Infection 2 Flashcards
What is the virus that causes bronchiolitis and what is the treatment?
Respiratory Syncytial Virus
1st:
- nebulised saline
2nd line:
- steroids
3rd line:
- Ribavirin
Prevention:
Palivizumab
What infection causes herpangitis? and what is it?
Hand foot and mouth disease
- coxsackivirus A16
Posterior oralpharngeal vesicular rash
with ulceration and constriction
If there is an affected joint, within 30 days of the operation. what is option 1 for management?
DAIR
- debridement
- Antibiotics
- Inplant Retained
if there is an affected joint, after 30 days of operation, what is the surgical options?
Option 2:
Joint removal
- must removal all cement as well in order to let it heal
What anti-malarial drug can cause psychosis?
Mefloquine
What is the treatment for life threatening malaria?
Artemisinin
Quinine
Doxycycline
Why does HIV have so many variable genetic codes?
It makes a lot of mistakes when replicating leading to mutations.
during the chronic phase may actually devleop CXC4 strain which allows it to target CD4 cell more readily
What are some key symptoms of <200 T cell count?
Constant: Fatigue Fever Diarrhea Lymphadenopathy
What are some AIDs defining illnesses?
Miliary TB
Pneumocystis Jiroveci
systemic
Candidiasis
Kaposi Tumours
CNS Lymphoma - EBV
What tests should be done when HIV is suspected?
HIV antibody test - for diagnosis
HIV PCR
CD4 count - monitoring progress
What is the most important risk factor in the immunocompromised patient towards developing infection?
Neutropenia
Neutrophils are essential for promoting the next stage of attack
Whats the most common pathogens in neutropenic febrile cancer patients?
Although the cause of the fever is rarely actually infection, a neutropenic patient must be treated as infected until proven otherwise.
common infections are:
- coagulase neg Staph
- Staph Aureus
E.Coli
Candida infection
How is Sepsis scored?
National Early Warning Score - NEWS
- temperature
- blood pressure
- respiratory
- oxygen stats
- oxygen supplementation
- AVPU - alertness, voice, pain, unresponsive
higher the score the worse.
If a patient is neutropenic and febrile what should the management be, including antibiotic use:
Patient must be assessed within 15 minutes.
Identify is patient is septic and source point of infection.
definition of shock in neutropenics is:
- Neutropenic + Fever/ hypothermia
(+/- SIRS or Septic shock)
*Sepsis 6
Antibiotics:
NEWS<5:
- Tazocin
NEWS>6
- Tazocin
+
-Gentamicin
How quickly must a neutropenic febrile patient be assessed?
within 15 minutes
Commencing Sepsis 6 within 1 hour
In the management of a febrile neutropenic patient, what are the alternative drug routines in empirical management, with explanations.
If penicillin allergic: change to vancomycin + ciprofloxacin
If evidence of skin infection add Vancomycin
If Atypical pneumonia is suspected add Clarithromycin
If ESBL present, add meropenem
In solid organ transplant patients - name some common infections:
Donor Derived infections:
- CMV
- HSV
- HHV - 6 (EBV)
- syphilis
- TB
Infections related to surgery:
- Staph
- Pneumonia
- MRSA
1-6 months post operation: mainly opportunistic infections - Pneumocystis Jervico - toxoplasmosis - histoplasmosis - cryptococcus
> 6 months - same risk as generally immunosuppressed individuals
List the cycle of contagious spread and name some preventions that can be done.
Infectious agent
Reservoirs
- humans
- animals
Portal of exit
- sneezing
- cough
- faeces
Means of transmission
- direct
- indirect (airborne)
Portal of entry
- mouth
- open skin
- respiratory
Susceptible host
- vaccines
- isolation
- nutrients
What type of diarrhea does Enterotoxigenic E.Coli (ETEC) cause?
- what is ETEC also known as?
If treatment is needed, what is given?
Watery loose diarrhea
- usually within 12-72 hours
- within the 4-14 day period
self resolves. Hydration is needed.
if treatment:
ciprofloxacin `
In the setting of malaria, what is considered a severe infection?
what are some symptoms?
what is the treatment?
Parasitaemia >2%
- severe anaemia
- renal failure
- cerebral involvement
- DIC
treatment:
- Artmenther
- Doxycycline
- Quinine
What is the prevention medication for malaria?
Mefloquine
Doxycycline
Malarone
What the management for enteric fever?
Ceftriaxone
or
Quinolones
What the history of viral Hemorrhagic fevers?
