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Infection 2 Flashcards

1
Q

What is aseptic meningitis?

A

Clinical and lab evidence of meningeal inflammation but negative routine bacterial cultures. May be secondary to : enteroviruses (most common), mcyobacteria, funci, spirochetes.

Autoimmune = sarcoidosis, behcets, SLE

Malignancy e.g. lymphoma, leukaemia, metastatic carcinoma
medication = NSAIDS, trimethroprim, azathioprine

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2
Q

Causative bacteria for meningitis?

A

Strep pneumoniae, Neisseria meningtidis, Haemophilus influenzae B, viral, fungal, arasites

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3
Q

Cause of encephalitis?

A

Infectious and non-infectious causes. Viruses mainly (herpes)

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4
Q

Meningitis symptoms, investigations and management?

A

Photpphobia, neck stiffness, headache and fever.

Ix: LP for CSF

Mx: Ceftriaxone and vancomycin for antimcrobial

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5
Q

Encephalitis symptoms and investigations?

A

Altered state of consciousness, seizures, personality hange, cranial nerve palsies, speech problems and motor and sensory deficit

Ix: Blood cultures, neuroimaging (MRI), CSF analysis

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6
Q

Causes of meningitis and RFs in neonates?

A

Group B strep (extnded labour and infection in prior pregnancy)
E.COli (late neonatal infection)
Also Listeria monocytogenes

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7
Q

Causes of meningitis in kids and teenagers?

A

Gram -ve diplococci -> Neisseria meningitides

Unvaccinated -> Haemophilus influenzae

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8
Q

Causes of meningitis in adults and elderly?

A

Gram +ve cocci -> Strep pneumoniae

Elderly, cheese, unpasteurized milk, alcoholics -> Listeria monocytogenes

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9
Q

Signs of meningitis?

A

Brudzinskis sign = Neck stiffness causes knees and hips to flex when neck brought forward from supine

Kernigs SIgn = severe stiffness of hamstrings mean legs cannot be straightened when hips at 90 degrees

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10
Q

Signs of meningitis infection?

A

Fever, tachycardia, hypotension
Altered mental state
Skin rash - petechiae -> meningococcal septicaemia

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11
Q

When to avoid LP?

A

Neurological signs suggesting raised ICP
Superficial infection over LP site
Coagulopathy

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12
Q

Bacterial CSF infection?

A

Turbid appearance, very high neutrophils, Very high protein, very low glucose and positive gram stain

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13
Q

Viral CSF infection?

A

Clear/cloudy appearance, high WCC of lymphocytes, increased protein and normal glucose

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14
Q

TB or fungal CSF infection?

A

Clear/fibrin web appearance, High WCC - lymphocytes, increased protein and decreased glucose

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15
Q

What is management of non-blanching rash or meningococcal septicaemia?

A

Admit and single dose IV benzypenicillin

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16
Q

Causes of encephalitis?

A

Viral : herpes viruses
Bacterial: neisseria meningitides, TB, syphilis, listeria
Fungal: crytococcus, candida
Parasitic: toxoplasma gondii, malaria
Para-infectious: acute diseeminsated encephalomyelitis, acute haemorrhagic leukoencephalitis
Prion disease e.g. mad cow
Autoimmune: encephalomyelitis

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17
Q

Causative organisms of infective endocarditis and associated RFs?

A

1) streptococci -> abnormal valves e.g. congenita e.g, DiGeorgel, post-rheumatic, calcification, degeneration
Strep Bovis with GI malignancy
Strep viridans from dental

2) Staphylococci -> prosthetic heart valves and IV drug use

3) Enterococci
4) Other organisms (HACEK) - negative blood culture

Other RFs: tubrulent flow e.g. PDA or VSD and recent dental work

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18
Q

WHat are the HACEK organisms for IE?

A

Hameophilus, actinobacillus, cariobacterium, eikenella, kingella.

Also Coxiella, histoplasma

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19
Q

IE Symptoms and signs?

A

Fever with sweats/chills/rigors.
Malaise, arthralgia, myalgia, confusion

Sings: pyrexia, tachycardia, anaemic signs,
Clubbing, New murmur (frequency M>A>T>P)
Splenomegaly, vasclitic lesions

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20
Q

What are the IE vasculitis lesions?

A

Petechiae e.g. retina = roths spots, pharyngel and conjunctival lesiosn, janeway lesions,
Osleers nodes and splinter haemorrhages

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21
Q

IE mneumonic?

A

FROM JANE with Heart

Fever, Roth spots, Oslers nodes, Murmur, Janeway lesions, ANaemia, Nail bed haemorrhages, Emboli

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22
Q

Buzzwords for IE?

A

Prosthetic valves, dental procedures, new onset murmur, vegetation on echo, right heart and indwelling catheter

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23
Q

IE investigations?

A

Bloods : FBC (high neutrophils, normocytic anaemia), ESR and CRO, U&Es, rheumatoid factor positive

3 blood cultres, 1 hour aprt, in 24 hours

Urgent ECHO, DUKES classifcaiton and borad spectrum abx till sensitivity

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24
Q

IE complications?

