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Infectious Disease Flashcards

1
Q

Amoebiasis

A

Entamoeba histolytica, spread by faeco-oral route

= asymp, mild diarrhea, dysentery (profuse watery, may be long incubation)

Inv - hot stool microscopy

-> PO metronidazole, luminal agent

Comp - liver abscess (right lobe, fever/ RUQ pain, US, anchovy paste aspiration)

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2
Q

Bites

A

Causes - dogs and cats (multiple org, Pastuerella), human

-> clean wound, co-amoxiclav (doxy + met if allergy)

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3
Q

Anthrax

A

Woolsorter’s disease, bacillus anthracis, gram+ rod, spread by infected carcasses

= painless black eschar, no pus, GI bleeding

-> ciprofloxacin

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4
Q

Aspergilloma

A

Mass-like fungus ball (mycetoma), often colonises an existing lung cavity

RF - lung cancer, CF, TB

= cough, blood

Inv - CXR (rounded opacity, crescent sign), Aspergillus preciptins

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5
Q

Bacillus cereus

A

Gram+ rod, food poisoning, resolves <24hrs

Causes - reheated rice

= (30m-6hrs after) vomiting from cereulide toxin, (8-16hrs) diarrhea from other exotoxins, crampy abdo pain

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6
Q

Botulism

A

Clostridium botulinum, produces neurotoxin that irreversibly blocks Ach release

Causes - tinned food, IVDU

= flaccid paralysis, diplopia, ataxia, bulbar palsy, fully conscious

-> botulism antitoxin must be given early

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7
Q

Campylobacter jejuni

A

Most common bacterial GE in UK, gram- bacillus, foecal-oral

= headache/ malaise prodrome, diarrhea, may be bloody, abdo pain

-> self limits, clarithromycin if severe/ IC

Comp - Guillain-Barre, reactive arthritis

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8
Q

Cat Scratch disease

A

Bartonella henselae, gram- rod

= Hx cat scratch, fever, regional nodes, headache

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9
Q

Chancroid

A

Haemophilus ducreyi, tropical disease

= painful genital ulcers, unilateral painful inguinal nodes

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10
Q

Chickenpox Exposure: IS

A

-> VZ Ig

See obs for pregnancy

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11
Q

Cholera

A

Vibrio cholerae, gram-

= profuse diarrhea (rice water), dehydration, hypoglycaemia

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12
Q

Classification of bacteria

A

Gram+ cocci = staph, strep, enterococci

Gram+ rods (ABCD L)
= actinomyces, bacillus anthracis, clostridium, diphtheria, listeria monocytogenes

*Gram+ turn purple/ blue when stained

Gram- cocci = Neisseria meningitidits/ gonorrhoea, moraxella catarrhalis

Gram- rod = everything else

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13
Q

Cryptosporidiosis

A

Most common protozoal diarrhea in UK, hominis or parvum

RF - IS, young children

= water diarrhea, abdo cramps, fever, sclerosing cholangitis, pancreatitis

Inv - acid-fast stool (red cysts)

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14
Q

Cytomegalovirus

A

= congenital, mononucleosis, retinitis (bleeds, necrosis, pizza -> IV ganciclovir), encephalopathy, penumonitis, colitis

Inv - Owl’s eye (intranuclear inclusion bodies)

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15
Q

Dengue Fever

A

Viral infection, RNA, mosquito spread, hemorrhagic if severe

= fever, headache, bone pain, myalgia, pleuritic pain, flushing, MP rash, vomiting, DIC (v PLT, bleeding)

Comp - dengue shock syndrome

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16
Q

Diphtheria

A

Corynebacterium diphtheriae, gram+, exotoxin

RF - east Europe/ Asia,

= sore throat, diphtheric membrane on tonsils (necrotic mucosal cells), bulky cervical lymp, neuritis, heart block

-> IM penicillin, antitoxin

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17
Q

Enteric Fever

A

Salmonella typhi (typhoid) and paratyphi (paratyphoid), gram- rods, faecal-oral

= headache, fever, arthralgia, bradycardia, abdo pain, distention, constipation, rose spots (trunk, ^pt)

Comp - osteomyelitis (^sickle cell), GI bleed, meningitis, cholecystitis

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18
Q

EBV: Links

A

Burkitt’s, Hodgkin’s, nasopharyngeal cancer, HIV-associated CNS lymphomas.

