Infectious Diseases Flashcards
What vaccinations do splenectomy patients require?
Pneumovax (13PPV then 23PPV 8 weeks later, then 23PPV 5y later), HiB, meningococcal ACWY + B + annual influenza
When are live vaccinations contraindicated?
Pred > 20mg daily
CD4 < 200
Primary immunodeficiency
Pregnancy
What are the live vaccines?
MMR, VZV, oral polio, BCG, oral typhoid, yellow fever, JEV
What vaccinations are contraindicated in egg anaphylaxis?
Q fever and yellow fever
What organism are hyposplenic sickle cell patients predisposed to?
Salmonella
What organism causes infection following dog bite?
Capnocytophagia
What antibiotic for prophylaxis post-splenectomy, and for how long?
Phenoxymethyl penicillin or amoxicillin, at least 2 years if healthy or lifelong if previous OPSI
Incubation period for Dengue
3-14 but usually 4-7 (short)
Incubation period for Zika
2-14 days (short)
Incubation period for Typhoid
5-21 days
Incubation period for malaria
1-6 weeks (can be much longer)
Incubation period for Ebola
6-12 days
What infections cause eschar?
Rickettsia, plague, trypanosomiasis
Treatment for severe falciparum malaria
IV artesunate, add IV quinine if from greater mekong
What gene confers resistance to artemesinin? Where found?
Kolch 13, SE Asia
What test must you do before treating vivax/ovale, and what treatment?
G6PD, primaquine for 7-14 days
Mosquito species for malaria
Anopheles
Treatment of non-severe malaria
Artemether + lumefantrine
List 4 flaviviruses
Dengue, Zika, Yellow fever, JEV
Mosquito for Dengue
Aedes aegypti - same as for Zika, Chikungunya
What is ADE with regards to Dengue?
Antibody dependent enhancement, meaning second infection with another Dengue serotype being a risk factor for severe Dengue
Viral protein that causes Dengue shock
NS1Ag
Test for diagnosis when < 5 days of illness in Dengue
NS1Ag
Diagnosis > 5 days of illness in Dengue
Serology
Who do you vaccinate against Dengue?
Seropositive individuals in endemic areas
What is clinical course of Dengue?
Biphasic, with defervescence of fevers after 5 days then get sick again
What is main complication of Zika in adults?
GBS
How do you diagnose Zika?
< 7 days = PCR
> 7 days = serology
Name three alphaviruses
Chikungunya, Ross River Virus, BF
Organism causing Typhoid
Salmonella enterica, serotypes typhi, paratyphi A/B/C
Key skin finding for Typhoid
Rose spots
Empiric treatment of typhoid
Ceftriaxone or azithromycin
Mechanism of action of triazoles
Inhibit C14alpha demethylase which is required for ergosterol synthesis in cell membrane. Fungistatic.
Mechanism of action of polyenes (amphotericin)
Bind to sterol ergosterol, forming pores in membrane
Echinocandins MOA
Inhibit B-1,3-D glucan synthase, inhibiting cell wall synthesis. Fungicidal.
Griseofulvin MOA
Inhibits nuclear division
First line antifungal for invasive aspergillus?
Voriconazole. Second line amphotericin/echinocandins
What is the vector for cutaneous leishmaniasis?
Sandflies
What are key words for biopsy of cutaneous leish lesion?
Rod-shaped kinetoplasts
How does HIV attach to CD4?
Via Gp120
What are HIV attachment coreceptors?
CCR5 early, CXCR4 late
What cells are CD4 positive and susceptible to HIV
Lymphocytes, macrophages, DCs
Mutation that confers immunity to HIV infection
CCR5delta32
HLA type with slowest progression to AIDS in HIV
HLAB5701
What are side effects of tenofovir?
Osteoporosis and RTA. TAF less toxic than TDF due to longer plasma half-life.
What drug classes are used to treat HIV in general?
2x NRTI + integrase inhibitor (ends in -tegravir)
When should you give PEP?
Best if < 24h, no longer than 72h
What drugs do you give for PEP? How long?
Tenofovir, emtricitabine, integrase (dolutegravir, raltegravir). 28 days
What drugs for PrEP?
Tenofovir and emtricitabine
What are the AIDS defining illnesses?
PJP, toxoplasmosis, CMV, TB/MAC, oesophageal candidiasis, Cryptosporidium/microsporidium, Kaposi’s
When should you start HIV treatment assuming no infection?
ASAP
What prophylaxis needs to be given at what CD4 counts for HIV?
< 200 PJP -> Bactrim
< 100 Toxo -> Bactrim
< 50 MAC, Crypto - Azith
What are RFs for IRIS?
High VL, high pathogen burden, low CD4 count
Top causes of IRIS?
TB, Crypto, MAC, CMV, PML
When to start ART with OI?
If TB and CD4 > 50, delay until 4-8 weeks of TB treatment
If TB and CD4 < 50, delay 2-4 weeks
Crypto - Delay until 4-6 weeks post amphotericin, sooner if mild and CD4 < 50
If crypto meningitis or other neurological OI - optimum time to start unclear
When do you treat a pregnant woman with HIV?
ASAP - risk to baby is 25% if untreated
WHen do you give zidovudine to pregnant woman?
If VL > 1000 at birth give IV zidovudine and deliver via C-section
What is ecthyma gangrenosum?
Ecthymatous skin lesions associated with Pseudomonas bacteraemia
Risk factors for invasive moulds?
AML, neutrophils < 0.1 for 2-3/52, neutropaenic + steroids, ALL, HSCT, cytarabine/fludarabine
What is Nocardia?
Gram positive rod, long chains of acid fast bacilli, branching like a mould. Causes lung and brain abscesses.
What is PTLD?
Post transplant lymphoproliferative disorder. High risk if EBV D+/R-, lymphoid rich transplant, ATG use.
What organism causes PML?
Progressive multifocal leucoencephalopathy- JC Virus (John Cunningham)
What drugs are highest risk for PML?
Natalizumab, TNFa inhibitors, rituximab