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Royal College 2023 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

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1
Q

What is immunosenescence?

A

Declining function of the immune system
Reduced ability to trigger effective antibody and cellular responses against infections and vaccinations

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2
Q

What type of immunity does aging more extensively affect?

A

Acquired immunity vs. innate

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3
Q

What physiologic changes of aging occur with regards to the immune system?

A

Inc CV risk factors = local cell death = inflammatory cytokines
Thymic involution = dec regulatory/naive T lymphocytes in favour of memory T cells
Inc adipose tissue = makes IL-6, TNF-A and adipokines
Chronic exposure to stress = pro inflammatory influence on T lymphocyte function

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4
Q

What are risk factors for TB in the elderly?

A
  1. Immunosenescence - lymphopenia
  2. Inflammaging
  3. Decreased lung function
  4. Individual susceptibility - comorbidities
  5. Closeness in LTC
  6. Use of steroids or immunosuppressants
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5
Q

What vaccines are recommended for older adults?

A
  1. Tetanus/diphtheria - primary series then booster q10 years
  2. Herpes zoster - 50+ yo recommend 2 doses Shingrix (1 year after Zostavax or infection)
  3. Influenza - annual
  4. Measles/mumps - 1 dose if born after 1970
  5. Pertussis - 1 dose in adulthood
  6. PNA - 1 dose 65+
  7. Varicella - if known seronegative 2 doses
  8. COVID-19
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6
Q

What are 3 age related changes that make older adults at increased risk for C diff?

A
  1. Dec production of anti-toxin antibodies
  2. Altered gut microbiota (colonization resistance)
  3. Dec innate immune response
    Other
  4. Inc likelihood of exposure to meds that inc risk like ABs, PPI
  5. More exposure to healthcare/hospitalization
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7
Q

What are 4 reasons that those in LTC have inc risk of C diff?

A
  1. Antibiotic use
  2. Immunosenescence/older age
  3. Frequent need for hospitalization
  4. Presence of underlying comorbidities
  5. Exposure to chemo and immunosuppressants
  6. Close patient proximity/shared washrooms
  7. Inadequate hand hygiene
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8
Q

What are 3 infection control measures to reduce the spread of C diff?

A
  1. Hand hygiene
  2. Contact precautions
  3. Isolation
  4. Environmental cleaning
  5. Appropriate antibiotic use
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9
Q

What are 6 factors that increase transmission of COVID in LTC?

A
  1. Older facility age
  2. Resident index case
  3. Poorer assessment tool performance
  4. Occurrence of staff infections
  5. Crowding
  6. Chain ownership
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10
Q

What are 8 steps to manage an outbreak in LTC?

A
  1. Determine if patient was exposed to others
  2. Isolate and test contacts
  3. Notify hospital if within 14 days of transfer
  4. Increase frequency of cleaning and disinfection
  5. Movement restrictions for residents (stop non essential activities)
  6. Use portable equipment
  7. Inc frequency of screening
  8. Contact tracing of individuals
  9. Visitor restrictions
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11
Q

What are 4 benefits of flu vaccine?

A

Prevents confirmed flu
Prevents flu like illness
Reduce time off work
Provides cost savings
Reduce risk of flu associated hospital and ICU

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12
Q

What are anticipated adverse effects from antiviral prophylaxis for influenza?

A
  1. Diarrhea
  2. Nausea/vomiting
  3. Dizziness
  4. Oropharyngeal or facial edema
  5. Bronchospasm
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13
Q

What are 3 conditions that predispose to herpes zoster?

A
  1. Transplant patients
  2. Autoimmune disease
  3. HIV infection
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14
Q

Why is zoster more frequent in the trigeminal distribution?

A

In primary varicella infection, virus airborne to nasopharynx
Migrates to lymphoid tissue
Infects nerve endings of skin of that area

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15
Q

What is the first line therapy for C diff?

A

Fidaxomicin 200 mg BID x 10 days
alternative: Vancomycin 125 mg PO QID x 20 days

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16
Q

What is the best treatment for fulminant C diff infection?

A

Vancomycin 500 mg PO QID
IV metronidazole 500 mg q8hrs especially if ileum

17
Q

Why are the elderly at high risk of TB reactivation?

A
  1. Immunosenescence = less able to suppress latent TB
  2. Age related comorbidities
  3. TBST reactivity may be reduced = dec tx of latent TB
  4. Reactivation risk with immunocompromising conditions and age related decline in cell mediated immunity
18
Q

What are 5 features of post-polio syndrome?

A
  1. Somatic weakness
  2. Respiratory weakness
  3. Dysphagia
  4. Fatigue
  5. Pain
  6. RLS
19
Q

What are the diagnostic criteria for post polio syndrome?

A

1, A prior episode of poliomyelitis with evidence of residual motor neuron loss
2. A period of at least 15 years after the acute onset of polio with neurologic and functional stability
3. A gradual (or rarely abrupt) onset of new weakness and abnormal muscle fatigability that persists for at least one year
4. Exclusion of other medical conditions that cause similar symptoms

20
Q

What do you need to consider with exercise program for people with post polio?

A

Non-fatiguing exercise programs that use low-intensity sessions with short repetitions lasting several seconds, alternating with intervals of rest

Overexertion or overuse should be avoided during these sessions

21
Q

You have been asked to establish a new facility-wide infection control program in a long-term care facility. Based on Society for Health Care Epidemiology of America and the Association of Professionals for Infection Control (SHEA/APIC) guidelines, list 5 key components of such a program.

A

Accept any 5 of:
* Surveillance – systematic data collection to identify infections
* Outbreak control – a system for detection, investigation, and control of epidemic infectious diseases in the LTCF
* Isolation – an isolation and precautions system to reduce risk of transmission
* Antibiotic stewardship – a system for antibiotic review and control
* Disease reporting to public health authorities
* Facility management, including environmental control, waste management, product evaluation and disinfection and sterilization procedures
* Formal policies and procedures relevant to infection control
* Continuing education in infection prevention and control
* Resident health program (history and physical on admission, review of immunization records, antiviral prophylaxis as appropriate, etc.)
* Employee health program (including assessment of immunization status upon employment, annual influenza vaccination)
* Performance improvement / resident safety
* Preparedness planning

22
Q

Risk factors for the development of resistant organisms in the elderly.

A
  • prior antibiotic treatment
  • inappropriate antibiotic use
  • chronic lung disease
  • chronic liver disease
  • cerebral disease
  • prior multidrug resistant infection or colonization
  • recent hospitalization
  • longer hospital stay
  • endotracheal tracheostomy
  • mechanical ventilation
  • tube feeding
  • nursing home residence
  • higher disease severity score

Royal College 2023 (79 decks)

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