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causes of signs > Infection > Flashcards

Infection Flashcards

1
Q

Resistance mechanisms

A

-inactivation- beta lactamase.
-target alteration- penBP mutation.
-alter metabolic paths- use pre formed folic acid.
-reduce IC AB accumulation-
Reduce permeability eg Pa lose carabepenem poring.
Increase active efflux eg tetracyclines.

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2
Q

Resistance prevention

A

-antimicrobial stewardship-
Right AB at right time.
Right dose, frequency and duration.
-infection control.

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3
Q

Sepsis signs

A

High EWS score- High temperature, Tachyc+p, Hypotension
Pallor
Bounding pulse
Specific eg stiff neck, purpuric rash.
Red flags- high RR, low BP, unresponsive.

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4
Q

Sepsis definitions

A
  • sepsis= life threatening organ dysfunction due to dysregulated host response to infection.
  • septic shock= persistent hypotension requires tx to maintain BP despite fluid resus. Imminently fatal w/o acute tx.
  • bacteraemia- bacteria in blood with or w/o clinical features. Blood culture.
  • septacaemia- generalised sepsis of blood.
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5
Q

Sepsis 6

OBIV FML

A 
Oxygen
Blood culture
IV AB
Fluid challenge 
Measure urine output
Lactate
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6
Q

Sepsis other investigations

A 
All bloods including CRP
Coagulation studies 
ABG
Samples culture 
Blood culture and PCR
CSF analysis- PCR< glucose, protein, turbidity, microscopy.
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7
Q

N meningitidis

A

Polysaccharide capsule= increase adherance, reduce phagocytosis, pills, LPS.
OM endotoxin.
Serogroup ABC UK, B most common.
25% young adults asymptomatic carriers.
Aerosol and NP secretion transmission.
C conjugated vaccine, also ACWY, and now serogroup B.

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8
Q

Sepsis pathology

A

Local cytokine release and inflammatory response.
Systemic cytokines in circulation stimulate HF, mac, pl etc.
If not controlled then overreaction= circulatory insult and sepsis. Activation humoral casacdes and RE system.
Risk DIC.
Cytokines activate thrombin and inhibit fibrinolysis so macrovascular thrombosis= organ ischaemia, dysfunction and failure.
Macrovascular injury may cause shock and multi organ fail.
Progressive necrosis.

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9
Q

Sepsis tx

A 
Specif AB
Empiric AB eg ceftriaxone for meningitis
Supportive physiological restoration 
Monitoring and re assessment 
Sepsis 6
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10
Q

Sepsis complications

A 
Irreversible hypotension
Respiratory failure
AKI
RICP
Ischaemic necrosis extremities.
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11
Q

Skin Commensals

A 
Papilloma virus, HSV
Gram pos- Sa, coagulase neg staph, corynebacterium 
Gram neg- enterobaceria 
Candida, dermatophytes
Mites
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12
Q

commensal infection mechanisms

A

Direct invasion- strep pyogenes pharyngitis
Migration- ecoli UTI
Inoculation- coagulase neg staph prosthetic
Haematogenous- viridans endocarditis

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13
Q

Heart valve infection

A

Over 1 year post op- viridans, enterobacteria faecalis, Sa, HACEK, candida.
Under 1 year- coagulase negative staph.

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14
Q

Biofilm

A 
EC polusacccharide ma
Small bacteria long t/o so AB not effective
Reduce AB diffusion 
AB neutralisation by EPS binding
Quorum sensing
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15
Q

Malaria symptoms

A 
Cyclic fever and chills 
Cough
Headache
Pain
Fatigue
Nausea
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16
Q

malaria signs

A 
Tachyc
Hypotension
Arrhythmia
Diarrhoea
High LFTs and bilirubin
AKI
CNS confusion, fits
Low WCC and RBC, DIC
Metabolic acidosis
Hypoglycaemia
17
Q

Malaria investigation

A

3 x blood smear
All bloods including coagulation
CT head
CXR

18
Q

Malaria tx

A

Falciparum- artesunate, quinine+doxycycline

Others- chloroquinine, primaquine

19
Q

HIV pathmenmonic

A

Candida albicans
Caposi sarcoma HHV8
PCP fungus

20
Q

HIV infections as CD4 decrease

A

Bacterial skin infection, HSV, VZV, fungus.
Caposi sarcoma
TB, leukoplakia
PCP, toxoplasmosis, CMV, lymphoma, MAC.

