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Year 5 Core Conditions > Infection - Level 2 > Flashcards

Infection - Level 2 Flashcards

1
Q

Epidemiology of HIV?

A
  • 110,000 people living with HIV in the UK.
  • 5% MSM living in the UK has HIV.
  • Black African people make up 36% of all people living with HIV in UK
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2
Q

What is HIV and how does it progress?

A

o Retrovirus which infects and replicates in human lymphocytes (CD4 + T-Cells) and macrophages
 Retrovirus encodes reverse transcriptase, allowing DNA copes to be produced from viral RNA, it is error prone
o Leads to progressive immune system dysfunction, opportunistic infection and malignancy=AIDS
o Subtypes include HIV1 (global epidemic) and HIV2 (low pathogenic, West Africa)

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3
Q

Transmission of HIV?

A

Blood, sexual fluids and vertically (pregnancy, childbirth, breastfeeding)

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4
Q

Risk Factors of HIV?

A
  • Partner infected or from high risk area of HIV
  • MSM
  • Female sexual contacts of MSM
  • Multiple partners
  • History of STIs, Hep B, Hep C
  • Migration from high prevalence countries (particularly sub-saharan Africa)
  • Failure to use barrier contraception.
  • IVDU
  • Needle-stick injury
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5
Q

Pathophysiology of HIV?

A

o HIV binds, via its GP120 envelope glycoprotein, to CD4 receptors on helper-T-cells, monocytes and macrophages
o CD4 cells migrate to lymphoid tissue where virus replicates, producing new virions
o Released and infect new CD4 cells
o As infection progresses, depletion or impaired function of CD4 cells leads to decreased immunity

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6
Q

When is HIV most infective?

A
  • Acute primary HIV infection is the time of highest infectivity.
  • The risk of transmission per exposure via sex is relatively low (~0.1-3%).
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7
Q

Symptoms and signs of primary HIV?

A

Primary HIV infection (seroconversion illness)

  • Symptomatic in 80%, typically 2-4 weeks after infection
  • Flu-like symptoms
    o Fever
    o Malaise
    o Myalgia
    o Lymphadenopathy
    o Pharyngitis
  • Erythematous/Maculopapular rash
  • Headache/Aseptic meningitis
  • Unusual signs: oral thrush, recurrent shingles, leukopenia
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8
Q

Symptoms and signs of asymptomatic HIV?

A

Asymptomatic infection (clinical latency)

  • After seroconversion, virus levels low as replication continues
  • CD4 and CD8 normal and may persist for many years
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9
Q

Symptoms and signs of persistent generalised lymphadenopathy HIV?

A
  • Swollen/Enlarged lymph nodes >1cm in 2 or more non-contiguous sites (not inguinal) persisting >3 months
  • Due to follicular hyperplasia caused by HIV
  • Exclude TB, infection and malignancy
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10
Q

Symptoms of infections in HIV?

A
  • Non-Specific symptoms
    o Fever, night sweats, diarrhoea, weight loss
  • Minor opportunistic infection
    o Oral thrush, oral hairy leukoplakia, HZV, recurrent shingles, tinea infection, seborrheic dermatitis
    o Lymphopenia, thrombocytopenia
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11
Q

WHO clinical stage 1 of HIV?

A

o Asymptomatic

o Persistent generalised lymphadenopathy

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12
Q

WHO clinical stage 2 of HIV?

A

o Moderate unexplained weight loss (<10% presumed or measured body weight)
o Recurrent respiratory tract infections  sinusitis, tonsillitis, otitis media and pharyngitis.
o Herpres zoster
o Recurrent oral ulceration
o Papular puritic eruptions
o Seborrhoeic dermatitis
o Fungal nail infections

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13
Q

WHO clinical stage 3 of HIV?

A

o Unexplained severe weight loss (>10% of presumed or measured body weight), chronic diarrhoea for longer than 1-month, persistent fever (>37.6 degrees intermittent or constant, longer than 1 month).
o Persistent oral candidiasis
o Oral hairy leukoplakia
o Pulmonary tuberculosis
o Severe bacterial infections (pneumonia, empyema, pyomyositis, bone/joint infections, meningitis or bacteraemia).
o Acute necrotising ulcerative stomatitis, gingivitis or periodontitis.
o Unexplained anaemia (<8g/dL), neutropenia (<0.5 x 109/L) or chronic thrombocytopenia (<50 x 109/L)

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14
Q

WHO clinical stage 4 of HIV?

A

o HIV wasting syndrome (weight loss with diarrhoea or weakness and fever)
o Pneumocystis jirovecii pneumonia, recurrent severe bacterial pneumonia
o Chronic HSV (orolabial, genital or anorectal for more than one month or visceral at any site).
o Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs).
o Extrapulmonary tuberculosis
o Kaposi’s sarcoma
o CMV (retinitis or infection of other organs)
o CNS toxoplasmosis
o HIV encephalopathy
o Extrapulmonary cryptococcosis including meningitis
o Disseminated non-tuberculous mycobacterial infection
o Progressive multifocal leukoencephalopathy
o Chronic cryptosporidiosis (with diarrhoea)
o Chronic isoporiasis
o Disseminated myocisis (coccidomycosis or histoplasmosis)
o Recurrent non-typhoidal Salmonella bacteraemia.
o Lymphoma (cerebral or B-cell non-Hodgkin) or other solid HIV associated tumours.
o Invasive cervical carcinoma
o Atypical disseminated leishmaniasis
o Symptomatic HIV-associated nephropathy or symptomatic HIV associated cardiomyopathy.

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15
Q

When should HIV testing be offered?

A 
o	All at risk patients
	Anyone with STI
	MSM
	Buying/Selling sex
	From countries of high HIV prevalence
	IVDU
	Any sexual partner of the above
o	Blood or organ donation
o	Opt out screening – attendees of sexual health clinics, antenatal screening
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16
Q

Benefits of HIV testing?

A

 Negative - Reassurance, motivation to maintain behaviours

 Positive – Effective treatment to reduce morbidity, better prognosis, reduce risk of inadvertent transmission

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17
Q

What 2 tests are offered to diagnose HIV? Describe process of diagnosing HIV?

A

o ELISA + Western Blotting for HIV antibody and p24 antigen
 Assays for HIV1, HIV2 and HIVp24 antigen
 Send 10mls of clotted blood to virology, marked HIV test
 Window period up to 12 weeks
 If positive, diagnosis confirmed by confirmatory assay
 If negative, reassuring but repeat at 3 months
 If at risk – 3-6 monthly testing

o Point-of-care Tests
 Finger-prick or mouth samples used in some GUM clinics, results within 1 hour (can be used in acute setting)
 If positive, lab test done

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18
Q

Other tests used in HIV monitoring? and their uses?

A

o CD4 Count
 Used to monitor immune system function and disease progression (<200 cells/microlitre is AIDS)

o Viral Load
 Quantification of HIV RNA
 Used to monitor response to ART
 Not diagnostic so care of use in symptomatic window period – need confirmation of seroconversion

o Nucleic Acid Testing/Viral PCR
 Test for viral RNA, used in vertical transmission in neonates

o Routine Bloods
 FBC, U&E, LFT, lipid/bone profile, glucose

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19
Q

Prevention and management of needle stick injury in patient with HIV?

