Infectious Flashcards
Chicken-pox
left thigh is erythematous, tense and tender to touch. There is palpable crepitus
Chickenpox is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis
Rare complications include (PED PAN)
- pneumonia
- encephalitis (cerebellar involvement)
- disseminated haemorrhagic chickenpox
- arthritis, nephritis and pancreatitis may very rarely be seen
Extended spectrum B-lactamase (ESBL)
Best Ab
Trimethoprim
Tetracycline
Amoxicillin
Cefalexin
Ertapenem
ESBL producers are most commonly Escherichia coli (E. coli) and Klebsiella species
Ertapenem
Malaria
Fever every 2 days
Malaria: non-falciparum (Fever, headache, SM)
- 48h (P.vivax, P.ovale)
Hypnozoite stage and relapse following treatment
Give Primaquine (destroy liver hypnozoites and prevent relapse) - 72h (P.malariae) = Nephrotic syndrome
- P.knowlesi
Artemisinin-based combination therapy (ACT) (CI in pregnancy)
or chloroquine (in sensitive area)
Cellulitis classification and
Management
The Eron classification system can be used to guide how we manage patients with cellulitis:
Class Features
I There are no signs of systemic toxicity and the person has no uncontrolled co-morbidities
II The person is either systemically unwell or systemically well but with a co-morbidity (for example peripheral arterial disease, chronic venous insufficiency, or morbid obesity) which may complicate or delay resolution of infection
III The person has significant systemic upset such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable co-morbidities that may interfere with a response to treatment, or a limb-threatening infection due to vascular compromize
IV The person has sepsis syndrome or a severe life-threatening infection such as necrotizing fasciitis
Eron Class I
oral antibiotics NICE
oral flucloxacillin as first-line treatment for mild/moderate cellulitis
oral clarithromycin, erythromycin (in pregnancy) or doxycycline is recommended in patients allergic to penicillin
Eron Class II
NICE recommend: ‘Admission may not be necessary if the facilities and expertise are available in the community to give intravenous antibiotics and monitor the person - check local guidelines.’
Eron Class III-IV
admit
NICE recommend: oral/IV co-amoxiclav, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone
Complications of Mumps
Complications
- Orchitis - uncommon in pre-pubertal males but occurs in around 25-35% of post-pubertal males. Typically occurs four or five days after the start of parotitis
- Hearing loss - usually unilateral and transient
- Meningoencephalitis
- Pancreatitis
Viral hemorrhagic fever
Examples of viral haemorrhagic fever (VHF) include:
- Flaviviridae: dengue, yellow fever
- Arenaviridae: Lassa fever
- Filoviridae: Ebola virus, Marburg virus
- Bunyaviridae: Hantaviruses, Crimean-Congo haemorrhagic fever, Rift Valley fever
Eczema management (Topical/Systemic) and prognostic factors
Emollients
Integral to all treatment plans, regardless of eczema severity. Advise on liberal
Topical corticosteroids (Vital for flare-ups)
- Mild eczema: hydrocortisone 1%
- Moderate eczema: betamethasone valerate 0.025% or clobetasone butyrate 0.05%
- Severe eczema: betamethasone valerate 0.1%
Topical calcineurin inhibitors
Suitable for sensitive skin regions; include agents like tacrolimus and pimecrolimus.
Topical antimicrobials
Used when there is clinical evidence of secondary infection.
Systemic therapy (Indicate severe/unresponsive)
- Oral corticosteroids:
Cautiously (acute severe exacerbations)
- Immunosuppressants:
Ciclosporin, methotrexate, or azathioprine (chronic, severe eczema)
- Biologic therapies:
Dupilumab (Advanced unresponsive to conventional therapy)
- Phototherapy
Considered for extensive eczema
Prognostic markers of severe disease:
- onset at age 3-6 months
- severe disease in childhood
- associated asthma or hay fever
- small family size
- high IgE serum levels
Guttate psoriasis
Guttate psoriasis is more common in children and adolescents. It may be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.
Features
tear drop papules on the trunk and limbs
gutta is Latin for drop
pink, scaly patches or plques of psoriasis
tends to be acute onset over days
Management
Self resolve 2-3 months
*Need to be differentiated from Pityriasis rosea