A

CHF, valve incompetence, aneurysm formation, systemic embolization, renal failure and glomerulonephritis

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25
IE management?
4-6 weeks Abx Native valves: penicillin sensitive strep viridans = benzypenicillin + gentamicin. S.aureus = flucloxacillin Prosthetic: staph = fluclocaclloin/vancomycin + rifampicin + gentamicin If resistant or penicillin allergic replace with vancomycin
26
Viral gastroenteritis causes?
ROTAVIRUS, adenovirus, astrovirus and calcivirus
27
Bacterial gastroenteritis causes?
CAMPYLOBACTER jejuni, E.COLI (O157), SALMONELLA< shigella, Vibrio cholera, listeria, yersernia enterocolitica
28
Protozoal gastroeneteritis causes?
Entamoeba histolytica, cryptosporidium parvum, giradia lamblia
29
Toxin producing things for gastroenteritis?
From Staphylococcus aureus, Clostridium botulinum, Clostridium perfringens, Bacillus cereus, mushrooms, heavy metals, seafood.
30
Common contaminated food?
Improperly cooked meat (S. aureus, C. perfringens), old rice (B. cereus, S. aureus), eggs and poultry (Salmonella), milk and cheeses (Listeria, Campylobacter), canned food (botulism).
31
Dysentery (bloody) causes?
``` CHESS Campylobacter/clostridium Haemorrhagic ECOLI Entamoeba histolytica Shigella Salmonella ```
32
Diarrhoea C.Difficile indicators?
Abx use, antiperistaltic drugs
33
Staph aureus indicators diarrhoea?
Food, 1-6 hours eating, short lived
34
Cholera diarrhoea indicators?
Rice water diarrhoea, poor sanitation, shock
35
E.COli diarrhoea indicators?
Leafy vegetables
36
Bacillus cereus diarrhoea indicators?
reheated rice | Can cause cerebral abscess
37
Salmonella diarrhoea indicator?
EGGS, poultry may present with constipation and multplies in peyers patches of intestine
38
Campylobacter dysentery clue?
Uncooked poultry
39
Haemorrhagic ECOLI dysentery clue?
leafy vegetables. | Bloody diarrhoea followed by haemolytic uraemic synrdrome
40
Entamoeba histolytica dysentery clues?
poor sanitation, tropical places and MSM
41
Shigella dysentery clues?
person to person, poor sanitation and MSM
42
Salmonella dysentery clues?
Eggs
43
GE symptoms?
Sudden onsent nausea, vomiting, anorexia, diarrhoea (+/_- blood), abdo pain, fever and malaise
44
GE Ix?
Examination: mucous membranes, skin turgor, cap refill for dehydration HR/BP for shock Temp Bloods: FBC,CRP/ESR U&Es Stool MC&S: bacterial pathogens, ova cysts, parasites
45
GE management?
No systemic signs -> supportive (bed rest, fluids and electrolytes with oral rehydration solution) ``` Systemic signs(>39, visible blood, dehydrarion>2weeks) -> admit and oral fluids, Abx if organism identified. Need direct faecal smear then culture ```
46
Key features of hepatitis?
Aetiology = vral A-E, alcoholic and autoimmune | Fever, jaundice and raised ALT and AST
47
WHich Viral hepatitis have stronger links to HCC?
B and C
48
Viral hepatitis investigations?
``` Blood : FBC, LFTs, U&E CLotting: Prolonged PT USS for other causes Viral serology and PCR Liver biopsy (useful for cirrhosis diagnosis) ```
49
Key Hep A &E Features?
Faceo-oral Hep A: Acute - travel history (water) Asymptomatic Hep E: Enteric, Epidemics (water), Expectant mothers E - immunocompromised Management: supportive and avoid alcohol
50
Hep B features?
Acute infection -> nausea, anorexia, RUQ pain and jaundice Chronic = 10% Tranmission: Baby-making -> unprotected sex, MSM Blood Birthing Acute : symptom supportive Chronic: peginterferon alpha or tenofovir
51
Hep C Features?
Chronic HCC Rf Management: Curative antiretrovirals Sofosbuvir (NS5B inhibitor) Ledipasvir (NS5A inhibitor) Grazoprevir (NS3/4 protease)
52
UTI definition?
Presence of >100,000 of colony-forming units per milimetre of urine. May be cystitis, pyelonephritis or prostatis
53
UTI signs and symptoms?
``` Cystitis: frequency, urgency, dysuria, Haematuria Foulsmelling +/- cloudy Suprapubic or loin pain ``` Pyelonephritis: Rigors, pyrexia, nause + vomiting Acute confusional stae -> elderly
54
Aetiology of UTI?
E>COLI!!! (gram -ve) Proteus mirabilis Klebsiella Enterococci
55
UTI investigations?
Assess RF, Distick urinalysis: positive nitrates +/- leukocytes Urine MC&S ABso USS to exclude ut obstruction or renal stones
56
Management of UTI?
Trimethroprim or nitrofurantoin
57
Malaria definition and aetiology?
Plasmodium protozoa Usually incubates 1-2 weeks Anopholes mosquito tranmission Spp, FACIParum, Vivx/ovale, malaria
58
Malaria signs and symptoms?
Symptoms: HEADACHE. weakness, myalgia, arthralgia, anorexia, FEVER severe cold and rigors then sweating paroxysms Signs: pyrexia, anaemia, splenomegaly
59
Malaria investigations?
Giemsa-stained thock and thin blood smears Thick - parasite present thin - species detection FBC, Clotting, U&E, blood glucose, urinalysis
60
What are yersinia, leptosiria and coxiella features?
Yersinia causes plaques Leptosiria due to water with animal urine Coxiellla burnetti cauese Q fever, from cattle, sheep and goats

MedEd (32 decks)

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