Infectious diseases Flashcards
Cyst in woman from the middle east
Hydatid cyst
What causes gastroenteritis post a long incubation period and travelling abroad
Amoebiasis
Giardia
When is neuroimaging indicated in meningitis
Any signs of increased ICP
- postural headache
- focal neurology
- seizure
- very drowsy
criteria for taking a urine culture in women
Pregnant
Over 65
Non-visible or visible haematuria
What organism causes steatorrhoea, flatulence and foul smelling stools in a recent traveller
Giardiasis
Management of asymptomatic tick bite
Remove with tweezers
No need for abx
What is another infection to syphylis that get jarisch herxheimer reaction in
Lyme disease
What give for cellulitis on the face
Co-amox
Presentation of chancroid
Painful genital ulcers which were initially papules or pustules- have sharply defined ragged border
Unilateral painful inguinal lymphadenopathy
Travel to africa
Management of UTI post partum
Trimethoprin
Gastroenteritis with a prodrome of feeling unwell
Campylobacter jejuni
Management of toxoplasmosis
Only treat if immunocompromised or severe infection in immunocompetent
- pyrimethamine and sulphadiazine (sulphonamide abx)
How long treat UTI in non pregnant women
3 days
Most common cause of viral meningitis
Enteroviruses- cocksackie
What is needed for pregnant women with a UTI after treatment
Test of cure MSU
Most common infection for central line infections
Staph epidermis
When are steroids not indicated in meningitis
Meningococcal
Shock
Post surgical
Immunocompromised
What do if Hep B antibodies are not at the desired levels
Give another dose of the vaccine
Investigation for spinal epidural abscess
MRI of whole spine as can get skip lesions
Presentation of spinal epidural abscess
Fever, back pain and neurological defect
What is a spinal epidural abscess
A spinal epidural abscess (SEA) is a collection of pus that is superficial to the dura mater (of the meninges) that cover the spinal cord. It is an emergency requiring urgent investigation and treatment to avoid progressive spinal cord damage.
Causes of spinal epidural abscess
IVDU
Immunocompromised
Post spinal surgery
Discitis
Presentation of staphylococcal toxic shock syndrome
High fever
Shock
Erythematous rash
Desquamating rash on the hands and feet
Evidence of any organ failure
What is used to screen for and diagnose HIV
Both HIV p24 antigen and HIV antibodies
When test for HIV after exposure
4 weeks
What do if combined test for HIV positive
Repeat to confirm
What do if combined test for HIV negative at 4 weeks post exposure
Offer a repeat at 12 weeks post exposure
What tests are done to screen HIV antibodies then what to confirm
ELISA then Western blot to confirm
How test for legionella
Urinary antigen
How test for mycoplasma pneumonia
Serology
Most common cause of diarrhoea in a HIV patient
Cryptosporidium
Presentation of clostridium botulinum infection
Flaccid paralsysis
Diplopia
Ataxia
Bulbar palsy
Management of c. botulinum
Antitoxin if given early
How does uncomplicated toxoplasmosis present
Resembles EBV
- fever
- malaise
- diffuse lymphadenopathy
Most common cause of neutropenic sepsis
Staph epidermis
What can offer to women with recurrent UTIs from sex
Post coital abx prophylaxis
Indications for treating campylobacter with clarithomycin
Very high fever
Bloody diarrhoea
8 or more stools a day
Immunocompromised
Symptoms over a week
What is first line antibiotic for campylobacter
Clarithomycin
How is yellow fever spread
Aedes mosquito
Presentation of yellow fever
Biphasic presentation
Initially flu like illness
- fever
- rigors
- N&V
- bradycardia
Get brief remission followed by haematemesis, bleeding, jaundice and oliguria due to liver involvement
Which zoonotic infection can present with bradycardia and a biphasic presentation
Yellow fever
What is most likely pathogen if present with fever, myalgia, cough and headache
