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Systems > Infection > Flashcards

Infection Flashcards

1
Q

Infective gastroenteritis

A

Inflammation of stomach and intestines due to infection

- 3+ stools in 24 hours +1 (fever, vomiting, abdominal pain, blood/mucus)

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2
Q

Non-inflammatory gastroenteritis

A

Secretory enterotoxin mediated. Watery diarrhoea.

  • Enterotoxigenic E. Coli (travellers)
  • Bacillus
  • Staph aureus
  • Rotavirus
  • Norovirus
  • Giardia
  • Cryptosporidium
  • Vibrio cholera
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3
Q

Inflammatory gastroenteritis

A

Toxin damage and mucosal destruction. Bloody diarrhoea + pain/fever etc

  • E. Coli (SLT)
  • Campylobacter
  • Shigella
  • Salmonella
  • Staph aureus
  • Entamoeba histolytica
  • Adenovirus
  • C. Diff - prevent (4C’s)
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4
Q

Infective gastroenteritis investigations

A
  • Assess hydration
  • Inflammatory features (bloods)
  • Routine stool culture (campylobacter, E. Coli O157, Salmonella, Shigella)
  • Specific stool culture
  • PCR (viral)
  • Stool microscopy (parasite)
  • Blood culture
  • Renal function
  • Imaging
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5
Q

Infective gastroenteritis management

A
  • Hygiene (prevention)
  • Rehydration
  • Fasting
  • Antimicrobials
  • Tx of complications
  • Metronidazole for parasitic
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6
Q

Haemolytic-uraemic syndrome (HUS)

A
  1. Acute renal failure
  2. Haemolytic anaemia
  3. Thrombocytopenia
    Bloody diarrhoea, fever, vomiting, weakness following E. Coli O157 infection
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7
Q

Post-campylobacter infection

A
  • Polyneuritis

- Reactive arthritis

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8
Q

Sepsis-3

A

Life-threatening organ dysfunction (q-SOFA>2) due to dysregulated host response to infection (usually bacterial)

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9
Q

Sepsis mechanism

A
  1. Breach of integrity of host barrier
  2. Bacterial toxin release
  3. Mediator release
  4. Effects of excessive mediators
    - Exotoxin: Th1 -> pro-inflammatory -> septic shock + MODS
    - Endotoxin: Th2 -> anti-inflammatory -> immunoparalysis
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10
Q

qSOFA

A

Systolic BP < or = 100 mmHg
Altered mental status
RR > or = 22

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11
Q

Sepsis investigations

A

Bloods:

  • FBC
  • LFTs
  • Coagulation
  • U&Es
  • CRP
  • lactate
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12
Q

Sepsis-6

A 
ABCDE
Take 3:
- Blood cultures
- Serum lactate
- Urine output 
Give 3:
- IV antibiotics
- IV fluids 
- Oxygen
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13
Q

Septic shock

A

Fluid refractory hypotension requiring vasopressors to maintain MAP >65 mmHg with serum lactate >2 mmol/L

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14
Q

HIV virological mechanism

A
  1. Viral surface glycoproteins (gp120) bind to CD4 glycoprotein on host cell surface
  2. Virus penetrates host cell and releases RNA
  3. Reverse transcription
  4. Transcribed DNA incorporated into host genome
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15
Q

HIV aetiology and spread

A
  • Sexual transmission
  • Blood exposure - IVDU, needlestick, transfusion
  • Vertical transmission
  • Organ donation
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16
Q

HIV symptoms

A
  • Weight loss
  • Lymphadenopathy
  • Opportunistic infection: thrush, skin, oral
  • (Primary infection) Flu-like
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17
Q

HIV investigations

A
  • Serum (acute/recovery phase) - antigen/antibody presence
  • CD4 lymphocyte count (<200 -> symptomatic)
  • PCR assay (viral load)
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18
Q

HIV management

A

Lifelong antiretroviral therapy

  • Reverse transcriptase inhibitors
  • Integrase inhibitor
  • Protease inhibitor

Prevention:

  • Education and behaviour
  • Pre- and post-exposure prophylaxis
19
Q

Blood or body fluid exposure

A

Hand hygiene
Encourage bleeding
Hep B > Hep C > HIV

20
Q

Pyrexia of Unknown Origin

A

> 38 degrees
- Caused by pyrogens acting on the hypothalamic thermoregulatory centre (vasoconstriction, decreased peripheral heat loss)

