Infectious Diseases Flashcards
1
Q
measles
A
Notify department of health
– Take blood for measles serology-in Australia measles vaccine is given at the age of 12 months.
– Discuss the nasal swab PCR for measles with the department of health.
– Isolate her in the community from other contacts.
– There is no need to send the patient to the emergency department as it would risk the spread of measles to other susceptible patients in the hospital.
2
Q
Zostavax
A
vaccine used to prevent herpes zoster infection
live attenuated vaccine
3
Q
Zostavax contraindications
A
– Severely immunocompromised patients such as this patient who is on long term
steroids for his rheumatoid arthritis.
– Hematological malignancy.
– Recipients of haemopoietic stem cell transplantation.
-HIV infection and immunosuppression (below 15% CD4 lymphocytes).
4
Q
Genital chlamydial infection
A
sexually transmitted
is commonly asymptomatic until severe salpingitis or urethritis occurs
common cause of infertility due to
tubal obstruction
5
Q
cat scratch disease
A
- B.henselae from cats to humans through a contaminated
cat scratch wound or across a mucosal surface - Symptoms occurs 3 to 10 days after initial injury.
- papulopustular lesions at the bite site
- enlarged tender regional lymph nodes.
6
Q
Axillary vein thrombosis
A
sportsmen
after strenuous exercise like wrestling.
oedema and redness
No tender lymphadenopathy
7
Q
JE vaccination for shorter-term travellers, particularly if:
A
travel is during the wet season
travel may be repeated
the person will spend a lot of time outdoors
the person’s accommodation has no air-conditioning, screens or bed nets
8
Q
Typhoid vaccine may be recommended for travellers ≥2 years of age travelling to
endemic regions, including:
A
the Indian subcontinent
most Southeast Asian countries
several South Pacific nations, including Papua New Guinea
9
Q
cholera vaccine
A
Most travellers do not need
not officially recommended by WHO
10
Q
if the traveller has never received a dose of traveller has never received a dose of dTpa.
A
offer dTpa vaccine
11
Q
if the last dose was more than 10 years ago
A
Adults are recommended to receive a booster dose of tetanus-containing vaccine
12
Q
Fever with rigors and chills
A
Biliary sepsis, lymphoma, pyelonephritis and pneumococcal pneumonia
13
Q
Thailand + fever + rash + joint pain + low platelets + low WBC
A
Dengue fever
14
Q
Dengue fever treatment
A
Suppurative treatment
15
Q
Zika virus
A
microcephaly
- SEEN IN BABIES
16
Q
shingles (herpes zoster infection)
A
- within 72 hours= famciclovir or acyclovir for
7-10 days after taking the viral swab.
after 72 hours since the onset of rash= no
benefit with antiviral treatment.
17
Q
key serological feature of hepatitis D
A
Anti-LKM3 (liver, kidney microsomes)
18
Q
autoimmune hepatitis.
A
anti-LKM1
19
Q
outcome of liver transplantation
A
chronic hepatitis D is better than that for
chronic hepatitis B
20
Q
Chronic hepatitis D infection
A
increases the severity and progression of chronic hepatitis
21
Q
if HDV infection occurs in acute hepatitis B
A
Chronic hepatitis D infection is unlikely
22
Q
malaria incubation period
A
23
Q
malaria prevention
A
- Doxycycline 100mg daily one day before the trip and continuing for four
weeks after leaving malaria zone. - Atovaquone/proguanil 250mg/100mg tablet started 1-2 days before travel and continued for
seven days after leaving malaria area
24
Q
clinical diagnosis of herpes zoster infection
A
- maxillary nerve of the trigeminal nerve in this patient with a rash without an eruption.
Severe unilateral facial pain may be the first symptom of acute herpes zoster (shingles) and precedes the skin rash by a few days
25
Trigeminal neuralgia
sudden, brief and very severe paroxysms of
pain on one side of the face, in the distribution of one or more branches of the
trigeminal) nerve.
26
Definitive diagnosis of N. gonorrhoea infection
nucleic-acid amplification testing of a urethral or urine sample
27
Appropriate therapy for gonococcal urethritis
single dose of ceftriaxone 250 mg
intramuscularly plus a single dose of azithromycin 1 gram orally
28
Treatment of Chlamydia
- Single dose of 1-gram Azithromycin or Doxycycline for
seven days.
