INFECTIOUS DISEASE Flashcards
Mainly with symptoms of meningitis or meningoencephalitis
common cause of HIV-related meningitis
cryptococcosis
Ix for cryptococcosis
Gold standard = culture CrAg
LP = round encapsulated yeast
management of cryptococcosis
Amphotericin B + flucytosine
fever dry cough chest discomfort progressive dyspnoea on exertion lethargy and headaches
histoplasmosis
Ix for histoplasmosis
histology/cytology of lymph node or lung disease
fungal culture
management of histoplasmosis
Amphotericin B and itraconazole
non-productive cough exertional dyspnoea fever tachypnea chest pain
usually opportunistic in HIV
Pneumocystis Jiroveci
Ix for pneumocystis jiroveci
exertional O2 stats = usually drop
sputum culture
CXR - typically normal
Management of pneumocystis jiroveci
IV/high dose of co-trimoxazole (Septrin) and steroid
check G6PD status
prodrome = headache, fever and agitation
hydrophobia - water provoking muscle spasms
hypersalivation
negri bodies in infected neurons
rabies
Ix for rabies
usually clinical suspicion
immunofluorescence from saliva/CSF or anti-rabies antibodies
management of rabies
contact PHE
vaccines given
benzodiazepines, haloperidol analgesia and anticholinergics
manifests as colitis hepatitis encephalitis pneumonitis retinitis
commonly affects immunocompromised people
transmitted through sex/close contact
cytomegalovirus
'blueberry muffin' lesions on skin growth retardation sensorineural deafness seizures hepatosplenomegaly
congenital cytomegalovirus syndrome
Ix of cytomegalovirus
serology IgM/G
‘owls eye’ inclusions on CMV PCR
management of cytomeglovirus
supportive in immunocompetent & antiviral in immunocompromised
cidofovir/foscarnet and ganciclovir
diarrhoea nausea vomiting fever abdo cramps
salmonella
Ix for salmonella
stool MCS
management for salmonella
supportive - hydration
if severe, consider ciprofloxacin or azithromycin
isolate for 48hrs after last vomiting/diarrhoea episode and notify PHE
fever headaches constipation dry cough rash
complications = confusion/delirium, intestinal perforation
salmonella typhi & paratyphi
Investigations of salmonella typhi & paratyphi
blood culture
stool MCS
serology unreliable
management of salmonella typhi and paratyphi
IV ceftriaxone
follow with oral azithromycin
diarrhoea - often bloody
fever
abdo pain
acquired faeco-oral or sexually transmitted
shigella
Ix for shigella
stool MCS
management for shigella
supportive - hydrate
if really unwell = ciprofloxacin/azithromycin
reinforce hand hygiene and notify PHE
prodrome = fever, lethargy., headache
trismus (lockjaw)
spasms (dysphagia)
opisthotonus - arched back/hyperextended neck
tetanus
management of tetanus
usually in ICU setting
- wound debridement
- ceftriaxone and metronidazole
- vaccinate
supportive treatment, muscle relaxants and IM tetanus Ig
diarrhoea = ‘rice-water stool’
abdo pain
vomiting
hypoglycaemia/dehydration
cholera
Dx of cholera
largely clinical and stool MSC
management of cholera
aggressive volume repletion (oral/IV)
adequate nutrition & Abx ciprofloxacin/doxycycline
flaccid paralysis (paresthesia/weakness)
diplopia
ataxia
bulbar palsy
hx of contaminated food ingestion or IV drug use
botulism
management for botulism
supportive care, close monitoring and botulism antitoxin
chronic, non-healing sores/shallow ulcers with grey membrane
- oftend preceded by trauma
OR
sore throat, cervical lymphadenopathy and low grade fever
classic grey pseudomembrane
bull neck = stridor
diptheria
Ix fro diptheria
throat swabs with MCS
management of diptheria
erythromycin
contact trace and prophylaxis
notify PHE
fever night sweats
weight loss
lymphadenopathy
hepatomegaly = anaemia, leucopenia and hypoalbuminaemia
atypical mycobacterium disease
Ix for atypical mycobacterium disease
mycobacterial cultures
management for atypical mycobacterium disease