21
Q

PUO classifications

A
  1. Classical
  2. Nosocomial
  3. Neutropenic
  4. HIV associated
22
Q

Staphylococcus aureus bacteraemia

A
  • Gram +ve cocci in bloodstream (toxin or non-toxin mediated)
  • Any infection, broken skin
  • Examination: fever, hypotension, tachycardic/pnoea
  • Microscopy, cultures and imaging
  • IV antibiotic therapy
23
Q

Outbreak

A

2 or more cases of infection linked in time and place

  • IPC: prevent
  • Surveillance: detect and identify
24
Q

Infection chain

A
  1. Infectious agent
  2. Reservoir
  3. Portal of exit
  4. Transmission
  5. Portal of entry
  6. Susceptible host
25
Q

Breaking infection chain

A
  1. Diagnose and treat
  2. Cleaning, disinfection and sterilisation
  3. Hand hygiene, PPE, resp hygiene
  4. Hand hygiene, PPE, cleaning etc, isolation, food safety
  5. Hand hygiene, PPE, first aid, removal of devices (e.g. catheter)
  6. Immunisations, education
26
Q

Mode of transmission examples

A
  • Direct contact: E. Coli
  • Aerosol: COVID, influenza
  • Ingestion: campylobacter, norovirus, C. diff
  • Vector-borne: Lyme, malaria
27
Q

Influenza virology

A

RNA virus

  • Surface proteins haemagglutin antigen (attach host cell) and neuraminidase antigen (virion release)
  • Antigenic shift (H/N mutations)
28
Q

Influenza transmission

A

Seasonal - winter

  • Airborne (droplet)
  • Contact
29
Q

Influenza symptoms and complications

A 
Incubation: 2-4 days
- Fever 
- Cough 
- Fatigue/myalgia (weakness)
- Headache 
- Sore throat 
Note: influenza like illness (WHO) - fever and cough in <10 days

Complications: acute bronchitis, pneumonia (CURB65), peri/myocarditis, polyneuritis

30
Q

Influenza investigations

A 
Viral nose/throat swabs
Blood culture
CXR
Bloods 
ABG
31
Q

Influenza management

A
  • Oxygen if needed (<92%)
  • Neuraminidase inhibitors: Oseltamivir
  • Vaccination, PPE and hand/resp hygiene
32
Q

Fungal infections

A

Opportunistic!!

  • Impaired immune system
  • Chronic disease
  • ICU
33
Q

Fungal species

A

Aspergillus
Candida
Cryptococcus

34
Q

Aspergillus infection

A

Invasive pulmonary aspergillosis

  • Acute, Sub-acute, Chronic (>3 mth), Allergic
  • Airborne
35
Q

Aspergillosis symptoms

A
  • Fever
  • Chest pain
  • Cough
  • Haemoptysis
  • Dyspnoea
36
Q

Aspergillosis investigations

A
  • Sputum culture
  • Biopsy
  • CT chest
  • Blood cultures
  • Bloods (IgG/E)
37
Q

Candida infection

A

Candidiasis

  • Mucocutaneous: moist areas
  • Invasive (gut commensal)

Risk Factors:

  • Antibiotic use
  • Impaired immune system - neonate, illness
  • Chronic disease
  • Medical devices/surgery
38
Q

Candida investigations

A
  • Fever + chills that doesn’t improve with antibiotics
  • Bloods
  • Blood cultures
  • Clinical: oral candidiasis (thrush) etc
39
Q

Cryptococcus infection

A

Cryptococcosis

  • Aerosol from environment
  • Organism can cross blood-brain barrier (cryptococcal meningoencephalitis)
40
Q

Cryptococcosis symptoms

A

From asymptomatic to pneumonia (chest pain, cough, fever)

  • Headache
  • Confusion
  • Visual disturbances
  • Coma
41
Q

Cryptococcosis investigations

A

CSF

  • Culture (and cryptococcus antigen)
  • Protein (high)
  • Glucose (low)

Blood
- Culture and antigen

42
Q

Antifungals

A

IV (…azoles)

  1. Amphotericin B formulations
  2. Azoles
  3. Echinocandins
  4. Flucytosine
43
Q

Zoonosis

A

Infections that are naturally transmitted between vertebrae animals and humans

  • Virus: rabies, ebola, yellow fever
  • Bacterias: salmonella, campylobacter, Toxoplasma
  • Parasites
  • Fungi
44
Q

Rabies

A

Viral zoonose

- Bite of infected animal (dogs, bats etc)

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