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Year 3 > infection > Flashcards

infection Flashcards

1
Q

Define malaria

A

infection with protozoan Plasmodium usually transmitted with female Anopheles mosquito bite.

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2
Q

Life cycle of malarial parasite

A
  1. mosquito injects plasmodium (sporozoites) into bloodstream
  2. Invasion and replication of parasites in hepatocytes
  3. released into bloodstream and enter + infect RBCs to replicate (SYMPTOMS)
  4. => form Gametocytes taken up when another mosquito feeds and develops into sporozoites in mosquito gut
  5. then moves to salivary gland to be passed on to human the next bite
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3
Q

Which populations have innate immunity to malaria

A
  • sickle cell anaemia
  • GP6D deficiency
  • pyruvate kinase deficiency
  • thalassemia
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4
Q

presenting symptoms of malaria

A

symptoms are cyclical
- high fever (39+)
- headache
- flu-like symptoms (lethargy, fatigue)
- severe sweating
- shivering cold
*travel history (incubation period 1yr)

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5
Q

features of severe malaria (e.g. cerebral malaria)

A
  • impaired consciousness
  • seizures
  • altered respiration
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6
Q

examination findings of malaria

A
  • check for signs of severe malaria (impaired consiousness, seizures, altered respiration)
  • basic obs (pyrexia)
  • jaundice
  • hepatosplenomegaly
  • pallor (anaemia)
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7
Q

investigations + findings for suspected malaria

A
  1. THIN/THICK blood film
    - bloods (FBC, LFT, U&Es, ABG)
    - urinalysis (check for blood/ protein)
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8
Q

What groups are at risk of developing severe malaria?

A
  • children
  • pregnant women
  • elderly (>65)
  • immunocompromised (HIV)
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9
Q

Management for malaria

A
  • anti-malarial drugs (depending on plasmodium type)
  • monitor other contacts for malaria (NOTIFIABLE DISEASE => to public health authorities)
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10
Q

Define sepsis

A

Life threatening organ dysfunction caused by dysregulated host response to infection

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11
Q

Causes of sepsis

A

Infection => stimulates immune response =>
Vasodilation + increased capillary refill => raised bp (usually respiratory/ UTI => CXR)

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12
Q

Risk factors for sepsis

A

Immunocompromised
Diabetics
Elderly
Catheter
Open wound
IV drug user

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13
Q

How to assess for SEPSIS? + symptoms

A
  • less time to do history/ examination => treat immediately
  • A=> E approach for initial assessment of SEPSIS
  • Airway
  • Breathing- cyanosed, high RR, low O2
  • Circulation- febrile, warm/ cold peripheries, long capillary refill time
  • Disability- confused
  • Everything (fever, rashes, blood glucose, fever)

Other Symptoms:

  • high resp rate (tachypnoea)
  • low bp
  • fever
  • tachycardia (high HR)
  • malaise/lethargy
  • nausea/vomiting/ diarrhoea
  • low urine output = marker of AKI
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14
Q

How to diagnose sepsis? (Criteria)

A

QSOFA score - 2/3= SEPSIS

  1. Altered mental status (GCS<15)
  2. increased resp rate (>22)
  3. Low systolic bp (<100)

NEWS2 =/>5 = SEPSIS

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15
Q

Investigations for sepsis

A

Bedside

  • hourly urine output
  • blood glucose
  • ECG - rule out MI
  • Urinalysis - check for UTI

Bloods:

  • blood cultures
  • Venous blood gas => serum Lactate (marker of severity/ tissue hypoperfusion)
  • FBC- check for thrombocytopenia (worse prognosis)
  • U&E- check for renal dysfunction
  • LFT- high bilirubin (organ dysfunction)
  • high CRP (not specific)
  • Clotting screen- elevated PT/APTT

Imaging:

  • CXR - check for Respiratory tract infection
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16
Q

Treatment for SEPSIS (SEPSIS 6- give OAF, take LOB/ BUFALO)

