Infectious Diseases Flashcards by Abigail Sim

Live vaccines

BCG
Japanese encephalitis
MMR
Rotavirus
Oral typhoid
Varicella
Yellow fever
Zoster

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Treatment of choice for aspergillus?

Voriconazole

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Treatment of choice for nocardia?

Sulfa-based medications
Bactrim - TMP-SMX

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Treatment of choice for strongyloides?

Ivermectin

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Side effects of linezolid?

BM depression (reversible, with prolonged use)
Neuropathy (irreversible)
Optic neuropathy (rare)
Serotonin syndrome (avoid concurrent tramadol/SSRIs)

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Mechanism of resistance to vancomycin?

D-Ala D-Ala > D-Ala D-Lac

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VanA vs. VanB vs. VanC gene clusters?

VanA - transferable, resistant to vancomycin & teicoplanin, high vancomycin MIC

VanB - transferable, moderate resistance to vancomycin but teicoplanin sensitive

VanC - non-transferable, resistant to vanc (low-level) but teicoplanin sensitive

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VanA vs. VanB vs. VanC gene clusters?

VanA - transferable, resistant to vancomycin & teicoplanin, high vancomycin MIC

VanB - transferable, moderate resistance to vancomycin but teicoplanin sensitive

VanC - non-transferable, resistant to vanc (low-level) but teicoplanin sensitive

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Indications for CT prior to LP

Immunocompromised state
History of CNS disease
New onset seizure
Papilloedema
Focal neurological deficit
Abnormal GCS

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Common causes of bacterial meningitis in adults

SHIN

Strep. pneumoniae
Haemophilus influenzae
Neisseria

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Causes of aseptic meningitis?

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4 high-risk criteria requiring TOE if bacteraemic:

Community acquired bacteraemia
IV drug use
High risk cardiac condition
Indeterminate/positive TTE

In patients without above 4, normal TTE ruled out IE with sensitivity of 97% and NPV of 99%

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Indications for surgery in infective endocarditis

(1) Heart failure
- Severe valve dysfunction
- Poor cardiac function
- Pulmonary oedema

(2) Uncontrolled infection
- Root abscess
- Persisting fevers/positive BC despite >10 days therapy
- Fungal/MDRO

(3) Prevention of embolism
- Vege >15mm
- Large vege + embolic episodes

If valve culture negative at surgery, antibiotics can be stopped 2/52 post op

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Class of drug: raltegravir, dolutegravir?

Integrase inhibitors (HIV)

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Class of drug: ritonavir, lopiravir, indinavir?

Protease inhibitors (HIV)

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Class of drug: tenofovir, adefovir?

Nucleotide reverse transcriptase inhibitors (HIV)

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Class of drug: abacavir, emtricitabine, lamivudine?

Nucleoside reverse transcriptase inhibitors (HIV)

What HIV medication is associated with hypersensitivity reactions ?

Abacavir
Test for HLAB5701 prior to commencing therapy

Examples of gram positive rods?

Non-spore forming:
Listeria monocytogenes
Corynebacterium
Gardnerella vaginalis

Spore forming:
Bacillus cereus
Clostridium

Treatment of uncomplicated malaria?

Symptomatic but without features of severe malaria.

Oral therapy can be used.

1st line: artemether + lumefantrine (can be used after 1st trimester)

If in 1st trimester: atovaquone + proguanil.

If P vivax/P ovale: need primaquine for hypnozoites.

Features of severe malaria?

Blood parasite count >100 000/mL (>2% cells parasitised)
Impaired consciousness
Jaundice
Oliguria/AKI
Respiratory distress
Severe anaemia
Hypoglycaemia
Vomiting
Metabolic acidosis

Treatment of severe malaria?

Immediate IV treatment.

Usually caused by P falciparum.

1st line: IV artesunate

IV ceftriaxone 2g as concurrent bactereraemia common.

