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Infectious disease Flashcards

1
Q

What is tuberculosis?

A

-Chronic granulomatous disease

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2
Q

What causes tuberculosis?

A

-Aerobic mycobacterium tuberculosis complex

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3
Q

What are the 3 different mycobacterium tuberculosis complex bacteria called?

A
  • M. Bovis
  • M. tuberculosis
  • M. africanum
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4
Q

How is tuberculosis caught?

A
  • Spread by infected droplets coughed up by infected patients when the granulomas rupture
  • Can live on environmental surfaces for long periods of time
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5
Q

How might a primary infection of tuberculosis present?

A
  • Asymptomatically

- Mild flu-like illness

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6
Q

What is the pathogenesis of TB?

A

-Droplets inhaled into the alveoli of the lungs
-Macrophages engulf organisms and attempt to control them in the hilar lymph nodes
-Granulomas form
>Some bacteria are eliminated, some lay dormant, some disseminate

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7
Q

Why do only a small proportion of patients progress to active TB?

A

-The body is usually good enough to control the mycobarcterium but when someone is immunosuppressed (AIDS, long term steroids, age), the TB escapes the granulomas and spreads to the apices.

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8
Q

Why does active TB spread to the apices of the lungs?

A

-TB is aerobic and the apices receive more oxygenation

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9
Q

What are risk factors for TB?

A
  • Close contact of TB patient
  • Ethnic minority groups
  • Homeless patients, alcoholics, drug abusers
  • HIV
  • Extremities of age
  • Comorbid patients especially immunosuppressed
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10
Q

What are the systemic clinical features of TB?

A

-Long progressive history of:
>Fever
>Night sweats
>Weight loss

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11
Q

What are the pulmonary presentations of TB?

A
  • Haemoptysis
  • 3/52 productive cough
  • Breathlessness
  • Chest pain
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12
Q

How does Miliary TB present?

A
  • Kidneys (most common extra-pulmonary site): sterile pyuria
  • Meningitis
  • Pott disease in lumbar vertebrae
  • Addisons
  • Hepatitis
  • Lymphadenitis
  • Arthritis
  • Erythema Nodosum
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13
Q

What are the TB differentials?

A
  • Cancer
  • Atypical pneumonias
  • Fibrotic lung disease
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14
Q

What should be the first thing that is done if you suspect TB in a patient?

A
  • Allocate them a side room

- Barrier nurse with advanced masks

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15
Q

What investigations should be done for a patient suspected with TB?

A
  • Chest Xray
  • Ziehl-Neelsen Stain for acid fast bacilli
  • Culture on Lowenstein-Jensen slope
  • Rapid diagnostic nucleic acid amplification test (expensive)
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16
Q

How long does culture results take for TB?

A
  • 4-6 weeks.

- If have a high suspicion and a positive Ziehl-Neelsen stain and CXR treat for TB

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17
Q

What colour does Ziehl-Neelsen stain turn if Tb is present?

A
  • TB mycobacterium are aerobic acid fast bacilli and will turn red on staining.
  • Other acid fast bacilli will also turn red on staining
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18
Q

Apart from sputum samples, what other samples should be cultured if TB is suspected?

A
  • Lymph node biopsies
  • Aspirated pus
  • Early morning urine
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19
Q

When is the montoux test useful?

A

-For contact tracing. Identifies anybody with a previous exposure to the mycobacterium

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20
Q

What is the management for TB?

A
  • Side room and TB
  • Notify PHE
  • RIPE drug treatment
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21
Q

What tests should be done before commencing on TB treatment?

A
  • LFTs

- U&Es

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22
Q

What are the RIPE drugs?

A
  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
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23
Q

How long should the RIPE drugs be taken for and why?

A
  • 2 months: Pyrazinamide and ethambutol
  • 6 months: Rifampicin and isoniazid
  • Drugs only target active TB. Longer treatment time increases chance of latent TB becoming active and destroyed
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24
Q

Which RIPE drugs are bactericidal and which are bacteriostatic?