- Should not have sex until at least a week has passed after the treatment.
- notifiable disease
29
Post-exposure prophylaxis for hepatitis B (hepatitis B vaccine and immunoglobulins)
recommended
– The exposed person has been vaccinated in the past and the post-vaccination antiHBs level is below 10 mIU/ml.
– Un-vaccinated exposed individuals.
– Unknown vaccination status of the exposed person.
30
previously vaccinated persons exposed + response to previous vaccination is unknown
the anti-HBs level should be
determined as quickly as possible
31
previously vaccinated persons exposed+
protective response anti-HBs level =10
mIU/mL at any time after previous vaccination
post-exposure prophylaxis is
not necessary
32
Live attenuated zoster vaccine is contraindicated in persons
– Chemotherapy.
– Radiation therapy.
– Oral corticosteroids (asthma, COPD, etc)
– Disease-modifying anti-rheumatic drugs (DMARDs).
– Malignant conditions of the reticuloendothelial system (such as lymphoma, leukaemia, Hodgkin’s disease).
– AIDS or symptomatic HIV infection.
33
positive HBsAg
positive HBcAb (IgM)
Acute infection
34
HBeAg positive
high infectivity in recent infection
35
influenza vaccine
- Protection for the mother and the
newborn baby for the first six months after birth
- free to all pregnant woman in Australia.
- recommended for all pregnant women regardless of
gestation.
- recommended for a woman planning a pregnancy.
- An unvaccinated pregnant woman should be immunised at any time during influenza season
36
unsafe sex + for HIV checkup
wait for 12 weeks before a test can
reliably confirm or rule out HIV infection
37
Contraindications for administering
pertussis-containing vaccinations
- severe allergic reaction to the vaccine (or
to one of its components)
- encephalopathy not due to any other cause within 7
days of a prior vaccination.
- Uncontrolled neurological disorders should prompt a
delay of the vaccination until the condition has been sufficiently assessed
38
Post sexual assault victim + STI prophylaxis
ceftriaxone 250 mg intramuscular as a single dose,
azithromycin 1 gram as a single dose and metronidazole 2 gram as a single
dose
to cover gonorrhoea, chlamydia species
and trichomonas vaginalis
39
most commonly seen symptom in botulism
Dysarthria
40
needle stick injury + exposure to an HIV positive person
PEP is recommended. ASAP
PEP should not be offered more than 72
hours after exposure.
health care worker should have
follow-up HIV-antibody testing at baseline, 6 weeks,
3months up to 6 months
41
medication of choice for prophylaxis
of malaria
Doxycyclin and atovaquone-proguanil
42
Current recommendations about chlamydia infection of urogenital tract
– Treat the patient with oral antibiotics.
– Do contact tracing and treat the patient’s all sexual contacts in last six months.
– Notify health department (GP responsibility).
– Repeat testing for chlamydia in 3-12 months for reinfection.
43
Most common pneumonia with HIV/AIDS
Pneumocystis Jiroveci (PJP)
44
dry cough + slow onset of pneumonia symptoms + CD4 < 200
Pneumocystis Jiroveci (PJP)
45
HIV + rapid onset acute pneumonia symptoms + lung consolidation
Streptococcus pneumoniae
46
hospital-acquired
pneumonia (HAP
Staphylococcus aureus
47
Streptococcus pneumoniae
community-acquired pneumonia
48
high grade fever + chills after recovering from pneumonia
IV cannula bacteraemia
49
copious yellow-green sputum + underlying condition (pneumonia)
Bronchiectasis
50
Bronchiectasis management
Ticarcillin-clavulanate.
51
foul-smelling productive cough + Fever + Weight loss + Malaise
lung abscess
52
high fever + respiratory symptoms precipitated from pneumonia treatment
Superinfection by a different type of bacteria.
53
fever + arthralgia/arthritis + skin rash precipitated by pneumonia treatment
Serum sickness (hypersensitivity reaction to penicillin)
54
lung abscess management protocol
1. chest X-ray
2. sputum stains and
cultures
3. Chest CT
Uncomplicated: IV antibiotics
Complicated: Transpleural drainage/lobectomy
55
eyebrow and eyelash loss with no loss of scalp hair; skin changes +
history of paresthesias
Hansens disease/ leprosy
56
Standard treatment for lepromatous leprosy
dapsone, rifampin, and clofazimine administered for 12 to 24 months.