Paracetamol - reduces risk of haemolytic AKI

Which species of malaria have dormant stages?

P vivax
P ovale

Dormant = hyponozoite = liver

Definition of drug-resistant TB?

Resistance to one or more TB drugs

Definition of multidrug-resistant TB (MDR-TB)?

Resistance to at least isoniazid AND rifampin And possibly other TB drugs.

Definition of extensively drug-resistant TB (XDR-TB)?

Resistance to isoniazide, rifampin, a fluoroquinolone and at least one second line injectable agent or linezolid.

Most important predictors of drug-resistant TB?

- Previous episode of TB treatment - Persistent or progressive clinical and/or radiographic findings whilst on first-line TB therapy - Residence/travel to a region with high prevalence of drug-resistant TB - Exposure to an individual with known/suspected infectious drug-resistant TB

Treatment for drug susceptible pulmonary TB?

Traditional regimen of ≥6 months - 2 months intensive phase - ≥4 months continuation phase Rifampicin Isoniazid Pyrazinamide Ethambutol After completion of intensive phase, repeat clinical assessment + repeat sputum AFB - Routine CXR not required if improving clinically

Indications for shortened regimen for TB?

Non-pregnant patients with drug susceptible TB in absence of extra pulmonary involvement. Exclusion criteria: History of cardiac disease Advanced liver/renal disease Pregnant/lactating women Rifapentin, moxifloxacin, isoniazid, pyrazinamide - 8 weeks intensive phase - 9 weeks continuation phase

Role of pyridoxine (vit B6) in TB?

Given to patients with isoniazid and at risk of neuropathy (pregnancy, HIV, diabetes, EtOH, renal failure) Isoniazid prevents conversion of pyridoxine to active form. Needed as cofactor for GABA.

ESCHAPPM organisms?

* Enterobacter spp * Serratia spp. * Citrobacter freundii * Hafnia spp. * Aeromonas spp. * Proteus spp. (except P mirabilis) * Providencia spp. * Morganella morganii AmpC beta lactamase genes Inducible

Clinically important CPE/CREs?

* Klebsiella pneumoniae carbapenemase - KPC * New Delhi metallo-beta-lactamase proteinase - NDM * Oxacillin-type beta lactamase 48 - OXA 48 * Verona integron encoded metallo-beta-lactamase - VIM * Imipenem hydrolysing metallo beta lactamase - IMP

CSF in bacterial meningitis?

High opening pressure Elevated WCC (primarily PMNs) Low glucose High protein Neisseria, S pneumoniae, Listeria

CSF in viral meningitis?

Normal/high opening pressure Elevated WCC (primarily lymphocytes) Normal glucose (may be low in HSV) Elevated protein HSV, VZV

CSF in GBS?

Clear Normal/high opening pressure Normal WBC Normal glucose High protein ++ Albuinocytologic dissociation

NS5B nucleotide inhibitors?

Sofosbuvir

NS5A nucleotide inhibitors?

Velpatasvir Elbasvir Ledipasvir

Drug of choice for Hep B treatment during pregnancy?

Tenofovir

Indications for Hep B treatment in chronic HBV infection?

Immune clearance - HBsAg positive - HBeAg positive - Anti-HBeAg negative - ALT >19 women, >30 men - Viral load >20,000 Immune escape - HBsAg positive - HBeAg negative - Anti-HBeAg positive - Elevated ALT - Viral load >20,000 Detectable viral load + cirrhosis

When to start HCC surveillance in hep B?

Cirrhosis ATSI >50 Asian male >40 Asian female >50 African >20 1st degree relative with HCC

Indications for Hep B treatment with chemotherapy/immunosuppression?

If HBsAg positive, should have antiviral therapy if undergoing chemotherapy/immunosuppression. If B-cell depleting (e.g. rituximab), need to continue for 18-24 months post therapy. Also with B-cell depleting therapy, indication includes HBsAg negative/anti-HBc positive.