Infectious Disease Flashcards
How should you take blood cultures from a patient with suspected endocarditis?
Three cultures from at least three different sites
To be taken before antibiotics commenced
What is sepsis?
life-threatening organ dysfunction caused by a
dysregulated host response to infection
What is the sepsis 6?
Give O2 Give IV fluids Give IV Abx Take blood cultures Measure lactate Measure urine output
What are the common organisms that cause soft skin infections?
Staphylococcus aureus
Streptococci
MRSA
What organisms can cause MSK infections?
Staphylococcus aureus
Streptococci
MRSA
TB
What organisms commonly causes respiratory infections?
Streptococci pneumoniae
Haemophilus influenzae
Atypical: legionella, mycoplasma
Rhinovirus/adenovirus/enterovirus/influenza
What organisms commonly cause GI infections?
Rotavirus, adenovirus Campylobacter Shigella E.Coli Salmonella typhi/paratyphi Enterobacteriacae (visceral infection/peritonitis)
What organisms typically cause GU infections?
Enterobacteriacae (e.g. e.coli, klebisella sp, proteous sp.) Pseudomonas arogenosa ESBL/resistant organisims Neisseria gonorrhoeae Chlamydia trachomatis
What organisms commonly cause CNS infections?
Streptococci pneumoniae Neisseria meningitidis Listeria TB Herpes simplex virus
What organisms typically cause endocarditis?
Streptococci viridans group
Enterococci faecalis/faecium
Staphlococcus aureus
MRSA
What organisms typcially cause line infections?
Staphylococcus aureus
Streptococci
MRSA
What is the first line antibiotic to treat suspected sepsis?
Meropenem stat dose
What organisms typically cause hospital aquired infections?
Enterobacteriacae (E.coli, Klebsiella spp.)
Pseudomonas spp.
C. difficile
Staph. aureus (pneumonia)
What is the 10 point approach to a patient with an infection?
- What is the evidence for infection
- Severity
- Patient factors to consider
- Body system/organ affected
- What is the likely organism involved?
- And therefore what is the best antimicrobial therapy?
- Which route of administration is best?
- Is any other treatment needed?
- Is there any risk of transmission to others?
- What planning is required for follow-up and discharge?
What travel-related illness signs/symptoms do patients most commonly present with?
Diarrhoea Vommiting Jaundice Lymphadenopathy Hepatosplenomegaly Cough SOB Rash
What should be asked when taking a history from a patient where travel-related infection is suspected?
Geographic region of travel within the last 12-18 months ANY previous travel to the tropics Dates of travel and duration of stay Time and onset of signs and symptoms Rural vs urban stays - accomidation Recreational activities and exposures Food and water Sexual exposures PMH and predisposition to infection
What kind of infection is likely to present 0-10 days after travel
Dengue Rickettesa (insects) Viral Bacteria Amoeba
What type of infection is likely to present 10-21 days after returning from travel?
Malaria
Typhoid
Primary HIV infection
What type of travel-related infection is likely to present after 21 days?
Malaria
Chronic bacterial infections (brucella, coxiella, endocarditis, bone and joint infections)
TB
Parasitic infections
What infections can cause splenomegaly?
Mononucleosis Malaria Visceral leishmaniasis Thyphoid fever Brucellosis
What infections may present with a maculopapular rash?
Dengue fever Leptospirosis Rickettsia EBV CMV Rubella Parovirus 19 Primary HIV infection
What travel-related infections can cause meningo-encephalitis?
Cerebral maleria
Japanese enchephalitis
West nile virus encephalitis
(+common causes) N.meningitis/STrep penumonia/ HSV
What is the most common species of malaria that causes serious illness?
Plasmodium falciparum
What is the most common species of malaria?
Plasmodium vivax
How does malaria present?
