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Infectious disease Flashcards

1
Q

What are examples of inactivated vaccines?

A

Polio
Flu vaccine
Hep A
Rabies

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2
Q

What are some examples of conjugate/ subunit vaccines?

A 
Pneumococcus
Meningococcus
Hep B
Pertussis
HPV
Shingles
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3
Q

What are inactivated vaccines?

A

Patient given killed version of pathogen

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4
Q

What are subunit and conjugate vaccines?

A

Patient given part of an organism in order to stimulate an immune response

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5
Q

What are live attenuated vaccines?

A

Contain a weakened version of the pathogen

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6
Q

Who should not be given live attenuated vaccines?

A

Immunocompromised patients as they can still cause infection

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7
Q

Give examples of live atenuated vaccines:

A 
MMR
BCG
Chickenpox
Nasal influenza
Rotavirus
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8
Q

What are toxin vaccines?

A

Contain a toxin that is normally produced by a pathogen, and cause immunity to the toxin not that pathogen

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9
Q

What are some examples of toxin vaccines?

A

Diptheria

Tetanus

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10
Q

At what stages in development are vaccines given?

A 
8 weeks
12 weeks
16 weeks
1 year
3
12-13
14
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11
Q

What vaccines are given at 8 weeks?

A

6-in-1
Meningococcal B
Rotavirus

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12
Q

What is included in the 6-in-1 vaccine?

A 
Diptheria
Tetanus
Pertussis
Polio
Hib
Hep B
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13
Q

What is included in the 12 week vaccine?

A

6-in-1
Pneumococcal
Rotavirus

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14
Q

What is given at the 16 week vaccines?

A

6-in-1

Meningococcal B

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15
Q

What vaccines are given at 1 year?

A

2 in 1
Pneumococcal
MMR
Meningococcal B

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16
Q

What is in the 2 in 1 vaccine?

A

HiB

Mening C

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17
Q

What vaccines are given at 3 years 4 motntsh?

A

4 in 1

MMR

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18
Q

What vaccines are in the 4 in 1 vaccine?

A

Diptheria
Tetanus
Pertussis
Polio

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19
Q

What vaccine is given at 12-13 years?

A

HPV

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20
Q

How many doses of the HPV vaccine are given?

A

2: 6-24 months apart

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21
Q

What vaccines are given at 14?

A

3 in 1

Meningococcal A, C, W & Y

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22
Q

What is included in the 3 in 1 vaccine?

A

Tetanus
Diptheria
Polio

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23
Q

Why is the HPV vaccine given at 12-13?

A

Hopefully before they become sexually active

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24
Q

What is the BCG vaccine and who gets it?

A

Offered from birth for babies who are at higher risk of tuberculosis

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25
Q

What white blood cells pay a key part in sepsis?

A

Macrophages
Lymphocytes
Mast cells

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26
Q

What do the WBC’s release in response to the causative pathogen?

A

Cytokines (Interleukins, TNF)

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27
Q

What is the action of the cytokines?

A

Activate other parts of the immune system, leading to further release of chemicals

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28
Q

What is the action of nitrous oxide?

A

Released in an immune response to cause vasodilation

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29
Q

What do cytokines do to blood vessels?

A

Cause the endothelial lining to become more permeable

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30
Q

Why do you get oedema in sepsis?

A

The blood vessels become more permeable, causing fluid to leak out into the extracellular space

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31
Q

What is the effect of the oedema in sepsis?

A

It creates space between the blood and tissues, reducing the amount of oxygen that reaches the tissues

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32
Q

What system is also activated in sepsis?

A

The coagulation system

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33
Q

What does the activation of the coagulation system lead to in sepsis?

A

Deposition of fibrin throughout the circulation, compromising organ/ tissue perfusion
Thrombocytopenia
Haemorrhages
DIC

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34
Q

What is disseminated intravascular coagulopathy?

A

Small blood clots develop throughout bloodstream and block small blood vessels

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35
Q

Why does blood lactate rise in sepsis?

