Infectious diseases Flashcards
- if +ve = anticoag
- if -ve = D-dimer – if +ve rpt USS in 6-8Bacterial causes of meningitis per age group ( newborn, young children, teens/adults)
Newborn - GBStrep; e.coli/coliform, listeria monocytogenesYoung children - N. meningitidis, strep pneumoniae, H.influenzaeTeens/adults - Strep pneumoniae, N.meningitidis, listeria monocytogenes
Viral causes of meningitis
enterovirusVZVHSVHIVmumps
Fungal cause of meningitis
Crytpociccus neoformans
CSF interp for bacteria
WCC v raised (100-50,000)protein v raised (>1)glucose low (<40%)opening pressure high
CSF interp for viral
WCC raised (5-1000)protein N/raised (0.4-1)glucose Nopening pressure M/slighlty raised
CSF interp for fungal
WCC N/raised (0-1000)Protien raised (0.2.5)glcuose N/low (<40%)opening pressure v high
CSF interp TB
WCC slightly raised (<500)protein v raised (1-5)glucose v low (>30%)Opening pressure - high
tx bacterial meningitis (initial)
if susptected in GP - IM benzylpenicillin if no delay
IV cefotaxime or ceftriaxone
if <3 mo or >50 yrs - add amoxicillin IV
Treatment for aspergilloma
Itraconazole
Demographic that acquies Aspergilloma
- Immunocompromised
- cavitating lung disease (TB, emphysema)
Clinical presentation of aspergilloma
hx of TB;
haemoptysis (severe);
rounded opacity on CXR
Clinical presentation TB
fever; night sweats; anorexia; weight loss; chronic cough
Abx to treat IE chronic bronchitis
amoxicillin or tatracycline or clarithromycin
Abx to treat uncomplicated CAP
Amoxicillin
pen allergic = doxycylicine or clarithromycin
add flucloxacillin if ?satphylococci (in influenza)
Abx to treat atypical pnuemonia
clarithromycin
Abx to treat HAP
<5 days admission: co-amox or cefuroxime
>5 days - piptaz/razocin OR broad spectrum cephalosporin (ceftazidime) OR quinolone (ciprofloxacin)
Abx to treat Lower UTI
trimethorpin or nitrofurantoin
Abx to treat acute pyelonephritis
broad specturum cephalosporin (ceftrazidime) or quinolone (ciprofloxacin)
Abx to treat acute prostatitis
quinolone (ciprofloxacin) or trimethoprim
Abx to treat impetigo
topical hydrogen peroxide
oral flucloxacillin (erythromycin if widespread)
Abx to treat cellullitis
flucloxacillin
pen allergic = clarithromycin, erythromcyin or doxycyclin
Abx to treat cellulitis near eyes ro nose
co-amox
pen allergic = clarithromycin + metronidazole
Abx to treat erysipelaas
flucloxacillin
pen allergic = clarithromycin, erythromcyin or doxycyclin
Abx to treat animal/human bite
co-amox
pen allergic = clarithromycin + metronidazole
Abx to treat mastitis (breast feeding)
flucloxacillin
Abx to treat pharyngitis
phenoxymethylpenicllin (penV)
pen allergic = erythromycin
Abx to treat sinusitis
phenoxymethylpenicllin (penV)
pen allergic = erythromycin
Abx to treat otitis media
amoxicillin
pen allergic = erythromycin
Abx to treat otitis externa
flucloxacillin
pen allergic = erythromcyin
Abx to treat periapical or periodontal abscess
amoxicillin
Abx to treat genngitivits
metronidazole
Abx to treat gonorrhoea
IM ceftriaxone
Abx to treat chlamydia
doxycycline or azithromycin
Abx to treat pelvic inflammatory disease
PO doxycycline
PO metronizadole
IM cetriaxone
Abx to treat syphillis
benzathine benzylpenicillin
pen allergic = doxycycline or erythromycin
Abx to treat bacterial vaginosis
PO or topical metronidazole or clindamycin
Abx to treat clostridiodes difficile
1st: PO vancomycin
2nd/subsequent: PO fidaxomicin
Abx to treat campylobacter enteritis
clarithromycin
Abx to treat Salmonella (non-typhoid)
ciprofloxacin
Abx to treat shigellosis
cirpofloxacin
Typical causative pathogen for croup
parainfluenza virus
Typical causative pathogen for CAP
Streptococcus pneumoniae
Typical causative pathogen for bronchiolitis
respiratory syncytial virus
Typical causative pathogen for acute epiglottitis
Haemophilus influenzae
Typical causative pathogen for pneumonia following influenza
staphylococcus aureus
Typical causative pathogen for atypical pneumonia
mycoplasma pneumonia (flu-like sx precedes dry cough)
Legionella pneumophilia (dry cough, lymphopenia, deranged LFTs, hyponatraemia)
complications of atypical pneumonia caused by mycoplasma pneumonia
haemolytic anaemia
erythema multiforme
Typical causative pathogen for pneumonia in HIV pts
pneumoctystis jirovecii
Typical fts of pneumonia jirovecii
few chest signs
exertional dypnoea
HIV
Typical causative pathogen for tuberculosis
mycobacterium tuberculosis
warning signs in ?meningitis requiring senior review
- rapidly progressive rash
- poor peripheral perfusion
- RR <8 or >30 OR HR <40 or >140
- pH <7.3 OR WBC <4 OR lactate >4
- GCS <12 or drop of 2
- poor response to fluid resus