57
Gonorrhea infection management
– Ceftriaxone 500mg IM in 2ml of 1% lignocaine Plus Azithromycin 1000mg stat
orally.
– Advise no sex even with condoms for 7 days and no sex with recent or previous
partners until they have been tested and treated.
– Contact tracing for gonorrhoea is recommended for the previous 2 months.
– Offer test of cure in 4 weeks.
58
patient on high-dose corticosteroids +
positive CSF India ink stain
Cryptococcal meningitis
59
patient with hemolytic uremic syndrome,
stool culture on sorbitol MacConkey will
help diagnose E coli O157:H7
60
Primary syphilis
-10-90 days after contact
- glans penis/vulva-cervix
61
Secondary syphilis
2-10 weeks
- headache, anorexia, vomiting, fever, neck stiffness
- non-pruritic bilateral maculopapular rash
- generalised non-tender lymphadenopathy
patchy alopecia/condylomata lata
62
Latent syphilis
63
Syphilis tests
dark field microscopy
rapid plasma reagin (RPR) test
fluorescent treponemal antibody absorption (FTA-ABS) tes
64
erythema nodosum + weight loss + productive cough/blood
Tuberculosis
65
Tuberculosis steps in investigation
1. QuantiFERON-TB/Tuberculin test
2. Chest X-ray
3. 3 sputum (AFB)
66
history of pulmonary tuberculosis +
MRI shows a right frontal lesion +
biopsied which shows
Caseating granulomas
67
patients with HIV + CD4 below 50 cells/μ
prophylaxis?
prophylaxis against Mycobacterium Avium
Complex (MAC) should also be commenced, after exclusion of active MAC Complex (MAC) should also be commenced, after exclusion of active MAC
or Mycobacterium Tuberculosis (TB)
68
opportunistic infections in HIV infected patients
- Pneumocystis jiroveci: Trimethoprim-sulfamethoxazole
- Toxoplasmosis: Trimethoprim-sulfamethoxazole
- Mycobacterium avium: Azithromycin
69
80-year-old + 3-day history of a painful rash +
forehead and down to his left eyelid + weeping vesicular lesions
Herpes zoster
70
Giardia lamblia
CLAMPS, bloating, loose stools or explosive watery foul diarrea smeling.
weight loss and steatorrea
**INCUBATION 7-14 DAYS**
dx: ELISA
PCR
STOOL MICROSCOPY
asymptomatic inmunocompetent DONT NEED TX
-
ssymptomatic or inmuno :
METRONIDAZOLE 2G X 3 DAYS
71
mainstay of Vibrio cholerae therapy
Oral glucoseelectrolyte solution rehydration
72
First-line treatment of PHN (Postherpetic neuralgia)
(TCAs)
73
Investigations for Men who have sex with Men (MSM)
– Pharyngeal swab for gonorrhoea
– Anal swab gonorrhoea and chlamydia PCR
– Urine PCR for chlamydia
– Serology for HIV, Syphilis, Hepatitis B and C.
– Vaccinate for hepatitis B if not immune
– Repeat test for HIV in 12 weeks (window period).
74
peripheral blood film in infectious mononucleosis (glandular fever)
lymphocytosis with >10% atypical/reactive
lymphocytes (Downey cells).
75
Elevated
aminotransferases + pharyngitis
possibility of IM.
76
Resuming activity in IM
resume non-contact sports after >3
weeks and contact sports >4 weeks after illness onset to prevent splenic rupture.
77
high grade fever+ swollen tonsils with exudate + rash precipitated by penicillin
Epstein-Barr infectious mononucleosis (EBV IM)
78
Epstein-Barr infectious mononucleosis (EBV IM) investigation
- Most appropriate: FBC to see lymphocytosis (>50% lymphocytes)
- Diagnostic: Paul-Bunnell test / Monospot test
79
EBV associated cancers
Burkitt lymphoma and nasopharyngeal CA.
80
Rocky Mountain spotted fever
tick bite
fever, headache, malaise, myalgia, nausea, vomiting,
and anorexia as the most common symptoms
Involvement of the palms and
soles is considered important for diagnosis of Rocky Mountain spotted fever.
81
Lyme
disease
Borrelia burgdorferi
erythema chronicum migrans, a target-shaped lesion
chronic
meningitis preceded by an arthralgia
Facial weakness may be the only neurologic sign of Lyme disease.
