Infectious diseases 2 Flashcards
What tests should be done into TB?
Bloods:
- FBC
- CRP
- U&Es
- LFTS
**HIV test
Orifices:
- sputum smear - Ziehl Neelsen stain
- 3 samples
- Early morning
- Acid fast Bacilli *if positive should start treatment
- Sputum Culture
- 1-3 weeks to grow
X-ray:
- CXR
Complications of TB?
Massive haemoptysis
Cor Pulmonale
Bronchiectasis
Enteritis
Pericarditis
Pott’s disease
Anorectal disease - due to swallowed sputum
After a diagnosis of TB - who should be contacted?
Public health - TB is a notifiable disease
What are some of the complications of Malaria?
Severe anaemia
Intracerebral anaemia
Shock
- AKI
Hypoglycaemia
What would you expect the bloods to be in malaria?
Anaemia
Thrombocytopenic
Parasitaemia
Deranged coagulation
What are the symptoms for croup and how is it managed?
*caused by parainfluenza virus
Barking cough
Difficulty breathing
Hoarse voice
Males
Treatment:
- Steroids
- Supportive
Severe:
- Nebulised Adrenaline
- Oxygen therapy
What are the symptoms of viral pharyngitis?
Sore throat Hyperaemia of adenoids Coryzal symptoms Hoarseness to voice Dysphagia
What is the management for epiglottitis?
Caused by: H.Influenza
FBC
Blood Cultures
laryngoscope
Treatment:
- oxygen
- IV Ceftriaxone + Clindamycin
- Nebulised Adrenaline
- Inhaled corticosteroids
What are the antibiotics given for Necrotising Fasciitis?
Benzylpenicillin Flucloxacillin Gentamicin Metronidazole Clindamycin
How is the urine sample collected for STI from men?
First void urine
- which is then sent for NAAT
What are the symptoms of chlamydia in women?
Dysuria Clear discharge from the vagina Bleeding between periods Dyspareunia Prostatitis
What are the symptoms of chlamydia in men?
Dysuria
Watery discharge of penis
Pain in the testicles
What are some of the complications of gonorrhea?
Septic arthritis
Gonococcal conjunctivitis
Pelvic inflammatory disorder
Urethral strictures
What are the complications of TB:
Cervical lymphadenopathy
TB meningitis
Intestinal TB
Adrenal TB - hypoadrenalism
Kidney TB
- sterile pyuria
Peritoneal - TB ascites
Testicular infiltration
- infertility
Aspergilloma formation
- invades into the TB cavity
What are the diagnostic tests for TB?
Ziehl Neelsen Stain
Cultures
- 10 weeks
Liquid media Based radiometric assays
- picks up the metabolic activity of TB
What drug must be given with isoniazid?
Vitamin B6
If you are giving Rifampicin and patient is on warfarin, what do to do?
Rifampicin is an Inducer and thus will break down warfarin
- higher doses are needed
Which TB drug can cause vision defects including vision colour changes?
Ethambutol
What radiological signs may you see on x-ray of pneumonia?
Consolidation
Air-bronchograms (where the bronchi passess throughthe aveoli with high amount of fluid in them)
Pleural effusions
What are the types of pneumonia?
CAP
HAP
Aspiration
Ventilator associated
What are the risk factors for pneumonia?
Influenza Alcoholics Smokers <5 years old, >65 years Previous pneumonia Chronic lung disease Neurological pneumonia Immunosuppressed
What are the systemic signs of pneumonia?
Fever Herpes labias - known to reactivate Shock Central cyanosis AF
Whilst monitoring a patient with pneumonia, they are not improving, what should you do?
• Repeat Chest x-ray
• Tap any pleural effusions
• Re-culture for resistance organisms
- Reconsider diagnosis
Following a pneumonia and a patient deteriorates again what things may have caused the complication?
Empyema
Cellulitis
- from where the IV line was in
C. Diff
What is a differential for cellulitis?
