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Infectious Diseases Flashcards

1
Q

Mechanisms of resistance

A

Antibiotic inactivation
- Beta lactamases
- Pneumococcus and macrolides
- Enzymatic modification of aminoglycosides

Alteration of antibiotic target
- Pneumococcus and penicillin
- Staph aureus and methicillin like antibiotics

Decreased uptake
- Reduced penetration
- Antibiotic effluc

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2
Q

MRSA mechanism of resistance

A

Penicillin-binding protein mutation coded by the mecA gene on a transposon

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3
Q

MRSA treatment

A

Vancomycin
Teicoplanin
Rifampicin
Fusidic acid
Ciprofloxacin
Clindamycin

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4
Q

VISA mechanism of resistance

A

Genes code for factors such as additional peptidoglycan synthesis and reduced need for peptidoglycan cross-linking

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5
Q

VISA management

A

Teicoplanin
Linezolid
Quinupristin-dalforpristin
Cotrimoxazole

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6
Q

VRE pathogens

A

E faecium
E faecalis

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7
Q

VRE mechanism of resistance

A
  • penicillin-binding protein mutations
  • beta-lactamase production
  • aminoglycoside-modifying enzymes
  • antibiotic drug efflux pumps
  • alterations in cell wall components coded by transposons (Van A to F phenotypes)
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8
Q

Treatment of VRE

A

Teicoplanin
Linezolid
Daptomycin
Tigecycline

Van A: resistant to vancomycin and teicoplanin

Van B: resistant to vancomycin, teicoplanin may be effective but resistance likely to emerge with prolonged use (use linezolid, tigecycline, dalfopristin-quinapristin, daptomycin)

Van C: partly resistant to vancomycin

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9
Q

ESCAPPM organisms

A

Enterobacter species
Serratia species
Citrobacter freundi
Aeromonas
Proteus vulgaris (non-mirabilus) + Pseudomonas
Providencia
Morganella morganii

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10
Q

ESCAPPM resistance and mechanism

A

Resistance to cephalosporins (especially third generation) due to overexpression of induceable chromosomal AmpC/β-lactamase enzymes.

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11
Q

Treatment of ESCAPPM

A

Carbapenems
Fourth generation cephalosporins
Ciprofloxacin
Aminoglycosides

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12
Q

Mechanism of penicillin resistance in staph aureus

A
  1. Production of beta-lactamase, conferred by the gene blaZ - inactivates penicillin by hydrolyzing the beta-lactam ring
  2. Altered penicillin-binding protein, PBP2a, encoded by mecA
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13
Q

Classes of beta lactamase enzymes

A

A - penicillinases (TEM, SHV, CTX-M)
B - metalloenzymes (NDM, VIM, IMP)
C - cephalosporinases (AmpC)
D - oxacillinases (OSA)

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14
Q

ESBL mechanism of resistance

A

Arise by
- mutations in old beta lactamase genes (i.e. TEM, SHV)
- Plasmid mediated transfer

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15
Q

ESBL organisms

A

Klebsiella
E coli
Salmonella
Proteus
Enterobacter
Citrobacter
Serratia
Pseudomonas

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16
Q

Treatment of ESBL

A

Carbapenems
Colistin
Amikacin
Ciprofloxcin

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17
Q

Metallo betalactamases organisms

A

Pseudomonas
Acinetobacter

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18
Q

Metallo betalactamases mechanism of resistnace

A

New Delhi metallo-Clactamase 1 (NDM-1) - an enzyme that produces resistance to a broad-range of beta-lactam antibiotics
produces a carbapenemase

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19
Q

Treatment of metallo-beta-lactamases

A

Tigecycline
Colistin

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20
Q

Linezolid mechanism

A

Activity against gram positive (+ mycobacteria, nocardia spp.)
Inhibits protein synthesis

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21
Q

Side effects of linezolid

A

GI upset
Cytopenias
Neuropathy
MAO inhibition (avoid SSRIs, tramadol, pethidine)

