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Medicine > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What is sepsis

A

Body launches a large immune response

Get systemic inflammation that affects the functioning of organs

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2
Q

What is septic shock

A

When arterial BP drops enough to cause organ hypo-perfusion (systolic BP < 90 despite fluids)

Get buildup of lactate (organs undergoing anaerobic respiration)

Treatment: aggressive IV fluid regime, refer to HDU/ITU (for inotropes)

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3
Q

What is severe sepsis

A

Sepsis with organ dysfunction

Hypoxia, oliguria, AKI, thrombocytopenia, coagulation dysfunction, hypotension, hyperlactaemia

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4
Q

What are the risk factors for sepsis

A

Extremes of age

Chronic conditions

Immunosuppression

Recent surgery or trauma

Pregnancy or peripartum

Indwelling medical device

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5
Q

How might sepsis present

A

High NEWS

Signs of potential source (cellulitis, wound discharge, cough…)

Non-blanching rash

Reduced urine output

Mottled skin

Cyanosis

Arrhythmia

Tachycardia often first sign

Elderly often confused and drowsy

Immunosuppressed patients may have normal obs despite being very unwell

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6
Q

What investigations are needed for sepsis

A

FBC, U&Es LFTs, CRP, clotting

Blood cultures

ABG

Urine dip

CXR

Lumbar puncture (if suspect meningitis)

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7
Q

Go through sepsis 6

A

Give oxygen

Give broad spectrum antibiotics

Give IV fluids

Take lactate

Take blood cultures

Take urine output

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8
Q

How do chest infections typically present

A

Cough

Sputum production

Shortness of breath

Fever

Lethargy

Crackles

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9
Q

What are the most common causative organisms for chest infections

A

Streptococcus pneumoniae

Haemophilus influenzae

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10
Q

Which organisms cause chest infections in cystic fibrosis

A

Pseudomonas aeruginosa

Staphylococcus aureus

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11
Q

What are the causative organisms for atypical pneumonia

A

Legionella pneumophila

Chlamydia psittaci

Mycoplasma pneumoniae

Chlamydophila pneumoniae

Q fever (coxiella burnetii)

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12
Q

What are the antibiotic choices for chest infections

A

Community: amoxicillin

Alternatives: erythromycin, clarithromycin, doxycycline

Atypical bacteria: clarithromycin, levofloxacin, doxycycline

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13
Q

How might lower UTIs present

A

Dysuria

Suprapubic pain/discomfort

Frequency

Urgency

Incontinence

Confusion (in old/frail)

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14
Q

How might pyelonephritis present

A

Fever

Loin, suprapubic, and back pain

Feeling generally unwell

Vomiting

Loss of appetite

Haematuria

Renal angle tenderness

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15
Q

What would be the abnormalities on urine dipsticks in UTIs

A

Nitrites (gram negative break down nitrates to nitrites)

Leukocytes (rise in infection)

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16
Q

What are the causative organisms of UTIs

A

E coli

Klebsiella pneumoniae

Enterococcus

Pseudomonas aeruginosa

Staphylococcus saprophyticus

Candida albicans

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17
Q

What duration of antibiotics need to be used in UTIs

A

3 days: simple UTIs in women

5-10 days: immunosuppressed, anatomical abnormality, impaired kidney function

7 days: men, pregnant women, catheter-relates

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18
Q

What are the antibiotic choices in UTIs

A

Community: trimethoprim, nitrofurantoin

Alternatives: amoxicillin, cephalexin

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19
Q

How are UTIs managed in pregnancy

A

7 days: nitrofurantoin (first line, but avoid in 3rd trimester), amoxicillin, cefalexin

Higher risk of: pyelonephritis, premature rupture of membranes, preterm labour

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20
Q

What are the NICE guidelines for managing UTI pyelonephritis

A

In community, 7-10 days of: cefalexin, co-amoxiclav, trimethoprim, ciprofloxacin

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21
Q

How might skin/soft tissue infections present

A

Erythema

Hot

Tense

Thickened

Oedema

Bullae

Golden-yellow crust (staph aureus infection)

