Infectious Disease Flashcards
Which vaccinations are inactivated preparations (employ pathogens that have been killed by heat or chemicals to elicit an immune response - often require boosters)?
- Hepatitis A
- Influenza IM
- Rabies
HIR
Which vaccinations are live attenuated?
- MMR
- Oral polio
- BCG
- Oral typhoid
- Yellow fever
MOBOY
Which vaccinations are toxoid (inactivated toxins - often require boosters)
- Diphtheria
- Tetanus
- Pertussis
DTP
Which vaccinations are subunit/conjugate (utilise part of the pathogen)?
- Pneumococcus
- Haemophilus
- Meningococcus
- Hepatitis B
- HPV
Which vaccinations are viral vectors (use a harmless virus to deliver pathogen and stimulate an immune response)?
Ebola
Covid-19
Note these vaccines can be produced more rapidly to emerging threats
Describe the HPV immunisation programme
Eligibility:
- All school chidren aged 12-13 get 1 dose
- Eligible GBMSM (1 dose if under 25, 2 dose if 25-45)
- Immunosuppressed or HIV positive get a 3 dose schedule
Vaccinates against 6, 11 (wart causing) and 16, 18 (cancer causing)
When should tetanus vaccination be given?
If at least 3 doses given with last dose <10 years - nil needed
If 3 doses with last dose >10 years - give booster if medium/high risk
+ immunoglobulin for high risk
If vaccination history unknown or less than 3 doses - give reinforcing dose even to LOW RISK + immunoglobulin for medium/high risk
Medium risk:
- Puncture type injuries in contaminated envirnemnt
- Foreign bodies
- Compound fractures
- Sepsis secndary to wound
- Certain animal bites and scratches
High-risk:
- Heavy contamination with soil/manure
- Extensive devitalised tissue
- Wounds/burns requiring surgical intervention
UTI treatment in non-pregnant women?
- 3d trimethoprim or nitrofurantoin
- Send urine culture if >65 or haematuria
UTI treatment in pregnant women?
Symptomatic:
- Send urine culture
- 1st line nitrofurantoin (unless near term) 7d
- 2nd line amoxicillin or cefalexin 7d
Asymptomatic (positive urine culture at routine antenatal visit)
- Immediate abx of nitro, amox or cefalexin 7d
- Due to increased risk of pyelo
- Send urine culture for test of cure
UTI treatment in men?
- 7d trimethorpim or nitrofurantoin
- Always send urine culture
UTI treatment if catheterised?
- DO NOT TREAT ASYMPTOMATIC BACTERURIA
- 7d course if symptomatic and change catheter if possible
Pyelonephritis treatment?
- Consider hosptial admission
- Broad spectrum cephalosporin or quinolone for 10-14d
What are the features of giardiasis?
Foreign travel, swimming in lake, MSM
- Presents like IBS (non bloody diarrhoea, bloating, lethargy)
- Incubation period >7d (usually longest in the question)
- Positive protozoa on stool test
- Manage with metronidazole
What are the features of E. coli gastroenteritis?
- Most common cause of travellers disarrhoea (>3 loose stools in 24h with other sx)
- Watery stools, abdo cramps and nausea
What are the features of staphylococcus aureus gastroenteritis?
- Severe vomiting
- Short incubation period
What are the features of shigella?
- Bloody diahorrea, vomiting and abdo pain
- Manage with ciprofloxacin
What are the features of campylobacter?
- Flu like prodome followed by abdo pain, fever and diarrhoea (sometimes bloody)
- May mimic appendicits
- Manage with clarithromycin
- Complications include GBS
What are the features of bacillus cereus?
Two types of illness:
1. Vomiting within 6h usually due to ricce
2. Diarrhoeal illness after 6h
What are the features of amoebiasis?
- Gradual onsert bloody diarrhoea, abdominal pain and tenderness which may last for several weeks
- Incubation period >7d
What are the features of salmonella?
