Infectious Disease Flashcards
Green and purulent discharge =G
normal examination,
not often associated with an odour.
Which org?
Gonorrhea=G
problems with cervix =C
mucopurulent discharge.
cervical excitation =C
Which org?
Chlamydia=C
most prevalent sexually transmitted infection in the UK
treated with Doxy(1-7 days)
if doxycycline is contraindicated / not tolerated= azithromycin (1g od for one day, then 500mg od for two days) should be used
if preg=azithromycin, erythromycin or amoxicillin may be used.
In women: cervicitis (discharge, bleeding), dysuria
In men: urethral discharge, dysuria
Potential complications
epididymitis, endometritis=pelvic inflammatory disease
increased incidence of ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)
initial partner notification -
1. for men with urethral symptoms: all contacts 4 weeks prior to, the onset of symptoms
2. for women and asymptomatic men all partners from the last six months or the most recent sexual partner should be contacted
3. contacts of confirmed Chlamydia cases should be offered treatment prior to the results of their investigations being known (treat then test)
tests;
men;urine sample
women; swab cervical or vulvovaginal swab
NAAT is performed on them
Doesn’t cause vaginal discharge,
crop of ulcers
tingling type sensations around the vulva.
flu-like illness,
some lymphadenopathy.
Herpes Simplex
a lot more itching/vulval irritation
thick creamy consistency like cottage cheese.
Candidiasis
Thin watery discharge that can have a green or white hue.
vaginal discharge: ‘fishy’, offensive
asymptomatic in 50%
Diagnosis would be confirmed with a vaginal pH > 4.5 and clue cells on microscopy.
Bacterial Vaginosis
Gardnerella vaginalis. This leads to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.
treatment of BV
oral metronidazole for 5 to 7 days
topical metronidazole and clindamycin
BV in pregnancy causes?
low birth weight
chorioamnitis
late miscarriage
treatment of BV in pregnancy?
Oral metro
(same)
and topical clindamycin
There are some similarities between BV and Trichomoniasis
offensive vaginal discharge
PH>4.5
treated with metro
differences between BV and Trichomoniasis
yellow green discharge
Strawberry cervix
motile trophozoites on wet mounts
vulvovaginitis
A patient presents with fever,tachy,low bp, productive coughcxr shows lower lobe consolidation.
He has been feeling unwell from past 10 days(had flu like symptoms)
which organism is it?
Commonest cause of CAP after “the flu” is Staphylococcus aureus
COMMONEST ORGANISMS for CAP
MOST COMMON=Streptococcus pneumoniae (accounts for around 80% of cases)
Haemophilus influenzae
Staphylococcus aureus: commonly after influenza infection
atypical pneumonias (e.g. Due to Mycoplasma pneumoniae)
viruses
Rapid onset
high fever
pleuritic chest pain
herpes labialis (cold sores)
Characteristics of which org?
Penumococcal pneumonia
in a non symptomatic uti
preg woman
which antibiotic to not give in 1st term?
Trimethoprim
it is a folate antagonist
it is a prime time of developing of neural tube
so it will cause teratogenciity
which one should not be given near term?
Nitrofurantoin(it causes neonatal hemolysis)
which other antibiotics should be avoided during peg?
Sulfonamides and quinolones
Also trimethoprim
flu like symptoms classically precede a dry cough
rashes like target lesions=Erythema Multiforme
bilateral consolidation on x-ray
which org is the one causing pneumonia?
Mycoplasma P= * Multiforme
*Cold autoimmune haemolytic anaemia(cold agglutinins IGM)
Acute food poisoning is typically caused by
Staphylococcus aureus, Bacillus cereus or Clostridium perfringens.
Gastroenteritis
complication;GBS syndrome
marked right iliac fossa pain mimicking appendicitis. bloody diarrhoea.
Compylobacter
vomiting within 6 hours, stereotypically due to rice
diarrhoeal illness occurring after 6 hours
bacillus serous
gradual onset of bloody diarrhoea
Amoebiasis
bloody diarrhoea
Shigella
Prolonged, non-bloody diarrhoea
giardiasis
Profuse, watery diarrhoea
cholera
travellers diarrhoea
e coli
Cellulitis casting organisms
due to infection by Streptococcus pyogenes or Staphylcoccus aureus.
Indications for IV antibiotics for cellulitis
Has Eron Class III or Class IV cellulitis.
Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin).
Is immunocompromized.
Has significant lymphoedema.
facial cellulitis or periorbital cellulitis.
