Infection conditions Flashcards
What symptoms will someone with meningitis classically present with?
Headache Neck stiffness Photophobia Confusion Fever Lethargy Drowsiness Lack of appetite
Who is more at risk of meningitis? Why?
Old people (over 60) Young people (under 2) Due to immune system compromise
What are the first line investigations you should do if you suspect someone has meningitis? Explain why they are done
Bloods: FBC, PCR meningitis screen, WCC
Lumbar puncture- don’t do this if someone is hypotensive or has raised ICP
Venous blood gas- to check for lactate to see if they are septic
How is meningitis managed?
Hospitalise the patient and give antibiotics
Supportive treatment eg IV fluids, oxygen
Possibly give corticosteroids but not if they are under 3
What are other names for infectious mononucleosis?
Glandular fever, EBV (epstein barr virus), kissing disease, mono
What symptoms will some with glandular fever present with?
Sore throat Fever Swollen tonsils White exudate on tonsils Chills Sweats Rash- may be macropapular after treatment with amoxicillin Splenomegaly
What age group is glandular fever common in?
15-24 years old
How is glandular fever spread?
Via contact or sexual contact eg kissing, sharing utensils/ food and drink
What is the first line investigation for glandular fever? What will they show to confirm diagnosis
Bloods- check FBC (WCC- lymphocytes will make up more than 50% total or there will be 10-20% that are atypical)
Monospot test
What symptoms will someone with herpes simplex virus classically present with?
Oral/ mouth/ genital ulcers Lymphadenopathy Fever Malaise Dysuria in women
What is the first line investigation for herpes simplex virus?
Viral screen or PCR (done by taking a swab)
Ideally done in a GUM clinic
How is herpes simplex virus infection managed?
First line antibiotics:
Start them as as soon as possible
Aciclovir, if not valciclovir or famciclovir
200mg 5 times daily
If they have neurological symptoms admit them and give these abx via IV
Topical lidocaine can be given to reduce pain from ulcers
The antibiotics will be needed again when they have flare ups
Who is more at risk of herpes simplex virus infection?
Immunocompromised patients
Those who have HIV
Those who undertake high risk sexual behaviour
What are the main strains of herpes simplex virus? Describe how they are transmitted and how they differ in terms of symptoms etc
HSV1- transmitted through vaginal or anal intercourse
HSV2- transmitted through oro-genital sex, is usually more severe in terms of number of flare ups after first exposure
How is herpes simplex virus transmitted? What are some things it is important to tell the patient?
It is transmitted via shedding- this can be though lesions or mucosal surfaces
The person will always have the virus so they should know they can transmit it if they have sex- for advice on how to not transmit tell them this is possible with correct use of condoms however they can still spread it during foreplay or from other mucosal linings and lesions so the condoms won;t prevent transmission completely
What symptoms will someone with oral candida classically present with?
White/ creamy/ yellow plaques on the mucosal surfaces of their mouth
Lesions anywhere in the mouth
Burning oral pain
What is the first line investigation for oral candidiasis?
None, diagnosis is clinical and after examination
Swabs are not useful and most people have candidiasis in their mouth already
How is oral candidiasis managed?
Topical antifungals first line eg miconazole
If severe or genital then oral flucazone
They may also need topical corticosteroids if particularly complicated
What is gangrene?
A complication of necrosis
What are the 2 types of gangrene?
Ischaemic and infectious
What is wet gangrene?
Infectious gangrene
What is dry gangrene?
Ischaemic gangrene
What are the 2 types of infectious gangrene?
Gas gangrene
Necrotising fasciitis
Why does ischaemic gangrene arise?
Due to compromised arterial or venous supply
What symptoms will someone with gangrene present with?
A painful joint/area- if the pain is acute then it suggests infectious gangrene
Crepitus may be heard on light palpation if there is gas gangrene (crunching or crackling noises)
Oedema
Heaviness of the joint
Who is more likely to get gangrene?
Diabetes mellitus Alcohol misuse Athersclerosis Malignancy Long term smokers Renal disease
What investigations would you do if you suspect gangrene? What will you expect to see
Full set of bloods- LFTs, U+Es, FBC (look for leukocytosis and anaemia)
Blood culture- look for infectious organism
Metabolic profile- look for acidosis etc
CRP- raised
X ray of joint- high specificity for gas gangrene but will not usually be visible on admission
CT- look for abcess/ oedema etc
How is gangrene managed?
IV antibiotics (vancomycin plus one more), surgical debridement (completely remove the necrotic area and the incision should extend past it)
What are some complications of gangrene?
Amputation Haemolysis Shock Sepsis DIC Acute renal failure
What sign might you see in ischaemic gangrene due to arterial insufficiency?
Diminished pulses
What is influenza infection?
An acute respiratory infection
What respiratory tracts does influenza affect?
Both upper and lower
What symptoms will someone with influenza classically present with?
Runny nose Cough Sore throat Fever Malaise May have some GI symptoms May have some ocular symptoms eg lacrimation, pain on eye movement
Who is more likely to get infleunza?
Overall more likely in the winter season Immunocompromised people Chronic kidney disease Pregnant women Those with longstanding cardiovascular and respiratory conditions Those with diabetes Those who aren't vaccinated
What is the first line investigation for influenza? What would you expect to see?
None, diagnosis is usually clinical
If you want to confirm the agent or believe they are at risk of developing complications you can do a viral culture or rapid test
How is influenza managed?
Usually management is not needed- just tell the patient to drink lots of water, rest and take antipyretics if needed
If you believe they are at risk of developing complications give them antivirals- most commonly oral oseltamivir
What are some complications of influenza
Bacterial pneumonia (when caused by bacteria) Otitis media
How many strains of influenza are there and what are they called?