Abrupt onset rigors High fevers Malaise Severe headache Myalgia Vague abdo pain N&V Diarrhea (25%) Jaundice Hepatoslenomegaly Anaemia, thromovytopenia, leukopenia, abnormal LFTs(chronic illness) Untreated p. falciparum: hypoglycemia, renal failure, pulmonary odema, neurologic deterioration
Where is typhoid fever prevalent?
South east Asia
Southern and Centeral America
How does Thypoid Fever present?
Sustained fever Anorexia Malaise Vague abdominal discomfort Constipation or diarrhea Dry cough Hepatospleonmegaly Rose spots Pule-temperature dissociation Leucopenia, lymphopenia, raised CRP
How is typhoid fever diagnosed?
Isolation of organism in cultures of blood, stool, urine, bone marrow, duodenal aspirates
How is suspected Typhoid fever treated empirically?
IV Ceftriaxone
What is used to treat Typhoid once sensitivites known?
Ciprofloxacin or Azithromycin
What is the definition of Pyrexia of Unknown Origin?
Temperature > 38 degrees on multiple ocassion
Illness > 3 weeks duration
No diagnosis despite > 1 week inpatient stay
Causes of PUOs?
Infective - TB, abscesses, infective endocarditis, brucellosis
Autoimmune/connective tissue adult onset Still’s disease, temporal arteritis, Wegner’s granulomatosis
Neoplastic - leukaemias, lymphomas, renal cell carcinoma
Other - drugs, thromboembolism, hyperthroidsim, adrenal insufficiency
Key parts of examination when reviewing a pt with PUO
Lymph nodes
Stigmatat of endocarditis
Evidence of weight loss
Joint abnormalities
What is the lifetime reactivation risk of TB?
10-15% usually due to immunosupression, HIV, increasing age
What screening is used to identify latent TB?
quantiFERON or T-spot - measurement of interferon gamma
CXR
Who should be screened for latent TB?
Immigrants from high prevalence countries
Healthcare workers
HIV positive patients
Patient starting on immunosupression
What drugs are used to treat latent TB?
3 MONTHS RIFAMPICIN + ISONIAZID
or
6 MONTHS RIFAMPICIN
Active TB symptoms
Non-resolving cough
Unexplained persistent fever (low or high grade)
Drenching night sweats
Weight loss
What clinical signs may be present in a patient with TB?
Clubbing Cachexia Lymphadenopathy Hepato/splenomegaly Erythema Nodosum Crepitations Bronchial breathing Pericardial rub
What imaging may be used for TB?
CXR - pulmonary TB
CT - Lymphadenopathy, nodes with central necrosis, lesions in viscera
MRI - can show leptomeningeal enhancement in TB meningitis
What may be seen on the CXR of a patient with pulmonary TB?
Mediastinal lymphadenopathy
Cavitating pneumonia
Pleural effusion
What is the gold standard for diagnosing TB?
Bacterial culture
Ideally taken before treatment commenced
But do not need to wait to start therapy as may take up to 6 weeks
What is smear positive TB?
TB can be seen on a sample using single microscopy
High bacterial load and high infectivity
In smear negative pulmonary TB what investigation is done next?
Bronchoscopy +/- endobronchial guided biopsy of pulmonary lymph nodes
How is meningeal TB diagnosed?
Lumbar puncture for TB culture and PCR
How is lymph node TB diagnosed?
Core biopsy of lymph node
How is pericardial TB diagnosed?
If practical (often not) pericardiocentesis
How is GI TB diagnosed?
Colonoscopy and bowel biopsy/US guided omentum biopsy
What is seen on TB histology?
Caseating/necrotising granulomatous inflammation
When should steroids be given alongside ATT?
When TB is affecting sites that cannot tolerate swelling e.g. meningial/spinal/pericardial
Steroids given at the start of treatment
Why do many patients feel worse at the start of TB treatment?
Increase in inflammation as bacteria die causing worsening symptoms
What complications may result from pericardial TB? What signs might be seen?
Pericardial Effusion
Tamponade
Pericardial rub
Kussmaul’s sign
When should ATT be started in patients with MIliary TB?
