Infections Flashcards
Describe the causes of encephalitis
Infections:
- Viral: HSV 1 (most common), CMV, VZV
- Non-viral: any bacterial meningitis, TB, Lyme
Inflammatory:
-Autoimmune
Describe the presentation of encephalitis
- Headache
- Confusion, reduced GCS
- Fever, tachycardia
- Focal neurology
- Seizures
Describe the investigations for encephalitis
- History and examination + obs
- Urine dip
- Bloods: FBC, CRP, U+Es, LFTs, TFTs, clotting, B12, glucose, VBG, culture
- CT head
- LP
Describe the management of encephalitis
A to E Call for senior help, neuro referral. HDU/ITU bed 1. IV fluids 2. IV aciclovir 10mg/kg every 8 hours Seizure Mx eg phenytoin
Describe the differential diagnoses for encephalitis
Causes of encephalopathy/confusion:
- Infections/inflammation- encephalitis, sepsis
- Vascular/trauma: stroke, bleeds
- Metabolic: hypoxia, uraemia, liver failure, electrolytes, alcohol, glucose, B12
- Neoplasms
- Drugs
- Endocrine: Cushing’s, hypothyroidism
Describe the causes of meningitis
Bacterial: N meningitidis, Strep pneumo, HiB, Listeria, E coli, GBS
Viral: Coxsackie, echovirus
TB
Describe the presentation of meningitis
Acute constant severe headache Neck stiffness Photophobia Fever Kernig's + (bending knees), Brudzinski's (lift head) \+/- non-blanching purpuric rash
Describe the investigations for meningitis
- History, examination, obs
- Bloods: FBC, CRP, U+Es, clotting, VBG, culture
- CT head
- LP
Describe the LP results in meningitis
Bacterial: low glucose, high protein, high neutrophils
Viral: N glucose, high protein, high lymphocytes
TB: low glucose, high protein, high lymphocytes
Describe the management of meningitis (in hospital)
A to E Admit -IV BS antibiotics eg ceftriaxone 2g +/- ampicillin (if old) -IV fluids -Analgesia *Dex if bacterial
Which pathogen is responsible for epiglottitis?
Haemophilus influenzae B
Describe the presentation of epiglottitis
Usually children, unvaxed
- Acutely unwell with fever
- Difficulty swallowing + drooling
- Stridor
Describe the management of epiglottitis
A to E
- Essential to secure airway. Call anaesthetics
- Nebulised adrenaline
- IV/IM steroids
- IV cefotaxime
Describe the management of meningitis in primary care
If signs of meningococcal disease, call 999
Give IM benpen
Otherwise, refer to ED urgently
Describe the pathophysiology of toxic shock syndrome
Exotoxin mediated illness caused by Staph or Strep
Staph TSS is assoc with tampons + post-partum infections
-> immune system activation + release of cytokines
-> multi-organ dysfunction
Describe the presentation of toxic shock syndrome
Non-specific: fever, aches, malaise, pain -Vomiting, diarrhoea -Rashes -Shock -Difficulty breathing, hypoxia etc
Describe the investigations for TSS
- Urine dip, MCS
- Swab any wounds, sputum
- Bloods: FBC, CRP, U+Es, LFTs, clotting, glucose, VBG, culture
- CXR
- Consider imaging + LP if indicated (meningitic)
Describe the management of TSS
A to E
Call for help. ITU needed
IV fluids, high flow O2 etc
IV antibiotics - clindamycin + Taz/vanc/carbapenem
What is necrotising fasciitis? Describe the types
A life-threatening soft tissue infection
Type I: mixed anaerobic
Type II: monobacterial, usually Grp A Strep
Describe the presentation of necrotising fasciitis
Rapidly progressive soft tissue infection (eg cellulitis): redness, swelling, warmth
+ Pain disproportionate to clinical findings
Fever
May very quickly become systemically unwell
Describe the investigations for necrotising fasciitis
- Swabs
- Urine
- Bloods: FBC, CRP, U+Es, LFTs, clotting, glucose, G&S, VBG, culture
- CXR if indicated. ECG pre-op
- Imaging: CT
Describe the management of necrotising fasciitis
A to E: supportive
Immediate surgical referral- do not wait for Ix
-IV fluids
-Analgesia
-IV BS Abx eg. Taz/ cef
-Urgent surgical debridement -> re-exploration
What is the difference between per-orbital and orbital cellulitis?
Peri-orbital is superficial to septum (in the eyelid) and normal ocular function
Orbital is deep to septum, affects muscles + fat in the orbit. Usually arises from sinusitis. Compromises ocular function. Emergency
Describe the presentation of pre-orbital and orbital cellulitis
Pre-orbital: redness of the eyelid, with minimal swelling/pain/fever. No ocular symptoms
Orbital: redness, swelling, pain, fever. Proptosis, ophthalmoplegia, visual loss
