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Finals > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

HIV

Pathophysiology

A

HIV1/ 2 binds to CD4 receptors (via gp120 envelope glycoprotein)

  • Viral reverse transcriptase makes DNA copy of RNA genome
  • Viral integrase integrates it into DNA

Synthesized!

  • Viral protease cleaves into e_nzyme/ building blocks for new virus_
  • CD4+ cells migrate to lymphoid tissue where 1000s virions released!

Impairs CD4+ function ⇒ LOW immunity

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2
Q

HIV

5 stages

A
  1. Acute; often asymptomatic
  2. Seroconversion - primary infection
    • ABs detectable
    • 2-6wks ambiguous + LAD
    • Maculopapular rash (hands/feet)
    • Meningoencephalitis (rare)
  3. Asymptomatic period
    • 30% have PGL (persistent generalized lymphadenopathy)
  4. Constitutional symptoms: AIDS-related complex (ARC)
    • Pyrexia + Night sweats
    • Diarrhoea + Weight loss
    • +/- Opportunistic infections
  5. CD4 count <200cells/mm3
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3
Q

HIV

Diagnosis

A
  • Serum (/salivary) HIV-Ab by ELISA
    • Confirmed by western blot
  • Acute or Seroconversion stage
    • HIV RNA (PCR)
    • Core p24 Ag in plasma
    • Repeat ELISA at 6 weeks
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4
Q

HIV

Anti-retrovirals

Classes + Mechanism + Examples

A

HAART

  • Highly Active Anti-Retroviral Therapy
  • = Combination of at least 3 drugs
  • Typicaly 2 NRTIs + 1 PI or NNRTI

NRTI

  • Nucleoside analogue Reverse Transcriptase Inhibitors⇒ Inhibiting DNA synthesis!
  • Zidovudine, Didanosine
  • Lamivudine, Stavudine, Zalcitabine

PI -AVIRs

  • Competitively inhibits aspartyl protease enzyme (involved in viral protein +enzyme production)
  • Indinavir
  • Nelfinavir, Ritonavir, Saquinavir

NNRTI

  • Non-Nuceloside Reverse Transcriptase Inhibitors⇒ Inhibiting DNA synthesis!
  • Nevirapine
  • Efavirenz
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5
Q

HIV

Anti-retroviral

NRTI SEs

A

NRTIs

  • Lactic acidosis
  • Peripheral neuropathy (Didanosine)
  • Pancreatitis (Didanosine)
  • Anaemia, black nails, myopathy (Zidovudine)
  • Lipodystrophy (Zidovudine, Stavidudine)
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6
Q

HIV

ARD

PI SEs

A

PIs

  • Lipodystropy
  • *DM, hyperlipidaemia, central obesity** + buffalo hump
  • P450 inhibition (Ritonavir)
  • Peri-oral pareasthesia (Ritonavir)
  • Renal stones, asymptomatic hyperbilirubinaemia (Indinavir)
  • Intracranial bleeding (Tipranavir)
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7
Q

HIV

ARD

NNRTI SEs

A

NNRTI

  • P450 interaction (inducer: Nevirapine)
  • Rashes + Toxic Epidermal Necrolysis
  • High LFTs
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8
Q

HIV

Diarrhoea

Differentials + Diagnosis

A
  1. Cryptosporidium ⇒ modified Ziehl-Neelson acid-fast strain = Red Cysts
  2. CMV
  3. Mycobacterium avium intraceullulare
    • Atypical CD4 <50
    • Blood cultures, LFTs
    • T: Rifabutin, ethambutol + Clarithromycin
  4. Giardia
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9
Q

HIV

Immunisations allowed

A
  • Cholera
  • Inflenza-INTRANASAL
  • Poliomyelitis-ORAL
  • TB (BCG)

CD>200

  • MMR
  • Varicella
  • Yellow Fever
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10
Q