Influenza- far more common than atypical pneumonias
Presentation of LGV
MSM with HIV
stage 1: small painless pustule which later forms a painless ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
Differentials for genital ulcers
HSV
Syphyllis
Chancroid
LGV
Management of LGV
Doxy
Management of syphilis
IM benxathine penicilline
Can use doxy
How monitor syphilis treatment
Using non-treponemal tests
- RPR
- VDRL
What counts as an adequate response to treatment to syphilis
A four fold decrease in titres
(e.g. 1:16 → 1:4 or 1:32 → 1:8)
Management of asymptomatic bacteriuria
No treatment
Monitor for if develop symptoms
NOst common cause of pneumonia in COPD
Haemophilus influenzae
Presentation of leptospirosis
Fever
Flu like
Conjunctival redness
Calf pain
Meningitis headache
Renal and liver failure
What infection causes calcification of the bladder
Schistosomiasis
Management of schistosomiasis
Praziquantel
Presentation of leprosy
Hypopigemented skin lesions
Sensory loss in those areas
What is adequate number of tetanus vaccines needed
5
What do if someone has cut but has had 5 doses of tetanus
Supportive management
How is herpes diagnosed
NAAT
What is investigation to determine TB drug sensitivities
Sputum culture
What antibiotics give if pneumonia secondary to the flu
Add flucloxacillin
What is best investigation for UTI in over 65
Urine culture
What is most common non-falciparum malaria
Plasmodium vivax
What is difference in cyclical fever time between the non-falciparum
Vivax and ovale- 48 hrs
Malariae- 72 hours
What is a hypnozoite
Parasite laying dormant in the liver
Which malaria species have hypnozoite phase
Vivax
Ovale
Which malaria species need to treat after initial treatment
Vivax and ovale as they have hypnozoite phase
Given primaquine
What use to treat vivax and ovale after initial treatment
Primaquine
Management of non-falciparum species
Artemisin basec combination therapy or chloroquine
ACT if chloroquine resistant species
If vivax or ovale then give primaquine after initial treatment to treat hypnozoite
How is lyme disease diagnosed
If erythema migrans present then can diagnose clinically
If unsure then ELISA for borrelia burgdorferi antibodies
Presentation of lyme disease
Initially
- erythema migrans rash
- headache
- fever
- arthralgia
- tired
Can get cardiac involvement- heart block, myocarditis
Neuro signs too
Management of lyme disease
1st line doxycycline
If CI like pregnancy then amoxicillin
If disseminated- ceftriaxone
How long treat UTIs for in pregnancy
7 days
Test of cure with culture
What effect does sepsis have on neutrophils
Can become neutropenic
What can cause false positive syphilis result on non-treponemal tests
SLE
Pregnancy
HIV
TB
How do non-treponemal tests work
Based off reactivity to cardiolipin cholesterol antigen
Is how get false results in SLE due to cardiolipin antibodies
What does a negative non-treponemal test + positive treponemal test suggest
Treated syphilis
What does a positive non-treponemal test + negative treponemal test suggest
False positive result due to SLE etc
Management of jarisch herxheimer reaction
Oral paracetamol
Primary syphilis presentation
Tender inguinal lymphadenopathy
Painless genital ulcer
What do if MRSA screen pre surgery etc is positive
Nasal mupirocin
Chlorhexidine all over skin
How is MRSA screened for
Nasal swab
Renal transplant patient develops bilateral infiltrates in lungs
CMV infiltrates
How does CMV present in immunocompetent
Infective mononucelosis like illness
Who is CMV retinitis seen in
HIV CD4<50
Presentation of CMV retinitis
Blurred vision
On fundoscopy see retinal haemorrhages and necrosis- pizza retina
Management of CMV retinitis
IV ganciclovir
Presentation of bacillus cereus gastroenteritis
Incubation period of 24 hours
Post eating rice that is undercooked or reheated
