infectious disease Flashcards
Travellers diarrhoea Cause
E. Coli
Meningococcal prophylaxis for close contacts
PO Ciprofloxacin/ Rifampicin
Bacterial Meningitis Mx
IV Cefotaxime (+Amoxicillin <3yo or >50yo)
Meningococcal meningitis Mx
IV Benpen/ Cefotaxime/ Ceftriaxone
Meningitis caused by Pneumococcal or Haemophilus Mx
IV Cefotaxime/ Ceftriaxone
Meningitis caused by Listeria Mx
IV Amox + Gent
Causes of bloody diarrhoea
Shigella - vomiting, abdo pain
Campylobacter - flu-like prodrome, fever, abdo pain
Amoebiasis - gradual onset, weeks maybe
Gonorrhea (Gram neg diplococcus) Mx
1st - IM Ceftriaxone + GUM clinic
2nd - PO Cefixime + PO Azithromycin
Lyme disease Ix
1st - Erythema Migrans - clinical diagnosis
2nd - ELISA for Borrelia Burgdorferi (repeat after 4-6 weeks if initial test negative, but is suspected)
3rd - immunoblot test
Lyme disease Mx
Doxycycline
Or Amox (eg pregnancy)
Animal or Human bite Mx
Co-Amoxiclav
If pen allergy - Metro + Doxy
Diarrhoea incubation periods
1-6 hrs
12-48 hrs
48-72 hrs
> 7 days
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
Chlamydia Ix
women - vulvovaginal swab
men - urine sample
both sent for nucleic acid amplification tests (NAATs)
UTI in pregnancy
1st - Nitrofurantoin (Cefalexin if third trimester)
2nd - Amox/ Cefalex
Asymptomatic bacturia should be treated as UTI
Genital wart treatment
multiple, non-keratinised warts:
solitary, keratinised warts:
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
If recurrent - Top Imiquimod
Salmonella (Typhoid) Mx
Ciprofloxacin
Rifampicin side effects
potent liver enzyme inducer
hepatitis, orange secretions
flu-like symptoms
Isoniazid side effects
peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
liver enzyme inhibitor
Pyrazinamide side effects
hyperuricaemia causing gout
arthralgia, myalgia
hepatitis
Ethambutol side effects
optic neuritis: check visual acuity before and during treatment
Behcet’s syndrome (3)
Oral ulcers
Genital ulcers
Uveitis
(associated with DVTs)
Lymphogranuloma venereum (caused by chlamydia) Fx
painless genital pustule/ ulcer
painful inguinal lymphadenopathy
proctocolitis
Lymphogranuloma venereum Mx
Doxycycline
Epstien Barr virus association with what malignancies (3)
nasopharyngeal
Hodgkins
Burkitt’s lymphoma
Bacterial vaginosis cause
Gardnerella vaginalis
Live attenuated vaccines (7)
BCG
MMR
oral polio
yellow fever
oral typhoid
Influenza (intranasal)
oral rotavirus
Latent Tuberculosis Mx
Isoniazid 6 months
or Isoniazid + rifampicin 3 months
Active Tuberculosis Mx
First 2 months - ALL 4 RIPE
Next 4 months - Isoniazid + Rifampicin
Meningococcal Tuberculosis Mx
12 months of RIPE + steroids
Leptospirosis Fx
associated with rat urine - vets, sewage worker, farmers OR with returning traveller from tropics
Fx - fever, flu like, subconjunctival haemorrhages
Weil’s disease (more severe) - AKI, Hepatitis, aseptic meningitis
Leptospirosis Ix
Serology - Antibodies occur after 7 days
PCR
Blood culture
Leptospirosis Mx
Benpen or doxy
Bacterial Vaginosis Mx
1st - PO Metronidazole
2nd - Top Clindamycin
Chlamydia Mx
1st - Doxycycline + IM Ceftriaxone + Metro
2nd - Ciprofloxacin/ Azithro/ Erythromycin/ Amox (eg pregnancy, breastfeeding)
Acute epiglottitis cause
Haemophyillus Influenza type B
Otitis externa cause
Pseudomona aeriginosa
2nd - staph aureus
Atypical pneumonia Mx
(legionella, mycoplasma etc)
Clarithromycin
Dental abscess Mx
1st Amoxicillin
2nd Metronidazole
Mastitis Mx
Flucloxacillin
HIV post exposure prophylaxis
Oral Antiretrovirals for 4 weeks (28 days) start asap
Preferably start within 24 hours, can be started up to 72 hours.
