Infection Flashcards

Question

Asthma fungal sensitisation

Answer 1

Aspergillus in airway causes inflammation and bronchospasm Risk factor Thunderstorm

Answer 2

Pg Low grade invasion aspergillus hyphae to airway walls Th2 reacts to antigen Middle aged immune compromised w chronic lung disease Fever malaise WL Resp symptoms inc haem Ix Cavitatory Thin walled cavity slow progress in UZ. Dry no air fluid level Serology IgG to aspergillus always raised cavitatory Azole boric Good prognosis mycetoma Fibrosing CT fibrosis with pleural thickening Necrotising CT focal lump w micronodular change *** with progression *** CT Bx gold standard IgG sometimes positive Azole NEVER GIVE PRED Pg good mycetoma Mx sx in CPA Focal UL and good FEV1/TLCO post op Otherwise Azole and then amphotericin Mortality 30% mortality in 2 years 50% in 5 y

Answer 3

CT Thin walled cavity Air crescent sign Cavity STABLE Culture aspergillus, IgG may be positive Bdg and galactomanan may be positive Risk factor TB pre existing cavity CX Haemoptysis - txa then IR then sx CPA Mx No symptoms fu 2y stable disease Azole VORICONAZOLE then second posicomazole/amphotericin vs surgery

Answer 4

Less than 3cm Asymptomatic CT nodules Bx vs resection is Ddx cancer

Answer 5

Macrophages absorb aspergillus fail to neutralise so vessel infarction due to fungul protease damage Risk factor neutropenia and pred BMT /AIDS /COPD /failure ITU /chronic gran BAL aspergillus Serology galactomanan 70% sensitive but not specific , raised IgG serology or IgE both sensitisation, sputum aspergillus or PCR CT diffuse nodules and reverse halo , pleural bases area, non specific necrosis. Balls consolidation Resp better than serology expect bdg Galactomanan worse outcome non neut Mx IV voriconazole for 6-12m then amphotericin 2nd line

Answer 6

Bronchitis CT thick walled bronchi, tree in bud Negative serology Aspergillus tracheobronchitis Ulcer and plaque Dx bronch with positive aspergillus culture Mx itra

Answer 7

Normal flora immune competent but immune suppressed spread and infiltrate lung CT Nodule Infiltrates RF ISS or central line or GI surgery or Lung or liver Tx Sample and culture Tx fluconazole 2nd line amlhotericin Candidaemia iv caspofungin

Answer 8

Fungus airborne transmission RF HIV or BMT or chemo or pred more than 26mg for 8w Other non adherence prophylaxis or candidiasis or ohl or weight loss or bacterial pneumonia or pcp or high viral load Exertional sob Cough sob chest tightness Malaise CX Ptx or Resp failure Ix bal and silver stain then use GROCOTT STAIN 100% spec and 90% sensitive OR lung bx if not improving 2nd line induced sputum and IF 90% specific or bc 98% sensitive but Bx risk Cxr can be normal CT infiltrates w proximal cysts / pneumatoceles and spare cpa CX Ptx and Resp failure Mx Iv Sept rain 120mg per kg then reduce after 3d for total 21 days Pao2 less than 9.3 or Sats less than 93% then pred 40mg BD for 5 days — then OD for 5 days then 20mg for 10d Early HAART 2nd line clinda w primaquine OR pentamidine G6PD def then pentamidine OR atorvaquone Prophylaxis septrin or dapsone Cd4 less than 200 Long term iss Prognosis 90% survival Early cpap good Inv avoid

Answer 9

Bird droppings then inhale encapsulated yeasts propagate in alveoli Cough Pleuritic chest pain Fever Meningitis CT Nodule GGI or Consolidation or cavity Diffuse infiltrates in immunosuppressed LAN Pleural inflammation with effusion or Ptx Bronch Also LP Diagnosis fluid bronch/ pleural GIEMSA stain or LP India ink stain Serology CRAG 100% sensitivity or 98% specific Mx Iv amphotericin Second line flucytosine —> step down to fluconazole Isolated Resp with no hypoxia and CSF negative Then fluconazole 400mg OD for 10w Mild itra

