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ICM Matrix > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What is candidiasis?

A

thrush

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2
Q

Features of candidiasis

A
  1. ‘Cottage cheese’, non-offensive discharge
  2. Vulvitis: superficial dyspareunia, dysuria
  3. Itch
  4. Vulval erythema
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3
Q

Investigations for vaginal candidiasis

A

a high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis

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4
Q

What is cryptococcosis?

A

Opportunistic fungal infection

  • Caused by environmental fungus found worldwide
  • often found in soil contaminated with bird droppings
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5
Q

How does cryptococcosis infection present?

A
  1. Meningitis is the most frequently seen presentation
  2. Clinical manifestation can vary:
    - Headache
    - Lethargy
    - Pyrexia
    - Productive cough
    - SOB
    - personality changes will develop over 2-4 weeks (sometimes months)
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6
Q

Investigation for cryptococcosis

A
  1. Lumbar puncture will feature high opening pressure, lymphocytic CSF, high protein and low glucose
    - CSF CrAg: Sensitivity 93 - 100%, Specificity 93 - 98%
  • Gold standard diagnostic test is culture*
    2. Serum Cryptococcal Antigen (CrAg) also used
    3. India ink stain: round, encapsulated yeast
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7
Q

Gold standard diagnostic test for cryptococcosis

A

Culture!

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8
Q

What is histoplasmosis?

A

Histoplasma capsulatum - another environmental fungus
- found worldwide
but most commonly America in soil with bird/bat droppings

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9
Q

How is histoplasmosis transmitted?

A

Via inhalation of microscopic spores, incubation 3-17d

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10
Q

Features of histoplasmosis

A
  1. Flu-like (fever/cough/lethargy/headache)
  2. Consider in patients with pneumonia and mediastinal LN, pulmonary nodule, pericarditis with LN, pulmonary manifestations with arthralgia
  3. Severity depends on host immunity and intensity of exposure
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11
Q

Investigations for histoplasmosis

A 
1st line = CXR
common findings for histoplasmosis pneumonia:
- nodules
- mediastinal or hilar lymphadenopathy
- cavitary lesions
- pleural effusions

Gold standard /Diagnostic:
Culture of pulmonary secretions

Other: Histoplasma antigen on serum or urine

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12
Q

What is pneumocystis jiroveci pneurmonia also known as?

A

Pneumocystis carinii pneumonia (PCP)

- common opportunistic infection in AIDS

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13
Q

Featues of pneumocystis jiroveci

A

dyspnoea
dry cough
fever
very few chest signs

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14
Q

Investigations for pneumocystis jiroveci

A
  1. CXR:
    - bilateral interstitial
    pulmonary infiltrates
    - lobar consolidation.
    - May be normal
  2. exercise-induced desaturation
  3. sputum often fails to show PCP
  4. bronchoalveolar lavage (BAL) = silver stain shows characteristic cysts
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15
Q

Most common complication of pneumocystis jiroveci

A

Pneumothorax

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16
Q

What is Epstein-Barr virus?

A

Infectious mononucleosis (glandular fever)

EBV, also known as human herpesvirus 4, HHV-4

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17
Q

Features of EBV

A

Classic triad of :

  1. sore throat
  2. pyrexia
  3. lympadenopathy
  • Symptoms typically resolve after 2-4 weeks
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18
Q

Diagnostic test for EBV

A

heterophil antibody test (Monospot test)

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19
Q

Types of herpes simplex virus

A

HSV-1 : oral lesions (cold sores)

HSV-2 for genital herpes

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20
Q

Features of HSV

A
  • primary infection: may present with a severe gingivostomatitis
  • cold sores
  • painful genital ulceration
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21
Q

What is mumps?

A

Mumps is a caused by RNA paramyxovirus and tends to occur in winter and spring

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22
Q

How do mumps spread?