A
  • Risk of HIV transmission from single needle-stick exposure from person with HIV not on ART is 1 in 300
  • Prevent
    o Use safer sharps (mechanism to minimise injury)
    o Do not recap medical sharps
    o When using sharps, ensure disposal container near
  • Manage
    o Encourage wound to bleed, ideally under running water (do not suck)
    o Wash with soap and running water, do not scrub
    o Contact OH/infection control (or A&E outside working hours) regarding testing and post-exposure prophylaxis
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20
Q

Monitoring in HIV infection?

A
  • Clinical assessment
  • CD4 count
  • Plasma HIV RNA levels
  • 6-monthly review at GP
  • Annual full sexual health screen
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21
Q

Management of new diagnosis of HIV - referral?

A
  • Refer urgently (within 48 hours, no later than 2 weeks) to GUM or HIV specialist
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22
Q

Management of new diagnosis of HIV - general measures?

A

Sex safe promotion (barrier contraception, dangers of multiple partners)

Needle exchange schemes

Vaccine for HepB, pneumococcal and Hib, influenza and swine flu

Partner notification
 Speak to GUM if not willing
 Estimate date when infection occurred, all contacts within 90 days prior to infection
 If estimate cannot be made, all prior partners should be informed

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23
Q

Management of new diagnosis of HIV - follow up?

A
  • Follow Up in 1-2 days
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24
Q

Contact tracing in new diagnosis of HIV?

A

 Speak to GUM if not willing
 Estimate date when infection occurred, all contacts within 90 days prior to infection
 If estimate cannot be made, all prior partners should be informed

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25
Q

What is ART management?

A
  • Antiretroviral therapy (ART) used in everyone with HIV
  • Aims to reduce HIV viral load to undetectable level leading to immunological recovery, reduced clinical progression and reduced mortality
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26
Q

Mechanism of HAART - NRTI/NNRTI?

A

o Nuclotide/Non-nucleoside reverse transcriptase inhibitors (NRTI/NNRTI)
 Inhibit reverse transcriptase and conversion of viral RNA into DNA
• NRTI – Zidovudine, abacavir, didanosine, lamivudine
• NNRTI – Efavirenz, etravirine, nevirapine, rilpivirine

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27
Q

Mechanism of HAART - Protease inhibitors?

A

o Protease Inhibitors
 Inhibit HIV enzymes required to produce mature infectious particles by cleaving structural proteins and enzymes
 Atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, ritonavir

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28
Q

Mechanism of HAART - CCR5 antagonist?

A

o CCR5 Antagonist
 Inhibit entry of virus into cell by blocking CCR5 co-receptor
 Maraviroc

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29
Q

Mechanism of HAART - Integrase inhibitor?

A

o Integrase inhibitor
 Dolutegravir, elvitegravir, raltegravir
 Used in HIV infection resistant to 1st line

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30
Q

Investigations to perform when starting HAART?

A

o Counselling – health promotion, not a cure and lifelong therapy, side effects of treatment
o Screen for infections and malignancy (TB and HepB&C)
o Baseline tests – CD4, viral load, FBC, LFT, U&E, pregnancy test, viral genotype

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31
Q

1st line drug regimen in HAART in HIV?

A

o 2 NRTIs + one of:
 Ritonavir-boosted protease inhibitor
 NNRTI
 Integrase inhibitor

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32
Q

1st line NRTIs used in HAART for HIV?

A

 Tenofovir + Emtricitabine (Truvada), abacavir + lamivudine (Kivexa)
 SE: GI disturbance, anorexia, pancreatitis, lactic acidosis, low bone density

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33
Q

1st line Protease inhibitors used in HAART for HIV?

A

 Atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, ritonavir
 SE: hyperglycaemia, insulin resistance, dyslipidaemia, jaundice, hepatitis

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34
Q

1st line NNRTIs used in HAART for HIV?

A

 Rilpivirine (give with food), efavirenz (CNS toxicity, care in depression, adverse lipids, rash)

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35
Q

1st line Integrase inhibitors used in HAART for HIV?

A

 Dolutegravir, elvitegravir, raltegravir

 SE: rash, GI disturbance, insomnia

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36
Q

1st line regimen choice in HAART for HIV?

A

o Tenofovir + emtricitabine (Truvada) + efavirenz/atazanavir/darunavir

o Abacavir + lamivudine (Kivexa) + lopinavir with ritonavir/fosamprenavir/nevirapine/rilprivirine

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37
Q

Aims of HAART treatment in HIV?

A

o Reduce viral load to <50copies/ml within 4-6 months

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38
Q

Primary prevention of infections used in HIV?

A
  • PCP – co-trimoxazole if CD4 <200
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39
Q

What is Post-exposure prophylaxis in HIV?

A
  • Short-term use of ART recommended ASAP after potential sexual or occupational exposure (up to 72h, ideally <24h)
  • Need to assess level of risk with OH or specialist
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40
Q

1st line PEP in HIV?

A 
o	Truvada (tenofovir +emtricitabine) and raltegravir for 28 days
o	Test for HIV 8-12 weeks after exposure
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41
Q

What is Pre-exposure prophylaxis in HIV?

A
  • Used in HIV-negative patients with high risk of acquiring HIV including serodifferent relationships without suppression of viral load, condomless anal in MSM
  • Taken before, during and after – daily or around sexual activities
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42
Q

Drug used in PrEP in HIV?

A
  • Truvada used (Emtricitabine + Tenofovir)
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43
Q

Is HIV tested in pregnancy?

A

• HIV blood test as part of the routine antenatal screening.

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44
Q

Contraception counselling advice in HIV?

A
  • Where the mother is positive and the partner negative, self-insemination with the partner’s sperm is recommended.
  • If the male is positive and the female is negative, sperm washing is recommended (alternatively, donor insemination is an option).
  • IVF should take account of the parents’ viral load, CD4 counts and any AIDS defining illness.
  • Consideration should be given to current therapy (HAART) as there is the possibility of teratogenicity with some drug combinations of taking folate antagonists for PCP prophylaxis.
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45
Q

Testing in patient with HIV and pregnant?

A

o HIV test at booking
 Testing of other children is recommended.
o Check for Hep B, Hep C, VZV, measles and toxoplasmosis antibodies
o Offer Hep B, pneumococcal and influenza vaccine
o Screening for STI’s should be performed at booking and 28 weeks
o Treat asymptomatic infections
o Viral load and CD4 count should be repeated every 3 months and specifically at 36 weeks to inform neonatal therapy

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46
Q

HAART management during pregnancy for patient with HIV?

A

o Continue in pregnancy if needed for mothers’ health
o If not needed, start HAART by 24 weeks until delivery
 cART
 If viral load <10000 and elective CS – ZDV monotherapy between 20-28 weeks, then IV ZDV 4 hours before CS until cord clamped
o Warm about risk of GDM and premature labour

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47
Q

How to prevention vertical transmission of HIV in pregnancy?

A
  • Antenatal HAART (highly active antiretroviral therapy)
  • Delivery by CS
  • Avoidance of breast feeding
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48
Q

Delivery in patient with HIV - premature labour?

A

o If membranes rupture >34 weeks, expedite
o If membranes rupture <34 weeks, give steroids, erythromycin, HAART regimen and seek HIV specialist review
o If no membrane rupture, manage as if HIV negative

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49
Q

Delivery in patient with HIV - C-section?