A 
-Bactericidal
>Rifampicin
>Isoniazid
>Pyrazinamide
-Bacteriostatic
>Ethambutol
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25
What are the side effects of rifampicin?
-Red body secretions -Induction of liver enzymes affecting: >Oestrogens, steroids, phenytoin, anticoagulants -Hepatitis
26
What are the side effects of isoniazid?
- Hepatitis | - Neuropathy
27
What drug reduces the risk of isoniazid induced neuropathy?
-Pyridoxine
28
What are the side effects of pyrazinamide?
- Hepatitis - Arthralgia - Gout - Rash
29
What are the side effects of ethambutol?
-Optic neuritis | >Usually resolves if drug is stopped immediately.
30
What patient group is multi drug resistance likely to occur?
-HIV patients
31
When is treatment failure likely to happen?
- Incorrect prescribing | - Lack of compliance
32
How is latent TB managed in a patient without HIV?
-6/12 isoniazid OR 3/12 rifampicin + isoniazid
33
How is latent TB managed in a patient with HIV?
-6/12 isoniazid
34
What treatment should be given to patients with known contact to a TB patient?
-6/12 rifampicin
35
What is HIV
Human Immunodeficiency virus
36
How does HIV infection lead to AIDs?
-Causes the immune system to fail and not fend off infections
37
What is the most common HIV strain in the world?
-HIV 1
38
How is HIV transmitted?
``` -Sexual intercourse >MSM (most common) >Heterosexual intercourse (M->F usually) -IVDU -Pregnancy >placenta, delivery, breast milk -Blood transfusions ```
39
What are the 9 steps of HIV replication?
1. Attachment 2. Entry 3. Uncoating 4. Reverse transcription 5. Genome integration 6. Transcription of RNA 7. Splicing of mRNA and translation 8. Assembly of new viruses 9. Budding
40
What is HIV formed of?
- An outer envelope | - An inner core containing RNA and RNA reverse transcriptase
41
What is the HIV surface glycoprotein that binds to CD4 receptors?
-GP120
42
What immune cells contain CD4 receptors?
- T cells - Lymphocytes - Dendritic cells - Monocytes - Macrophages
43
What bacteria is someone that has | a HIV infection presdisposed to?
- Penumoniae | - H. Influenzae
44
What is the category A section of HIV natural history?
-Primary infection or seroconversion | >Non-specific symptoms: malaise, fever, maculopapular rash, myalgia, headache, meningitis
45
What is the clinical latency phase?
- Mainly asymptomatic | - Lasts from 6weeks to 10 years
46
What happens in the category B phase?
- Rise in viral load, fall in CD4 count. | - Development of clinical features due to immunosuppression
47
What are some examples of category B diseases?
- Bacillary angiomatosis - Candidiasis - Oral hairy leukoplakia - Herpes zoster (>1 dermatome) - ITP - Listeriosis - PID - Peripheral neuropathy
48
What are examples of category C diseases?
- Candidiasis of bronchi, trachea, lungs, oesophagus - Invasive cervical carcinoma - CMV - Encephalopathy - HSV - Histoplasmosis - Kaposi's sarcoma - Burkitt's lymphoma - TB - PJP - Recurrent pneumonia - Recurrent salmonella septicaemia - Toxoplasmosis of the brain
49
What are some of the clinical features of AIDS?
- Aseptic meningitis - Retinal cotton wool spots - Aphthous ulcerations - Neutropenia - HIV enteropathy - Renal impairment - Reduced adrenal function - Myocarditis, cardiomyopathy - Infections - Coinfections ie Hep B
50
How is HIV diagnosed?
-Antibody assays (detectable 6-12 weeks post infection) -Viral genotype analysis
51
How is HIV monitored?
- CD4 count 3 monthly * <200=greatest risk of HIV related pathology * rapidly falling CD4 of <350 needs antiretroviral therapy - HIV RNA 3-6 montly
52
What is a normal CD4 count?
-500
53
How is HIV managed?
- Drugs - Social and psychological care - Contacting tracing and sexual education - Prevention of infections
54
What are the different types of HIV drugs?
- Nucleoside reverse transcriptase inhibitors - Non-Nucleoside reverse transcriptase inhibitors - Protease inhibitors - Fusion inhibitors - Integrase inhibitors
55
What is the ideal treatment combination for HIV?
-2NRTI and 1 NNRTI/protease inhibitors
56
What is the HIV treatment goal?
-Suppress viral load to <50 copies/ml
57
How do nucleoside reverse transcriptase inhibitors work?
-Inhibits synthesis of DNA by reverse transcriptase and acts as DNA chain terminators
58
How do non-nucleoside reverse transcriptase inhibitors?
-Bind directly to and inhibit reverse transcriptase
59
How do protease inhibitors work?
