ID: General Flashcards
Rx osteomyelitis
Vanc + Ceftriaxone
Rx Legionnaire’s
Azithromycin
RX crabs
Malathion
Gram + Rods (bacilli)
Actinomyces
Bacillus antracis
Clostridium
Corynebacterium diphtheriae
Listeria monocytogenes
Gram +ve Cocci
makes catalase: Staphylococci
does not make catalase: Streptococci
what can be rx with bendazoles
Cestodes (tapeworms): Echinococcus granulosus, Taenia solium
Nematodes (roundworms):
Strongyloides stercoralis,
Enterobius vermicularis (pinworm),
Ancylostoma duodenale, Necator americanus (hookworms),
Trichinella spiralis
Ascaris lumbricoides (giant roundworm)
What can be rx with Praziquantel
Trematodes (flukes)
Schistosoma haematobium
Paragonimus westermani
Clonorchis sinensis
prophylaxis for contacts of patients with meningococcal meningitis
Oral ciprofloxacin
2nd ln rifampicin
Meningitis Initial empirical 3 mo.- 50 years and most common bugs
Intravenous cefotaxime (or ceftriaxone)
Neisseria meningitidis, Haemophilus influenzae up to 6 y/o,
Streptococcus pneumoniae
Meningitis: empirical > 50 years
IV cefotaxime (or ceftriaxone)
+ amoxicillin (or ampicillin)
- Streptococcus pneumoniae
- Neisseria meningitidis
- Listeria monocytogenes (>60 y/o)
Meningitis: rx Meningococcal meningitis & Prophylaxis
IV benzylpenicillin/cefotaxime (or ceftriaxone)
prophylaxis : oral ciprofloxacin or rifampicin - needs to be offered to household and close contacts of patients affected with meningococcal meningitis
Meningitis: empirical < 3 months
Intravenous cefotaxime + amoxicillin (or ampicillin)
- Group B Streptococcus (most common cause in neonates)
- E. coli
- Listeria monocytogenes
rx Meningitis caused by Listeria
Intravenous amoxicillin (or ampicillin) + gentamicin
Bacterial meningitis CSF
Bacterial meningitis
Appearance: Clear, cloudy, or purulent
Opening pressure: Usually elevated (>25 cmCSF)
WBC count: >100 cells/µL; >90% PMN
Glucose level: Low (< 40% of serum glucose)
Protein level: Elevated (>50 mg/dL)
Additional tests: CSF Gram stain and cultures, blood cultures, CSF bacterial antigens, CSF polymerase chain reaction (PCR) for common viruses
csf Viral meningitis
Viral meningitis
Appearance: Clear
Opening pressure: Normal or elevated
WBC count: 10-1000 cells/µL
Classically lymphocytes but may be PMN early
Glucose level: >60% serum glucose (may be low in HSV infection)
Protein level: Elevated (>50 mg/dL)
CSF high lymp but low glucose
HSV
CSF low glucose
- mumps is unusual in being associated with a low glucose level in a proportion of cases.
- herpes encephalitis
raised protein levels in CSF
viral encephalitis
tuberculous, fungal and bacterial meningitis
Guillain-Barre syndrome
Froin’s syndrome*
Bloody diarrhoea
- Shigella rx Ciprofloxacin
- Salmonella (non-typhoid)rx Ciprofloxacin
- Campylobacter- RX clari
- E. coli
- Amoebiasis-metronidazole and tinidazole
Diff btwn Clostridium botulinum and Clostridium tetani
- Clostridium botulinum presents with flaccid paralysis,
whereas
Clostridium tetani presents with spastic paralysis
Rx First episode of C. Diff
1st-line therapy: oral vancomycin for 10 days
2nd-line therapy: oral fidaxomicin
3rd-line therapy: oral vancomycin +/- IV metronidazole
Rx Recurrent episode
- Within 12 weeks of symptom resolution
-After 12 weeks of symptom resolution
Within 12 weeks of symptom resolution: oral fidaxomicin
After 12 weeks of symptom resolution:
oral vancomycin OR fidaxomicin
faecal microbiota transplant- considered for pts W/ 2 or >2 episodes
Life-threatening C. difficile infection
vancomycin &IV metronidazole
specialist advice - surgery may be considered
bezlotoxumab is a monoclonal antibody which targets C. difficile toxin B
What causes?
