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Infectious diseases Flashcards

1
Q

Name 5 main live attenuated vaccines

A

BCG
MMR
oral polio
yellow fever
oral typhoid

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2
Q

HIV testing

When is p24 indicated?
What is better in testing asymptomatic individuals with signs of chronic infection?

A

P24 test
* Present in newly infected individuals during infection and seroconversion

HIV-1/2 Ab/Ag immunoassay
* screening for chronic HIV infection (most sensitive)

HIV RNA
* For neonatal HIV infection, screening blood donors

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3
Q

Malaria treatment

Non-falciparum malaria

A

Chloroquine sensitive area
* ACT or chloroquine
Chloroquine resistant area
* Artemisin based combination therapy like artemther-lumefantrine

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4
Q

Malaria treatment

Ovale, vivax

Describe the features distinguishing between vivax/ovale & malariae

A

Give chloroquine after initial treatment to destroy liver hypnozoites and prevent relapse

Features
* general features of malaria: fever, headache, splenomegaly
* Plasmodium vivax/ovale: cyclical fever every 48 hours.
* Plasmodium malariae: cyclical fever every 72 hours, is associated with nephrotic syndrome.

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5
Q

Malaria treatment

When is IV artesunate indicated?

A

IV artesunate - parasite count >2%
Give ACT for uncomplicated falciparum malaria
>10% parasitaemia - exchange transfusion

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6
Q

Fever in the returning traveller

Three days ago
Muscle ache
Headache
Maculopapular rash
Thrombocytopenia

A

Dengue fever
Remember break-bone fever
Virus induced bone marrow suppression and liver derangements
Facial flushing

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7
Q

Dengue - management

A

No drug treatment, just supportive

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8
Q

Botulism - describe features of presentation

A

Features
* patient usually fully conscious with no sensory disturbance
* flaccid paralysis
* diplopia
* ataxia
* bulbar palsy

Risk factors - eating tinned food, IVDU

Can mimic Guillian barre syndrome

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9
Q

Management of strongyloidosis

A

Ivermectin

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10
Q

Diarrhoea in traveller

What are the differences between shigella, giardia, campylobacter, entamoeba histolytica

A

Shigella dysenteriae
* Incubation period 1-3 days
* Bloody diarrhoea
Campylobacter jejuni
* Bloody diarrhoea - incubation period 2-4 days
Giardia lamblia
* Incubation 3-40 days
* Non bloody diarrhoea
Entamoeba histolytica
* Amoebiasis 2-4 weeks incubation
* Entamoeba - months to years
* Bloody diarrhoea

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11
Q

Syphilis investigations

Non-treponemal tests

A

Not specific for syphilis
* RPR
* VDRL
* Will become negative after treatment, will show repeat infection

Treponemal specific tests
* Qualitative results - reactive vs non-reactive
* Remain positive after the first infection
* TPHEA, TP-EIA

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12
Q

Campylobacter vs Salmonella

A

Campylobacter
* Bloody diarrhoea
* Barbecues

Salmonella typhi
* Abdo pain
* Constipation
* Vomiting

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13
Q

Antibiotic for cryptosporidiosis
Only for immunocompromised

A

Nitazoxanide

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14
Q

Management of multibacillary leprosy (>6 lesions)

A

This man has multibacillary leprosy (>6 lesions) so should have triple therapy with rifampicin, dapsone and clofazimine for 12 months. For paucibacillary leprosy (5 or less lesions) you should give rifampicin and dapsone for 6 months.

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15
Q

CSF analysis
Describe analysis of bacterial, viral, tuberculosis - appearance, glucose, protein, white cells

A
  • Bacterial - cloudy, low glucose, high protein, WCC high in polymorphs
  • Viral - clear or cloudy with slightly low glucose, normal prtein, lymphocytes WCC high
  • Tuberculosis - slight cloudy with fibrin web, low glucose, high protein with high lymphocytes
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16
Q

What is used to confirm tuberculous?

A

The Ziehl-Neelsen stain is only 20% sensitive in the detection of tuberculous meningitis and therefore PCR is sometimes used (sensitivity = 75%)

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17
Q

What would be the result for mumps meningitis

A

*mumps is unusual in being associated with a low glucose level in a proportion of cases. A low glucose may also be seen in herpes encephalitis
evidence of viral features of CSF sample

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18
Q

Which HPV serotypes increase risk of cervical cancer

A

Human papillomavirus (HPV), particularly serotypes 16,18 and 33, is by far the most important factor in the development of cervical cancer.