In general, salmonella causes:
- Severe vomiting and pyrexia +/- bloody diarrhoea
- Incubation period 12-48h
- Manage with ciprofloxacin
Salmonella typhi/paratyphi cause TYPHOID!!!! Enteric fevers with systemic upset, constipation, rose spots. Complications included OM, GI bleed, meningitis, cholecsytisi, bradycardia
How is herpes infection managed?
Gingivostomatitis - oral aciclovir, chlorhexidine mouthwash
Cold sores - topical aciclovir
Genital - oral aciclovir
How is herpes in pregnancy managed?
If attack occurs during pregnany at over 28 weeks - elective C section
If recurrent herpes - treat with suppressive therapy
What are the features and management of bacterial vaginosis?
Features:
- Overgrowth of anaerobic organisms such as gardnerella vaginosis
- Diagnose if 3/4 of thin white discharge, clue cells on microscopy, pH >4.5, positive whiff test
Management:
Asymptomatic - no treatment
Symptomatic - oral metronidazole 5-7d (or single 2g dose if adherence concerns)
Pregnancy - oral metronidazole 5-7d if symptomatic
What are the risks of BV in pregnanacy?
Preterm labour
Low birth weight
Chorioamnionitis
Late miscarriage
What are the features and management of trhichomonas vaginalis?
Features:
- Offensive green frothy discharge
- Strawberry cervix
- Vulvovaginitis
- pH >4.5
- Motile trophozoites on microscopy
Management:
- Oral metronidazole 5-7d or one off dose 2g metronidazole
What are the features of chlamydia infection?
- Asymptomatic in 70%, incubation in 7-21d
- May present as cervicitis/dysuria (women) or urethral discharge/dysuria (men)
- Complications include epididymitis, PID, endometritis, ectopic pregnancy, infertility, reactive arthritis, Fitz-Hugh-Curtis syndrome
- May cause lymphogrannuloma venereum > proctitis
- Test first void urine sample or swab with NAAT technique - shows red inclusion bodies
How is chlamyda infection managed?
1st line - 7d course doxycycline
If CI/resistant - given azithromycin
If pregnanant - give azithromycin 1g STAT, erythromycin, amoxicillin
Contact tracing:
For symptomatic men - 4 weeks prior
For asymptomatic men or women - 6 months prior
Offer contacts treatment before investigations
Test of cure:
Only necessary for pregnant women, test 3-5 weeks after treatment
What are the features of gonorrhoea?
- Gram negative diplococcus Gonorhoeae neisseria
- Incubation period 2-5d
- Presents as urethral discharge/dysuria in males and cervicitis in females
- Rectal/pharyngeal infection usually asymptomatic
- Complications include INFERTILITY, strictures, epididymitis, salpingitis and disseminated infection
How is gonorrhoea managed?
1st line - IM ceftriaxone 1g STAT
If sensitive to cipro - 500mg oral ciprofloxacin
If needle phobic - oral cefixime 400mg STAT and oral azithromycin 2g STAT
What are the features of disseminated gonoccal infection?
- Tenosynovitis
- Migratory polyarthritis (most common cause of septic arthrits in young adults)
- Dermatitis (maculopapular/vesicular)
What are the features of genital warts and how are they managed?
Features:
- AKA condylomata accuminata
- Most commonly caused by HPV 6 and 11
- If caused by 16, 18, 33 > high risk of cervical cancer
Management:
1st line - topical podophyllum or cryotherapy
2nd line - imiquimod
What are the features and management of non-gonoccal urethritis?
Features:
- Defined as presence of urethritis WITHOUT gonococcal bacteria
- Usually due to chlamydia or mycoplasma
Management:
- Contact tracing
- Oral azithromycin or doxycycline
What are the features and management of chancroid?
Features:
- Tropical disease caused by haemophilus ducreyi
- Causes painful genital ulcers with unilateral painful inguinal lymph node enlargement
Management:
1st line - Azithromycin 1g STAT or ceftriaxone 250mg IM or ciprofloxacin 500mg BD for 3 days or erythromycin 400mg TDS for 7d
What are the features of syphilis?
