Infectious diseases Flashcards
features of acute pyelonephritis
ascending infection (typically E. coli from the lower urinary tract
fever, rigors
loin pain
nausea/vomiting
symptoms of cystitis may be present:
dysuria
urinary frequency
treatment of acute pyelonephritis
signs of acute pyelonephritis - hospital admission
broad-spectrum cephalosporin or a quinolone (non-pregnant) - for 7-10 days
causes of amoebiasis
entamoeba histolytica (an amoeboid protozoan)
spread by the faecal-oral route
can be asymptomatic, cause mild diarrhoea or severe amoebic dysentery, can cause liver and colonic abscesses
features of amoebic dysentry
profuse, bloody diarrhoea
there may be a long incubation period
stool microscopy may show trophozoites if examined within 15 minutes or kept warm (known as a ‘hot stool’)
treatment
oral metronidazole
a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
features of amoebic liver abscess
single mass in the right lobe (may be multiple)
features
fever
right upper quadrant pain
systemic symptoms e.g. malaise
hepatomegaly
positive serology, USS
oral metronidazole
a ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
management of animal bites
generally polymicrobial but the most common isolated organism is Pasteurella multocida
cleanse wound
co-amoxiclav
if penicillin-allergic then doxycycline + metronidazole is recommended
causes and management of human bites
Common organisms include:
Streptococci spp.
Staphylococcus aureus
Eikenella
Fusobacterium
Prevotella
co-amoxiclav
consider risk of viral infections such as HIV and hepatitis C
features of anthrax
caused by Bacillus anthracis, a Gram positive rod, spread by infected carcasses
Features
causes painless black eschar (cutaneous ‘malignant pustule’, but no pus)
typically painless and non-tender
may cause marked oedema
anthrax can cause gastrointestinal bleeding
management of anthrax
ciprofloxacin
indications and moa of amphotericin b
Used for systemic fungal infections
indications and moa of terbinafine
Commonly used in oral form to treat fungal nail infections
indications and moa of nystatin
As very toxic can only be used topically (e.g. for oral thrush)
features of aspergilloma
a mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to tuberculosis, lung cancer or cystic fibrosis)
asymptomatic, cough, haemoptysis
effects of b. cereus poisoning
symptoms typically resolve within 24 hours in both syndromes
casuses diarrhoea and crampy abdominal pain
diagnosis of bacterial vaginosis
Amsel’s criteria for diagnosis of BV - 3/4 present
thin, white homogenous discharge
clue cells on microscopy: stippled vaginal epithelial cells
vaginal pH > 4.5
positive whiff test (addition of potassium hydroxide results in fishy odour)
management of bacterial vaginosis
if asymptomatic - no need for treatment
if symptomatic - oral metronidazole for 5-7 days, >50% relapse rate <3m
if pregnant - topical clindamycin
features of botulism
Clostridium botulinum - may result from eating contaminated food (e.g. tinned) or intravenous drug use
neurotoxin often affects bulbar muscles and autonomic nervous system
Features
patient usually fully conscious with no sensory disturbance
flaccid paralysis
diplopia
ataxia
bulbar palsy
treatment of botulism
botulism antitoxin and supportive care
antitoxin is only effective if given early - once toxin has bound its actions cannot be reversed
features of campylobacter infection
commonest bacterial cause of infectious intestinal disease in the UK
spread by the faecal-oral route and has an incubation period of 1-6 days
prodrome: headache malaise
diarrhoea: often bloody
abdominal pain: may mimic appendicitis
managment of campylobacter
first-line antibiotic is clarithromycin
features of cat scratch disease
generally caused by the Gram negative rod Bartonella henselae
Features
fever
history of a cat scratch
regional lymphadenopathy
headache, malaise
features of cellulitis
commonly occurs on the shins
usually unilateral
erythema
blisters and bullae may be seen with more severe disease
swelling
systemic upset
fever
malaise
nausea
what is a chancroid
caused by Haemophilus ducreyi
causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
features of chlamydia
asymptomatic in around 70% of women and 50% of men
women: cervicitis (discharge, bleeding), dysuria
men: urethral discharge, dysuria
investigation findings in chlamydia
NAAT
urine - first void (men), vulvovaginal swab (women), cervical swab
management of chlamydia
doxycycline (7 day course) if first-line
if pregnant then azithromycin, erythromycin or amoxicillin
features of cholera
Overview
caused by Vibro cholerae - Gram negative bacteria
Features
profuse ‘rice water’ diarrhoea
dehydration
hypoglycaemia
treatment of cholera
oral rehydration therapy
antibiotics: doxycycline, ciprofloxacin
gram positive cocci examples
Gram-positive cocci = staphylococci + streptococci (including enterococci)
gram negative cocci
Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis
gram positive rods
Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes
gram negative rods
Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella sp.