A
  • 38 weeks
  • If viral load >50 (>400 on HAART), or co-infected with Hep C and not on HAART
  • If viral load <50 – plan for 39+ weeks
  • Performed within 4 hours of SROM.
  • HAART needed if not on medication
  • Early clamping of the cord is recommended
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50
Q

Delivery in patient with HIV - vaginal delivery?

A
  • Viral loads <50 (<400 if on HAART)
  • Continue HAART in labour
  • Avoid foetal blood sampling/scalp electrodes/amniotomy unless delivery imminent
  • Oxytocin augmentation can be used
  • Low cavity forceps preferred (avoid mid -cavity or rotational)
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51
Q

Delivery in patient with HIV -HAART?

A

cART for advanced disease

  • ART initiated by 24th week and discontinued at delivery
  • If viral load <10000 and elective CS – ZDV monotherapy between 20-28 weeks, then IV ZDV 4 hours before CS until cord clamped
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52
Q

Neonatal treatment to baby born to HIV positive mother?

A

cART for advanced disease

  • ART initiated by 24th week and discontinued at delivery
  • If viral load <10000 and elective CS – ZDV monotherapy between 20-28 weeks, then IV ZDV 4 hours before CS until cord clamped
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53
Q

When to test neonate after birth to HIV positive mother?

A

o HIV DNA PCR (or HIV RNA testing):
o Day 1, 6 weeks and 12 weeks
o Confirmatory HIV antibody testing at 18 months

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54
Q

Definition of AIDS?

A

• The development of opportunistic infections or malignancy (including cervical carcinoma) or a CD4 count <200 cells/mm3 are diagnostic of AIDS.

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55
Q

Common AIDs defining diseases?

A

 Pneumocystitis pneumonia
 Oesophageal candida
 Non-Hodgkin’s lymphoma
 Tuberculosis (pulmonary and extra pulmonary)

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56
Q

Side effects of HAART medications?

A
  • Common side effects include: collection of fat on the back (buffalo hump) and abdomen, diarrhoea, malaise, headache, nausea, weakness, high glucose, high cholesterol
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57
Q

Definition of influenza?

A
  • Acute respiratory illness caused by RNA viruses of Orthomyxoviridae (influenza viruses)
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58
Q

Types of influenza?

A

o Influenza A – more frequent and more virulent, responsible for local outbreaks, large epidemics and pandemics
o Influenza B – co-circulates with influenza A during yearly outbreaks, less severe
o Influenza C – mild or asymptomatic infection similar to common cold
- Seasonal outbreaks divided by H and N antigens on virus

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59
Q

What is uncomplicated influenza?

A

o Acute infection usually self-limiting in general population

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60
Q

What is complicated influenza?

A

o More severe, usually Influenza A

o Symptoms that require hospital admission, involve LRT, exacerbated pre-existing medical condition

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61
Q

Epidemiology of influenza?

A
  • Occurs during winter months, typically between December and March
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62
Q

Symptoms of uncomplicated influenza?

A 
o	Coryza, nasal discharge
o	Cough
o	Fever
o	GI upset
o	Headache, malaise, myalgia, arthralgia
o	Photophobia, conjunctivitis
o	Sore throat
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63
Q

Symptoms of complicated influenza

A

o Signs and symptoms that require hospital admission
o LRTI
o CNS involvement
o Exacerbation of underlying medical condition

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64
Q

Management of influenza - general advice?

A

o Drink adequate fluids
o PRN paracetamol and ibuprofen
o Bed rest
o Stay off work until feel able to attend
o Symptoms usually resolve within 1 week, may be up to 2 weeks

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65
Q

Management of influenza - safety net?

A

o Warn about complicated symptoms
 Signs and symptoms that require hospital admission
 LRTI
 CNS involvement
 Exacerbation of underlying medical condition
o If develop SOB, CP or haemoptysis or no improvement within 1 week – follow up

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66
Q

Management of influenza - admission?

A

 Complication of influenza – pneumonia
 Co-existing medical condition that puts them at high risk
 Under 2 years old and in high risk group

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67
Q

Management of influenza - antiviral therapy - when to give?

A

Antiviral (oral oseltamivir or inhaled zanamivir) if:

 National survery indicates influenza is circulating
 Person is ‘at risk’
• >65 years, <6 months, pregnant women and 2 weeks post-partum
• Asplenia
• COPD, bronchiectasis, CF, Asthma (continuous or repeated use of corticosteroids)
• CHD, CHF, IHD,
• CKD,
• Cirrhosis, biliary atresia, hepatitis,
• TIA, stroke,
• T1DM, T2DM, Immunosuppression,
• BMI >40
 Person can start treatment within 48 hours of onset of symptoms (36 in zanamivir)

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68
Q

Management of influenza - post exposure prophylaxis?

A

o DO NOT consider in at-risk groups if vaccinated >14 days before exposure
o Only prescribe if:
 National surveillance indicates influenza circulating
 Person exposed (in same household)
 At risk group and not adequately protected by vaccine
 Able to start treatment within 48 hours of contact (oseltamivir) or 36 (zanamivir)
o Arrange flu jab

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69
Q

Management of influenza - prevention?

A

Vaccination (quadrivalent – 2 types of A & B)
o How to give:
 Adults – IM injection in deltoid
 Children 2-10 - Intranasal spray in each nostril

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70
Q

Management of influenza - when to give vaccine?

A

All people aged >65 (adjusted trivalent or quadrivalent)

All people aged 6 months to 65 years in clinical risk group:
• Respiratory – COPD, bronchiectasis, CF, IPF, BPD, asthma (continuous or repeated corticosteroids or previous hospital admission)
• Cardiac – congenital HD, hypertension with cardiac complications, CHF, IHD
• CKD
• Liver – Hepatitis, cirrhosis, biliary atresia
• Neurological – TIA, stroke, cerebral palsy, Parkinson’s, MS, MND, polio
• T1DM, T2DM
• Immunosuppressed – chemo, bone marrow transplant, myeloma, HIV/AIDs, DMARDs, systemic corticosteroids (>1 month)
• Asplenia
• Pregnant women
• BMI >40

Children aged 2-10 (LAIV)

People in long-stay residential and nursing homes

Close contacts of immunocompromised people

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71
Q

Management of influenza - contraindications to influenza vaccine?

A

 Allergy (if true egg allergy – may need admission for it)

 Acutely unwell (febrile, systemic infection)

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72
Q

Management of influenza - adverse effects of influenza vaccine?

A

 Pain, swelling, redness at site
 Low-grade fever, malaise, fatigue
 Headache, myalgia

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73
Q

Complications of influenza?

A

o Respiratory - Acute bronchitis, exacerbation of asthma or COPD, otitis media, pneumonia, sinusitis
o Cardiac - Myocarditis, pericarditis
o Febrile convulsions
o Myalgia, myositis
o Neurological – Reyes syndrome, encephalomyelitis, GBS, aseptic meningitis
o Toxic shock syndrome

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74
Q

Definition of measles? Transmission? Incubation?

A
  • RNA paramyoxyviridae virus
  • Highly infectious
  • Transmitted by droplets / direct contact
  • Incubation period: 7-14 days
  • Infectious 4d before symptoms and 4d after onset of rash
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75
Q

Epidemiology of measles?

