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MSRA > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Which vaccinations are inactivated preparations (employ pathogens that have been killed by heat or chemicals to elicit an immune response - often require boosters)?

A
  • Hepatitis A
  • Influenza IM
  • Rabies

HIR

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2
Q

Which vaccinations are live attenuated?

A
  • MMR
  • Oral polio
  • BCG
  • Oral typhoid
  • Yellow fever

MOBOY

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3
Q

Which vaccinations are toxoid (inactivated toxins - often require boosters)

A
  • Diphtheria
  • Tetanus
  • Pertussis

DTP

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4
Q

Which vaccinations are subunit/conjugate (utilise part of the pathogen)?

A
  • Pneumococcus
  • Haemophilus
  • Meningococcus
  • Hepatitis B
  • HPV
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5
Q

Which vaccinations are viral vectors (use a harmless virus to deliver pathogen and stimulate an immune response)?

A

Ebola
Covid-19

Note these vaccines can be produced more rapidly to emerging threats

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6
Q

Describe the HPV immunisation programme

A

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)

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7
Q

When should tetanus vaccination be given?

A

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

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8
Q

UTI treatment in non-pregnant women?

A
  • 3d trimethoprim or nitrofurantoin
  • Send urine culture if >65 or haematuria
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9
Q

UTI treatment in pregnant women?

A

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

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10
Q

UTI treatment in men?

A
  • 7d trimethorpim or nitrofurantoin
  • Always send urine culture
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11
Q

UTI treatment if catheterised?

A
  • DO NOT TREAT ASYMPTOMATIC BACTERURIA
  • 7d course if symptomatic and change catheter if possible
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12
Q

Pyelonephritis treatment?

A
  • Consider hosptial admission
  • Broad spectrum cephalosporin or quinolone for 10-14d
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13
Q

What are the features of giardiasis?

A

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

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14
Q

What are the features of E. coli gastroenteritis?

A
  • Most common cause of travellers disarrhoea (>3 loose stools in 24h with other sx)
  • Watery stools, abdo cramps and nausea
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15
Q

What are the features of staphylococcus aureus gastroenteritis?

A
  • Severe vomiting
  • Short incubation period
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16
Q

What are the features of shigella?

A
  • Bloody diahorrea, vomiting and abdo pain
  • Manage with ciprofloxacin
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17
Q

What are the features of campylobacter?

A
  • Flu like prodome followed by abdo pain, fever and diarrhoea (sometimes bloody)
  • May mimic appendicits
  • Manage with clarithromycin
  • Complications include GBS
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18
Q

What are the features of bacillus cereus?

A

Two types of illness:
1. Vomiting within 6h usually due to ricce
2. Diarrhoeal illness after 6h

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19
Q

What are the features of amoebiasis?

A
  • Gradual onsert bloody diarrhoea, abdominal pain and tenderness which may last for several weeks
  • Incubation period >7d
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20
Q

What are the features of salmonella?

A

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

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21
Q

How is herpes infection managed?

A

Gingivostomatitis - oral aciclovir, chlorhexidine mouthwash

Cold sores - topical aciclovir

Genital - oral aciclovir

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22
Q

How is herpes in pregnancy managed?

A

If attack occurs during pregnany at over 28 weeks - elective C section

If recurrent herpes - treat with suppressive therapy

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23
Q

What are the features and management of bacterial vaginosis?

A

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

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24
Q

What are the risks of BV in pregnanacy?

A

Preterm labour
Low birth weight
Chorioamnionitis
Late miscarriage

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25
Q

What are the features and management of trhichomonas vaginalis?

A

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

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26
Q

What are the features of chlamydia infection?

A
  • 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
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27
Q

How is chlamyda infection managed?

A

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

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28
Q

What are the features of gonorrhoea?

A
  • 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
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29
Q

How is gonorrhoea managed?

A

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

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30
Q

What are the features of disseminated gonoccal infection?

A
  1. Tenosynovitis
  2. Migratory polyarthritis (most common cause of septic arthrits in young adults)
  3. Dermatitis (maculopapular/vesicular)
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31
Q

What are the features of genital warts and how are they managed?

A

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

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32
Q

What are the features and management of non-gonoccal urethritis?

A

Features:
- Defined as presence of urethritis WITHOUT gonococcal bacteria
- Usually due to chlamydia or mycoplasma

Management:
- Contact tracing
- Oral azithromycin or doxycycline

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33
Q

What are the features and management of chancroid?

