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Conditions + definitions > Infection > Flashcards

Infection Flashcards

1
Q

What is gastro enteritis?

A

3+ loose stools/day

With accompanying features

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2
Q

What causes gastroenteritis?

A

Contamination of foodstuffs (eg chicken)
Poor storage (allowing proliferation of bacteria)
Travel related infections
Person-person spread - norovirus

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3
Q

What bacteria is the most common foodborne pathogen?

A

Campylobacter

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4
Q

Which bacteria causes the most hospital admissions for food poisoning?

A

Salmonella

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5
Q

Types od diarrheal illness

A

Non-inflammatory/secretory (cholera)
Inflammatory - shingella
Mixed (c.diff)

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6
Q

Describe secretory/non-inflammatory diarrhoea

A

Secretory toxin-mediated
I.E - cholera raises cAMP levels + cl secretion

Frequent watery stools - little abdominal pain
Rehydration for therapy

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7
Q

Describe inflammatory diarrhoea

A

Toxin damage causes inflammation + mucosal destruction
Causes pain + fever
Bacterial infection
Often rehydration sufficient. Sometimes antimicrobials

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8
Q

How long does gastroenteritis last?

A

Normally less than 2 weeks

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9
Q

Investigations into gastroenteritis

A 
Stool culture
Blood culture
Renal function (dehydration)
Blood count
Abdominal xray if distended abdomen
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10
Q

What are the differentials of gastroenteritis?

A

inflammatory bowel disease
Spurious diahrroea
Carcinoma

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11
Q

Define campylobacter gastroenteritis

A

Up to 7 days incubation
Stools negative within 6 weeks
Severe abdominal pain
Very unlikely to be invasive (into blood <1%)

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12
Q

What can campylobacter gastroenteritis lead to?

A

Guillian barre syndrome

Reactive arthritis

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13
Q

Define salmonella gastroenteritis

A

Symptoms usually within 48 hours
Diahrroea lasts for less than 10 days
<5% invasive
20% still have positive stools 20 weeks later

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14
Q

Bacterial cultures - differences

A

Salmonella are lactose non-fermenters

Campylobacter needs specialised conditions

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15
Q

What are the most common salmonella strains in UK

A

Salmonella enteritidis
Salmonella typhimurium
Most are imported

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16
Q

What salmonella cause enteric fever?

A

Salmonella typhi

Salmonella paratyphi

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17
Q

Why strain of e.coli causes gastroenteritis?

A

E.coli O157

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18
Q

What is characterisitc of E.Coli O157 gastroenteritis?

A

Frequent bloody stools
Produces toxins which causes harmolytic-uraemic syndrome
E.Coli stays in blood, but toxin enters blood
Often from contminated meat or person to person spread

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19
Q

What is HUS? (haemolytic-ureamic syndrome)

A

Renal failure
Haemolytic anaemia
Thrombocytopenia
Through binding of globotriaosylceramide

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20
Q

What bacteria cause gastroenteritis outbreaks?

A

Staph A
Bacillus cereus (from refriend rice)
Clostridium perfringens

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21
Q

When are antibiotics indicated for gastroenteritis?

A 
In immunocomprimised
Severe sepsis/invasive infection
Valvular heart disease
Diabetes
Chronic illness
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22
Q

How do you treat c.diff infection?

A

Metronidazole - First line, no severity markers
Oral vancomycin - 2+ severity markers
Fidaxomaicin
Stool transplants

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23
Q

How do you prevent C.diff

A 
Avoid the 4 c antibiotics
Isolate symotomatic patients
Wash ahnds (not alcohol gel) between patients
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24
Q

What are the 4 antibiotics to avoid to prevent c.diff

A

Cephalosporins
Co-amoxiclav
Clindamycin
Clarithromycin

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25
Q

How do you request a parasite screen?

A

Parasites, cysts + ova

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26
Q

What are the common UK parasites?