A
  • Peak age= <1 year (before immunisation) or older children that are not immunised
  • Occurs typically in preschool children - peak in winter/spring
  • Commonest in developing countries
  • Rare due to MMR vaccine
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76
Q

Risk factors of measles?

A
  • Not immunised, immunocompromised, contact
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77
Q

Symptoms of measles?

A
  • Prodrome (2-4 days) of:
    o Fever 39oC
    o Conjunctivitis, coryza, cough, lymphadenopathy
    o Koplik’s spots (grain like spots opposite lower molars and buccal mucosa)
  • Rash appears 3-4 days later usually on face & behind ear and spreads to whole body
    o Initially erythematous and maculopapular but then blotchy and conflueunt, may desquamate in 2’ wk.
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78
Q

Diagnosis of measles?

A
  • Clinical diagnosis confirmed by serology &/ or viral culture (oral fluid sample)
  • Blood Film
    o Leucopenia, lymphopenia
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79
Q

Management of measles - general advice?

A
  • Notifiable disease to Health Board
    o Testing kit – oral fluid sample for IgG/IgM and/or RNA testing
    o Seek advice from HPT about immunosuppressed, pregnant and infants <1
  • Supportive – Antipyretics, ibuprofen and fluids
  • Stay off school/work for 4 days after development of rash
  • Avoid contact with people not vaccinated, infants, pregnant women or immunocompromised
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80
Q

Management of measles - if susceptible and >1, pregnant or immunosuppressed?

A

o Give immediate MMR vaccine

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81
Q

Management of measles - if immunocompromised?

A

o Ribavirin

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82
Q

Prognosis of measles?

A

o Most people with measles make full recovery after a week

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83
Q

Complications of measles?

A 
-	Common
o	Otitis Media
o	Pneumonia
o	Tracheobronchitis
o	Diarrhoea
  • Rare
    o Convulsions
    o Encephalitis
    o Subacute Sclerosing Panencephalitis
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84
Q

Definition of mumps? Incubation time? Infective?

A
  • Acute infection caused by RNA paramyoxavirus
  • Droplet/Saliva spread and replicates in upper respiratory mucosa
  • Incubation time - 14-21 days
  • Infective – 7 days before and 9 days after parotid swelling starts
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85
Q

Epidemiology of mumps?

A
  • Introduction of MMR has reduced rates of mumps
  • 90% in people >15
  • Rare in children <1 due to passive immunity
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86
Q

Risk factors of mumps?

A
  • Likely in unimmunised, recent contact or outbreak of mumps in local area
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87
Q

Symptoms of mumps?

A

o Prodromal malaise
o High temperature
o Painful parotid swelling (typically one side first, then bilateral in 70%)
 Ear lobe deflected upwards and outwards
 Angle of mandible obscured
 Pain when chewing, speaking

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88
Q

Investigations of mumps?

A
  • Clinical Diagnosis

- Confirmed by saliva sample to detect presence of IgM mumps antibody

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89
Q

Management of mumps - notify public health?

A

o Arrange testing kit through saliva swab

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90
Q

Management of mumps -general advice?

A

o Self-limiting – resolves over 1-2 weeks
o Bed Rest
o Drink adequate fluids
o PRN paracetamol and ibuprofen
o Warm/Cold packs to parotid gland
o OFF SCHOOL/WORK FOR 5 DAYS AFTER INITIAL DEVELOPMENT OF PAROTIDITIS
o 1-week follow up to check symptoms resolving and immunised

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91
Q

Management of mumps -contacts?

A

o Offer MMR if not fully immunised

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92
Q

Management of mumps -pregnant women?

A

o Manage in same way, MMR is CI in pregnancy

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93
Q

Management of mumps -if epididymo-orchitis diagnosed?

A

o Symptomatic relief
o Symptoms should resolve in 2 weeks
o If concerned about fertility issues, offer semen analysis 3 months after mumps resolved
 If abnormal then refer to fertility specialist

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94
Q

Management of mumps -admission?

A

o Mumps encephalitis or meningitis

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95
Q

Prognosis of mumps?

A

o Self-limiting disease that resolves within 1-2 weeks and most recover without any long-term complications

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96
Q

Complications of mumps?

A 
o	Usually none
o	Parotiditis
o	Epididymo-orchitis (+/- infertility)
o	Oophoritis
o	Arthritis
o	Meningitis
o	Pancreatitis
o	Myocarditis
o	Deafness
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97
Q

Definition of rubella? Transmission? Incubation period? Infectivity?

A
  • Infectious RNA togaviridae viral illness, Rubella virus spread via air-droplets
  • Known as German measles or three-day measles
  • Transmitted by droplet spread or via placenta to foetus
  • Incubation period = 14-21 days
  • Infectious: most infectious when rash erupting but 7 days before to 7 days after rash appears
  • Prevention of Spread – MMR vaccine at 12-15 months, booster at 4-6 years
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98
Q

Epidemiology of rubella?

A
  • 1/25,000

- Peak age: >15 years

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99
Q

Risk Factors of rubella?

A
  • Malnutrition, not immunised, immunocompromised, contact with Rubella
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100
Q

Symptoms if caught during pregnancy of rubella? ?

A

o Teratogen during pregnancy
 Infection before 8 weeks leads to cataracts, congenital heart defects and deafness
• Congenital Rubella Syndrome

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101
Q

Symptoms of rubella?

A
  • Clinical Features 2-3 weeks after exposure and include:
    o Rash – Pink or light red maculopapular rash starts on face which spreads to chest, upper arms, abdomen and thighs
    o Lymphadenopathy (suboccipital, postauricular and cervical lymph nodes)
    o Arthralgia and arthritis
    o Malaise
    o Low-grade Fever
    o Headache
    o Coryza
    o Non-purulent conjunctivitis
102
Q

Investigations of rubella?

A
  • Clinical diagnosis

- Confirmed by serology &/ or viral culture

103
Q

Management of rubella - notifying HPT?

A

o Notifiable disease – inform HPT
o Discuss need for testing
 Immediate oral fluid sample for serology and PCR may be requested – if positive then further testing needed
 May need to test for other infections

104
Q

Management of rubella - general advice?

A

 Normally self-limiting – resolve within 1 week
 Supportive – Antipyretics, keep hydrated
 Avoid school for 5 days after development of rash
 Avoid contact with pregnant women

105
Q

Management of rubella - pregnant women - if confirmed and <20 weeks?

A

 Refer urgently to obstetrics for risk-assessment (lower gestation, the higher risk of CRS)

106
Q

Management of rubella - pregnant women - if confirmed and >20 weeks?

A

 Reassure that no reported cases of CRS after this age

 Give rubella vaccine post-partum only

107
Q

Complications of rubella in healthy people?

A

o Arthritis and arthralgia

o Encephalitis rare

108
Q

Complications of rubella in pregnant women?

A

Miscarriage, stillbirth and Congenital Rubella Syndrome
o Cataracts, hearing impairment, PDA and pulmonary artery stenosis, microencephaly, mental retardation, IUGR, autism, DM and thyroid dysfunction

109
Q

Definition of Chicken Pox?

A
  • Highly infectious disease caused by herpes virus transmitted by air droplets
  • VZV infection between 1-6yrs commonly —winter/spring
110
Q

Transmission of Chicken Pox?

