Infection Flashcards
Symptoms of vaginal candidiasis?
Management?
Vaginal itching or soreness
Abnormal vaginal discharge - cottage cheese appearance
Pain during sexual intercourse
Pain or discomfort when urinating
Antifungal topical cream, single dose of oral fluconazole
Oral candidiais treatment?
Complication of oral candidiasis?
Topical antifungal e.g. clotrimazole
Complications include esophageal candidiasis(dysphagia, odynophagia),
Symptoms of systemic candidiasis?
Risk factors?
Management?
Ranges from mild Fever to signs of sepsis e.g. hypotension.
Atypical findings= skin lesions and bisual changes
central venous catheters, exposure to broad-spectrum antibiotics, surgery, and immunosuppressant therapy, parenteral nutrition
Caspofungin 1st line. Amphotericin B second line
Remove central venous catheter, ophthalmological exam required
Differentiate between the types of necrotising fasciitis
Type I necrotising fasciitis is a polymicrobial infection. Occurs in diabetics, immunocompromised, vascular disease, following surgery. Fourniers gangrene = subtype in perinuem
Type II = a monomicrobial infection with Streptococcus pyogenes. Occurs in healthy people following skin injury
Necrotising fasciitis symptoms and management?
Anaesthesia or severe pain over the site of cellulitis indicates necrotising fasciitis.
Hypotension, fever
URGENT surgical debridement +/- amputation, IV antibiotics/antifungal e.g. benzylpenicillin and clindamycin
Brain abscess symptoms investigations and management
Headache, fever, focal neurological sign e.g cranial nerve palsy
Raised ICP signs - siezures, nausea, papilloedema
RF: ear infection, sinus infection, head trauma
1ST line = MRI with contrast - shows one or more ring enhancing lesions
IV vancomycin, metronidazole and Ceftriaxone
Craniotomy
If parasitic = antiparasitic
If fungal = antifungal
Mastitis symptoms and subtypes
Inflammation of breast with or without infection
ERYTHEMA
FLU LIKE SYMPTOMS
FEVER
PAIN
lactational or non-lactational mastitis which has subtypes
lactational mastitis:
- first line is continue breastfeeding, analgesia
- if no improvement in 24 hours, nipple fissure, systemically unwell, second line is oral flucloxacillin
Co-amoxiclav for non lactational mastitis
Symptoms of conjuctivitis and management
Allergic - itchy eyes, bilateral
Bacterial - pus - e.g. chlamydia trachomatis - eyelashes may eventually press into globe
Viral - Most Common - often adenovirus - sparse and watery mucous discharge,
Tender preauricular lymphadenopathy (viral>bacterial)
Allergic = topical mast cell stabilisers, antihistamines Bacterial = topical antibiotics - azithromycin opthalmic Viral = topical antihistamine
COVID-19 symptoms, investigation and management
fever, cough, dyspnoea, and loss of taste/smell
RT-PCR
Mild = home isolation Severe = enoxaparin thromboembolsim prophylaxis Critical = mechanical ventilation
Dexamethasone and tocilizumab used in the uk. Remdesivir, Ronapreve
Encephalitis symtoms, investigation and management?
rash, ALTERED MENTAL STATE (more common than in meningitis) motor or sensory deficits
Focal neurological deficit (altered behaviour and personality changes, speech or movement disorders)
Usually caused by viruses, HSV-1 most common cause
EEG shows background slowing, brain MRI>CT
CSF - will have increase in WBC and protein, low/normal glucose if it is a viral cause. elevated RBC
IV aciclovir, IV fluids
Hepes simplex virus investigations and management?
Viral culture
HSV polymerase chain reaction (PCR)
Serology gG1 and gG2
Oral acyclovir
IV if disseminated
MRSA infection presentation and management
MRSA infections can include syndromes of bacteraemia, pneumonia, endocarditis, joint infections, and skin or soft-tissue infections.