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22
Q

Daptomycin mechanism

A

Cyclic lipopeptide
Binds to cell membrane and leads to inhibition of synthesis of DNA, RNA and protein

Bactericidal activity against most gram positive

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23
Q

Tigecycline mechanism

A

Protein synthesis inhibitor
Bacteriostatic

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24
Q

Tigecycline targets

A

MRSA, MSSA, VISA, VRE - low MICs required
Active against gram negatives (except pseudomonas)

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25
Q

Ceftaroline/ceftobirole mechanism and targets

A

Novel cephalosporins
Active against MRSA
Not good for VRE

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26
Q

Colistin mechanism

A

Binds lipopolysaccharides and phospholipids in outer cell membrane
Leads to disruption of outer cell membrane, leakage and cell death

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27
Q

Colistin targets

A

Pseudomonas
Acinetobacter
E Coli
Enterobacter spp
Klebsiella
Salmonella
Stenotrophomonas

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28
Q

Fosfomycin mechanism

A

Inhibits MurA enzyme and bacterial cell wall biogenesis
Bactericidal

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29
Q

Fosfomycin targets

A

Targets gram -ve and +ve resistant cystitis UTIs
Not pseudomonas or morganella

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30
Q

Cefiderocol mechanism

A

Siderophore cephalosporin that binds to iron
Actively transported into bacterial cells

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31
Q

Cefiderol targets

A

Multi-resistant gram negatives
ESBL
Pseudomonas
Acinetobacter
Stenotrophomonas
Burkholderia

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32
Q

Prophylaxis for C-section, H&N, thoracic, neck, ortho

A

1st line - cefazolin 2g
2nd - vancomycin 25mg/kg

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33
Q

Prophylaxis for colorectal surgery, biliary, hysterectomy, major ENT, infrarenal vascular surgery

A

1st line - cefazolin + metronidazole
2nd line - vanc + gent

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34
Q

Prophylaxis for amputation

A

1st line - benzylpenicillin
2nd - metronidazole

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35
Q

Prophylaxis for ERCP

A

1st line - gentamycin
2nd line - cefazolin

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36
Q

Indications for dental prophylaxis

A

Mechanical valve
Prior IE
Congenital heart disease
Rheumatic heart disease
Heart transplant

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37
Q

Standard therapy for TB

A

2 weeks of isoniazid, rifampicin, ethambutol, pyridazinamide
4 weeks of isoniazid and rifampicin

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38
Q

Greatest risk of reactivating TB

A

HIV

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39
Q

Growing resistance to which antimicrobial in TB

A

Isoniazid > Rifampicin

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40
Q

Features of paradoxical reactions in TB

A

Clinical or radiological deterioration of pre-existing lesions or appearance of new lesions whilst on therapy

Presents with fever, nodes, respiratory failure, neuro deterioration, sinus formation

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41
Q

Treatment of paradoxical reactions in TB

A

Corticosteroids
Aspiration of pus
Excision
Continue anti-TB therapy

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42
Q

Mechanism of action of quantiferon gold assay

A

Exposes whole blood to TB antigens
Sensitised lymphocytes release measurable cytokines in response

Unable to differentiate latent vs active TB

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43
Q

Features of nodular bronchiectasis

A

Presents in elderly women with chronic suppressed cough
Affects RML and lingular segment

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44
Q

Features of fibronodular bronchiectasis

A

Middle-aged, male smokers/drinks
Presents with productive cough positive with MAC

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45
Q

Antibiotic guidelines of CAP

A

Mild CAP - doxycycline or amoxicillin (or clarithromycin)

Moderate CAP - Benzylpenicillin + doxycycline

Severe CAP - ceftriaxone + azithromycin

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46
Q

Indications to treat aspiration pneumonia with metronidazole

A

Terrible gums, foul smelling sputum
Severe EtOH abuse
Lung abscess with fluid level
Empyema or complete white out

