infectious diseases Flashcards by denise lin

gingivostomatitis in herpes infection can be treated with

oral acyclovir
chlorhexidine mouthwash

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during pregnancy, when is herpes risky

primary attack of herpes in third trimester - after 28 weeks gestation

needs elective c-section

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For patients with suspected Lyme disease, If the ELISA is positive or equivocal, what is the next step

Immunoblot test

Abx can be prescribed while awaiting the Immunoblot result

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Lyme disease is what pathogen

Borrelia burgdorferi

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What rash is seen in lyme disease

erythema migrans

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If erythema migrans rash is present for Lyme disease then you can start what treatment

Doxycycline for 21 days

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What is the first-line test for Lyme disease

ELISA test

assay for antibodies to Borrelia burgdoferi

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The ELISA test is the first-line test for Lyme disease. If this is negative, and Lyme disease is still suspected within 4 weeks, what should you do next

Repeat ELISA 4-6 weeks after the first

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The ELISA test is the first-line test for Lyme disease. If this is negative, and Lyme disease is still suspected for 12 weeks or more, what should you do next

Immunoblot test

(4-6 weeks - repeat ELISA)

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What treatment is given for disseminated lyme disease

ceftriaxone

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Eron classification is used for cellulitis. What management is used for Stage 1-4

1: oral Abx
2: unwell with comorbidity. May not need admission if community IV Abx and monitoring can happen.
3-4: need admission for IV Abx i.e. periorbital

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Genital wart treatment for multiple, non-keratinised warts

topical podophyllum

2nd line = imiquimod

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For adults with mild facial cellulitis, prescribe …?

co-amoxiclav 7 days

(or clarithro if pen allergic)

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Genital wart treatment for solitary, keratinised warts

cryotherapy

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Genital warts (aka condylomata accuminata) are caused by which HPV

HPV 6 and 11

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Pathogen of bacterial vaginosis

Gardnerella vaginalis

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Amsel’s criteria for bacterial vaginosis. 3 out of the 4 following points must be present:

Thin, white homogenous discharge
Clue cells on MC&S
Vaginal pH >4.5
Whiff test +ve

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MC&S slide shows:
Clue cells, stippled vaginal epithelial cells

what is diagnosis

bacterial vaginosis

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Asymptomatic bacterial vaginosis Rx

NOT required
Incidental swab findings
ONLY treat if woman is having a TOP

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Symptomatic bacterial vaginosis Rx

Oral metronidazole for 5-7 days

OR
single dose of 2g metronidazole

(can also use topical metronidazole or clindamycin as alternatives)

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Bacterial vaginosis in pregnancy - symptomatic treatment

Oral metronidazole for 5-7 days or topical treatment

The stat 2g dose is not recommended

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Both the National Chlamydia Screening Programme and SIGN guidelines support the screening of asymptomatic patients for Chlamydia. Which age group should be targeted?

Sexually active patients aged 15-24

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Investigation of chice for chlamydia

NAAT technique:
Men - 1st pass urine
Women - vulvovaginal swab or cervical swab

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When should chlamydia testing be carried out after possible exposure

2 weeks

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Treatment of chlamydia

doxycycline 7 day If contraindicated/not tolerated: azithromycin 1g OD for one day then 500mg OD for 2 days

If a patient with chlamydia is pregnant what are the antibiotic options

Azithromycin Erythromycin Or Amoxicillin

For patients with chlamydia, they should contact all partners since what timeframe: (a) men with urethral symptoms (b) women and asymptomatic men

(a) men with urethral symptoms - 4 weeks before symptoms (b) women and asymptomatic men - partners from 6 months, or the most recent sexual partner

What is the most common cause of diarrhoea in patients with HIV infection

Cryptosporidium

For patients with gonorrhoea, if the patient refuses IM ceftriaxone, what is the alternative oral treatment

oral cefixime 400mg + oral azithromycin 2g

First line treatment for gonorrhoea

IM ceftriaxone 1g +/- oral ciprofloxacin 500mg if sensitivities are known

Most common pathogen cause of septic arthritis in young adults

Neisseria gonorrhoea

3 key features of disseminated gonococcal infection

Tendosynovitis Migratory polyarthritis Dermatitis (lesions can be maculopapular or vesicular)