A
  • Transmission is by personal contact or droplet spread, with an incubation period (the time from becoming infected until symptoms appear) of 1-3 weeks
111
Q

Infectivity of Chicken Pox?

A
  • Chickenpox is infectious from 1-2 days before the rash appears until the vesicles are dry or have crusted over, usually 5 days after the onset of the rash
112
Q

What is Herpes Zoster Virus?

A
  • Herpes Zoster (shingles)
    o a reactivation of the latent infection may occur -> vesicular lesions in the distribution of the sensory nerve. Increased risk in immunosuppressed
113
Q

Epidemiology of Chicken Pox?

A
  • Incidence is highest before 10 years of age
  • > 90% of people older than 15 years of age UK are immune
  • Peak incidence from March-May
114
Q

Cause of Chicken Pox?

A
  • Caused by varicella-zoster virus (VZV)
115
Q

Symptoms of Chicken Pox?

A

Prodrome:

  • Infection begins 2 days before vesicles appear
  • Infection ends when last vesicle crusts over

Rash:

  • Head and trunk rest of body.
  • Red macules papulevesiclepustulecrusting
  • Crusting within 5 days and fall off after 1-2 weeks

Other features: headache, anorexia, URTI (sore throat, coryza, cough), fever and itching

116
Q

Investigations of Chicken Pox?

A

Ex: Characteristic rash, its distribution and progression

Laboratory tests, rarely required

117
Q

Management of Chicken Pox - general advice?

A

o Usually self-limiting
o Encourage fluid intake
o Wear smooth, cotton fabrics
o Keep nails short to minimise damage from scratching
o Avoid contact with immunocompromised, pregnant women and infants <4 weeks until 5 days after rash
o School/nursery exclusion until all lesions crusted over

118
Q

Management of Chicken Pox - symptomatic advice?

A

o Paracetamol
o Calamine lotion
o Chlorphenamine

119
Q

Management of Chicken Pox - if >14, presenting within 24 hours of rash and severe or risk of complications (smoker)?

A

o Consider Aciclovir PO 800mg 5x/day

120
Q

Management of Chicken Pox -admission?

A
  • Admit if severe complications (pneumonia, encephalitis, dehydration)
121
Q

Management of Chicken Pox - pregnant women - admission?

A
  • Admit to hospital if pregnant woman has:
    o Respiratory symptoms, neurological symptoms, haemorrhagic rash or bleeding, dense rash with mucosal lesions, immunosuppressed
  • All other women:
    o Seek specialist advice from obstetrician
122
Q

Management of Chicken Pox - pregnant women - drug management?

A

o Oral aciclovir

o Symptomatic Treatment
 Paracetamol
 Calamine lotion

123
Q

Management of Chicken Pox - pregnant women - general advice?

A

 Usually self-limiting
 Encourage fluid intake
 Wear smooth, cotton fabrics
 Keep nails short to minimise damage from scratching
 Avoid contact with immunocompromised, pregnant women and infants <4 weeks until 5 days after rash
 School/nursery exclusion until all lesions crusted over

124
Q

Manageemnt of exposure to chicken pox?

A
  • Significant exposure if mother, continuous home contact, contact in same room for 15 minutes, face to face contact
  • If pregnant woman and never had chicken pox – Test for IgG VZV and if negative seek specialist advice
  • If immunocompromised or neonate – immediate specialist advice
125
Q

Complications of Chicken Pox in pregnancy?

A
  • Varicella in pregnancy can result in severe chickenpox
  • Infection during 1st 28 weeks of pregnancy can lead to intrauterine infection and foetal varicella syndrome
    o Skin scarring in dermatomal distribution, microphthalmia, chorioretinitis, cataracts, hypoplastic limbs, microcephaly
126
Q

Complications of Chicken Pox?

A
  • Secondary bacterial infection
    o Due to staphylococcal/streptococcal leading to toxic shock syndrome or necrotising fasciitis
  • Encephalitis
    o Cerebellitis, meningitis
  • Purpura fulminans
    o Vasculitis in the skin due to cross-reactivity of antiviral antibodies
  • Immunocompromised can disseminate causing pneumonitis/DIC – fatal 20%
127
Q

Definition of whooping cough?

A
  • Pertussis - a highly infectious form of bronchitis
128
Q

Epidemiology of whooping cough?

A
  • Usually epidemics every 3-4 years

- Incidence is increasing

129
Q

Risk factors of whooping cough?

A

o Young Infants
o Unvaccinated children
o Immunocompromised

130
Q

Cause of whooping cough?

A
  • Caused by Bordetella pertussis

- Spread with close contact of air-born droplets

131
Q

Symptoms of whooping cough - catarrhal phase?

A 
	Nasal discharge
	Conunctivitis
	Malaise
	Sore throat
	Low-grade fevfer
	Dry, unproductive cough
132
Q

Symptoms of whooping cough - paroxysmal phase?

A

o Paroxysmal Phase (1-6 weeks)
 Coughing fits (paroxysms)
 Short expiratory burst followed by inspiratory gasp, causing whoop sound
 More common at night and triggered by stimulus (cold, noise)
 Can cause cyanosis, post-tussive vomiting

133
Q

Symptoms of whooping cough - convalescent phase?

A

o Convalescent Phase (3 months)

 Gradual improvement in cough

134
Q

Signs of whooping cough?

A

o During paroxysm child goes red or blue in face
o Whoop may be absent in infants
o Apnoeas common in infants
o Epistaxis and sub-conjunctival haemorrhages can occur after vigorous coughing
o Exhausted by coughing

135
Q

Diagnosis of whooping cough?

A 
-	Clinical Diagnosis
o	If acute cough >14 days without cause and has:
	Paroxysmal cough
	Inspiratory whoop
	Post-tussive vomiting
	Undiagnosed apnoeic attack in infants
136
Q

Management of whooping cough - notification and testing?

A
  • Notify local Public Health England centre within 3 days

o If cough <2 weeks – culture nasopharyngeal aspirate or swabs

o If <3 weeks duration – PCR testing of nasopharyngeal/throat swabs

o If cough >2 weeks – anti-pertussis toxin IgG detection in serology (over 16) or oral fluid (children 5-16 years)

137
Q

Management of whooping cough - when is diagnosis confirmed?

A

Bordetella pertussis on aspirate/swab, PCR detection of pertussis or anti-pertussis toxin IgG in serum/oral fluid in abscnece of vaccine within the last year

138
Q

Management of whooping cough - admit?

A

o <6 months and acutely unwell
o Apnoeas/Severe paroxysms/Cyanosis
o Complication (seizures, pneumonia)

139
Q

Management of whooping cough - general measures?

A

o Rest
o Adequate fluid intake
o Paracetamol and ibuprofen
o Avoid school/work/nursery until 48 hours of antibiotics or 21 days after onset of cough

140
Q

Management of whooping cough - antibiotic therapy?

A 
o	If onset of cough within 21 days:
	Clarithromycin if <1 month of age
	Clarithromycin or azithromycin if >1 month old
	Erythromycin in pregnant women
•	Alternative – co-trimoxazole
141
Q

Management of whooping cough - antibiotic prophylaxis - who?