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47
Q

Mechanisms of oseltamivir

A

Neuraminidase inhibitor
Reduces duration of flu symptoms by 1-2 days

More effective for Flu A than Flu B

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48
Q

Causes of avian influenza

A

Bird exposure

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49
Q

Features of pertussis

A

Incubation period: 1-4 weeks

Catarrhal phase (1-2 weeks) - non specific URTI features

Paroxysmal phase (2-6 weeks) - intense paroxysmal coughing

Convalescent phase - progressive reduction in symptoms

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50
Q

K1 Klebsiella pneumoniae features

A

Novel strain associated with community acquired liver abscesses, bacteraemia and endophthalmitis

More common in diabetes

Susceptible to ceftriaxone (unless ESBL)

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51
Q

Indications for surgery in endocarditis

A

Absolute
- Severe AR or MR
- Cardiac failure (related to valve dysfunction)
- Fungal or highly resistant organisms
- Perivalvular abscess or fistula
- Prosthetic valve endocarditis

Relative
- Multiple or severe embolism
- Uncontrolled infection (e.g. MSSA, pseudomonas, Q fever)
- Size of vegetation

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52
Q

Necrotising fasciitis bacteria and treatment

A

Usually group A strep, may be polymicrobial in diabetes

Treatment with penicillin, clindamycin, pip/taz +/- gent +/- IVIG
Surgery

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53
Q

Mycobacterium ulcerans features

A

From Bairnsdale, Phillip Island, Point Lonsdale, Daintree

Treatment with rifampicin + clarithromycin (or moxifloxacin)

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54
Q

Neisseria gonorrhoeae triad

A

Tenosynovitis, dermatitis and polyarthralgias without purulent arthritis

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55
Q

Features of Bartonella

A

Cat scratch disease - B. henselae and B. quintana

Cutaneous lesion at bite site after 3-10 days

Resolves in 1-4 months, sometimes longer

May have ocular features, encephalopathy, radiculitis, myelitis, cerebellar ataxia, granulomatous hepatitis or splenitis, or bone lesions

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56
Q

Types of tick-borne rickettsial infections

A

R. australias - Australian tick typhus
R. honei - Flinders Island spotted fever
R. rickettsi - Rocky Mountain SF
R. africae - African tick bite fever

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57
Q

Treatment for Rickettsia

A

Doxycycline

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58
Q

Anthrax features

A

Bacillus anthracis - gram positive spore forming bacterium

Clinical syndromes
- Inhalation
- Cutaneous
- GI

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59
Q

Features of Inhalational anthrax

A

Flu-like symptoms for two days
Sudden deterioration - severe SOB and hypoxia
Haemorrhagic mediastinum
Can cause pleural effusion, meningitis, low BP

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60
Q

Plague features

A

Yersinia pestis (enterobacteriae)

Reservoir - rats, gerbils, prairie dogs, other rodents
Transmission via infected fleas

Types
- Bubonic
- Pneumonia (primary or secondary)
- Septicaemic
- Meningitis, pharyngitis

Treatment with streptomycin, doxycycline, ciprofloxacin

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61
Q

Features of tularaemia

A

Francisella tularensis

Incubation 2-10 days

Sudden onset fever, chills
Headache
Malaise

Treatment with streptomycin, tetracycline or chloramphenicol

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62
Q

Features of botulism

A

Toxins A, B and E
Binds to pre-synaptic nerves to prevent release of acetyl choline

Affects CN than symmetrically descends
No sympathetic or sensory involvement

Food history
EMG

Supportive treatment +/- antitoxin or penicillin

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63
Q

Infections to suspect with red eyes

A

Leptospirosis
Measles
Dengue
Kawasaki
Adenovirus
Stevens-Johnson

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64
Q

Causes of nodular lymphangitis

A

Sporotrichosis (Sporothrix schenckii)
Nocardia spp
Mycobacterium marinum
Leishmania braziliensis
Francisella tularensis

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65
Q

Features of Whipples disease

A

Tropheryma whipplei, an intracellular gram-positive bacteria

Abdominal pain, intestinal malabsorption
Enteropathic arthritis
Cardiac symptoms
Neurological symptoms i.e. myoclonus, ataxia, oculomotor impairment