Haematological complication of mycoplasma pneumoniae

Cold agglutins (IgM) can cause a haemolytic anaemia Thrombocytopenia

What rashes are seen with mycoplasma pneumoniae

erythema multiforme (erythema nodosum too)

Investigations to diagnose mycoplasma pneumoniae

Mycoplasma serology

Management for mycoplasma pneumoniae

doxycycline or macrolide (erythro/clarithro)

EBV associated malignancies:

Burkitt's lymphoma Hodgkin's lymphoma Nasopharyngeal carcinoma

The non-malignant condition hairy leukoplakia is associated with which viral infection

EBV

Treatment of erysipelas

Fluclocloxacillin (clarithro if pen allergic)

What is the pathogen that usually causes erysipelas (superficial infection of the dermis)

B-haemolytic group A strep

2 commonest pathogen causes of cellulitis

1. Strep pyogenes 2. Staph aureus

HIV seroconversion (flu-like illness) typically occurs after how long post-infection

3-12 weeks after

Legionella investigation

Urinary antigen

Management of legionella

Erythromycin or clarithromycin

What are the three types of Leishmaniasis

1. Cutaneous 2. Mucocutaneous 3. Visceral (kala-azar)

Cutaneous leishmaniasis presents with...

ulcers crusted lesion at site of the bite Dx = punch biopsy

What is cutaneous leishmaniasis caused by

Leishmania tropica or maxicana

Mucocutaneous leishmaniasis is caused by...

Leishmania braziliensis

Visceral leishmaniasis (kala-azar) is caused by...

Leishmania donovani

Visceral leishmaniasis (kala-azar) caused by Leishmania donovani presents with..

Fevers, rigors Splenomegaly Hepatomegaly Weight loss Grey skin Pancytopenia

What is the gold standard test for diagnosis of visceral leishmaniasis (Leishmania donovani)

Bone marrow or splenic aspirate n.b. in cutaneous leishmaniasis, punch biopsy of bite/crusting ulcer can be done

Which HPV strains are linked to cancers

16, 18, 33

HPV vaccines are offered to

All 12-13 year olds MSM under 45

First line pregnant woman UTI symptomatic treatment

Nitrofurantoin 7 days (avoid near term) (Avoid trimethoprim in 1st trimester)

Asyptomatic bacteriuria (UTI) in pregnant women are still treated with antibiotics - what length of course

7 days Nitro (avoid near term), amoxi or cefalexin

Men are treated with a course of UTI antibiotics for what time frame

7 days

If a patient who is catheterised has a UTI, what length of Abx course is given?

7 days

A patient with acute pyelonephritis should be given broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for how long

10-14 days

What is the latest time that HIV post-exposure prophylaxis may be given?

72 hours post exposure event

Trichomonas vaginalis - treat with...

Oral metronidazole for 5-7 days (or one-off dose of 2g metronidazole)

microscopy of a wet mount for trichomonas vaginalis shows...

motile trophozoites

what is the typical temperature (C) range that the vaccines need to be stored at?

2-8 degrees celsius

what pathogen causes croup

parainfluenza virus

Travelled to India Went swimming Non-bloody diarrhoea Long incubation period Bloating Trophozoite and cysts MC&S What is likely organism

Giardiasis

What is the treatment for giardiasis

Metronidazole

Flu-like symptoms RUQ pain Tender hepatomegaly Raised BR Raised ALT/AST Normal/slightly raised ALP what is likely condition

Hepatitis

transmission of hepatitis A

faecal-oral route

Hep C and D transmission

Blood-borne

Hepatitis D only occurs in people who are also infected with

Hepatitis B

Which hepatitis do people usually make a full recovery

Hepatitis A 85% of people with hep A recover within 3-6 months. There is no chronic liver disease.