A

Giardia lamblia

Cryptosporidium parvum

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27
Q

Describe Giardia lamblia

A

Found in contaminated water
Causes diarrhoea, malabsorption + failure to thrive
Cysts seen on stool micropsopy
Treat with metronidazole

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28
Q

Describe Cryptosporidium parvum

A

Found in contaminated water (animal faeces)
Cysts on micropscopy
No specific treatment required

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29
Q

What is entamoeba histolytica

A 
Parasite causing amoebic dysentery
Vegitive form in symptomatic patients - hot stools
Cysts in asymptomatic patients
May cause liver abscesses long term
Treat with metronidazole
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30
Q

What is viral diarrhoea

A

Common in winter
Often rotaviruses
Sometimes adenoviruses
Common cause of outbreaks (hospital, community, cruise ships)

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31
Q

What are noraviruses

A 
Small round structured viruses
Diagnosed through PCR
Very infectious
Infect through airbourne particles 
Need strict infection control measures
Ward closures common
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32
Q

What is SIRS?

A 
Temperature change
->38 or <36
HR > 90
RR>20 or paCO2 <32
WBCs 
- >12000 or <4000
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33
Q

What is sepsis?

A

An infection of blood along with SIRS

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34
Q

What is the mortality with septic shock?

A

40%

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35
Q

What is qSOFA?

A

Hypotension - Systolic <100mmHg
Altered mental state
Tachypnea (Resp rate >22)

Score of 2 or more indicates high risk of poor outcome

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36
Q

What is Sepsis 6?

A

Blood cultures
|-> From two-three different sites, before antibiotics start
Blood lactate
Measure urine output

Oxygen
IV antibiotics
IV fluids

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37
Q

Why is lactate important in sepsis?

A

A marker of generalised hypoperfusion/severe sepsis/poor prognosis
Type A indicated Hypoperfusion
Type B - mitochondrial toxins, alcohol, malignancy, metabolism errors

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38
Q

When should you refer a septic patient to ITU?

A

Septic shock
Multi-organ failure
Needing sedation, intubation or ventilation

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39
Q

When should you refer a septic patient to HDU?

A 
Low BP 
Lactate >2 despite resus
Elevated creatinine
Oliguria
Liver dysfunction
Bilateral infiltrates
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40
Q

What is a pyrexia of unkown origin?

A

No diagnosis after 3 outpatient visits
3 days in hospital
Or one week of outpatient investigation

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41
Q

What is a fabricated fever?

A

A real fever that is induced by patient ie inject self with foreign material (eg faeces)

Microbiology strongest clue

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42
Q

What is the difference between colonisation and infection?

A

Colonisation is presence on surfaces open to environment

Infection is presence inside the body that causes damage to body/tissues

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43
Q

Which bactera are spread through direct contact?

A

Staph A

Coliforms

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44
Q

Which bactera are spread through respiratory/droplets?

A

Neisseria meningitidis

Mycobacteria tuberculosis

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45
Q

Which bactera are spread through faecal oral?

A

Clostridium difficile

Salmonella

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46
Q

Which bactera are spread through Penetrating injury?

A

Group A streptococcus

Blood bourne viruses

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47
Q

What are the modes of HIV infection?

A

Sexual - mostly MSM in this country
Injecting drug users
Blood products
Organ transplant

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48
Q

What is the virology of HIV?

A

A type of retrovirus (lentivirus) that attaches to cells with CD4 on surface (lymphocytes) and other chemokine receptors
Uses reverse transcriptase to replicate
Uses integrase to integrate into host cell DNA

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49
Q

What is the main strain of HIV?

A

HIV-1 group M

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50
Q

What does an HIV infection do to the CD4 count?

A

Decreases it

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51
Q

What is the CD4 level for AIDS diagnostics?

A

Below 200

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52
Q

What are the most common (new) opportunistic infections in HIV?

A

Pneumocytis jiroveci pneumoia
Candidiasis
Mycobacterium avium complex
Cryptosporidious

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53
Q

What are the most common reactivation opportunistic infections in HIV?

A

Cerebral toxoplasmosis
TB
CMV disease

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54
Q

What is the natural history of HIV?

A 
Acute infection (seroconversion)
Asymptomatic
HIV related illness
AIDS-defining illness
Death
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55
Q

What is a seroconversion illness?