A
  • by droplets
  • respiratory tract epithelial cells → parotid glands → other tissues
  • infective 7 days before and 9 days after parotid swelling starts
  • incubation period = 14-21 days
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23
Q

Symptoms of mumps

A
  • fever
  • malaise, muscular pain
  • parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral
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24
Q

Investigations of mumps

A
  1. Serum mumps IgM – Positive igM confirms diagnosis.
  2. Negative IgM does not rule out mumps infection
  3. Serum Mumps IgG
  4. Viral culture (Saliva)
  5. Consider CT Head if there are focal neurological symptoms
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25
Q

What is roseola infantum?

A

AKA as exanthem subitum is a common disease of infancy caused by the human herpes virus 6 (HHV6).

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26
Q

Features of Roseola infantum

A
  1. high fever: lasting a few days, followed later by a
  2. maculopapular rash
  3. Nagayama spots: papular enanthem on the uvula and soft palate
  4. febrile convulsions
  5. diarrhoea and cough
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27
Q

How is Roseola infantum diagnosed?

A

Clinical diagnosis

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28
Q

Treatment of Roseola infantum

A

Self-limiting

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29
Q

What is rubella AKA and causative organism?

A

AKA German measles, is a viral infection caused by the togavirus.

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30
Q

When is rubella infectious?

A

infectious from 7 days before symptoms appear to 4 days after the onset of the rash

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31
Q

Features of rubella

A
  1. prodrome, e.g. low-grade fever
  2. rash: maculopapular, initially on the face before spreading to the whole body, usually fades by the 3-5 day
  3. lymphadenopathy: suboccipital and postauricular
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32
Q

Gold standard for rubella

A

Serological and/or polymerase chain reaction (PCR) testing is the gold standard.

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33
Q

Causative organism of Measles

A

RNA paramyxovirus

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34
Q

Transmission of Measles

A
  1. spread by droplets
  2. infective from prodrome until 4 days after rash starts
  3. incubation period = 10-14 days
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35
Q

Features of Measles

A
  1. prodrome: irritable, conjunctivitis, fever
  2. Koplik spots (before rash): white spots (‘grain of salt’) on buccal mucosa
  3. rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
  4. diarrhoea
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36
Q

Investigation of Measles

A

IgM antibodies can be detected within a few days of rash onset

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37
Q

Causative organism of Erythema Infectiosum

A

Parvovirus B19 is a DNA virus which causes a variety of clinical presentations.

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38
Q

Symptoms of Erythema Infectiosum

A
  1. ‘slapped cheek’ rash
  2. An erythematous maculopapular rash on the trunk, back, and limbs may develop a few days after the facial rash
  3. This then fades to produce a lace-like, reticular rash.
  4. low-grade fever
  5. Prodromal viral infection prior to onset of rash
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39
Q

Investigations of Erythema Infectiosum

A

Only done in pregnant/immunocompromised patients = serology

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40
Q

Causative organism of rabies

A

Rhabdoviridae family

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41
Q

What is rabies?

A

viral disease that causes an acute encephalitis

42
Q

Features of rabies

A
  1. Prodrome: headache, fever, agitation
  2. Hydrophobia
  3. hypersalivation
43
Q

Investigations for rabies

A
  1. Clinical suspicion

2. immunofluorescence from saliva/CSF or anti- rabies antibodies

44
Q

Treatment of rabies

A
  1. Contact PHE
  2. Late-stage Rx:
    - Symptomatic Mx:
     Quiet
     private room
     benzodiazepines
     haloperidol
     analgesia
     anti-cholinergics
  3. At risk countries:
    - HRIG
45
Q

Define Cytomegalovirus Infections

A

Cytomegalovirus is part of the Herpesvirus family

- Primary infection presentation = EBV

46
Q

How CMV transmitted?