Answer 10

Endemic mycosis Bat or bird droppings inhaled to lymphatics cause granuloma OHIO Asymptomatic Resp symptoms Arthritis CX rash systemic endocarditis meningitis CT Infiltrates UL nodules LAN Cavitatory disease Bronchiolitis Mediastinal fibrosis Dx bmb or culture or histology Antibody false negative Mx itraconazole Iv amphotericin severe

Answer 11

Inhaled spores from soil Mississippi Lrti Severe ARDS B symptoms Disseminated disease in skin bone cm Dx bal with minimal lidocaine PCR fast but false negative Sputum mcs weeks CT consolidation or diffuse nodular Mx Itraconazole Severe amphotericin

Answer 12

Resp sx Raised Eo CT consolidation cavity pleural Mx fluconazole Severe amphotericin

Answer 13

Side effect Drug interaction Long qtc Deranged lft NV Peripheral neuropathy Pulmonary oedema Adrenal insufficiency Alooecia Checks Drug interaction Lft and ecg baseline then 2w then 3m

Answer 14

Homeless poverty overcrowding Etoh ivdu Born endemic Low bmi Biomass exposure Tb Hx or exposure Silicosis or fibrocavitatory disease HIV or aids DM /CKD /Ca /steroids/ tnfa blocker/ISS

Answer 15

Airborne droplets inhaled then mtb taken up mc Via lymph to LN cell mediated IR ghon focus then granuloma limits spread 90% IC so rids or contain latent 10% mostly ISS active infection Ix PCR MTB species and if rif mutation 2 h Smear days positive more infectious Culture 6 weeks less infectious Other samples no formalin Pleural and ascetic fluid ADA Mantoux and igra latent

Answer 16

Resp inc Haemoptysis CX Bronchiectasis pleural cavity pneumothorax LN enlargement LAN Clubbing CNS SOL meningitis Pericarditis or effusion Spinal disease Potts Epidydimitis or orchitis Military

Answer 17

Aim Take sample Then tx 4ab Sensitive TB RHZE for 2m then RH for 4m CNS 12m so 4 for 2m then RI for 10m Spinal TB for 6m LP low glucose/ high protein and lymphocytes/ high pressure Steroids CNS and pericarditis

Answer 18

No clinical signs Cxr clear Test indication new UK no BCG or healthcare worker no BCG Positive Mantoux more than 5mm IGRA more than 0.35 Testing sensitisation Which one High risk and contact positive then Mantoux if negative ok if positive IGRA Treat pts IGRA Screen contacts cxr and IGRA Caveats BCG - FP affects Mantoux more than IGRA Mantoux read 3d or positive valid FP BCG or NTM or incorrect FN steroid or sarcoid or iss IGRA is cytokine released TC when exposed MTB - stays positive after tb treatment FP BCG or NTM False positive prednisolone Ix in HIV need IGRA Mx indication less than 65 or 35-65 no hepatotox RH 3m for less than 35 and risk hepatotox H for 6m for rif interaction risk Rif 4m

Answer 19

To prevent B6 deficiency in Isoniazid

Answer 20

2 RZE then 7RE HIV REP w levoflox for 6m Start HAART asap

Answer 21

2HRZES 1HRZE 5HRE

Answer 22

Rif and iso resistant 8 months Bdq w lzd w lfx Plus Cfz or cs Plus Injectable **All oral for 6m** 6 bdq w lfx w cfz w z w e w th w eto 5 lfx w cfz w z w e

Answer 23

Rif Bacteriocidal Inducer red urine hepatitis GI Isoniazid Bacteriocidal Hepatitis periN b6 def Peripheral neuropathy risk increased: renal failure/ etoh/ HIV/ diabetes Ethambutol Bacteriostatic ON Renal Pyrz Bacteriocidal GI hepatitis gout Streptomycin Bactericidal Ototoxic se