A
  • inform senior
    1. Give 3
  • oxygen- >94% (vasodilation in lungs)
    -broadspectrum IV antibiotics- within hour
  • IV fluids- increase preload/stroke volume => increase O2/blood delivery to tissues
    *over oxygenation => hyp
  1. Take 3
    - blood cultures (give antibiotics before)
    - lactate (see if they need ITU)
    - urine output (measure fluid balance so not giving too much fluid)
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17
Q

Define HIV

A

infection of the human immunodeficiency virus

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18
Q

Transmission of HIV

A
  • sexual contact (heterosexual mainly)
  • blood contact (mother=>baby during intrauterine, breastfeeding), needle sharers, blood transfusions, organ transplantation.
19
Q

pathophysiology of HIV

A
  1. HIV binds to CD4+ T cells via gp120 receptors
  2. reverse transcriptase codes the viral genome => incoporates into hosts DNA
  3. HIV multiples => T cell death => depletion
20
Q

Presenting symptoms + signs of HIV

A
  1. Seroconversion (self-limiting)
    - fever
    - night sweats/ chills
    - sore throat , encephalitis, diarhhoea
    - SIGNS: lymphadenopathy, oral ulcers, rashes,
  2. early/ asymptomatic
    - quite well
    - can get lymphadenopathy/ oral thrush/ weight loss
  3. AIDS- syndrome of secondary diseases due to immunodeficiency
21
Q

Direct complications of HIV

A
  • Neurological- polyneuropathy, dementia
  • Lung- interstitial pneumonitis
  • Heart- cardiomyopathy
  • Haematology- anaemia
  • GI- anorexia
  • Eyes- cotton wool spots
22
Q

Secondary complications of HIV (from immunodeficiency)

A
  • bacterial infection (TB, pneumococcal, skin)
  • viral infection (HPV, VSZ)
  • fungal infection (canadiadis, cryptococcus)
  • protozoan (toxoplasmosis)
  • tumours (kaposi sarcoma, SCC)
23
Q

Investigations + findings for HIV

A
  • HIV test (HIV antibodies, PCR test for viral RNA, viral load, CD4 count)
  • CXR- Pneumocystic pneumonia
  • brain CT or MRI, LP - Cryptococcal meningitis
  • colonoscopy and biopsy - CMV (colitis)
  • brain CT or MRI- Toxoplasmosis
  • stool microscopy- Cryptosporidia
24
Q

Management of HIV

A

Combo of Anti-retroviral therapies (ARTs)

  1. nucleoside reverse transcriptase inhibitor (NRTIs)

+ 1 of

  • integrase inhibitor (INI)
  • non-nucleoside reverse transcriptase inhibitor (NNRTI)
  • boosted protease inhibitor (PI)
25
Q

What should be given for potential/future exposure to HIV

A

pre-exposure prophylaxis (prEP) ARTs

26
Q

Define infectious mononucelosis (glandular fever) and it’s main cause

A
  • infection mainly caused by Epstein-Barr virus
  • aka kissing disease
  • usually transmitted via saliva (kissing)/ sex
  • mild in children, severe in adults
27
Q

Presenting symptoms of infectious mononucleosis

A
  • fever
  • sore throat (pharyngitis)
  • regional lymphadenopathy (tender, non-erythematous)
  • malaise (unwell)
28
Q

Examination findings of infectious mononucleosis

A
  • pyrexia
  • regional lymphadenopathy
  • splenomegaly
  • signs of hepatitis (jaundice, hepatomegaly)- adults more likely to have
29
Q

Investigations for infectious mononucleosis

A

Bedside: Throat swab

  • positive heterophile antibodies (Paul Bunnel test)- IgM AB agglutinate red cells of other animals(non-specfic)
  • EBV antibodies (specific + sensitive)

Bloods:

  • FBC- raised WCC, Hb-anaemia
  • LFTs- raised AST,ALT (hepatitis)

Imaging

  • Abdomen Ultrasonography - detect splenomegaly
  • CT abdo - detect splenic rupture
30
Q

Management of infectious mononucleosis

A
  • hydration
  • analgesia (paracetomol/ ibuprofen -NSAID)
  • antipyretics
  • Lifestyle - stop alcohol, avoid physical contact with others (kissing, sports => splenic rupture)

For severe disease:

Upper airway obstruction => corticosteroid (prednisilone)

