Infections 2 - common infections Flashcards
what are the causes of lower UTI?
Commonly bacteria (usually E. coli from GI tract) in bladder/urethra
what are the risk factors of UTI?
Female, sexual activity, pregnancy, post-menopausal, predisposition, diabetes
what are the symptoms of UTI ?
Increased urgency, burning in urination (dysuria), lower abdominal discomfort, pelvic/back pain, cloudy or bloody urine, strong smelling urine, sometimes fever
what is the first line treatment for UTI?
Short course nitrofurantoin 100mg (MR) BD, 3 days or trimethoprim. Trimethoprim only if low chance of resistance.
[Note: 2nd line options pivmecillinam or Fosfomycin]
(not preg)
what are the causes of pneumonia?
Range of causative organisms, commonly Strep. pneumoniae (pneumococcal), typically in ‘at risk’ groups. Via air droplets or skin contact.
what are the symptoms of pneumonia?
cough, breathing difficulty, fever, loss appetite, feel unwell, shivering, chest pain and others
what is the treatment/prevention of pneumonia?
Treatment: Depends on severity, organism and
type: e.g. CA vs HA
Oral antibiotics (home, mild), e.g. amoxicillin**
IV antibiotics (hospital, severe) – depend on local
Hospital guidelines/organism
PREVENTION: Vaccine PPV (65yrs) against pneumococcal
what is the ph of the stomach
Stomach: low pH (~pH1-3). Few bacteria [H. pylori]
what is the ph of the stomach
Stomach: low pH (~pH1-3). Few bacteria [H. pylori]
what is the pathophysiology of Helicobacter pylori
Causes damage to the stomach and duodenal epithelial lining via multiple mechanisms. Can cause gastritis (inflammation). Can lead to damage and later ulcers. Inflammation and other effects of H. pylori can also lead to gastric cancer in chronic infection.
what is the symptoms of GI tract ulcers/cancer
: abdominal pain (burning), nausea, bloating, belching
what is the treatment for GI tract ulcers / cancer
Treatment: PPI* + 2 antibiotics: Amoxicillin (1000mg/BD) +
either clarithromycin (500mg BD)
or metronidazole (400mg BD) for 7 days.
*PPI can be e.g., lansoprazole 30mg BD, pantoprazole 40mg BD, omeprazole 20-40mg BD, esomeprazole 20mg BD, …
what is ineffective endocarditis
Rare
Usually bacterial and in patients with
heart valve replacement or damage
what is the causes of inefective endocarditis
commonly S. aureus or Strep
what is the symptoms of ineffective endocarditis
Include – Fever, chills,
heart murmurs, tiredness/fatigue, cough,
headache, shortness of breath, night sweats + others
what is the treatment of IE
Depends on number of factors. e.g. a penicillin (+gentamicin, Strep) or flucloxacillin (Staph). If serious, empiric treatment: e.g. ampicillin (or vancomycin, MRSA)/flucloxacillin/gentamicin to cover common pathogens. Duration 2-6 weeks. Surgery.
what is the causes of BV
Overgrowth of ‘bad’ bacteria in the vagina, anaerobic
what are the symptoms of BV>
May be asymptomatic but can have discharge that is white/pale grey, milky, fishy-smelling
what is the treatment of BV
If required, typically oral metronidazole 400mg BD 5-7d or 2g single dose or topical metronidazole gel, 0.75%/night (5d) or 2% clindamycin cream, 5g/night (7d)
what is the difference between BV and Thrush
bv:
vaginal discharge : may be increased
colour: white or pale
consistency: thin,smooth, milky, cream
odur: fishy smell
itching: no
thrush
vaginal discharge : may be increased
colour: white
consistency: cottage cheese like
odur: no
itching: yes and pain in urination and intercourse
what is the moA of metronidazole?
Structure Is a nitroimidazole
Contains imidazole ring
Contains nitro group that gets reduced
by redox-active ferrodoxin to nitro radical
Nitro radicals damage DNA – only occur in anaerobic conditions – used in anaerobic condition like BV
Reduction happens more in anaerobes - largely does not affect human cells or aerobic cells
Also useful in treating protozoal infection
what is the cause impetigo?
Break in skin, infection with Staphylococcus aureus or Streptococcus pyogenes. Contact with infected individual/objects - contagious.
what is the diagnosis impetigo?
lesions start as e.g. pustules that release exudate forming a crust (non-bullous) or blisters that burst forming crust (bullous), systemic features can include: swollen glands, fever, diarrhoea (esp. bullous)
what is the treatment impetigo?
good hygiene
Small localised areas of skin (non-bullous)
Topical antiseptic 1% cream hydrogen peroxide. If not suitable/unsuccessful…
Topical fusidic acid, 5d. If resistant, topical mupirocin 2% ointment 5d. MRSA – consult microbiologist
Widespread infection (non-bullous)
Oral flucloxacillin (see Prof. Osborn’s lectures) – for beta-lactamase producing Staph. 500mg, QDS, 5d, clarithromycin 250mg BD, 5d (allergy) or erythromycin 250-500mg BD 5 days (pregnancy) for adults, see NICE/BNF for child doses
Bullous impetigo, systemically unwell, high risk complications – oral antibiotics
what is cellulitis?
Rapidly spreading infection and inflammation of skin and sub-cutaneous tissue
what is the symptom of cellulitis?