A

When case within 21 days and close contacts in one of these groups:

 Group 1 – unimmunised infant born <32w <2m, unimmunised infant born >32w and <2m if mother did not have pertussis vaccine, infant >2m who are unimmunised
 Group 2 – Pregnant woman >32 weeks, healthcare worker with infants or pregnant women, people sharing household with infant too young to vaccinated

142
Q

Management of whooping cough - antibiotic prophylaxis - what?

A

 Clarithromycin if <1 month of age
 Clarithromycin or azithromycin if >1 month old
 Erythromycin in pregnant women
• Alternative – co-trimoxazole

143
Q

Definition of gastro-enteritis?

A
  • Decreased stool consistency from water, fat or inflammatory discharge
144
Q

Classification of gastro-enteritis?

A
  • Acute <2 weeks

- Persistent >2 weeks

145
Q

Definition of dysentery?

A

o Loose stools with blood and mucus
o Organisms that cause bloody diarrhoea include campylobacter, entamoeba histolytica, E.coli, salmonella serotypes and Shigella

146
Q

Definition of Traveller’s Diarrhoea?

A

o Diarrhoea starting during or shortly after foreign travel

o Organism most commonly E.coli, Salmonella, Viruses, Cryptosporidium, Giardia

147
Q

Common causes of diarrhoea?

A 
-	Common Causes
o	Gastroenteritis
o	Parasites/protozoa
o	IBS
o	Colorectal cancer
o	IBD
-	Drugs
o	Antibiotics, PPI, NSAIDs, laxative, alcohol, cytotoxics
-	Rarer Causes
o	Chronic pancreatitis, laxative abuse, lactose intolerance, overflow diarrhoea, ileal resection, thyrotoxicosis, Ischaemic colitis
148
Q

Cause of gastro-enteritis?

A

o Often contaminated food, usually meat, egg or milk products which been prepared inadequately

149
Q

Types of diarrhoea and their cause?

A

o Bloody Diarrhoea
 Campylobacter, Shigella/Salmonella, E.coli, amoebiasis
 IBD, colorectal cancer, colonic polyps, colitis
o Mucous
 IBS, colorectal cancer, polyps
o Frank Pus
 IBD, diverticulitis, abscess or fistula
o Explosive
 Cholera, giardia, rotavirus

150
Q

Important history questions in gastro-enteritis?

A

o Important questions – duration, frequency, food and water intake, cooking method, time until onset, other diners affected, any swimming or canoeing

151
Q

Assessment of dehydration in gastro-enteritis?

A

o Mild – anorexia, nausea, light headedness, postural hypotension

o Moderate – tiredness, dizziness, nausea, headache, muscle cramps, dry tongue, sunken eyes, reduced skin turgor, tachycardia, oliguria

o Severe – Profound apathy, weakness, confusion, shock, tachycardia, peripheral vasoconstriction, low BP, anuria/oliguria

152
Q

Investigations in gastro-enteritis?

A

o FBC, ESR/CRP, U&E, TSH, coeliac serology

153
Q

When to do stool culture in gastro-enteritis?

A

o Only used if patient has been abroad, severely ill, prolonged symptoms or works as food-handler

154
Q

Food associated with S.aureus?

A

Meat

155
Q

Food associated with Bacillus Cereus?

A

Rice

156
Q

Food associated with Salmonella?

A

Meat, eggs, poultry

157
Q

Food associated with C.botulinum?

A

Processed food

158
Q

Food associated with V.cholerae?

A

Water

159
Q

Associated with C.diff?

A

Abx associated

160
Q

Food associated with Campylobacter?

A

Milk, poultry, water

161
Q

Food associated with Listeria?

A

Cheese, pate

162
Q

Associated with E.coli 0157?

A

HUS

163
Q

Associated with norovirus?

A

Faecal oral spread, very contagious

164
Q

Food associated with Shigella?

A

Any Food

165
Q

Management of gastroenteritis - prevention?

A

o Hygiene (hand, water sources, no ice cubes, salads)
o Eat only freshly prepared hot food
o Food handlers – no work until stool samples negative

166
Q

Management of gastroenteritis - symptomatic treatment?

A

 Usually self-limiting
 Maintain oral intake
 ORT (Dioralyte) – contains glucose, Na, K, Cl
 Loperamide if mild-to-moderate traveller’s diarrhoea
• Avoid in bloody or inflammatory dysentery and significant abdominal pain

167
Q

Management of gastroenteritis - when to admit?

A

seriously ill, dehydrated >5%, high fever, infants

168
Q

Management of gastroenteritis - Fluid therapy if shocked?

A

IV saline bolus 500ml (in children 20ml/kg)

169
Q

Management of gastroenteritis - Fluid therapy if not shocked?

A

Encourage oral intake (in children – ORS 50ml/kg, continue breastfeeding, avoid fruit jucie and carbonated drinks)

170
Q

Management of gastroenteritis - IV Fluid therapy if adult?

A

IV fluids 0.9% saline + 20mmol/L K/L IVI

171
Q

Management of gastroenteritis - IV Fluid therapy if child?

A

Deficit 0.9% NaCl (100ml/kg if shocked, 50ml/kg if not),

Maintenance (100ml/kg/day for 1st 10kg, 50ml/kg/day for 2nd 10kg, 20ml/kg/day for subsequent kg)

172
Q

Management of gastroenteritis - antibiotic therapy?

A

• Ciprofloxacin

o If systemically unwell, elderly, immunosuppressed, Salmonella, shigella or campylobacter

173
Q

Definition of malaria?

A
  • Infection of RBCs by plasmodium parasites including:

o P.falciparum, P.vivax, P.ovale, P.malariae

174
Q

Transmission of malaria?

A
  • Transmission through bite of infected female Anopheles mosquito
    o Sporozoite inoculated into humans in saliva of mosquito
    o Travels in blood stream to the liver, enter liver cells and mature into schizonts which rupture and release thousands of merozoites
    o Each merozoite infects a RBC where they divide and reupture
  • Found in tropical and subtropical area
175
Q

Causes of malaria and their distribution?

A

.falciparum – African continent, most common, incubation 7-10 days and symptoms recur 36-48 hourly
o P.vivax – Asia, Latin America, Africa, incubation period 10-17d and can remain dormant for months
o P.ovale – Africa, western Pacific, dormant for months
o P.malariae – South America, Asia, Africa, chronic infection, incubation 18-40d, recurs 72 hourly
o P.knowlesi – from monkeys in Asia, can be fatal

176
Q

Features of malaria?

A

o Usually present within 6 months of exposure

177
Q

Symptoms of malaria?

A 
o	Fever (often >39o, and spikes), sweat, chills
	Shivering <1h
	Hot, fever 2-6h
	Sweats as temperature falls
o	Headache
o	Malaise, lethargy, fatigue
o	Anorexia, nausea, vomiting, diarrhoea
o	Myalgia, arthralgia
o	Sore throat, cough
178
Q

Symptoms of severe malaria?

A 
o	Cerebral – GCS <11 or seizures
o	Renal impairment
o	Acidosis
o	Hypoglycaemia
o	RDS
o	Anaemia
o	Bleeding
o	Shock, sepsis
179
Q

Bloods taken in malaria?

A

o Thick and thin blood film microscopy

o Antigen Detection Test

180
Q

Management of malaria - prevention?