Common finding = pain at catheter site-> UTI, abcess
Blood, urine, tissue, sputum culture
Management = antibiotics
How is HIV treated?
HIV antibody testing
Bronchoalveolar lavage to diagnose PCP which occurs when CD4 count falls below 200
Antiretroviral therapy - consists of 3 drugs, 2 NRTIs and preferably an integrase inhibitor.
Other drugs include protease inhibitors, NNRTIs, entry inhibitors
Co-trimoxazole for PCP prophylaxis
Symptoms, investigations and management for C. Diff?
Complications?
New onset diarrhea, abdominal pain, leukocytosis
Stool polymerase chain reaction - looking for the toxin - positive
Treatment is to discontinue the inciting antimicrobial agent and start therapy with oral fidaxomicin or vancomycin or metronidazole.
Ileus, peritonitis, toxic megacolon = complications
Glandular Fever symptoms investigations and management
triad of fever, pharyngitis(sore throat, difficulty swallowing, petechiae may be present on soft palate), and generalised or cervical lymphadenopathy (tender, most commonly posterior chain)
Hepatosplenomagaly and hepatitis may occur
heterophile antibody test and serological test for antibodies against EBV
Throat swab to rule out strep.
Paul bunnel test - for EBV virus - not specific
Give painkillers
Avoid alcohol, contact sports, avoid amoxicillin
Malaria symptoms investigation and management?
Fevers, chills, sweats, Headache, weakness, myalgia
Anorexia, diarrhea
RF = travel history/endemic region
Giemsa-stained blood film = 1st line = ring form trophozoites or gametocytes seen
Uncomplicated disease, not pregnant = chloroquine, hydroxychloroquine
Sever disease or pregnant = artesunate,
Meningitis symptoms investigation amd management
Viral meningitis usually due to entoroviruses (coxsackieviruses, echoviruses, and polioviruses)
Headache, neck stiffness, fever, photophobia, seizures
Brudzinskis sign - patient’s hips and knees to flex when the neck is flexed.
Kernigs sign - flexing the thighs at the hip, and the knees, at 90 degree angles, and assessing whether subsequent extension of the knee is painful
Lumbar puncture/ spinal tap = 1st line
bacterial meningitis = Ceftriaxone (+amoxicillin if 60 or older or immunocompromised)..
Viral = supportive care
Bacterial meningitis w non-blanching rash or menigococcal scepticemia
IV/ IM benzylpenicillin
CSF intepretation: viral vs fungal vs bacterial meningitis
Bacterial - protein markedly increased, glucose decreased, PMNs high
Viral - glucose normal, wcc really high
Fungal -
Symptoms of meningococcal disease?
Management?
Meningism + purpuric/ petechial rash
100% oxygen + IV/IM benzylpenicillin.
Orbital and periorbital cellulitis findings investigations and management
Redness, SWELlING and painful eye
orbital cellulitis only= occular dysfunction - reduced visual acuity, proptosis, painful eye movements
RF = bacterial sinusitis, insect bite, chalazion, ear or face infection
CT sinus and orbits with contrast - mainstay for orbital cellulitis diagnosis
Opthalmological examination
IV antibiotics or oral for orbital cellulitis only
Symptoms of peritonitis?
What investigations are carried out for the different subtypes and what are the findings?
Abdominal pain, tenderness, ascites, nausea, fever,
Guarding, rebound tenderness, abdominal tenderness on examiation
SBP - common bacterial infection in patients with cirrhosis and ascites. Usually gram -ve bacteria like ecoli.
Paracentesis -> absolute neutrophil count (ANC) >250 is diagnostic. Ascitic fluid may be hazy, cloudy, bloody. First line treatment is a 3rd generation cepholosporin like cefotaxime
Tuberculous peritonitis - CT scan may show enlarged abdominal lymph nodes. Adenosine deaminase level >39 units/L is highly suggestive
Secondary peritonitis - Polymicrobial growth, increased protein and LDH with decreased glucose in ascitic fluid culture = secondary peritonitis
Signs of sepsis?