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66
Q

Vancomycin targets

A

Most gram positive

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67
Q

Carbapenem targets

A

Most gram positive, gram negative, anaerobes

68
Q

Fluoroquinolones targets

A

Older (cipro, norflox) - most aerobic gram negatives (including pseudomonas)

Newer (moxiflox) - most gram positive, gram negative (not pseudomonas), anaerobes, TB, atypicals

69
Q

Ceftriaxone targets

A

Streps
Gram negatives
Weak for staph and anaerobes

70
Q

Penicillin targets

A

Streps
Enterococcus faecalis
Syphilis/spriochaetes
Meningococcus

71
Q

Aminoglycosides targets

A

Gram negatives
Some gram positives
Not anaerobes

72
Q

Macrolide targets

A

Atypicals
G+C
G-C
Non-enteric G-B
Mycobacteria
H. pylori

73
Q

Clindamycin targets

A

Gram positive
Anaerobes

74
Q

Doxycyline targets

A

Gram positive and gram negatives
Atypicals
Spriochaetes (lyme)
Rickettsia
Malaria

75
Q

Co-trimaxazole

A

Aerobic G-B
Staph including NORSA
Nocardia
Listeria
Meliodosis

76
Q

Rifampicin drug interactions

A

Induction of CYP450
Warfarin
Voriconazole
Protease inhibitors
AEDs
Methadone
Tamoxifen
SSRIs
CyA
Tacrolimus
Corticosteroids

77
Q

Quinolone drug interactions

A

Reduced absorption with Ca, Fe, Zn, antacids

78
Q

QT prolonging drugs

A

Voriconazole
Macrolides
Moxifloxacin
Pentamidine
Mefloquine
Bedaquiline

79
Q

Cells infected by HIV

A

CD4+ T lymphocytes
Monocytes and macrophages
Dendritic cells
Astrocytes
Thymic progenitor cells
CD34+ progenitor cells

80
Q

HIV lifecytle

A

1) Attachment and fusion
2) Reverse transcription
3) Integration
4) Transcription
5) Translation
6) Budding and maturation

81
Q

Natural history of untreated HIV disease

A

Primary infection - rise in HIV viral load with wide dissemination of virus seeding of lymphoid organs
Clinical latency - decrease in HIV viral load and blood CD4 T cells
Fall in CD4 T cells - opportunistic diseases, rise in HIV viral load and death

82
Q

Classes of HIV ART

A

1) Reverse transcriptase inhibitors - nucleoside/nucleotide analogues
2) Integrase inhibitors
3) Reverse transcriptase inhibitors - non-nucleoside reverse transcriptase inhibitors
4) Protease inhibitors
5) Entry inhibitors

83
Q

Examples of NRTIs

A

Nucleoside analogues
- Lamivudine
- Emtricitabine
- Abacavir

Nucleotide analogues
- Tenofovir (disoproxil fumarate or alefenamide)

84
Q

Examples of INSTIs

A

Raltegravir
Dolutegravir
Bictegravir

85
Q

Examples of entry inhbitors

A

Fusion inhibitors - enfuvirtide
CCR5 inhibitors - maraviroc
Attachment inhibitor - ibalizumab, fostemsavir

86
Q

Examples of protease inhibitors

A

Darunavir
Atazanavir

87
Q

Examples of NNRTIs

A

Nevirapine
Efavirenz
Etravirine
Rilpivirine

88
Q

Recommendation for treatment naive HIV

A

Doltegravir (INSTIs) + Lamivudine (3TC)

Suggested if starting HIV viral load < 500,000

89
Q

Definition of treatment success

A

Virological suppression
Confirmed HIV RNA below limit of assay detection
Low level viraemia

90
Q

Definition of virologic failure

A

Incomplete virologic response - HIV RNA > 200 after 24 weeks ART
Viral rebound - repeated detection of HIV RNA > 200 after viral suppression