Answer 24

Rifater :: R ISO Pz Rifinah :: RI Voracativ :: RIFE

Answer 25

Smear positive then 2 weeks MDR negative pressure side room and isolate longer Longer Tolerance adherence No cough with improvement No IC people at home Smear grade low No extensive cavitation No laryngeal

Answer 26

Cxr FU Normal or single drug 2m MDR follow up 12m Relapse restart same

Answer 27

4% cases Not more infectious RF prev tb reduced compliance Contact MDR HIV From high prevalent area Treat 18m

Answer 28

Live attenuated M Bovis so low risk TB in humans Indication - New to uk - Previously unvaccinated - less than 16 or 16-35 from high prevalence eg SSaharan - HCP or prison or police - contacts with pulmonary and laryngeal tb who are not vaccinated and under 35 or over 35HCW 70% efficacy in children BCGosis in bladder cancer tx then iss. CT miliary nodular pattern. Micro MBOVIS so culture Mycobacteria spp.

Answer 29

RIE for 6m Less than 2 weeks tx sputum positive mums then pre delivery treat iso and skin test 6w 6 week bab6 skin test negative then BCG Breast feeding Ok all meds pyridoxine with iso + monitor iso toxicity (convulsion and neuropathy) Outcomes Dx trim 1 same 2-3 4x increase mortality

Answer 30

Liver Stop all when 5x above upper Then Restart 2x (and bili normal and symptoms resolved) one at a time. Restart ethambutol and strep 2x continue but repeat weekly Renal Pyraz and ethambutol reduce dose. Ensure pyridox with iso Drugs after dialysis HIV HAART start TB meds 2w if cd4 less than 50 otherwise 2m IRIS pred DM risk TB. SU interacts rif Skin Risk drug related lupus reaction Stop and restart lower risk drugs Ethambutol/streptomycin

Answer 31

Soil and water GP aerobic filamentous rod AFB on ZNS Lobar pneumonia cavity Rib erosion CNS brain lesion Skin abscess Pericarditis Mediastinitis SVCO Mx Septrin 6m or amik or 3rd gen cephalosporin or mero 90% cure

Answer 32

Gram positive spore forming bacillus Spores soil then skin vs Resp 4-6 days incubation Resp worse outcome cutaneous Flu like symptoms Pleural effusion haemorrhagic Cutaneous oedema with necrosis Meningitis CT Pleural effusion Mx Cipro clinda linezolid mero And antitoxin and IVIG

Answer 33

Gram positive anaerobic filamentous bacilli Clinical presentation Consolidation /sinus rib erosion /effusion Dental disease Head and neck soft tissue infection with sinus Brain abscess meningitis Vaginal discharge vs epididymitis Risk factors dental disease vs ICC vs Copd Microscopy yellow sulphur granules but not dx Difficult to culture less than 50% Mx 6m penicillin or doxy Taz mero clinda EM

Answer 34

Found in soil and water. Less virulent than MTB M fortify not pathogenic lung. Skin and bone infection Marinatum fish Risk factors Gord ISS Chronic lung disease Gord. Pectus excavatum. Kyphoscoliosis Vit d def Cough fever Weight loss Disseminated infection Dx Symptoms and CT thin walled upper lobe cavity, pleural involvement, nodules, tree in bud, cylindrical Bronchiectasis, bilateral ground glass, Mosaicism AND Sputum afb x2 or 1 bronch or tbb (granuloma and positive NTM) Treat 12 months after negative expect MAb longer Tx Lower lode MAbsc eradicate and accept risk poorer outcome Progressive Dx CI

Answer 35

Elderly male smokers Risk factor HIV Fever Night sweats Fatigue Anorexia Diarrhoea LAN HSM ulcer septicA OM pericarditis CT Upper lobe fibrocavitatory disease Mx REC +- amik or strep for 12m