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19
Q

HIV management

Antiretroviral therapy

Describe a typical HIV regimen and rationale

A

Antiretroviral therapy (ART) involves a combination of at least three drugs, typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). This combination both decreases viral replication but also reduces the risk of viral resistance emerging

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20
Q

HIV management

Describe MOA of entry inhibitors
Give 2 examples

A
  • Prevents HIV from entering immune cells
  • CCR5 antagonist - maraviroc
  • Fusion inhibitor - enfuvirtide
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21
Q

HIV management

Nucleoside analogue reverse transcriptase inhibitors
MOA
General SE
Give examples

A

examples:
zidovudine (AZT),
abacavir,
emtricitabine,
didanosine,
lamivudine,
stavudine,
zalcitabine,
tenofovir
general NRTI side-effects: peripheral neuropathy

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22
Q

HIV management

Specific SE for NRTI
Tenofovir
Zidovudine
Didanosine

A
  • Tenofovir - renal impairment and ostesoporosis
  • Zidovudine- anaemia, myopathy, black nails
  • Didanosine - pancreatitis
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23
Q

Give 2 examples of NNRTI
SE

A

Non-nucleoside reverse transcriptase inhibitors (NNRTI)
examples: nevirapine, efavirenz
side-effects: P450 enzyme interaction (nevirapine induces), rashes

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24
Q

HIV management

Give 4 examples of protease inhibitors
Give 6 SE

A

Protease inhibitors (PI)
examples: indinavir, nelfinavir, ritonavir, saquinavir
side-effects: diabetes, hyperlipidaemia, buffalo hump, central obesity, P450 enzyme inhibition