A

It is a waste product which forms as a result of anaerobic respiration in hypo-perfused tissues

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36
Q

Why are tissues hypo-perfused in sepsis?

A

Chemicals cause vasodilation
Oedema reduces amount of oxygen reaching tissues
Fibrin depositions compromise perfusion
Inflammation

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37
Q

When does sepsis become septic shock?

A

When sepsis has lead to cardiovascular dysfuntion

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38
Q

How should septic shock be treated?

A

IV fluid resuscitation

Inotropes

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39
Q

What signs should you look out for that indicate sepsis?

A 
Deranged obs
Prolonged CRT
Fever/ hypothermia
Deranged behaviour
Poor feeding
Incosolable
Reduced consciousness
Floppy
Skin colour changes
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40
Q

How are children assessed for sepsis?

A

Traffic light system:
Green= low risk
Amber= medium risk
Red= high risk

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41
Q

What features are children assessed on when looking for sepsis?

A 
Colour
Activity
Respiration
Circulation
Other (fever, rash, seizures)
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42
Q

When would a child be treated immediately for sepsis?

A

All under 3 months with a temperature of >38

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43
Q

What is the immediate management of sepsis?

A 
3 In:
- IV fluids
- Abx
- Oxygen
3 Out:
- Blood cultures
-Urine ouput/ dipstick
- Blood tests
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44
Q

What blood tests should be done when investigating sepsis?

A 
FBC
U&E
CRP
INR
Blood gas: Lactate and acidosis
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45
Q

What additional investigations may be performed when diagnosing sepsis?

A 
CXR
Abdo/ pelvic USS
LP
Meningococcal PCR
Serum cortisol
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46
Q

How long should antibiotics be continues if bacterial infection is the suspected cause of sepsis?

A

5-7 days

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47
Q

When would you consider stopping antibiotics in a suspected sepsis case?

A

When there is low suspicion of bacterial infection
Patient is well
Blood cultures and two CRP results are negative at 48 hours

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48
Q

What is the most common cause of fever in infants <3 months?

A

Bacterial

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49
Q

Why is it unlikely for an infant <3 months to have a viral infection?

A

Due to passive immunity from mother

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50
Q

What is meningitis?

A

Inflammation of the meninges

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51
Q

What are the meninges?

A

Lining of the brain and spinal cord

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52
Q

What meningococcal septicaemia?

A

Meningococcus bacterial infection in the bloodstream

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53
Q

What is meningococcus full name?

A

Niesseria meningitidis

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54
Q

What kind of bacteria is meningococcus?

A

Gram-negative diplococcus

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55
Q

What causes the classic ‘non-blanching’ rash in meningitis?

A

Meningococcal septicaemia causing DIC and subcutaneous haemorrhages

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56
Q

What is meningococcal meningitis?

A

When meningococcus infects the meninges and CSF

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57
Q

What are the most common causative organisms of meningitis?

A 
Niesseria meningitidis (meningococus) 
Strep pneumoniae (pneumococcus)
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58
Q

What is the most common cause of bacterial meningitis in neonates?

A

Group B strep (found in the mothers vagina)

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59
Q

What are the typical symptoms of meningitis?

A 
Fever
Neck stiffness
Vomiting
Headache
Photophobia
Altered consciousness
Seizures
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60
Q

What is the characteristic symptoms of meningococcal septicaemia?

A

Non-blanching rash

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61
Q

How do neonates and babies present with meningitis?

A 
Non-specific: 
hypotonia
Poor feeding
Lethargy
Hypothermia
Bulging fontanelle
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62
Q

When is a lumbar puncture indicated in meningitis investigations?

A

< 1 months presenting with fever
1-3 months with fever and unwell
<1 year with unexplained fever and serious illness

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63
Q

What are the two special tests that can be performed to look for meningeal irritation?

A

Kernig’s test

Brudzinski’s test

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64
Q

What is Kernig’s test?

A

Lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee to stretch the meninges

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65
Q

What is Brudzinski’s test?

A

Lying patient flat on back and gently lifting head and neck off bed. Positive test is if patient involuntarily flexes hips and knees

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66
Q

How is bacterial meningitis managed in the community?