Optic neuritis
82
significantly decreased CSF glucose + high protein level + elevated CSF opening pressure
bacterial, TB, fungal and carcinomatosis meningitis,
83
bacterial meningitis treatment
1. IV antibiotics
2. Corticosteroids (dexamethasone)
3. analgesics
84
bacterial meningitis + Listeria
monocytogenes
ampicillin plus gentamicin.
85
infant + drowsiness + fever + petechial rash
meningococcaemia (life threatening)
86
meningococcaemia treatment
IV fluids + supplemental oxygen
87
sleeping sickness + tsetse flies
Human African trypanosomiasis
Pentamidine is used in the treatment
88
investigations in female sexual health workers
– HPV test 5-yearly (unless abnormal)
– HIV screening (if negative, proceed with HIV serology), then perform serology test annually
– First-catch urine for chlamydia and gonorrhoea PCR
– Syphilis serology and 12-monthly
– Endocervical swabs for Chlamydia and gonorrhoea 3 monthly (if 100% condom
use, more frequently if <100% condom use)
-Hepatitis A and B serology, (if hep A and B status unknown and patient has not
completed a course of hep A and B vaccination, offer testing and if no serological
evidence of immunity (i.e., anti-HA negative and/or anti-HBs negative, offer
appropriate immunisation) –> only perform annual serology test for hepatitis A and
B if not immunised)
– Hepatitis C serology and 12-monthly
If there is a history of oral sex without condoms, consider doing throat swab for
gonorrhoea and chlamydia.
89
immunity status is unknown in measles
recommended that all
immunocompetent. non-pregnant patient receive MMR of vaccine with in 72 hours
of exposure. A second dose should then follow at least 4 weeks later.
90
head injury to the left temporal region + unresponsive after a lucid interval + progressive right-sided weakness
epidural hematoma
features Rapid expansion expansion of
the EH:
Increase intracranial pressure (eg, Cushing triad of hypertension, bradycardia, and bradypnea),
compress compress the temporal lobe leads to uncal herniation
91
(in epidural hematoma)uncal herniation in temporal lobe causes:
- Ipsilateral fixed and dilated pupil from compression of the ipsilateral
oculomotor nerve (CN III)
- Contralateral hemiparesis Contralateral hemiparesis (compression of the ipsilateral cerebral peduncle)
-Contralateral homonymous hemianopsia with macular sparing from
compression of the ipsilateral posterior cerebral artery
worsening herniation = psilateral hemiparesis, a false localizing sign known as Kernohan phenomenon
92
Local tenderness + erythema + IV drug abuse
osteomyelitis
93
osteomyelitis investigation
MRI
94
acute dacryocystitis treatment
oral di/flucloxacillin, amoxicillin-clavulanate, or cephalexin
-IV if severe cellulitis,
orbital involvement (orbital cellulitis) or severe adjacent facial/periseptal cellulitis.
95
UTI treatment in renal impairment
Trimethoprim
96
HACEK
H Hemophilus,
A Aggregatibacter actinomycetmcomitans,
C Cardiobacterium hominis,
E Eikenella corrodens
K Kingella kingae.
97
HACEK in infective endocarditis complications
mycotic (infective) aneurysms
98
HACEK investigation
CT angiography
99
most common cause of epididymoorchitis
<35: Chlamydia
>35: E.coli
100
inflammation of meibomian glands
Internal hordeolum (meibomian
abscess).
101
Internal hordeolum infection pathogen
Staphylococcus aureus)
102
entamoeba histolytica
clinica
dx
tx
Amoebic dysentery and extraintestinal disease
uncommon in travelers who have spent less than one month in endemic area
-
*Amoebic liver abscess *Pleuropulmonary infection*Brain abscess*Perinephric or splenic abscess*Cardiac disease (e.g pericarditis
DX
Stool microscopy :The demonstration of cysts or trophozoites in the stool suggests intestinal amebiasis.*Antigen testing*Molecular methods: PCR
TX
1. **Asymptomatic carriage **of Entamoeba histolytica: luminal agent: Paromomycin 500 mg orally, 8-hourly for 7 days
2. **Invasive amoebiasis :**For acute amoebic colitis (dysentery), use:
1 Tinidazole 2 orally, daily for 3 days OR 2 Metronidazole 600 mg orally, 8-hourly for 7 days
3.**For severe amoebic coliti**s (eg frequent blood-stained stools, perforation, peritonitis or toxic megacolon), use:
1 Tinidazole 2 g orally, daily for 5 days OR
2 Metronidazole 800 mg (orally, 8-hourly for 7 days
103
entamoeba histolytica
AMOEBIC LIVER ABSCESS
clinic
dx
tx
*(A)
Sonogram shows a round mass consisting of a** band of peripheral solid part (arrows), and central liquefied part showing low-level internalechoes.**
(B)
A contrast-enhanced computed tomography scan shows a **peripheral solid and central liquefied part.**
* Upon surgical intervention, the central portion was liquefied and contained "anchovy paste."