A

Sex/close contact (URT & Urine) / blood/transplant

47
Q

Features of CMV

A

Manifest as colitis, hepatitis, encephalitis, pneumonitis, retinitis

48
Q

Investigations for CMV

A

Serology (IgM & IgG), CMV DNA PCR, Histology (‘inclusions’)

49
Q

Treatment of CMV

A
  1. Supportive in immunocompetent

2. Antiviral in immunocompromised (Cidofovir/Foscarnet/Ganciclovir)

50
Q

What pathogen causes influenza?

A

RNA virus - orthomyxoviridae

51
Q

What are the symptoms of influenza?

A
  • Coryzal symptoms
  • Fever
  • Headache
  • Non-productive cough
  • Sore throat
52
Q

How is influenza diagnosed?

A

Clinical diagnosis

- viral culture - PCR

53
Q

What is varicella-zoster infection?

A

Chickenpox

- shingles is reactivation of VZV (herpes zoster)

54
Q

Symptoms of shingles

A

prodromal period
1. burning pain over the affected dermatome for 2-3 days

  1. fever, headache, lethargy

rash
1. initially erythematous, macular rash over the affected dermatome

  1. quickly becomes vesicular
  2. does not cross the midline.
55
Q

Facts about salmonellosis

A

Leading cause of foodborne illness
(poultry, eggs, milk products)
- Incubation period 8-72h post exposure (ingestion of contaminated food/water)

56
Q

Features of salmonellosis

A
  1. Diarrhoea
  2. Nausea
  3. Vomiting
  4. Fever
  5. abdo cramps
57
Q

Investigation for salmonellosis

A

Stool Microscopy, Culture & Sensitivities (MCS)

58
Q

What is shigellosis?

A

Shigella species cause a diarrhoeal illness

59
Q

Transmission of shigellosis

A

Faeco-oral transmission, can be sexually acquired

60
Q

Features of shigellosis

A
  • Diarrhoea (often bloody)
  • fever
  • abdominal pain
61
Q

Investigation for shigellosis

A

Stool MCS

62
Q

Causative organism of tetanus

A

tetanospasmin exotoxin released from Clostridium tetani

63
Q

How does tetanus affect the body?

A

Prevents release of GABA

64
Q

How is tetanus transmitted?

A

Spores of the bacteria enter the body through a wound

65
Q

Features of tetanus

A
  1. painful muscle contractions esp Masseter and neck muscles
  2. prodrome: fever, lethargy, headache
  3. trismus (lockjaw)
  4. risus sardonicus (distorted grin)
  5. opisthotonus (arched back, hyperextended neck)
  6. spasms (e.g. dysphagia)
66
Q

Diagnosis of tetanus

A

clinical

67
Q

What is cholera?

A

Acute diarrhoeal illness caused by toxin-producing strains of gram negative Vibrio cholerae.

68
Q

How is cholera transmitted?

A

ingesting contaminated food or water

69
Q

Features of cholera

A
  1. Diarrhoea - profuse ‘Rice water stool’
  2. Dehydration
  3. hypoglycaemia
70
Q

Investigation for cholera

A
  1. Largely clinical

2. Stool MCS

71
Q

Causative organism for diphtheria

A

Gram-positive bacillus Corynebacterium diphtheriae

72
Q

Features of diphtheria

A
  1. sore throat –> with diphtheric membrane’ : grey pseudomembrane on the posterior pharyngeal wall
  2. bulk cervical lymphadenopathy –> ‘bull neck’
  3. low-grade fever
73
Q

Investigation for diphtheria

A

Culture of throat swab: uses tellurite agar or Loeffler’s media

74
Q

What is botulism?

A

Rare, but potentially life-threatening neuroparalytic syndrome caused by a neurotoxin of Clostridium botulinum

75
Q

Features of botulism

A

Acute onset bilateral cranial neuropathies with symmetric descending weakness

  1. patient usually fully conscious with no sensory disturbance
  2. flaccid paralysis
  3. diplopia
  4. ataxia
  5. bulbar palsy
76
Q

Investigation for botulism

A

Clinical suspicion, anaerobic culture

77
Q

What is Atypical Mycobacterial Disease?