HIV

Neurological complicaions

A
  • Toxoplasma gondii
    • 50%, ambiguous
    • CT: Multiple RING enhancing lesions
  • CNS Lymphoma: EBV​
    • CT: huge fat lesion
  • AIDs dementia complex
  • Progressive multifocal leukoencephalopathy (PML)
    • JCV (John Cunningham Virus)
  • Cryptococcus (fungal meningitis)
  • Encephalitis (HIV, or CMV)
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11
Q

HIV

Oesophagitis

Most likely cause + Treatment

A
  • Oral Candidiasis: Oesophagitis
    • T: Fluconazole + Itraconazole
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12
Q

HIV

Kaposi’s sarcoma

Cause, presentation + treatment

A

Kaposi’s sarcoma

  • HHV8 (human herpes virus 8)
  • Purple papules/plaques on skin or mucosa
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13
Q

HIV

Most common opportunistic infection

Complication, prevention, diagnosis + treatment

A

Pnemocystic Jiroveci (Carinii) Atypical Pneumonia

  • Complication: Pneumothorax
  • CD4+ <200 require ABx prophylaxis
  • Diagnosis
    • Bronchoalveolar lavage (BAL) + Silver stain ⇒ Cysts
  • Treatment: Co-trimoxazole
    • Severe: IV Pentamidine, Steroids
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14
Q

HIV

Pregnancy Management

A
  1. Maternal antiretroviral
    • Start @ 28 to 32wks (or earlier)
  2. Neonate antiretroviral
    • Viral load <50: Zidovudine PO 4-6wks
  3. Delivery
    • Viral load <50 @36wk: C-Section
    • Zidovudine infusion 4hrs-Pre⇒Cord clamp
  4. Bottle feed
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15
Q

Malaria

Pathophysiology

A

Female Anopheles mosquito bites

  • Sporozoites⇒blood
  • ⇒​hepatocytes ⇒ multiply as schizonts⇒release as merozoites
    • ⇒latent hypnozoites (yrs⇒relapse)
  • ⇒RBC ⇒Trophozoites ⇒Schizonts ⇒Haemolysis (Merozoites + Cytokines)
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16
Q

Malaria

Species

A
  • P. falciparum - 48hr
    • Inc: 10d
    • Fulminating disease (nasty)
    • Africa
  • P. vivax - 48hr
    • Inc: 10d
    • ‘Benign tertian malaria’
    • ⇒Hyponozoites
    • SE asia
  • P. ovale - 48hr
    • Similar to P. vivax but quicker recovery
  • P. malariae - 72hr
    • Inc: 40d
    • ⇒‘Lie low’ in blood, recrudesce 1-52yr
    • ⇒GNitis?
  • P. knowlesi (monkeys..)
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17
Q

Malaria (Plasmodium Falciparum)

  • Classic presentation
  • Fever Paroxysms
  • Fever Periodicity
  • Grim signs
A
  1. 1month flu-prodrome
  2. Paroxyms
    1. Shivering <1hr “I feel cold”
    2. Hot stage 2-6hr (flushed, dry skin, N+V)
    3. Sweating 2-4hr
  • Periodicity reflext haemolysis (every 48hr)
    • P. Malariae 72hr
  • Anaemia, thrombocytopenia, hepatosplenomegaly, jaundice

Grim signs (CHAAC);

  • Cerebral malaria; coma/ convulsions
  • HyPOglycaemia
  • ATN Renal Failure
  • Acidosis Lactic
  • Chronic illness
    • Choleraic malaria
    • Vivax⇒Splenic rupture
    • Malariae⇒Quartem malarial nephropathy
    • ABV Burkitt’s lymphoma
18
Q

Malaria

Diagnosis + Investigations

A
  • Serial thin & thick blood film (3thick/72hr)
  • FBC: ​Thrombocytopenia+Anaemia

Memorise;

  • Blood film, count & culture
    • Thrombocytopenia
    • Anaemia
  • Urinalysis+E (U+E) [Hb, protein, casts]
    • ATN Renal Failure
    • Quartem malarial nephropathy
  • ABGlucose
    • Lactic acidosis
    • hyPOglycaemia
19
Q

Malaria

Protective Factors

A
  • Sickle cell trait
  • Hereditary elliptocytosis (melanesian ovalocytosis)
  • G6PD deficiency
  • Some HLA B53 alleles
20
Q

