Infectious Diseases Flashcards by Anna Hay

Meningitis - common symptoms and signs

Neck stiffness 
Headahce 
↓ conciousness
Seizures
photophobia 
Kernig sign
\+/- rash if meningococcal septicaemic

How well did you know this?

Not at all

Perfectly

When do you not do an LO

Thrombocytopenia (bleeding risk)
↑ICP
CV unstable, septic 
Coagulation problems 
Infection at LP site
Neurolgy - focal symptoms

How well did you know this?

Not at all

Perfectly

LP interpretation

Bacterial: Turbid, Cells: neutrophils, Glucose ↓: protein ↑↑
Viral: Cells: Lymphocytes, glucose normal, protein ↑

How well did you know this?

Not at all

Perfectly

What factors to consider for causative organisms

Age (baby, young person, old person)

Immunosuppressed (HIV)

How well did you know this?

Not at all

Perfectly

Common bacterial and viral causes

Bacterial
Neiseeria meningitis 
S. pneumonia 
Listeria
Haemophilus
TB

Viral
HSV
Enterovirus: Coxsackie

How well did you know this?

Not at all

Perfectly

< 1 month

Ampicillin and cefotamine

How well did you know this?

Not at all

Perfectly

> 1 month and < 50 yrs

Ceftriaxone & vancomycin + dex

How well did you know this?

Not at all

Perfectly

> 50 yeats

Ampicillin & vancomycin

How well did you know this?

Not at all

Perfectly

Contacts

Ciprofloxacin, Rifampicim

How well did you know this?

Not at all

Perfectly

Viral mgmt

Tx as bacterial until proven otherwise
Supportive
HSV or VZV aciclovir
CMV: Ganciclovir

How well did you know this?

Not at all

Perfectly

Viral meningitis mgmt

Tx as bacterial until proven otherwise
Supportive
HSV or VZV aciclovir
CMV: Ganciclovir

How well did you know this?

Not at all

Perfectly

Encaphilitis

Focal neurology 
Altered consciousness levels 
Seizures
Personality changes
Hx travel/animal bit

Prodromes →
rash cold sore
Conjunctivitis
Lymph nodes

How well did you know this?

Not at all

Perfectly

Causes

Viral 
HSV2 
CMV
EBV
VZV
HHV6

Bacterial

How well did you know this?

Not at all

Perfectly

Mgmt

Associated problems → mg seizures (phenytoin), electrolytes
Tx IV aciclovir

once got CSF results back tx with specific antivirals e.g. + ganciclovir for CMV

How well did you know this?

Not at all

Perfectly

Toxplasmosis encephalitis - how does it show on CT

Multiple ring enhancing lesion

How well did you know this?

Not at all

Perfectly

Weight loss, night sweats, haemoptysis

Effusions, recent travel, crowded living environments

How well did you know this?

Not at all

Perfectly

Primary TB

Spreading coughing

Primary Gohn focus in lungs

How well did you know this?

Not at all

Perfectly

Secondary TB (latent)

Remains asymptomatic, non infectious 10% will reactive in their lifetime. (10% yearly for HIV)
1/3 of world population have latent TB

How well did you know this?

Not at all

Perfectly

Secondary

Active TB, often due to ↓ host immunity (chemo) or re-infection.

How well did you know this?

Not at all

Perfectly

Investigations for active TB

CXR
Sputum samples - 3 
1) culture  → gold standard, takes 3 weeks 
2) Microscopy: acid fast bacilli → fast
3) NAAT (PCR)

Latent TB - two tests.

For the first - describe the test and its limitations.

Mantoux test → intradermal TB injection of protein, look for size induration at 48-72 hours.

False positive → BCG, previous exposure, environmental mycobacteria
False negative → HIV, Sarcoid, lymphoma, current infection

IGRA - used if positive mantoux test - shows if positive due to BCG vaccine

Mgmt Tb - common side effects of the 4 drugs

Initial 2 months
Rifampicin
isonizid 
pyrozinamide 
ethambutol

Rifampicin SE

ORANGE urine

isonizid SE

sensory neuropathy

pyrozinamide SE

hepatits, arthralgia

ethambutol SE

Optic neuritis

Define MDR-TB

Resistant to any 2 of first line drugs

XDR-TB

Resistant to ++++

How to spot HIV in MCQ

Patient background Seroconversion Complications of HIV

Seroconversion - when does it happen and how does it present

2-3 weeks after first infection, non-specific flu like symptoms, rash malaise

Inv HIV a) point of care b) follow up

Point of care → ELISA (immnuoassay) - blood or saliva Western blot - confirmation - must be a while after exposure Viral PCR used in the window period - not common

Mgmt

2NRTIs + 1 other agent - regardless of CD4 count NRTI - Zidovudine, Emtricitabine, Tenofovir INSTI, NNRTI, PI

Monitoring of HIV mgmt

Load viral load - monitor 3-6 months or 2-3 months if more severe

Complications of HIV TB

risk of reactivation + disseminated disease

Complications of HIV pneumonia

Pneumocystic Jerovicci (co-trimoazole prophlyaxsis if lof CD4)

Complications of HIV - encephalitis

Toxoplasmossis

Complication of HIV - mouth/osephagus

Candidiais

Malaria in MCQs

``` High fever - cyclic every 2 or 3 days Recent travel (usually within 1 month) Headache Malaise Jaundice Anaemia Splenomegaly Seizure, metabolic acidosis, pulmonary oedema - if falciparum ```

Inv of malaria

Serial giesma stain thick and thin blood films

Types of malaria a) Most common, most serious b) less serious

a) Plasmodium falciparum | b) other ones (p. ovale, p malariae, p vivax)

Mgmt malaria

Depends on type and sensitivity (chloroquine sensitivity ↑- used to be common Tx) Plasmodium falciparum → Artmether/lumefantrine - 6 oral doses over 2-3 days if uncomplicated

Prophylaxis

Depends on where you are going and sensitivity of region. Usually on required when p. falciaparum Resistant areas: Atovaquone, malarone, doxycycline

Buzzword - dengue

``` Haemorrhagic fever Aedes Mosquitos Flushing face & neck Macuopapular rash Headache, arthalgia Bleeding gums Hepatospegauly and jaundice Confirmed on serology South & central america, Asia, africa ```

Buzzword typhoid

``` Faecol/oral Salmonella 3-21 days incubation Malaise, headache, cough, constipation High fever with relative bradycardia Dirrhoea after 1 week Rose spots (patch red) Tx Ceftoamine cipro ```

Buzzword Lyme

Borrelia burgdoferi Tick bite walkers Early: erythema migrant - target lesion Disseminated: malaise, arthritis, hepatitis Late: focal neurology, myocarditis, heart block Tx: Doxycyclin, IV benzlpen (complications)

Buzzword Rickettsia

Rocky mountain spotted fever Tick fever, N+V, conjucitivtis Widespread rash, peripheral to central and more widespread

Buzzword Leptospirosis

``` Weil's disease Spread by infected rat urine Swimming, canoeing High fever cough +haemoptysis (pulmonary haemorrhage_ meningitis Jaunduce ```

Buzzword Brucellosis

``` Unpasteurised milk and chees Vets/farmers Undulant fever - peak in afternoon Sweats, malaise, anorexia Arthritis/ spine tenderness Rose bengal test Anti-o polysaccharide test ```

Buzzword Trypanosomiasis

``` African sleeping sickness Fly fever, riggers, headaches rash Meningoencaphilitis stage → weeks to months after confusion, agitation, conclusions, psychiatric changes 2 different types in W and E africa Thick and thin blood films ```