macrolide and ethambutol and rifabutin for more than 3/12
majority asymptomatic some GI symptoms anaemia mild cough serum eosinophilia
walking in contaminated soil
hookworm
Ix for hookworm
stool ova cysts and parasites
perianal itching
more predominant at night
soreness around anus
threadworms (enterobiasis and pinworms)
diagnosis of threadworm
cellophane test and clinical suspicion
management of threadworm
albendazole/mebendazole for 2 weeks
treat the entire family
reinforce specific hygiene measures
avoid medication in pregnancy and breastfeeding
abdo pain
diarrhoea
bloody stools or mucus
fever
(mainly asymptomatic
amoebiasis
Ix of amoebiasis
stool OCP microscopy/PCR, serology
USS liver
management of amoebiasis
metronidazole for invasive colitis
followed by puromycin or diloxanide furoate
fever, headache, nausea arthralgia, anaemia and abdominal pain tachycardia/pnoea thrombocytopenia high transaminase levels splenomegaly
malaria
management of malaria
uncomplicated malaria - oral artemether lumefantrine
OR
malarone/Quinine and doxycycline
severe complication = IV artesunate 24hrs followed by riamet or IV quinine
fever night sweats headaches myalgia hepatosplenomegaly lymphocytosis, increased LFTs and CRP
affects immunocompromised people
toxoplasmosis
Ix for toxoplasmosis
serology and PCR
management of toxoplasmosis
acute is usually self-limiting in immunocompetent
severe disease = pyrimethamine and sulfadiazine
sore throat lymphadenopathy (anterior/posterior triangles) pyrexia splenomegaly maculopapular rash - post amoxicillin transient hepatitis
infectious mononucleosis/ glandular fever
Ix for glandular fever
monospot test
management for glandular fever
plenty of fluids, analgesia
avoid alcohol and contact sport
fever malaise
myalgia
parotitis = presents as earache/pain on eating
typically unilateral
mumps
high fever for a few days with a subsequent maculopapular rash
can have febrile convulsions
nagayama spots on uvula & soft palate
diarrhoea and cough
common in infancy
roseola (exanthem subitam)
management of roseola
analgesia to calm the fever
rest and hydration
prodrome = low grade fever
rash = maculopapular initially on face but then spreads to the body
usually resolves within 3-5days
lymphadenopathy - suboccipital and postauricular
rubella
Ix for rubella
serological and PCR
management for rubella
fluids, rest and analgesia
prodrome = irritable, conjunctivitis and fever
maculopapular rash - starts behind ears and spreads to the whole body
diarrhoea
koplik spots
measles
Ix for measles
IgM antibodies
management for measles
mainly supportive - inform PHE
admit if immunocompromised or pregnant
unimmunised contacts should be offered vaccine within 72hrs
initially fever
itchy rash starting on the had/trunk before spreading to the rest of the body
macular -> papular -> vesicular
varicella zoster virus /chickenpox
management of chickenpox
mainly supportive
calamine lotion
school exclusion till the all the lesions have crusted over
immunocompromised/newborns = VZIG and IV aciclovir
prodrome of mild malaise, fever, headache, sore-throat and rhinitis
symptom free period followed by an erythematous rash on the cheeks which disappears after 2-4days
slapped cheeks/Parvovirus B19/ erythema infectiosum
Ix for slapped cheeks
B19 specific IgM and IgG and PCR test for B19
management of slapped cheeks
conservative symptomatic treatment
avoid contact with at risk individuals
fever headache myalgia fatigue cough sore throat runny/stuffed nose
usually seasonal
influenza
management of influenza
fluids, analgesia and rest
primary infection = severe gingivostomatitis
cold sores
painful genital ulceration
herpes simplex virus
management of herpes simplex virus
- gingivostomatitis = oral aciclovir, chlorhexidine mouthwash
- cold sore = topical acyclovir
- genital ulcers = oral aciclovir
elect a c-section at 28 weeks