-Acts as competitively on HIV enzyme which prevents production of functional viral proteins and enzymes
60
What are some examples of nucleoside reverse transcriptase inhibitors?
- Abacavir | - Didanosine
61
What are some examples of non-nucleoside reverse transcriptase inhibitors?
- Efavirenz | - Etravirine
62
What are some examples of protease inhibitors?
- Atazanavir | - Darunavir
63
When should post exposure prophylaxis be taken?
- Combination of oral antiretrovirals immediately for up to 4 weeks - Testing at 12 weeks
64
Where are sterile sites within the body?
- Ureter - CSF - Peritoneal fluid - Pericardial fluid - Pleural fluid - Synovial fluid - Bone marrow - Blood
65
What are gram +ve bacteria?
- Streptococci | - Staphylococci
66
How are gram +ve bacteria differentiated?
- Staph = catalast +ve | - Strep = catalase -ve
67
What conditions can Staph. aureus cause?
- IE - Wound infections - Abscesses - Osteomyelitis - TSS - Pneumonia - Scalded skin syndrome - Food poisoning (3 hour incubation period
68
What condition does staph. saprophyticus cause?
-UTI
69
What causes skin abscesses, cellulitis and tonsilitis?
-Strep pyogenes | >usually sensitive to penicillin (clarithromycin if allergic)
70
What does strep penumoniae cause? | Who's more predisposed to the infections?
``` -CAP Predisposition: -Bronchiectasis -Asplenia -primary ciliarly diskinesia ```
71
What does strep viridans cause?
-Deep organ abscesses ie liver and brain
72
What class of bacteria is diptheria?
-Gram +ve >eradicated with childhood vaccine >notifiable disease
73
What is a gram -ve cocci?
-Neisseria meningitidis
74
What is an example of gram +ve bacilli?
-Listeria mononcytogenes (causes meningitis in extremities of age and in the immunosuppressed) -Treat with amoxicillin
75
What are examples of alpha haemolytic strep?
- Strep pneumoninae | - Strep viridans
76
What are examples of beta haemolytic strep?
-Pyogenes
77
What are examples of lactose fermenting gram -ve bacilli?
- E.coli | - Klebsiella
78
What are examples of non-lactose fermenting gram -ve bacilli?
- Salmonella | - Shigella
79
What test is required for mycobacteria?
-Ziehl-Neilson stain
80
How do you differentiate between shigella and salmonella in the lab?
- Shigella turns XLD agar red | - Salmonella turns XLD agar black
81
What infections can E.coli cause?
- Food poisoning - UTI - Skin wound infections - Travellers diarrhoea - Dysentry
82
What symptoms does a shigella infection present with?
- Dysentry, 30 stools a day | - If shigella toxin enters blood> can target kidney and cause haemolytic uraemic syndrome = kidney failure
83
How does a cholera infection present?
- From shellfish, untreated water - Incubation period > hours to 5 days - Rice water stool, no blood
84
What is pseudomonas aeruginosa and how does it present?
- Gram -ve bacilli | - Causes infections in cystic fibrosis and bronchiectasis patients
85
What's the most common cause of pneumonia in COPD pts?
-Haemophilus influenza
86
What agar is required to grow Haemophilus influenzae in the lab?
-Chocolate agar
87
What condition has HiB vaccine decreased incidence of?
-Acute epiglottitis in children
88
What is legionella pneumophila?
- Gram -ve bacilli - Causes legionaires disease (atypical pneumonia) - Grows in shower heads and water tanks/taps - check travel history
89
What condition does bordatella pertussis cause?
-Whooping cough | >paroxysmal wheeze and cough
90
What classification is neisseria meningitidis?
-Gram -ve diplococcus | >common cause of meningitis
91
What class is neisseria gonorrhoea?
-Gram -ve coccus
92
What is helicobacter pylori?
- Gram -ve spiral - Causes duodenal ulcers - Detected by urea breath test or stool test
93
How is H.pylori treated?
-Metronidazole + clarithromycin + PPI or -Amoxicillin + clarithromycin + PPI
94
What class of bacteria is chlamydia? What does it cause?
- Gram -ve | - STDs, PID, resp tract infections
95
What are exmaples of spirochetes?
- Syphilis > 3 stages | - Lyme disease
96
What are the 3 stages of a syphilis infection?
- Primary stage: localised infection ie ulcer on penis - Second stage: systemic features, skin, lymph, joints, plantar palmar rash - Tertiary rash: neurosyphilis, CVS syphilis
97
What is leprosy caused by? How does it present? How is it spread?
- Mycobacteria leprae - Causes peripheral anaesthesia due to nerve damage (may also see skin lesions) - Spread by touch
98
What are the 5 antibiotics that cause C. Difficile?