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22
Q

What are the causes of skin/soft tissue infections

A

Staph aureus

Group A strep (mostly strep pyogenes)

Group C strep (mostly strep dysgalactiae)

MRSA

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23
Q

What is the Eron classification

A

NICE assessment of severity of cellulitis

Class 1: no systemic toxicity or comorbidity

Class 2: systemic toxicity or comorbidity

Class 3: significant systemic toxicity or comorbidity

Class 4: sepsis, or life-threatening

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24
Q

When should skin/soft tissue infections be admitted

A

All class 3 or 4 infections (need IV antibiotics)

Consider for: frail, very young, immunocompromised

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25
Q

What are the antibiotics used for skin or soft tissue infections

A

Flucloxacillin (first line, IV or oral)

Clarithromycin

Clindamycin

Co-amoxiclav

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26
Q

What are the common causative organisms of intra-abdominal infections

A

E coli

Klebsiella

Enterococcus

Streptococcus

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27
Q

What is septic arthritis

A

Infection within a joint

An emergency (mortality of 10%)

Important complication of joint replacement

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28
Q

How might septic arthritis present

A

Single joint affected

Rapid onset

Hot, red, swollen, painful

Stiff, reduced range of motion

Systemic symptoms (fever, lethargy, sepsis)

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29
Q

Which bacteria commonly cause septic arthritis

A

Staphylococcus aureus

Neisseria gonorrhoea

Streptococcus pyogenes

Haemophilus influenzae

E coli

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30
Q

What are the differentials for septic arthritis

A

Gout

Pseudogout

Reactive arthritis

Haemarthritis

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31
Q

What is the management for septic arthritis

A

Low threshold for suspicion (until ruled out by joint fluid examination)

Follow local hot joint policy

Empirical IV antibiotics: until sensitivity testing comes back

3 - 6 weeks of antibiotics

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32
Q

Who is offered the influenza vaccine

A

> 65s

Young children

Pregnant women

Chronic conditions

Healthcare workers

Carers

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33
Q

How might influenza present

A

Fever

Coryzal symptoms

Lethargy and fatigue

Anorexia

Muscle and joint aches

Headache

Dry cough

Sore throat

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34
Q

How is influenza diagnosed

A

Nasal/throat swab

35
Q

What is the management for influenza

A

Only for those at risk of complications: oral oseltamivir (5 days), inhaled zanamivir (5 days)

Need to start within 48 hours of symptoms

Can give post-exposure prophylaxis to high risk patients (10 days of antivirals)

36
Q

What are the complications of influenza

A

Otitis media

Sinusitis

Bronchitis

Viral pneumonia

Secondary bacterial pneumonia

Worsening of chronic conditions

Febrile convulsions

Encephalitis

37
Q

What are the viral causes of gastroenteritis

A

Rotavirus

Norovirus

Adenovirus

38
Q

What are the bacterial causes of gastroenteritis

A

E coli (0157 produces shiga toxin, get haemolytic uraemic syndrome, bloody diarrhoea, avoid antibiotics (higher risk of HUS))

Campylobacter jejuni (travellers’ diarrhoea, can treat with azithromycin or ciprofloxacin)

Shigella (bloody diarrhoea, can get haemolytic uraemic syndrome, can treat with azithromycin or ciprofloxacin)

Salmonella (raw eggs/poultry, watery diarrhoea)

Bacillus cereus (rice, cramps, vomiting, diarrhoea, self resolves in 24 hrs)

Yersinia enterocolitica (from pork)

Staph aureus (eggs, dairy, meat)

Giardia (from animals, chronic diarrhoea, treat with metronidazole)

39
Q

What is the management for gastroenteritis

A

Good hygiene

Immediately isolate patient

Microscopy, culture and sensitivity of faeces

Do a fluid challenge

Rehydration solution

Stay off work/school for 48 hrs after resolution)

