Infectious Diseases Flashcards
What are the genetic mechanism by which bacteria develop resistance to antibiotics?
Bacteria gain genes that encode for proteins that confer protection with the following mechanisms:
- Gene ‘mutation’
- Gene ‘acquisition’ from another bacterial species
What genetic package do bacteria use to exchange genetic information to gain resistance?
Plasmids.
Plasmids are circular segments of DNA separate to bacterial chromosome and are easily spread from bacteria-to-bacteria.
Think of it as a transferrable resistance package.
What is the usual route of transmission for Giardia lamblia?
Faeco-oral.
What are the typical clinical manifestations of Giardia lamblia?
Obvious: nausea, diarrhoea and abdominal pain.
Less obvious: steatorrhoea
Giardia makes your poo float!
True/False: Giardia lamblia infections are always symptomatic.
False.
Often asymptomatic, carriers secrete cysts in their stools.
How is Giardia lamblia diagnosed?
Stool MCS +/- duodenal aspirates or biopsy.
What is the treatment of hookworm infections?
Mebendazole
What is the treatment of Giardia lamblia?
Metronidazole
Pasteurisation of milk has reduced the incidence of which pathogen?
Brucella (from cows)
What type of bacteria is Brucella?
Gram negative bacillus - fastidious (from cows)
What are the clinical manifestations of Brucella?
- Non-specific: fever, malaise, arthralgia and depression.
- 35% with hepatosplenomegaly
Are leucocytes increased or decreased with Brucellosis?
Leucopenia (75% of cases)
What animal is associated with Toxoplasma infection in humans?
Cats
True/False: Toxoplasma infections can cause eye complications.
True.
Many:
- Focal choroidoretinitis
- Granulomatous uveitis
- Optic atrophy
- Retinal detachment
- Cataract
- Posterior uveitis
- Glaucoma
What are the clinical manifestation of diphtheria (Corynebacterium diphtheriae)?
Non-specific:
- Fever and sore throat
- Cervical LNs
More specific:
- Adherent grayish pharyngeal membrane
- Potential cardiac and nerve toxicity
What is the treatment of diphtheria?
Expedient diphtheria antitoxin +/- Benzylpenicillin.
Febrile patient recently returned from overseas has a sore throat and on inspection has a grossly inflamed and membranous pharyngitis.
What are the DDx?
Most commonly EBV, however in a returned overseas traveller Diphtheria is a DDx.
When should ‘vaccination’ occur in the following scenarios involving splenectomy:
- Elective splenectomy
- Emergency splenectomy
- Unvaccinated splenectomised patient
- Immunosuppressed patient from chemotherapy/radiotherapy
- Elective splenectomy = 2 week pre-op to ensure optimal antibody response
- Emergency splenectomy = ASAP
- Unvaccinated splenectomised patient = ASAP
- Immunosuppressed patient from chemotherapy/radiotherapy = delayed for 6m with interim prophylactic Abx
Treatment-naive patient with HIV is about to be commenced on HAART, she is diagnosed with TB.
When should TB treatment commence (before or after HAART)?
TB treatment to occur PRIOR to initiation of HAART.
What is the significance of HLA-B*5701 in HIV?
- Associate with long-term non-progressive chronic HIV-1 infection (good prognosis)
- HIV-specific Cytotoxic T-lymphocytes are restricted by this allele
- Able to control viraemia below detectable levels (<50 RNA copies/mL plasma) WITOUT antiviral therapy.
- May cause hypersensitivity reaction (SJS/TENS/SLE) if Abacavir (NRTI) given in HL-B*5701 positive patients.
What conditions is Tenofovir indicated for ?
What are the 2 side effects of Tenofovir (NRTI)?
Indications:
- HIV-1 infection
- Chronic Hep B
SEs: renal impairment and osteoporosis
Patient is diagnosed with malaria with plasmodium vivax.
What treatment is used to eliminate dormant liver hypnozoites?
Primaquine
An asymptomatic patient has a positive Quantiferon gold test, negative CXR and is from a South-East Asian country of origin with evidence of a previous BCG vaccine.
What is the diagnosis?
What is the treatment?
Latent TB
Single-agent isoniazid
NB: Quantiferon test is NOT affected by BCG vaccinations
SE-Asian patient with newly diagnosed AML is noted to positive interferon-gamma release assay (IGRA).
What is the immune mechanism that mediates this?
IGRA tests T-cell or peripheral monocyte response to M. tuberculosis antigens.
What are the live attenuated viruses?
Clue: very bimpy
VR-BIMPY (very bimpy):
Varicella Rotavirus (PO) BCG (TB) Influenza (nasal) MMR (measle/mumps/rubella) Polio Yellow fever
NB: mode of administration is important, IM influenza is ok for the immunocompromised.
What are the clinical features of acute rheumatic fever (4)?
Obvious: fever, polyarthritis
Less obvious: prolonged PR interval, subcutaneous nodules
The rate of recurrence of C. Difficile infection is higher in which of the following populations:
- Community-acquired
- Hospital-acquired
Neither, they are the same.
N. Meningitides:
- What type of organism?
- T/F: found in normal nasopharyngeal flora.
- What type of organism?
gram NEGATIVE diplococci
- T/F: found in normal nasopharyngeal flora.
True
Give examples of ‘diplococci’:
- Gram positive (SE)
- Gram negative (HB-MAN)
- Gram positive
Strep. peumonia
Enterococcus
2. Gram negative Haemophilus Brucella Maroxella catarrhalis Actinobacter N. meningitidis
Post-CABG patient is found to have Mycobacterium Chimaera surgical site infection several months post-op after requiring a Sorin heater-cooler unit intra-op.
What 3 antimicrobials are indicated?
M. Chimaera (non-TB pulmonary infection) typically occurs greater than 3 months post-op.
- Azithromycin or Clarithromycin
- Rifabutin
- Ethambutol
NB: ARE you treated?
T/F: Mycobacterium Other Than Tuberculosis (MOTT) is a rare complication of patients treated with infliximab for rheumatological or inflammatory bowel disease.
True.
In a patient with a MOTT infection as a complication of infliximab treatment for IBD, what might occur with withdrawal of infliximab treatment?
IRIS (Immune reconstitution inflammatory syndrome).
What is Strongyloidiasis?
Infection with Strongyloides Stercolaris (worm) often from contact with its filariform larvae form from soil or faeces.
What is the ‘life cycle’ of Strongyloides Stercolaris?
The following process takes 3-4 weeks:
- Filariform larvae penetrates the skin and migrates via blood to the lung alveoli.
- Larvae ascend the tracheobronchial tree and are swallowed.
- Larvae mature to adult worms and burrow into the duodenum and jejunum and may live up to 5 years.
- Female worms produce eggs which form infectious ‘rhabdiform larvae’ that develop within the GIT and pass in the faeces.
What is the spectrum of clinical features in a patient with Strongyloides?
‘Asymptomatic eosinophilia’ in immunocompetent to ‘Disseminated hyperinfection syndrome’ in immunocompromised.
How is Strongyloidiasis diagnosed?
Serology and 2 concentrated stool samples for rhabdiform larvae +/- duodenal fluid if clinical suspicion remains.