104
Amoebic Vs Pyogenic Liver Abscess
105
SCHISTOSOMIASIS
genitourinary disease ?
It targets the vasculature of the GIT or genitourinary tract.
Egypt, other parts of Africa, South America, some parts of Southeast Asia, and China.
** highest insub-Saharan Africa**
Freshwater snails are the carriers (vectors).
Schistosoma haematobium=genitourinary disease . Hematuria and obstructive uropathy; associated with squamous cell bladder cancer
clinical:
local skin reaction
Within a week or so there is a generalized allergic response
A gastroenteritis-like syndrome
lymphadenopathy and hepatosplenomegaly.
Neurologic complications: Spinal cord neuroschistosomiasis (transverse myelitis), cerebral or cerebellar neuroschistosomiasis (increased ICP, focal CNS signs, seizures)
*Pulmonary complications: Granulomatous pulmonary endarteritis, pulmonary HTN, cor pulmonale; especially in patients with hepatosplenic involvement
dx:
Serology (high sensitivity and specificity), CBC (eosinophilia, anemia, thrombocytopenia)
S. Mansoni, S. Japonicum: eggs in stool, liver U/S shows fibrosis, rectal biopsy
*S. Hematobium: bladder biopsy, eggs in urine and occasionally stool, kidney, and bladder USG
tX :
***Praziquantel** (may need retreatment)*Add **glucocorticoid** if acute schistosomiasis or neurologic complications develop
106
HYDATID DISEASE
usually form hydatid cysts in the liver and lungs
dog parasite Echinococcus granulosus
Clinical manifestations:--------------------------------
Mostly asymptomatic
*If the liver is involved (2/3 of the time) nausea, vomiting, and right upper quadrant pain
*If the lung is involved (25% of the time)cough, chest pain, dyspnea, and hemoptysis
*Rupture of a cyst (usually hepatic) can cause severe anaphylaxis with possible death.
***Hepatosplenomegaly**
**DIAGNOSIS** :-----------------------------
Complete blood count:
*Mild eosinophilia + Mild elevation in liver function
labs Serologic and antigen assays:
***Enzyme-linked immunosorbentassay (ELISA)>>Can be used for primarydiagnosis and follow-up after treatment**
*A negative serologic test does not rule out echinococcosis.
**Cyst aspiration/biopsy:If serologic test indeterminate/negative.Caution: There is a risk of anaphylaxis andsecondary spread of infection.**
TX-------------------------------
First-line *Albendazole* Single cyst < 5 cm
Second-line*Image-guided percutaneous drainage*For Cysts 5-10 cm*Must be done in combination with medical therapy
Adverse effect:*Risk of seeding*Risk of anaphylaxis
Third-line:Resection:*Cysts > 10 cm* Complicated cysts*Associated with rupture, infection, Compression/mass effect, biliary fistulae, hemorrhage, multiple daughter cysts, or extrahepatic cysts
Adverse effect:The risk of seeding and anaphylaxis is less than percutaneous drainage as the attempt is to resect the whole cyst.
107
FILARIASIS
107
MALARIA
-infected mosquitoes (Female Anopheles mosquitos)
-Disproportionately high burden of malaria inSub-Saharan Africa.
*Incubation period: P. falciparum 7–14 days; others 12–40 days
FEVER+ CHILLS + HEADACHE = MALARIA
**PAROXYSMAL FEVER**
DX
febrile illness who have visited a malarious area, particularly within the preceding year.