Painless penile ulcers are usually caused by

syphilis i.e. treponema pallidum

incubation period of syphilis

9-90 days

chancre - painless ulcer is seen in which STI

syphilis (treponema pallidum)

primary features of syphilis

chancre local non-tender lymphadenopathy

secondary features of syphilis (6-10 weeks after primary infection)

systemic: fevers rashes on trunk, palms, soles buccal snail track ulcers condylomata lata

tertiary features of syphilis

gummas - granulomatous lesions of skin and bones Argyll-Robertson pupil tabes dorsalis aortic aneurysms

What eye pupil condition is seen in tertiary syphilis

Argyll-Robertson pupil

blunted upper incisor teeth (Hutchinson's teeth) 'mulberry' molars rhagades (linear scars at the angle of the mouth) keratitis saber shins saddle nose deafness these are seen in which congenital condition

congenital syphilis

what transmission is hepatitis E

faecal-oral spread

what hepatitis infections are spread via faecal oral route

hepatitis A hepatitis E

what are the tests used for diagnosis and screening of HIV

combination tests (HIV p24 antigen and HIV antibody)

Needlestick injury from HIV positive patient - what is the chance of contracting HIV

0.3%

Campylobacter is what type of pathogen

Gram negative bacillus

First-line antibiotic for severe campylobacter

Clarithromycin

for contacts of patients (within 7 days before onset) with bacterial meningococcal meningitis, what medications can be used

oral ciprofloxacin (single dose) or rifampicin

If meningococcal disease is suspected then what medication should be given immediately

IM benzylpenicillin

IV antibiotics to treat meningitis (with delayed LP) for patients aged 3 months to 50 years

Cefotaxime (or ceftriaxone)

IV antibiotics to treat meningitis (with delayed LP) for patients aged over 50 years

Cefotaxime (or ceftriaxone) And amoxicillin (or ampicillin)

sore throat, fever, a fine red rash over the entire body, flushed face with sparing around the mouth, and 'strawberry tongue' what is the diagnosis

scarlet fever (group A strep)

what is scarlet fever treated with

10 day course of penicillin (or erythromycin if allergic)

A 44-year-old farmer presents with headache, fever and muscle aches. He initially thought he had a bad cold but his symptoms have got progressively worse over the past week. During the review of systems he reports nausea and a decreased urine output. On examination his temperature is 38.2ºC, pulse 102 / min and his chest is clear. Subconjunctival haemorrhages are noted but there is no evidence of jaundice. What is the most likely diagnosis?

Leptospirosis

What are investigations for leptospirosis

Serology - antibodies develop after 7 days PCR Culture

Management of leptospirosis

High dose benzylpenicillin Or doxycycline

unilateral painful ulcer, painful inguinal lymph node enlargement ragged, undermined border what is the diagnosis

chancroid caused by haemophilus ducreyi

Pregnant women who have travelled to a Zika virus area are referred immediately to secondary care for what investigations

regular ultrasound of the foetus

Which 2 malaria prophylaxis medications are contraindicated in epilepsy

Chloroquine Mefloquine (Larium)

5 options for malaria prophylaxis

1. Atovaquone + proguanil (Malarone) 2. Chloroquine 3. Doxycycline 4. Mefloquine (Lariam) 5. Proguanil 6. Proguanil + chloroquine

What malaria prophylaxis can pregnant women have

Chloroquine Proguanil - with folate supplementation

diethyltoluamide (DEET) 20-50% has been shown to repel up to 100% of mosquitoes if used correctly. It can be used in children over how old

2 months

doxycycline is only licensed in the UK for children over the age of...

12 years

Genital ulcers painful what two ddx

Herpes Chancroid (unilateral)

Genital ulcers painless what two ddx

syphilis lymphogranuloma venereum

treatment for initial herpes infection

acyclovir for 7-10 days

infectious mononucleosis (glandular fever) is caused by EBV - which HHV virus is this

HHV-4 (can also be caused by CMV and HHV-6)

Triad of infectious mononucleosis (glandular fever)

Sore throat Fever Lymphadenopathy

Diagnosis of infectious mononucleosis (glandular fever) - what tests should be done in the 2nd week of illness

Heterophil antibody test (Monospot test) + FBC

Management of glandular fever (infectious mononucleosis)

Rest Analgesia Avoid contact sports for 4 weeks

which antimalarials can be stopped 7 days after returning from a malarial zone

atovaqone + proguanil (malarone)

A 40-year-old man develops pneumonia following an episode of influenza. what is the likely causative organism

Staph aureus

The most common pathogen causing pyelonephritis is

E. coli

Investigation for acute pyelonephritis

MSU before starting Abx

What swabs for chlamydia and gonorrhoea in women should be taken

vulvo-vaginal (introitus) swab

antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic

Erythromycin NOT clari

Management of salmonella

Ciprofloxacin

UTIs in pregnancy - what should be done following completion of Abx to test for cure

Repeat urine culture

Responders with anti-HBs levels greater than or equal to what level do not require any further primary doses?