A

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

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34
Q

What are the features of syphilis?

A

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

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35
Q

What are the features of congenital syphilis?

A
  • Blunted upper incisor teeth (Hutchinson’s teeth)
  • Rhagades (linear scars at angle of mouth)
  • Keratitis
  • Saber shins
  • Saddle nose
  • Deafness
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36
Q

How is syphilis investigated and managed?

A

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

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37
Q

What is a Jarisch-Herxheimer reaction?

A
  • 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
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38
Q

What causes HIV?

A

Retrovirus infects and replicates in human lymphocytes and macrophages, culminating in immune deficiency and susceptibility to infections as well as development of certain malignancies

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39
Q

What is HIV seroconversion and how is it diagnosed?

A

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

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40
Q

How is HIV managed?

A

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)

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41
Q

What are the side effects of NRTIs?

A

General - perpiheral neuropathy
Tenofovir - renal impairment, osteoporosis
Zidovudine - anaemia, myopathy, black nails
Didanosine - pancreatitis

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42
Q

What are the side effects of PIs?

A

General - diabetes, high lipids, buffalo hump, central obesity (THINK CUSHINGS)

Indinavir - renal stones, high bilirubin
Ritonavir - p450 inhibition

43
Q

What are the side effects of NNRTIs?

A

eg. nevirapine, efavirenz

p450 interaction, rashes

44
Q

What is AIDS?

A

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

45
Q

What are the features and management of Kaposi’s sarcoma?

A

Features:
- Purple papules or plaques on skin or mucosa
- Caused by HHV-8
- Resp involvement causes haemoptysis/pleural effusion

Management:
- Radiotherapy and resection

46
Q

What are the features and management of PCP?

A

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

47
Q

What are the features and management of cryptosporidium?

A

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

48
Q

What are the features and management of mycobacterium avium intracellulare?

A

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

49
Q

What PEP is available for HIV?

A

Combination or oral antiretrovirals from 1 hr to 72h post exposure for 4 WEEKS

Serological testing at 12 weeks following completion of PEP

50
Q

What are the features and management of staphylococcus aureus pneumonia?

A

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

51
Q

What are the features and management of haemophilus influenzae?

A

Features:
- Presents as known COPD pt or smoker with profuse sputum production, fever and malaise
- May cause acute epiglottitis

Management:
- IV cephalosporin

52
Q

What are the features and management of legionella pneumohilia?

A

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

53
Q

What are features and management of mycoplasma pneumoniae?

A

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

54
Q

What are the features and management of klebsiella pneumonia?

A

Features:
- Usually alcohol dependence
- CXR shows consolidation with abscess/cavitation formation in upper lobes

Management:
- Cephalosporin or carbapenem

55
Q

What are the features and management of psuedomonas aeruginosa?

A

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

56
Q

What are the features and management of infectious mononucleosis?

A

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

57
Q

Which malignancies are associated with EBV?

A
  • Burkitt’s lymphoma
  • Hodgkins lymphoma
  • Nasopharyngeal carcinoma
  • ## HIV-associated CNS lymohoma
58
Q

What are the features and management of parvovirus B19?

A

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

59
Q

How are animal and human bites treated?

A

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

60
Q

What is cat scratch disease?

A
  • Fever, lymphadenopathy and headache
  • Usually caused by gram negative rod bartonella henselae
  • Self-limiting
61
Q

When should you admit a patient with cellulitis for IV abx?

A
  • 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

62
Q

What are the different types of necrotising fascitis and how is it managed?

A

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

63
Q

What are the features and management of diphtheria?

A

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

64
Q

What are the features and management of leptospirosis?

A

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

65
Q

What are the features and management of listeria?

A

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

66
Q

How is listeria in pregnancy managed?

A

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

67
Q

What are the features and management of Lyme disease?

A

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

68
Q

What are the different options for malarial prophylaxis?

A

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

69
Q

What malaria prophylaxis is given in pregnancy and in children?

A

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

70
Q

What are the features of malaria?

A
  • Spread by protozoa (single cell parasites)
  • Vector is the female anopheles mosquito
  • Infects and destroys liver cells and FBC once in the blood stream
71
Q

How is malaria falciparum treated?

A

Most peopl:
3d treatment with artemisin based combination therapies - will contain artemether/artesunate + one other

Pregnancy:
7d quinine + clindamycin

72
Q

What are the 4 causes of non-falciparum malaria ?

