Infectious Disease Flashcards
Treatment Campyloabcter/undercooked meat
Clarithromycin 250mg – 500 mg BD PO for 5–7 days
Treatment giardia
Metronidazole 400mg TDS PO for 5days
C diff treatment
10 days Vancomycin 125mg QDS PO
When should you give a tetanus vaccine?
5x as part of vaccination schedule
If wound is tetanus prone:
Puncture injuries involving soil (gardening)
Wounds containing foreign bodies
Compound or open fractures
Wounds or burns with systemic sepsis
Heavy contamination with soil, manure.
wounds or burns that show extensive devitalised tissue.
wounds or burns that require surgical intervention that is delayed >6 hours
Management of cellulitis
Flucloxacillin 500mg -1g QDS PO
OR
Clarithromycin 500mg BD PO
Co-amox if face
Review after 48hrs, if improving, continue for 7-14 days
If joint involved-> T+O
If oribital-> ophthalm
If head + neck-> ENT
If sepsis-> admit medicine
When does a bite need antibiotic prophylaxis?
Human- only if broken skin + drawn blood (or if person/location high risk) Doxycycline 200mg stat then 100mg BD + metronidazole 400mg TDS 3 days
Dog- only if broken skin + drawn blood, co-amox 625 TDS 3 days
Cat- if deep or if broken skin + drawn blood, co-amox 625 TDS 3 days
If human bite, also assess risk HIV/HepB/HepC
Bat bite- admit
Treatment of infected bite
5-7 days
Human- Doxycycline 200mg stat then 100mg BD + metronidazole 400mg TDS
Dog/Cat- co-amox 625 TDS
Fever in returned traveller differentials if returned<2 weeks ago
COVID-19, influenza, malaria, typhoid, yellow fever, leptospirosis, zika, Ebola, typhus, rickettsia
Fever in returned traveller differentials if returned 2-6 weeks ago
Malaria, HepA-E, schistosomiasis, amoebic liver abscess, HIV, Brucellosis
Fever in returned traveller differentials if returned >6 weeks ago
Malaria (vivax)
HepA-E, HIV
Schistosomiasis
TB
Rabies
Who is at higher risk of Hep B?
Asia, africa, middle east, S+ E Europe, Central + South America, Carribbean
Sex workers, inmates, healthcare workers, needlestick injuries, MSM, IVDU, blood products pre 1990, dialysis
Features of acute hepatitis
Fever
Abdominal pain, anorexia, nausea, vomiting
Icteric features, jaundice, dark urine, pale faeces
Enlarged tender liver or spleen
Urticaria, and joint pains (hep A +B)
Referral criteria Hep B
Admit if: acute hepatitis/liver failure/liver decompensation
Urgent hepatology if:
↑bilirubin, ↑PT
symptoms>3m
Routine hepatology if: anti‑HBc positive (+ notify public health)
How is Hep C treated?
Direct acting antivirals up to 95% of patients are cured and have a sustained viral response.
Who is at risk of Hep C?
SE Asia, middle east, africa
Healthcare workers
Sex workers
IVDU
Tattoo/piercings
Blood products pre 1992
What is Ramsay Hunt syndrome?
Herpes zoster oticus
Infection of facial nerve
Facial palsy common
Features of herpes zoster ophthalmicus
pain around the eye.
rash and skin eruption in the V1 dermatome, usually spreads up into the hair line.
Hutchinson sign (vesicle tip of nose)
upper lid may be swollen and eye mildly red.
early conjunctivitis and mild corneal changes (mucous plaques on the surface) are common in the first 10 days.
Aciclovir + admit ophthalm
Management of shingles
Admit if:
Red eye
Concern re herpes zoster ophthalmicus
Immunocompromised child
Immunocompromised adult, systemically unwell
Aciclovir within 72hrs rash onset if:
-Immunocompromised adult
-Neck/limbs/perineum involvement
-Mod severe pain or rash
-Age>50 to reduce risk neuralgia
Can start up to 7 days after rash if severe/risks
Avoid work, school, or nursery if the rash is weeping and cannot be covered.
