Infectious Diseases

Question 1

What features of a patient’s history will make you think meningitis?

Answer 1

Fever
Neck Stiffness
Headache
Photophobia
Non-blanching rash

Question 2

What’s the difference between meningitis and encephalitis? How might they both present?

Answer 2

Encephalitis - inflammation of the brain
Meningitis - inflammation of the meninges

Both will have a fever

Encephalitis will show neuro signs (reduced consciousness, altered behaviour, focal seizures, altered cognition)

Question 3

What is the immediate management of meningitis?

Answer 3

Single dose (IM/IV) of benzylpenicllin prior to hospital transfer if in primary care.

Ceftriaxone IV + Dexamethasone (reduces hearing loss/neuro complications)

Question 4

How does management of meningitis differ for paediatrics?

Answer 4

<1 month old:
Cefotaxime
Amoxicillin
Gentamicin

> <3 months old:
Ceftriaxione
Amoxicillin

> 3 months old:
Ceftriaxone
(+ amoxicillin if suspect listeria)

Question 5

What investigations are needed to confirm meningitis?

Answer 5

Lumbar Puncture
Send bloods for meningococcal PCR

Question 6

What tests on examination can support your diagnosis of meningitis and how do you perform them?

Answer 6

Kernig’s:
1. While laying on back flex hip and knee to 90 degrees.
2. Resistance to attempts to try and straighten the knee.

Brudzinki’s:
1. Flex the patients chin towards the chest while they are laying flat
2. +VE test will show the hips+knees involuntarily flex.

Question 7

What diseases are ‘notifiable’ and what does this mean?

Answer 7

Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Monkeypox
Mumps
Plague
Rabies
Rubella
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever

Question 8

What are the different types of meningitis?

Answer 8

Bacterial Meningitis:
Neisseria meningitis (meningococcus)
Streptococcus pneumonia (pneumococcus)
Neonates (Group B strep)

Viral Meningitis:
Herpes simplex virus, Enterovirus, Varicella zoster virus (VZV)

Question 9

What’s the difference with CSF sample between bacteria and virus?

Answer 9

Bacterial:
Cloudy
High Protein
High WCC (neutrophils)
Low glucose

Virus:
Clear
Normal Protein (mildly raised)
High WCC (lymphocytes)
Normal glucose

Question 10

What are the complications of meningitis?

Answer 10

HEARING LOSS
Seizures/epilepsy
Cognitive impairment + learning disability
Memory Loss
Cerebal Palsy

Question 11

What questions are important to ask when somebody has a fever after returning from abroad?

Answer 11

Any pre-travel vaccines?
Where did you travel?
How long did you go and when did your symptoms come on (incubation period)?
What food did you eat?
Any insect bites?
Any water activities?
Anybody else unwell?
Any sexual intercourse abroad?
Any reason to be immunosuppressed?

Question 12

What infectious diseases are associated with patients travelling to Sub-Saharan Africa?

Answer 12

MALARIA
Dengue Fever
Enteric Fever
Schistosomiasis
TB
STIs/HIV

Question 13

What investigations would you request for somebody with a travel-related illness?

Answer 13

FBC
LFTs
U+Es
Malaria smears x3
Urinalysis/Urine culture
Stool culture (ova/parasites)
CXR
HIV,HEP B+C, Syphillis

Question 14

How is malaria diagnosed and how is it treated?

Answer 14

Malaria Blood Film (x3 -ve samples over 3 days needed to exclude)

Uncomplicated Malaria:
1. Artemether with lumefantrine (Riamet)
2. Quinine + Doxycline/Clindamycin

Severe Malaria:
1. Artesunate IV
2. Quinine IV

Question 15

A man presents with 2 month history of productive cough, weight loss, haemoptysis with a 10 year pack history. What else would you want to know and what are you main differential diagnosis?

Answer 15

Any relevant travel history?
Ever been tested for TB or had BCG vaccine?
Any family history of cancer?
Any fever?
Any night sweats or fever?

Lung Cancer
TB

Question 16

What investigations are needed to confirm TB?

Answer 16

Sputum Sample + Culture (Ziehl-Neelson Stain)

CXR
(Patchy consolidation, Pleural effusion and hilar lymphadenopathy)
(Reactivated TB - Consolidation with cavitation in upper zone)
(Milary TB - millet seeds across lung fields)

NAAT

Lymph Node Biopsy will show ceasating granuloma

Question 17

What is the treatment for TB and what is a side effect associated with each drug?

Answer 17

Rifampacin (Orange urine)
Isoniazid (Drug induced hepatitis)
Pyrazinamide (Drug induced hepatitis)
Ethambutol (optic neuropathy)

RIPE

Question 18

What are other forms of TB apart from pulmonary TB?

Answer 18

Meningeal TB (lumbar puncture needed)
Lymph node TB (biopsy needed)
Pericardial TB
Gastrointestinal TB
Urinary TB

Question 19

What are the principals of TB contact tracing?

Answer 19

Once a patient is diagnosed they are referred to the TB nurses.
These then carry out contact tracing and will test household contacts with a CXR or QuantiFERON testing
Any latent TB will be treated

Question 20

If a patient wit TB develops neck stiffness/headache what might you be concerned of? How would you investigate this?

Answer 20

TB Meningitis

Lumbar Puncture (high protein + lymphocytes, low glucose)

MRI (leptomeningeal enhancement)

Question 21

How is a diagnosis of latent TB made and how is it treated?

Answer 21

QuantiFERON test (interferon gamma assay):
Blood test

Tuberculin Skin testing:
TB injected intradermally to see if reaction

Treatment:
3/12 of Rifampacin + Isonazaid
6/12 of Rifampacin

Patients over 35 yrs are at risk of hepatotoxicity so don’t treat unless at risk (HIV/Healthcare worker)