A
  1. Plasmodium vivax - central america and india, feveryevery 48h
  2. Plasmodium ovale - africa, fever every 48h
  3. Plasmodium malariae - cyclical fever every 72h, assoc with nephrotic syndrome
  4. Plasmodium knowlesi
73
Q

How is non-falciparum malaria treated?

A

Artesimin-based combination therapy or chloroquine

Ovale/vivax - give primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse

74
Q

What are the features and management of schistosomiasis?

A

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

75
Q

What are the two main types of trypanosomiasis?

A

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

76
Q

What are the features and management of rabies?

A

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

77
Q

What are the features and management of toxoplasmosis?

A

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

78
Q

What are the features and management of suspected bacterial meningitis?

A

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

79
Q

How are contacts of meningococcal meningitis managed?

A

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

80
Q

What are the different types of TB?

A
  1. 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
  2. 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)
81
Q

How is TB diagnosed?

A
  1. Tuberculin skin test (Mantoux) - if skin swells it indicates previous vaccination, latent TB or active TB
  2. Interferon-gamma release assay blood test - if positive it indicates vaccination, latent TB or active TB
  3. Sputum smear - presence of acid-fast-bacilli indicates TB disease

Diagnosis of active TB is above + clinical symptoms

82
Q

How is latent TB managed?

A

Either:
1. 3 months isoniazid with rifampicin - if concern for hepatotoxicity
2. 6 months isoniazid- if interactions with rifampicin, or immunocomprmised

83
Q

How is active TB managed?

A

Initially (first 2 months) RIPE:
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Continuation (next 4 months)
Rifampicin
Isoniazid

Treat for 12 months + steroids if meningeal TB diagnosed

84
Q

What is immune reconstitution syndrome (IRIS)?

A
  • A complication of TB which occurs 3-6 weeks after starting treatment
  • Presents as large lymph nodes
  • Treat with steroids
85
Q

What are the side effects of rifampicin?

A
  • Potent liver enzyme inducer
  • Hepatitis
  • Orange urine
  • Flu-like symptoms
86
Q

What are the side effects of isoniazid?

A
  • Peripheral neuropathy (prevent by giving vitamin B6 aka pyridoxine)
  • Hepatitis
  • Agranulocytosis
  • Liver enzyme inhibitor
87
Q

What are the side effects of pyrazinamide?

A
  • Hyperuricaemia causing gout
  • Arthralgia, myalgia
  • Hepatitis
88
Q

What are the side effects of ethambutol?

A
  • Optic neuritis; must check visual acuity before and during treatmet
89
Q

Which patient groups are eligible for the BCG vaccine?

A
  • 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

90
Q

What are the features and management of aspergilloma?

A

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

91
Q

What PEP is given after Hep A exposure?

A

Human Normal Immunoglobulin (HNIG) or Hep A vaccine

92
Q

What PEP is given after Hep B exposure?

A

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

93
Q

What PEP is given after Hep C?

A

Monthly PCR - if seroconversion then interferon +/- ribavirin

94
Q
A
95
Q

Which groups should get PEP after chickenpox exposure?

A
  1. Significant exposure
  2. Immunocompromised/pregnant/neonates
  3. No antibodies to varicella virus

Give IVIG

96
Q

Who should get the Hep A vaccine?

A
  • Travelling to/residing in area of intermediate prevalence
  • Chronic liver disease
  • Haemophilia
  • MSM
  • IVDU
  • Occupational
97
Q

Which groups are given influenza vaccine?

A

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

98
Q

What is given for MSRA suppression therapy? How is MSRA treated?

A

Suppression:
Mupriocin 2% ointment TDS for 5d
Chlorhexidine gluconate OD for 5d

Treatment:
Vancomycin, teicoplanin or linezolid

99
Q

What are the features and management of mumps?

A

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!

100
Q

What are the complications of mumps?

A
  • Orchitis
  • Pancreatitis
  • Hearing loss
  • Meningoencephalitis
101
Q

Which diseases are notifiable?

A

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

102
Q

What is a spinal epidural abscess and how is it managed?

A
  • 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
103
Q

What is stronglyoides stercoralis and how is it managed?

A
  • Human parasitic nematode worm
  • Presents with diarrhoea, abdo pain, papulovesicular lesions, pneumonitis
  • Treat wihth ivermectin and albendazole
104
Q

What is cutaneous larva migricans and how is it managed?

A

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

MSRA (24 decks)

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