*While malaria usually occurs within a few weeks of infection, the disease can occasionally be delayed for many months
*CBC***PERIPHERAL BLOOD SMEAR- THICK AND THIN FILMS** *Thick smear allows detection of parasites (some laboratories are poorly skilled with thick films).*Thin smear helps diagnose malaria type.*If the index of suspicion is high, repeat the smear (‘No evidence of malaria’ = 3 negative daily thick films).*OTHERS>> Newer tests (e.g. the malaria rapid diagnostic test, polymerase chain reaction [PCR] tests, and immune chromatographic test [ICT] card tests for PFM.
108
*Uncomplicated malaria TX
108
complicated malaria TX
109
ANTIMALARIAL PROPHYLAXIS
Malaria in pregnant women or patients with asplenia or hyposplenism is potentially serious, so itis strongly recommended that these individuals do not travel to malarious areas
MALARIA PROPHYLAXIS IN PREGNANCY *For pregnant patients who cannot defer travel to regions where **chloroquine-sensitive** malaria is present, mosquito avoidance measures should be used in conjunction with **chemoprophylaxis with chloroquine**. Mefloquine is also acceptable.*For pregnant patients who cannot defer travel to regions where** chloroquine-resistant** malaria is present, mosquito avoidance measures should be used in conjunction with chemoprophylaxis using **mefloquine**.
110
**TREATMENT OF MALARIA IN PREGNANT FEMALES **
111
MALARIA PROFILAXIS
112
DENGUE FEVER
CLINIC
Mosquito-borne (Aedes aegypti) viralinfection.
*** Incubation period 5–6 days**
Virus replicates in and destroys the bone marrow
**FEVER + SEVER HEADACHE + RASH **
113
DENGUE FEVER
DX
114
ZIKA VIRUS
SYMPTOMS
** SEXUAL EXPOSURE TO OTHER WHO WENT TO ENDEMIC AREAS**
115
ZIKA VIRUS
DX
TX
*If the husband came from zika affected area they should avoid unprotected sex for 3 months.*If the lady who wants to conceive comes from Zika-affected areas avoid unprotected sex for at least 8 weeks.
*And if they both came from zika affected area and are worried then doserology at 4 weeks, Or one sample at 2 weeks and the other at 8 weeks.
116
YELLOW FEVER
fever + bradicardia + jaundice
117
JAPANESE B ENCEPHALITIS
vector
area of risk
triad
FEBRILE + VOMITING + STUPOR
japanese b encephalitis
118
JAPANESE B ENCEPHALITIS *VACCINATION:
119
MURRAY VALLEY ENCEPHALITIS
where:
dx:
tx:
mosquito-borne virus that is found across Australia, Papua New Guinea, and Irian Jaya.
*MVEV is endemic to Northern Australia and causes occasional outbreaks across south-eastern Australia.
HIGH GRADE FEVER + NEUROLOGICAL COMPROMISE + TRAVEL TO NOTHERN AUSTRALIA)
120
ROSS RIVER FEVER
clinic:
121
ROSS RIVER FEVER
DX
TX
122
TRAVELLER’S DIARRHEA
when antibiotics?
| CLINICAL FEATURES
## Footnote
It occurs about 6–12 hours after taking infected food or water.
*The illness is usually mild and lasts only 2 or 3 days
Very severe diarrhoea, especially if associated with the passing of blood or mucus, may be a feature of **Shigella sp. or Campylobacter sp. infections and amoebiasis.***
Traveller’s diarrhoea is caused by a wide variety of organisms but mainly **enterotoxigenic E. coli(ETEC), Campylobacter sp., Shigella sp.** and **Salmonella sp.***
**Chemoprophylaxis is not recommended in healthy travellers.**
123
TRAVELLER’S DIARRHEA
mild
moderate
124
PERSISTENT DIARRHEA:
Giardiasis tx:
Amoebiasis tx:
125
CHOLERA
126
SHIGELLA INFECTION
TREATMENT
*SUPPORTIVE TREATMENT>> Correct dehydration
Antibiotics
*Ciprofloxacin
*Ceftriaxone
*Trimethoprim-sulfamethoxazole (TMP-SMX)
127
:)
128
CLOSTRIDIUM DIFFICLE
CLINICAL
RISK FACTORS
## Footnote
*Anaerobic gram +ve rod
*Produces 2 toxins that bind to intestinal mucosal cells
**Risk factors**
*Recent antibiotics use(clindamycin, ampicillin, cephalosporins,fluoroquinolones)*Proton-pump inhibitors*Recent hospitalization*Advanced age
*Causes pseudomembranous colitis and diarrhea
*Characterized by yellow-white plaques in the intestinal mucos
129
CLOSTRIDIUM DIFFICLE
DX
130
CLOSTRIDIUM DIFFICLE
TX
131
TYPHOID FEVER (Enteric fever)
SYMPTOMS
132
TYPHOID FEVER (Enteric fever)
INVESTIGATIONS : GOLD STANDAR?
