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Conditions + definitions > Infection - Travel related + microbial > Flashcards

Infection - Travel related + microbial Flashcards

1
Q

Why are travellers vulnerable to infection?

A

More likely to take risks when away from home
Different epidemiology of some diseases
Stress of travel

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2
Q

What are the infections related to water?

A 
Schistosomiasis 
Leptospirosis 
Liver Flukes 
Strongyloidiasis 
Hookworms 
Guinea Worms
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3
Q

What is the vector for malaria?

A

Female anopheles mosquito

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4
Q

What is the life cycle of malaria?

A

Mosquito bites human
Sporozoites go to liver + form merozoites
These enter red blood cells + make gametocytes in blood cells
Digested where gametocytes merge in mosquito and have more sporozoites

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5
Q

What are the species of malaria?

A 
Plasmodium falciparum (potentially severe)
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi
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6
Q

What are the symptoms of malaria?

A 
Fever
Rigors
Aching bones
Abdo pain
Headache
Dysuria
Frequency
Sore throat
Cough
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7
Q

What are the signs of malaria?

A

Splenomegaly
Hepatomegaly
Mild jaundice

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8
Q

What are the complications of malaria?

A 
Cerebral malaria (encephalopathy) 
Blackwater fever
Pulmonary oedema
Jaundice
Severe anaemia
Algid malaria (gram negative septicaemia)
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9
Q

How do you diagnose malaria?

A

Blood films
Quantitive buffy coat (centrifugion + UV micropscopy)
Rapid antigen tests (optimal + parasight-F)

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10
Q

What are the types of blood films used in malaria?

A

Giemsa

Fields stain

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11
Q

What determines complicated malaria?

A 
1+ of:
Impaired consciousness
Hypoglycaemia
Parasite count >2%
Haemoglobin <8mg/dl
Spontaneous bleeding
Haemoglobinuria
Renal impairment
Pulmonary oedema
Shock
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12
Q

What drugs are used for uncomplciated p. falcoparum malaria?

A

Riamet 3 days
Eurastesim 3 days
Malarone 3 days
Quinine 7 days

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13
Q

How do you treat complicated/sever p/ falciparum malaria?

A

IV artesunate –unliscenced

IV quinine + doxycyline

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14
Q

What are the causes of typhoid fever?

A

Salmonella typhi

Salmonella paratyphi

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15
Q

What are the predisposing factors for typhoid fever?

A

Poor sanitation

Unclean drinking water

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16
Q

What is the incubation period for typhoid fever?

A

1-4 weeks

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17
Q

What are the clinical features found in first week of typhoid fever?

A 
Fever
Headaches
Abdo discomfort
Constipation
Dry cough
Relative brachycardia
Neutrophillia
Confusion
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18
Q

What are the clinical features found in second week of typhoid fever?

A 
Fever peaks at 7-10 days
Rose spots
Diarrhoea
Tachycardia
Neutropenia
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19
Q

What are the complications possible in the third week of typhoid fever?

A

Intestinal bleeding
Perforation
Peritonism
Metastatic infections

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20
Q

What percentage of people relapse with typhoid fever (in 4th week)?

A

10-15%

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21
Q

How do you diagnose typhoid fever?

A

Clinical - evolution of features
Laboratory
Culture blood, urine + stool
Culture bone marrow

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22
Q

How do you treat typhoid?

A

Oral azithromycin - uncomplicated

IV ceftrixone or convern with reabsorption

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23
Q

What countires are most at risk of dengue fever?

A

Central belt (south america, africa, south asia

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24
Q

How is dengue fever transmitted?

A

Via mosquitoes

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25
Q

What is the presentation of dengue fever?

A

Sudden fever + headache (retro-orbital pain)
Severe myalgia + arthralgia
Macular/maculopapular rash
Haemorrhagic signs (petechia, purpura, positive tourniquet test)

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26
Q

How do you diagnose dengue fever?

A 
Lab tests - PCR, serology
Clinically - thrombocytopenia
Leucopenia
Elevated transaminases
Positive tourniquet test
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27
Q

How do you treat/manage dengue fever?

A

No specific agents to treat, managing complications

PREVENTION - avoid bites + vaccine

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28
Q

What organisms are responsible for schistosomiasis?

A

S. Haematobium
S. Mansoni
S. Japonicum

Freshwater snails

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29
Q

What are the types of schistosmiasis?

A

Hepatic/intestinal

Urinary

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30
Q

What i the demography od dengue fever?

A

Central belt - Africa, south America, Asia

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31
Q

What is the life cycle of schistosomiasis?

A

Eggs hatch, releasing miracidia
These penetrate snail tissue
Cercaria released by snail into water (free swimming)
Loses tail when penetrate human skin
Migrate into portal blood in liver + mature
Released by urine/faeces

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32
Q

What are the clinical features in the first day of schistosomiasis?