How best to prevent spread of norovirus
Hand hygiene with soap and hot water
How is leptospirosis diagnosed
Serology
When are vaccines given in relation to an elective splenectomy
2 weeks before
Presenteation of disseminated gonorrhoea
Migratory polyarthritis
Dermatitis- dry, itchy skin
Tenosynovitis- pain on moving fingers from bent
What do if someone on steroids or methotrexate comes into contact with someone who has varicella
Check if has had it in past
- if unsure check antibodies
If this negative then give VZIG
What is lemierres syndrome
Infectious thrombophlebitis of the internal jugular vein. The cause is a tonsil infection which spreads to internal jugular causing an infectious thrombus
Presentation of lemierres syndrome
preceding throat infection
Thrombophlebitis in neck- lump, tenderness and pain
Can get septic pulmonary emboli
What happens when drink alcohol on metronidazole
Causes a disulfiram like reaction
- get flushing, nausea, sweatiness and palpitations
Management of asymptomatic BV
No treatment required
What do if s.aureus is shown to resistant to fluclox
Means MRSA so vancomycin
Management of BV in pregnancy
Oral metronidazole
What is post exposure regime for HIV
Antiretrovirals for 4 weeks
Testing at 12 weeks
Hepatitis A presentation
Flu symptoms
Gastroenteritis symptoms
Fever
Hepatitis
Should you do LP or antibiotics first in meningitis
You should only give antibiotics before a LP if
- can’t be done within an hour
- severe sepsis or evolving rash
- raised ICP
Blood findings of EBV
Hepatitis- raised ALT
Lymphocytosis
Can get haemolytic anaemia
Which infections can cause cold agglutins
Mycoplasma
EBV
Management of EBV
Supportive- lots of fluids
Avoid contact sport for 4 weeks
Best way of measuring response to HCV treatment
HCV RNA levels
Campylobacter jejuni presentation
Attended BBQ
Prodrome of flu
Abdo pain
Bloody diarrhoea
Presenation of tetanus
IVDU
Prodrome of fever, flu etc
Lockjaw
Trismus
Facial spasms
Dysphagia
What is main risk factor for tetanus in UK
IVDU
Differences in management of UTI men vs women
Men
- 7 day abx
- always send culture
Women
- 3 day abx unless pregnant
- culture if microscopic haematuria, pregnant or over 65
What needs to be checked before starting terbinafine
LFTs
Secondary syphilis presentation
Occurs 6-10 weeks post primary
Unwell- fever and lymphadeopathy
Genital warts
Snail track ulcer
Maculopapular rash on soles and hands
Management of genital warts
Multiple non keratinised warts- topical podophyllum
Solitary keratinised- cryotherapy
Second line for genital warts
Imiquimod
Presentation of typhoid
Systemic upset initially
- fever
- headache
- dry cough
- joint pain
Then get rash- rose spots
Constipation
Splenomegaly
Bradycardia
Presentation of c perfringens
Tender skin with blebs and bullae
These have foul smelling discharge
If refuse IM ceftriaxone for gonorrhoea what give instead
Oral cefixime and oral azithromycin
Presentation of HIV seroconversion
Flu like
- maculopapular rash
- arthralgia
- mouth ulcers
- diarrhoea
Man being infused with vancomycin develops erythema over face and trunk, what is diagnosis
Red man syndrome- a common complication of infusing vancomycin too quickly
What is red man syndrome
Where infuse vancomycin too quickly
Management of PCP
Oral co-trimoxazole
What do if wound and tetanus status unknown
Booster vaccine and tetanus IG
How does dengue present
Fever
Nausea
Joint pain
Retro-orbital headache
Facial flushing
Can progress to haemorrhagic
Blood findings of dengue
Thrombocytopenia
What tropical disease classically presents with thrombocytopenia
Dengue
Malaria
What are the different ERON criteria
1-no systemic upset and co-morbities
2- systemically unwell or systemically well with a comorbidity like venous insufficiency or PAD
3- systemic upset with hypotension, confusion etc
4- sepsis or nec fasc