Answer 36

Risk factor HIV Fever and cough CT UL fibrocavitatory disease Mx REI C

Answer 37

Risk factor Cavitatory disease eg. COPD Mx REC severe add gent or amik

Answer 38

CT Upper lobe cavitatory disease Mx RECH and if severe aminog

Answer 39

Non smoking women Risk factor CF or BE Mx 4 weeks IV amik and iv tigecycline and iv imipenem and po Clari Maintenance neb amik with Clari with clofazamine or linez or minecycline or doxy

Answer 40

Start within 4 weeks of TB Dx CD4 less than 50 then in 2w CNS TB 8w MDR TB start tx asap Mx Efavrinz w tenofivir w emtrictibine Change rif to rifabutin due to interaction protease inhx TB meningitis add steroids and taper IRIS steroid and taper Latent 6m iso and cxr on completion HIV REP w levoflox for 6m Start HAART asap

Answer 41

Sealant or fibrin glue

Answer 42

Neb colistin then proph aza Eradicate iv taz or oral cipro

Answer 43

Tick bite parasitic disease Splenomegaly Pulm oedema ARDS Ix tetras ring RBc Mx atorv and Clari or clinda and quinine

Answer 44

Anti cd20 Hypogamma Risk cap

Answer 45

Ige 500-100 Ige raised No IgG

Answer 46

Risk factor Covid Iv amphotericin

Answer 47

GN Tx Co Amox Clari or cipro or doxy

Answer 48

South east Asia Water soil mo Inhalation GN bacillus Cavity empyema nodular consolidation Tx 3m Iv cef and metro or mero or imipenim

Answer 49

Fe2+ oxidised to fe3+ Left shift o2 dissociation curve Cellular hypoxia Sob headache NV collapse Met acidosis Collapse arrhythmia seizure coma Rf dapsone sm NF lidocaine poppers Mx methylene blue

Answer 50

1.1 M new cases per year 400,000 rif must or MDR 1.25 M total deaths

Answer 51

Cxr then ct Induced sputum vs bronch if no sputum GeneXpert 45 mins mtb complex and if rif mutation. More sensitive than smear but not culture Smear stains red in 2d - sensitivity 50% Culture 6w Back pain mri spine as 25% have multi focal disease Any fluid Ada afb geneXpert Bloods Normal HIV hep bnc

Answer 52

Pre xdr ISO rif fluoroquine resistant XDR MDR definition MDR plus resistance to fluroquinolones Rif iso fluoroquine linez and bedequilline

Answer 53

Agammaglobunaemia X linked AR No IgM or IgG or IgA or B cells Recurrent severe bacterial infection CVID get pcp MHominis MAI adenovirus. IgG / IgA / Bcell /T cell Bacterial infection w autoIS w malignancy IgA deficiency less than 7mg per dl Atopy autoimmune GIT defect Innate neutrophils and macrophages Steroid organtx AML BMT neutropenia Mtb aspergillus nocardia viraemia B cell or low ig Complement def or CVID or ritux or myeloma or splenectomy Bacterial or Resp or bre T cell Solid organ tx or T cell lymphoma or chemo or HIV PJP or cryptococcus or mtb or toxo or viraemia Ix Bloods Viral screen and fungal markers and parasite and endemic mycosis Crag HIV Blood culture inc mtb Urine atypical Throat swab Sputum mcs afb fungal BAL CT

Answer 54

MTB or HIB Nodules tree in bud TB or CPA or bacterial Cavity Aspergillus or mtb or nocardia Larger nodule PJP or viral or atypical bacterial GGO

Answer 55

Lung cancer 2x Copd 50% Primary PH Smoking related lung disease faster decline lung function

Answer 56

Paradoxical deterioration after starting HAART Days to weeks Lower cd4 higher risk Mx supportive and pred reduces morbidity