Hairy leukoplakia

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19
Q

Escherichia coli

A

Gram- rod

= traveller’s diarrhea, HUS (O157:H7, ground beef), UTI, neonatal menignitis

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20
Q

Genital Herpes

A

Causes - HSV2 (and HSV1)

= painful genital ulcers, dysuria, pruritis, systemically unwell in primary infection, tender ing nodes

Inv - NAAT

-> PO acyclovir, saline bathing, pain relief, lidocaine

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21
Q

Genital Warts

A

Condylomata accuminata, HPV 6/11

= small fleshy lumps, may bleed or itch

-> top podophyllum or cryotherapy, often resist/ recur

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22
Q

Giardiasis

A

Giardia lamblia, protozoa, faeco-oral spread

RF - travel, swimming in river/lake, MSM

= aymptomatic, non-bloody diarrhea, steatorrhoea, abdo pain, bloating, weight loss, malabsorption, lactose intol

Inv - stool microscopy (trophozoite, cysts), stool antigen

-> metro

23
Q

Gonorrhoea

A

Neisseria gonorrhoea, gram- diplococcus

= (males) urethral discharge, dyrsuria, (females) cervicitis, discharge

Comp - urethral strictures, epididymitis, salpingitis (infertility), septic arthritis, disseminated (migratory polyarthritis, dermatitis, tenosynovitis)

-> IM Ceftriaxone, or PO cefixime + azithromycin

24
Q

Gas Gangrene (Myonecrosis)