A

When HIV antibodies first develop
Has abrupt onset 2-4 weeks post exposure
Self limiting - lasts 1-2 weeks

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56
Q

What are the symptoms for seroconversion illness

A 
Flu-like illness
Fever 
Malaise/lethargy
Pharyngitis
Lympjadenopathy
Toxic exanthema

Looks like glandular fever but EBV not in keeping

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57
Q

How do you determine length of HIV infection?

A

If seroconversion illness, date of that
Else stored blood
Else most at risk

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58
Q

What are the respiratory AIDS-defining conditions?

A

TB

Pneumocystisis

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59
Q

What are neurology AIDS-defining conditions?

A

Cerebral toxoplasmosis
Primary cerebral lymphoma
Crytptococcal meningitis
Progressive multifocal leucoencephalopathy

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60
Q

What are the dermatology AIDS-defining conditions?

A

Kaposi’s sarcoma

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61
Q

What are the gastroenterology AIDS-defining conditions?

A

Persistant cryptosporidosis

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62
Q

What are the Oncology AIDS-defining conditions?

A

Non-hodgkin’s lymphoma

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63
Q

What are the Gynaecology AIDS-defining conditions?

A

Cervical cancer

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64
Q

What are the optholomology AIDS-defining conditions?

A

Cytomegavirus retinitis

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65
Q

How is HIV monitored?

A

CD4 lymphocyte count
HIV viral load
Clinical features

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66
Q

What is the current treatment for HIV therapy?

A

Combincation antiretroviral therapy - with 3 drugs from at least 2 groups

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67
Q

What do the different HIV drugs act on?

A

Different stages of HIV lifecycle

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68
Q

What is the adherance to medication needed to supress HIV? Can this lead to a normal life?

A

Adherance must be over 90%
cART can lead to a normal life but side effects can be significant
i.e metabolic, lipodystrophy

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69
Q

What are the three main types of medication MOAs for HIV?

A

Reverse transcriptase inhibtor
Integrase inhibitor
Protease inhibitor (prevents release of new virus)

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70
Q

When should you start HIV treatment?

A

If CD4 drops below 350cells/mm OR rapidly falling

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71
Q

What is the life expectancy based off CD4 of less than 100 before starting therapy?

A

52

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72
Q

What is the life expectancy based off CD4 of 100-200 before starting therapy?

A

62

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73
Q

What is the life expectancy based off CD4 of more than 200 before starting therapy?

A

70+

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74
Q

Why do HIV treatments fail?

A

Poor adherance
Not strong enough etc
All leads to viral mutation + resistance

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75
Q

What are the side effects of nucleoside reverse transcriptase inhibitors (HIV drug)?

A

Marrow toxicity
Neuropathy
Lipodystrophy

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76
Q

What are the side effects of non-nucleoside reverse transcriptase inhibitors drugs (HIV)?

A

Skin rashes
Hypersensitivity
Drug interactions

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77
Q

What are the side effects of protease inhbitors? (HIV drug)

A

Drug interactions
Diarrhoea
Lipodystrophy
HYperlipidaemia

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78
Q

What are the side effects of itegrase inhbiitors? (HIV drug)

A

Rashes

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79
Q

How can you reverse the effects of lipodystrophy (side effect from HIV medication?)

A 
Change drugs
Cosmetic procedures
Facelift
Liposuction
Fillers
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80
Q

What is the relationship between HIV and cardiovascular diseae?

A

Increased MI incidence
Hyperlipidaemia
Insulin resistance

81
Q

What are the main challenges of HIV care in this day and age?

A 
Osteoporosis
Cognitive impairment
Malignancy
Cerebrovascular disease
Renal disease
diabetes mellitus
Ischaemic heart disease
82
Q

How can you prevent HIV?

A

Change behaviour (condoms)
Treatment as prevention
Pre-exposure prophylaxis
Post-exposure prophylaxis

83
Q

What are the risks of transmission for percutaneous exposure?

A

HBV positive - 30%
HCV RNA positive blood - 3%
HIV positive blood - 0.3%

84
Q

What is the mucotaneous exposure of HIV positive blood? (Fluid entering eyes, nose, mouth or broken skin)

A

0.1%

85
Q

What fluids have to be handled with the same precautions as blood?

A 
CSF
Pleural, peritoneal or pericardial fluid
Breast milk
Amniotic fluid
Vagical secretions or semen
Synovial fluid
Unfixed tissues/organs
Saliva
Exudate/tissue fluid from burns or skin lesions
86
Q

What actions should be taken after bodily fluid exposure?