A

Swimmer’s itch 1st few hours but clear

Invasive stage after 24 hours (cough, abdo discomfort, splenomegaly, eosinophilla)

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33
Q

What complication can develop from schistosomiasis from 15-20 days?

A

Katayama fever

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34
Q

What are the clinical features of katayama fever?

A 
Fever 
Urticaria 
Lymphadenopathy 
Splenomegally 
Diarrhoea 
Eosinophilia
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35
Q

What is the acute disease phase of Schistosomiasis?

A

Eggs are deposited into bowel or bladder

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36
Q

How do you diagnose Schistosomiasis?

A

Antibody test
Clinical features
Ova in stools/urine
Rectal snip

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37
Q

How do you treat schistosomiasis?

A

praziquantel 2 doses 6 hrs apart (20mg/KG)

Prednisolone if severe

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38
Q

What are the clinical features of rickettsiosis?

A 
Abrupt onset of swining fever
Heache
Confusion
Endovasculitis
Rash
Bleeding
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39
Q

How do you diagnose rickettsiosis?

A

Clinical features + serology

40
Q

How do you manage rickettsiosis?

A

Tetracycline

41
Q

How is rickettsiosis spread?

A

Via tick typhus

42
Q

How do you manage viral haemorrhagic fever?

A

Rule out common severe infections first
Isolation in high security infection unit
Supportive treatment

43
Q

What is responsible for the zika virus?

A

Flavivirus

Transmitted via Aedes mosquitoes, sexual contact + blood

44
Q

What are the clinical features of the zika virus?

A

None or mild symptoms
Headaches, conjunctivitis, , joint pains
Can cause guillian barre

45
Q

What is the treatment for zika virus?

A

No antivirals, just supportive

46
Q

What travel related infections have a rash?

A

Typhoid
Typhus
Dengue

47
Q

What travel related infections have jaundice?

A

Hepatitis
Malaria
Yellow fever

48
Q

What travel related infections have abnormal lymph nodes?

A

Leishmania

Trypanosmoiasis

49
Q

What travel related infections have abnormal liver signs?

A

Malaria
Typhoid
Amoebic abscess

50
Q

What travel related infections have abnormal spleen signs?

A

Visceral leishmaniasis
Typhoid
Malaria

51
Q

What are the main targets for anti-viral agents?

A

Stages in the life cycle - most intracellular

As viralstatic and not viralcidal, they aime to inhibit more viral functions than host functions

52
Q

What are the types of viral treatment?

A

Prohylaxis - prevention
Pre-emptive - infected but no symptoms
Overt disease
Supression therapy - to keep viral load low

53
Q

When do you use an antiviral in herpres simplex?

A

If mucocutaneous (oral, genital etc)
Encephalitis
Immuno compromisied

54
Q

When do you use antivirals in chickenpox?

A

Neonates
Immunocompromised
Pregnant

55
Q

When do you use antivirals in shingles?

A

Elderly/immunocompromised

Only immunocomptetnt host if within 72 hours of onset

56
Q

What antivirals are used for HSV/VZV? (herpes/chickenpox)

A

Acicilovir (oral, IV eye oinment or topical)

Valacicilovir - oral

57
Q

What is the MOA for aciclovir?

A

Converted to ACVMP by virus
ACVMP converted to ACV-TP by host
This competitively inhibits HSV-specific DNA polymerase

Prevents further DNA synthesis without affecting normal processes

58
Q

When do you treat CMV infections?

A

Only life threatening as significant toxcitity
Eg HIV - colitis + retinitis
Transplant recpients - penumonitis

59
Q

What agents are used in CMV?

A

Ganciclovir (IV
Valganciclovir - oral
Cidofovir IV

60
Q

What antivirals are used in chronic hepatitis B

A

Pegylated interferon alpha
Neculoside analogues
Tenofovir, adefovir, entecavir etc

61
Q

What antivirals are given for chronic hep C?

A

Pegylated interferon alpha + ribavirin
Sometimes protease inhibitor on top

Elvolving field

62
Q

When do you test for viral resistance to antivirals?

A

After 7 days in immunocomprimised if no response

63
Q

What agents cause soft tissue infections?

A

Streptoccous pyogenes
Staph A
Strep group C/G

E coli
Pseudoaeruginosa
Clostridium sp.

64
Q

What bacterium cause pneumonia?

A 
Strep pneumonia
Haemphilius influenzae
Staph A
Klebsiella pneumonia
Moraxella catarrhalis
Mycoplasma pneumonia
Legionella pneumoia 
Chlamydia pneumonia
65
Q

When are bactericidal and bacteristatic indicated?

A

Cidal - when need to kill organims quickly
E.g mengitis, endocarditis, neutropenia

Static - toxin mediated disease

66
Q

What are the common side effects from antibiotics?