Continue for 28 days
HIV Ix/ screening
HIV p24 antigen and HIV antibody test
- immediately and three months post exposure
Campylobacter Mx
1st - no treatment, self resolves, fluids in majority
2nd (if severe) - Clarithromycin
MRSA Mx
Nasal mupirocin + chlorhexidine for the skin
Chancroid cause
Haemophilus ducreyi
Syphilis Cause
cause - Treponema pallidum
Syphilis Fx
painless ulcer
Chancroid Fx
Painful ulcer - ragged undermined border
inguinal LN
Genital herpes Fx
HSV type 2
Multiple painful ulcers
Syphilis Mx
BenPen/ Doxy/ Erythromicin
C. Diff Mx
1st - Vancomycin PO
2nd - Fidaxomicin PO
Otitis externa Mx
Flucloxacillin
Erythromycin (pen allergy)
Pneumococcal polysacchride vaccine (PPV) - required in what groups
asplenia
chronic respiratory disease: COPD, bronchiectasis, cystic fibrosis, interstitial lung disease. Asthma if using oral steroids
chronic heart disease: IHD, CHF, congenital heart disease.
chronic kidney disease
chronic liver disease
diabetes mellitus if requiring medication
immunosuppression (either due to disease or treatment). This includes patients with any stage of HIV infection
cochlear implants
patients with cerebrospinal fluid leaks
adults over 65 years old
Diptheria Fx
grey coating surrounding the tonsils, fever, and cervical lymphadenopathy
Facial cellulitis Mx
1st - Co Amox
2nd - Clari (pen allergy)
Cellulitis M
1st - Fluclox
2nd - Clarithro (if pen allergy)
3rd - Erythromycin (if pregnant)
Vaccinations for asthmatics
salbutamol only (BTS stage 1): nothing needed
has a steroid inhaler (BTS stages 2-4): annual influenza
severe asthma requiring regular/long-term prednisolone (BTS stage 5): annual influenza + pneumococcal
Tetanus wound exposure Mx
Full course of tetanus vaccination with last dose < 10 years ago
- no vaccine or Ig required
Full course of tetanus vaccination with last dose > 10 years ago
- low risk (but not clean) wound - vaccine booster
- high risk wound - vaccine booster + Ig
Unclear vaccination Hx
- Vaccine + Ig
Prostatitis Mx
Ciprofloxacin
Influenza vaccine criteria
chronic respiratory disease (including asthmatics who use inhaled steroids)
chronic heart disease (heart failure, ischaemic heart disease, including hypertension if associated with cardiac complications)
chronic kidney disease
chronic liver disease: cirrhosis, biliary atresia, chronic hepatitis
chronic neurological disease: (e.g. Stroke/TIAs)
diabetes mellitus (including diet controlled)
immunosuppression due to disease or treatment (e.g. HIV)
asplenia or splenic dysfunction
pregnant women
adults with a body mass index >= 40 kg/m²
residents in care homes
carers of elderly or disabled
> 65 years old
Chlamydia partner notification
symptomatic men: all partners from the 4 weeks prior to the onset of symptoms
women + asymptomatic men: all partners from the last 6 months or the most recent sexual partner
Malaria prophylaxis
Atovaquone + proguanil (Malarone)
SE - GI upset
Take up to 7 days after return (all others are 4 weeks)
Malaria prophylaxis
Chloroquine
Mefloquine (Lariam)
SE
Headache (Chloroquine)
Dizziness (Mefloquine)
Contraindicated in epilepsy
Taken weekly
Malaria prophylaxis
Doxycycline
SE
Photosensitivity
Oesophagitis
Giardiasis Mx
Metronidazole
Recurrent Genital herpes mx
PO Aciclovir 800mg TDS for 2 days