Shigella sp.
Campylobacter jejuni
features of cryptosporidiosis
commonest protozoal cause of diarrhoea in the UK
Features
watery diarrhoea
abdominal cramps
fever
modified Ziehl-Neelsen stain of stool - red cysts of cryptosporidium
features of cutaneous larva migrans
dermatological condition prevalent in tropical and subtropical regions, largely attributable to cutaneous penetration and subsequent migration of nematode larvae
intensely pruritic, ‘creeping’, serpiginous, erythematous cutaneous eruption that advances over time
Treatment options revolve around anthelmintic agents, such as ivermectin or albendazole
features of CMV infection
only usually causes disease in the immunocompromised
infected cells have a ‘Owl’s eye’ appearance due to intranuclear inclusion bodies
CMV mononucleosis
CMV retinitis
CMV encephalopathy
CMV pneumonitis
CMV colitis
features of dengue fever
fever
headache (often retro-orbital)
myalgia, bone pain and arthralgia (‘break-bone fever’)
pleuritic pain
facial flushing (dengue)
maculopapular rash
haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis
features of severe dengue (dengue haemorrhagic fever)
this is a form of disseminated intravascular coagulation (DIC) resulting in:
thrombocytopenia
spontaneous bleeding
around 20-30% of these patients go on to develop dengue shock syndrome (DSS)
features of enteric fever
yphoid and paratyphoid are caused by Salmonella typhi and Salmonella paratyphi respectively
transmitted via the faecal-oral route
Features
initially systemic upset as above
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots
malignancies associated with epstein Barr virus
Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas
hairy leukoplakia
features of genital herpes
dysuria and pruritus
the primary infection is often more severe than recurrent episodes
headache, fever and malaise
- more common in primary episodes
tender inguinal lymphadenopathy
urinary retention
positive NAAT
management of genital herpes
saline bathing
analgesia
topical anaesthetic agents e.g. lidocaine
oral aciclovir
features of genital warts
condylomata accuminata - caused by the many varieties of the human papillomavirus HPV, especially types 6 & 11
types 16, 18, 33 - predispose to cervical cancer
small (2 - 5 mm) fleshy protuberances which are slightly pigmented
may bleed or itch
management of genital warts
topical podophyllum or cryotherapy
imiquimod
risk factors for giardiasis
caused by the flagellate protozoan Giardia lamblia
risk factors
faeco oral route
foreign travel
swimming/drinking water from a river or lake
male-male sexual contact
features of giardiasis
often asymptomatic
non-bloody diarrhoea
steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur
investigation and management of giardiasis
stool microscopy for trophozoite and cysts
tool antigen detection assay
treat with metronidazole
features of gonorrhea
caused by the Gram-negative diplococcus Neisseria gonorrhoeae
any mucous membrane surface can be infected, typically genitourinary but also rectum and pharynx.
incubation period of gonorrhoea is 2-5 days
males: urethral discharge, dysuria
females: cervicitis e.g. leading to vaginal discharge
rectal and pharyngeal infection is usually asymptomatic
treatment of gonorrhoea
single dose of IM ceftriaxone 1g
if cipro sensitive single dose of oral ciprofloxacin 500mg
if ceftriaxone IM is refused - oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)
features of hepatitis A
benign, self-limiting disease
incubation period: 2-4 weeks
transmission is by faecal-oral spread
flu-like prodrome
abdominal pain: typically right upper quadrant
tender hepatomegaly
jaundice
deranged liver function tests
features of hepatitis B
spread through exposure to infected blood or body fluids, including vertical transmission
6-20w incubation
features of hepatitis B include fever, jaundice and elevated liver transaminases
features of hepatitis C
incubation period: 6-9 weeks
a transient rise in serum aminotransferases / jaundice
fatigue
arthralgia
> 50% develop chronic hepatitis
features of hepatitis D
transmitted parenterally
transmitted via bodily fluids
may be infected with hepatitis B at the same time
Co-infection: Hepatitis B and Hepatitis D infection at the same time.