91
Q

Management of treatment experienced HIV pt

A

Drug resistance testing should be obtained whilst pt taking failing regimen
Genotype testing
- usually need HIV VL > 1000 for test
Phenotype testing
- though very expensive

92
Q

Complications of ART

A

Drug resistance
Toxicities
Drug interactions
Cost

93
Q

Tenofovir drug toxicity

A

Renal toxicity
Decline bone mineral density

94
Q

Abacavir drug toxicity

A

Allergic reaction –> GIT symptoms, myalgia +/- rash, cough, leukopenia
Doubles risk of AMI

95
Q

Tenofovir alefenamide vs donepexil

A

Less renal dysfunction and bone effects with TAF compared to TDF

Weight gain with TAF

96
Q

Protease inhibitor toxicities

A

Dolutegravir, bictegravir
Insomnia, headache, dizziness, fatigue, nausea, diarrhoea
Weight gain

97
Q

Efavirenz toxicities

A

NNRTIs
CNS side effects - vivid dreams, sleep change, headache
Rash
Teratogenic

98
Q

PI and NNRTI metabolism

A

By hepatic cytochrome P4503A4 enzymes

99
Q

Opportunistic infection and malignancy with HIV infected patients

A

CD4 cell count 200-500: Herpes zoster, pneumococcal pneumonia, oral candidiasis, tuberculosis

50-200: PJP, CNS toxoplasmosis, cryptococcus, Kaposi’s sarcoma, NHL, PCNS, lymhpoma

<50: Disseminated MAC, CMV retinitis, cryptosporidiosis

100
Q

Features of IRIS

A

Inflammatory syndrome that can occur after initiation of ART and consists of either the appearance of a new condition or worsening of a preexisting condition (infection, malignancy or autoimmune)

Develops within 4–8 weeks of initiation of ART
Presentation varies depending on the underlying illness, however, patients often have clinical deterioration and localized tissue inflammation.

101
Q

Risk factors for IRIS

A

CD4+ cells < 50
Older age
Genetic suscepitbility

Most commonly seen with mycobacteria Tb, cryptococcus meningitis, PJP and PML

102
Q

Kaposi sarcoma virus association

A

HHV-8 disease

103
Q

Disseminated mycobacterium avium complex (MAC) epidemiology

A

M avium causative agent in majority of AIDS patients with disseminated MAC

Transmission via inhalation, ingestion, inoculation, person-person transmission unlikely

104
Q

Clinical manifestations of MAC

A

Fever
Night sweats
Abdominal pain
Diarrhoea
Wt loss
Cough
Lymphadenopathy

Lymphadenitis, pnumonitis, pericarditis, OM, skin or soft tissue abscesses, genital ulcers, CNS infections

105
Q

Diagnosis of toxoplasma gondii encephalitis

A

Serum IgG
Imaging - oedematous enhancing lesions

PET scan can help distinguish TE from lymphoma

Brain biopsy - however presumptive diagnosis if clinical picture and above investigations positive

106
Q

Treatment of toxoplasma gondii

A

Pyrimethamine 200mg first > 50mg-75mg daily + sulfadiazine + leucovorin

Corticosteroids if indicated for mass effect treatment

Anticonvulsants for seizures

107
Q

Malaria life cycle

A

Infected anopheline mosquito injects sporozoites

Sporozoite passes to liver and multiplies

Infected cells burst and release merozoites into circulation to invade RBC

Asexual division into schizonts

Daughter merozoites released when RBC bursts

Invade other RBC

108
Q

Features of P. falciparum on blood film

A

Multiple infected RBC but no enlargement of RBC
Crescent shaped gametocytes

109
Q

Features of P. vivax on blood film

A

Fewer infected RBC
Swollen RBCs
Fine eosinophilic dots

110
Q

Malaria bacteria with hypnozoites

A

P. vivax and P. ovale
Treat with primaquine

111
Q

Diagnosis of malaria

A

Rapid diagnostic testing
Thick and thin films
- determines species and parasite count
- repeat if clinical suspicion high