How manage cellulitis based off ERON criteria
1= oral abx
2= oral abx or consider admission
3 and 4- admit
IV abx for severe cellulitis
Ceftriaxone
Co-amoxiclav
Clindamycin
Second line antibiotic for MRSA
Linezolid
Baseline investigations for starting TB meds
FBC
LFTs
U&Es
Vision testing
Management of tetanus
Supportive with muscle relaxants
Tetanus immunoglobulin
Interpreting CSF glucose in case of bacterial meningitis
It will be roughly half the serum level
First line for acute pyelonephritis
Cefalexin or ciprofloxacin
Complications of mycoplasma
AIHA
Erythema multiforme
Myocarditis
Bullous myringitis
GBS
What is bullous myringitis
Painful vesicles on the tympanic membrane caused by mycoplasma
Neurological symptoms following flu/pneumonia symptoms
Mycoplasma as can cause GBS
When diagnosing chlamydia and gonorrhoea, where is swab taken from for women
Vulvovaginal
What are hard to scrape off, non painful white patches on tongue of sex worker
Oral hairy leukoplakia as EBV driven but associated with HIV
What causes oral hairy leukoplakia
EBV- associated with HIV
What is post exposure prophylaxis regime for Hep B
Depends on if a responder to the vaccine
- if responds then just booster vaccine
- if a non-responder then booster vaccine and HBIG
What causes of sore throat presents with palatal petechiae
EBV
What can get hepatitis A from
Undercooked meat
Unclean water
Who refer to if needlestick with known HIV
ED or occ health
Pregnant woman comes in with hepatitis, what is cause
Hepatitis E
How is Hep E spread
Faeco oral
- Undercooked pork
- Shellfish
When add amoxicillin on to meningitis treatment
Over 50
What is a calcified nodule on lateral side of lung
Calcified ghon focus indicating latent TB
Management of falciparum malaria
Uncomplicated= artemisinin based combination therapy such as oral artemether plus lumefantrine
Severe= IV artesunate
Management of rabies exposure from dog bites
If in UK no risk
If in developing country depends if vaccinated
If vaccinated then give 2 further doses of vaccine
If not then give full vaccine course and human rabies IG
If present with LGV, what test is needed
HIV
What presents with flushing all over body, headache and sweating
Disulfiram like reaction
What is test for chlamydia in a male
NAAT on first catch urine sample
What is diagnostic test for lyme disease
Immunoblot test
if ELISA positive then do it
Antibiotic of choice for neutropenic sepsis
Tazocin
Sites for possible primary syphilis ulcer lesion
Mouth
Anus
MOUTH
Cholera presentation
Rice water diarrhoea
Hypoglycaemia
Dehydration
Organism for tetanus
Clostridium tetani
Organism for botulinism
Clostridium botulini
Differentiating tetanus from botulinism
Both caused by clostridium bacteria and very common in IVDU
In tetanus you get a spastic paralysis with spasms but in botulinism it is a flaccid paralysis
Management of uncomplicated toxoplasmosis
No treatment
What is done for prophylaxis against PCP in HIV patients
If CD4 below 200 then give co-trimoxazole
Post splenectomy, what infection are people still susceptible to despite pen V
Haemophilus due to production of BLs
What pneumonia cause presents with oral ulcers
Strep pneumoniae
What is prophylaxis regime for close contacts of meningitis patients
1 off dose of oral ciprofloxacin
HIV patient with widespread demyelination in the brain
Progressive multifocal leukoencephalopathy
What infection causes facial nerve palsy
Lyme disease
What causes bloody diarrhoea with long incubation period after retunring from africa
Amoeba- giardiasis would not cause bloody diarrhoea
What is seen in tertiary syphilis
Gummas
Aortic aneurysms
Tabes dorsalis
Argyll-robertson pupil
What stain use for cryptosporidium
Ziehl neelsen
What drug can cause a black hairy tongue
Tetracyclines
What can arise in cavities left from previous TB
Aspergilloma
What is used to diagnose typhoid
Blood cultures