Answer 57

HiB Moraxiella M catarrhalis

Answer 58

Post parasite ascaris strongyloides or schisto Af or Asia or central South America Ix Eo blood normal Peri hilar infiltrates resolve after a month Bal more than 25% Eo and hyphae Mx Azoles Severe pred Pg resolve

Answer 59

T cell depletion AIDS lymphoma steroid Histo Coccidio Blasto Mucomycosis IC Black lesions mouth Fever sob cough chest pain Consolidation cavity nodule Tx amphotericin Paracoce S America Fever and HSM Cytopenia Diffuse nodules Culture sputum or BAL Itra and severe amphotericin

Answer 60

AR Defect phagocyte function Bacterial and fungal infection eg aspergillus

Answer 61

Community strep Hx proteus and staph aureus

Answer 62

Baby staph and HiB Teenage pseud Adult burkholdeira and strenotroph

Answer 63

Echinoccocus commonest parasite in lung Dogs and sheep vectors Cough Haemoptysis fever HM Cxr notch sign CT cyst that calcify, pleural and pericardial cyst Mx Azole

Answer 64

Post oropharyngeal infection to bacteraemia IJV thrombus Lung abscess To brain joints and liver also Fuscibacterium Staph Strep Anaerobes Tx betalactamase res Abx eg mero or taz

Answer 65

LN or cerebral disease Less than 6w start HAART Ddx Treatment fail Drug resistance Malabsorption

Answer 66

Hx non adherence Previous TB**** Hx homeless ivdu etoh Prison Psych or memory issues Denial re TB Too ill Pt request PHA section 37 and 38

Answer 67

Less than 30d DAH or engrafment ( in a week, fever rash ARDS mods, mx steroids) Bacterial ecoli strep pseud (GP or GN); candida or aspergillus or hsv or viral 30-100d Cellular immunity GvHD Staph strep asperg candida PCP CMV or IA Over 100d Humoral immunity BO in chronic GVHD or PTLD or COP Encapsulated bacteria aspergillus CMV or nocardia Other Cop Pulmonary VO disease cause G1 PAH. Ct pulmonary oedema

Answer 68

Severe staph aureus pneumonia Cavitation Mx Rif linez or clinda

Answer 69

Fever 1d Hr over 100 Rr over 24 Bp less than 90 Sats less than 90

Answer 70

Cipro tendon rupture and long qt Doxy bone deposition baby

Answer 71

High rates on unit Prior Abx Recent prolonged Hx more than 5d Colonisation pathogen

Answer 72

1000 Bal 10.000

Answer 73

Fever dry cough Tender ulcer Regional lan Rural farmer or hunter Gram negative Cipro strep gent

Answer 74

Prone up to 28w Toci if crp over 75 Remdez only if worsening Pred 40mg if not preterm if preterm dex 12mg in 24h then pred

Answer 75

Aspergillosis most common Tracheobronchitis disease bronch ulcer Prophylaxis inhaled amphotericin or oral vori Risk factors Induction alemtuzumab Single lung CMV Hypogamma Rejection use mAB GvHD Neutropenia more than 2w

Answer 76

Photosensitisation Can become cancerous

Answer 77

OM sinusitis pneumonia Strep HiB Mycoplasma pseud staph MCatarrhalis Mycoplasma susceptible due to ureaplasma urealyticum

Answer 78

Low Karnofsky Cancer

Answer 79

Allogrnic due to prolonged iss Esp ritux and purine analogue impair BT Commonest virus RSV higher mortality

Answer 80

Higher autologous 96 hours Rash fever pulm infiltrates liver dysfunction aki encephalopathy Steroids Good prognosis

Answer 81

Equal auto and allo Early Bloodier bal from sub segments Haemosiderin laden macrophages No infection Moderate response steroids MOF and death

Answer 82

Allogenic 1 year Wheeze cough sob Ct hyper inflated /air trapping / Mosaicism Obstructive Normal TLCO Bal no infection. Hx fibrotic plugs obliterate bronchoceles with if and scar Steroids and iss Poor pg - older or non related or total body irradiation or over 12Gy or acute GvHD