Infectious Mononucleosis
Glandular fever
Epstein-Barr virus

  • Presentation
  • Diagnosis
  • Management
  • Complications
A

EBV (enveloped DNA) via Saliva infects B-Lymphocytes ⇒ Proliferation Mononuclear T-Cell

  • Fleeting macular rash + facial oedema
  • Generalised Lymphadenopathy
  • Hepatitis + Jaundice
  • +Amoxicillin⇒ Jerish-Hexheimer RASH

Diagnosis

  • Monospot/ Paul-Bunnel Heterophil AB test
  • Viral PCR
  • Downy bodies (atypical T-cells)

Management

  • Rest + Support
  • NO contact sports 8wks (splenic rupture)

Complications

  • +Amoxicillin⇒ Jerish-Hexheimer RASH
  • Burkitt’s lymphoma
  • Hodgekin’s lymphoma
  • HIV CNS Lymphoma
  • Nasopharyngeal carcinoma
21
Q

MRSA

  • What is it
  • Screening protocol
  • Management
A

What

  • Methicillin-Resistant Staphylococcus Aureus (MRSA)
  • Resistant to Penicillins + Cephalosporins

MRSA screen 2-4wks prior admission in ALL;

  • + MSSA (Full Staph) screen: Implant/ high risk surgery
  • Swabs
    • Anterior nares (nasal)
    • Any skin lesion
    • Catheterised: CSU (Catheter Specimen of Urine)
    • Productive cough: Sputum
    • Staph screen/ patient tagged: Perineum swab

Blind management

  • >65yrs+transferred from carehome/hospital
  • MRSA Hx in past 6months

Management min 5days and rescreen d7

  • Single room
  • Nasal: Mupirocin 2% 8hrly
  • Skin: Chlorhexidine 0.1% + Neomycin 0.5%
  • Wash body daily
  • Infection
    • Vancomycin, Teicoplanin, Linezolid

ESBL, MGNB, CARB screen

  • ALL patient (unless hasnt been in hospital/ abroad for 1yr)
  • Rectal swab (stoma/ unable: stool sample)
  • Catheter: CSU
  • Management: Microbiologist

ESBL: Extended Spectrum Beta-Lactamase-producing Bacilli

MGNB: Multi-resistant Gram-Negative Bacilli

CARB: Carbapenemase-producing Gram-negative Bacilli

22
Q

Vaccination Schedule

A

5in1

  • Diphtheria, Tetanus, Whooping cough (pertussis), Polio and HIB
  • 2m, 3m, 4m
    • HIB 1yr (with MenC)
    • 4in1 3-5yr (all but HIB)
    • 3in1 13-18yr (Dip, Tet, Polio)

PCV (Pneumococcal): 2m, 4m, 1yr

Meningitis C: 3m, 1yr (with HIB), 13-15yr, 18-25yrs (students)

Rotavirus: 2m, 3m

MMR: 1yr, 3-5yr,

HPV: 12-13 girls

23
Q

Measles of MMR

  • Vaccination schedule
  • Classic presentation
  • Complications
A

Vaccination: 1yr, 3-5yr

Rubeola virus droplet 10d

  • ⇒4d fever
  • ⇒3C (cough, coryza, conjunctivitis)
  • Koplik spot’s (mucosal grey salt grain)
  • Maculopapular rash behind ears⇒ head⇒ body

Complications

  • Giant cell pneumonia
  • SSPE (subacute sclerosing panencephalitis)
24
Q

Mumps of MMR

  • Vaccination schedule
  • Classic presentation
  • Complications
A

Vaccination: 1yr, 3-5yr

Paramyxovirus droplet 2wk

  • ⇒Parotitis + swelling

Complications

  • Orchitis
  • Meningitis
25
Q

Rubella of MMR

  • Vaccination schedule
  • Classic presentation
  • Complications
A

Vaccination: 1yr, 3-5yr

Rubella: German measles

  • ⇒LAD (post-auricular + occipital)
  • Erythamatous rash

Complications

  • Pregnant: Congenital Rubella Syndrome
26
Q

Chicken Pox

  • Presentation
  • Diagnosis
  • Treatment
  • Complications
A

Varicella Zoster virus droplet 2wks

Infectious 1d before rash⇒ last crusted spot

  • Rash⇒ Papules⇒ Vesicles⇒ Pustules⇒ Crust
  • Fever

Diagnosis: PCR for VZV (secretions/ vesicles)

