashcards
Likely organism in animal and human bites
animal: pasteurella multicida
human: strep spp, staph aureus
Mx animal/human bites
co-amox
What is campylobacter
gram -ve bacillus
Symptoms of campylobacter
headache malaise -> bloody diarrhoea abdo pain
Management and complications of campylobacter
self limitin
Clari if immunocomp/severe
-GBS, reactive arthritis, sepsis
When would you admit cellulitis for IV Abx?
Eron class 3-4
deteriorating
immunocomp
lymphoedema
facial or periorbital
At risk group with hep E
pregnant women - 20% mortality due to fulminant hepatitis
Serology of active, previous and immunised HBV
active: HBeAg, HBs Ag, Anti HBV IgM
Previous: Anti HBV IgG, HBs Ab
Imms: HBsAb
Management of HBV
pegylated interferon alpha
telbivudine, tenofovir
Imms: routine, IVDU, occupation, CLD, CKD
Management of HBV in prengnancy
90% risk of neonate developing chronic hep so given HBV vaccine and anti hep B immunoglobulins
HCV serology
HCV RNA +Ve
If >6m = chronic HCV
Management of HCV
protease inhibs
- daclatasvir+sofobuvir ±ribavirin
Types of HDV
co-infection: same time as HBV
superinfection: after HBV , associated with fulminant hep, chronic hep, cirrhosis
Diagnosis and management of HDV
PCR hepatitis D RNA
interferon
Pathophysiology HIV
binds to CD4 and GP120 glycoprotein on T cells
RNA->DNA (transcriptase)
Viral DNA into host DNA (integrase)
host cell releases virons (protease) which infect further T cells
Examples of cells with CD4 receptors
Macrophages, monocytes, T cells
How is HIV diagnosed
HIV antibody and HIV Antigen
Symptoms based on time HIV
first 12 weeks - acute phase, flu like
following this symptoms based on CD4 count
Presentation if CD4 count 200-500
-oral thrush
-shingles
-hairy leukoplakia
-Karposi sarcoma
Presentation if CD4 count 100-200
*pneumocystic jirovecii pneumonia
cerebral toxoplasmosis
multifocal lymphadenopathy
Presentation if CD4 count 50-100
aspergillosis
oesophageal candidiasis
cyrptococcal meningitis
CNS lymphoma
Presentation CD4 count <50
cytomegalovirus retintitis
mycobacterium avium complex
Compare CT findings of cerebral toxoplasmosis and CNS lymphoma
Cerebral toxoplasmosis: multiple ring enhancing lesions
CNS lymphoma: one homogeneous enhancing lesion
Management of HIV
start on diagnosis
2 NRTI + PI or NNRTI
What would pizza haemorrahage on fundoscopy indicate in HIV pt and how would you treat
cytomegalovirus CD4 count <50
IV ganciclovir
Presentation of malaria
fever
fatigue
headache
jaundice
splenomegaly
Pattern of malaria fever based on organism
vivax/ovale - 48hrs
malariae - 72hrs
falciparum - variable
Signs & treatment of severe malaria
- falciparum
schizonts on blood film
>2% parasitaemia: IV artesunate
>10% parasitaemia: plasma exchange
Treatment of non falciparum malaria
artemisinin based combination therapy (ART) or choroquine
ovale/vivax: primaquine after cholorquine to destroy liver hypnozoites and prevent relapse
Diagnosis of malaria
thin blood film: species
thick blood film: specific
Prophylaxis malaria
malarone: 1-2 days before, 7 days after
doxy: 1-2 days before, 4 weeks after
chloroquine: 1 week before, 4 weeks after
Causes of meningitis 0-3m
GpB strep, e, coli, listeria
Causes of meningitis 3m-6y
N meningitis, s pneumoniae, h influenzae
Causes of meningitis 6-60
N meningitis, s pneumonia
Causes meningitis >60
N meningits, s pneumoniae, Listeria
Cause of meningitis immunocomp
listeria
Reasons to delay LP in ?meningitis
severe sepsis, resp/cardio compromise, increased ICP
Management of meningitis
IV cef (+ amox if >50)
IV amox (listeria)
When do you give prophylaxis in meningitis
bacterial + contact within 7 days of symptoms
PO cipro or rifampicin
Diagnosis of chlamydia
NAAT
Management chlamydia
doxy 7/7
azithromycin if preg
diagnosis of genital herpes
NAAT
HSV1 HSV2
Management of genital herpes
PO aciclovir
ECS if 28/39
Management of genital warts
topical podophyllum or cyrotherapy
Organism gonorrhoea
gram -ve diplococcus
Management of gonorrhoea
IM ceftriaxone + PO cipro if sensitive
What can gonorrhoea progress to?
disseminated gonococcal infection
-tenosynovitis
-migratory polyarthritis
-dermatitis
Diagnosis of mono
Monospot test
Cause of PID
chlamydia trachomatis, n. gonorrhoea
Management PID
PO met + PO ofloxacin
or
PO met + PO doxy + IM cef
Cause of syphilis
treponema pallidum
Presentation of syphilis
Primary: chancre
Secondary: rash, fever, ulcer, genital warts
Tertiary: skin/bone lesions, aortic aneurysm, argyll-robertson pupil
Management of syphliis
IM benzathine penicillin
non-treponemal titres to monitor
Cause/Presentation/Mx of BV
gardnerella vaginalis
fishy, thin white discharge
Clue cells
PO met
Cause/presentation/Mx of trichomonas
trichomonas vaginalis
offensive green discharge
strawberry cervix
microscopy: wet mount
PO met
Cause of acute epiglottitis
h. influenzae
on XR what would thumb sign and and steeple sign indicate
thumb: acute epiglottitis
Steeple: Croup
Management of acute epiglottitis
senior support, o2 IV Abx
Management of croup
dex
Cause of croup
PIV
Dengue cause
RNA virus, aedes aegypti mosquito
Presentation of Dengue
fever
headache
myalgia
pleuritic pain
rash
Investigation and treatment of Dengue
NAAT
symptomatic
Explain the types of TB
primary: Ghon focus+hilar lymph nodes = Ghon complex
Secondary: reactivation due to immunosuppression (steroids, HIV, malnutrition)
Site of TB
Usually lung apex
CNS
Vertebral bodies
TB symptoms
Primary: fever, pleuritic pain
Secondary: cough, weight loss, fatigue, night sweats
TB diagnosis
Latent: Mantoux test
Active: CXR, sputum smear, sputum culture, NAAT
TB management
active
2/12: RIPE
4/12: RI
Latent
3/12: RI
or 6/12 I
