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ALS > Infectious Disease > Flashcards

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
Q

Hepatitis: Key Bits

A

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
Q

Herpes Simplex Virus

A

= 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
Q

Infectious mononucleosis

A

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
Q

Legionella

A

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
Q

Leprosy

A

Mycobacterium leprae, granulomatous disease of peripheral nerves and skin

= hypopigmented bum/ face/ extensors, sensory loss

-> rifampicin + dapsone + clofazimine

30
Q

Leptospirosis

A

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
Q

Leishmaniasis

A

Sandfly bite

Cutaneous - crusted lesion

Mucocutaneous - nose and pharynx involved

Visceral - fevers, sweats, splenomegaly, weight loss, grey skin, hypersplenism

32
Q

Lyme disease

A

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
Q

Lymphogranuloma Venereum

A

Chlamydia trachomatis

RF - MSM, HIV, tropics

  1. Small painless pustule, forms into ulcer
  2. Painful inguinal nodes
  3. Proctocolitis

-> doxycycline

34
Q

Malaria

A

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
Q

Necrotising Fasciitis

A

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
Q

Pseudomonas aeruginosa

A

Gram- rod

= chest infections (^CF), burns, wound infections, ‘hot tub’ folliculitis, otitis externa, UTI

37
Q

Q fever

A

Coxiella burnetti

Causes - abattoir, cattle, sheep

= prodrome (fever, malaise), atypical pneumonia, endocarditis (culture negative), transaminitis

-> doxy

38
Q

Rabies

A

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
Q

Schistosomiasis haematobium

A

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
Q

Toxic Shock Syndrome

A

Severe systemic reaction to staphylococcal exotoxins, infected tampons

= fever, v BP, diffuse erythematous rash, desquamation

41
Q

Syphilis

A

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
Q

Syphilis: Investigation

A

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
Q

Tetanus

A

Clostridium tetani, exotoxin prevents GABA release

RF - IVDU

= fever, lethargy, headache, lockjaw, facial spasm, arched back/ extended neck (opisthotonus)

-> metronidazole, IM HT Ig

44
Q

Toxoplasmosis gondii

A

Obligate intracellular pathogen, cats

= asymp, like infectious mononucleosis, IS get cerebral toxoplasmosis (CT multiple ring enhancing lesions), chorioretinitis

-> pyrimethamine + sulphadiazine for 6 weeks

45
Q

Yellow Fever

A

Viral hemorrhagic fever, mosquito

= flu-like, sudden onset high fever, rigor, n+v, bradycardia, brief remission before jaundice, oliguria

46
Q

TB

A

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
Q

TB: Management

A

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
Q

HIV

A

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
Q

HIV management

A

ART asap after diagnosis e.g., 2NRTI + PI or NNRTI

50
Q

AIDS defining illnesses

A

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
Q

Cryptococcus

A

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
Q

Benign Liver Lesions

A

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
Q

Live Vaccines

A

BCG
MMR
oral polio
yellow fever
oral typhoid

ALS (22 decks)

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