Treatment

  • Calamine lotion
  • Severe: Aciclovir

Complications

  • Chickenpox pneumonitis
  • 2ndary Bacterial skin infection (staph aureus⇒ Impetigo)
  • Rare: Varicella cerebellitis
27
Q

Clostridium difficile

  • Pathophysiology
  • Aetiology
  • Treatment
A

G+ rod anaerobe bacteria⇒ Toxin entero-A + cyto-B

  • ⇒Pseudomembranous colitis

Aetiology

  • Elderly, Antibiotics, Illness, Hospital
  • Low gut flora (Clindamycin)

Diagnosis: Stool culture x3

Treatment

  • 1st episode: Metronidazole 10-14d
  • 2nd+: Vancomycin
    1. ⇒Combine is severe
  • Isolation, barrier nursing
28
Q

Tetanus

  • Pathophys
  • Presentation
  • Diagnosis
  • Treatment
A

Clostridium tetani G+⇒ Exotoxin blocks inhibitory motor neurones⇒ Tetanic spasm

  • Hypertonicity (2-3m)
    • Neck: Trismus (risus sardonicus)
      ​⇒ Truncal muscles
  • Reflex spasms (7-21d)
    • Violent sustained muscle contraction
      patient conscious

Clinical Diagnosis

Treatment

  • Human tetanus immunogloblin
  • Benzylpenicillin IV
  • Sedation
  • Wound debridement
29
Q

Cholera

  • Pathophys
  • Investigation
  • Treatment
A

Vibrio cholera G- rod via feacal water contamination

  • Toxin acting on enterocyte causing secretory Diarrhoea
  • Profound dehydration + Low Na, Cl, HCO3-

Investigation

  • ABG: Metabolic Acidosis (HCO3- loss)
  • Stool culture

Treatment: Fluid balance, ORS/ IVI fluids.

30
Q

List G- bacteria

A

Stain pink

  • E. coli
  • Salmonella
  • Shigella
  • Neisseria meningitidis
  • Haemophilus influenza
  • Vibrio Cholera
31
Q

List G+ bacteria

A

Stain blue

  • Streptococcus
  • Staphylococcus
  • Listeria
  • Enterococcus
  • Clostridium tetani
32
Q

Campylobacter

  • Prevalence UK
  • Presentation
A

Campylobacter jejuni

Number 1 Diarrhoea UK

  • N+V+D
  • Mimics Appendicitis
33
Q

Shigella

  • Species type
A
  1. Shigella Dysenteriae
  2. S. flexnerii
  3. S. boydii
  4. S. sonneii
34
Q

Contents of ORS

A

1L ORS

  • 20g Glucose
  • 3.5g NaCl
  • 2.5g NaHCO3
  • 1.5 KCl
35
Q

Cytomegalovirus

  • Pathophysiology
  • Presentation
  • Diagnosis
A

CMV is a herpes DNA virus, sheds in secretions

  • Placenta cross⇒ Congenital malformation
  • 3-12wks long time!

Diagnosis

  • Histology: Owl-Eye nuclei
  • CMV PCR
  • Low PLT, high WCC, deranged LFTs
36
Q

Giardia

  • Pathophysiology
  • Presentation
  • Treatment
A

Giardia intestinalis (lamblia/ duodenale) protozoa producing SB overgrowths

Spread via water (cysts survive there)

  • Non-bloody Diarrhoea + Malabsorption symptoms

Treatment: Trinidazole or Metronidazole

37
Q

Typhoid

A
38
Q

Diptheria

A
39
Q

Lyme disease

A
40
Q

Leptospirosis/ Weil’s disease

A
41
Q
A

Finals (23 decks)

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