STI caused by spirochaete Treponema pallidum
Primary features:
- Painless chancre at site of sexual contact with local lymphadenopathy
Secondary features (6-10w after):
- Systemic symptoms
- Rash on trunk, palms and soles
- Buccal snail track ulcers
- Condylomata lata
Tertiary features:
- Gummas (granulomatous lesions on skin and bones)
- Ascending aortic aneurysms
- General paralysis of the insane
- Tabes dorsalis
- Argyll-Robertson pupil
What are the features of congenital syphilis?
- Blunted upper incisor teeth (Hutchinson’s teeth)
- Rhagades (linear scars at angle of mouth)
- Keratitis
- Saber shins
- Saddle nose
- Deafness
How is syphilis investigated and managed?
Investigations:
- Microscopy of swab from lesion
- Serum treponema enzyme immunoassay (EIA) or TPPA
- Consdier LP, CXR, echo
Management:
- IM ben/pen
- Doxy if pen allergic
- Monitor VDRL titres for treatment response
What is a Jarisch-Herxheimer reaction?
- Fever, rash, tachycardia after abx treatment for syphilis
- Absence of hypotension/wheeze (differentiate from anaphylaxis)
- Due to release of endotoxins following bacterial death
- No treatment needed
What causes HIV?
Retrovirus infects and replicates in human lymphocytes and macrophages, culminating in immune deficiency and susceptibility to infections as well as development of certain malignancies
What is HIV seroconversion and how is it diagnosed?
The period in which the body starts producing detectable levels of HIV antibodies - presents as a glandular fever type illness 3-12 weeks after infection
Diagnosis uses a combination of:
- HIV antibodies with ELISA and western blot assay (usually present at 4-6 weeks)
- p24 antigen (viral core protein which is usually present 3-4 weeks after infection)
- Test asymptomatic pts 4 weeks after exposure and again at 12 weeks if negaive
How is HIV managed?
Two NRTIs + PI/NNRTI
NRTI - nucleoside reverse transcriptase inhibitor
PI - protease inhibitor
NNRTI - non-nucloeside reverse transcriptase inhibitor
This should be started as soon as diagnosis has been made (rather than waiting for a particular CD4 threshold)
What are the side effects of NRTIs?
General - perpiheral neuropathy
Tenofovir - renal impairment, osteoporosis
Zidovudine - anaemia, myopathy, black nails
Didanosine - pancreatitis
What are the side effects of PIs?
General - diabetes, high lipids, buffalo hump, central obesity (THINK CUSHINGS)
Indinavir - renal stones, high bilirubin
Ritonavir - p450 inhibition
What are the side effects of NNRTIs?
eg. nevirapine, efavirenz
p450 interaction, rashes
What is AIDS?
HIV infection with either:
- CD4 cell count <200
- Occurence of AIDS defining illness (see below)
Oesophageal candida
Cryptococcosis
CMV retinitis
HSV
Histoplasmosis
Kaposis sarcoma
Burkitts lymphoma
Mycobacterium avium complex
PCP
Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy
What are the features and management of Kaposi’s sarcoma?
Features:
- Purple papules or plaques on skin or mucosa
- Caused by HHV-8
- Resp involvement causes haemoptysis/pleural effusion
Management:
- Radiotherapy and resection
What are the features and management of PCP?
Features:
- Pneumocystis carinii pneumonia (now called pneumocystis jiroveci)
- Fungal respiratory infection (most common opportunistic infection in AIDS)
- Presents with SOB, cough, pneumothorax
- Bronchoalveolar lavage with silver stain shows characteristic cysts
Management:
- Co-trimoxazole is 1st line
- IV pentamidine in severe cases
- Steroids if hypoxic
- Prophylaxis with trimethoprim/sulfmaethoxazole if CD4<200
What are the features and management of cryptosporidium?