Do not give antidiarrhoeals or antiemetics

40
Q

What are some post-gastroenteritis complications

A

Lactose intolerance

IBS

Reactive arthritis

Guillain-Barre syndrome

41
Q

What are the common causative organisms of bacterial meningitis

A

Neisseria meningitidis

Streptococcus pneumoniae

Group B strep

42
Q

What is meningococcal septicaemia

A

When meningococcal bacteria infect the bloodstream

Causes a non-blanching rash

Can cause: DIC, subcut haemorrhage

43
Q

How might bacterial meningitis present in adults

A

Fever

Neck stiffness

Vomiting

Headache

Photophobia

Altered consciousness

Seizures

44
Q

How might bacterial meningitis present in neonates and babies

A

Non-specific signs and symptoms

Hypotonia

Poor feeding

Lethargy

Hypothermia

Bulging fontanelles

45
Q

What are the NICE guidelines for lumbar puncture in neonates and babies

A

Under 1 month with a fever

1 - 3 months with fever and generally unwell

Under 1 with unexplained fever and features of serious illness

46
Q

What are the special tests for bacterial meningitis

A

Kernig’s sign

Brudzinshi’s sign

47
Q

What is the management for bacterial meningitis

A

Community: children need stat IM/IV benzylpenicillin before transfer to hospital

Hospital: blood cultures, lumbar puncture, send blood tests for meningococcal PCR, low threshold for treating

Antibiotics, steroids (reduce neurological damage)

Notifiable disease

48
Q

What is the post exposure prophylaxis for bacterial meningitis

A

Single dose of antibiotics

Close prolonged contact with someone 7 days prior to onset of illness

49
Q

What are the causes of viral meningitis

A

Herpes simplex

Enterovirus

Varicella zoster

50
Q

What is the management for viral meningitis

A

Send CSF for viral PCR testing

Usually only supportive treatment needed

May need antivirals

51
Q

What are the complications of meningitis

A

Hearing loss

Seizures and epilepsy

Cognitive impairment

Memory loss

Focal neurological deficits

52
Q

What is the disease course of TB

A

Droplet inhalation spread

Granulomas containing bacteria from around the body

Active TB: active infection in various parts of the body

Latent TB: immune system encapsulates sites of infection, stop disease progression, becomes secondary TB when reactivates

If immune system unable to control disease: disseminated TB

Severe disease: miliary TB

53
Q

How might TB present

A

Chronic, gradually worsening symptoms

Lethargy

Fever

Night sweats

Weight loss

Cough

Haemoptysis

Lymphadenopathy

Erythema nodosum

Spinal pain (Pott’s disease of the spine)

54
Q

What are the risk factors for TB

A

Known contact with active TB

Immigrants from high TB areas

Close contact with countries with high TB rates

Immunosuppression

Homeless

Drug use

Alcoholics

55
Q

Who is the BCG vaccine offered to for TB

A

Neonates from UK areas with high TB

Neonates with relatives from high TB countries

Neonates with family history of TB

Unvaccinated children and adults with close TB contacts

Unvaccinated children and young adults recently arrived from high TB country

Healthcare workers

56
Q

What are the investigations for TB

A

Ziehl-Neelsen staining

Mantoux test: shows previous immune response, get a ‘bleb’ under skin, test for active disease if have positive result

Interferon-Gamma release assay (IGRA): mix blood sample with TB antigen, used to diagnose latent TB

CXR

Cultures

Nucleic acid amplification test

57
Q

What would be seen on CXR in TB

A

Primary TB: patchy consolidation, pleural effusion, hilary lymphadenopathy

Reactive TB: patchy or nodular consolidation with cavitation, usually in upper zones

Disseminated miliary TB: ‘millet seeds’ uniformly throughout lung fields

58
Q

What is the management for latent TB

A

No treatment in healthy people

If at risk of reactivation: isoniazid and rifampicin for 3 months, or rifampicin for 6 months

59
Q

What is the management for acute TB

A

RIPE

Rifampicin for 6 months (causes red urine/tears and hepatotoxicity)

Isoniazid for 6 months (causes peripheral neuropathy and hepatotoxicity)

Pyrazinamide for 2 months (causes gout and hepatotoxicity)

Ethambutol for 2 months (causes colour blindness and reduced visual acuity)