100

Responders with antiHBs levels of what range should receive one additional dose of vaccine at that time.

10-100 (over 100 do not need more doses)

When antibody levels for anti-HBs response to Hep B vaccine are <10 (i.e. non-response to vaccine), what should be done

Test for current/past infection Repeat vaccine course Retest 1-2 months after second course

What percentage of patients with genital Chlamydia infection are asymptomatic?

70% women 50% men

annual flu and pneumococcal (one-off) vaccine is recommended for ages above what

65 years

What condition are there Negri bodies (cytoplasmic inclusion bodies) found in infected neurons

Rabies

Following an animal bite in at-risk rabies countries what steps should be taken?

1. Wash wound 2. If patient is already immunised, then further 2 doses of vaccine should be given 3. If not previously immunised, give human rabies Ig (HRIG) with full course of vaccination 4. +/- Abx

Women who suffer regular urinary tract infection following sexual intercourse can be offered

single dose use post-coital Abx prophylaxis

cochlear implant she is at risk of what infections

pneumococcal therefore now eligible for the vaccine

what type of vaccine is the intranasal influenza vaccine

live vaccine

What is the most appropriate type of chemical to clean up body fluid spillage e.g. vomit

hypochlorite (chlorine in oxidation state +1) granular/powder form or Virkon in some NHS trusts

Testing for HIV in asymptomatic patients should be done at what time frame after exposure

4 and 12 weeks after (for antibodies and p24 antigen)

Post-exposure prophylaxis for HIV

Oral antiretroviral therapy for 4 weeks

Mumps is caused by

RNA paramyxovirus occurs inwinter and spring

fever malaise, muscular pain parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70% what is the condition

mumps!

what is the management for mumps

rest analgesia notifiable disease

what are 4 complications of mumps

orchitis hearing loss - unilateral, transient meningoencephalitis pancreatitis

microscopy shows flagellated protozoa discharge what is the condition

trichomonas vaginalis

what is the treatment for pubic lice

malathion lotion or permethrin cream apply and then wash off after 12 hours reapply 7 days again

infective exacerbation of COPD treatment

amoxicillin or tetracycline or clarithromycin

how many injections does the HPV vaccine require

2 injections

pneumococcal vaccine is usually a one-off but every 5 years a booster is given if the patient has...

splenectomy or chronic kidney disease

in the UK, how many doses of the tetanus vaccine are given over the course of routine immunisation schedule

5 doses

which pathogen causing diarrhoea has shortest incubation period

bacillus cereus approx 6-15hrs (also staph aureus)

pregnant women are advised to have what vaccine from weeks 16-32

whooping cough (pertussis) vaccine

all at risk drug misusers should be offered vaccination against

hepatitis B

BCG live attenuated vaccine is what bacteria

Mycobacterium bovis

any person being considered for the BCG vaccine must first be given

tuberculin skin test i.e. Heaf or Mantoux (intradermal)

5 contraindications to BCG vaccine

Previous BCG vaccine Past history of TB HIV Pregnancy Positive tuberculin test

BCG is not given to anyone over the age...

what hepatitis is curable

hep C

painless genital ulcer and painful lymphadenopathy

lymphogranuloma venereum

Lymphogranuloma venereum usually involves three stages:

1. painless ulcer 2. painful lymphadenopathy 3. proctocolitis

preventing the spread of norovirus - handwashing should be done with what

soaps + warm water alcohol gels are less effective

what is the treatment for extensive otitis externa

flucloxacillin

what is the triple Abx treatment for pelvic inflammatory disease

doxycycline metronidazole ceftriaxone

can patients have HPV against parental wishes when they are a child

yes

What is the most likely complication from repeated infection of gonorrhoea in women

infertility secondary to pelvic inflammatory disease

Lymphogranuloma venereum (painless ulcer, painful lymphadenopathy) is caused by what pathogen

chlamydia trachomatis

suppression of MRSA from a carrier once identified - treatment for nose and skin

Nasal mupirocin + chlorhexidine for the skin

Live attenuated vaccines (seven)

BCG MMR Influenza (intranasal) oral rotavirus oral polio yellow fever oral typhoid

Inactivated preparation vaccines (three)

rabies hepatitis A influenza (intramuscular)

Toxoid (inactivated toxins) vaccines (three)

tetanus diphtheria pertussis

Subunit and conjugate vaccines (five)

pneumococcus (conjugate) haemophilus (conjugate) meningococcus (conjugate) hepatitis B HPV

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller what is a differential

dengue

raised eosinophils tend to be seen in which tropical viral infection

Chagas disease

Dengue fever is a RNA virus of Flavivirus. What is it transmitted by

Aedes aegypti mosquito

Severe dengue haemorrhagic fever can result in disseminated intravascular coagulation (DIC) which results in..

Thrombocytopenia Bleeding High d-dimer High PT, APPT Low fibrinogen

Dengue fever treatment

Symptomatic No antivirals are available

treatment for shigella and salmonella

ciprofloxacin

lactose intolerance can develop after which GI infection

Giardiasis

Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago with wound what management

no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago with: (a) tetanus prone wound (b) high risk tetanus prone heavy contaminated wound

(a) vaccine dose (b) vaccine dose + tetanus Ig

Patient with vaccination history is incomplete or unknown for tetanus with wound:

Vaccine dose Tetanus Ig

if person who is not vaccinated against hep B gets a needlestick from hep B patient, how should they be treated

accelerated course of hep B vaccine and hep B immunoglobulin

what vaccines do CKD5 patients require

Pneumococcal - every 5 years Influenza - every year Hep B

For a patient undergoing an elective splenectomy, when is the optimal time to give the pneumococcal vaccine?

2 weeks before

Within what time frame does Public Health England state you must submit a Notifiable Diseases form?

72 hours

A patient who was an intravenous drug user in the 1990s asks for a hepatitis C test. What is the most appropriate blood test?

Anti-HCV antibody test

The majority of malaria cases are caused by

plasmodium falciparum (commonest non-falciparum malaria is plasmodium vivax)

Which test is used to confirm the diagnosis for brucellosis?

brucella serology detects antibodies against brucella antigens

The most common side effect of atovaquone/proguanil is

GI upset

what is the pH in trichomonas vaginalis and bacterial vaginosis

pH >4.5

Children aged 6 months to 2 years who are at high risk of flu are offered ...

annual INTRAMUSCULAR flu vaccination

live intraNASAL influenza vaccine is offered to kids aged from

2 years before that is intramuscular

grey coating on tonsils fever cervical lymphadenopathy what is likely condition

diptheria

how long does a child with erythema infectiosum i.e. fifth disease (slapped cheek syndrome) need to be excluded from school for

no exclusion

what virus causes erythema infectiosum (fifth disease or slapped cheek syndrome)

parvovirus B19

patients becoming pregnant should avoid becoming pregnant while in an area with Zika virus and for how long after their return

2 months (3 months if male partner went too)

what should be checked before starting ethambutol

visual acuity

what is the most common Bacterial cause of otitis externa

Pseudomonas aeruginosa

An 8-year-old boy is brought in by his mother with a history of shortness of breath and fever over the last few hours. On examination, he has a toxic appearance, has inspiratory stridor, and is drooling. what is the likely cause?

ACUTE EPIGLOTTITIS caused by HiB

what is the most common resp infection in COPD

Haemophilus influenzae

Stat IM benzylpenicillin doses for: 0-1 years 1-10 years >10 years

Start at 3 and double each time! 0-1 years: 300mg 1-10 years: 600mg >10 years: 1200mg

patients with ovale or vivax malaria should be given primaquine following acute treatment with chloroquine. what is the benefit of the primaquine?