Alternative to oral metronidazole in BV
Topical clindamycin
What effect does EBV have on WCC
Lymphocytosis but also a neutropenia
What vaccines should IVDU be offered
Hep A and B
Tetanus
Management of pubic lice
Malathion
Management of amoebiasis
Metronidazole
Best antibiotic for salmonella
Ciprofloxacin
What causes IE within 2 months post prosthetic valve replacement
Staph epidermis
RFx for staph epidermis IE
Recent prosthetic valve
Indwelling central line
Management of cryptosporidium
Supportive
After a solid organ transplant, what is most likely cause of widespread infection
CMV
How does genital HSV present
Multiple painful ulcers
Tender lymphadenopathy
Is latent TB contagious
No so no need to contact trace
What eye defect most likely in raised in ICP
Sixth nerve palsy
Then- third nerve palsy
What is presentation of multiple system atrophy
Parkinsonism
Autonomic dysfunction early
- erectile dysfunction
- atonic bladder
- postural hypotension
Cerebellar signs
Presentation of oral hairy leukoplakia
White patches on side of tongue which look like hairs
Difference in presentation discitis vs SEA vs iliopsoas abscess
Discitis- back pain, sepsis signs
spinal epidural abscess- back pain, fever and neurological signs
Iliopsoas abscess- fever, pain, limp, especially pain on hyperextension of hip
Staph aureus gastroenteritis 2 main features
Short incubation
Lots of vomiting
Management of periobital cellulitis
Urgent opthal referral
How investigate EBV
WCC and monospot test in second week
If negative then repeat in week if still suspicious
What is herpes labialis
Oral herpes
Management of herpes labialis
Simple and immunocompetent- topical aciclovir
Oral aciclovir if large and painful, recurrent or immunosuppressed
Management of genital herpes
Refer to GUM
If not willing then oral aciclovir
Resp complications of HIV
PCP
Mycobacterium avium complex
TB
Aspergilloma
Neuro complications of HIV
HIV dementia
Enceph from HIV or CMV
Toxoplasmosis
CNS lymphoma
Cryptococcus meningitis
JC PML
Oral complications of HIV
Oral candidiasis
Hairy leukoplakia
What are 2 conditions seen when CD4 under 50
CMV retinitis
MAC
Pre exposure prophylaxis regime
Tenofovir and emtricitabine= 2 NRTIs
Post exposure prophylaxis regime
Tenofovir and emtricitabine= 2 NRTIs
and raltegravir =Integrase inhibitor
Take within 72 hours
For 28 days
HIV starting ART
2 NRTIs (emtricitabine, lamivudine, tenofovir)
Plus 1 of
- integrase inhibitors (dolutegravir etc)
- protease inhibitor (ritonavir)
Initial malaria presentation
Cyclical fever
Myalgia
Headache
Anorexia, nausea
Hepato-splenomegaly
Severe malaria complications
Hypoglycaemia
DIC
ARDS
Cerebral oedema
Severe anaemia
RFx for botulism
Eating canned food
IVDU
Management of leptospirosis
Benzylpenicillin
Doxy if allergic
Investigation for hep A
Gold standard is Hep A RNA PCR
Second line- HAV-IgM
Management of Hep A
Notify
Supportive
- anti emetic (metoclopramide)
- chlorphenamine for itch
- analgesia
Diagnosing current Hep B infection
HbsAg
Appropriate serology
Management of people who test positive for acute Hep B
Refer to gastro
Acute management generally supportive
however if severe signs of liver failure then start entecavir or tenofovir
Chronic hep B management
Entecavir or tenofovir or peginterferon (provided no cirrhosis)
What would encourage you to treat acute Hep B
Raised INR
High bilirubin
Systemically very unwell
Ascites
Investigation for Hep C
HCV RNA
Hep B presentation
Asymptomatic most of time
Unwell
Anorexia
Pain
Jaundice
Hep C presentation
Normally asymptomatic
Arthralgia
Jaundice
Tired
Chronic hep c maangement
Concoction of
- sofosbuvir
- simeprevir
- daclatasvir
Chancroid organism and treatment
Haemophilus ducreyi
Azithromycin or ceftriaxone
Which TB drugs cause hepatitis
All except ethambutol
Eye side effect of tb medications
Ethambutol affects colour vision