As soon as it is determined whether or not there is a CNS involvement, using CT/MRI head, should not be delayed whilst awaiting biopsies
Where can Miliary TB be found?
Widespread Lung CNS Bone marrow Pericardium
What precautions should be taken in terms of infection control for patients with MDR TB
Negative pressure room
Staff to wear masks and PPE
What is the Standard ATT (used for all sites but CNS)
2 months: Rifampicin Isoniazid Ethambutol Pyrazinamide (Pyridoxine) 4 months Rifampicin Isoniazid (Pyridoxine)
Side effects of Rifampicin?
Turns urine/tears orange
Hepatitis
Side effects of Isoniazid?
Peripheral nueropathy
Colour blindness
Hepatitis
Ethambutol side effects?
Optic neuropathy
Reduced visual acuity
Which drug used in ATT is most likely to cause hepatitis?
Pyrazinamide
What monitoring is required before commencing ATT?
Baseline LFTs
Ethambutol - visual acuity
What must be monitored throughout ATT?
LFTs
For how long must a patient with TB be isolated?
Until they have been treated for 2 weeks
How can NAATS be performed when screening for chlamydia trachomatis or neisseria gonorrhoeae?
first pass urine (men)
vulvo-vaginal swab
pharyngeal swab
rectal swab
Where should a vaginal discharge swab be taken from when testing for trichomonas vaginals and candida?
Posterior fornix
Charcoal swab
Where should a vaginal discharge swab be taken from when testing for Gonococcal culture?
Cervical os
Charcol swab
What kind of swab should be used for Gonococcal cultures?
Charcol
What viruses should be tested for in patients with genital and oral ulcers?
HSV 1
HSV 2
What infections may cause anal discharge?
Gonorrhea
HSV
What baseline investigations should be carried out on patients newly diagnosed with HIV?
Confirmatory HIV test
CD4 count
HIV viral load
HIV resistance profile
HLA B*5701 status
Serology for syphillis, hepatitis B, hep C, heP A
Toxoplasma IgG measles IgG varicella IgG rubella IgG
FBC U&Es LFTs bone profile lipid profile
Schistosoma serology (if spent >1 month in sub-Saharan Africa)
Women should have annual cervical cytology
What serology should be conducted for Hep B?
sAg
cAb
sAb
Below which CD4 count should HIV patients be perscribed prophylactic antibiotics against PCP?
CD4 < 200
Below what CD4 is considered AIDs?
CD4 < 200
What vaccinations should be given to patients with HIV?
Hep B
Pneumococcus
Annual Influenza
After what time period following ingestion does Bacillus cereus infection present?
Within 6 hours
What food most commonly causes Bacillus cereus?
Rice
What symptoms does Bacillus Cereus infection cause?
Vomiting
Diarrhoea
How does Heamophillus Influenzae present on gram stain?
Gram negative cocci
What drugs can be used to treat VRE?
Linezolid
Teicoplanin
What is the gold standard in diagnosis of malaria?
Thick and thin blood films
Thin: identification of species
Thick: estimation of parasite density
What is the most common cause of food poisoning in the UK?
Campylobacter jejuni
What kind of diarrhoea does campulobacter jejuni cause?
Dysenteric (blood+mucus) due to bacterial invasion of the intestinal mucosa
What is the investigation of choice for chlamydia?
NAATs
Nuclear acid amplification test
How does HSV typically present
Painful ulcers
How does syphillis normaly present?
Painless ulcers
What kind of bacterium is chlamydia trachomatis?
Obligate intracellular
What kind of bacterium is N.gonorrhoea - intracellular or extracellular?
Extracellular
How is chlamydia managed?
7 days doxycycline
Azithromycin if not tolerated or in pregnancy
What can predispose patients with parovirus B19 to aplastic aneamia?
Patients with a background of haemolytic aneamia
What virus can cause a characteristic slapped cheek rash, particularly in children?