A

Avoid travel if high risk (pregnant, child, age >70, immunosuppression)

Avoid risk factors:
 Outside between dusk and dawn, unscreened accommodation

PPE: insect repellent (20% DEET or icardin), protective clothing, insecticide impregnated bed nets

Chemoprophylaxis
 Start 1 week before travel, for 4 weeks
 Chloroquine, mefloquine, proguanil hydrochloride

Standby emergency medication if remote areas without medical facilities for 24 hours

Upon return - if develop any illness within 1st 3 months to see doctor immediately

181
Q

Management of malaria -admission of acute infection?

A

o Admit any person with suspected severe or complicated malaria, falciparum malaria, pregnant, child or >65

182
Q

Management of malaria - discussion in anyone with suspected malaria?

A

o Urgently discuss all other patients with ID specialist with view to admission for rapid blood testing
o Notify PHE

183
Q

Management of malaria - general advice?

A

 Warn that if family members get symptoms to see doctor
 Notified to PHE
 Relapses can occur
 Excluded from blood donation

184
Q

Management of malaria -immediate referral to ID or MAU for blood testing?

A
  • Severe, complicated or falciparum malaria
  • Pregnant
  • Child
  • > 65 years
185
Q

Management of malaria - testing in ID or MAU?

A

• Thick and thin blood films
o If negative, further blood test 12-24 hours later and again after 24 hours
o Calculate percentage of RBC parasitized

  • Antigen Detection Test if blood films not available
  • FBC (anaemia, thrombocytopenia), Clotting (DIC). Glucose (low), U&E (renal failure)
  • ABG (lactic acidosis)
  • Urinalysis (protein, blood, casts)
  • Blood Culture – rule out sepsis
186
Q

Management of malaria - drug management - if species not known?

A

o Artemether with lumefantrine (ACT)
o Quinine
o Atovaquone with proguanil

187
Q

Management of malaria - drug management -if uncomplicated falciparum malaria?

A

 Artemether with lumefantrine (ACT)
 Atovaquone with proguanil
 Quinine (IV if severe)
• Oral given for 5-7 days, with or followed by oral doxycycline for 7 days

188
Q

Management of malaria - drug management - if complicated falciparum malaria?

A

 IV Artesunate or Quinine

189
Q

Management of malaria - drug management - if non-falciparum malaria (P.v, P.o, P.m, P.k)?

A

o Chloroquine
o If resistant then use artemether-lumefantrine
o If P.v or P.o – use chloroquine + primaquine after for 14 days

190
Q

Management of malaria - drug management - cerebral malaria?

A

 Manage fluids
 Haemofiltration
 Ventilation
 Exchange transfusion if severe

191
Q

Prognosis of malaria?

A

o If identified, appropriate treatment is given and no organ dysfunction – most people make rapid recovery
o If delayed – severe or fatal malaria can develop
o Death more likely in >65
o In pregnancy – pulmonary oedema and hypoglycaemias

192
Q

Complications of malaria?

A 
o	Cerebral malaria
o	ARDS
o	Coagulopathy
o	Sepsis
o	Severe anaemia
o	Hypoglycaemia
o	Metabolic acidosis
o	AKI
o	Nephrotic syndrome
193
Q

Symptoms pointing towards diagnosis in febrile traveller - jaundice?

A 
	Viral hepatitis
	Cholangitis
	Liver abscess
	Leptospirosis
	Typhoid
	Malaria
	Dengue fever
	Yellow fever
194
Q

Symptoms pointing towards diagnosis in febrile traveller - splenomegaly?

A

 Malaria

 Leishmaniasis

195
Q

Symptoms pointing towards diagnosis in febrile traveller - D&V?

A 
	E.coli (Travellers)
	Salmonella
	Shigella
	Campylobacter
	Vibrio cholerae
196
Q

Symptoms pointing towards diagnosis in febrile traveller - hepatosplenomegaly??

A

 Malaria
 Typhoid
 Brucella

197
Q

Symptoms pointing towards diagnosis in febrile traveller - anaemia?

A

 Hookworm
 Malaria
 Haemolysis

198
Q

Symptoms pointing towards diagnosis in febrile traveller - bleeding?

A

 Viral haemorrhagic fevers

199
Q

Cause, incubation and spread of typhoid?

A
  • Caused by Salmonella typhi (typhoid) and S.paratyphi (types A, B, C) (paratypod)
  • Incubation – 3-21 day
  • Spread – Faecal-oral route
200
Q

Epidemiology of typhoid?

A
  • Type A most common

- S.typhi 10:1 S.paratyphi

201
Q

Risk factors of typhoid?

A

o H2RA, PPIs – reduced stomach acidity
o Immunosuppression
o Other infections
o SCD

202
Q

Symptoms of typhoid?

A

o Week One
 Diarrhoea after first week
 Malaise, headache, high fever, cough
 Relative Bradycardia – pulse slower than expected from temperature
 CNS signs (delirium, meningism, cerebellar signs, fits, coma)
 Rose spots – on trunk
 Epistaxis, bruising and splenomegaly

Week Two
 Sustained pyrexia, high fever, malaise and weakness
 Confusional state
 Rose spots – crops of macules in diameter that blanch on pressure
 Pea soup diarrhoea

203
Q

Investigations of typhoid?

A 
-	Bloods
o	LFTs raised
-	Blood culture – positive for 10 days
-	Stool culture
-	Bone marrow aspirate
-	Serology – Widal’s Test (measures agglutinating antibodies against antigens)
204
Q

Management of typhoid?

A
  • Notifiable in UK
  • IV fluids
  • Ciprofloxacin PO 500m BD for 10 days (Alternatives if Asia: ceftriaxone, azithromycin)
    o In severe give IV ceftriaxone + ciprofloxacin
  • In encephalopathy – dexamethasone
205
Q

Testing clearance of typhoid?

A

o 6 consecutive negative cultures of urine + faeces

o Treat with ciprofloxacin 500mg BD for 6 weeks if chronic carrier

206
Q

Complications of typhoid?

A 
o	Osteomyelitis
o	GI bleed
o	Cholecystitis
o	Myocarditis
o	Pyelonephritis
o	Meningitis
o	DVT
207
Q

Definition of Dengue Fever?

A
  • Mosquito-borne viral haemorrhagic fever, transmitted by female mosquitos (Aedes aegypti)
  • Most common self-limiting flu-like illness
  • RNA flavivirus
208
Q

Epidemiology of Dengue Fever?

A
  • Endemic in Africa, Americas, Southeast Asia

- 90% of severe dengue in <15 years old

209
Q

Risk factors of Dengue Fever?

A

o High population density
o Urban living
o Poor public hygiene
o Exposure to mosquitoes

210
Q

Symptoms of Dengue Fever?

A

o Flushes (neck, face, chest)
o Centrifugal maculopapular rash, progresses to confluent petechiae with pale areas of normal skin
o Headache
o Arthralgia
o Hepatosplenomegaly
o Haemorrhagic signs
 Petechiae, GI/gum/nose bleeds, haematuria, menorrhagia

211
Q

Monitoring of Dengue Fever?

A

o BP, urine output
o Bloods
 Prolonged APTT, WCC low, platelets low
o Tourniquet Test - >20 petechiae/inch2

212
Q

When is Dengue fever excluded?