A

Stat Benzylpenicillin injection prior to transfer to hospital

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67
Q

What should be sent off prior to starting antibiotics in an ideal worlsd?

A

Blood culture and CSF

Meningococcal PCR

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68
Q

How is bacterial meningitis treated in hospital?

A

Follow local guideline antibiotics

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69
Q

What are the typical antibiotics given to an infant <3 months to treat meningitis?

A

Cefotaxime + amoxicillin

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70
Q

What antibiotic is given to children >3months for meningitis?

A

Ceftriaxone

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71
Q

What should be added to antibiotic treatment if there is a risk of penicillin resistant pneumococcal infection?

A

Vancomycin

72
Q

What is given to children with meningitis in addition to antibiotics and why?

A

Dexamethasone to reduce the frequency and severity of hearing loss and neurological damage

73
Q

What must be done in all cases of bacterial meningitis and meningococcal infection?

A

Inform public health as they are notifiable diseases

74
Q

What is given to people who have had significant exposure to a patient with meningococcal infection?

A

Post exposure prophylaxis: single dose of ciprofloxacin

75
Q

What counts as significant exposure?

A

Prolonged contact with a patient with meningococcal infection within 7 days prior to onset of infection

76
Q

What are the most common causes of viral meningitis?

A

HSV
Enterovirus
VZV

77
Q

What must be done to differentiate between bacterial and viral meningitis?

A

LP for CSF

78
Q

How is viral meningitis treated?

A

Tends to be milder so usually supportive

Van use aciclovir

79
Q

Where is the needle inserted in a lumbar puncture and why?

A

L3-L4, as the spinal cord ends at L1-L2

80
Q

What are CSF samples tested for after an LP?

A 
Bacterial culture
Viral PCR
Cell count
Protein
Glucose
81
Q

What should be taken at the same time as an LP and why?

A

Blood glucose sample to compare to CSF glucose content

82
Q

What are the characteristic features of CSF sample infected with bacteria?

A 
Cloudy
High protein content
Low glucose content
High neutrophil count
Bacterial culture positive
83
Q

What are the characteristic features of a viral CSF sample?

A

Clear appearance
Normal (or raised) protein
Normal glucose
High lymphocyte count

84
Q

Why does the CSF contain high protein and low glucose with bacterial infection?

A

Bacteria release proteins and use up glucose

85
Q

What are the key complications of meningitis?

A 
Hearing loss
Seizures
Cognitive impairment
Learning disability
Memory loss
Cerebral palsy
86
Q

What is encephalitis?

A

Inflammation of the brain

87
Q

What are the non-infective causes of encephalitis?

A

Autoimmune

88
Q

What is the most common cause of encephalitis?

A

Viral infection

89
Q

What is the most common viral cause of encephalitis?

A

Herpes simplex virus (HSV)

90
Q

Wha is the most common viral cause of encephalitis in children?

A

HSV-1 from cold sores

91
Q

What is the most common viral cause of encephalitis in neonates?

A

HSV-2 from genital herpes contracted during birth

92
Q

What are other viral causes of encephalitis?

A 
VZV
Cytomegalovirus
EBV
Enterovirus
Adenovirus
Influenza
93
Q

How does encephalitis present?

A 
Altered consciousness
Altered cognition
Unusual behaviour
Acute onset of focal neurological symptoms and seizures
Fever
94
Q

What key investigations are done into encephalitis?

A 
LP
MRI
EEG
Swabs to find causative organism
HIV testing
95
Q

When would an LP be contraindicated and what investigation should be done instead?

A

GCS < 9
Haemodynamically unstable
Active seizures or post-ictal

Do CT scan instead

96
Q

How is suspected encephalitis managed?

A

IV antivirals

97
Q

What antiviral is used to treat HSV or VZV?

A

Aciclovir

98
Q

What antiviral is used to treat CMV?

A

Ganciclovir

99
Q

What are the complications of encephalitis?