60
Q

Which cells does HIV destroy

A

CD4+ T helper cells

61
Q

How is HIV transmitted

A

Unprotected anal, vaginal or oral sex

Vertical transmission

Open wound exposure to infected blood or bodily fluids

62
Q

What is AIDS-defining illness

A

Due to end-stage HIV infection

CD4 count drops so low that get opportunistic infections and malignancies

63
Q

How can HIV be tested for

A

Antibody blood test (P24 antigen)

Patients can self-sample (get online kit, post sample)

PCR for HIV RNA (can get a viral load)

64
Q

What monitoring is needed for HIV

A

Viral load

CD count: low count = higher risk of opportunistic infection, 500 - 1200 = normal, < 200 = end stage HIV/AIDS

65
Q

What treatment is needed for HIV

A

Give antiretroviral therapy (ART) irrespective of viral load

Aim: get CD4 normal CD4 count and undetectable viral load

HAART medications

Prophylactic co-trimoxazole

Closely monitor for cardiovascular disease

Yearly smear tests

Avoid live vaccines

66
Q

What are the medications in HAART management of HIV

A

Protease inhibitors

Integrase inhibitors

Nucleoside reverse transcriptase inhibitors

Non-nucleoside reverse transcriptase inhibitors

Early inhibitors

67
Q

How might malaria present

A

Incubation of 1-4 weeks

Fever, night sweats, rigors

Malaise

Myalgia

Headache

Vomiting

Pallor (due to haemolytic anaemia)

Hepatosplenomegaly

Jaundice (due to rupturing RBCs)

68
Q

How is malaria diagnosed

A

Malaria blood film (3 samples sent over 3 consecutive days, 48 hour cycle of malaria being released into bloodstream)

Often see deranged bloods (anaemia, thrombocytopenia, leukopenia, abnormal LFTs)

69
Q

How is malaria managed

A

Falciparum malaria: admit to treat (deteriorate very quickly)

Oral options for uncomplicated malaria: riamet, malarone, quinine sulphae, doxycycline

IV options for severe disease: artesunate, quinine dihydrochloride

70
Q

What are the complications of falciparum malaria

A

Cerebral malaria

Seizures

Reduced consciousness

AKI

Pulmonary oedema

DIC

Severe haemolytic anaemia

Multiorgan failure

Death

71
Q

What are some antimalarials that may be used for prophylaxis

A

Malarone

Mefloquine

Doxycycline

72
Q

What are some common infection presentations after travel

A

Fever

GI symptoms

Jaundice

Reticuloendothelial changes

Respiratory symptoms

Rash

73
Q

What are some common causes of fever in a returned traveller

A

Malaria

Dengue fever

Typhoid fever

74
Q

Which travel infections occur at 0 - 10 days

A

Dengue

Rickettsia

Viral

GI

75
Q

Which travel infections occur at 10 - 21 days

A

Malaria

Typhoid

Primary TB

76
Q

Which travel infections occur at > 21 days

A

Malaria

Chronic bacterial infections

TB

Parasitic infections

77
Q

Where is typhoid fever common

A

Asia

South America

78
Q

How might typhoid fever present

A

Fever

Anorexia

Malaise

Vague abdominal discomfort

Altered bowel habits

Dry cough

Pulse-temperature dissociation

Hepatosplenomegaly

Rose-spots on skin

79
Q

What investigations are needed for typhoid fever

A

FBC (leucopenia, lymphopena)

CRP (raised)

Isolate organism from cultures

80
Q

What is the management for typhoid fever

A

Antibiotics

81
Q

What is the definition of pyrexia of unknown origin

A

Temperature > 38 on multiple occasions

Illness for > 3 weeks

No diagnosis despite > 1 week of inpatient investigations

82
Q

What are the common causes of pyrexia of unknown origin

A

Infective (TB, abscess, infective endocarditis, brucellosis)

Autoimmune/connective tissue (adult onset Still’s disease, temporal arteritis, Wegner’s granulomatosis)

Neoplasia (leukaemia, lymphoma, renal cell carcinoma)

Other (drugs, VTE, hyperthyroidism, adrenal insufficiency)

83
Q

Who should be screened for basic STIs

A

All known to have an STI

All requesting a test

All known to be at high risk

Medicine (9 decks)

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