A

Wash off splashes on skin with soap/running water
Encorage bleeding
Report to sensior manager or doctor + OHS

87
Q

How is the risk assesed for bodily fluid exposure?

A

Source of contamination
Extendt of injury and type of sharp causing it
Liklihood of virus in source
Vaccination history

88
Q

What is an HAI (healthcare acquired infection?)

A

Infections that weren’t present at time of admission

Or an infection that arises after 48 hours of admission or within 48 hours of discharge

89
Q

What is the prevelance of HAIs?

A

4.9% of all patients in scotland

90
Q

What are the most common HAIs?

A

UTI (mainly due to cathertisation) 22.6%
Surgical site infection18.6%
Respiratory tract infection 17.5% (intubation)
Bloodstream infections (catheter related)
GI
Skin + soft tissue

91
Q

What microbial factors make infection more likely?

A 
Increased resistance
Increased virulence
Increased transmissability
Increased survivability
Ability to evade hosts immune
92
Q

What host factors make HAIs more common?

A 
Devices (catheters etc)
Antibiotics taken incorrectly
Break in skin
Foreign body
Immunosuppresion
Age extremes
Overcrowding
93
Q

What are the stages in the chain of infectio?

A

Source of microbe
Tranismission
Host

94
Q

What are the means of transmission for infections?

A

Direct contact
Respiratory/droplet
Faecal oral
Penetrating injury

95
Q

How can you break the chain of infection?

A 
Risk awareness
Hand hygiene
Appropriate PPE
Vaccination
Post exposure prophylaxis
Standard infection prevention and control precautions
96
Q

What is the definition of cleaning?

A

Physical removal of organic material + decreasing microbial load

97
Q

What is the definition of disinfection?

A

Large reduction in micrbe numbers, spores may remain

98
Q

What is the definition of sterilisation?

A

Removal/destruction of all microbes and spores

99
Q

When is cleaning appropriate?

A

Low risk procedures (intact skin contact)
I.e stethoscopes
Cots
Mattresses

100
Q

When is disinfection appropriate?

A

Medium risk procedures - mucous membrane contact
Endoscopes
Vaginal specula etc

101
Q

When is sterilisation appropriate?

A 
High risk (and sometimes medium risk)
Eg surgical instruments
102
Q

What is the cleaning process?

A

Detergent + water
DRY
Cleaning essential before disinfection + sterilisation if required

103
Q

What are the methods of disinfection?

A

Heat (pastureisation/boiling)

Chemical (alcohol etc)

104
Q

What are the methods of sterilsation?

A

Steam under pressure
Hot air oven
Gas
Ionising radiation

105
Q

What is the definition of an outbreak?

A

2 or more infections linked in time and palce

106
Q

What are the control measure in an outbreak?

A 
Single room isolation
Cohorting of cases
Clinical area or ward closure
Staff exclusion
Staff decolonisation
107
Q

What are the three main groups of influenza?

A

A (mammals and birds)

B + C (only humans)

108
Q

What family does influenza belong to?

A

Orthomyoxviridae family

8 segment RNA virus

109
Q

What is antigenic drift?

A

Mechanism of viral genetic variation

Occurs continually over time by small point mutations

110
Q

What do the changes in antigenic drift lead to?

A

Changes the antigenic properties - eventually immune system will not cope as well
Causes worse than normal epidemics + vaccine mismatch

111
Q

What is antigenic shift?

A

An abrupt major change in virus - leads to new H/N combinations
This is what allows for strains to jump from one species to another

112
Q

What can antigenic shift lead to?

A

Combination of multiple strians to form a new subtype
Reassortment of genome
This can lead to pandemics

113
Q

What are the differences between seasonal flue and pandemic flu?

A

Seasonal - every winter
Pandemic sporadically

Seasonal - 10-15% of population
Pandemic - 25%+ of population

Seasonal - unpleasant, not life-threatening
Pandemic - life threatening

114
Q

What are the two surface proteins on influenza?

A

Haemaglutinin (H)

Neuramindiase (N)

115
Q

How many different haemaglutinin antigens are there?

