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Med 1 Block > Infections Workshop > Flashcards

Infections Workshop Flashcards

1
Q

What are some common sites of bacterial infection?

A

Meningitis
ENT - ottis media/externa, laryngitis, tonsilitis, epiglottitis
Cellulitis
UTI - may be catheter related
Acute abdo - appendicitis, cholectytitis
Pericardititis, endocariditis, myocarditis
Pneumonia
Bloodstream infections

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2
Q

What are the general signs of a bacterial infection?

A

Fever (+/- rigors)
Malaises
Headaches
Dehydration
Anorexia
Nausea
Muscle and joint aches
Pain

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3
Q

What is a UTI?

A

Urinary tract infection - bacterial proliferation within the steril urinary tract. Causes irritation of the urothelium.

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4
Q

What are the key symptoms of a UTI?

A

Dysuria
Frequency and urgency with urination
Urge incontinence
Haematuria
Suprapubic pain
Very likely to cause confusion in older patients.

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5
Q

What are some common bacterial causes of UTI and their gram stain?

A

E.coli - gram negative bacilli
Proteus - gra negative bacilli
Staph asrpophyticus -

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6
Q

What is the relevance of asymptomatic bacteriuria in clinical practice?

A

Bacteriuria - bacteria in the urine - can be asymptomatic or symptomatic
In eldery asymptomatic does not require treatment - common urine tests positive
In pregnancy does require treatment due to risk of effects on pregnancy.

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7
Q

What are the risk factors for a UTI?

A

Pregnancy - renal pelvis dilation cause urine stagnation.
Diabetes Mellitus - glucouria, favourable enviro for bacteria
Renal stones/bladder stones - obstruct UT in infective proliferation, Proteus infections UTi can also increase the risk of stones
Menopause - thinning of urothelium, vulnerable to damage and infection
Sexual activity - pee after sex and clean gentials to reduce risk
Catheters - colonise tubing.
Anatomical abnormalities
Dysfuncation voiding

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8
Q

What are the key ideas surrounding catheter use and UTI?

A

Higher risk of atypical bacterial infection
Catheter should be changed with antibiotic cover is infection suspected
Asymptomatic colonisation of father does not require treatment
Catheter urine specimens are not recommended as stagnantations inc bacterial proliferation.

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9
Q

What investigations should be done for a suspected UTI?

A

Bedside - urine dip or MSU in over65yrs and urine culture, obs, inc NEWS score for sepsis, vulvula/pelvic exam if gynae differential likely, must have pregnancy test if of reporductive age
Bloods - FBC, U&Es, LFTs, CRP, blood cultures
Imaging - if recurrent abdo ultrasound, CTKUB

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10
Q

What is the management for UTIs?

A

Conservative - fluids/hydration
Medical - antibiotics (see cards)

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11
Q

What are some potential complications of a UTI?

A

Urinary Tract Stones - particualrly if proteus infection
SEPSIS - particularly dangerous in elderly
Pyelonephritis - upper UTI, associated with flank pain (loin-groin pain), fever, rigors and haematuria

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12
Q

What is the management of an elderly patient with UTI as a differential?

A

IV co-amoxiclav 1.2tds
May add a single dose gentamicin 3mg/kg

Second line - contact microbiologist

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13
Q

What treatment is used first line for symptomatic lower UTI (including catheter related)?

A

PO nitrofurantoin modified release 100mg bd
Requires eGFR 45ml/min or above

If eGFR too low PO trimethoprim 200mg bd.

May add single dose gentamicin 3mg/kg.

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14
Q

What treatment is used second line for symptomatic lower UTI (including catheter related)?

A

PO fosfomycin 3g sachet - single dose for women, two doses 72hrs apart for men

or

PO pivemecillinam 400mg stat then 200mg tds

Consider adding single dose genatmicin 3mg/kg.

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15
Q

What is the first line treatment for UTI in pregnancy?

A

PO nitrofurantoin mod release 100mg bd x7d
eGFR must be 45 or above to be effective

Cefalexin = second line

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16
Q

What is the first line treatment for pyelonephritis or lower UTI complicated by sepsis?

A

IV co-amoxicalv 1.2g tds

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17
Q

What is the second line treatment for pyelonephritis or lower UTI complicated by sepsis?

A

IV cefuroxime 750mg-1.5 tds or

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18
Q

What is the purpose of a urine culture for a UTI?

A

To confirm empirical treatment is appropriate.

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19
Q

On a urine dipstick test what is the most sensitive and most specific tests for a UTI?

A

Sensitive - leukocytes
Specific - nitrates

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20
Q

What is the relevant epidemiology of a UTI?

A

Peak incidence in 70+ yrs
More common in females 20:1

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21
Q

In what patient groups if a UTI appearance more suspicious?

A

Males - may indicate prostatis hypertrophy or prostatitis - cause urinary stasis and incomplete bladder emptying.
Children - can indicate abuse, sexual or neglect from soiled nappies etc. (Can also be normal)

22
Q

What are some common pathogens causing infections in the CNS?

A

Streptoccocus pneumonia
Neisseria meningitidis
Haemophilius influenza
Group B strep
Listerio spp

23
Q

What are some common pathogens causing oral cavity infection?

A

Prevotella spp.
Streptococcus spp.
Peptospreptococcus spp.
Actinomyces spp.

24
Q

What pathogens commonly cause intra-abdominal infections?

A

Enteric gram-negative rods
Enterococcus spp
Streptococcus spp
Bacteriodes spp

25
Q

What pathogens commonly cause urinary tract infection?

