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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
What is the presentation of dengue fever?
Sudden fever + headache (retro-orbital pain) Severe myalgia + arthralgia Macular/maculopapular rash Haemorrhagic signs (petechia, purpura, positive tourniquet test)
26
How do you diagnose dengue fever?
``` Lab tests - PCR, serology Clinically - thrombocytopenia Leucopenia Elevated transaminases Positive tourniquet test ```
27
How do you treat/manage dengue fever?
No specific agents to treat, managing complications | PREVENTION - avoid bites + vaccine
28
What organisms are responsible for schistosomiasis?
S. Haematobium S. Mansoni S. Japonicum Freshwater snails
29
What are the types of schistosmiasis?
Hepatic/intestinal | Urinary
30
What i the demography od dengue fever?
Central belt - Africa, south America, Asia
31
What is the life cycle of schistosomiasis?
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
32
What are the clinical features in the first day of schistosomiasis?
Swimmer's itch 1st few hours but clear | Invasive stage after 24 hours (cough, abdo discomfort, splenomegaly, eosinophilla)
33
What complication can develop from schistosomiasis from 15-20 days?
Katayama fever
34
What are the clinical features of katayama fever?
``` Fever Urticaria Lymphadenopathy Splenomegally Diarrhoea Eosinophilia ```
35
What is the acute disease phase of Schistosomiasis?
Eggs are deposited into bowel or bladder
36
How do you diagnose Schistosomiasis?
Antibody test Clinical features Ova in stools/urine Rectal snip
37
How do you treat schistosomiasis?
praziquantel 2 doses 6 hrs apart (20mg/KG) | Prednisolone if severe
38
What are the clinical features of rickettsiosis?
``` Abrupt onset of swining fever Heache Confusion Endovasculitis Rash Bleeding ```
39
How do you diagnose rickettsiosis?
Clinical features + serology
40
How do you manage rickettsiosis?
Tetracycline
41
How is rickettsiosis spread?
Via tick typhus
42
How do you manage viral haemorrhagic fever?
Rule out common severe infections first Isolation in high security infection unit Supportive treatment
43
What is responsible for the zika virus?
Flavivirus | Transmitted via Aedes mosquitoes, sexual contact + blood
44
What are the clinical features of the zika virus?
None or mild symptoms Headaches, conjunctivitis, , joint pains Can cause guillian barre
45
What is the treatment for zika virus?
No antivirals, just supportive
46
What travel related infections have a rash?
Typhoid Typhus Dengue
47
What travel related infections have jaundice?
Hepatitis Malaria Yellow fever
48
What travel related infections have abnormal lymph nodes?
Leishmania | Trypanosmoiasis
49
What travel related infections have abnormal liver signs?
Malaria Typhoid Amoebic abscess
50
What travel related infections have abnormal spleen signs?
Visceral leishmaniasis Typhoid Malaria
51
What are the main targets for anti-viral agents?
Stages in the life cycle - most intracellular | As viralstatic and not viralcidal, they aime to inhibit more viral functions than host functions
52
What are the types of viral treatment?
Prohylaxis - prevention Pre-emptive - infected but no symptoms Overt disease Supression therapy - to keep viral load low
53
When do you use an antiviral in herpres simplex?
If mucocutaneous (oral, genital etc) Encephalitis Immuno compromisied
54
When do you use antivirals in chickenpox?
Neonates Immunocompromised Pregnant
55
When do you use antivirals in shingles?
Elderly/immunocompromised | Only immunocomptetnt host if within 72 hours of onset
56
What antivirals are used for HSV/VZV? (herpes/chickenpox)
Acicilovir (oral, IV eye oinment or topical) | Valacicilovir - oral
57
What is the MOA for aciclovir?
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
When do you treat CMV infections?
Only life threatening as significant toxcitity Eg HIV - colitis + retinitis Transplant recpients - penumonitis
59
What agents are used in CMV?
Ganciclovir (IV Valganciclovir - oral Cidofovir IV
60
What antivirals are used in chronic hepatitis B
Pegylated interferon alpha Neculoside analogues Tenofovir, adefovir, entecavir etc
61
What antivirals are given for chronic hep C?
Pegylated interferon alpha + ribavirin Sometimes protease inhibitor on top Elvolving field
62
When do you test for viral resistance to antivirals?
After 7 days in immunocomprimised if no response
63
What agents cause soft tissue infections?
Streptoccous pyogenes Staph A Strep group C/G E coli Pseudoaeruginosa Clostridium sp.
64
What bacterium cause pneumonia?