Answer 83

Rare Proliferation EBV infected lymphocytes 6m later LAN HSM Anti B cell mAB

Answer 84

REI for 2 months Rifampicin and ISO for 7m

Answer 85

HIV Younger than 5 Alcohol excess ivdu Tx haem ca chemo Dm CKD silicosis Anti tnf drugs

Answer 86

Gcs 15 without focal then 20mg pred Gcs 11-14 or 15 with focal neurology then 30mg pred Gcs less than 11 with or without focal neurology 4 weeks IV steroids

Answer 87

60mg pred weaning over 2-3 weeks

Answer 88

2 months REI 7 months RI

Answer 89

2 months RIP 7 months RI

Answer 90

Gene rPoB Bedaquiline Levoflox Linezolid

Answer 91

Flight Less than 3 months on flights over 8h Teacher Class in the last 3m

Answer 92

3.5 x increase risk TB All need cxr and IGRA IGRA less sensitive in those taking pred and aza Chemoprophylaxis Treat 2 months prior to starting

Answer 93

Live attenuated BCG immunotherapy for superficial bladder cancer Breaks in epithelium risk of infection High fever and sepsis Mx RI

Answer 94

Rif Pyrazinamide Ethambutol Levoflox in

Answer 95

Mostly strep and HiB S aureus increasing Low cd4 pseud Hospital gram negative

Answer 96

KOH sputum GROCOTT gomori

Answer 97

No increased risk of developing but more severe Oseltamivir or alternative zanamivir IV if flu in less than 48hrs Also Co Amox and Clari for 7d OR doxy Prophylaxis indication cd4 less than 200/ no vaccination and exposed less than 48h

Answer 98

Klebsiella Staph aureus Legionella TB or NTM Nocardia Actinomycosis

Answer 99

Etoh strep or GN or legionella Copd HiB or catarrhalis DM strep Elderly strep or mycoplasma or legionella

Answer 100

Stop if FEV1 drops 10%

Answer 101

Ur antigen Sputum culture gold standard

Answer 102

Tropical fish

Answer 103

Cavitation lung disease Ddx TB

Answer 104

Rif Etham Azith Daily

Answer 105

20-30 Idiopathic 30% AR or AD Recurrent bacterial infection chest OM and BE GI inflammation Low plt Low IgA IgG IgM Lack ab response vaccines Path disorder B cell differentiation Risk Gastric ca lymphoma skincancer Bronchiectasis/ OP / ILD LIP Thymoma

Answer 106

Calcified LN and nodule In TB

Answer 107

Peribronchial consolidation Nodules GGO Septal thickening

Answer 108

Unvaccinated Mantoux negative under 35 if - vet prison school hospital care home asylum

Answer 109

Pentamidine alt days

Answer 110

Beclometasone reduced interaction ritonivir

Answer 111

Legionella w clear cxr Just fever Ur ag for ser 1 80% sensitive and 95% spec No Abx needed

Answer 112

Generic GI lft qtc interact Itra heart failure neuropathy adrenal insufficiency Vori rash

Answer 113

Less than 3m Over 8hrs Pt MDR or coughed

Answer 114

Up Abx within 4h Cxr 6w except less than 50 and never smoker Moderate above have full ss inc atypical Duration Low 5-7 Mod 7-10 MRsa or GN 14-21

Answer 115

Fast growing MAbsc Fortium Chlonae

Answer 116

Exposure swim garden soils Host ISS and underlying lung disease Vit D def RA GORD Low BMI Poor outcomes - more cultures positive - smear positive - species - Bronchiectasis - low bmi low alb - aspergillus coinf

Answer 117

3m sputum or bronch if unable CT start and end tx Converted 3 negative consecutive Recurrence 2 after clear Refractory never converted

Answer 118

Isolated progressive disease Started on abx and 1 year abx after