When to delay LP in ?meningitis
- signs of severe sepsis/rapidly evolving rash
- severe resp/cardiac compromise
- significant bleeding risk
- signs of raised ICP (focal neuro, papilloedema, continuous/uncontrolled seizures, GCS <12)
Management of ?meningiits
- IV access - bloods + cultures
- LP w/in 1st hour/before abx unless delay is inappropriate
- IV abx - cefotazime or ceftriaxome
- IV dexamethasone ( prior to or <12hrs from start of abx) ; avoid in septic shock, immunipcompromised, after surgery
Clinical fts of rubella
- prodrome - low grade fever
- rash: maculopapular; face –> whole body; fades by day 3-5
- lymphadenopathy : suboccipital and post-auricular
complications of rubella
- arthritis
- thrombocytopaenia
- encephalitis
- myocarditis
clinical fts of measles
- fever, cough , conjunctivities
- irritability
- blanching erythematous rash on face and upper chest
- white spots on the inside of cheeks
Clinical fts of infection with parvovirus B19
common:
- infants: erythema infectiosum (slapped-cheek syndrome) = mild fever with bright red rash after a few days (+/- spread to body - palms/soles) but feels better; can recurr with heat/sun
- adutls: acute arthritis
- immunosuprressed: pancytopenia
- sickle-cell: aplastic crysis
- fetus from 20/40: hydrops fetalis = severe anaemia –> T2HF –> fluid retention (ascites, pleural and pericardial effusions)
Presentation of trichomonas vaginalis
- vaginal discharge: offensive, yellow/green, forthy
- vulvovaginitis
- strawberry cervix
- pH >4.5
- men: asymptomatic/urethritis
microscopy trichomonas vaginalis
motile trophozoites
(seen on a wet mount)
presentation bacterial vaginosis
- PV discharge: offensive (‘fishy’), thin/white discharge
- vaginal pH >4.5
- non STI
Bacterial vaginosis microscopy
clue cells
classic presentation of infectious mononucleosis
sore throat
pyrexia
lymphadenopathy (ant and post triangles)
Maculopapular, pruritic rash after amoxicillin use
Other: hepatitis, transient rise in aLT; splenomegally; palatal petechia
diagnosis of infectious mononucleosis
heterophil antibody test (monospot test) in second week of illness
Typical presentation of gastroenteritis caused by E.coli
traveller
watery stools
abdominal cramps and nausea
Typical presentation of gastroenteritis caused by Giardiasis
Prolonged (2-6 weeks), non-bloody diarrhoea
+/- malabsorption (causing steatorrhea)
Typical presentation of gastroenteritis caused by cholera
Profuse watery diarrhoea
Severe dehydration w/ weight loss
not common amongst travellers
Typical presentation of gastroenteritis caused by shigella
bloody diarrhoea
vomiting and abdo pain
Typical presentation of gastroenteritis caused by staphylococcus aureus
severe vomiting
short incubation period
Typical presentation of gastroenteritis caused by campylobacter
flu-like prodromed
crampy abdominal pain, fever
+/- blood in diarrhoea
complication : Guillian-Barre
Typical presentation of gastroenteritis caused by bacilly cereus
2 types
- vomiting w/in 6hrs, stereotypically due to rice
- diarrhoeal illness ocurrign after 6hrs
Typical presentation of gastroenteritis caused by amoebiasis
gradual onset bloody diarrhoea, abdominal pain and tenderness
last for several weeks (2-6 weeks)
no malabsorption (steatorrhoea)
Typical presentation of pneumonia caused by legionella
- spread by air-conditioning systems (water tanks)
- flu-like sx incl fever
- dry cough
- relative bradycardia
- confusion
- lymphopaenia
- hyponatraemia
- deranged LFts
Investigation findings of legionella pneumonia
Bloods - lymphopaenia, hyponatraemia, derranged LFTs
CXR - mid-lower zone predominance of patchy consolidation + 40% show pleural effusions
Diagnosis = urinary antigen
Complications of chronic hepatitis C
- rheum: arthralgia, arthritis
- eyes : Sjorgren’s syndrome
- cirrhosis - 5-20%
- hepatocellular Ca
- cryoglobulinaemia type II (monoclonal and polylconal)
- prophyria cutanea tarda (esp if with alcohol abuse)
- membranproliferative glomerulonephritis
Fts of acute hepatitic C infection
- transient rise in serum aminotransferases/jaundice
- fatigue
- arthralgia
fts of rabies
animal bite (usually dog) in rural areas of Africa and Asia
- prodrome = headache, fever, agitation
- hydrophobia = water-provoking muscle spasms
- hypersalivation
- negri bodies: cyoplasmic inclusion bodies found in infected neurons
Treatment for rabies
immediate treatment - nearest Dr
- if already immunized: 2 further doses + abx
- if not immunized: human rabies immunoglobulin (HRIG) + full course of administered, if possible locally aroudn the wound
abx for prophylaxis for contacts of pts with meningococcal meningitis
oral ciprofloxacin