Superinfection: A hepatitis B surface antigen positive patient subsequently develops a hepatitis D infection.
Superinfection is associated with high risk of fulminant hepatitis, chronic hepatitis status and cirrhosis.
features of hepatitis E
spread by the faecal-oral route
incubation period: 3-8 weeks
management of herpes simplex virus
gingivostomatitis: oral aciclovir, chlorhexidine mouthwash
cold sores: topical aciclovir although the evidence base for this is modest
genital herpes: oral aciclovir. Some patients with frequent exacerbations may benefit from longer term aciclovir
features of infectious mononucleosis
caused by the Epstein-Barr virus
classic triad of sore throat, pyrexia and lymphadenopathy
Symptoms typically resolve after 2-4 weeks.
diagnosis of infectious mononucleosis
heterophil antibody test (Monospot test)
management of infectious mononucleosis
rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
avoid contact sports for 4w
features of legionella
caused by the intracellular bacterium Legionella pneumophilia - typically colonizes water tanks
flu-like symptoms including fever (present in > 95% of patients)
dry cough
relative bradycardia
confusion
lymphopaenia
hyponatraemia
deranged liver function tests
pleural effusion: seen in around 30% of patients
diagnosis and management of legionella
urinary antigen testing
CXR
a mid-to-lower zone predominance of patchy consolidation
pleural effusions in around 30%
treat with erythromycin/clarithromycin
features of leprosy
granulomatous disease primarily affecting the peripheral nerves and skin caused by Mycobacterium leprae
Features
patches of hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
sensory loss
types of leprosy
Low degree of cell mediated immunity → lepromatous leprosy (‘multibacillary’)
extensive skin involvement
symmetrical nerve involvement
High degree of cell mediated immunity → tuberculoid leprosy (‘paucibacillary’)
limited skin disease
asymmetric nerve involvement → hypesthesia
hair loss
management of leprosy
rifampicin, dapsone and clofazimine
features of leptospirosis
early phase - due to bacteraemia, lasts around a week
may be mild or subclinical
fever
flu-like symptoms
subconjunctival suffusion (redness)/haemorrhage
second immune phase may lead to more severe disease (Weil’s disease)
acute kidney injury (seen in 50% of patients)
hepatitis: jaundice, hepatomegaly
aseptic meningitis
investigations and management of leptospirosis
serology: antibodies to Leptospira develop after about 7 days
PCR
culture
high-dose benzylpenicillin or doxycycline
features of lyme disease
caused by the spirochaete Borrelia burgdorferi, spread by ticks
Early features (within 30 days)
erythema migrans
‘bulls-eye’ rash 1-4 weeks after the initial bite but may present sooner
usually painless, more than 5 cm in diameter and slowlly increases in size
present in around 80% of patients.
systemic features - headache, lethargy, fever, arthralgia
features of lymphogranuloma venereum
caused by Chlamydia trachomatis serovars L1, L2 and L3
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
may occasionally form fistulating buboes
stage 3: proctocolitis
treatment of lymphogranuloma venereum
doxycycline
features of severe falciparum malaria
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications as below
features of severe non falciparum malaria
general features of malaria: fever, headache, splenomegaly
Plasmodium vivax/ovale: cyclical fever every 48 hours. Plasmodium malariae: cyclical fever every 72 hours
Plasmodium malariae: is associated with nephrotic syndrome.