``` Strep pneumonia Haemphilius influenzae Staph A Klebsiella pneumonia Moraxella catarrhalis Mycoplasma pneumonia Legionella pneumoia Chlamydia pneumonia ```
65
When are bactericidal and bacteristatic indicated?
Cidal - when need to kill organims quickly E.g mengitis, endocarditis, neutropenia Static - toxin mediated disease
66
What are the common side effects from antibiotics?
``` GI - nausea/vommiting/diarrhoea C. diff Candida Liver toxicity Renal toxciity Neurological problems Haemalogical ```
67
What drugs cause candida?
Broad spectrum antibiotics | Cephlasporins
68
What drugs cause liver damage/problems?
All drugs, but especially tetracyclines + TB drugs | More likely if pre-exisitng disease
69
What drugs cause renal damage?
Gentamicin Vancomycin More likely if pre-exisiting disease
70
What drugs cause adverse neurological effects?
Ototoxcity - gentamcin/vancomycin Optic nuropathy - ethanbutol (TB) Convulsions/encephalopathy - penicillins, cephlasporin Peripheral neuropathy - isoniazid (TB), metronidazole
71
What are the adverse haemtological effects caused by some antibiotics?
``` Marrow-toxcity Megoblastic anemia (co-trimoxazole) ```
72
What are the classes of antimicrobials?
``` b lactams (penicillins + cephlasporins) Aminoglycacides Macrolides Quinolones Glycopeptides Antifungals Antivirals ```
73
Which drugs act to inhbit cell wall syntheiss?
B lactams + glycopeptides (vancomycin + teicoplanin)
74
Which drugs act to inhibt protein syntehsis?
Aminoglycosides (gentamicin) Macrolides (clairthromycin) Tetracylcines (doxyxycline) Ozazolidinoes (linezolid)
75
Which drugs act to inhibit nucleic acid synthesis?
Trimetroprim Sulfonamides (sulfamethoxazole) Quinolones (ciprofloxacin
76
What are the different penicillins?
``` Benzylpenicillin Amoxicillin Fluclocacilin Co-amoxiclav Piperacillin ```
77
When do you use benzylpenicillin?
Bacteria: Streptococci Neisseria Spirochetes ``` Infections: Soft tissue Pneumococcal Menigiococcal Gonorrhoa Syphilis ```
78
When do you use amoxicillin?
Broad spectrum Infections: UTI RTI
79
When do you use flucloxacillin?
Staphylococci - main uses Staph A
80
When do you use co-amoxiclav?
Braod spectrum - includes anerobes ``` Infections UTI RTI Soft tissue Surgical wound infections ```
81
When do you use piperacillin/tazobactam?
Broad spectrum incl pseudomonas, anaerobes Infections - neutropenic sepsis
82
What are the types of cephlasporins
1st gen - cefradine 2nd gen - Cefuroxine 3rd gen - Ceftriaxone, ceftazidime
83
When do you use cefradine?
Broad spectrum Used in UTI + spft tissue infection
84
When do you use cefuroxime?
Broad spectrum UTIs RTIs Surgical prophylaxis
85
When do you use ceftriaxone?
Broad spectrum - very good against gram negative bacilli Hospital infections + bacteraemia Pneumonia Abdo sepsis
86
When do you use ceftazidime?
Broad spectrum, useful against gram neg bacilli + pseudomonas Pseudomonal infections in hospital + CF
87
When do you use aminoglycosides?
(eg gentamicin) Gram-neg bacilli For serious gram-negative infections Ie bacteraemia Endocarditis Neutropenic sepsis
88
What are the types of macroolides?
Clarithromycin Erythromycin Azithromycin
89
When do you use clarithromycin? (and erythromycin)
``` Bacteria: Streptococci Staphylococci Myoplasma Chlamyia Legionella ``` Infections: Resp infection Soft tissue infection
90
When do you use azithromycin?
Good for gram negative (haemophilus, chlamydia) Used for chlamydia
91
What are the types of quinolones?
Ciprofloxacin | Levofloxacin
92
When do you use ciprofloxacin?
Gram negative bacilli Includes pseudomonas Used in complicated UTIs Complicated hospital acquired pneumnia
93
When do you use levofloxacin?
Active against staph/strepococci + [neumococcus Mycoplasma Chlamydia Legionella 2nd/3rd line for penumonia
94
When do you use glycopeptides?
Gram positive bacteria only MRSA Allergy to penicillin
95
What are some other antibiotics?
``` Trimethoprim Co-trimoxazole Clindamycin Tetracycline Rifampicin Meropenem Metronidazole Linezolid Daptomycin Tigecycline ```
96
When do you use trimpthropin
UTIs | MRSA

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