A

Escherichia coli
Proteus spp
Klebsiella spp
Staphylococcus saprophyticus
Streptococcus spp
Enterococcus spp

26
Q

What pathogens commonly cause skin/soft tissue infections?

A

Staphyloccus spp.
Streptococcus pyogenes
Pasteurella multocida
Gram negative rods

27
Q

What pathogens commonly cause respiratory tract infections?

A

Staphylococcus aureus
Pseudomonas aeruginosa
Streptococcus spp
Haemophilus influenzae
Moraxella catarrhalis
Gram negative rods.

28
Q

What is meant by lymphadenopathy?

A

Disease of the lymph nodes - resulting in swollen lymph nodes.
Normal nodes are less than 0.5cm

29
Q

What are the different causes of lymphadenopathy?

A

Viral = URTI, HIV, HepA/B. Measles, CMV
Neoplastic and proliferative disorders - leukemias, lymphomas, neoblastoma,
Bacterial = TB, cat-scratch disease, syphylis, typhoid fever, lyme disease
Protozoal = toxoplasmosis, chagas disease
Autoimmune disorders + hypersensitivity states = SLE, JIA

30
Q

What different investigations may you do to determine the different causes of lymphadenopathy?

A

Bloods - FBcs, blood film, ESR, plasma viscosity, CRP, LFTs, Viral titres (EBV and HIV), blood cultures and autoantibody screen
Imaging - CXR, US, CT/MRI, fine-needle aspiration.

31
Q

Define immunodeficiency

A

When the immune systems ability to fight infectious diseases and cancer is compromised or entirely absent.
Most causes are acquired e.g HIV or drugs suppression e.g steroids
Primary causes = SCID

32
Q

What is SCID?

A

Severe Combined Immunodeficient syndrome
Range of genetic variants - RAG1/2 mutation resulting in inability to undergone somatic recombination = immature T/B cells
X-linked = mutation in IL2G comma gamma chain - unable to produce function cytokine receptors
Results in loss of humoral B cell response and effector T cell response
Immunocompromised as loss of adaptive immune system.

33
Q

What is the role of complement in the immune system?

A

Part of the innate immune response
Triggered by: classical (antigen antibody complex on path surface), alternative (ant on path surf) and lectin pathways (requires carbohydrates on pathogen surface).
A cascade of enzymes/complement proteins
Results in 1. Opsonisation 2. Membrane attack complex formation 3.Chemotaxis

34
Q

What is the role of the polymorphonuclear neutrophil?

A

The most abundant type of granulocyte and make up 40-70% of all wbc in humans.
Part of innate immune response = phagocytosis.

35
Q

What is the basic role of the spleen in the immune system?

A

Centre of activity of mononuclear phagocyte (dendritic cells and macrophages)
Absence = predisposition to certain infections, risk of sepsis from polysaccharide encapsulated bacteria.
Filters blood for antigens
White pulp - PALS contains mainly T cells
Marginal zone - B cells and primary lymphoid follicies
Red pulp - macrophages and rbcs. phagocytose old rbc.

36
Q

Describe how an immune response may be initiated in the spleen.

A

Splenic artery - antigen into spleen, into marginal zone captured by dendritic cells
Dendritic cells move to PALS to activate T cells in white pulp
Active helper T cells move to marginal zone to activate B cells in primarly follicles.
Leads to production of a secondary follicle with a germinal centre - resulting in plasma cell differentiation and anibody production.
Key features : IgM memory B cells produced.

37
Q

What is the main cause of a humoral immune deficiency/B cell deficiency?

A

Multiple myeloma
CLL
AIDs

38
Q

What components of the immune system are affected in an humoral immune deficiency?

A

B cells
Plasma cells
Antibodies

39
Q

What are the main pathogens of resultant infections from a humoral immune deficiency?

A

Strep pneumoniae
Haemophilius infleunza
Pneumocystis jirovecii
Glardia intestinalis
Cryptosporidium parvum

40
Q

What are the main causes of a T cell immunodeficiency?

A

AIDs
Marrow and other transplants

41
Q

What are the main pathogens of resultant infections from a T cell deficiency?

A

Intracellular pathogens: HSV, mycobacterium listeria

42
Q

What are the main affected components on a neutropenia?
What are the main causes of neutropenia?

A

Neutrophil granulocytes
Causes: chemotherapy, bone marrow transplant.

43
Q

What are the main pathogens of resultant infections in neutropenia?

A

Enterobacteriaceae
Oral streptococci
Pseudomonas aeruginosa
Enterococcus species
Candida species
Asperigillus species

44
Q

What are the main causes of asplenia?

A

Splenectomy
Trauma
Sickle cell anaemia

45
Q

What pathogens tend to cause infections in patients with no spleen?

A

Polysaccharide encapsulated bacteria:
Streptoccus pneumonia
Haemophilius inlfuenza
Neisseria meningitidis

Plasmodium species

46
Q

What is the main cause of a complement deficiency?

A

Congenital deficiency

47
Q

What species of pathogens tend to cause infections in patients with complement deficiency?

A

Neisseria species.

48
Q

What cell makes up the majority of white blood cells?

A

Neutrophils = 40-60%
lymphocytes = 20-40%

49
Q

List five causes of spleenomegaly

A
  1. Sickle cell
  2. Liver cirrhosis
  3. ALL
  4. Infections - HIV,TB
  5. Autoimmune - RA and SLE
50
Q

What are some potential complications of a UTI?

A

Sepsis
Renal Abscess
Cystitis
Kidney stones

51
Q
A

Med 1 Block (39 decks)

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