Infectious diseases Flashcards
Testing for TB
FBC, U&E, ESR CRP, interferon gamma test
Sputum AFB/Bronchoscopy and lavage
CXR
Prior to treatment: RFT, LFT, visual acuity
Managing TB
- screen family members and close contacts
- report to health authorities
- 2 months 4 drugs initially, then 4 months 2 drugs
- isoniazid, rifampicin, pyrazinamide, ethambutol
- DOTS treatment, have to be compliant
- regular follow-up and repeat investigations at 2 and 6 months
Diagnosing EBV
FBC, PBF
Monospot for heterophil antibody, EBV-specific antibody, VCA antibody
Management for EBV
Supportive, rest during acute stage
NSAIDS/PCM
Gargle soluble aspirin/30% glucose
Adequate hydration
Advise AGAINST alcohol, fatty food, contact sports (splenic rupture)
Steroids only if neuro involvement, thrombocytopenia, threatened airway obstruction
Triad for malaria and other features
Fever + chills + headache
Rigor, sweating, myalgia, anemia, jaundice, hepatosplenomegaly, atypical (diarrhoea, abd pain, cough)
Malaria prevention (8 steps)
- keep away from rural areas
- avoid outdoor activities between dusk and dark
- sleep in AC/properly screened rooms
- use mosquito coils at night
- insect repellent on body
- mosquito nets with permethrin
- light-coloured clothing, long sleeves and trouser
- avoid perfume, cologne, after-shave
Malaria drug prophylaxis dose, duration, SE
Doxycycline 100mg OD for 1-2 days before, then during and for 4 weeks after.
Photosensitivity reactions
Investigations for malaria
PBF Thick and thin
FBC - anemia, leukocytosis, thrombocytopenia
Treatment of malaria
P falciparum: Quinine-based with quinine sulfate + doxycycline/clindamycin. Alternative is artemether-lumefantrine
P vivax and P ovale: chloroquine + primaquine
P malariae: chloroquine
Malaria paroxysm and when it happens
at 8-12 hours: suddenly feel very cold > mild shivering > violent shaking. after that hot flush with throbbing headache, palpitations, tachypnea, postural syncope and vomiting.
Tests for Hepatitis A
LFT, HAV IgG and IgM.
Ultrasound to exclude bile duct obstruction
Management of Hepatitis A
Rest, fat-free diet
Avoid alcohol, smoking, hepatotoxic drugs
No sex, no IV drugs, wash hands after toilet and disinfect, don’t handle others’ food, don’t share cutlery, don’t use towels to dry.
Prevention of Hep A
Hygiene
Immuneglobulin for close contacts and travelers to endemic areas for up to 3 months
Test for Hepatitis B
If HbsAg positive: do full viral profile and it signifies current infection/chronic infection (carrier if >6 months)
If HbeAg positive: active replication
If anti-Hbe: inactive virus and not infective
If HBV DNA high; active replication
If anti-HbC positive: previous/ongoing infection
Management and monitoring of Hep B
Avoid alcohol, avoid certain drugs till recovered like sedatives, NSAIDS, OCP
Hygiene like Hep A
Treat chronic Hep B with interferon and antiviral
Monitor LFT, HBeAg and HBV DNA, alpha-fetoprotein 6-12 monthly
Diagnosis of Hep C
By serology
HCV Ab: exposure
HCV RNA: chronic viraemia. once negative infection cleared
Must check CD4/HCV viral load and ALT (if high need referral)
If PCR positive, significant viral load, ALT high > perform HCV genotype
Management of Hepatitis C
Direct-acting antiviral + interferon
Pretreatment assessment: Confirm diagnosis, test for genotype and viral load, document travel history, evaluate comorbids and liver status, discuss contraception and pregnancy, select treatment regimen and review potential drug interaction
Hepatitis C cure confirmed when
Undetectable plasma HCV RNA at least 12 months post management
Tests for HIV
HIV infection: ELISA/HIV rapid test, if positive Western blot to confirm
immune function: CD4 lymphocyte count. <500 is defective, <200 is severely immunodeficient
Plasma HIV RNA
Test for opportunistic infection
Routine test: FBC UEC FBG lipid eGFR
Management of HIV
Preferred regimen: 2NTI + NNRI/PI
What vaccine required for Africa and South America
Yellow fever
What vaccine needed for India
Typhoid
What vaccine needed for Saudi Arabia
Meningococcal
Influenza management
Rest till fever subsides
analgesia
High fluid intake
Antivirals if elderly, pregnant, chronic disease, obese
- Oseltamivir 75mg Po BD for 5 days
- Zanamivir inhaled 10mg bd 5 days if oseltamivir resistant, poor response, poor GI absorption