A 
Lasting fatigue
Change in personality/ mood/ memory/ cognition
Learning disability
Headaches
Chronic pain
Movement disorders
Sensory disturbance
Seizures
Hormonal imbalance
100
Q

What causes infectious mononucleosis?

A

Epstein Barr Virus (EBV)

101
Q

What is infectious mononucleosis also known as?

A

Mono
Kissing disease
Glandular fever

102
Q

How is EBV spread?

A

Saliva of infected individuals: kissing, sharing cups, toothbrushes act

103
Q

When are most people infected with EBV?

A

As children when it causes few symptoms

104
Q

When does EBV infection tend to cause more severe symptoms?

A

In teenagers or young adults

105
Q

What is symptomatic infection with EBV called?

A

Infectious mononucleosis

106
Q

What are the symptoms fo IM?

A 
Fever
Sore throat
Fatigue
Lymphadenopathy
Enlarged tonsils
Splenomegaly
107
Q

Why should cefalosporins and amoxicillin be avoided in glandular fever?

A

Cause itchy maculopapular rash

108
Q

How is EBV diagnosed?

A

Antibody tests

109
Q

What are heterophile antibodies?

A

Antibodies that are produces in infectious mononucleosis (and other things)

110
Q

Up to how long does it take heterophile antibodies to be produced in IM?

A

Up to 6 weeks

111
Q

How are heterophile antibodies tested for?

A

Monospot test

Paul-Bunnel test

112
Q

What is a monospot test?

A

Introduces patients blood to RBC’s from horses. Antibodies will react to give a positive result

113
Q

What antibodies is it possible to test for in EBV infection?

A

IgM

IgG

114
Q

How is IM managed?

A

Supportive

Avoid alcohol and contact sports

115
Q

What are the complications of IM?

A 
Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue
116
Q

What kind of infection is mumps?

A

Viral infection

117
Q

How is mumps spread?

A

Respiratory droplets

118
Q

What is the incubation period for mumps?

A

15-25 days

119
Q

How long does mumps usually last?

A

1 week

120
Q

How is mumps managed?

A

Supportively

121
Q

What level of protection does the MMR vaccine offer against mumps?

A

80%

122
Q

What is the symptoms course of mumps?

A

Prodrome (flu-like symptoms) followed by parotid swelling a few days later
Symptoms of complications (abdo pain, testicular pain, meningitis)

123
Q

What is the characteristic feature of mumps?

A

Parotid gland swelling with associated pain

124
Q

What are the complications of mumps?

A

Pancreatitis
Orchitis
Meningitis
Sensironeural hearing loss

125
Q

How is mumps diagnosis confirmed?

A

PCR testing of saliva swab

126
Q

What must be done in all mumps cases?

A

Notify public health

127
Q

How can HIV be transmitted to children?

A

During pregnancy
During birth
Breastfeeding
Blood or bodily fluid exposure

128
Q

How can you prevent transmission of HIV during birth?

A

Alter mode of delivery

Prophylactic treatment

129
Q

When can normal vaginal delivery be performed when the mother has HIV?

A

If she has a viral load <50

130
Q

When should C-section be considered in a HIV +ve mother?

A

Should be considered >50

Definitely performed if viral load >400

131
Q

When should IV Zidovudine be given during C-section?

A

If the viral load is unknown or there are >10000 copies/ ml

132
Q

What prophylactic treatment should low risk babies be give?

A

Zidovudine for 4 weeks

133
Q

What prophylactic should high risk babies be given?

A

Zidovudine, lamivudine and nevirapine for 4 weeks

134
Q

What makes a baby high risk in terms of prophylaxis treatment offered?

A

Mums viral load is >50 copies/ ml

135
Q

Can HIV mothers breast feed?

A

Not recommended no matter how low the viral loaf

136
Q

Why might a child under 18 months test positive for HIV despite not having the virus?

A

Due to maternal antibodies

137
Q

When should you test children for HIV?

A

Babies to HIV positive parents
If immunodeficiency is suspected
Young people who are sexually active or there are other risk factors

138
Q

What are the two options for HIV testing?