- Ciprofloxacin - Clindamycin - Cephalosporins (cefuroxime. ceftriaxone) - Co-amoxiclav - Carbapenams
99
What is hameolytic uraemic syndrome?
-Seen in young children. -Triad of: >Acute renal failure >Microangiopathic haemolytic anaemia -Thrombocytopenia
100
What are the causes of haemolytic uraemic syndrome?
- Post dystentery - Tumours - Pregnancy - Ciclosporin - The pill - SLE - HIV
101
How is haemolytic uraemic syndrome investigated?
- FBC: anaemia, thrombocytopenia, fragmented blood film - U&E: raised CR, raise urea - Stool culture: +ve E. coli
102
How is haemolytic uraemic syndrome managed?
-Supportive Rx: fluids, blood transfusion, dialysis if required
103
What are features of Legionnaire's?
- Flu like symptoms (inc. fever) - Dry cough - Bradycardia - Confusion - Lymphopaenia - Hyponatramia - Deranged LFTs - Pleural effusion
104
How is legionnaires diagnosed?
- Urinary antigen for for Legionella - CXR - Sputum culture
105
How is Legionnaire's treated?
- Erythromycin | - Notifiy PHE
106
What are features of gonnorrhoea?
- Males: urethral discharge, dysuria | - Females: cervicitis: vaginal discharge, bleeding, dyspareunia
107
What are some local complications that can result from gonorrhoea infections?
- Urethral strictures - Epididymitis - Salpingitis
108
What are some systemic features of gonnorhoea?
- Gonococcal arthritis | - Tenosynovitis, migratory polyarthritis, dermatitis
109
How is gonorrhoea treated?
-Ceftriaxone 50mg IM | + azithromycin 1g PO
110
What are the features of chlamydia?
- Asymptomatic - Women: Discharge, bleeding, dysuria - Men: urethral discharge, dysuria
111
What are the complications of a chlaydia infection?
- Epididymitis - PID - Endometriosis - Increased incidence of ectopic pregnancies - Infertility - Reactive arthritis
112
How is chlamydia investigated?
-Nucleic acid amplification tests of 1st void urine sample or vulvovaginal swab
113
How is chlamydia treated?
- Azithromycin 1g PO | - Contact tracing
114
How is syphilis treated?
-Benzylpenicillin | doxycycline if allergic
115
What is BV?
-Overgrowth of anaerobic organisms ie gardnerella vaginalis
116
What are the features of BV?
-Fishy offensive smell
117
What are the Amels criteria for diagnosing BV?
- Thin, white discharge - Clue cells in microscopy - Vaginal pH >4.5 - Positive whiff test
118
How is BV managed?
-Oral metronidazole 5-7 days
119
What are implications of BV in pregnancy?
-Increased risk of: >preterm labour >low birth weight >late miscarriage
120
Which UTI abx should be used in pregnancy? and in breast feeding?
- Pregnancy: nitrofurantoin | - Breastfeeding: trimethoprim
121
What are the presenting features of trichomonas vaginalis?
- Vaginal discharge: offensive, yellow/green/ frothy - Vulvovaginitis - Strawberry cervix
122
How is trichomonas vaginalis managed?
-Oral metronidazole
123
What infectious disease can be caught by travel?
- Infective gastroenteritis - Malaria - Hepatitis - Legionella - Typhoid - Rabies - Ebola
124
What infections do sewage workers get?
- Leptospirosis (from rat urine) - Gastroenteritis - Hepatitis
125
What diseases do farm workers get?
- Orf - Coxsackie - Coxiella
126
What diseass are seen in commercial sex workers?
- STI - HIV - Hep B
127
What diseases are health care workers at increased risk of?
- Hep B - RTI - Infectious diarrhoea ie norovirus
128
What disease can be seen in trekkers?
-Lyme disease
129
What infections can be caught in restaurants?
- Salmonella | - Campylobacter
130
Which infectious disease can be caught from shellfish?
- Hep A | - Yersinia
131
What diseases can be caught from dirty water?
- Hep A & E - Cholera - Dysentery causing bacteria
132
Which infections are patients prone to if they've had a splenectomy?
-Pneumococcal sepsis
133
Which infections are post-transplant pts prone to?
- CMV - Apergillus - Fungal infections - Pneumocystis jiroveci
134
Which infections are HIV pts at risk of?
- PCP - Toxoplasma - Cryptococcus - Candidiasis
135
What is an alternative of BenPen for someone who is penicillin allergic with suspected meninigitis?
-Chloramphenicol
136
What are the possible causes of bacterial meningitis?
- Neisseria meningitidis - Strep pneumoniae - Listeria monocytogenes (elderly, babies, immunosuppressed)
137
What is the most common cause of viral meningitis?
-Enterovirus
138
What transmits malaria?
-Femal anopheles mosquito transmits plasmodium protozoa
139
What is the most common plasmodium speciest to cause malaria?
-Plasmodium flaciparum
140