A

o Symptoms start >2 weeks after leaving dengue area or if fever lasts >2 weeks, dengue ruled out

213
Q

Management of Dengue Fever?

A
  • IV resuscitation if needed
  • Paracetamol
  • Notifiable disease
214
Q

Cause of amoebiasis?

A
  • Caused by entamoeba histolytica

- Spread faecal-oral route

215
Q

Symptoms of amoebiasis?

A
  • Ameobic dysentery:
    o Starts slowly, becoming profuse and bloody
    o May remit and relapse
  • Amoebic colonic abscesses – may perforate causing peritonitis
-	Amoebic liver abscess
o	Single mass in right lobe containing ‘anchovy-sauce’ pus
o	High-swinging fevers, sweats, RUQ pain
o	Ix – High WCC, LFTs
o	Dx – PCR, Liver US/CT +/- aspiration
216
Q

Investigations of amoebiasis?

A
  • Stool microscopy – trophozoites, blood, pus cells

- Faecal antigen detection

217
Q

Management of acute of amoebiasis?

A

o Metronidazole 800mg TDS PO for 5 days

o Then diloxanide furoate 500mg TDS for 10 days to destroy gut cysts

218
Q

Management of amoebic liver abscess?

A

o Tinidazole for 5 days

o US guided aspiration if not improving

219
Q

Definition of Traveller’s Diarrhoea?

A
  • Diarrhoea in travellers usually in first week or two of stay in foreign country
220
Q

Epidemiology of Traveller’s Diarrhoea?

A
  • High risk – Africa, Latin America, Middle East and Asia

- 20-60% of travellers

221
Q

Causative organism of Traveller’s Diarrhoea?

A
  • E.coli
222
Q

Symptoms of Traveller’s Diarrhoea?

A
  • Self-limiting diarrhoea for <72 hours usually

- Longer than 14 days suggests Giardia, Entameoba, Cryptosporidium

223
Q

Management of Traveller’s Diarrhoea?

A

o Often last a few days
o Keep hydrated – ORS good
o Avoid alcohol, coffee, tea
o Loperamide/Bismuth subsalicylate used for symptomatic relief

224
Q

Prevention of Traveller’s Diarrhoea?

A

o Boil water if in doubt
 Chlorination okay but does not kill amoebic cysts
o Avoid ice
o Avoid salads, peel your own fruit
o If cannot wash hands, discard food you are holding
o If Crohn’s or immunosuppressed – prophylactic antibiotics - ciprofloxacin

225
Q

Definition of Lyme Disease?

A
  • Tick-bourne infection caused by Borrelia burgdorferi
226
Q

Epidemiology of Lyme Disease?

A
  • Found in grassy, wooded area

- Increase in prevalence in April-June

227
Q

Symptoms of Lyme Disease?

A

o Folowing tick bite
o Erythema migrans – circular rash occurring at site of rash and can expand
 Bull’s eye/Target sign appearance – centre may clear
o Fatigue, chills, fever, headache, muscle and joint pain, lymphadenopathy

228
Q

Complications of Lyme Disease?

A

o Myocarditis, heart block, meningitis, neuropathy

229
Q

Diagnosis of Lyme Disease?

A
  • Clinical diagnosis
  • If Lyme Disease suspected without erythema migrans – offer ELISA test for Lyme Disease
    o If positive – perform immunoblot
230
Q

Prevention of Lyme Disease?

A

o Keep limbs covered, use insect repellent
o Remove ticks using fine tweezers to grasp tick very close to skin and pull body away
o Clean with soap and water

231
Q

Management of skin rash in Lyme Disease?

A

o Doxycycline 100mg BD for 21 days

 Alternative: Amoxcillin 1000mg TDS for 21 days, azithromycin 500mg for 17 days

232
Q

Management of severe Lyme Disease?

A

o IV benzylpenicillin or ceftriaxone

233
Q

Cause of cholera? Incubation and spread?

A
  • Cause – Vibrio cholerae (Gram-negative comma-shaped flagellated mobile rods) 01 and 0139
  • Incubation – few hours to 5 days
  • Spread – faecal-oral route
234
Q

Epidemiology of cholera?

A
  • Endemic in Africa, Asia, Middle East, South America
235
Q

Symptoms and signs of cholera?

A
  • Profuse rice-water diarrhoea, fever, vomiting and rapid dehydration
  • Sunken eyes, impaired consciousness, dry skin, reduced skin turgor, tachycardia, low BP
236
Q

Investigations of cholera?

A
  • Stool microscopy (+/- dark ground) and culture
  • Bloods
    o U&E, FBC
237
Q

Management of cholera - general measures?

A 
o	Notifiable Disease
o	Strict barrier measures
o	Rehydration
	ORS if mild
	IV saline if severe
238
Q

Management of cholera - Antibiotics?

A

o Oral erythromycin or ciprofloxacin stat may reduce fluid loss

239
Q

Management of cholera - prevention?

A 
o	Good hygiene methods
o	Only drink boiled or treated water
o	Cook all food well, eat hot
o	Avoid shellfish
o	Peel all vegetables
240
Q

Causes of schistosomiasis?

A
  • Caused by blood-dwelling schistosoma worms
241
Q

Life cycle of schistosomiasis?

A

o Snails release cercariae tjhat penetrate skin (during paddling), causes itchy popular rash
o Cercariae shed tails to become schistosomules, migrating via lungs to liver where they grow
o In 8 weeks, flukes mature and migrate to bladder and mesenteric veins, releasing eggs and causing granulomas and scarring

242
Q

Symptoms of schistosomiasis?

A
  • 2 weeks after incubation period

o Fever, urticaria, diarrhoea, cough, wheeze, hepatosplenomegaly

243
Q

Investigations of schistosomiasis?

A
  • Eggs in urine or faeces

- Antibody testing

244
Q

Management of schistosomiasis?

A
  • Praziquantel with food into 2 divided doses
245
Q

Complications of schistosomiasis?

A
  • Hydronephrosis

- SCC of bladder

246
Q

Antibiotic therapy used in gastroenteritis - Entamoeba histiolytica?

A

Mild to moderate - Metronidazole 400mg TDS for 5-10 days, followed by diloxanide 500mg TDS for 10 days

Amoebic dysentery - Metronidazole 800mg TDS for 5 days, followed by diloxanide 500mg TDS for 10 days

Alternative to Metronidazole is Tinidazole

247
Q

Antibiotic therapy used in gastroenteritis - Campylobacter?

A

Consider is severe, immunocompromised, symptoms worsening or >1 week

Erythromycin 250mg-500mg QDS for 5-7 days

Ciprofloxacin 500mg BD for 5-7 days - if macrolides cannot be taken

248
Q

Antibiotic therapy used in gastroenteritis - Cryptosporidium?

A

None

249
Q

Antibiotic therapy used in gastroenteritis - Giardia Intestinalis?

A

Metronidazole 400mg TDS for 5 days

Tinidazole is alternative

250
Q

Antibiotic therapy used in gastroenteritis - Salmonella & Shigella?

A

Consider if severe, elderly, immunocompromised, valve problems

Ciprofloxacin 500mg BD for 1 day (5 days if Shigella Dysenteriae)

Alternatives - azithromycin 500mg OD for 3 days

Year 5 Core Conditions (55 decks)

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