A

18 (H1-3 affect humans)

116
Q

How many different N antigens are there?

A

11

117
Q

What is the function of haemaglutinin surface protein?

A

Facilitats viral attachment and entry to host cell

118
Q

What is the function of neuramindiase surface protein of influenza?

A

Enables new viron to be released from host cell

119
Q

What two strains of avian bird flue affect ?humans

A

H5N1

H7N9

120
Q

What are the fatality rates of avian flu?

A

H5N1 - 60%

H7N9 - 35%

121
Q

What is the incubation period for avian flu?

A

2-4 days

122
Q

What are the transmission modes for avian flu?

A

Direct contact with infected birds (dead or alive)
Occasional transmission with human contact
No know contact by eating properly cooked poultry

123
Q

What are the clinical features of influenza?

A

Fever lasting ~ 3 days
+ 2 or more of:
Cough, sore throat, rhinorrhoea, myalgia, headache, malaise
Mostly systemic symptoms

124
Q

What are the symptoms of swine flu?

A

Sudden fever + cough
Tiredness, chills
Heaache, sore throat, runny nose, sneezing
Diarrhoea, stomach upset loss of appeitte
Aching muscles, limb or joint pain

125
Q

What is the tranmission mode for flu?

A

Aiborne (person to person by large droplets)

Contact - direct vs indirect

126
Q

How long does the virus survive outside the host?

A

24-48 hours on no porous surfaces

8-12 hours on porous surface (eg tissue)

127
Q

What are the high risk groups for catching influenza?

A 
Chronic disease
Diabtetes mellits
Severe immunosuprresion
65+
Pregant women
Children under 6
Morbid obesity
128
Q

What are common complications of influenza?

A

Acute bronchitis

Seoncary bacterial penumonia (4-5 days after surgery)

129
Q

What are some uncommon complcaitions associated with influenza?

A

Primary viral pneumonia
Myocarditis/pericarditis
Transverse myelitis / guillian barre
Myositis & myoglobinuria

130
Q

How do you diagnose influenza?

A 
Clinical diagnosis
Viral nose/throat swabs
Chest x-ray
Blood culture
Resp rate/pule oximetry
U&amp;Es, FBC, CRP
131
Q

what is the assesment for penumonia?

A 
CURB65
Confusion
Urea ?7mmol/l
Resp rate >30
Blood pressure (diastolic <60, systolic <90)
65+
132
Q

What are the two types of antivirals for flu?

A

Osetamivir (tamiflu) - taken orally

Zanamivir (relenza) - inhaled dry poweder

133
Q

What areh the side effects of selatamir (tamiflu)?

A

Common - Nausea, vomitting, abdo pain, diarrhoea
Less common - Headache, hallucinations, insomina + rash
Cautions - renal dosing needed

134
Q

What are the side effects for zanamivir (relenza)?

A

Rare - occasional bronchospasm

135
Q

What is the first + second line in a complicated influenza (not immunocomprimised + immunocomromised)?

A

Osteamivir PO - 1st line

Zanamivir - 2nd line

136
Q

What is the treatment for uncomplicated influnza?

A

No treatment preferred

Osteltamivir PO within 48 hours if at risk of developing complications

137
Q

What treatment for immunocomprised patients with uncomplicated influenzae?

A

Oseltamivir PO + commence therapy within 48 hours

138
Q

What is the treatment in pregancy for influenza?

A

Antivirals with oseltamivir being first line

Also safe in breastfeeding.

139
Q

When does a patient become non-infections

A

24 hrs after last symptom (or after treatment if that is longer)
In immunocomprimised - cases differ

140
Q

What PPE is needed for healthcare staff in influnzae?

A

Surgical face mask
Plastic aprom
Gloves
Handwashing after examination

141
Q

What do seasnonal influnzae vaccines contain?

A

2 type A and 1 type B subtype viruses

Contraindicated in those with egg allergy

142
Q

Why should healthcare workers get a vaccination?

A

Protect themselves + family
Reduce risk to at risk patients
Reduce absence from work

143
Q

What is a zoonoses?

A

An infection that can pass between living animcals and humans, with the source being the animal
Note, malaria etc are not zoonoses as depend on human host for part of lifecycle

144
Q

What is anthroponosis?