A 
GI - nausea/vommiting/diarrhoea
C. diff
Candida
Liver toxicity
Renal toxciity
Neurological problems
Haemalogical
67
Q

What drugs cause candida?

A

Broad spectrum antibiotics

Cephlasporins

68
Q

What drugs cause liver damage/problems?

A

All drugs, but especially tetracyclines + TB drugs

More likely if pre-exisitng disease

69
Q

What drugs cause renal damage?

A

Gentamicin
Vancomycin

More likely if pre-exisiting disease

70
Q

What drugs cause adverse neurological effects?

A

Ototoxcity - gentamcin/vancomycin
Optic nuropathy - ethanbutol (TB)
Convulsions/encephalopathy - penicillins, cephlasporin
Peripheral neuropathy - isoniazid (TB), metronidazole

71
Q

What are the adverse haemtological effects caused by some antibiotics?

A 
Marrow-toxcity
Megoblastic anemia (co-trimoxazole)
72
Q

What are the classes of antimicrobials?

A 
b lactams (penicillins + cephlasporins)
Aminoglycacides
Macrolides
Quinolones
Glycopeptides
Antifungals
Antivirals
73
Q

Which drugs act to inhbit cell wall syntheiss?

A

B lactams + glycopeptides (vancomycin + teicoplanin)

74
Q

Which drugs act to inhibt protein syntehsis?

A

Aminoglycosides (gentamicin)
Macrolides (clairthromycin)
Tetracylcines (doxyxycline)
Ozazolidinoes (linezolid)

75
Q

Which drugs act to inhibit nucleic acid synthesis?

A

Trimetroprim
Sulfonamides (sulfamethoxazole)
Quinolones (ciprofloxacin

76
Q

What are the different penicillins?

A 
Benzylpenicillin
Amoxicillin
Fluclocacilin
Co-amoxiclav
Piperacillin
77
Q

When do you use benzylpenicillin?

A

Bacteria:
Streptococci
Neisseria
Spirochetes

Infections:
Soft tissue
Pneumococcal
Menigiococcal
Gonorrhoa
Syphilis
78
Q

When do you use amoxicillin?

A

Broad spectrum

Infections:
UTI
RTI

79
Q

When do you use flucloxacillin?

A

Staphylococci - main uses Staph A

80
Q

When do you use co-amoxiclav?

A

Braod spectrum - includes anerobes

Infections
UTI
RTI
Soft tissue
Surgical wound infections
81
Q

When do you use piperacillin/tazobactam?

A

Broad spectrum incl pseudomonas, anaerobes

Infections - neutropenic sepsis

82
Q

What are the types of cephlasporins

A

1st gen - cefradine
2nd gen - Cefuroxine
3rd gen - Ceftriaxone, ceftazidime

83
Q

When do you use cefradine?

A

Broad spectrum

Used in UTI + spft tissue infection

84
Q

When do you use cefuroxime?

A

Broad spectrum

UTIs
RTIs
Surgical prophylaxis

85
Q

When do you use ceftriaxone?

A

Broad spectrum - very good against gram negative bacilli

Hospital infections + bacteraemia
Pneumonia
Abdo sepsis

86
Q

When do you use ceftazidime?

A

Broad spectrum, useful against gram neg bacilli + pseudomonas

Pseudomonal infections in hospital + CF

87
Q

When do you use aminoglycosides?

A

(eg gentamicin)
Gram-neg bacilli

For serious gram-negative infections

Ie bacteraemia
Endocarditis
Neutropenic sepsis

88
Q

What are the types of macroolides?

A

Clarithromycin
Erythromycin
Azithromycin

89
Q

When do you use clarithromycin? (and erythromycin)

A 
Bacteria:
Streptococci
Staphylococci
Myoplasma
Chlamyia
Legionella

Infections:
Resp infection
Soft tissue infection

90
Q

When do you use azithromycin?

A

Good for gram negative (haemophilus, chlamydia)

Used for chlamydia

91
Q

What are the types of quinolones?

A

Ciprofloxacin

Levofloxacin

92
Q

When do you use ciprofloxacin?

A

Gram negative bacilli
Includes pseudomonas

Used in complicated UTIs
Complicated hospital acquired pneumnia

93
Q

When do you use levofloxacin?

A

Active against staph/strepococci + [neumococcus
Mycoplasma
Chlamydia
Legionella

2nd/3rd line for penumonia

94
Q

When do you use glycopeptides?

A

Gram positive bacteria only
MRSA
Allergy to penicillin

95
Q

What are some other antibiotics?

A 
Trimethoprim
Co-trimoxazole
Clindamycin
Tetracycline
Rifampicin
Meropenem
Metronidazole
Linezolid
Daptomycin
Tigecycline
96
Q

When do you use trimpthropin

A

UTIs

MRSA

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