Exposure >
Febrile of unknown source>
Hemorrhagic manifestations>
Septic Shock>
Death
Name some common pathogens of biliary sepsis:
Gram Negatives:
E.Coli
Klebsiella
Enterobacter
Gram Positives:
Enterococci
Anaerobes - C.Diff `
What drugs should be withheld in Necrotising fasciitis?
NSAIDs
What are the types of Necrotising fasciitis?
Type I - poly microbial - anaerobic involved
Type II - S. pyogenes
Type III - sea water trauma
Type IV - Fungal
How is the severity of C.Diff measured? and how does this influence treatment?
Severe Colitis - CT Scan
Pseudomembranous involvement/ Toxic megacolon
Fever
Rising Creatinine
If any of these are high, it will give a severity marker, meaning the most appropriate treatment would be:
Vancomycin
List the treatment of C.Diff:
metronidazole/ Vancomycin
Rehydration
Stopping medication that may be participating in it
- antibiotics
- PPI
Barrier treatment
- PPE
- Isolation
Reviewing of patient
Outline the main tests done for the core STIs:
Blood tests:
HIV - Antigen
Syphilis - Dark field Microscopy (from the chanre) and Antigen testing
Hep B (done for men who have sex with men)
NAAT:
- Chlamydia
- Gonorrhea
What are the risks associated with HSV?
This DNA virus is a life long virus. It can shed even when asymptomatic. It sheds about 1 every 50 days without symptoms.
Ulceration increase risk of other STI infections
Gonorrhea has multiple drug resistance properties, name some reasons for this:
What are some things that can be done to reduce resistance?
Gram negative species easily able to undergo conjugational change of plasmid - acquiring new genetic material
Inappropriately treated throughout history and especially in middle east.
- rapid NAAT testing
- Narrow spectrum prescribing
- good sexual practice
- notification to sexual partners - to avoid spread
How long can primary syphilis take to present, and what is the organism?
> 90days
Treponema Pallidum
When someone is initially treated for Treponema Pallidum, a certain reaction may occur - what is this? and what is the drug used?
The person may present with a fever and malasia following
List some important history points to take from someone presenting with diarrhea:
Food history
Travel history
Past medical history
- specifically about the bowel
History of illness in close contacts
- contagious bug?
Occupational
C.Diff Risk factors
- > 65years
- Recent hospitalisation
- Recent antibiotics
What are the C.Diff risk factors?
> 65 years
recent antibiotics
Recent hospitalisation
List the common types of gastrointestinal viruses and give a basic outline their diagnostic tests and their management:
Norovirus
sapovirus
**these are caliciviridae family
Rotavirus - <2 years old
- G1-4, G9.
- IgA antibodies - VP4,7
- Rotarix vaccine
Adenovirus - DNA
- 40 and 41
Astrovirus - RNA
Tests:
- PCR from samples
IV fluids
Anti-spasmodics
Anti- pyrexial
Analgesia
What are the strains of rotavirus and which is the most common?
Why do the infections become less severe with time?
G1-4 and G9
G1 accounts for 70% of infections
IgA production against the virus. namely the VP4 and VP7 of the virus
Only particularly strains of adenovirus causes gastrointestinal upset - which are they?
40
41
In Septic Arthritis: Outline the most common pathogens for age group:
Children:
- H. Influenza
- N. Meningitis
Young adults
- N. gonorrhea
- S. Aureus
Older adults:
- S. Aureus
- MRSA
What family does the rhinovirus belong too? What type of virus is it? and what does it cause?
Picornaviridae
ssRNA
Causes common cold
Pharyngitis is typically caused by which virus, but what other viruses may cause it?
What treatment can be given to those that are high risk?
Adenovirus
EBV
Monoclonal antibodies against the EBV.
- Palivizumab
What family does Influenza virus belong to?
Orthomyxovirus group.
3 main strains:
A
B
C
Outline the pathogenesis of influenza, name those most at risk, some diagnostic tests and treatment:
Haemagglutinin binds to sialic acid, 2-6. enters cell.
uses cellular machinery - RNA polymerase
Neuraminidase used to exit the cell - destroying it.
Sailic acid 2-6 found heavily on upper respiratory cells
those at risk:
- > 65 years
- pregnant women
- <1 month year old
*Rapid Influenza Diagnostic tests - detects influenza antigens
- Quadrivalent vaccines - children - Live
- trivalent vaccines
- live attenuated one
- non live one
What is SARS and give an example:
Coronavirus infection
Middle Eastern Respiratory Syndrome
What are the tests you should order for someone with diarrhea?
FBC
WWC
- infection
ESR
- inflammation
Stool cultures
Faecal Leukocytes
C.Diff toxins assay A and B toxins
- if reason to suspect C. Diff
In the setting of autoimmune:
- anti body testing - Anti tTG
Colposcopy