Primaquine in non-falciparum malaria destroys liver hypnozoites and prevent relapse

Plasmodium vivax/ovale has a cyclical fever of how long

every 48 hours

Plasmodium malariae has a cyclical fever of how long

every 72 hours

Areas that are known to have malaria that is chloroquine-sensitive, WHO recommend either...

chloroquine; or artemisin-based combination therapy (ACT)

Areas that are known to have malaria that is chloroquine-RESISTANT, WHO recommends...

artemisin-based combination therapy (ACT) CONTRAINIDICATED IN PREGNANCY

which type of pneumococcal vaccine should adults receive: polysaccharide or conjugate vaccine

pneumococcal POLYSACCHARIDE vaccine for over 65 years, chronic conditions

which type of pneumococcal vaccine should children receive: polysaccharide or conjugate vaccine

Pneumococcal conjugate vaccine at 3, and 12-13 months

bacterial pneumonias secondary to influenza infection are more commonly caused by...

staph aureus

Triad of Behcet's disease

Oral ulcers Genital ulcers Uveitis + clots

Is tuberculosis a notifiable disease

yes

What is the most effective single step to reduce the incidence of MRSA?

hand hygiene

Who should be screened for MRSA?

- all patients awaiting elective admissions - all emergency admissions

which 3 antibiotics can be used in the treatment of MRSA infections

vancomycin teicoplanin linezolid

standard therapy for active TB (RIPE)

Rifampicin - 6 months Isoniazid - 6 months Pyrazinamide - 2 months Ethambutol - 2 months

Treatment for latent TB

3 months of isoniazid (+ pyridoxine B6) and rifampicin OR 6 months of isoniazid monotherapy (+ pyridoxine B6)

Treatment for meningeal TB

At least 12 months of RIPE With steroids

Certain groups e.g. homeless people, poor adherence and prisoners, have directly observed therapy for tuberculosis. What is their dosing regimen?

3 times a week dosing

side effects of rifampicin

potent liver INDUCER orange secretions hepatitis flu-like symptoms

side effects of isoniazid

peripheral neuropathy - replace with B6 pyroxidine hepatitis agranulocytosis liver enzyme INHIBITOR

which TB drug is a liver enzyme: (a) inducer (b) inhibitor

(a) rifampicin (b) isoniazid

side effects of pyrazinamide

hyperuricaemia (causes gout) arthralgia myalgia hepatitis

which TB drugs can cause hepatitis

rifampicin isoniazid pyrazinamide

side effect of ethambutol

optic neuritis check visual acuity before and after treatment

For persistent BV in women with an intrauterine contraceptive device, what should be considered

removal of device alternative contraception

Orf is caused by the parapox virus which causes scabby red-blue lesions. what animals is it usually found in

sheep/goats FARMERS in questions

anthrax is caused by bacillus anthracis. it presents as a painless black eschar. what animals is it associated with

hides or wool livestock animal

In acute uncomplicated sinusitis, first-line therapy as per NICE guidelines would be

phenoxymethylpenicillin if pen allergic: doxycycline or clarithromycin 2nd line = co-amoxiclav

acute prostatitis (tender boggy prostate) with urinary symptoms what antibiotic is appropriate

ciprofloxacin

Patients who are immunosuppressed secondary to long-term steroids or methotrexate and are exposed to chickenpox by someone else should have what

Test for varicella antibodies VZ immunoglobulin

How is the BCG vaccine given?

intradermally

What findings in the full blood count would suggest glandular fever?

lymphocytosis

what pathogen causes the common cold

rhinovirus

After an initial negative result when testing for HIV in an asymptomatic patient i.e. at 4 weeks, when should a repeat test be done?

at 12 weeks

what % of hep C infections turn into chronic hep C

55-85% the majority

wasp/bee allergy treatment for prophylaxis in patients with venom-specific IgE

venom immunotherapy

Ziehl-Neelsen stain of stool in patient with HIV and diarrhoea shows red cysts. what is diagnosis

Cryptosporidium

what is caused by haemophilus ducreyi

chancroid

People who've had a systemic reaction to an insect bite - follow up management

referral to allergy specialist