2- they are called influenza A and B
What is infectious mononucleosis?
An infection most often by the epstein barr virus
What are some other names for infectious mononucleosis?
EBV Epstein barr virus Infectious mono Glandular fever Kissing disease
What will someone with infectious mononucleosis classically present with?
Sore throat Enlarged lymph nodes Fever White exudate on tonsils Malaise Fatigue Macropapular rash (after treatment with amoxicillin) Splenomegaly
Who is more likely to get infectious mononucleosis?
Young adults and teenagers
What is the first line investigation for infectious mononucleosis? What would you expect to see
If they are under 12 or immunocompromised and have been ill for 7 days then first line viral serology
If they are above 12 and not immunocompromised then first line bloods- you will see high WCC with more than 50% of white cells being lymphocytes (they may possibly also be abnormal). Then also do a monospot test in the 2nd week of illness
What will you see specifically in bloods in someone with infectious mononucleosis?
Raised WCC
More than 50% of them will be lymphocytes and may be abnormal
How is infectious mononucleosis managed?
Symptomatic relief with paracetamol
If they deteriorate eg resp rate is high, they are unable to swallow increasing risk of dehydration then admit them
What 2 things must you advise those with infectious mononucleosis to do?
1) don’t lift heavy weights to reduce risk of splenic rupture
2) avoid spreading by not sharing utensils/food and not kissing etc (spreads via saliva)
What are some complications of infectious mononucleosis?
Splenic rupture
Dehydration
How might older patients with infectious mono present?
Atypically- they may be jaundiced, there may not be a sore throat etc
After what with you see a macropapular rash in someone with infectious mono?
After the use of amoxicillin
What symptoms will someone with HIV classically present with?
Flu like symptoms- sore throat, fever, malaise, myalgia, lymphadenopathy Pyrexia Weight loss Night sweats Shingles Oral candidiasis Oral, genital or perianal ulcers (apthous ulcers in the mouth) Macropapular rash
Who is more likely to get HIV?
Needle sharing IV drug use
High risk sexual behaviour
Receptive anal sex
Receptive penile vaginal sexual intercourse
Percutaneous needle stick injury
Those who live in sub saharan or southern africa
What are the first line investigations for HIV? What would you see?
HIV ELISA (enzyme linked immunosorbant assay) HIV rapid test
Do baseline FBC, serum electrolytes, urinalysis, creatinine and monitor these with treatment
How is HIV managed?
First line ART (anti retroviral therapy)- this stops the virus replicating
Refer them to an HIV clinically for the next 48 hrs- 2 weeks and they can go home if they aren’t clinically unwell
ART regimen: 3 drugs
2 x NRTI (nucleoside reverse transcriptase inhibitors)- most commonly tenofovir and emitricitabine
1 x NNRTI or INI or PI (non nucleoside… or integrase inhibitor or boosted protease inhibitor)
What 2 tests are done to monitor HIV? What do they show
Viral load- shows how much virus is in the blood
CD4 count- shows how much HIV is suppressing the immune system
What symptoms might you get in HIV initially due to immunosupression?
Shingles
Oral candidiasis
What illnesses is HIV associated with?
PCP (pneumocystic pneumonia) Kaposi's sarcoma Lymphoma Bacterial LRTI Tuberculosis
What are some complications of HIV?
Everything- it increases risk of disease to most systems, cancer, diabetes, infections etc etc
What classes of drugs are used for HIV?
Antiretroviral therapy which includes:
2 x NRTI (nucleoside reverse transcriptase inhibitors)- most commonly tenofovir and emitricitabine
1 x NNRTI or INI or PI (non nucleoside… or integrase inhibitor or boosted protease inhibitor)
What symptoms will someone with with tuberculosis classically present with?
Chronic cough- initially dry and later productive
Anorexia
Weight loss
Low grade fever- not as common in older people
Malaise
Night sweats
Who is more likely to get TB?
Those born in an endemic country HIV Immunosupressive medication Silicosis Malignancy
What is the first line investigation for tuberculosis? What would you see?
Chest x ray- you would see cavitation, pleural effusion and lymphadenopathy in the upper lobes
Sputum pot- for culture and microscopy if chest x ray supports pathology
How is tuberculosis managed?
4 abx first line: RIPE
rifampicin and isonizide for 6 months
first 2 months pyrazinamide and ethambutol
Give vitamin B6 supplements as isonazide will reduce levels
Why does TB mostly affect the upper lung lobes most?
It is an aerobic bacteria and the upper lobes are most well perfused so have the most oxygen
What must you warn patients with TB when prescribing them antibiotics for treatment?
Their urine will turn orange
The OCP will be less effective so they should use condoms or other contraception
What is encephalitis?
Inflammation of the brain parenchyma
What symptoms will someone with encephalitis classically present with?
Neurological dysfunction- paresis, abulia, paralysis, cognitive decline
Fever
Rash
Altered mental state
Seizures
May have a cough and a GI infection to precede
Who is more likely to get encephalitis?
Those who have a viral infection Immunodeficiency Under 1 Over 65 Organ transplant
What are some investigations for encephalitis? What might you see?
CT head Lumbar puncture FBC- WCC raised Serum electrolytes- hyponatraemia LFTs- raised EEG
What are some common viruses that cause encephalitis?
Herpes simplex virus
Enterovirus (causes GI infection)
Varicella zoster virus
How is encephalitis managed?
First line IV aciclovir
Supportive treatment eg mechanical ventilation, ulcer therapy, DVT prophylaxis, electrolytes etc
What are some complications of encephalitis?
Seizure
Death
Neurological deficit