Parovirus 19/fifth disease
Parovirus 19 can cross the placenta, before what gestation should a pregnant woman seek advice if exposed?
20 weeks
What is Lemieere’s syndrome?
Thrombophlebitis of the internal jugular vein following an anaerobic oropharangeal infection (e.g. tonsillitis)
How long after transmission does hep A present? How is it often transmitted?
2-4 weeks
Undercooked meat/unclean water consumed in developing countries
Why should bacteria in the urine of a pregnant woman be treated, regardless of symptoms?
Risk factor for low birth weight, pyelonephritis, premature delivery
At what point in a pregnancy is trimethoprim tetragenic?
First trimester
When shout nitrofurantonin be avoided during pregnancy?
At term - may produce neonatal haemolysis
What are the main caustive organisms for cellulitis?
Staphylococcus aureus
Streptococcus pyogens
Antibiotic of choice for cellulitis?
Flucloxacillin
Clarithromycin if pen allergic
What is the treatment of choice for Neisseria gonorrhoeae infection
intramuscular antibiotic injection of ceftriaxone
Which antibiotic class can cause defective desquamation of the filiform papillae of the younger, leading to a black, hairy tongue
Tetracyclines (doxycycline, tetracycline)
What is the drug of choice to treat Schistosoma mansoni?
praziquantel
What is the treatment for PID?
Doxycycline + metronidazole + ceftriaxone
What is the antibiotic of choice for extensive otitis externa?
Flucloxacillin
What should be used to treat an outbreak of genital herpes?
Oral aciclovir
How many doses of tetnus vaccination is suitable for long term protection?
5
What vaccinations are routinely offered to women who are pregnant?
Influenza
Pertussis
How does BV (gardnerella vaginalis) infection present?
Offensive vaginal discharge Fishy smell - positive whiff test when potassium hydroxide added Clue cells Grey in colour Vaginal pH > 4.5
How does a vaginal canddida albicans infection typically present?
White ‘curdy’ vaginal discharge
pH < 4.5
How to trichomonas vaginalis infections typicall present?
Vulvovaginitis acoompinied by offensive, yellow-green frothy discharge
What drug is used to treat both BV and trichomonas
Metronidazole
WHat is the latest time HIV PEP can be given?
72 hours after exposure
What antibiotic should be given to treat an atypical pneumonia?
Clarithromycin
What antibiotic should be used to treat a lower urinary tract infection?
Trimethoprim
Nitrofurantonin
Amoxicillin
Cephalosporin
What antibiotic should be added in the treatment of penumonia secondary to influenza?
Flucloxacillin
What is the first-line antibiotic threapy for campylobacter infection?
Clarithromycin
What organism causes Q fever and what is its natural resevoir?
Coxiella burnetti
Cattle and sheep
What organism causes Q fever and what is its natural resevoir?
Coxiella burnetti
Cattle and sheep
Common local complication of gonorrhoea in men?
Urethral stricture
How does Neisseria Meningitidis appear on gram stain?
Gram negative diplococci
How does E coli appear on gram stain?
Gram negative rods
How does Staph aureus appear on gram stain?
Gram positive cocci - grape like
How does staph epidermis appear on gram stain?
Gram positive cocci - grape like
How does staph pyogenes appear on gram stain?
Gram positive cocci chains
GROUP A are B HAEMOLYTIC
How does staph pyogenes appear on gram stain?
Gram positive cocci chains
GROUP A are B HAEMOLYTIC
How does C. difficile appear on gram stain?
Gram positive rod
How does step pneumoniae appear on gram stain?
Gram positive cossus (usually diplococci)
How does viridans streptococci appear on gram stain?
Gram positive cocci in chains
How does haemophilus influenzae appear on gram stain?
Gram negative coccobacilli
How does salmonella typhi appear on gram stain?
Gram negative bacilli with flagella
How does legionella pneumophillia look on gram stain?