MOST ACCURATE?
MNEMONIC BASU
133
TYPHOID FEVER (Enteric fever)
TX
134
TYPHOID FEVER (Enteric fever)
vaccination
135
recall salmonella -
136
CAMPYLOBACTER JEJUNI
late onset complications:
dx ?
tx?
reactive arthritis
guillian barre syndrome
137
gullian barre syndrome (GBS)
dx?
The diagnosis is largely based on clinical patterns
Diagnostic biomarkers are not available for most variants of the syndrome.
**CSF=Elevated protein (only after 5-7 days of disease)
-Lung function tests= If FVC <20 mL/kg transfer to ICU**
**-Screen for infection**:
*viral PCR/ antibodies
***stool culture for Campylobacter**
*mycoplasma antibodies and CXR
138
HEPATITIS A
clinic
no chronic disease
subclinicla or self limited
139
hepatitis A
investigations
140
hepatitis A
managment
reassurance and patient education.
Supportive care in symptomatic infection.
*Hospitalization if severe illness or clinical deterioration.
-Follow a fat-free diet.
*Avoid alcohol, smoking, and hepatotoxic drugs (until recovery).
*Advise on hygiene at home to prevent spread to close contacts and family members.
***Hep A can also be spread sexually and by IV drug use.**
*Wash hands carefully after using the toilet and disinfect them with antiseptic.
*Do not handle food for others with your fingers.
*Do not share cutlery and crockery during meals.
*Do not use tea towels to dry dishes.
***If there is a risk of occupational transmission of hepatitis A (e.g. food handlers, healthcare workers, child-care workers), then must be excluded from work for at least 1 week after the onset of jaundice.**
*Contact tracing.
***Notify the state or territory health department**.
141
hepatitis A
prevention
142
HEPATITIS B
clinical features:
143
hepatitis b
investigations ?
main viral investigation-
144
4 phases of chronic infection are:
## Footnote
HEPATITIS B
145
145
HEPATITIS B
TX
146
Hepatitis B - Prevention
vaccination
147
recall hepatitis B
148
HEPATITIS C
clinic
149
HEPATITIS C
Diagnosis and progress
150
HEPATITIS C
TX?
MARKERS OF CIRROHOSIS IN INFECTIVE HEPATITIS ?
## Footnote
TREATMENT?
151
HEPATITIS D
152
HEPATITIS E
153
MENINGOCOCCAL DISEASE
154
MENINGOCOCCAL DISEASE
INVESTIGATIONS
155
MENINGOCOCCAL DISEASE
PROPHYLAXIS
156
MENINGOCOCCAL DISEASE
VACCINES
157
MENINGOCOCCAL DISEASE
VACCINES WHO SHOULD GET IT ?
158
159
INFECTIVE ENDOCARDITIS
160
INFECTIVE ENDOCARDITIS
Responsible organisms:
161
INFECTIVE ENDOCARDITIS
clinical features
162
**INFECTIVE ENDOCARDITIS **
investigations
DUKE CRITERIA
163
INFECTIVE ENDOCARDITIS
TX
empirical tx?
prophylaxis ?
164
BRUCELLOSIS
triad:
symptoms:
malta fever
165
BRUCELLOSIS
dx
tx
166
recall
brucellosis
167
Q FEVER
-
clinical features:
sudden onset fever, rigors, and myalgia
caused by coxiella burnetii
168
Q FEVER
dx
tx
prevention
**ANTICUERPOS NO cultivos!**
169
INFECTIOUS MONONUCLEOSIS
170
INFECTIOUS MONONUCLEOSIS
RASH:
171
INFECTIOUS MONONUCLEOSIS
dx?
172
COVID 19 - CLINIC
## Footnote
covid 19
173
COVID 19
TX
174
SUMMARY VACC
COMPULSORY VACC
175
VOLUNTARY INMUNIZATIONS
