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Infectious diseases Flashcards

1
Q

E.G Gram positive

A

Strep, Staph

C.diff - Anaerobic bacilli

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2
Q

E.G Gram negative

A 
E.coli
Klebsiella
Salmonella
shigella
Vibrio cholera
Neisseria (meningitidis, gonorrhoea)
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3
Q

Non Gram staining Bacteria

A

Mycobacteria (Ziehl-Neelsen)

Chlamydia e.g. Trachomatis (obligate intracellular)

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4
Q

Vancomycin / Teicoplanin Pathogen and SE

A

Severe sepsis (MRSA, C.diff)

SE: nephrotoxic, ototoxic

CI: renal fail, deafness

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5
Q

Benzylpenicillin

Pathogen and SE

A

Strep infections inc pneumoniae, Neisseria (meningitidis & gonococcal), syphilis

SE: hypersensitivity/anaphylaxis

CI: allergic

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6
Q

Flucloxacillin Pathogen and SE

A 
Staph aureus 
Strep pyogenes (GrpAS)

SE: hypersensitivity/anaphylaxis

CI: allergic§

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7
Q

Amoxicillin Pathogen and SE

A

UTIs, RTIs
Enterococcal infection

SE: nausea & vomiting

CI: Penicillin hypersensitivity

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8
Q

3rd gen Cephalosporins E.G. + Pathogen and SE

A

Ceftriaxone & Cefotaxime (Cefotaxime preferred in Neonates)

Staph aureus
Streptococci, Nisseria (used in meningitis), haemophilus

SE: Abx assoc colitis, Stephens-Johnson

CI: allergy

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9
Q

Penicillin drug examples

A

Amoxicillin/Co-amoxlclav (with clavulanic acid)
Benzypenicillin
Phenoxymethylpenicillin (Penicillin V)
Flucloxacillin

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10
Q

Beta lactam Abx

A

Penicillins, cephalosporins

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11
Q

Trimethoprim when used, SE and CI

A

UTI, prostatitis, acute/chronic bronchitis

CI in preg (folate synth inhibitor) - use nitrofurantoin instead, blood dyscarias

SE: hyperkalaemia, depressed haematopoiesis

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12
Q

Metronidazole when used, CI + SE

A

Anaerobes, Prophylaxis in GI surgery

SE: taste disturbance, anorexia

CI: interaction with alcohol - profuse vomiting

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13
Q

Chloramphenicol main indication & SE

A

H-influenzae b Epiglottitis

SE: Aplastic anaemia, optic neuritis, erythema multiforme

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14
Q

Macrolide e.g., used against & SE

A

Clarithromycin&Erythromycin

(Good substitiute if allergic to penicillin)

Strep pneumoniae, Staph aureus, legionella, Chlamydia

SE: Arrhythmia, Stephens-Johnson
CI: hepatic impairment

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15
Q

Doxycycline used against & SE

A

Broad spec
Strep (pneumoniae, viridians, pyogenes)
Staph aureus, chlamydia

SE: photosensitivity, oesophageal irritation

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16
Q

Aminoglycosides e.g., used against & SE

A

Gentamycin&streptomycin

Gent used against staph aureus, gram -ve bacilli (e.coli etc)

Used for severe sepsis

SE: nephrotoxic, vestibular/auditory damage

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17
Q

HIV pathophys

A

Enters cell via receptor (GP120) on virus binding to CD4 on T-cells, Macrophages, monocytes, glial cells

CD4 cells migrate to lymphoid tissue -> viral replication -> new visions to new Th-cells

Subsequent damage and depletion of CD4 cells = dec immune function

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18
Q

How doe HIV viral replication occur

A

Reverse transcription (error prone - allow viral mutation and escape) and genomic integration (integrase)

Transcription of viral mRNA by CD4

mRNA translated into new proteins = new virus -> budding

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19
Q

Why doesn’t HIV generate an immune response?

A

Low magnitude of HIV antibodies prod.