Features:
- Most common cause of diarrhoea in HIV pts
- Characteristic red cysts on Ziehl-Neelsen stain
- Can affect the whole GI tract causing sclerosing cholangitis and pancreatitis
Management:
- Supportive
- Start ARVT if HIV +ve
- Nitazoxanide for immuncompromised patients
- Rifaximin for immunocompromised patients or those with severe disease
What are the features and management of mycobacterium avium intracellulare?
Features:
- Atypical mycobacteria seen when CD4<50
- Causes fever, sweats, abdo pain and diarrhoea
- May have hepatomegaly and deranged LFTs
- Diagnosis with blood cultures and bone marrow examination
Manageemnt:
- Rifabutin, ethambutol and clarithromycin
What PEP is available for HIV?
Combination or oral antiretrovirals from 1 hr to 72h post exposure for 4 WEEKS
Serological testing at 12 weeks following completion of PEP
What are the features and management of staphylococcus aureus pneumonia?
Features:
- Preceded by influenza infection
- Presents with blood-streaked (rusty) sputum, pleuritic chest pain
- CXR shows thin walles cavitating lesion with associated pleural effusion
Management:
Amoxicillin + flucloxacillin
What are the features and management of haemophilus influenzae?
Features:
- Presents as known COPD pt or smoker with profuse sputum production, fever and malaise
- May cause acute epiglottitis
Management:
- IV cephalosporin
What are the features and management of legionella pneumohilia?
Features:
- Will talk about air conditioining unit
- Presents with fever, chills and cough
Diagnosis:
- Urinary antigen
- Hyponatremia and deranged LFTs on bloods
Management:
- Floroquinolone eg. levofloxacin, moxifloxacin or macrolide eg. azithro/clarithromycin
What are features and management of mycoplasma pneumoniae?
Features:
- Slow-progressing pneumonia
- Affects younger individuals
- Causes haemolytic anaemia
- CXR shows diffuse interstitial infiltrates
- May cause erythema multiforme, GBS, bullous myringitis, basically -itis of any organ !!!!
Diagnosis:
- Mycoplasma serology
- Positive cold agglutination test
Management:
- Clarithromycin or doxycycline
What are the features and management of klebsiella pneumonia?
Features:
- Usually alcohol dependence
- CXR shows consolidation with abscess/cavitation formation in upper lobes
Management:
- Cephalosporin or carbapenem
What are the features and management of psuedomonas aeruginosa?
Features:
- Aerobic gram negative rod
- Causes CAP in CF, skin burns incl hot tub folliculitis, otitis extera, UTI
Management:
- Resistant to many abx
- Quinolones eg. cirpfloxacin/levofloxacin and carbapenems eg. iminpenem, meropenem
What are the features and management of infectious mononucleosis?
Features:
- Caused by EBV aka HHV-4
- Classical triad of sore throat, pyrexia and lymphadenopathy
- Compliacted by splenomegaly, hepatitis, haemolytic anaemia
- Diagnose with monospot test and FBC in 2nd week
Management:
- Supportive; must REST
- Avoid contact sports for 4 weeks to reduce risk of splenic rupture
Which malignancies are associated with EBV?
- Burkitt’s lymphoma
- Hodgkins lymphoma
- Nasopharyngeal carcinoma
- ## HIV-associated CNS lymohoma
What are the features and management of parvovirus B19?
Features:
- Usually presents as slapped-cheek/fifth disease/erythema infectiosum
- May present as aplastic crisis or hydrops fetalis
Management:
- Simple fifth disease; conservative, no school exclusion needed as no longer infectious by the time the rash appears
- Manage hydrops fetalis with intrauterine blood trsnsfusions
How are animal and human bites treated?
Animal:
- Usually caused by pasteurella multocida
- Treat with co-amoxiclav
- Cleanse wound and let heal by secondary intention
Humans:
- Usually multimicrobial
- Treat with co-amoxiclav
What is cat scratch disease?
- Fever, lymphadenopathy and headache
- Usually caused by gram negative rod bartonella henselae
- Self-limiting
When should you admit a patient with cellulitis for IV abx?