treatment of falciparum malaria
uncomplicated falciparum malaria - artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine
severe falciparum malaria - intravenous artesunate
treatment of non-falciparum malaria
artemisinin-based combination therapy (ACT) or chloroquine
management of suspected bacterial meningitis
IV access → take bloods and blood cultures
lumbar puncture
if cannot be done <1hr, give IV antibiotics after blood cultures
IV antibiotics
3 months - 50 years: cefotaxime (or ceftriaxone)
> 50 years: cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin) for adults
IV dexamethasone
Management of patients with signs of raised intracranial pressure
get critical care input
secure airway + high-flow oxygen
IV access → take bloods and blood cultures
IV dexamethasone
IV antibiotics as above
arrange neuroimaging
when to delay lumbar puncture
signs of severe sepsis or a rapidly evolving rash
severe respiratory/cardiac compromise
significant bleeding risk
signs of raised intracranial pressure
focal neurological signs
papilloedema
continuous or uncontrolled seizures
GCS ≤ 12
suppression of MRSA from a carrier once identified
nose: mupirocin 2% in white soft paraffin, tds for 5 days
skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum
antibiotics used in treatment of MRSA
vancomycin
teicoplanin
linezolid
screening for MRSA
nasal swab and skin lesions or wounds
the swab should be wiped around the inside rim of a patient’s nose for 5 seconds
the microbiology form must be labelled ‘MRSA screen’
features of mumps
caused by RNA paramyxovirus and tends to occur in winter and spring
Spread by droplets
Clinical features
fever
malaise, muscular pain
parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
features of mycoplasma pneumonia
the disease typically has a prolonged and gradual onset
flu-like symptoms classically precede a dry cough
bilateral consolidation on x-ray
complications - cold agglutins, erythema multiforme, erythema nodosum, meningoencephalitis, GBC
investigations and managment of mycoplasma pneumonia
diagnosis is generally by Mycoplasma serology
doxycycline or a macrolide
two types of necrotising fasciitis
Necrotising fasciitis is a medical emergency that is difficult to recognise in the early stages
type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type
type 2 is caused by Streptococcus pyogenes
risk factors for necrotising fasciitis
skin factors: recent trauma, burns or soft tissue infections
diabetes mellitus
the most common preexisting medical condition
particularly if the patient is treated with SGLT-2 inhibitors
intravenous drug use
immunosuppression
features of necrotising fasciitis
most commonly affected site is the perineum (Fournier’s gangrene).
Features
acute onset
pain, swelling, erythema at the affected site - rapidly worsening cellulitis with pain out of keeping with physical features
extremely tender over infected tissue with hypoaesthesia to light touch
skin necrosis and crepitus/gas gangrene are late signs
fever and tachycardia may be absent or occur late in the presentation
management of necrotising fasciits
urgent surgical referral debridement
intravenous antibiotics
features of non-gonococcal urethritis
purulent urethral discharge and dysuria - microscopy shows neutrophils but no Gram-negative diplococci
potential causes of non gonococcal urethritis
Chlamydia trachomatis
most common cause
Mycoplasma genitalium
thought to cause more symptoms than Chlamydia
less common causes
Ureaplasma urealyticum
Trichomonas vaginalis
Escherichia coli
definition of pyrexia of unknown origin
Defined as a prolonged fever of > 3 weeks which resists diagnosis after a week in hospital
features of Q fever
caused by Coxiella burnetii, a rickettsia
originates from abattoir, cattle/sheep or it may be inhaled from infected dust
typically prodrome: fever, malaise
causes pyrexia of unknown origin
transaminitis
atypical pneumonia
endocarditis (culture-negative)
management of q fever
doxycycline
features of rabies
prodrome: headache, fever, agitation
hydrophobia: water-provoking muscle spasms
hypersalivation
Negri bodies: cytoplasmic inclusion bodies found in infected neurons
fatal if untreated
acute features of schistosomiasis
typically only develop in people who travel to endemic areas, as they don’t have any immunity to the worms
swimmers’ itch
acute schistosomiasis syndrome (Katayama fever)
fever
urticaria/angioedema
arthralgia/myalgia
cough
diarrhoea
eosinophilia
features of chronic schistosomiasis infection
worms deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation
can cause an obstructive uropathy and kidney damage, frequency, haematuria and bladder calcification
typically presents as a ‘swimmer’s itch’ in patients who have recently returned from Africa
treatment of schistosomiasis
single oral dose of praziquantel
sepsis vs septic shock
sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection
septic shock: a more severe form sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’
features of spinal epidural abscess
a collection of pus that is superficial to the dura mater (of the meninges) that cover the spinal cord
fever
back pain
focal neurological deficits according to the segment of the cord affected
causes of spinal epidural abscess
most common causative micro-organism is Staphylococcus aureus.
