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MedEd > Infection 2 > Flashcards

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
Q

IE management?

A

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
Q

Viral gastroenteritis causes?

A

ROTAVIRUS, adenovirus, astrovirus and calcivirus

27
Q

Bacterial gastroenteritis causes?

A

CAMPYLOBACTER jejuni, E.COLI (O157), SALMONELLA< shigella, Vibrio cholera, listeria, yersernia enterocolitica

28
Q

Protozoal gastroeneteritis causes?

A

Entamoeba histolytica, cryptosporidium parvum, giradia lamblia

29
Q

Toxin producing things for gastroenteritis?

A

From Staphylococcus aureus, Clostridium botulinum, Clostridium perfringens,
Bacillus cereus, mushrooms, heavy metals, seafood.

30
Q

Common contaminated food?

A

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
Q

Dysentery (bloody) causes?

A 
CHESS
Campylobacter/clostridium
Haemorrhagic ECOLI
Entamoeba histolytica
Shigella
Salmonella
32
Q

Diarrhoea C.Difficile indicators?

A

Abx use, antiperistaltic drugs

33
Q

Staph aureus indicators diarrhoea?

A

Food, 1-6 hours eating, short lived

34
Q

Cholera diarrhoea indicators?

A

Rice water diarrhoea, poor sanitation, shock

35
Q

E.COli diarrhoea indicators?

A

Leafy vegetables

36
Q

Bacillus cereus diarrhoea indicators?

A

reheated rice

Can cause cerebral abscess

37
Q

Salmonella diarrhoea indicator?

A

EGGS, poultry may present with constipation and multplies in peyers patches of intestine

38
Q

Campylobacter dysentery clue?

A

Uncooked poultry

39
Q

Haemorrhagic ECOLI dysentery clue?

A

leafy vegetables.

Bloody diarrhoea followed by haemolytic uraemic synrdrome

40
Q

Entamoeba histolytica dysentery clues?

A

poor sanitation, tropical places and MSM

41
Q

Shigella dysentery clues?

A

person to person, poor sanitation and MSM

42
Q

Salmonella dysentery clues?

A

Eggs

43
Q

GE symptoms?

A

Sudden onsent nausea, vomiting, anorexia, diarrhoea (+/_- blood), abdo pain, fever and malaise

44
Q

GE Ix?

A

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
Q

GE management?

A

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
Q

Key features of hepatitis?

A

Aetiology = vral A-E, alcoholic and autoimmune

Fever, jaundice and raised ALT and AST

47
Q

WHich Viral hepatitis have stronger links to HCC?

A

B and C

48
Q

Viral hepatitis investigations?

A 
Blood : FBC, LFTs, U&E
CLotting: Prolonged PT
USS for other causes
Viral serology and PCR
Liver biopsy (useful for cirrhosis diagnosis)
49
Q

Key Hep A &E Features?

A

Faceo-oral

Hep A: Acute - travel history (water)
Asymptomatic

Hep E: Enteric, Epidemics (water), Expectant mothers E - immunocompromised

Management: supportive and avoid alcohol

50
Q

Hep B features?

A

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
Q

Hep C Features?

A

Chronic
HCC Rf

Management: Curative antiretrovirals
Sofosbuvir (NS5B inhibitor)
Ledipasvir (NS5A inhibitor)
Grazoprevir (NS3/4 protease)

52
Q

UTI definition?

A

Presence of >100,000 of colony-forming units per milimetre of urine. May be cystitis, pyelonephritis or prostatis

53
Q

UTI signs and symptoms?

A 
Cystitis: 
frequency, urgency, dysuria, 
Haematuria
Foulsmelling +/- cloudy
Suprapubic or loin pain

Pyelonephritis:
Rigors, pyrexia, nause + vomiting
Acute confusional stae -> elderly

54
Q

Aetiology of UTI?

A

E>COLI!!! (gram -ve)
Proteus mirabilis
Klebsiella
Enterococci

55
Q

UTI investigations?

A

Assess RF,
Distick urinalysis: positive nitrates +/- leukocytes
Urine MC&S
ABso USS to exclude ut obstruction or renal stones

56
Q

Management of UTI?

A

Trimethroprim or nitrofurantoin

57
Q

Malaria definition and aetiology?

A

Plasmodium protozoa
Usually incubates 1-2 weeks
Anopholes mosquito tranmission

Spp, FACIParum, Vivx/ovale, malaria

58
Q

Malaria signs and symptoms?

A

Symptoms: HEADACHE. weakness, myalgia, arthralgia, anorexia, FEVER severe cold and rigors then sweating paroxysms

Signs: pyrexia, anaemia, splenomegaly

59
Q

Malaria investigations?

A

Giemsa-stained thock and thin blood smears
Thick - parasite present
thin - species detection

FBC, Clotting, U&E, blood glucose, urinalysis

60
Q

What are yersinia, leptosiria and coxiella features?

A

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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