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Infectious Diseases > Immunosupression/Other infectious diseases > Flashcards

Immunosupression/Other infectious diseases Flashcards

1
Q

How do you diagnose malaria?

A

Serial blood films

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2
Q

What is malaria?

A

A plasmodium protazoa taht is injected by female mosquitos and multiplies in red blood cells causing haemolysis, seuestrian and cytokine release. People present with fever, sweating and impaired GCS

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3
Q

How do you treat malaria?

A

Chloroquinine (don’t use if they have been taking this for prophylaxis)

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4
Q

What is the advice on malaria prophylaxis?

A

Malarone or mefloquine taken before, during and after trip

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5
Q

What are the main side effects on chloroquinine?

A

Headach, psychosis

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6
Q

How do diagnose someone whose chest X ray suggests TB?

A

Sputum samples for MC + S and acid fast bacilli

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7
Q

What is the histology of TB lesions like?

A

Causeating granulomas

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8
Q

What does a positive mantoux test mean?

A

Immunity, previous exposure of BCG

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9
Q

What conditions might you get a false negative on the mantoux test?

A

Immunosupressive states such as lymphoma, AIDs, Sarcoid, miliary TB

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10
Q

What does a very strongly positive mantoux test mean?

A

Active infection with TB

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11
Q

What tests do you need to do before you start treatment for someone with confirmed TB?

A

FBC
Renal function
Liver function
Colour vision and visual acuity (ethambutol can cause irreversible occular toxicity)

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12
Q

What is the treatment for TB?

A

Rifampicin
Isoniazid
Pyrizinamide
Ethambutol

All 4 for 2 months and then rifampicin and isonizid for a further two months

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13
Q

What are the main side effects of rifampicin?

A

hepatitis (small rise in AST is ok but stop if the bilirubin increases by too much) Orange discolouration of body fluids

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14
Q

What is the interaction between rifampicin and the cotraceptive pill?

A

Rifampicin is a potent enzyme inducer so inactivites the pill

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15
Q

What are the main side effects of isonizad?

A

Hepatitis, neuropathy, agranulocytosis

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16
Q

What are the main side effects of ethambutol?

A

Optic neuritis (colour vision is the first to go)

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17
Q

What are the main side effects of pyrazinamide?

A

Hepatitis, arthralgia

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18
Q

What is the test for genital herpes?

A

PCR

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19
Q

What is the treatment for genital herpes?

A

Aciclovir oral

Analgesia

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20
Q

How do you diagnose suspected herpes simplex encephalitis?

A

Urgent PCR on CSF

21
Q

how do you treat herpes simplex enchephalitis?

A

IV Aciclovir

22
Q

What is the incubation period of varicella zoster?

A

11 - 21 days

23
Q

When are you infectious with a varicella zoster infection?

A

4 days before the rash until all lesions have scabbed over

24
Q

What treatment do you give for the pain associated with shingles?

A

paracetamol and aciclovir

25
Q

What does the blood film of glandular fever show?

A

Lymphocytosis

atypical lymphocytes with large and irregular nuclei

26
Q

How do you diagnose EBV?

A

FBC (20% or more atypical lymphocytes)

Monospot test

27
Q

When do you do a monospot test for EBV?

A

2 - 5 weeks after the onset of glandular fever

28
Q

What is the monospot test?

A

Horse red blood cells agglutinate in the presence of hetrophile antibodies - most adults with EBV will have developed these after 2 - 5 weekjs of having the infection

29
Q

When would you do EBV specific antibodies?

A

immunocmprised

monospot negative but strong suspicion

30
Q

What is toxoplasmosis?

A

A protazoal infection spread through undercooked food or water infected with oocytes from infected cats. Infection in humans is life long and asymptomatic but if a patient becomes immunosupressed active infection can occur.

31
Q

What are the symptoms of toxoplasmosis?

A
  1. Chorioretinitis
    - Results from congenital infection that does not become apparant until reactivation
  2. Encephalitis or focal neurological defect
32
Q

What are the risk factors for getting toxoplasmosis?

A 
Immunosupression
Exposure during pregnancy 
High risk areas (central and south america)
Raw meat 
xposire to cat faeces
33
Q

What investigations do you do in someone who you think has toxoplasmosis?

A 
1. Anti toxoplasma IgG 
This indicated prior infection 
2. Anti toxoplasma IgM 
- Indicates active infection
3. CT or MRI brain for any patients with decreases consciousness or focal neurological defects
34
Q

Who gets screened for toxoplasmosis?

A
  1. Anyone with HIV

2. Heart transplant recipients (heart is the most common to see toxoplasmosis)

35
Q

How do you treat someone with HIV who has a positive IgG for toxoplasmosis?

A

Prophylaxis with trimethoprim/sulfamethoxacole (this also work as prophylaxis against PCP pneumonia). This can be discontinued if the patient is taking ART and has a CD4 count of greater than 200 for more than 3 months

36
Q

What prophylaxis do you get as a recipient of a heart transplant for toxoplasmosis?

A

If a positive donor and negative recipent
- pyrimethamine + Sulfadiazine + calcium folinate for 3 months
Lifelong - trimethoprim/sulfamethoxacole

37
Q

How do you treat active toxoplasmosis in immunocomprimised patients?

A
  1. Pyrimethamine
  2. Sulfadiazine
  3. Calcium folinate
    6 weeks
38
Q

What is cytomegalovirus?

A

A beta herpes virus that infects most people but primary infection is usually asymptomatic. It then becomes latent in host cell. Reactivation can occur in patients who are severely immunosupressed

39
Q

What are the symptoms of CMV in an immunosuppressed patient?

A 
Malaise
Fever
Diarrhoea
Nausea and vomiting 
Visual floaters and blindness
40
Q

What do you see on fundoscopy of patients with CMV?

A

Areas of infarction, haemorrhage, peri vascular sheathing and retinal opacification
(pizza pie retinopathy)

41
Q

How do you treat CMV is immunocompromised people?

A

ganciclovir IV

42
Q

What investigations do you do for CMV?

A

FBC, creatanine, LFTs
Serology using ELISA for CMV IgM
Nucleic acid testing is the most sensitive method for detecting CMV

43
Q

What is the treatment for latent TB?

A

3 months of isoniazid (with pyridoxine) and rifampicin

OR 6 months of isoniazid with pyroxidine

44
Q

What kind of vaccination is the BCG vaccine?

A

Live attenuated mycobacterium bovis. It offers limited protection against leprosy also.

45
Q

What are contraindications to the BCG vaccine?

A 
Previous BCG
Past history of tuberculosis 
HIV
Pregnancy 
Positive mantoux test
46
Q

What is the causitive organism in lyme disease?

A

Borrelia burgdorferi

47
Q

What investigation do you do if you suspect lyme disease?

A

Serology for borrelia burgdorferi

48
Q

How does lyme disease present?

A

Joint pain, facial nerve palsy, palpitations, heart block, myocarditis

49
Q

What is the treatment for lyme disease?

A

Doxycycline (amox in pregnancy) if early disease

Ceftrixone if dissemintaed

Infectious Diseases (11 decks)

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