A

Opportunistic infection
E.g. Mycobacterium avium and Mycobacterium kansasii

  • context of HIV, CD4 <50 are at higher risk of disseminated disease
  • environmental organism
78
Q

Transmission of Atypical Mycobacterial Disease

A

Transmission occurs via the respiratory or GI tract

79
Q

Features of Atypical Mycobacterial Disease

A
  1. fever, night sweats, weight loss, lymphadenopathy, hepatomegaly
  2. Anaemia, leucopenia, hypoalbuminaemia
80
Q

Investigation for Atypical Mycobacterial Disease

A

Mycobacterial cultures (blood/bone marrow/lymph node/ sputum/stool)

81
Q

Causative organis of threadworks

A

Infestation with threadworms (Enterobius vermicularis, sometimes called pinworms) is extremely common amongst children in the UK.

82
Q

Transmission of threadworms

A

Infestation occurs after swallowing egg

83
Q

Features of threadworms

A

Usually asymptomatic

  • perianal itching, particularly at night
  • girls may have vulval symptoms
84
Q

How do you diagnose threadworms?

A

Cellophane test/ Clinical suspicion

85
Q

Treatment for threadworms

A

1st line = Mebendazole with repeat dose in 2/52

  • Treat entire family, hygiene measures
86
Q

What is hookworm?

A

Hookworm (Ancylostoma duodenale and Necator americanus) as well as Ascaris (up to 35mm) and Trichuris (whipworm) are all soil-transmitted helminths account for the majority of infection

87
Q

Transmission of hookworm

A

Mainly acquired through walking barefoot in contaminated soil

88
Q

Features of hookworm

A
  • Majority asymptomatic
  • Some GI symptoms
  • anaemia
  • mild cough
  • serum eosinophilia
89
Q

Investigation for hookworm

A

Stool Ova, Cysts and Parasites

90
Q

Treatment of hookworm

A

Albendazole or Mebendazole

91
Q

Causative organism of amoebiasis

A

Entamoeba histolytica

92
Q

Transmission of amoebiasis

A

Spread by the faecal-oral route

93
Q

Symptoms of amoebiasis

A
  • Infection can be asymptomatic
  • cause mild diarrhoea
  • severe amoebic dysentery
94
Q

Sx, Ix & Mx of amoebic dysentery

A
  • profuse, bloody diarrhoea

Ix: stool microscopy may show trophozoites if examined within 15 minutes or kept warm (known as a ‘hot stool’)

Mx: metronidazole

95
Q

Causative organism of malaria

A

Mosquito-borne infection caused by Plasmodium protozoa

Four kinds of malaria parasite: Plasmodium falciparum, P. vivax, P. ovale and P. malariae

96
Q

Features of malaria

A
  1. Fever, arthralgia, headache, nausea, abdominal pain (often non-specific symptoms)
  2. Signs: Tachycardia, tachypnoea, fever, anaemia, thrombocytopenia, transaminitis, splenomegaly
97
Q

Causative organism of toxoplasmosis

A

Infection with a worldwide distribution caused by Toxoplasma gondii

98
Q

Transmission of toxoplasmosis

A
  1. Ingestion of infectious oocysts from soil/water
  2. Ingestion of tissue cysts in the meat of an infected animal
  3. Vertical transmission
  4. Transmission from organ transplantation from an infected donor
99
Q

Features of toxoplasmosis

A
  1. Immunocompetent person: primary infection usually asymptomatic
  2. If symptomatic: fever, sweats, headache, myalgia, hepatosplenomegaly
  3. Most common manifestation is bilateral, symmetrical non-tender cervical lymphadenopathy
  4. Labs: Lymphocytosis, raised LFTs, moderate increase in CRP
100
Q

Investigations of toxoplasmosis

A

Serology

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