Red skin, hot, swelling, painful
what is the causes of cellulitis?
Mostly S. pyogenes or S. aureus, damaged skin
what is the treatment of cellulitis ?
Depends on severity and other factors
e.g. mild: high-dose Flucloxacillin 500mg – 1g QDS, 5-7d
Clarithromycin, doxycycline or erythromycin are alternatives in mild cases with penicillin allergy
Severity can be classified to determine exact management (ERON classification e.g. see NICE guidance acute cellulitis ng141 and CKS, also CREST guidance)
If severity >Class III+, hospital admission, also often for Class II
what is the causes of bacterial conjunctivitis?
Typically Staph aureus, H. influenzae, S. pneumoniae
what is the symptoms of bacterial conjunctivitis?
Thick, yellow discharge (mucopurulent),
sandy/gritty/itchy feeling in the eye, pink/red
what is the treatment for bacterial conjuctivitis ?
Treatment: 1st line: Self care (bath/clean)
2nd line: topical antibiotics (OTC): chloramphenicol 0.5% drops or 1% ointment). Self-care
Care advice: to prevent spread,
Bathing eyes, lubricating eyes,
what is the cause of otitis externa?
Mainly bacterial (P. aeruginosa, S. aureus)
but can be e.g. fungal
what is the symptoms of otitis externa?
pain, itchiness, discharge, slight/temporary hearing loss, feel pressure
what is the treatment of otitis externa?
Usually clears up with self-help advice (don’t use cotton buds in the ear, use ear plugs…), first line can use pain relief and local heat.
Second line topical treatment. May use solutions that are: astringent (aluminium acetate), acid (topical acetic acid 2%), anti-fungal (clotrimazole), topical antibiotic (e.g. neomycin) and/or corticosteroid (betamethasone)
More detail in ENT in Spring Term
what is otitis media and who is it most common in?
Most common cause ear pain in children
: Commonly viral, can be
bacterial (e.g. S. pneumoniae/H. influenzae)
what are the symptoms of otitis media?
: include earache, high temperature (fever), vomiting, lack of energy, slight hearing loss
what is the symptoms of otitis media?
Usually self-limiting (3d), can use pain
relief. If severe, antibiotics, e.g. amoxicillin
what is the cause of sore throat?
Often viral, can be bacterial or other causes
Strep throat by airborne drops or contact
what are the symptoms of a sore throat ?
pharyngitis (throat inflamed)
tonsilitis (tonsils inflamed)
what are the treatments for a sore throat?
Usually self-limiting
IF needed and bacterial infection,
for GAS – phenoxymethylpenicillin
Can relieve symptoms: painkillers (paracetamol), gargling, fluids
what are the causes of musculoskeletal infections
+
treatments
Commonly caused by S. aureus (and Strep.) therefore examples of treatment are below but depend on organism(s) and severity:
Septic arthritis: flucloxacillin (4-6 weeks)
Osteomyelitis: flucloxacillin (6 weeks), possibly + fusidic acid/rifampicin 1st 2 weeks
what are the causes of bacterial meningitis?
Several causative organisms
Depends on age.
Older children and adults often
Strep. pneumoniae, Neisseria meningitidis
(meningococcal), H. influenzae B (young)
what are the symptoms of bacterial meningitis?
include headache, stiff neck,
fever, photophobia, altered consciousness,
meningococcal with non-blanching rash
what is the treatment of bacterial menigitis?
Treatment: Initially benzylpenicillin
(if meningococcal/rash, parenteral),
in hospital IV e.g. ceftriaxone/cefotaxime.
Often + corticosteroids (dexamethasone). Depends on confirmed diagnosis
PREVENTION: Vaccines HiB, PCV, MenB, MenC, MenACWY
what are possible organisms which cause cancer ?
and what sites are usually effected?
Include Staph, Strep (pyogenes, pneumoniae), C. diff, E. coli,
Pseudomonas, Enterococcus, Klebsiella…
Include Skin/mucous membranes (mouth), respiratory (throat), renal, wounds, catheter/IV site, GI, CNS
what is sepsis
Life-threatening condition – occurs due to inflammatory immune response to infection that leads to damage of tissues and organ failure
what is the underlying infection of sepsis
Typically bacterial (e.g., Gram+ Staph, Gram- E. coli) – less commonly a result of fungal or viral infection. Common infection sites include lungs (50%), UTIs (20-25%), abdominal (15-20%) and Skin/soft tissue (10-15%).
what are the symptoms of sepsis
Symptoms – depends on age: In older children/adults, early signs can be e.g., fever or low body temperature, elevated heart rate and breathing, chills and shivering. More severe symptoms e.g., confusion, low blood pressure, pale, blue or blotchy skin, non-blanching rash, significantly reduced urine output
what are the treatment options for sepsis
Treatment: Depends on age, severity and other factors. Typically antibiotics and can be i.v. fluids and oxygen as needed
sepsis and endo/exo toxins types
Examples include - S. aureus, S. pyogenes, E. coli, Klebsiella spp., P. aeruginosa. Different classification of toxin based on MoA:
Type I – disrupt host cell without entry (endotoxins and SAg);
Type II – destroy host cell membranes to invade and interrupt host defense;
Type III - disrupt host defense to allow dissemination of infection