bacteria enters the spinal epidural space by contiguous spread from adjacent structures (e.g. discitis), haematogenous spread from concomitant infection (e.g. bacteraemia from IVDU), or by direct infection (e.g. spinal surgery)
features of staphylococcal toxic shock syndrome
a severe systemic reaction to staphylococcal exotoxins
fever: temperature > 38.9ºC
hypotension: systolic blood pressure < 90 mmHg
diffuse erythematous rash
desquamation of rash, especially of the palms and soles
involvement of 3 or more organ systems - gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
treatment of staphylococcal toxic shock syndrome
removal of infection focus (e.g. retained tampon)
IV fluids
IV antibiotics
features of strongyloides stercoralis
a human parasitic nematode worm
diarrhoea
abdominal pain/bloating
papulovesicular lesions where the skin has been penetrated by infective larvae e.g. soles of feet and buttocks
larva currens: pruritic, linear, urticarial rash
if the larvae migrate to the lungs a pneumonitis similar to Loeffler’s syndrome may be triggered
treatment of strongyloides stercoralis
ivermectin and albendazole are used
primary features of syphilis
a sexually transmitted infection caused by the spirochaete Treponema pallidum
characterised by primary, secondary and tertiary stages
incubation period is between 9-90 days
Primary features
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)
secondary features of syphilis
Secondary features - occurs 6-10 weeks after primary infection
systemic symptoms: fevers, lymphadenopathy
rash on trunk, palms and soles
buccal ‘snail track’ ulcers (30%)
condylomata lata (painless, warty lesions on the genitalia )
tertiary features of syphilis
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil
testing for syphilis
non-treponemal tests
not specific for syphilis, therefore may result in false positives - RPR, VDRL
becomes negative after treatment
reponemal-specific tests
generally more complex and expensive but specific for syphilis - TP-EIA, TPHA
management of syphilis
intramuscular benzathine penicillin is the first-line management
alternatives: doxycycline
describe the Jarisch-Herxheimer reaction
occurs following treatment for syphilis
fever, rash, tachycardia after the first dose of antibiotic
in contrast to anaphylaxis, there is no wheeze or hypotension
it is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
no treatment is needed other than antipyretics if required
features of tetanus infection
prodrome fever, lethargy, headache
trismus (lockjaw)
risus sardonicus: facial spasms
opisthotonus (arched back, hyperextended neck)
spasms (e.g. dysphagia)
management of tetanus infection
supportive therapy including ventilatory support and muscle relaxants
intramuscular human tetanus immunoglobulin for high-risk wounds
metronidazole - first line
features of toxoplasmosis infection in immunosuppressed patient
Cerebral toxoplasmosis accounts for around 50% of cerebral lesions in patients with HIV
constitutional symptoms, headache, confusion, drowsiness
CT: usually single or multiple ring-enhancing lesions, mass effect may be seen
management: pyrimethamine plus sulphadiazine for at least 6 weeks
features of toxoplasmosis in immunocompetent patients
Most infections are asymptomatic. Symptomatic patients usually have a self-limiting infection, often having clinical features resembling infectious mononucleosis (fever, malaise, lymphadenopathy)
features of trichomonas vaginalis
Trichomonas vaginalis is a highly motile, flagellated protozoan parasite. Trichomoniasis is a sexually transmitted infection (STI)
vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
treatment of trichomonas vaginalis
oral metronidazole for 5-7 days, although the BNF also supports the use of a one-off dose of 2g metronidazole
features of trypanosomiasis
African trypanosomiasis (sleeping sickness) and American trypanosomiasis (Chagas’ disease)
Trypanosoma chancre - painless subcutaneous nodule at site of infection
intermittent fever
enlargement of posterior cervical lymph nodes
later: central nervous system involvement e.g. somnolence, headaches, mood changes, meningoencephalitis
management of trypanosomiasis
Management
early disease: IV pentamidine or suramin
later disease or central nervous system involvement: IV melarsoprol
treatment of latent tuberculosis
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)
