Infectious diseases Flashcards
Malaria
Tx of uncomplicated falciparum
Oral artemisinin-based combination therapy (ACT):
- RIAMET (artemether + lumefantine)
- Malarone
- Quinine
- Doxycycline
Malaria
Tx of complicated falciparum
IV Artesunate OR IV Quinine
Malaria
Tx of non-falciparum
- Oral chloroquinine
- If resistant area –> artemether and lumefantine (riamet)
- If p.ovale or p.vivax then PRIMAQUININE for the hypnozoites (after acute Tx)
Malaria
Types
- Plasmodium falciparum (75%) - most severe
- P. vivax (most common out of rest, c. america and india)
- P.ovale (africa)
- P.malariae
Malaria
Diagnosis
3 blood films over 3 consecutive days (to catch ruptured RBC releasing merozoites)
Will see parasites, the concentration of them and the type
When might you avoid IV dexamethasone?
- Septic shock
- Meningococcal septicaemia
- Immunocompromised
- Meningitis following surgery
Haemolytic uraemic syndrome
Symptoms
TRIAD
- AKI
- Macroangiopathic haemolytic anaemia
- Thrombocytopenia
Haemolytic uraemic syndrome
Causes
Most common = E.coli
Other:
- Pneumococcal infection
- HIV
- SLE, drugs, cancer
Haemolytic uraemic syndrome
Ix
- FBC: anaemia, thrombocytopaenia, fragmented blood film
- U&Es: AKI
- Stool culture: shiga toxins (PCR)
Haemolytic uraemic syndrome
Management
- supportive (fluids, blood transfusions, dialysis if required)
- no place for Abx
Most common cause of tonsillitis?
Group A strep
Streptococcus pyogenes!!
Most common cause of otitis media, sinusitis and tonsillitis (if not GAS)
- Strep pneum
Causes of UTIs
- Most common = E.Coli
- Klebsiella pneumoniae
- Enterococcus
- Pseudomonas aeruginosa
- Staphylococcus saprophyticus
- Candida albicans (fungal)
Why does presence of nitrites in urine mean bacterial infection is likely?
- Gram negative bacteria breakdown nitrates into nitrites
Duration of UTI Abx
- 3 days for simple LUTS
- 5-10 days for immunosuppressed, abnormal anatomy or impaired kidney function
- 7 days for men, pregnant women or catheter-related UTIs - It is worth noting that NICE recommend changing the catheter when someone is diagnosed with a catheter related urinary tract infection
UTI in pregnancy
Risks
- Pyelonephritis
- Premature rupture of membranes
- Pre-term labour
Trimethoprim in pregnancy
- Avoid in first trimester as affects folic acid
Nitrofurantoin in pregnancy
- Avoid in last trimester as linked with haemolytic anaemia of the newborn
Most common causes of cellulitis
- Staphylococcus aureus
- Group A Streptococcus (mainly streptococcus pyogenes)
- Group C Streptococcus (mainly Streptococcus dysgalactiae)
Common causes of intra-abdominal infections
- Anaerobes (e.g. bacteroides and clostridium)
- E. coli
- Klebsiella
- Enterococcus
- Streptococcus
Spontaenous bacterial peritonitis
Tx
This is a serious infection that typically occurs in patients with liver failure.
- Piperacillin/Tazobactam (Tazocin) is often first line
- Cephalosporins such as cefotaxime are also often used
- Levofloxacin plus metronidazole is an common alternative in penicillin allergy
Notifiable diseases
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