Erysipelas
What are some complications of cellulitis?
Sepsis
Endocarditis
Necrotizing fasciitis
What are some complications of Infectious mononucleosis?
Splenic rupture
Malignancy - Lymphoma
Encephalitis
What type of vaccine is the BCG and who is it offered to?
Live attenuated vaccine with M. Bovis
Offered to those at risk:
- children with positive mantoux parents
It doesn’t prevent pulmonary TB but prevents extrapulmonary and meningitis
When taking a history from a patient with a fever after traveling, what questions do you want to ask?
Location
- risk of certain infections
Travel dates
- malaria etc usually presents 1 month later
Activities while away
- out in the open?
- water?
Prophylactic medication prior
- use of nets
- DDT
Past medical history
Viral hemorrhagic risk
What are the varying types of necrotizing fasciitis?
Type I: polymicrobial
Type II: haemolytica Step A
Type III: Marine
Type IV: Fungi
What are some complications of HSV-1?
Herpetic Keratitis - eye ulceration
Encephalitis
Bell’s palsy
Herpetic whitlow
What are the complications of chickenpox?
Pneumonia - 1-6 days after infection
Bacterial super-infection of the skin
Dissemination and spread to internal organs - especially in immunocompromised host
Encephalitis
*risk to pregnant women
How is VZV tested for and how is it treated?
Tzanck test
PCR testing
Serology
Treatment:
- Aciclovir >16 years old
+ IgG immunoglobulins (zoster Immunoglobulins) - for immunocompromised
Pregnancy:
<20 weeks: IgG immunoglobulins
> 20 weeks: Aciclovir *must be given 7 days after exposure
What is the classic triad of symptoms of EBV?
Headache
Malasia
Sore throat
Lymphadenopathy
+
Palatal Petechiae
Macular rash (usually due to penicillin use)
Complications of EBV:
Guillain Barre syndrome
Splenic rupture
Encephalitis
Lymphoma
What is the recommended antibiotic for enteric fever?
Ciprofloxacin
How many a child have a positive HIV antibody but not be HIV infected?
IgG antibodies from the mother can cross the placenta
List some AIDs defining illnesses:
Candidiasis of esophagus/ Bronchi
CMV
Kaposi’s sarcoma
Primary lymphoma - especially of brain
Disseminated TB
Pneumocystis Jiroveci
List some effects of HIV:
Neurological:
- AIDS Dementia Complex
- Neuropathies
Mucocutaneous Manifestations:
- maculopapular rash
- Puritiis
Haematological:
- Lymphopenia
- isolated thrombocytopenia
G.I:
- malabsorption
Renal:
- HIV nephropathy
- Nephrotic syndrome
Cardio:
- cardiomyopathy
What is the natural history of HIV?
Initial infection: usually asymptomatic
Seroconversion:
- fever
- maculopapular rash etc
Asymptomatic phase:
- usually have persistent generalised lymphadenopathy
AIDs related Complex
- prodromal features: weight loss, night sweats, HSV
AIDs
- AIDS defining features
- CD <200
Name a nucleotide reverse transcriptase inhibitor and non nucleotide reverse transcriptase inhibitor
Truvada (combination)
Efavirenz
What can cause a false positive for HIV test and how is it confirmed?
Lupus
Syphilis
Western blot can confirm diagnosis
What screening test can be done into HIV?
Rapid HIV testing
- needs follow up with ELSIA testing
ELSIA involves:
- p24
- HIV antibody
What is the confirmatory test done for HIV?
Western Blot test
Practical points in the Anti-retroviral drugs for HIV:
Must be taken as prescribed
Should not be stopped suddenly
Can be compromised by other drugs such as inducers and herbal medicines
- Rifampicin
- St John’s wort
Associated with adverse drug reactions
May exacerbate comorbidities
Complications of HAART therapy?