Gram negative bacilli
What kind of virus is EBV?
dsDNA envoloped virus
How does EBV appear on a FBC?
Elevated lymphocytes, on microscopy atypical lympocytes will be seen
What kind of virus is Varicella Zoster?
Enveloped DNA virus
Where does latent infection of varicella zoster lie?
Dorsal root ganglia
What kind of rash does varicella zoster cause?
Vesicular rash
How can varicella zoster be treated?
Acyclovir
What kind of virus is HIV?
ssRNA, enbeloped retrovirus
Name opportunistic infections that can be found in patients with HIV?
Oral candidiasis - candida albicans
Kaposis sarcoma - HHV8
Pneumonocystis pneumonia - pneumonocystis
How is P.Falciarum treated
Quinine
Doxyclcyline
Can use chloroquinine but do G6PDH testing first
How is candida albicans treated?
Nystatin
CLotrimazole
IV fluconazole
How is aspirgillous infection treated?
Amphotericin B
What antibiotic is used to treat Neisseria Meningitdes infection?
Ceftriaxone (good activity in CSF) in sepsis
Best antibiotic for e-coli UTI?
Trimethoprim
What antibiotic is used to treat staph epidermis infection?
Flucloxacillin
What antibiotic is used to treat strep pyogenes infection?
Penicillin V
Clarithromycin if resistant
What antibiotic is used to treat c.diff infection?
Vancomycin
What antibiotic is used to treat strep pneumoniae infection?
MILD Amoxicillin/doxycyline
MODERATE (amoxicillin) + doxycycline
SEVERE: CO amoxiclav/meropenem and Doxycycline
What antibiotic is used to treat haemophilus influenzae infection?
Amoxicillin
What antibiotic is used to treat salmonella thyphi infection?
3rd gen cephalosporin (cefixime)
What is used to treat legionella pneumophila
CLarithromycin or fluroquinolones
In hepatitis B which antibody will be positive in vaccinated patients?
Anti HbsAb
How is Hep C treated?
Ribovarin and interferon (8-12 weeks)
How is HIV treated?
2 Nucleoside inhibitors + 1 non-nucleoside reverse transcriptase inhibitor / 1 protease inhibitor / 1 intergrase inhibitor
What is the most common caustive ogranism of bacterial tonsilitis?
Streptococcus pyogenes
What is used to treat bacterial tonsillitis?
Penicillin V
Most common causes of pharangitis?
EBV
Adenovirus
Steptococcus pyogenes
How may schitosomiosis infection present?
Hepatospleonmegaly Eosinophillia Katayama fever Helminth eggs in stools and urine Liver/bladder fibrosis
What is the diagnostic test for mumps?
Salivary IgM testing
Mode of transmission for measles?
Resp droplets
What are the white spots inside a patients cheek that are called found in children with measels?
Koplik
What test can quickly identify streptococcus pneumonia?
Urinary antigen testing
Risk factors for brucellosis?
Abatoir work
Unpasturised milk consumption
Transmission through resp droplets between farmers
Incubation of brucellosis
5-30 days
What CSF findings are found in bacterial meningitis?
Macroscopically purulent
Neutrophillic leukocytosis
Low glucose
High protein
What often causes a tertian pattern (every two days) fever?
Plasmodium vivax or ovale species
What is used to treat schistosomiasis?
Corticosteroids
Praziquantel
Whats the first line treatment for c diff?
Oral vancomycin
How does leprosy present?
Hypopigmented, hypoesthetic skin lesions
Leonine facial appearence
Neuorpathy with thickening of the peripheral nerves
Best investigation to diagnose BV?
Gram stain
Most common bacterial causes of gastroenteritis?
Staphylococcus aureus: usually found in cooked meats and cream products
Bacillus cerus: mainly found in reheated rice
CLostridium perfringes
E.coli
Salmonella
Shigella
What clinical exmaination test is ussed to differentiate gastroenteritis from Dengue?
