Infectious diseases 2 Flashcards
Give 4 causes of aseptic meningitis.
- Enterovirus: mycobacteria, fungi
- Autoimmune: Sarcoidosis, Behcet’s disease, SLE
- Malignancy
- Medication: NSAIDs, trimethoprim, azathioprine
How do investigations differ between meningitis and encephalitis?
Give 2 antibiotic managements for meningitis.
- Meningitis: straight to lumbar puncture for CSF.
- Encephalitis: blood cultures, MRI, CSF analysis.
- Ceftriaxone, vancomycin
Give the most likely bacteria for the following meningitis cases. Neonates - Extended labour, infection in previous pregnancy - Late neonatal infection - Other neonate Children/ teens - Gram -ve diplococci - Unvaccinated Adults/ elderly - Gram +ve cocci - Cheese/ unpasteurised milk, alcoholics
Neonates - Group B streptococcus - E. Coli - Listeria monocytogenes Children/ teens - Neisseria meningitides - Haemophillus influenzae Adults/ Elderly - Streptococcus pneumoniae - Listeria monocytogenes
What is Brudzinski’s sign?
What is Kernig’s sign?
Tests for meningitis
- Neck stiffness causes hips and knees to flex when neck is flexed.
- Hamstring stiffness causes inability to straighten leg when hip is flexed 90 degrees.
What needs to be excluded on imaging when investigating meningitis.
Need CT to exclude raised intracranial pressure.
Differentiate the LP CSF results for bacterial/ viral meningitis:
- Appearance
- White cells
- Protein
- Glucose
- Gram stain
Bacterial : Viral
- Turbid: Clear/ cloudy
- Very high neutrophils: High lymphocytes
- Very high protein: High protein
- Very low glucose: Normal glucose
- Positive: no gram stain
Give 3 contraindications for Lumbar puncture.
- Neurological signs suggesting raised ICP.
- Superficial infection over LP site
- Coagulopathy
What is the management for:
- Non-blanching rash or meningococcal septicaemia
- Bacterial meningitis
- Bacterial meningitis with affected consciousness.
What medication is given as prophylaxis to close contacts?
- Single does IV benzylpenicillin
- Bacterial meningitis: IV Ceftriaxone (3rd generation cephalosporin). Consider corticosteroid: dexamethasone for bacterial meningitis.
Do not give steroids if meningococcal septicaemia is suspected. - If consciousness affected, consider IV acyclovir to cover encephalitis.
- Rifampicin or ciproflaxin for prophylaxis.
What is main cause of encephalitis?
- Give 3 bacterial causes of meningitis other than Neisseria mengititides
- Herpes virus
- TB, Syphillis, Listeria
Give 3 most common pathogens causing infective endocarditis and their respective risk factors
Give 2 other risk factors for infective endocarditis.
Which pathogen causes IE with colorectal cancer
Which pathogen causes IE from dental tooth extraction?
- Streptococci: Abnormal valves (congenital, post-rheumatic, calcification/ degeneration)
- Staphylococci: Prosthetic heart valves
- Enterococci: IV drug use.
- Turbulent flow
- Recent dental work.
- Strep. Bovis
- Strep. Viridian
What is the mnemonic for signs and symptoms of infective endocarditis.
From Jane with Love:
- Fever (and tachycardia), malaise, arthralgia
- Roth spots
- Osler nodes
- Murmur: Mitral> aortic> tricuspid> pulmonary
- Janeway lesions
- Anaemia- normocytic
- Nail-bed (splinter) haemorrhage
- Emboli.
Give 5 buzzwords for infective endocarditis
- Prosthetic valve
- Dental procedure
- New onset murmur
- Vegetation on echo
- Indwelling catheter
How many blood cultures should be taken to investigate infective endocarditis?
What is the Duke’s classification for diagnosis of endocarditis?
- 3 cultures, 1 hour apart.
Dukes:
- Major: positive blood culture in 2 samples. Positive echo.
Minor: High grade pyrexia, risk factors, vascular signs.
What are the initial antibiotic managements on suspicion of infective endocarditis?
What are the antibiotic regimes for the following IE pathogens:
- Streptococci
- Staphylococci
- Enterococci
In penicillin allergy what is the alternative?
- Benzylpenicillin + gentamicin
- Strep; same as above
- Staph: Flucloxacillin/ Vancomycin + gentamicin
- Entero: Ampicillin + gentamicin.
Penicillin alternative is vancomycin
Give 6 complications of infective endocarditis
- Congestive heart failure
- Valve incompetence
- Aneurysm formation
- Systemic embolization
- Renal failure
- Glomerulonephritis
Give 2 viral and 3 bacterial causes of gastroenteritis.
Viral: rotavirus, adenovirus.
Bacterial: Campylobacter jejuni, Escheria Coli, salmonella (egg shell).
Give 3 bacterial causes of diarrhoea
Give 3 bacterial causes of dysentery.
Give 2 bacterial causes of both
Diarrhoea: - Staph aureus - Vibrio cholera - E. Coli Dysentery: - Haemorrhagic E. Coli - Entamoeba hystolytica - Shigella Both: - Campylobacter/ clostridium difficile - Salmonella
Which bacterial causes of diarrhoea do the following relate to?:
- > 70, use of antibiotics.
- 1-6 hours after eating, short lived
- Rice water diarrhoea, poor sanitation
- Leafy vegetables
- Reheated rice, can cause cerebral abscess
- Eggs, poultry, constipation, Peyer’s patches
- C. Diff
- Staph aureus
- Vibrio cholera
- E. Coli
- Bacillus Cereus
- Salmonella
Which pathogenic causes of dysentery are related to the following:
- Uncooked poultry
- Leafy vegetables, haemolytic uraemia
- Poor sanitation, tropical places, MSM
- Personal contact, poor sanitation, MSM
- Eggs
- Campylobacter
- Haemorrhagic E. Coli
- Entamoeba hystolytica
- Shigella
- Salmonella
Acronym CHESS for dysentery.
Give management of gastroenteritis with no systemic signs.
Give 2 management steps for gastroenteritis with systemic illness, >39C temp, visible blood or ongoing for > 2 weeks.
- Supportive therapy (electrolyte replacement, bed rest, fluids), no stool culture needed.
- Admit and give oral fluids
- Direct faecal smear, then culture.
What are the 3 signs/ symptoms of hepatitis?
What clotting sign is marker of liver damage?
- Fever, jaundice, raised ALT/ AST
- Prolonged PT is sensitive marker of significant liver damage.
Give the transmission route of hepatitis A-E.
A- Faecal oral- no permanent damage to liver.
B- Sexual contact, body fluids, contaminated needles
C- Blood-blood transmission. Asymptomatic, flu-like.
D- Previous infection of Hep B (D resides in hep B). Liver failure risk greater.
E- Faecal oral route
Give features of Hep A history.
Give 4 Es of Hep E
What is management of hepatitis A&E?
- Acute travel history/ contaminated water.
- Usually asymptomatic.
- Can have nausea, vomiting, jaundice, RUQ abdominal pain.
- Enteric
- Epidemics (water)
- Expectant mothers
- E- immunocompromised.
Supportive, avoid alcohol.
What percentage of Hep B infections are chronic?
What are the two medication options for chronic hepatitis B?
- Chronic in 10% of cases.
- Peginterferon alpha or Tenofovir.
Hep D needs Hep B surface antigen to enter hepatocytes.