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25
Integrase inhibitors MOA Examples
Integrase inhibitors * block the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell * examples: raltegravir, elvitegravir, dolutegravir
26
HHV-5 infection Also known as... Treatment of CMV post renal transplant
Human herpes virus 5 (HHV 5), is cytomegalovirus (CMV). In patients who are post-transplant, CMV infections can occur from reactivation of latent infection, infection via the transplanted organ, or because of a new primary infection. 'Treatment is with IV ganciclovir, and where there is ganciclovir resistance, foscarnet or cidofovir are alternative options.
27
# Tuberculosis management Describe initial phase of treatment Describe the continuation phase of treatment
Initial phase - first 2 months (RIPE) * Rifampicin * Isoniazid * Pyrazinamide * Ethambutol (the 2006 NICE guidelines now recommend giving a 'fourth drug' such as ethambutol routinely - previously this was only added if drug-resistant tuberculosis was suspected) Continuation phase - next 4 months * Rifampicin * Isoniazid
28
# Tuberculosis management Latent tuberculosis
The treatment for latent tuberculosis is 3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine)
29
# Tuberculosis management Management of meningeal TB
Patients with meningeal tuberculosis are treated for a prolonged period (at least 12 months) with the addition of steroids
30
# Anti-viral agents Aciclovir MOA Indications SE
Name of drug: Aciclovir Mechanism of action: Guanosine analog, phosphorylated by thymidine kinase which in turn inhibits the viral DNA polymerase Indications: HSV, VZV Adverse effects/toxicity: Crystalline nephropathy
31
# Anti-viral agents Galcanciclovir MOA Indications SE
Name of drug: Ganciclovir Mechanism of action: Guanosine analog, phosphorylated by thymidine kinase which in turn inhibits the viral DNA polymerase Indications: CMV Adverse effects/toxicity: Myelosuppression/agranulocytosis
32
# Anti-viral agents Ribavirin MOA Indications SE
Mechanism of action: Guanosine analog which inhibits inosine monophosphate (IMP) dehydrogenase, interferes with the capping of viral mRNA Indications: Chronic hepatitis C, RSV Adverse effects/toxicity: Haemolytic anaemia
33
# Antiviral agents Amantadine MOA Indications SE
Mechanism of action: Inhibits uncoating (M2 protein) of virus in cell. Also releases dopamine from nerve endings Indications: Influenza, Parkinson's disease Adverse effects/toxicity: Confusion, ataxia, slurred speech
34
# Anti-viral agents Oseltamivir MOA Indications
Mechanism of action: Inhibits neuraminidase Indications: Influenza
35
# Anti-viral agents Foscarnet
Name of drug: Foscarnet Mechanism of action: Pyrophosphate analog which inhibits viral DNA polymerase Indications: CMV, HSV if not responding to aciclovir Adverse effects/toxicity: Nephrotoxicity, hypocalcaemia, hypomagnesaemia, seizures
36
# Anti-viral agents Interferon alpha
Name of drug: Interferon-α Mechanism of action: Human glycoproteins which inhibit synthesis of mRNA Indications: Chronic hepatitis B & C, hairy cell leukaemia Adverse effects/toxicity: Flu-like symptoms, anorexia, myelosuppression
37
# Anti viral agents Interferon alpha
Name of drug: Interferon-α Mechanism of action: Human glycoproteins which inhibit synthesis of mRNA Indications: Chronic hepatitis B & C, hairy cell leukaemia Adverse effects/toxicity: Flu-like symptoms, anorexia, myelosuppression
38
# Anti-viral agents Cidofovir
Name of drug: Cidofovir Mechanism of action: Acyclic nucleoside phosphonate, and is therefore independent of phosphorylation by viral enzymes (compare and contrast with aciclovir/ganciclovir) Indications: CMV retinitis in HIV Adverse effects/toxicity: Nephrotoxicity
39
# Helminths: roundworms Strongyloides Stercoralis Presentation Treatment
Features include diarrhoea, abdominal pain, papulovesicular lesions where the skin has been penetrated by infective larvae e.g. soles of feet and buttocks, larva currens Treatment - ivermectin, bendazoles
40
# Helminths: roundworms What helminth infection can cause elephantiasis? What is the vector? What is the treatment?
* Wuchereria bancrofti * Transmission by female mosquito * causing blockage of lymphatics * Treatment: diethylcarbamazine
41
# Helminths: roundworms What is Lofflers syndrome
This is when helminths like ascaris lumbricoides migrate to the lung
42
# Helminths: tapeworms Echinococcus granulosus * Features * How is it transmitted * Which occupation is this more common??
* Fetaures - liver cysts causing anaphylaxis in rupture * Transmitted through ingestion of eggs in dog faeces * Often seen in farmers | Treatment is bendazoles
43
# Helminths: tapeworms Cysticerosis and neurocysticercosis
Ingesting undercooked pork Mass lesions in brain with swiss cheese appearances | Treatment is bendazoles
44
# Helminths: Trematodes Schistosoma haematobium
* host: snails * cercariae penetrate the skin * swimmers itch manifests with frequency, haematuria * Risk factor for squamous bladder cancer * treated with praziquantel
45
# Helminths: Trematodes Which organism is transmitted by ingsting Undercooked crabmeat Undercooked fish
* Undercooked crabmeat - paragonimus westermani * Undercooked fish - features include biliary tract inflammation, rf for cholagniocarcinoma * Both are treated with praziquantel
46
What organism is also known as the liver fluke
Fasciola hepatica Causes biliary obstruction Treated with triclabendazole
47
Coxiella burnetti Q fever
* Associated with abbatoir workers, cattle/sheep based jobs * Prodromal illness - fever, malaise * PUO * Transaminitis * Atypical pneumonia * Endocarditis culture negative * Treated with doxycycline
48
Necrotising fascititis Type 1 and Type 2
* 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
49
Necrotising fasciitis risk factors
* skin factors: recent trauma, burns or soft tissue infections * diabetes mellitus - most common preexisting medical condition - particularly if the patient is treated with SGLT-2 inhibitors * intravenous drug use * immunosuppression
50
How does necrotising fasciitis present?
acute onset pain, swelling, erythema at the affected site often presents as 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
51
Leishmaniasis Name the 3 types and the subtype that causes each one
Cutaneous leishmaniasis * Leishmania tropica or Leishmania mexicana Mucocutaneous leishmaniasis - mucosal ulceration of nose, pharynx * Leishmania braziliensis Visceral leishmaniasis * mostly caused by Leishmania donovani
52
Causes of false positive non-treponemal (cardiolipin) tests:
pregnancy SLE, anti-phospholipid syndrome tuberculosis leprosy malaria HIV yaws
53
Infections that can result in viral haemorrhagic fever
Yellow fever Dengue fever Lassa fever Ebola
54
# Viral Haemorrhagic fevers What is plasma leak? How do you manage discharging a patient with viral haemorrhagic fevers?
The plasma leak phase may occur anytime within the first 48 hours after the fever has broken and manifests with leakage into pleural and peritoneal spaces. It may be accompanied by shock and in some cases haemorrhage. Platelets and renal function may be falsely reassuring as they tend to improve after the febrile phase but rising haematocrit is a sensitive sign of plasma leak. It is therefore essential to monitor patients for a full 48 hours after the febrile phase and ensure haematocrit is stable prior to discharge. Platelets should be at least 50 * 109/l and rising prior to discharge.
55
Yellow fever Vector Incubation period
zoonotic infection: spread by Aedes mosquitos incubation period = 2 - 14 days
56
Yellow fever Presentation
* may cause mild flu-like illness lasting less than one week * classic description involves sudden onset of high fever, rigors, nausea & vomiting. * Bradycardia may develop. * A brief remission is followed by jaundice, haematemesis, oliguria * If severe jaundice, haematemesis may occur Councilman bodies (inclusion bodies) may be seen in the hepatocyte
57
Complications of mycoplasma pneumoniae
* cold agglutins (IgM): may cause an haemolytic anaemia, thrombocytopenia * erythema multiforme, erythema nodosum * meningoencephalitis, Guillain-Barre syndrome and other immune-mediated neurological diseases * bullous myringitis: painful vesicles on the tympanic membrane * pericarditis/myocarditis * gastrointestinal: hepatitis, pancreatitis * renal: acute glomerulonephritis
58
Pneumonias - worsening flu like symptoms with dry cough... diagnosis?
Mycoplasma pneumoniae
59
Legionella and mycoplasma share some similarities in presentation and treatment, how do we differentiate them?
60
Steps in screening for pulmonary TB for close contacts (asymptomatic)
* You are testing for latent TB because the patient is asymptomatic * If asymptomatic and younger than 65 years then test for latent TB. If Mantoux-negative and unvaccinated then offer vaccination. If at risk of HIV then test for HIV first. * If asymptomatic and older than 65 years then assess with a chest X-ray.
61
How to test for active TB?
CXR: upper lobe cavitation is classical finding for reactivated TB + 3 sputum sample **smears** for MC&S - ZN staining + Sputum culture is gold standard but can take 1-3 weeks + NAAT allows rapid dx 24-48h
62
What is the first line agent for ESBL
Ertapenem Extended spectrum B-lactamase (ESBL) producing organisms are typically resistant to penicillins and cephalosporins and as such the carbapenem class of antibiotics are typically first-line although nitrofurantoin or fosfomycin are also frequently effective.
63
What are Calabar swellings a sign of?
Loiasis is a filarial infection caused by Loa Loa. It is transmitted by the Chrysops deerfly and tends to occur in rainforest regions of Western and Central Africa. Clinical features * pruritus * urticaria * Calabar swellings: transient, non-erythematous, hot swelling of soft-tissue around joints * 'eye worm' - the dramatic presentation of subconjunctival migration of the adult worm.
64
# Viral haemorrhagic fevers Triad of symptoms
* Haemorrhage manifestations, platelets <100, evidence of plasma leakage
65
Management of contacts of measles: * in a child * in an immunosuppressed patient
* Unimmunized child that is exposed -then MMR should be offered (vaccine-induced measles antibody develops more rapidly than that following natural infection)- this should be given within 72 hours * Immunosuppressed patient - administer immunoglobulin following exposure will reduce risk of infection
66
# HIV medication What is eviplera a combination of?
* emtricitabine * rilpivirine * tenofovir
67
How does ritonavir interact with steroids to cause Cushings?
Ritonavir is a protease inhibitor which are potent P450 inhibitors. Steroids are metabolised by P450 system. So addition of ritonavir will cause increased bioavailability of the drug.
68
# Clinicl pharmacology Can you give first-line TB therapy to a patient on anti-retrovirals?
Rifampicin interacts with protease inhibitors. Rifampicin is a potent induer of p450 reducing concentration of ritonavir. Rifabutin is used as it is less potent inducer of P450.
69
# Pneumocystis Jiroveci Indication for PJP prophylaxis in HIV patients What is a common complication of PJP
Indication for PCP prophylaxis in HIV patients - CD4 count <200 Pneumothorax is a common complication of PCP. CXR - bilateral interstitial pulmonary infiltrates Sputum often negative so BAL needed to demonstrate silver staining showing characteristic cysts Management - cotrimoxazole
70
# Pneumocystis Jirovecii Management of severe PJP When do you give steroids?
IV pentamidine Aerolised pentamidine is also used but less effective with risk of pneumothorax Steroids are used if hypoxia ie pO2<9 as it reduces risk of respiratory failure by 50% and death by a third
71
How can meningitis type A, B, C be distinguished by geographic locations?
Type A - saudi arabia Type B, C- Europe and South America
72
# Listeria meningitis How is it usually spread? Risk factors
Listeria monocytogenes is a Gram-positive bacillus which has the unusual ability to multiply at low temperatures. It is typically spread via contaminated food, typically unpasteurised dairy products. Risk factors elderly neonates immunosuppression especially glucocorticoids pregnancy
73
# Listeria infection Presentation
gastroenteritis diarrhoea bacteraemia flu-like illness central nervous system infection meningoencephalitis ataxia seizures
74
# Investigations Listeria infection Blood culture appearance CSF findings - wcc, protein, glucose
blood cultures * 'tumbling motility' on wet mounts cerebrospinal fluid findings: * pleocytosis, often lymphocytes (nontuberculous bacteria usually cause a rise in neutrophils) * raised protein * reduced glucose
75
# Rickettsial diseases Typhus types
Endemic typhus - fleas on rats, relative brady Epidemic typhus - body louse, prowazekii, Africa, South America Spotted fever - Rocky Mountain, spread by ticks
76
Presentation of typhus Antibiotic for typhus
Maculopapular rash Fever headache malaise Exotic travel locations Mx - doxycycline
77
Management of multi drug resistant TB
multi-drug resistant TB requires 18-24 months of at least 5 drugs.
78

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