Infectious diseases Flashcards
Describe the management of septic arthritis
If in doubt, start empirical IV antibiotics (after aspiration) until sensitivities are known
Antibiotics are required for a prolonged period, conventionally ~2 weeks IV, then if patient improves 2-4 weeks PO
Consider orthopod review – arthrocentesis, washout & debridement
Describe the symptoms, investigations & management of osteomyelitis
Fever, local pain & erythema
CT/MRI/bone scan
Blood cultures, as well as bone cultures & biopsy -> identify the organism & sensitivities
Treatment = flucloxacillin & fusidic acid for at least 4-6 weeks, starting IV
List clinical features of spondylodiscitis
Back/neck pain
Constant pain, more worse at night
Radicular pain radiating to chest or abdomen
Fever
Describe the management of spondylodiscitis
Conservative – antibiotics & immobilisation of the spine
Surgery – radical surgical debridement, stable reconstruction
List the clinical features of cellulitis
Erythema in the involved area, with poorly demarcated margins, swelling, warmth & tenderness
May be low-grade fever
Describe the management of cellulitis
Flucloxacillin
Define necrotising fasciitis
Rapidly progressive
Infection of the deep fascia causing necrosis of subcutaneous tissue
Describe the management of necrotising fasciitis
Radical debridement +/- amputation
IV antibiotics – benzylpenicillin and clindamycin
List the clinical features of cystitis
Frequency
Dysuria
Urgency
Suprapubic pain
Polyuria
Haematuria
List the clinical features of pyelonephritis
Fever
Rigor
Vomiting
Loin pain/tenderness
Costovertebral pain
Associated cystitis
Septic shock
List the clinical features of clostridium difficile
Watery diarrhoea
Mild -> fulminant colitis
Ileus
Toxic megacolon
Describe the management of clostridium difficile
SIGHT – suspect, isolate within 2 hours, gloves and aprons, hand wash with soap, test immediately
Metronidazole PO
Severe – vancomycin PO
Describe the management of meningitis
Start treatment immediately if suspected
Urgent abx treatment – benzylpenicillin, ceftriaxone
List clinical features of encephalitis
Bizarre encephalopathic behaviour/consolidation
Decreased GCS/coma
Fever
Headache
Focal neurological signs
Seizures
History of travel or animal bite
List investigations to do for suspected encephalitis
Bloods
Contrast-enhanced CT
LP
EEG
Describe the management of encephalitis
Start aciclovir within 30min of the patient arriving
Supportive therapy – in high-dependency unit/ICU environment
Symptomatic treatment – phenytoin for seizures
List investigations for fever in the returned traveller
Bloods – FBC, LFTs, U&Es
Malaria smears +/- antigen detection dipstick
Blood cultures x2
Urinalysis
Stool cultures +/- stool for ova, cysts and parasites
CXR
HIV, hep B, hep C and syphilis serology
List clinical features of malaria
Abrupt onset of rigors followed by high fevers, malaise, severe headache & myalgia, vague abdominal pain, N&V
Diarrhoea
Jaundice and hepatosplenomegaly
Bloods – anaemia, thrombocytopenia, leukopenia & abnormal LFTs
Describe the management for malaria
Uncomplicated falciparum – artemisinin combination therapies, if ACT unavailable -> atovaquone-proguanil, oral quinine sulphate plus doxycycline
Non-falciparum – chloroquine, primaquine (risk of haemolysis in G6PD deficiency so screen prior to use)
List the clinical features of typhoid fever
Sustained fever
Anorexia
Malaise
Vague abdominal discomfort
Constipation/diarrhoea
Dry cough
Describe the management of typhoid fever
IV ceftriaxone
Once sensitivities known, switch to PO ciprofloxacin or PO azithromycin
Describe pyrexia of unknown origin
Temperature > 38 degrees on multiple occasions
Illness > 3 weeks duration
No diagnosis despite >1 week’s worth of inpatient
Describe the management of patients with pyrexia of unknown origin
Aim to establish diagnosis, rather than treated blindly
Try and stay up to date on what tests have been done
Stable patients can be managed as outpatients following a period of observation in hospital