- Systemic upset or unstable co-morbidities
- Severe or rapidly deterioarting cellulitis
- Below 1yrs old or very old/frail
- Immunocompromised
- Significant lymphoedema
- Facial cellulitis
Admit for IV co-amoxiclav/clindamycin/cefuroxime/ceftriaxone
What are the different types of necrotising fascitis and how is it managed?
Type 1 - mixed anaerobes and aerobes (often occurs post surgery in diabetics)
Type 2 - caused by streptococcus pyogenes
Manage with urgent surgical referral debridement and IV antibiotics
What are the features and management of diphtheria?
Features:
- Gram positive bacterium Corynebacterium diphtheriae
- Releases a toxin which causes NECROSIS on tonsils, heart, brain and kidneys
- Recent visit to eastern europe/russia/asia with grey sore throat, bulky lymphadenopathy, neuritis and heart block
Investigations:
- Culture of throat swab
Management:
- IM penicillin
- Diphtheria antitoxin
What are the features and management of leptospirosis?
Features:
- Caused by spirochaete Leptospira interrogans
- Spread with infected ran urine
- Early phase (fever, red eyes, flu)
- Second phase aka Weil’s disease (AKI, hepatitis, aseptic meningitis)
Investigations:
- Serology after 7d
Management:
- High dose ben pen or doxycycline
What are the features and management of listeria?
Features:
- Gram positive bacillus which is spread via contaminated dairy products
- Presents as diarrhoea, flu, CNS infection
Investigations:
- Tumbling motility on blood cultures
- CSF has high lymphocytes, protein and low glucose
Management:
- Amoxicillin/ampicillin
- Treat meningitis with IV amox/ampicillin + gentamicin
How is listeria in pregnancy managed?
Pregnant women are 20x more likely to develop listeriosis!!!
Complications include miscarriage, premature labour, stillbirth and chorioamnionitis
Diagnose with blood cultures and treat with AMOXICILLIN
What are the features and management of Lyme disease?
Features:
- Caused by spirochaete borrelia burgdorferi
- EARLY FEATURES include erythema migrans and systmic features
- LATE FEATURES include heart block, pericarditis, neurological
Investigation:
- ELISA (repeat 4-6 weeks later if first one negative)
- Immunoblot test if sx for >12 weeks
Management:
- Nil if asymptomatic tick bite
- If rash present, start PO doxycycline (don’t need to wait for positive ELISA)
- If systemically unwell, IV ceftriaxone
What are the different options for malarial prophylaxis?
Malarone (atovaquone + proguanil):
- Take 1-2 days before travel
- Stop 7 days after travel
- Cause GI upset
Chloroquine:
- Take 1 week before travel (take weekly)
- Stop 4 weeks after travel
- Causes headache
- CI in epilepsy
Doxycycline:
- Take 1-2 days before travel
- Stop 4 weeks after
- Causes photosenstivity and oesophagitis
Lariam (mefloquine):
- Take 2-3 weeks before travel (take weekly)
- End 4 weeks after travel
- Causes neurpsychiatric disturbance
- CI in epilepsy
Paludrine (proguanil):
- Take 1 week before travel
- Stop 4 weeks after
- Can take with chloroquine
What malaria prophylaxis is given in pregnancy and in children?
Pregnancy:
- Advise to avoid travel if able
- Chloroquine best option
- Can give proguanil with folate 5mg OD
Children:
- Advise to avoid travel if able
- Use DEET if over 2 months
- Doxy if aged 12 or over
What are the features of malaria?
- Spread by protozoa (single cell parasites)
- Vector is the female anopheles mosquito
- Infects and destroys liver cells and FBC once in the blood stream
How is malaria falciparum treated?
Most peopl:
3d treatment with artemisin based combination therapies - will contain artemether/artesunate + one other
Pregnancy:
7d quinine + clindamycin
What are the 4 causes of non-falciparum malaria ?
- Plasmodium vivax - central america and india, feveryevery 48h
- Plasmodium ovale - africa, fever every 48h
- Plasmodium malariae - cyclical fever every 72h, assoc with nephrotic syndrome
- Plasmodium knowlesi
How is non-falciparum malaria treated?
