Infections Flashcards by Shahid Hamid Shali

Features of underlying immunodeficiency in shingles

Severe disease

Prolonged duration of rash

Multiple dermatomal involvement

Recurrence

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CNS involvement in shingles

Ramsay Hunt syndrome

due to geniculate ganglion
facial palsy
I/L loss of taste
buccal ulceration
rash in external auditory canal

Myelitis
Cranial nerve palsy
Encephalitis

Granulomatous cerebral angiitis - stroke like syndrome a/w shingles (esp in an ophthalmic distribution)

Post herpetic neuralgia

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Post herpetic neuralgia

Persistent pain following healing of the rash of shingles

for 1-6 months or longer
common with advancing age

Rx :
- Aggressive analgesia

Amitriptyline 25-100 mg daily OR
Gabapentin (start at 300 mg daily, increase slowly to 300 mg twice daily or more)
Capsaicin cream (0.075%)
Corticosteroids (controversial)

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Complications of EBV infection

Severe pharyngeal edema

Antibiotic induced rash (80-90 % with ampicillin)

Hepatitis (80%)

Prolonged post viral fatigue (10%)

Jaundice (

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CNS & CVS complications of EBV infection

CNS

Cranial nerve palsies
Polyneuritis
Transverse myelitis
Meningoencepahilitis

CVS

Myo & Pericarditis
ECG abnormalities

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Hematological complications of EBV infection

Hemolytic anemia

Thrombocytopenia

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Renal abnormalities of EBV infection

Abnormal urine analysis

Interstitial nephritis

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EBV associated malignancy

Nasopharyngeal Ca

Burkitt’s lymphoma

Primary CNS lymphoma

Hodgkin’s disease

Duncan’s syndrome - lymphoproliferative disease in immuno compromised

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How does vertical transmission occurs in dengue ?

If infection occurs within 5 weeks of delivery

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How long does the protection of yellow virus vaccination last ?

Single vaccination with a live attenuated vaccine lasts for atleast 10 years

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Bartonellosis - Name the diseases

Trench fever
Cat scratch disease
Bacillary angiomatosis

Bacteremia & endocarditis in the homeless

Oroya fever & verruga peruana (Carrion’s disease)

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Brucella spp

B.melitensis - most severe
B.abortus
B.suis - a/w abscess formation
B.canis

G -ve
Intracellular
Survive for long periods in the RE system

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C/F of acute brucellosis

High swinging temperature
Rigors
Lethargy

Headache
Joint & muscle pain
Scrotal pain

CNS - Delirium
GIT - Abdominal pain, Constipation

Signs

Enlarged LN
Splenomegaly –> hypersplenism, thrombocytopenia

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CNS involvement in brucellosis

Meningitis
IC or SAH
Stroke

Cranial nerve palsies

Myelopathy
Radiculopathy

Eyes

Uveitis
Retinal thrombophlebitis

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CVS involvement in brucellosis

Endocarditis

Myocarditis

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Respiratory system involvement in brucellosis

Pneumonitis or abscesses

Hilar LAP

Bone involvement in brucellosis

Spinal spondylitis or sacroiliitis
Paravertebral or psoas abscess

Suppurative arthritis
Synovitis
Bursitis
Osteomyelitis

GIT & GU involvement in brucellosis

Splenic abscess or calcification
Hepatitis

Epididymo-orchitis

Hematological abnormality in brucellosis

Pancytopenia

General examination finding in brucellosis

Malodorous perspiration

LAP

MC HIV related cancer

HHV-8 related Kaposi’s sarcoma

EBV related cancers occurring in HIV patients

Non-Hodgkin lymphoma

Hodgkin lymphoma

HPV related cancers occurring in HIV patients

Anal Ca

Cervical Ca
Vulval Ca

Penile Ca

CNS involvement in HIV

Cognitive Impairement

ICSOLs

Meningitis

ICSOLs occurring in AIDS patients

Toxoplasmosis Primary CNS lymphoma Tuberculoma Cryptococcoma

Causes of meningitis in AIDS patients

Cryptococcal TB Pneumococcal HIV

Post exposure prophylaxis for AIDS

1st dose asap (preferably within 6-8 hours) NO use starting PEP after 72 hours Low risk exposure - Dual NRTIs (Tenofovir + Emtricitabine) High risk exposure - Dual NRTIs + PI or Efavirenz (NNRTI) HIV antibody testing at 6, 12, 24 weeks after exposure

Common causes of chronic watery diarrhoea in AIDS patients

When CD4+ T cell count

Opportunistic infections in AIDS reduced by Cotrimoxazole

Pneumocystis jiroveci pneumonia Isospora belli diarrhoea Cerebral toxoplasmosis Dose : 960 mg daily

Opportunistic infections in AIDS along with Rx

Cryptococcosis - Fluconazole 200 mg daily CMV - Valganciclovir 900 mg daily MAC - Clarithromycin 500 mg BD - Ethambutol 800 mg daily

MC drug rash occurring in HIV patients

Erythematous MP rash - maybe scaly MC drugs - Sulphonamides - NNRTIs Life threatening features of rashes - Blistering - TEN ( blistering >30% of surface area) - SJS (involves mucous membranes) - Systemic involvement with fever or organ dysfunction

Organisms causing mucormycosis

Mucoraceous moulds - Lichthemia (Absidia) - Rhizomucor spp - Mucor spp - Rhizopus spp

Disease patterns in mucormycosis

Rhinocerebral/Craniofacial Pulmonary Cutaneous Systemic

Predisposing factors for mucormycosis

Profound immunosuppression - Neutropenia - HSC transplantation Uncontrolled DM Iron chelation therapy - Desferrioxamine Severe burns

Rx of mucormycosis

Antifungal therapy - Amphotericin B - Posaconazole Surgical debridement Correction of predisposing factors

Rx of schistosomiasis

PRAZIQUANTEL - 20 mg/kg orally - twice daily for 1 day - Kills adult worms & stops egg laying - In early infection, it reverses hepatomegaly, UB wall thickening & granuloma SURGERY - for residual lesions - Eg: Ureteric strictures, small fibrotic UB, granulomatous masses in brain & spinal cord

C/F of shingles (herpes zoster)

Burning discomfort in the affected dermatome - Thoracic dermatomes - Ophthalmic (Vth CN) - vesicles appear on cornea --> ulceration --> blindness Discrete vesicles appear 3-4 days later (a/w brief viremia) Zoster sine herpetica - paraesthesia occurs without rash