112
Q

Causes of false positive and false negative of T&T films

A

False negative - partial treatment, fluoroquinolones, tetracycles

False positive - artefacts, debris (Howell-Jolly, platelets)

113
Q

Drug resistant genes in malarial treatments

A

Mefloquin and lumefantrine
- Pfmdr1

Chloroquine
- Pfmdr1, plasmodium falciparum chloroquine resistant transporter, K76T

Antifolate drugs (sulfadoxine-pyrimethamine)
- Point mutations in dihydrofolate reductase (DHFR) and hydropteroate synthase (DHTS) genes

114
Q

Treatment of malaria

A

P. vivax, malariae, ovale and uncomplicated P. falciparum
- artemether + lumefantrine
- atovaquone + proguanil
- quinine sulfate + doxycycline
- primaquine for vivax and ovale

Severe malaria (chloroquine-resistant P. falciparum)
- IV artesunate or quinine

115
Q

Features of severe malaria

A

Reduced consciousness
Jaundice
Oliguria
Severe anaemia
Hypoglycaemia
Pulmonary oedema

116
Q

Features of typhoid fever

A

Faecal-oral spread

Fever, abdominal pain, constipation
LFT derangement
“Rose spots” - maculopapular, truncal distribution
Complications in 3rd-4th week
Leukopenia
Blood culture, stool culture

117
Q

Complications of typhoid fever

A

Occur in 3rd-4th weeks
Intestinal perforation
Bone and joint
Endocarditis
Pericarditis
Splenic or liver abscess
Endovascular - grafts, atherosclerotic plaques, aneurysms

118
Q

Treatment of typhoid fever

A

Azithromycin
Ciprofloxxacin
Ceftriaxone

119
Q

Features of dengue

A

Fever
Headache and retro-orbital pain
MSK pain
Rash

“Break bone fever”

120
Q

Typhoid fever bacteria

A

S. typhi, parathyroid

121
Q

Dengue vector

A

Aedes aegyptii
Breeds around human dwellings

122
Q

Diagnostic features of typhoid fever

A

Leukopenia
Neutropenia
Thrombocytopenia
LFT derangement
Arbovirus IgM serology

123
Q

Amoebiasis bacteria

A

Entamoeba histolyica

124
Q

Cycle of amoebiasis

A

Ingestion > excystation (small intestine) > trophozoite infection (colon)
Cysts remain viable for weeks-months in moist environments outside body

125
Q

Diagnosis of amoebiasis

A

3 fresh stool specimen
Serology - antibodies detectable in 99% of pts with liver abscess

126
Q

Management of amoebiasis

A

Metronidazole
Paromomycin or diloxanide furoate

127
Q

Hepatitis A features

A

Acute, self limiting virus
Faecal-oral transmission - contaminated water, milk, food (seafood), institutionalised, travel to endemic areas
Highly contagious

128
Q

Hepatitis A diagnosis

A

IgM anti-HAV

129
Q

Pathogens in Traveller’s diarrhoea

A

E. coli (ETEC, EIEC)
Shigella sp
Salmonella sp
Campylobacter jejuni
Vibrio parahaemolyticus
Aeromonas hydrophila
Giardia lamblia
Entamoeba histolytica
Cryptosporidium sp,
Rotavirus, norwalk virus

130
Q

Ebola virus

A

Filovirus family

Zaire ebolavirus
IP 11 days
- Fever
- Weakness
- Diarrhoea

131
Q

Zika virus features

A

Flavivirus
Mosquito borne transmission (Aedes aegypti), mother-infant, sexual

  • Acute febrile illness (rash, fever, arthralgia, conjunctivitis, myalgia, headache)
  • Neurological
  • Adverse foetal outcomes (microcephaly)

Symptomatic management

132
Q

Influenza features

A

Droplet spread and direct contact

  • Fever
  • Headache
  • Tiredness
  • Respiratory tract symptoms
  • Myalgia
133
Q