Allergic reactions
Lipodystrophy and metabolic syndrome
Mitochondrial
How is pneumocystis Jiroveci diagnosed?
High resolution CT
conformation:
- Bronchoalveolar lavage
- Blood test for PCR of pathogen DNA
What are some specific illnesses to complicate HIV?
Pneumocystis Jiroveci
CMV
- retinitis
Toxoplasmosis
Cryptococcal meningitis
- headache
- papilloedema
Progressive multifocal leukoencephalopathy
- JC virus
Kaposi sarcoma
- HHV8
What are some complications of Gonorrhoea?
Prostatitis Epididymitis Reactive arthritis Septic arthritis PID
How is syphilis diagnosed?
Serology for antigens
- Group Specific: TPHA
- Non specific: Cardiolipin, VDRL, RPR
*group specific always positive, non-specific should go down with treatment.
Dark Field microscopy
What are some differentials for malaria?
Dengue fever
Yellow fever
Pneumonia
Enteric Fever
What is the granuloma called in TB and what is it called when the lymph node is attached? and what is it called when its scared over?
Ghon focus
Ghon Complex
Ranke Complex
What are the treatment options for Flu and how are they delivered?
Oseltamivir - Oral - 5 days
Zanamivir - Nasal spray - 5 days
What are some of the complications of flu?
Febrile seizures
- in children
Secondary bacterial pneumonia
Viral pneumonia
Encephalitis
Croup
What are some common causes of a fever of unknown origin:
Usually defined as >38C for >3 weeks
Infections
Cancer - leukemia
Autoimmune/ vasculitis
- Adult’s still disease - this is a disease of exclusion and characterised by:
- myalgia
- lymphadenopathy
- splenomegaly
List some causes of a fever:
Infection Cancer Drug abuse - amphetamines VTE Trauma/ Surgery Heat stroke Epilepsy
What are the differentials for meningitis?
Migraine
SAH
Dengue fever
Malaria
Encephalitis
What should you do when doing an LP during meningitis?
Record opening pressures.
- they will be elevated
What are some poor prognostics of bacterial meningitis?
Pneumococcal
Lowered GCS
> 60 years old
Focal neurological signs
What further test should be conducted on those who suffered from meningitis after the infection has settled?
Pure tone Audiometry test
What are some of the signs seen on MRI of toxoplasmosis infection?
Enhancing ring lesions
patients present with:
- headache
- focal neurological
- confusion
What is the pathogen which causes cholera? and list some complications:
Vibro Cholera
Dehydration
Electrolyte disturbance
Replaced needs:
- fluids
- sodium correction
- K+
- glucose
List some specific intracerebral complications associated with HIV infection:
Toxoplasmosis Gondi
- most common cause and will present with raised intracranial pressure
Crytococcal Mengitis
HIV encephalopathy
Progressive Multifocal leukoencephalopathy
- caused by the JC virus
What are the complications of Hepatitis B?
Hepatocellular carcinoma
Fulminant disease
Polyarteritis nodosa
Chronic Hep B
List some features present in trichomonas vaginalis to help distinguish it from bacterial vaginosis:
Frothy yellow discharge
Strawberry cervix
Vulvovaginitis
Which set of infections present in a very similar way to EBV infection?
CMV Toxoplasmosis HIV - pharyngitis - lymphadenopathy - splenomegaly - fever
What does Entamoeba histolytica cause and why may it cause shoulder tip pain or fullness?
Causes Amoebiasis
- can cause liver abscess formation which leads to liver enlargement causing diaphragmatic irritation
- require US and biopsy of cysts
Schistosomiasis:
Infection caused by swimming infected water.
Presents:
1. Swimmers wash - pruritic rash initially
- 4 weeks later:
- Asthma like fevers
- Diarrhoea
- Eosinophilia
- Hepatomegaly
- urticaria
Diagnosis:
- urine sample for ova
- serology
Treatment:
- Praziquantel
Complication:
- bladder cancer - squamous type