Features of EBV
Fever
Pharyngitis, usually with exudate
Lymphadenopathy, usually posterior cervical lymphadenopathy
Fatigue
Atypical lymphocytosis
Hepatosplenomegaly
Jaundice
Rash (esp if given penicillins)
Management of meningococcal sepsis/meningitis with non blanching rash
Admit via 999.
IM/IV benzylpenicillin, proximally
Age<1- 300 mg.
Age 1–9- 600 mg.
Age>10- 1200 mg.
Notifiable disease
Who needs prophylaxis when neisseria meningitidis infection is confirmed?
prolonged close contact during the 7 days before onset of illness (household, dormitory, boy/girlfriends, or university students sharing a kitchen in halls).
Transient close contact with a case if large resp droplets/secretions from case around the time of admission to hospital.
Ciprofloxacin or rifampicin ASAP after the diagnosis of the index case.
Symptoms of mumps
Parotid swelling
Anorexia, headache, fever, myalgia
Orchitis
Pain or discomfort of the angle of the jaw
Dry mouth
Aseptic meningitis
Notifiable disease, paramyxovirus
Features of bordatella
paroxysmal cough- can last 3 months
cough ending in vomiting or apnoea
inspiratory whooping
Untreated patients are infectious from the early catarrhal stage to 21 days after the onset of cough
Management suspected bordatella
Take swab
Admit if child<6m or child with chronic lung disease/apnoea/cyanosis
Azithromycin (erythromycin if pregnant)
Isolate until 48hrs of abx given
Close contacts at risk should be given abx prophylaxis if age<2 months or pregnant or healthcare worker in obs/paeds
Staph aureus decolonisation
Mupirocin nasally BD 5 days
Chlorhexidine wash OD 7 days
Impetigo treatment
Non-bullous localised:
hydrogen peroxide 1% cream TDS 5 days
OR fusidic acid 2% TDS 5 days
If fusidic acid resistant, mupirocin
Non-bullous, widespread:
Fusidic acid 2% TDS 5 days
Flucloxacillin QDS 5 days
Bullous:
Flucloxacillin QDS 5 days
Isolate until all lesions are healed, dry, and crusted over or until 48 hours after commencing treatment
Advise re hygeine, towels
Features of scarlet fever
Fever, sore throat, headache, fatigue, n+v
Blanching rash, pinpoint, sandpaper, on trunk 12-48hrs after symptoms then spreads, palms and soles spared
Skin peeling on fingers
Strawberry tongue
Cervical lymphadenopathy
Pharyngitis with petechiae on palate
Management scarlet fever
Consider swab
10-day course of phenoxymethylpenicillin
Notify public health
Isolate for 24hrs after abx started
What is rheumatic fever?
Immune mediated reaction to group A strep infection
can cause carditis and endocarditis (leading to valvular heart disease) and reactive arthritis.
Features of scabies
Itchy rash caused by a 0.3 mm mite that burrows into the skin surface and triggers a hypersensitivity skin reaction to the protein in the mite and/or its faeces
Transmission skin to skin but also bedding/furniture
Extremely itch rash, flexor surfaces/groin, burrows + pustules/vesicles
Management scabies
Permethrin, all over, wash off after 12 hours. Reapply after 7 days
Apply to whole household
Ivermectin PO if permethrin fails, 7 days
Management threadworms
Mebendazole PO for whole household (if age>2)
May be repeated in 2 weeks if not cleared
Vigorous hygeine methods (incl daily shower to remove eggs)
Which malaria prophylaxis can be used in pregnancy?
Chloroquine (not in epilepsy, some resistance)
Proguanil (+ folic acid) (not supplied UK)
Which malaria prophylaxis can epileptics use?
Doxycycline
Atovaquone with proguanil
Who can’t use doxycycline?
Children + pregnant women, breastfeeding
Features of legionnaires
Dry cough
High fever, chills, rigors, excessive sweating
Dyspnoea, pleuritic chest pain
Headaches, myalgia
N+V, abdominal pain, diarrhoea
How can you catch legionnaires?
Exposure to potentially contaminated and aerosolised water sources, e.g. humidifiers, air conditioners, or hot-water systems
Treatment of headlice
Wetcombing
dimeticone 4% gel, lotion, or spray (Hedrin)
Malathion