Is very young (under 1 year of age) or frail.
mild to moderate cellulitis treat
1st line Fluc
Clarithromycin, erythromycin (in pregnancy) or doxycyline is recommended in patients allergic to penicillin.
severe cellulitis
co-amoxiclav, cefuroxime, clindamycin or ceftriaxone.
Glandular fever description
URTI symptoms + amoxicillin → rash =glandular fever
glandular fever; Ebstein-Barr virus aka HH4
more common in teenagers and is commonly spread via respiratory droplets and has been nicknamed the “kissing disease”.
Symptoms
Early stages=Triad
1. sore throat
2. lymphadenopathy: may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged
3. pyrexia
In the later stages of the illness, splenomegaly
other symptoms;
hepatitis, transient rise in ALT
Palatal petechia
malaise,anaorexia,headache
Glandular fever is diagnosed by;
Monospot test, a blood test that detects the presence of heterophil antibodies made following infection with Ebstein-Barr virus.
On FBC=lymphocytosis.
Tx;
rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
consensus guidance in the UK is to avoid playing contact sports for 8 weeks after having glandular fever to reduce the risk of splenic rupture
painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
Which org?
Which dis?
Chancroid is a tropical disease caused by Haemophilus ducreyi.
painful genital ulcers, smaller, multiple and primary attacks are often associated with fever.
Which org?
Herpes simplex virus
painful “genital ulcers”, smaller, multiple and primary attacks are often associated with fever.
Primary attacks are often severe and associated with fever whilst subsequent attacks are generally less severe and localised to one site.
Which org?
Tx?
Herpes simplex virus/Genital herpes/HSV2 OR 1
Oral antiviral therapy(Acyclovir) is indicated for primary genital herpes infections, even if the presentation is delayed for up to 5 days
*gingivostomatitis: oral aciclovir, chlorhexidine mouthwash
*cold sores: topical aciclovir although the evidence base for this is modest
*genital herpes: oral aciclovir. Some patients with frequent exacerbations may benefit from longer term aciclovir
Which organisms cause painless ulcers?
C. trachomatis causes lymphogranuloma venereum;
T. pallidum causes syphilis; (A painless ulcer (chancre) is seen in the primary stage. on the coronal sulcus of the penis. The ulcer is not causing him any discomfort. On examination an ulcer with an erythematous border and a clean base is found.)
K. granulomatis causes granuloma inguinale.
red, scaly lesions and again is not seen on mucosal surfaces
Psoriasis
red, scaly lesions , not seen on mucosal surfaces
Psoriasis
WHICH DIS AND ORG?
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis.
LGV treated using ?
doxycycline.
PAINFUL BOTH oral and genital ulcers are caused in?
Behcet disease
Tx of Acute Prostatitis
quinolone antibiotic (ciprofloxacin 500 mg twice daily
or ofloxacin 200 mg twice daily) for 28 days.
If ciprofloxacin and ofloxacin cannot be taken, then they should be given trimethoprim 200 mg twice daily for 28 days is recommended.
drug of choice for the prophylaxis of contacts of meningococcal septicaemia
oral ciprofloxacin
Pneumonia causative organisms description
Respiratory syncytial virus = Bronchiolitis
Parainfluenza virus = Croup
Rhinovirus = Common cold
Influenza virus = Flu
Streptococcus pneumoniae = The most common cause of community-acquired pneumonia
Haemophilus influenzae = Community-acquired pneumonia,Most common cause of bronchiectasis exacerbations,Acute epiglottitis
Staphylococcus aureus Pneumonia = particularly following influenza
Mycoplasma pneumoniae = Atypical pneumonia
Flu-like symptoms classically precede a dry cough. Complications include haemolytic anaemia and erythema multiforme
Legionella pneumophilia = Atypical pneumonia
Classically spread by air-conditioning systems, causes dry cough. Lymphopenia, deranged liver function tests and hyponatraemia may be seen
Pneumocystis jiroveci Common cause of pneumonia in HIV patients ,develop exertional dyspnoea
Mycobacterium tuberculosis = Cough, night sweats and weight loss may be seen
‘bulls-eye’ rash is typically at the site of the tick bite; erythema migrans
Org?
borelia burgdorferi
Lyme dis
symptoms of lyme dis?
within 30 days;
Erythema migrans; typically develops 1-4 weeks after the initial bite but may present sooner
usually painless
headache
lethargy
fever
arthralgia
Later features (after 30 days)
cardiovascular;
heart block
peri/myocarditis
neurological;
facial nerve palsy
radicular pain
meningitis
test for lyme dis?
ELISA test
Tx for symptomatic people
D=doxycycline if early disease.
A=Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)
C=ceftriaxone if disseminated disease