A

Infections from humans to animals

145
Q

What are some common bacterial zoonoses>

A 
Salmonella
Campylobacter
Shigella
Anthraz
Brucella
Plague
146
Q

What are some common viral zoonoses?

A 
Rabies
Avian influnza
Ebola virus
Lassa fever
Rift valley fever
Yellow fever/west nile fever
147
Q

What are some parasitc zoonoses?

A 
Toxoplasmosis (Common in the UK) 
 Cysticercosis 
Echinococcosis 
Trichinellosis 
Visceral Larva Migrans (Toxocara)
148
Q

What are some fungal zoonsoses?

A

Dermatophytoses

Sporotrichosis

149
Q

How is rabies transmitted?

A

From the bite of an infected animal

150
Q

What is the life cycle of rabies?

A 
Incubation period of 2 weeks in humans
Travels to brain via periperal nerves
Causes acute encephalitis
Progresses to mania, lethargy and coma
Overproduction of saliva + tears
Unable to swallow and hydrophobia
Death by respiratory failure
151
Q

How do you treat rabies?

A

Immediate post-exposure prophylaxis
Human rabies immunoglobulin
+ 4 doses of rabies vaccines over 14 days

Fatal if untreated

152
Q

what is brucellosis?

A

Was an occupational hazard of animal workers

Due to an organism excreted in milk, placenta and aboreted foetus

153
Q

How are humans infected with brucellosis?

A

Milking infected animals
During parturition
Handling carcasses of infected animals
Consumption of unpasteurised dairy products

154
Q

How does brucellosis present?

A

Incubation of 5-30 days (up to 6 mongths)

Split into acute, subacute, chronic and subclinical presentations

155
Q

What is the acute presentation of brucellosis?

A 
1-3 weeks of:
High fever
Weakness + headaches
Drenching sweats
Splenomegaly
156
Q

What is the subacute presentation of brucellosis?

A

A month or more of fever and joint pains

157
Q

What are the chronic presentations of brucellosis?

A 
Lasting months to years
Flu like symptoms. 
Depression
Maliase
Chronic arthritis
Endocarditis
Rarely - meningism
Splenomegaly
158
Q

What is subclinical brucellosis?

A

50% have positive serology

159
Q

How do you treat brucellosis?

A

Long acting doxycycline for 2-3 months + rifampicin or IM gentamicin for first week
If chronic difficult to treat
If CNS add cotrimoxazole for 2 weeks

160
Q

What is the most common form of leptospirosis?

A

L. hardjo (from cattle)

161
Q

How does leptopriosis present?

A

Fever, menigism

No Jaundice

162
Q

What is leptospirosis?

A

Highly mobile spirochaetesSurvives environment for weeks-months

163
Q

How do you treat leptospirosis?

A

Penicillin as early as possible
Prompt dialsysis
Mechanical ventilation

164
Q

What organisms cause lyme disease?

A

Borrelia burgdorferi

Spirochaete found in wild deer

165
Q

How is lyme disease spread to humans?

A

Via ticks

166
Q

What is ereythema migrans?

A

A rash occuring in 80-90% of lyme disease cases
Appears 7-30 days after bite
Can have single or multiple lesions

167
Q

What is acrodermatitis chronica atroficans ACA? (caused by lyme disease)

A

Extensor surfaces of distal extremities turn bluish/reddish
Progresses to atrophic disease
Peripheral neuropathy common
Common in elderly

168
Q

What is lymphocytoma? (caused by lyme disease)

A

Bluish, solitary + painless nodules
Often in earlobe or areola
More common in children

169
Q

What is neuroborreliosis? (caused by lyme)

A

Triad of facial nerve palsy,
radicular pain (migratory and worse at night)
lymphocytoic meningitis

170
Q

How do you diagnose lyme disease?

A

Clinical diagnosis
-Single or multiple lesions with red area that then spread
ACA + lymphocytoma, clinical and high serology titres
Arthritis

171
Q

How do you treat lyme disease?

A

Oral doxycyline or ammoxicillin, or IV ceftriaxone
Treat for 21 days
Unless arthritis or ACA, then 28 days

172
Q

What is the main source of toxoplasmosis?