Management?
fever, tachycardia and hypotension are common
Oliguria, poor cap refill, altered mental status may also occur
Give oxygen and take blood cultures
IV fluid challenge
IV antibiotics - Anti-pseudomonal cover is important for people with suspected Neutropenic sepsis, so a first-line choice may be monotherapy with piperacillin/tazobactam
Surgical site infection symptoms and management
redness, delayed healing, fever, pain, tenderness, warmth, or swelling.
Superficial SSI
Deep SSI
Organ or space SSI
Antibiotics +/- surgery
Varicella Zoster restults in what conditions? How do you manage this?
Herpes zoster, also known as shingles, is caused by the reactivation of varicella zoster virus in already infected individuals. is characterised by a single dermatomal pain and papular rash. The pain typically precedes the rash by several days and can persist for several months after the rash resolves. Common complication is postherpetic neuralgia. Ophthalmic zoster can also occur
Chicken pox
Neonates and children 1-3 months = IV acyclovir
People at risk of moderate to severe disease (E.g. healthy patients age 13 or over) = Oral acyclovir
Children at low risk of severe disease = paracetamol, oral and topical diphenhydramine
Viral gastroenteritis symptoms and management
Diarrhea <14 days, non-bloody
Vomiting, nausea, abdominal pain
usually norovirus
Oral rehydration therapy. Iv fluids if severe
Viral hepatitis A Mode of transmission Symptoms Investigation Management
Faecal oral mode
Abrupt onset fever, abdominal pain, malaise and jaundice (can be seen in all hepatitis virus subtypes)
Hepatomegaly and clay coloured stools can occur
IgM anti-hepatitis A virus serology is the test of choice for diagnosis.
Serum transaminases and bilirubin = elevated
Supportive care. Liver transplant if worsening jaundice
Viral hepatitis b Mode of transmission Symptoms Investigation Management
Blood, sexual contact
Usually asymptomatic
VIRAL SEROLOGY - Hep B antibodies
Antiviral therapy - entecavir
Hepatitis _ cause fulminant hepatitis in pregnant women
E
Hepatitis _ only infects cells infected with Hep B
D
Key causes of bloody diarrhea can be remembered using the acronym SSYCEE
Which stands for?
Salmonella, shigella, yersinia, campylobacter, EIEC and EHEC
Name some causes of watery diarrhea
Cholera - rice water diarrhea (mostly water with flakes of mucus) - stool culture 1st line. Oral rehydration
ETEC - common cause of travellers diarrhea
Cdiff
Rotavirus - most important cause of infantile gastroenteritis - no testing needed - vaccine recommended
Norovirus
Giardia lamblia - watery foul smelling steatorrhea. stool microscopy (ova and parasite): positive for trophozoites. stool enzyme immunoassay:positive for Giardia antigen. Metronidazole treatment
Cryptosporidium - mild watery diarrhea, severe in AIDS
Breast abscess treatment?
Drainage via needle aspiration or surgical drainage
Doxycycline
How does dry gangrene present?
Necrotic/black area WELL demarcated from surrounding tissue. No signs of infection. Can auto-amputate
Ischeamic causes such as peripheral arterial disease, thrombosis eg hypercoagulable states, and vasospasm
How does wet gangrene present?
Necrotic area is POORLY demarcated from surrounding tissue.
Patients are pyrexial/septic.
Surgical debridement/amputation/ IV antibiotics
Viral Gastroenteritis
- Symptoms and risk factors
- common organisms and their classifications
Most COMMON = Norovirus
Gram negative CURVED ROD- Campylobacter(undercooked poultry, meat, unpasteurised milk)
Gram negative Bacilli - ecoli, salmonella, shigella, yersinia
Symptoms = diarrhoea (may be bloody), nausea/vomiting, abdominal pain
RFs: contaminated food/water, close contacts
