INFECTION Flashcards
**Infection in surgical patients
Commonly Staph or enterococcus
**Infectious Mononucleosis
“Kissing disease”
Glandular Fever
EBV 90% or CMV
Incubation 4-6 weeks
CF: Mild fever, soar throat, exudative tonsillitis, rash, nausea, lymphaedenopathy pain in RUQ, fatigue
Late sign: Splenomegaly, hepatomegaly
IVX: Blood film shows raised WCC + atypical
Monospot test
Throat Swab
Centor Abdo USS for splenomegaly
Management: Avoid alcohol and vigorous sport for 3 weeks
- Paracetemol PO to control fever
- Steroids and Aciclovir if sevre infection
** Severe Sepsis
Sepsis = Severe inflammatory response syndrome + proven infective cause
BP <90 or >40 fall systoic
MAP < 65mmg
HR> 131 and RR > 30
Severe sepsis + end organ dysfunction
Septic shock + presistently low BP failed to respond to IV fluids
**C diff
Anaerobic Gram +ve
CF
IVX
MAnagement
abx moderate
abx severe
RF: ↑Hospital stay, Abx (cephalosporins, macrolides, quinolones), PPI, elderly, co-morbidity, NG tube, ITU, immunocompromised
CF: Symptoms apprear 5-10 days post ABX
- Water dirrhoea blood stained
- Colicky abdo cramp
- Fever with rigours
IVX: Bloods, CRP, low albumin 3 X Stool sample- cyctotoxin test Culture of C diff Sigmoid/colonoscopy will whow colitis and yellow plaques - Report to Public Health England
Management: ABCDE Stop Causative Antibiotics Isolate Patients Metronidazole mild VANCOMYCIN QDS for severe Life threatening - Van + Met Septic --> BUFALO
HIV
Binds to CD4 receptor on T cell
1. Primary infection 2-6 weeks post contact - flu, fever, headache, malaise, mouth ulcers, maculopapular rash on trunk
- Clinical latency: persistent generalised lymphadenopathy
- AIDS - opportunisitc infections
IVX: Anyone who asks, sexual intercourse from high risk country, anyone wiht STI, MSM, IVDU
Monitor every 3 months Cd4
Management: HAART
Highly Active Anti-retroviral therapy
+ vaccines for common illnesss
+PEP or PEPSE for partners
Influenza
CF:
IVX:
Most common resp virus
- Fever, headache, malaise, N+V, conjunctivitis
IVX: Nasopharangel swab culture or PCR
Management: Bed rest, antivirals if patient at risk group
RX: Haemophilus influenza can cause epiglottitis
Measles
prodrome?
what spots?
CF:
IVX
Management:
Complications
Prodrome (2-3 days) – infection of nasopharynx:
Fever, Coryza + Harsh cough, Conjunctivitis – non-purulent
Koplick spots (day 3 or 4) – like grains of sugar in mouth, close to parotid ducts
Exanthematous phase (5-7 days)
- Maculopapular rash: ears, face, trunk
IVX: raised LFT, leucopenia, oral fluid sample + PCR
Management: Isolate in hospital, nutrition, paracetemol, Amoxicillin for 2 bacterial and Ribavarin
MMR vaccinarion 1 yr
Complications: Acute Otitis media, pneumonia, encephalitis, sub-acute sclerosing parencephalitis
Mumps
CF:
Complications:
CF: Prodrome of Fever, malaise, myalgia
Parotitis, painful swelling
Earache whilst eating
Dry mouth
Complications: Orchitits, hearing loss, acute pancreatiits, meninigitis
Rubella
Infective time period?
CF:
important to ask?
Infective 5 d before and 5 d after rash starts
CF: prodrome low grade fever
Typical: Macular rash pink on face and spreads to body
Red spots on mouth
Lymphadenopathy
Arthralgia
IVX: Serology + Pcr testing
TX: symptomatic control and ask about contact with pregnant women
Chicken Pox
CF:
Management
When to miss school?
Varicella Zoster
Viral prodrome 2 days before: Fever, coryza
–> Vesicular Rash: head + trunk + body very itchy
IVX: Serology
Management: Miss school 5 days from start of skin reuption
Supportive: fluids, analgesia, calamine lotion to soothe rash
- Acicolivur for severe
Complication: Nec Ent or Shingles
Whooping cough
Incubation period
CF:
When to hospitalise?
Highly contagious inspiratory whoop, coughing fits and vomiting
Incubation period 7-20 days
RF: Recent travel to asia or africa
CF: cough + fever -for 2 weeks
2-6 weeks: Dry cough + inspiratory whoop, worse at night and post feeds
Subconjunctival hameorrhage common
IVX: PCR via nasal swab
Management: Hospitalisation if under 6 months.
Erythromycin tx
Immunisation at 8 + 16 weeks
Infective Gastroenteritis
CF:
RF: poor hand hygiene, travelling, foods, immunocomp, food,
Viral (incubation typically 1d)– Norovirus (adults), Rotavirus (child), Adenovirus (10-15%)
CF: Watery Diarrhoea & Vomiting + Signs of dehydration
Bloody diarrhea = E.coli
Rice water stools = cholera
Fever - shigella
IVX: Blood culture before abx, FBC, notifiable disease
Management: Admit if unable to retain PO fluid
OR Solution + Maintainace fluids
Malaria
Clinical features?
Phase 1-3
IVX:
Treatment:
Plasmodium Falciparum
Mosquito
Incubation 7-14 days, travellers present within 8 weeks
CF: Fever paroxysms
Phase 1: shivering
Phase : High temp >41 flushed dry skin, N+V
Phase3: cold sweats
Sign: Spleno/hepatomegaly
IVX: Serial thick + thin blood films
Paraside count
ABG: lactic acidosis
TX: PO Chloroquinine for non flaciparum
Compicatied flacifparum = IV IV Artesunate or IV quinine
prophylaxis = doxycycline
Febrile Traveller
Yellow fever: Fever + no rash
Typhoid: contaminated food or water + fever + maculopapular rose spots
Febrile Traveller
Yellow fever : Fever + no rash
Typhoid: contaminated food or water + fever + maculopapular rose spots
Rabies: bite Dengue SARS Cholera Hep A Malaria
