ID III Flashcards
What is Lyme disease caused by
Lyme disease is caused by the spirochaete Borrelia burgdorferi and is spread by ticks
Early features of Lyme disease
Erythema migraines
Systemic features - headaches, lethargy, fever, arthralgia
Features of erythema migrans
‘bulls-eye’ rash is typically at the site of the tick bite
typically develops 1-4 weeks after the initial bite but may present sooner
usually painless, more than 5 cm in diameter and slowlly increases in size
Late features of Lyme disease
cardiovascular
heart block
peri/myocarditis
neurological
facial nerve palsy
radicular pain
meningitis
Diagnosis of Lyme disease
Clinical if erythema migraines is present
Enzyme-linked immunoabsorbent assay(ELISA) antibodies to borrelia burgodorferi are - first line
Mx of asymptomatic tick bites
if the tick is still present, the best way to remove it is using fine-tipped tweezers, grasping the tick as close to the skin as possible and pulling upwards firmly. The area should be washed following.
NICE guidance does not recommend routine antibiotic treatment to patients who’ve suffered a tick bite
Mx of suspected/confirmed Lyme disease
Doxycycline if early disease - amoxicillin if contraindicated
Ceftriaxone if disseminated disease
What is a Jarisch-herxheimer reaction
Jarisch-Herxheimer reaction is sometimes seen after initiating therapy: fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)
What type of bacterium is neisseria meningitidis
gram neg diplococcus
Most common causes of bacterial meningitis in adults and children
Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus).
Most common cause of bacterial meningitis in neonates
Group B strep (GBS)
Tests to look for meningeal irritation in infants
Kernigs Test
Brudzinski’s Test
Mx of bacterial meningitis in community
IM or IV benzylpenicillin
Mx of bacterial meningitis in hospital
LP prior to antibiotics unless acutely unwell
Meningococcal PCR
What can be added to management of bacterial meningitis
Steroids - dexamethasone to reduce the frequency and severity of hearing loss and neurological damage
Post exposure prophylaxis for bacterial meningitis
Most likely within first 7 days
Ciprofloxacin
Most common causes of viral meningitis
HSV
Enterovirus
VZV
Mx of viral meningitis
Supportive
Aciclovir can be used to treat suspected or confirmed HSV meningitis.
CSF - bacterial meningitis
Cloudy
High protein
Low glucose
Neutrophils
CSF - viral meningitis
Clear
Mildly raised/normal protein
Normal glucose
Lymphocytes
Complications of meningitis
Hearing loss Seizures/epilepsy Cognitive impairment Memory loss Focal neurological deficits
CSF - TB
Slightly cloudy
Low glucose(1/2 plasma)
High protein
Lymphocytes
CSF - Fungal
Cloudy
Low glucose
High protein
Lymphocytes
Most common cause of meningitis in >60 years
Strep pneumoniae
Most common cause of meningitis in immunocompromised people
Listeria monocytogenes
Causes of short-lived gastroenteritis(1-2 days)
Toxin-mediated - bacillus cereus, norovirus
Causes of medium duration gastroenteritis
Salmonella
Shigella
E coli
Rotavirus
Causes of longer duration gastroenteritis
Giardiasis
Campylobacter
C. diff
4 C’s of measles
Cough
Coryza
Conjunctivitis
Koplik spots
Risk factors for candidemia
Surgery Immunosuppressants(steroids) Central line TPN Broad spectrum abs
Causes of typhoid and paratyphoid fever
Salmonella typhi and Salmonella paratyphi (types A, B & C) respectively
How is typhoid transmitted
Faecal-oral route
Contaminated food and water
Features of enteric fever
Initial systemic upset Relative bradycardia Abdominal pain/distension Constipation Rose spots(trunk)
Complications of enteric fever
Osteomyelitis
GI bleed/perf
Meningitis
Cholecystitis
What is cellulitis typically due to
infection by Streptococcus pyogenes or Staphylcoccus aureus.
Features of cellulitis
commonly occurs on the shins
erythema, pain, swelling
there may be some associated systemic upset such as fever
Classification for how to manage cellulitis
Eron classification
When should patients be admitted for IV abx in cellulitis
Eron class III or IV
Severe or rapidly deteriorating
Immunocompromised
What is iron class III/IV
Significant systemic upset
Sepsis/severe life-threatening infection such as necrotising fasciitis
1st line antibiotic for cellulitis
flucloxacillin as first-line treatment for mild/moderate cellulitis.
severe cellulitis should be offered co-amoxiclav, cefuroxime, clindamycin or ceftriaxone.