Thrombocytopoenia => corticosteroid/ IV imunoglobulin

31
Q

Why avoid giving antiboitics in infectious mononucelosis

A
  • can cause antibiotoic induced rash
32
Q

Complications of infectious mononucleosis

A
  • splenic rupture
  • Viral meningitis
  • thrombocytopenia - corticosteroids
  • depression
  • Guillan- Barre syndrome
  • Burkitt’s lymphoma (cancer)
33
Q

define herpes simplex virus

A

sexually transmitted disease spread by direct contact

  • HSV1(most common)
  • HSV2
34
Q

Types of herpes

A
  • oral- ulcers on nose/lips (herpes labialis) or pharyngeal/oral mucosa (gingivostomatitis)
  • genital- ulcers on external genetalia
  • ocular- inflammation of eye usually blepharoconjuctivitis
  • herpetic whitlow- infection o finger
35
Q

symptoms of genital herpes

A
  • usually asymptomatic
  • fever, malaise
  • multiple painful blisters around genetalia
  • usually burst and leave ulcers
  • urethral,vaginal discharge
36
Q

symptoms of oral herpes

A
  • fever, sore throat, lymphadenopathy
  • painful, burning, itching
  • blisters around the nose/mouth (herpes labialis)
  • blisters in pharyngeal/oral mucosa (gingivostomatitis)
37
Q

symptoms of ocular herpes

A
  • mainly asymptomatic
  • red, watery eye
  • blurred/reduced vision
  • hazy cornea
  • irregular pupils (uveitis)
38
Q

management of herpes

A

genital

  • anaesthetic
  • fluids to dilue urine
  • oral acyclovir

ocular

  • refer to opthamologist => topical anti-virals

oral

  • analgesia
  • oral acyclovir
  • avoid triggers (stress, sunlight)- suncream lip balm
39
Q

complications of herpes

A
  • worse in immunocompromised individuals
  • eczema herpetica
  • erythema multiforme (target shaped lesions)
  • herpetic whitlow
  • eye disease
  • meningitis/ encephalitis
40
Q

define varicella zoster

A
  • chicken pox is caused by infection of varicella zoster virus
  • spread by direct contact/droplet infection
  • incubation period of <3 weeks
41
Q

symptoms of varicella zoster virus

A
  • fever, malaise, fatigue
  • nausea, myalgia, headache, decreased appetitie
  • followed by small, red itchy widespread rash which start on chest/face/back
  • forms itchy blisters <5 days
42
Q

management of varicella zoster virus

A
  • paracetamol
  • topical calamine lotion (for itch)
  • chlorophenamine (anti-histamine - for itch)
  • fluids, soft clothes, short nails to avoid scratching

if severe complications/ pregnant/immunocompromised

  • oral acyclovir
43
Q

complications of varicella zoster virus

A

Children:

  • bacterial skin infection (impetigo, cellulitis, erysipeles, necrotising fasciitis)
  • neurological (Reye’s, cerebellar ataxia, encephalitis, myelitis)

Adults (more severe complications/ hospitalised)

  • hepatitis
  • encephalitis
  • pneumonia

Long term: VZV stays dormant in spinal ganglia => activated in adults as herpes zoster virus (shingles)

44
Q

differentials for chicken pox

A

Widespread Rashes

  • herpes zoster (painful unilateral blotchy rash)
  • herpes simplex
  • coxsacchie virus (hand,foot,mouth disease)
  • drug induced
  • contact dermatitis
  • measles (fever/watery eyes=> red blotchy rash first on forehead)

Other infection

  • impetigo (yellow crusting in face, contagious)
  • scabies- bite (itchy, red rash)
  • syphillis -STI (cold sores => hair loss, sore throat, rash)
  • TSS

Skin diseases

  • guttate psoriasis (small, round scaly spots)
  • erythema multiforme- allergy (symmetrical red raised lesions)
  • dermatitis herpetiformis- coeliac disease (intense,itchy,blistering rash)
  • steven johnson (rare)- allergy (fever => blistering rash => skin peels and heals)
  • henoch-schonlein purpura - IgA vasculitis

Year 3 (27 decks)

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