malabsorption: diarrhoea, weight loss
large-joint arthralgia
lymphadenopathy
skin: hyperpigmentation & photosensitivity
pleurisy, pericarditis
May have neur sx
Name IX, HLA ass, Rx
Whipple’s disease is a rare multi-system disorder caused by Tropheryma whippelii infection. It is more common in those who are HLA-B27 positive and in middle-aged men.
jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules
Rx: co-trimoxazole
Screening for latent tuberculosis
Mantoux test is the main technique used to screen for latent tuberculosis. In recent years the interferon-gamma blood test
What leads to false -ve Mantoux test
False negative tests may be caused by:
miliary TB
sarcoidosis
HIV
lymphoma
very young age (e.g. < 6 months)
Missed lump
Diagnosis of active tuberculosis
- Chest x-ray
upper lobe cavitation is the classical finding of reactivated TB
bilateral hilar lymphadenopathy
1.Nucleic acid amplification tests (NAAT)
allows rapid diagnosis (within 24-48 hours)
more sensitive than smear but less sensitive than culture
-
Sputum smear- Need 3 specimens; presence of acid-fast bacilli (Ziehl-Neelsen stain); rapid & inexpensive test
-sensitivity is between 50-80% decreased in HIV to around 20-30% - Sputum culture- gold standard but can take 1-3 weeks
Rx TB
2 months RIPE + 4 Month of RI
Rx latent TB
3 months RIP
isoniazid (with pyridoxine) and rifampicin
OR
6 months of PI
isoniazid (with pyridoxine)
Rx meningeal tuberculosis
at least 12 months with the addition of steroids
What is Immune reconstitution disease
Sx, Lab & imaging get worse with initial rx
occurs typically 3-6 weeks after starting treatment
often presents with enlarging lymph nodes
What should always be prescribed with Isoniazid
isoniazid causes peripheral neuropathy, and pyridoxine (vitamin B6) is co-prescribed to help prevent this
(“I’m-so-numb-azid”).
MOA & SE Isoniazid
- MOA: inhibits mycolic acid synthesis
- peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
- hepatitis, agranulocytosis
- liver enzyme inhibitor
- drug-induced lupus
MOA & SE Pyrazinamide
Pyrazinamide
- moa: converted by pyrazinamidase into pyrazinoic acid –> inhibits fatty acid synthase (FAS)
- hyperuricaemia causing gout
- arthralgia, myalgia
- hepatitis
MOA & SE: Ethambutol
Ethambutol
- MOA : inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan
- optic neuritis: check visual acuity before & during RX
- dose needs adjusting in patients with renal impairment
MOA & SE: Rifampicin
- MOA: inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA
- potent liver enzyme inducer
- hepatitis,
orange secretions - flu-like symptoms
CSF in TB
Slight cloudy, fibrin web
Glucose: Low (< 1/2 plasma)
Protein High (> 1 g/l)
Live attenuated vaccines cant be given to the immocompirmised
which are they
Live attenuated vaccines
BCG
MMR
oral polio
yellow fever
oral typhoid
Gram-positive cocci
staphylococci + streptococci (including enterococci)
Gram-negative cocci
= Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis
Gram-positive rods (bacilli)
ABCD L
Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes
Abx : Inhibits cell wall formation
peptidoglycan cross-linking:
penicillins,
cephalosporins-( cephalexin, cefuroxime ceftriaxone
carbopenems (Meropenem.)
Abx : Inhibits cell wall formation peptidoglycan synthesis:
peptidoglycan synthesis: glycopeptides (e.g. vancomycin)
ABX
Inhibits protein synthesis by acting on the ribosome
50S subunit:
macrolides, chloramphenicol, clindamycin,
linezolid,
streptogrammins
ABX
Inhibits protein synthesis by acting on the ribosome
50S subunit:
aminoglycosides, tetracyclines
Abx inhibits DNA synthesis
quinolones (e.g. ciprofloxacin)
Abxs Damages DNA
metronidazole
Abxs Inhibits folic acid formation
Inhibits folic acid formation
sulphonamides
trimethoprim
abs Inhibits RNA synthesis
rifampicin