Glycoprotein envelope poorly immunogenic

Mutation prone reverse transcription = viral mutation = viral escape

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20
Q

Transmission and who at risk

A

Blood, sex, vertical (mother to child)

IVDU, african, commercial sex worker, multiple partners

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21
Q

Life expect HIV when is this less

A

Near normal

X10 risk of death if late diagnosis

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22
Q

When to suspect HIV

A

Generalised lymphadenopathy

Acute rash

Flu-like/Glandular fever like

Prolonged herpes simplex (cold sores)

mouth lesions

Unexplained weight loss & night sweats

Recurrent bacterial infection

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23
Q

HIV diagnosis

A

1) ELISA (assay looking for HIV Antibodies and antigens)
2) Western blot (expensive and confirmatory)
3) Serum p24 (HIV antigen)
4) Serum CD4/HIV RNA (PCR)

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24
Q

When is HIV detectable

A

Assay tests +ve in 95% at 4 week and 99% at 12 weeks

p24 detectable at 4 weeks

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25
HIV severity parameters Treatment aim
CD4 count Viral load Used to determine how advanced and to monitor Tx response CD4 over 400cells/mm3 Viral load = 0
26
Normal CD4 range
450-1600 cells/mm3
27
Stages of HIV
Seroconversion: (antibody to HIV detectable in blood, antigen undetectable) - Fever, aches, rash, headache, diarrhoea, mouth ulcers Asympt: - May last years - Progressive loss of CD4 - 30% generalised lymphadenopathy Symptomatic HIV: - Opportunistic infection - Kaposi sarcoma/lymphoma AIDS: - Worsening of symptomatic - Pyrexia, night sweats, diarrhoea, Wt lss - Oral candida/herpes zoster/simplex
28
AIDS: - Def - When dev - Diag
Acquired immune deficiency syndrome HIV without Tx in 5-10 years HIV +ve + AIDS defining condition (Pneumocystis pneumonia, CMV, TB, Toxoplasmosis - brain lesion, tumour - kapok's sarcoma or lymphoma)
29
Opprtunistic infections in HIV
``` TB Pneumocystis pneumonia (fungal) Candidiasis (oral/bronchial/oesophageal) Cryptococcal meningitis Toxoplasmosis SMV ```
30
Cancers in HIV
Burkitt's lymphonma (NHL) Kaposi's sarcoma (HHV8)
31
HIV organ system effect: ``` Lung GI Eye CNS Psych Cancer ```
``` Lung: - TB, S.pneum, H.inf GI: - Oral candida - Salmonella, C.diff Eye: - CMV retinitis -Toxoplasmosis eye disease CNS: - Cerebral toxoplasmosis (Ring on CT) - TB meningitis - CNS lymphoma Psych: - HIV dementia Cancer: - HPV: cervical ca - HHV: Kaposi - EBV: NHL (Burkitt) ```
32
Prophylactic Abx in HIV:
Co-trimoxazole (toxoplasmosis,) | Isoniazid ± Rifampicin
33
Methods of preventing HIV
Reduce vertical transmission Behavioural: sex-ed, condoms
34
HIV Tx - therapy name - how it works - how many
HAART (highly active antiretroviral therapy) Inhibit enzymes involved in RNA reverse transcription, HIV cell fusion etc Use at least 3 antiretrovirals
35
How antiretrovirals work
Prevent DNA chain forming from RNA Block viral reverse transcriptase Block cleavage of active proteins to form virions Block entering CD4
36
Post-Exposure prophylaxis HIV
4 week course Tenofovir + Emtricitabine + Raltegravir Given 1hr --> 3 day from needlestick (0.3-0.5% transmission risk for needlestick)
37
E.g. of antiretrovirals | just to see
Tenofovir Emtricitabine Raltegravir Enfurvitide Ritonavir
38
What HAART compliance is needed?
a 95% compliance is needed for good response
39
Vertical HIV transmission - methods - risk % - prev
From delivery or breast milk 25-40% risk HAART to mother form end of T1 C-section unless viral load less than 50 Post-natal infant zidovudine mono therapy for 4w (takes risk to 1%)
40
Viral haemorrhage fevers: - Filovirus e.g. - Flavivirus e.g.
Ebola Zika, Yellow fever Notifiable diseases
41
Ebola - where from - mech
Bats Work by inc vascular permeability. Causes mucous membrane haemorrhage, hypovolaemia, shock and circulatory collapse
42
Viral haemorrhage fever Pres
Overseas travel to affected area Flu-like symptoms: temp, sore throat, headache, myalgia, N&V Maculopapular/petechial rash, hypotension, mucus membrane haemorrhage
43
Viral haemorrhage fever investigations
