Infections in Primary Care pt 2

Question 1

How do you diagnose and manage influenza?

Answer 1

Diagnosis - PCR.
Management - supportive. Can give oseltamivir if presents within 48h of onset and at risk of complications.

Question 2

What is the presentation of Lyme disease?

Answer 2

Erythema migrans - bulls-eye rash which is seen in 80%. Typical presents 1-4 weeks after bite and is painless.
Systemic features - headache, lethargy, fever, arthralgia.
Late features - heart block, peri/myocarditis. Facial nerve palsy, radicular pain, meningitis

Question 3

What are the investigations for lyme disease?

Answer 3

Clinical diagnosis if erythema migrans present.
First line - ELISA antibodies to borrelia burgdorfri. If positive then do immunoblot test. If negative but clinical suspicion high then repeat in 4-6 weeks.

Question 4

Management of lyme disease?

Answer 4

Early disease - Doxycycline (amox if pregnancy).
Late disease - Ceftriaxone.
May experience Jarisch-Herxheimer reaction

Question 5

Presentation of measels?

Answer 5

Prodrome phase - irritible, fever, conjunctivits.
Koplick spots - Typically develop before the rash and appear as white spots on buccal mucosa.
Rash - Maculopapular rash which starts behind the ears then spread across body. Often desquamatous

Question 6

What are the investigations for measles?

Answer 6

IgM which can be detected within a few days of rash onset.

Question 7

What is the management for measles?

Answer 7

Mainly supportive treatment. Must inform public health as it is a notifiable disease. Admission to be considered if immunosuppressed or pregnant patients.

Question 8

What are the complications of measeles?

Answer 8

Otitis medial - most common.
Pneumonia - most common cause of death.
Encephalitis
Subacute sclerosing panencephalitis
Febrile convulsions
Keratoconjunctivits
Diarrhoea
Appendicitis
Myocarditis

Question 9

How do you manage contacts of measles?

Answer 9

If child has not been immunised then offer MMR which should be given within 72 hours.