Causes of aseptic meningitis

A

Enteroviral: echovirus, coxsackie
Mumps
EBV
CMV
HIV
HSV
TB
Cryptococcus
Leptospirosis
Syphilis
Non infectious - sarcoid, vasculitis, CNS lymphoma

134
Q

Use of steroids in meningitis

A

Should have dexamethasone 10mg IV, before or with first dose of antibiotics then 6/24 for 4 days

135
Q

Treatment of pneumococcal meningitis

A

Benzylpenicillin
If gram positive diplococci –> add on vancomycin

136
Q

Infectious causes for diffuse erythematous rash

A

Scarlet fever
Toxic shock syndrome
Staph scalded skin syndrome
Dengue
Enteroviral infection

137
Q

Infectious causes of purpuric rash

A

Meningococcaemia
Staphylococcal sepsis
Gonococcaemia
Rickettsial infection
Dengue
Enteroviral infection
Hepatitis B

138
Q

Strep pyogenes bacteria

A

Beta haemolytic streptococcus

139
Q

Features of impetigo

A

Erythematous papule > vesicle > pustule > yellow crust and purulent discharge

Spread to close contacts, schools

Associated scabies

140
Q

Clinical syndromes of cellulitis

A

Beta haemolytic streptococci (group A, B, C, G)
Staph aureus
Pasteurella - dog/cat bite, with puncture wound
Aeromonas spp.
Vibrio spp.
Clostridia spp. - gram negative, immunocompromised
Mycobacteria marinum
Erisepelothrix

141
Q

Features of necrotising myofasciitis

A

Acutely swollen and painful lower limb or abdominal wall
Severe pain
High fevers

142
Q

Risk factors for necrotising myofasciitis

A

Diabetes
IVDU
Alcoholism
Local trauma
Surgery
Bowel pathology

143
Q

Management of necrotising myofasciitis

A

Surgery
Broad spectrum antibiotics (meropenem, penicillin, clindamycin)
IVIg - improved mortality in group A strep

144
Q

Causes of asplenia

A

Splenectomy
Functional asplenia/hyposplenism
- haematological - hereditary spherocytosis, sickle cell anaemia, thalassaemia major, Hodgkin’s disease, NHL, CLL, Sezary’s syndrome
- Splenic irradiation
- High dose steroid therapy
- Coeliac disease
- Bone marrow transplant

145
Q

Risk of infections in splenectomy

A

Strep pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Capnocytophaga canimorsus
Malaria

146
Q

Infection risk with solid organ transplantation

A

Cardiac transplant
- pneumonia, mediastinitis
- CMV
- toxoplasmosis
- Nocardia

Liver
- Candida
- Hepatobiliary sepsis
- CMV hepatitis

Renal
- UTI
- CMV
- PJP
- Fungal e.g. cryptococcus
- BK nephropathy

147
Q

Features of pneumocytis jiroveci

A

Ubiquitous fungus, reactivated in impaired cellular immunity
Diffuse bilateral interstitial infiltrates

Respiratory tract sampling
IF, PCR

Management with Bactrim, pentamidine, clindamycin or primaquine
Corticosteroids

148
Q

Nocardia features

A

Gram positive
N. asteroides, N. farcinica, N. brasileinsis
Environmental, soil, organic matter, water

Clinical features
- Cutaneous/lymphocutaneous
- Pulmonary
- systemic/CNS

Management
- surgical drainage/debridement
- Bactrim –> for pulmonary disease (resistant for N. farcinica, N. otitidiscaviarum)
- imipenem, ceftriaxone

149
Q

Toxoplasmosis features

A

T. gondii, parasite
Increased risk with T cell mediated defects

CNS, myocardial, pulmonary, chorioretinitis

Management with pyrimethamine/folinic acid, sulfadiazine or clindamycin

150
Q

Toxoplasmosis lifecycle

A

Cats shed oocyst > sporulation occurs outside cat 1-5 days later (required to be infectious) > tachyzoite (human intestine) > cyst (tissue)