A

Clostridia perfringens, a-toxin causing gangrene and haemolysis

= tender oedematous skin, haemorrhagic blebs and bullae, crepitus

25
Hepatitis: Key Bits
A) FO, institutions, not chronic, no HCC, vaccine available B) fluids, chronic and HCC (polyarteritis, cryo, GN), vaccine available C) blood (IVDU/ transfuse <1991), chronic and HCC (porphyria, cryo, GN), no vaccine D) fluids (with hep B only), chronic and HCC, no vaccine E) FO (pork), mortality during pregnancy, no chronic, no HCC, no vaccine
26
Herpes Simplex Virus
= gingiviostomatitis (primary infection), cold sores, painful genital ulcers -> PO/ topical acyclovir Pregnant Primary - urgent referral, treat in T3, elective c-section if acquired at term Recurrent - risk of transmission is low, may suppress >36wks
27
Infectious mononucleosis
Causes - EBV, CMV, HHV6 = sore throat, fever, lymph nodes, malaise, palatal petechiae, splenomegaly, ^LFTs, atypical lymphocytes, cold hemolytic anaemia, MP rash with amoxicillin Inv - heterophil Ab test (monospot) in 2nd week of illness -> supportive, avoid contact sports for 4wks (splenic rupture)
28
Legionella
Colonizes water tanks = flu-like, fever, dry cough, bradycardia, confusion Inv - lymphopenia, v Na, ^LFTs, CXR (mid/lower consol, pleural effusion), urinary antigen to diagnose -> erythromycin or clarithromycin
29
Leprosy
Mycobacterium leprae, granulomatous disease of peripheral nerves and skin = hypopigmented bum/ face/ extensors, sensory loss -> rifampicin + dapsone + clofazimine
30
Leptospirosis
Leptospira interrogans, infected rat urine RF - sewage worker, farmer, vets, ^tropics = (early) fever, flu-like, subconjunctival haemorrhage, (second - Weil's) AKI, hepatitis, jaundice, aseptic meningitis Inv - Ab Leptospira develop after 7 days, PCR, blood/ urine culture, CSF -> high-dose benzylpenicillin or doxycycline
31
Leishmaniasis
Sandfly bite Cutaneous - crusted lesion Mucocutaneous - nose and pharynx involved Visceral - fevers, sweats, splenomegaly, weight loss, grey skin, hypersplenism
32
Lyme disease
Borrelia burgdorferi, spread by ticks Early (<30d) = erythema migrans (bulls eye), headache, fever, joint pain Late (>30d) = heart block, peri/myocarditis, facial nerve palsy Inv - clinical, ELISA Ab if no rash (repeat at 4wks if still suspected), immunoblot -> remove tick, doxy if early (amox if allergy/ preg), ceftriaxone if disseminated
33
Lymphogranuloma Venereum
Chlamydia trachomatis RF - MSM, HIV, tropics 1. Small painless pustule, forms into ulcer 2. Painful inguinal nodes 3. Proctocolitis -> doxycycline
34
Malaria
Plasmoidium protozoa, spread by female anopheles mosquito, ^severe with falciparum Falciparum = acidosis, fever, anaemia, low glucose, schizonts on blood film Comp - seizures, AKI, ARDS, DIC Vivax, Ovale, Malariae = fever (cycles 48hrs), headache, splenomegaly, nephrotic syndrome with malariae -> artemisinin based combination or chloroquine
35
Necrotising Fasciitis
Medical emergency Causes - T1 by mix (post-surgical DM), T2 by strep pyo = ^perineum (Fournier's), acute onset, pain ≠ features, swelling, erythema, necrosis, crepitus, fever, tachy -> urgent referral to surgery, debridement, IV Abx
36
Pseudomonas aeruginosa
Gram- rod = chest infections (^CF), burns, wound infections, 'hot tub' folliculitis, otitis externa, UTI
37
Q fever
Coxiella burnetti Causes - abattoir, cattle, sheep = prodrome (fever, malaise), atypical pneumonia, endocarditis (culture negative), transaminitis -> doxy
38
Rabies
Viral disease causing acute encephalitis = prodrome of headache, fever and agitation, hydrophobia (water causes muscle spasm), salivation -> HR Ig and full course of vaccine
39
Schistosomiasis haematobium
Parasitic flatworm, Africa, risk of bladder SCC = swimmer's itch, obstructive uropathy, bladder calcification, haematuria Inv - XR (calcification of egg clusters) -> single PO praziquantel
40
Toxic Shock Syndrome
Severe systemic reaction to staphylococcal exotoxins, infected tampons = fever, v BP, diffuse erythematous rash, desquamation
41
Syphilis
Treponema pallidum Primary = chancre (painless ulcer), local non-tender nodes Secondary (6-10wks later) = fever, lymphadenopathy, rash on trunk/ palms/ soles, buccal ulcers (snail track), condylomata lata (painless warts on genitals) Tertiary = gummas (skin/ bone granuloma), aortic aneurysms, tabes dorsalis, Argyll-Robertson pupil -> IM benpen, may get Jarisch Herxheimer reaction (fever, rash, tachy but no wheeze/ v BP) Congenital = blunt incisors, mulberry molars, rhagades (linear mouth scar), keratitis, saber shins, saddle nose, deaf
42
Syphilis: Investigation
Non-treponemal - RPR, VDRL (not sensitive to syphilis) *False positives in pregnancy, HIV, Malaria, TB and SLE Treponemal - T pallidum-EIA, TP-HA (sensitive) Results +ve NT and +ve Trep = active infection +ve NT and -ve Trep = false positive -ve NT and +ve trep = successfully treated syphilis
43
Tetanus
Clostridium tetani, exotoxin prevents GABA release RF - IVDU = fever, lethargy, headache, lockjaw, facial spasm, arched back/ extended neck (opisthotonus) -> metronidazole, IM HT Ig
44
Toxoplasmosis gondii
Obligate intracellular pathogen, cats = asymp, like infectious mononucleosis, IS get cerebral toxoplasmosis (CT multiple ring enhancing lesions), chorioretinitis -> pyrimethamine + sulphadiazine for 6 weeks
45
Yellow Fever
Viral hemorrhagic fever, mosquito = flu-like, sudden onset high fever, rigor, n+v, bradycardia, brief remission before jaundice, oliguria
46
TB
RF - Asia/ South America/ Africa, exposure, HIV (20x), IS, silicosis, apical fibrosis Primary: Ghon focus in lungs (complex with hilar nodes), granuloma formation, necrosis in centre, heals by fibrosis (or miliary if IS) Secondary: reactivation when host is IS - apex of lungs, CNS (meningitis), cervical nodes (scrofuloderma), vertebral bodies (Pott's), renal, GIT Inv - Mantoux for latent, in active use CXR (upper cavitation, BHL), 3 acid-fast sputum smears (v sensitive in HIV), NAAT, sputum culture is best Mantoux test - induration <6mm is negative (give BCG), 6-15mm is hypersensitive (? prev BCG/ TB), >15mm TB
47
TB: Management
Active -> 2m RIPE, RI for 4m, if meningeal then 1yr steroids as well Latent -> 3m RI or 6m I (p), cannot pass on the disease
48
HIV
Seroconversion 3-12wks after infection = sore throat, lymph, myalgia, diarrhea, MP rash, mouth ulcers, then asymp until IC (AIDS defining) Inv - HIV Ab (99% by 3m, ELISA and Western blot) + p24 antigen, repeat to confirm (12wk if neg), viral load *Test 4wks post-exposure if no symptoms
49
HIV management
ART asap after diagnosis e.g., 2NRTI + PI or NNRTI
50
AIDS defining illnesses
Kaposi's sarcoma - HHV-8 = purple skin papules, radio + resect Pneumocystis jiroveci pneumonia (PCP) - ^common opportunistic, prophylaxis if CD4 <200 = few chest signs, SOB, dry cough, fever, pneumothorax, exercise induced desat, BA lavage -> co-trimoxazole Candidiasis - ^common cause of oesophagitis in HIV -> fluconazole CNS lymphoma - linked with EBV = homogenous ring enhancing lesion, single or multiple, SPECT+ve Others incl. oral thrush, shingles, hairy leukoplakia (EBV), Cryptosporidium diarrhoea, cerebral toxoplasmosis, leukoencephalopathy, HIV dementia, aspergillosis, TB
51
Cryptococcus
Fungal infection of CNS, seen in HIV = headache, fever, n+v, seizures, focal neuro Inv - LP (high opening pressure, India ink), CT (meningeal enhancement, oedema)
52
Benign Liver Lesions
Hemangioma: benign tumour = red/ purple, hyper-vascular, US (hyperechoic) Liver abscess: comp of biliary sepsis = US (fluid-filled cavity) Hydatid cyst: Echinoccous infection, fibrotic reaction = malaise, RUQ pain, ^LFTs, eosinophilia, US (septa, daughter cysts), don't aspirate -> mebendazole to sterilise, resect
53
Live Vaccines
BCG MMR oral polio yellow fever oral typhoid

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