Artesimin-based combination therapy or chloroquine
Ovale/vivax - give primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse
What are the features and management of schistosomiasis?
Features:
- Helminth from infected water
- Presents as swimmer’s itch and acute Katayama fever (fever, urticaria, arthralgia, cough, diarrhoea, eosinophilia
- Chronically, eggs can deposit in bladder causing uropathy and bladder cancer
- Also risk of hepatomegaly and liver disease if travel to the liver
Management:
- Single oral dose of praziquantel
What are the two main types of trypanosomiasis?
African/sleeping sickness:
- Caused by protozoa tyrpanosoma gambiense and rhodesiense
- Spread by tsetse fly
- Cause chancre, fever, lympadenopathy and CNS involvenet (headaches, somnolence)
American/Chagas:
- Caused by protozoa trypanosoma cruzi
- Initially asymptomatic, may cause chagoma nodule or periorbital oedema
- Later will cause dilated cardiomyopathy and megaoesophagus/colon
What are the features and management of rabies?
Features:
- RHA rhabdovirus (lyssavirus)
- Transmitted by dogs, bat, raccoon and skunk
- Causes prodromal headache, fever and agitation before developing muscle spasms, hypersalivation and CNS dysfunction
- Negri bodies are found in infected neurons
Management:
- Wash wound and seek urgent medical attention
- If immunised then need 2 boosters
- If not immunised need human rabies immunoglobulin alon with full vaccination couse
What are the features and management of toxoplasmosis?
Features:
- Protozoa that infects the body via the GI tract, lung or broken skin
- Oocysts release trophozoites which migrate to eye brain and muscle
- Transmitted by cats
- Usually asymptomatic or self-limiting with features of glandular fever
Management:
- Usually self-limiting
- Give pyreimethaine plus sulphadiazine for 6 weeks if immuncompromised
What are the features and management of suspected bacterial meningitis?
Management:
- IM benpen if OOH
- LP unless severe sepsis/significant comprimse/bleeding risk/signs of raised ICP
- THEN give IV cefotaxime (+ amoxicillin if under 3 months or over 50yo)
- IV dexamethasone adjunct
If signs of raised ICP:
Critical care > secure airway > IV access > Iv steroids > IV abx > neuroimaging
How are contacts of meningococcal meningitis managed?
Give prophylactic abx to people who have been in contact with a patient with bacterial meningitis in the last 7 days
Whils awaiting serotype:
Abx of choice is oral ciprofloxacin or rifampicin
Confirmed meningococcal vaccination - vaccination
Confirmed pneumococcal meningitis - no prophylaxis
What are the different types of TB?
- Primary
- Infection after first exposure
- Formation of Ghon focus in the lung + hilar lymphadenopathy (Ghon complex)
- Initial lesion will heal by fibrosis
- If immunocompromised they may develop miliary TB - Secondary
- If host becomes immunocompromised the infection will be reactivated in the apex of lungs
- Spreads locally or to more distant sites (CNS, vertebral bodies, cervical lymph nodes, renal, GI tract)
How is TB diagnosed?
- Tuberculin skin test (Mantoux) - if skin swells it indicates previous vaccination, latent TB or active TB
- Interferon-gamma release assay blood test - if positive it indicates vaccination, latent TB or active TB
- Sputum smear - presence of acid-fast-bacilli indicates TB disease
Diagnosis of active TB is above + clinical symptoms
How is latent TB managed?
Either:
1. 3 months isoniazid with rifampicin - if concern for hepatotoxicity
2. 6 months isoniazid- if interactions with rifampicin, or immunocomprmised
How is active TB managed?
Initially (first 2 months) RIPE:
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Continuation (next 4 months)
Rifampicin
Isoniazid
Treat for 12 months + steroids if meningeal TB diagnosed
What is immune reconstitution syndrome (IRIS)?
- A complication of TB which occurs 3-6 weeks after starting treatment
- Presents as large lymph nodes
- Treat with steroids
What are the side effects of rifampicin?