151
Q

Features of candidiasis

A

C. albicans - commensal on skin, GIT, female genital tract

Active in ICU or immunosuppressed patients

152
Q

Syndromes of candidiasis

A

Syndromes
- Disseminated candidiasis –> fever after neutrophil recovery, abdominal pain, increase ALP
- Candidaemia –> fever +/- sepsis, use with broad spectrum abx, CVC, urinary catheters, TPN, renal imapriment, GIT surgery, mucositis, neutropenia

153
Q

Management of candidiasis

A

Immunocompetent
- Systemic antifungal treatment for 14 days
- Removal of device, drain any collection

Immunocompromised
- Systemic antifungal therapy, 10-14 days

Triazole
Echinocandins
Amphotericin

154
Q

Features of aspergillus

A

Ubiquitous, environmental spores
A. flavus, A. fumigatus

Primary infection in lung, later dissemination

Syndromes
- Pulmonary aspergillosis
- Cerebral –> severe immunocompromised, sinusitis with bone erosion
- ABPA
- Aspergilloma

155
Q

Management of aspergillus

A

Antifungal therapy - voriconazole, posaconazole, amphotericin B, caspofungin
Surgery if isolated lesions

156
Q

Features of zygomycosis

A

Absidia spp., Mucor, rhizopus

Risk with acute leukaemia, solid organ transplantation, DKA, iron overload, burns

Involvement of paranasal sinuses with dissemination. tobrain and orbit

157
Q

Features of cryptococcus

A

Budding yeast

C. neoformans var gattii (immunocompetent hosts), vars neoformans (immunodeficient hosts)

Elevated CSF opening pressure, protein and lymphocytes. Decreased glucose.

Management with amphotericin B and flucytosine

158
Q

Multidrug resistant candida

A

Candida auris
Echinocandin therapy as first line

159
Q

Schistosomiasis features

A

Penetration of intact skin by cercarial lavae in fresh water

Pruritic rash within days, febrile illness, fibrotic response in urinary tract or gut, chronic infection (colitis, portal HTN, urolithiasis, SCC bladder)

Diagnosis via serology, eosinophilia, urine/stool microscopy

Management of praziquantel

160
Q

Features of ascariasis

A

A. lumbricoides
Most common human helminthic infection, usually asymptomatic

Adult worms in small intestine shed ova > ingested eggs hatch > migrate into intestinal wall and via portal veins to lungs + small intestine

Pulmonary (laval migration)
Nutritional
Mechanical i.e. SBO

Treatment with stool microscopy

Management with mebendazole, pyrantel pamoate

161
Q

Rabies features

A

Infection by contact with respiratory secretions from animal hosts

Fever, headache, malaise in prodrome (4-10 days), encephalitic-hydrophobia, deliriu, agitation, arrhythmias, autonomic dysfunction, paralysis

162
Q

Leptospirosis features

A

Spirochete zoonosis from contaminated water

Mild, self-limiting
Hyperbilirubiaemia, AKI, pulmonary haemorrhage
Biphasic illness

Supportive therapy with antibiotics (penicillin and doxycycline)

163
Q

Melioidosis features

A

Burkholderia pseudomallei (gram negative rod, soil saprophyte)

SEA,Northern Australia

Diabetes, EtOH use are risk factors

Pneumonia, abscesses (spleen, prostate), OM, septic arthritis, skin. andsoft tissue infection, high mortality in sepsis

Treatment with ceftazidime, carbapenem

164
Q

Common manifestations fo strongyloidiasis

A

GI symptoms
Hepatomegaly, hepatic abscess, abnormal LFTs
Respiratory symptoms - dyspnoea, bronchospasm, haemoptysis, bronchopneumonia, interlobular septal fibrosis
Eosinophilia
Bacterial meningiits
Erythematous serpinginous lesions
Gram negative septivaemia or sepsis
MOF

165
Q
A

BPT Flashcards (32 decks)

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