21
Q

HAART highly active anti retro viral therapy

A 
3 drugs to prevent resistance.
-nucleoside reverse transcriptase inhibitor eg tenofovir. X2. 
-nnRTI eg nevirapine. 
OR protease inhibitor eg atazanavir
OR integrate inhibitor eg raltegravir 
OR CCR5 entry inhibitor eg maraviroc
22
Q

hypersensitivity

A
  • T1 immediate- IgE mast activation. Eg allergies, asthma, anaphylaxis.
  • T2 cytotoxic- cytotoxic Abs and complement. Eg graves, MG, AI haemolytic anaemia, pernicious anaemia, goodpastures.
  • T3 immune complex- Abs, complement and leucocytes. Eg AI disease SLE, hypersensitivity, pneumonitis, RA, glomerulonephritis.
  • T4 delayed- T cells, mac, IL, cytokines. eg granuloma TB, leprosy, schistosomiasis, sarcoid, coeliac.
23
Q

Anaphylaxis

A

Systemic activation of mast cells by IgE.
Signs- hypotension, CVS collapse shock, urticaria, angiooedma, breathing restriction.
Tx- IM adrenaline= vasoconstriction, decrease oedema, stops hypotension, brocho relax, increase myocardial force, inhibits mast activation. Saves time, may need other dose.

24
Q

UTI common organism

A

Ecoli
Klebsiella pneumonia
Proteus
Pa

25
Q

CF infection

A 
H influ
Sa
Pa
Atypical mycobacteria
Candida albicans 
Aspergillus fumigatus
26
Q

COPD exacerbation infections

A

H influ
Pa
RSV

27
Q

DM infections

A

-Reduced huomoral immunity, reduced lymphocyte and leucocyte function, reduced perfusion, reduced sensation.
-so get common UTI, ENT infection, skin/ST infection.
-egs
Pa otitis externa
Mould causing rhinocerebral mucormycosis- sinus colonisation and invasion. Hyphi.
Neurogenic bladder due to neuropathy= defective emptying. Risk ecoli and Pa bacteruria, pyuria, cystitis, UUTI.
Foot ulcer and necrotising fasciitis- Sa, GBS, enterobacteria, various anaerobes.

28
Q

Signs of immunodeficiency

SPUR

A

Severe
Persistent
Unusual
Recurrent

29
Q

Immunodeficiency age of symptom onset and type of infection

A
  • under 6 month- T cell of phagocyte defect. Eg SCID (combined B and T).
  • 6 month to 5 yr- B cell, Ab, or phagocyte defect. Eg x linked Brutons. Chronic granulomatous disease aspergillus.
  • over 5yr- B cell, Ab, complement defect or secondary immunodeficiency (malnutrition, infection, liver disease, lymphoproliferative disease, splenectomy). Eg CVID.
  • virus and fungi- T cells deficiency
  • bacteria and fungi- B or granulocyte deficiency.
30
Q

Immunodeficiency tx

A 
Prophylaxis
Immunisation, avoid live attenuated 
Nutrition
IV or SC Ig
haematopoietic SC therapy sometimes 
Tx comorbidities- CA, organ damage.
31
Q

Spleen

A

Immune function
-bloodbourbe pathogen, especially encapsulated bacteria.
-Ab production- acute IgM, LT IgG.
-splenic mac- remove opsonised microbes, remove immune complexes.
Asplenic suceptible to encapsulated eg H influ, S pneum, N meningitidis.
Tx- pen prophylaxis for life, immunisation against encapsulated, alert band.

causes of signs (13 decks)

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