Torniquet test
What is a positive torniquet test?
BP cuff inflated to midway between systolic and diastolic for five mins
If 10 or petechiae per square inch, positive
Treatment for athletes foot?
Topical terbinafine?
What ATT is most likely to cause hepatotoxicity?
Isoniazid
What is given in bacterial meningitis to reduce morbiditiy and mortality?
IV Dexamethasone
What should be used with caution in patients with a history of penicilin anaphylaxis?
1st gen cephalosporins such as ceftazadime
What is the Argyll Robertson pupil and what is it associated with?
The pupil is constricted and does not react to light but does react to the accomidation reflex
Tertiary syphillis or neurosyphillis
What is the first line in suspected bacterial meningitis in the primary care setting?
Benzylpenicillin
What is a chancre?
A painless ulcer, appears in syphillis, typically with central slough and rolled edge
What is a clinincal sign pathonogenic for Lymes disease?
Erthema migrans
Rash with red centre and red circle surrounding
Which patients may suffer from pneumocystis jirovecci infection (fungal)?
Immunocompromised patients, usually with HIV
How is pneumocystis jirovecii treated?
Co-trimoxazole
What type of pneumonia does klebsiella pneumoniae cause?
Cavitating pneumonia
How does klebsiella pneumoniae appear on gram stain?
Gram negative rods
Where is pseudomonas usually aquired?
Hospital - contaminated ventilator
How is Legionella pneumophilia treated?
Macrolides: erythromycin, roxithromycin, azithromycin and clarithromycin
What blood test abnormalities may be present in legionella?
hyponatraemia and lymphopenia
What is erythema migrans pathognomic of?
Lyme disease
What causes lyme disease?
Borrellla burgdoferi (tick borne)
How does stahpylococcal scalded skin syndrome present?
Red tender blistering skin Positive Nikolsky (the very thin top layer of skin will shear off, leaving skin pink and moist, and usually very tender) A prodome of sore throat or conjunctivitis may occur
What CSF results are typical of bacterial meningitis?
A cell count of 90-1000+ mm3
Predominantly consisting of polymorphs
CSF glucose < 1/2 plasma glucose
CSF protein of over 1.5g/L
What is bordetella pertussis?
Whooping cough
Symptoms, worse at night: cold, a runny nose, red and watery eyes, a sore throat, and a slightly raised temperature
What triad does pneumocystis jirovecii?
Shortness of breath
Cough
Fever
Presents in Immunocompremised states such as HIV
What is the gold standard investigation for TB?
Culture in Lowenstein-Jensen media
What is schistosomiasis?
Infection from a trematode (fluke) of the genus Schistosoma
Indemic in many countries in sub-sahran africa
Leading cause of portal-HTN in those endemic areas (ascities, caput medusae)
Can cause genitourinary symptoms: frquency, haematuria, urinary tract obstruction)
GI symtpoms: GI bleed, diarrhoea, abdominal pain
How does Mycoplasma penumonia infection present
Preceding flu like lillness, dry cough, erthema mutiforme (target shaped lesions), eveidence of anaemia (SOB and low Hb)
Common cause of atypical pneumonia
What is erythema multiforme?
Target shaped lesions
First line treatment for ESBL-producing organisms?
Cabapenums e.g. meropenem
Treatment of MRSA?
Glycopeptides such as
Teicoplanin
Vancomycin
Treatment for pseudomonas?
IV Ciprofloxacin
1st line treatment for haemophilius influenzae?
Amoxicillin
Doxycycline if pen allergic
1st line treatment for pseudomonas aeruginosa?
Ciprofloxacin
What rare side effect of Ciprofloxacin should patients be conselled about?
Achillies tendinitis
Common causative organisims of reactive arthritis?
Chlamydia trachomatis
Chlamydia pneumoniae
Campylobacter spp.
Neisseria gonorrhoeae
Which oral antibiotic is most suitable for a dog bite?