A

Toxoplasma gondii (found commonly in cats)

173
Q

How is toxoplasmosis transmitted to humans?

A

From oocysts in cat faeces

From trophozoites in under-cooked meats

174
Q

How does tocoplasmosis infection present?

A 
Can be asymptomatic
Acute: Pneumonia, fever, cough, rash
Chronic: Lymphadenopathy
Lymphocytosis
Atypical mononuclear cells on blood film
Can present with chorio-retiniits + uveitis
Ocasionally congenital (calcification in brain on x-ray. Often fatal)
175
Q

How is toxoplasmosis treated?

A

Most don’t require treatment
Sulponamide + pyrimethamine
Ocasionally tetracycline

176
Q

How is toxoplasmosis treated?

A

Most don’t require treatment
Sulponamide + pyrimethamine
Ocasionally tetracycline

177
Q

What are the main three fungal pathogens?

A

Aspergillus species (fumigatus)
Candida sp. (albicans)
Crytptococcus sp. (neoformans)

178
Q

Who do fungal infections affect?

A

As they are oportunistic:
Impaired immune systems (AIDS, malignancies/transplants, primary immunodeficiencies etc)
Chronic lung diseases like asthma/CF
ICU setting

179
Q

What is the most common type of candida sp. infection

A

Mucocutaneous candidiasis

i.e nappy rash, thrush

180
Q

Where do candida infections occur?

A

Commensal, so on skin
Attracted to moist areas
Often when patient is on antibiotics, steroids (or immuno depressed)
Neonates often affected

181
Q

What is the pathology of invasive candidiasis?

A

A comensal gut flora, mostly endogenous origin of infection (going to sterile area)
4th most common blood stream infection, with same clinical presentation as bacterial BSIs
up to 40% mortality

182
Q

What are the risk factors for invasive candidiasis?

A

Broad-spectrum antibiotics
IV catheters
Total parenteral nutrition

183
Q

How is Aspergillosis transmitted between people?

A

Sproulation - inhaled spores

An intact immune system will have no problem

184
Q

What are the classifications of pulmonary Aspergiullus disease?

A

Acute invasive
Chronic (> 3months)
Allergic

185
Q

What are the predispositions for Acute invasive Aspergillus pulmonary disease?

A

Neutropnenic patients

Phagocyte defects

186
Q

What are the predispositions for chronic Aspergillus pulmonary disease?

A

Patients with underlying chronic lung conditions

187
Q

What are the predispositions for Allergic Aspergillus pulmonary disease?

A

Common in CF/asthma
Extrinsic allergic alveolitis
More common in fungal sensitisation

188
Q

What are the symptoms of Acute invasive pulmonary aspergilliosis?

A

Rapid + extesive hyphal growth
Thrombosis + haemorrhage
Non-spefici signs
Persistent febrile neutropenia (despite antibiotics)

189
Q

What is pulmonary aspergillioma?

A

Fungal mass growing in lung cavities

More common in: TB, Sarcoidosis, cronchiectasis + after pulmonary infections

190
Q

Where are cryptococcal species found?

A

Bark of trees
Bird faeces
Organic matter

191
Q

Which cryyptococcal disease is associated with HIB/AIDS?

A

Cryptococcal meningoencephalitis

192
Q

How do you diagnose Cryptococcal meningoencephalitis?

A

Indian-ink CSF

193
Q

What are the classes of antifungal drugs?

A

Polenes
Azoles
Echinocandins

194
Q

What are the most common Polyene antifungal drugs?

A

Amphotericin B
Grisofulvin
Nystatin

195
Q

What are the most common Azole antifungal drugs?

A

Fluconazole
Voriconaxole
Posaconazole

196
Q

What are the most common Echinocandin antifungal drugs?

A

Anidulafungin
Caspofungin
Micafungin

197
Q

How is invasive aspergilliosis

A

IV or oral Azole

IV amphotericine B(if serious)

198
Q

How is invasive candidiasis treated?

A

Echocandins IV

Fluconazole IV/oral

199
Q

How is crytptococcal meningitis treated?

A

IV amphotericine B + flyctosine

Followed by fluconazole

Conditions + definitions (68 decks)

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