- Potent liver enzyme inducer
- Hepatitis
- Orange urine
- Flu-like symptoms
What are the side effects of isoniazid?
- Peripheral neuropathy (prevent by giving vitamin B6 aka pyridoxine)
- Hepatitis
- Agranulocytosis
- Liver enzyme inhibitor
What are the side effects of pyrazinamide?
- Hyperuricaemia causing gout
- Arthralgia, myalgia
- Hepatitis
What are the side effects of ethambutol?
- Optic neuritis; must check visual acuity before and during treatmet
Which patient groups are eligible for the BCG vaccine?
- All infants where TB incidence >40/100000 in their area, or their parent/grandparent was born there
- Previously unvaccinated contacts of respiratory TB
- Previously unvaccinated <16yos from high risk area
- Healthcare workers
- Prison staff
- Staff at care homes
- Those who work with homeless people
Must have tuberculin skin test first (unless <6yo with no previous contact)
Give 4 weeks after other live vaccines (if not simultaneously)
Do not give to anyone over 35yo
What are the features and management of aspergilloma?
Feautres:
- Mycetoma (mass like fungus ball) which often colonises an exisiting lung cavity (eg. TB, lung cancer, CF)
- Usually asymptomatic but may present with severe haemoptysis
Investigations:
- CXR shows rounded opacity and crescent sign
- High titres aspergillus precipitins
Management:
- Voriconazole
What PEP is given after Hep A exposure?
Human Normal Immunoglobulin (HNIG) or Hep A vaccine
What PEP is given after Hep B exposure?
HBsAg positive source:
If known responder to HBV vaccine - give booster
If non-responder (anti-HBs<10 1-2m post imms) - hep B IG and booster
Unknown source:
If known responder - consider booster
If non-responder - HBIG and booster
If in process of vaccination - accelerated course
What PEP is given after Hep C?
Monthly PCR - if seroconversion then interferon +/- ribavirin
Which groups should get PEP after chickenpox exposure?
- Significant exposure
- Immunocompromised/pregnant/neonates
- No antibodies to varicella virus
Give IVIG
Who should get the Hep A vaccine?
- Travelling to/residing in area of intermediate prevalence
- Chronic liver disease
- Haemophilia
- MSM
- IVDU
- Occupational
Which groups are given influenza vaccine?
Children:
- Intranasal live vaccine
- At 2-3 years then annually
Adults/at risk groups:
- Inactivated vaccine
- Give if over 65, high risk group or occupational
What is given for MSRA suppression therapy? How is MSRA treated?
Suppression:
Mupriocin 2% ointment TDS for 5d
Chlorhexidine gluconate OD for 5d
Treatment:
Vancomycin, teicoplanin or linezolid
What are the features and management of mumps?
Features:
- RNA paramyxovirus
- Spready by droplet infection
- Long incubation period, infective 7d before and 9d after parotid swelling
Management:
- Conservative
- Isolate for 5 days
- NOTIFIABLE!
What are the complications of mumps?
- Orchitis
- Pancreatitis
- Hearing loss
- Meningoencephalitis
Which diseases are notifiable?
Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires Disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever
What is a spinal epidural abscess and how is it managed?
- Collection of pus that is superficial to the dura mater of the meninges
- Usually staph aureua
- Present with fever, back pain and focal neurological deficit
- MRI whole spine
- Long-term antibiotics, initially broad spectrum before being refined
- May need surgical evacuation if progressive neurological deficit
What is stronglyoides stercoralis and how is it managed?
- Human parasitic nematode worm
- Presents with diarrhoea, abdo pain, papulovesicular lesions, pneumonitis
- Treat wihth ivermectin and albendazole
What is cutaneous larva migricans and how is it managed?
Features:
- Ancylostama genus of nematode larvae
- Transmission via faecal-contaminated soil or sand eg. barefoot beach visit
- Presents as intensely itchy, snaky red rash
Management:
- Anthelmitic agents eg. ivermentin/albendazole
- Topical therapy with thiabendazole