Co-amoxiclav
Treatment of choice for severe cellulitis?
IV benzylpenicillin and IV flucloxacillin
What blood tests may be derranged in in legionella pneumophila?
LFT
FBC
U&E - hyponatremia
Other than on FBC, how might legionella pneumophilla cause derranged blood tests?
LFTs deranged
U&Es - hyponatraemia
What are fluroquinolones?
Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin etc.) are commonly used antibiotics for conditions such as infectious diarrhoea, pyelonephritis, otitis externa, pseudomonal infections and many other medical problems. Notable side effects include gastric distress, QT interval prolongation, tendonitis and tendon rupture. They are contraindicated in pregnant women.
In patients with suspected infection without evidence of erythema migrans, NICE guidelines recommend what?
ELISA - enzyme linked immunosorbant assay
What organism stains with india ink?
Cryptococcus neoformans
Rash associated with rheumatic fever?
erythema marginatum
Features associated with cholera diagnosis?
DIahorrea
Hypoglycemia
Causes of genital ulcers?
painful: herpes much more common than chancroid
painless: syphilis more common than lymphogranuloma venereum
Prophylaxis against animal bites?
co amoxiclav
W
A risk higher than 3% (as is the case with this patient) indicates that the patient should undergo PCI within 72 hours of hospital admission
Preceding influenza predisposes to which organism?
staph aureus pneumonia
menigococcal meningitis prophylaxis
Oral ciprofloxacin or rifampicin is used as prophylaxis for contacts of patients with meningococcal meningitis
A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with what?
A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with oral fidaxomicin
Gas gangrene?
There are multiple causes of gas gangrene but often clostrida species, particularly clostridium perfringens are implicated. Key features often begin with pain and then become systemic (fever, dehydration). This progresses on to skin changes, which are often seen as blisters which can burst produced a foul smelling discharge. Often crepitus can be heard on movement.
pH glucose and LDL in empyema?
Empyema: Turbid effusion with pH<7.2, Low glucose, High LDH
Causes of false negative mantoux test?
TB AIDS Long-term steroid use Lymphoma Sarcoidosis Extremes of age Fever Hypoalbuminaemia Anaemia
What travel related infection gets better and the worse again over a short duration?
Yellow fever has an incubation period of 2 to 14 days
Special considerations in MENINGOCOCCAL SEPTICAEMIA? (VS classic bacterial meningitis)
DO NOT GIVE DEXAMETHASONE
DO NOT DO LUMBAR PUNCTURE
DO give cefotaxime
Gastroenteritis within 12 hours?
Staph aureus
Bacillus cereus
Bloody diahorrea
Salmonella
Shigella
Campylobacter (flu-like)
Non bloody diahorrea most likely
E Coli
Giardiasis vs amoebiasis?
G: bleeding, bloating, abdominal pain, flatulence, non-bloody diarroea
A:: non-bloody, liver absess
What can vitamin A def cause?
Immune deficiency
Loss of nighttime vision
Most common gram pos cause of CAP
Strep pneumonia
Most common gram neg cause of CAP
H Influenzae
Mechanism of action of amoxicillin?
Inhibits bacterial cell wall synthesis
Clarithromycin mechanism of action?
Inhibits protein synthesis
Mechanism of action of doxycycline?
Inhibits protein synthesis
Pneumocystis jiroveci penumonia is treated withwhat?
Pneumocystis jiroveci penumonia is treated with co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole
Post-HIV exposure screening?
p24 antigen and antibody testing in 4 weeks time and in 3 months time
What organism that often causes infection in patients with HIV may manifest as newfound breatjlessness?
The classic sign of PCP is a lowering of oxygen saturations on exercise. This would manifest as newfound breathlessness in patients recently infected
Pneumocystis Pneumonia (PCP) is an infection with the fungus Pneumocystis Jiroveci. It is a common presentation associated with individuals with HIV who are noncompliant with their cART regimens or antibiotic prophylaxis.