Where is malaria most common?
- Sub-saharan Africa - Central Asia - Eastern Europe - South East Asia
141
Risk factors for malaria?
- Travel to endemic area - Low socioeconomic status - Young children and infants - Pregnancy - Elderly - Outdoors between dusk and dawn
142
What are protective factors against malaria?
- Sickle cell trait | - G6PD deficiency
143
Features of severe malaria?
- Temp >39 - Headache - Myalgia - Parasitaemia - Hypoglycaemia - Acidosis - Severe anaemia - Presence of complications
144
Signs of malaria?
- Fever - Splenomegaly - Hepatosplenomegaly - Jaundice
145
Complications of malaria?
- Cerebral malaria: seizures, confusion, coma, death - Acute renal failure: black water fever due to intravascular haemolysis - ARDS - Pulmonary oedema - Hypoglycaemia - DIC
146
Differentials of malaria?
- Typhoid - Hepatitis - Dengue fever - Influenza - HIV - Meningitis - Viral haemorrhagic fever
147
investigations for suspected malaria?
- Thick and thin blood fims with Giemsa stain - Rapid diagnostic tests - FBC: thrombocytopenia, anaemia - LFTs: abnormal - U&E: hyponatraemia, ^Cr
148
How can malaria be prevented?
- Deet - Mosquite nets - Long clothes - Avoid dusk/dawn - Short term antimalarials: malarone, doxycycline - Long term antimalarials: Mefloquine, proguanil
149
1st line Treatment for severe malaria?
-IV artesunate
150
How does lyme disease present?
- Erythema chronicum migrans 9migrating redness from tick bite) - Systemic features: fever, arthralgia - CVS: heart block, myocarditis - Neuro: CN palsies, meningitis
151
How is lyme disease treated?
- Oral doxycycline | - Ceftriaxone in disseminated disease
152
Most commo cause of infective gastroenteritis?
-Campylobacter
153
How is gastroenteritis investigated?
- Stool sample - Vital signs - Assess for dehydration - FBC, U&E
154
Treatment for gastroenteritis?
- Normally self limiting. Suportive therapy. | - Analgesia for stomach cramps
155
If someone works with food and acquires food poisoning, what action needs taking and when can they return to work?
- Notify PHE - 3x -ve stool samples before returnign to work - 48 hours minimus before returning to work/school
156
What is cellulitis?
- Inflammation of the skin and subcutaneous tissue | - Typically caused by strep pyogenes or staph. aureus
157
Features of cellulitis?
- Commonly occurs on the shins - Erythema - Pain - Swelling
158
How is cellulitis investigated?
- Rule out DVT - Mark borders - Swab if exudative - Blood cultures
159
Treatment for cellulitis?
- Flucloxacillin | - Sever: IV BenPen and Flucloxacillin
160
What dangerous condition should be a differential of cellulitis?
-Necrotising fasciitis
161
What red flag feature points towards nec. fasciitis?
- Severe pain out of proportion with the affected area | - Extremely unwell pt
162
What is nec. fasciitis?
-Inflammation of the fascia of muscles or other organse and results in rapid destruction of overlying tissues
163
Features of nec. fasciitis?
- Acute onset - Painful erythematous lesion - Extremely tender over infected tissue - Bubble wrap (subcut emphysema) - Systemically unwell
164
Management of nce. fasciitis?
- ABCDE - surgeons for surgical debridement - Broad spec IV abx (clindamycin)
165
What are the main einfective causes of jaundice in the UK?
- Hep B - Hep C - Ascending cholangitis
166
What are features or erythema multiforme?
- Hypersensitivity reaction commonly triggered by infection - Target lesions seen on bank of hnads and feet and then spread to torso - Upper limbs > lower limbs
167
Causes of erythema multiforme?
- Viruses - Idiopathic - Bacterial ie mycoplasma, strep - Drugs: penicillin, carbamazepine, allopurinol - Connective tissue disease: SLE - Sarcoidosis - malignancy
168
What are the features of mycoplasma pneumonia ?
- Prolonged and gradual onset - Flu like prodrome and dry cough - Bilarteral consolidation on x ray
169
What are some complications of mycoplasma pneumoniae?
- Haemolytic anaemia, thrombocytopenia - Erythemia multiforme - Meningoencephalitis, GBS - Painful vesicles on tympanic membrane - Pericarditis - hepatitis - acute glomerulonephritis
170
How is mycoplasma pneumonia treated?
-erythromycin/clarithromycin
171
Which vaccines are live attenuated?
-BCG -MMR -Oral polio -Yellow fever -Oral typhoid (AVOID if on immunosuppressants)
172
Which infective organism is most common cause of chronic wound infections?
-Pseudomonas aeruginosa

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