A

HIV antibody screen

HIV viral load

139
Q

How and when are babies to HIV positive parents tested?

A

HIV viral load test at 3 months

HIV antibody test at 24 months

140
Q

What are the key principles in managing HIV?

A

Antiretroviral therapy
Normal childhood vaccines
Prophylactic Septrin with low C4 counts
Treatment of opportunistic infections

141
Q

What kind of infection is hepatitis B?

A

DNA virus

142
Q

How is Hep B transmitted?

A

Direct contact with blood or bodily fluids

Vertical transmission

143
Q

How quickly do most children recover from Hep B infection?

A

Within 2 months

144
Q

What happens to a small proportion of people with Hep B infection?

A

Become chronic hep B carriers0 Virus DNA integrates into their own DNA

145
Q

What is the risk of developing chronic hepatitis B after exposure in a neonate?

A

90%

146
Q

What is the risk of developing chronic hepatitis B after exposure in a child <5?

A

30%

147
Q

What is the risk of developing chronic hepatitis B after exposure in an adolescent?

A

<10%

148
Q

Are chronic hep B carriers symptomatic?

A

No have normal growth and development and liver function tests

149
Q

What happens to <5% of chronic hep B carriers?

A

Develop liver cirrhosis

150
Q

What are the different antigens and antibodies you can look for in Hep B infection?

A 
HBsAg
HBeAg
HBcAb
HBsAb
HBV DNA
151
Q

What is HBsAg and what does it signify?

A

Surface antigen

Indicates active Hep B infection

152
Q

What is HBeAg and what does it signify?

A

E antigen

Marker of viral replication and implies high infectivity

153
Q

What is HBcAb and what does it indiate?

A

Core antibodies

Implies past or current infection

154
Q

What is HBsAb and what does it indicate?

A

Surface antibody

Implies vaccination or past/ current infection

155
Q

What is HBV DNA and what does it indicate?

A

Direct count of viral load

156
Q

When screening for hep B, what is initially looked for?

A

HBcAb and HBsAg for previous and active infection

157
Q

If HBcAb and HBsAg are positive, what is then looked for?

A

HBeAg and HBV DNA (Viral load)

158
Q

What can HBcAb help distinguish between?

A

Acute, chronic and past infection

159
Q

What does the level of HBeAg correlate with?

A

The infectivity

160
Q

Which children should be tested for hep B?

A

Those with hep B positive mums
Migrants from endemic areas
Close contacts of patients with hep B

161
Q

What should neonates with hep B positive mothers be given within 24 hours of birth?

A

Hep B vaccine

Hep B immunoglobulin infusion

162
Q

What additional measures to babies born to hep B positive mothers recieve?

A

Hep B vaccine and Ig infusion at birth
Addition vaccine at 1 and 12 months
Test for HBsAg at 1

163
Q

Is it safe for a hep B positive mother to breastfeed?

A

Yes if baby has been properly vaccinated

164
Q

What does the hep B vaccine involve?

A

Injecting hep B surface antigen

3 doses at different intervals

165
Q

How is Hep B managed?

A

Supportive

Regular follow up with chronic cases

166
Q

What kind of virus is Hep C?

A

RNA virus

167
Q

How is hep C spread?

A

By blood and bodily fluids

168
Q

Is there a vaccine for hep C?

A

No

169
Q

What is the disease course of Hep C in adults?

A

1 in 4 make full recovery

3 in 4 develop chronic hep C

170
Q

What are the complications of hep C?

A

Liver cirrhosis

Hepatocellular carcinoma

171
Q

What percentage of babies the Hep C infected mothers develop the virus?

A

5-15%

172
Q

Do babies and children get affected by hep C?

A

No symptoms or pathology associated

173
Q

How is Hep C tested for?

A

Hep C antibody

Hep C RNA testing

174
Q

How is Hep C managed in adults?

A

Curable using direct acting antivirals

175
Q

How is Hep C managed in children?

A

Test babies at 18 months with positive mothers
Often clear is spontaneously
Treatment typically delayed until adulthood

Paeds (18 decks)

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