standard therapy for active tuberculosis
initial phase - first 2 months (RIPE)
Rifampicin - liver enzyme inducer
Isoniazid - peripheral neuropathy, agranulocytosis
Pyrazinamide - hyperuricaemia causing gout
Ethambutol - optic neuritis
Continuation phase - next 4 months
Rifampicin
Isoniazid
investigation findings of active tuberculosis
Chest x-ray
upper lobe cavitation is the classical finding of reactivated TB
bilateral hilar lymphadenopathy
Sputum smear
3 specimens are needed
stained for the presence of acid-fast bacilli
sputum culture - gold standard investigation - more sensitive, can take 1-3w
NAAT - rapid diagnosis 24-48h
causes and treatment of non specific urethritis
Common causes of NSU
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma genitalium
Treatment
oral doxycycline for 7 days or single dose of oral azithromycin
when should urine cultures be sent in UTI (females)
women aged > 65 years
recurrent UTI (2 episodes in 6 months or 3 in 12 months)
pregnant women
men
visible or non-visible haematuria
treatment of UTI (female)
pregnant and symptomatic - urine culture + nitrofurantoin
asymptomatic bacteruria and pregnant - urine culture , nitrofurantoin
treatment of UTI (male)
immediate abx for 7 days
trimethoprim or nitrofurantoin should be offered first-line unless prostatitis is suspected
urine culture
examples of live attenuated vaccines
BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid
examples of inactivated preparations
rabies
hepatitis A
influenza (intramuscular)
examples of subunit and conjugate vaccines
pneumococcus (conjugate)
haemophilus (conjugate)
meningococcus (conjugate)
hepatitis B
human papillomavirus
examples of toxoid vaccines
tetanus
diphtheria
pertussis
action and side effects of vancomycin
a glycopeptide antibiotic used in the treatment of Gram-positive infections - inhibits cell wall formation, preventing polymerisation of peptidoglycans
Adverse effects
nephrotoxicity
ototoxicity
thrombophlebitis
red man syndrome; occurs on rapid infusion of vancomycin
causes of viral meningitis
Causes
non-polio enteroviruses e.g. coxsackie virus, echovirus
mumps
herpes simplex virus (HSV), cytomegalovirus (CMV), herpes zoster viruses
HIV
measles
risk factors of viral meningitis
Risk factors
patients at the extremes of age (< 5 years and the elderly)
immunocompromised, e.g. patients with renal failure, with diabetes
intravenous drug users
features of meningitis
inflammation of the leptomeninges and the cerebrospinal fluid of the subarachnoid space
headache
evidence of neck stiffness
photophobia (often milder than the photophobia experienced by a patient with bacterial meningitis)
confusion
fevers
management of meningitis
LP
supportive management
broad spectrum abx - cefriaxone and IV aciclovir
viral meningitis - self limiting, sx improve over 7-14 days
features of yellow fever
Type of viral haemorrhagic fever (also dengue fever, Lassa fever, Ebola).
zoonotic infection: spread by Aedes mosquitos
incubation period = 2 - 14 days
may cause mild flu-like illness lasting less than one week
sudden onset of high fever, rigors, nausea & vomiting. Bradycardia
brief remission is followed by jaundice, haematemesis, oliguria
if severe jaundice - haematemesis
Councilman bodies (inclusion bodies) may be seen in the hepatocytes
features of trimethoprim
interferes with DNA synthesis by inhibiting dihydrofolate reductase - may interact with methotrexate, which also inhibits dihydrofolate reductase
adverse effects of trimethoprim
myelosuppression
transient rise in creatinine: trimethoprim
action of tetracyclines
Mechanism of action
protein synthesis inhibitors
binds to 30S subunit blocking binding of aminoacyl-tRNA
uses of tetracyclines
acne vulgaris
Lyme disease
Chlamydia
Mycoplasma pneumoniae
action and examples of sulphonamides
inhibit dihydropteroate synthetase
co-trim
sulfamethoxazole
sulfasalazine
sulfonylurea
action and indications for rifampicin
tuberculosis
prophylaxis for close contact with tuberculosis or meningitis
inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA
side effects of rifampicin
potent CYP450 liver enzyme inducer
hepatitis
orange secretions
flu-like symptoms
action and adverse effects of metronidazole
Metronidazole is a type of antibiotic that works by forming reactive cytotoxic metabolites inside the bacteria.
Adverse effects
disulfiram-like reaction with alcohol
increases the anticoagulant effect of warfarin