LFT: elevated transaminases FBC: leukopenia, thrombocytopenis Coal: PTT and INR prolonged DIC: D-dimer high, fibrinogen low
44
Amoebic liver disease - organism - pres - Ix - Tx
Entamoeba histolytica (tropical illness_ Fever. RUQ pain (Referred to R shoulder), Wt loss signs: hepatomeg, pallor, jaundice Stool antigen, serum antibody, Liver USS Metronidazole ± aspiration
45
``` Giardia - Transmission - Pres - Ix Tx ```
Oral ingest (tap water, salads mainly) diarrhoea (weeks), burping, abdo bloating and pain Stool microscopy (trophozoites), ELISA stool antigen test Metronidazole
46
Typhoid - organism - trans - pathophys
Salmonella typhi Faeco-oral (food/water) Adhesion & invasion through gut wall, spread through reticuloendothelial system (spleen, BM)
47
Typhoid - pres - Ix - Tx - complications
Fever, frontal headache, malaise, Prostration (very weak) FBC, LFT (transaminase high), blood/stool/BM culture may show Ceftriaxone or azithromycin Fluids Antipyretics (para) Chronic carriage (biliary, hepatic), bowel perforation
48
Dengue - Spread - Pres
Mosquito Fever, rash, flushing, haemorrhage fever, (DIC, hepatomegaly, pleuritic effusion, circulatory collapse) LFT: transaminase high, albumin low (leaky vessels), IgM +ve serology Oral//IV fluids, antipyretics, NOTIFICATIONS
49
Schistosomiasis - Pathology - Sympt - Ix - complication
Eggs in bladder. haematologinous spread to liver = chronic liver disease fever, abdo pain, haematuria Urine microscopy - direct visualisation of eggs Bladder cancer (from chronic inflammation)
50
Chlamydia - Type of organism - Sympt - Ix - Tx
Obligate intracellular Dysuria, discharge First catch urine, nucleic acid amplification testing Contact tracing, Azithromycin (single oral), Doxy
51
Gonorrhoea - Type of organism - Sympt - Ix - Tx
Gram -ve diplococci Dysuria, purulent discharge nucleic acid amplification testing, gram stain Contact tracing, IM ceftriaxone, Azithromycin
52
Thrush - Type of organism - Sympt - Tx
Candida White curds, Itch Fluconazole
53
Syphilis - Organism - Pres (primary, secondary, tertiary)
Spirochete - Treponema pallidum Primary: local papule / ulcer (Chancre), lymphadenopathy Secondary: rash on plasma, soles, trunk, alopecia Teritary: end organ complication after years of infection (dementia, ataxia, aortic regurgitation (diastolic murmur)
54
Syphilis - Ix - Tx
Swab and microscopy LP/CSF analysis CXR + ECHO (aortic regurgitation) IM benzylpenicillin + Prednisolone
55
Syphilis prognosis
65% no sequelae 10% neurosyphilis (doral column degen - paralysis, dementia) at 10 years 10% CV syphilis at 20 years
56
Malaria - What is - Where - Types
Plasmodium parasitic infection 90% cases/deaths in Sub-Saharan Africa Falciparum (most dangerous, Africa/SE Asia) Vivax, Ovale, Malariae, Knowlesi
57
Malaria RF
Endemic area, no chemoprophylaxis, no physical barriers (bed net) Preg Immunocompromised Olde
58
Who protected against Malaria
G6PD | Sickle cell
59
Which cells affected in malaria
Erythrocytes Liver Parasite divides in cells until cells rupture and spill out parasite to infect other cells
60
Problem with malaria Prev/Tx
Resistance is a problem
61
Prevention Falciparum
Chloroquine sensitive: Chloroquine, hydroxychloroquine (1w prior, 4w after) Resistant: Doxy (1-2 days prior, 4w after)
62
Primary prevention Malaria
``` Avoid outdoor after sunset Insect repellent Long sleeves Insecticide treated bed nets Antimalarial chemoprophylaxis ```
63
Malaria Symptoms
``` Fever (chills, rigors) Headache weakness Myalgia Arthralgia Anorexia Diarrhoea Jaundice Tachycardia & Hypotension Hepatosplenomegaly ```
64
Malaria investigation
Giemsa stained thick and thin blood films (parasites within RBC) Thick film for parasite number Thin film for species
65
Tx Falciparum
Chloroquine or hydroxychloroquine If resistant: Quinine + Doxy OR Artemether + Lumefantrine
66
Malaria complications
Acute renal failure (dehydration) Hypoglycaemia Metabolic acidosis (tissue hypoxia from anaemia and hypovolaemia Seizure (acidosis, hypoglycaemia)
67
If a Q mentions Caves or Bats ...
Viral haemorrhage fever Rabies Histoplasmosis
68
MRSA - Resistance to - What to use
Methicillin resistant Staph aureus Methicillin is precursor of Flucloxqcillin (resist to beta lactams - penicillin, cephalosporins) Vancomycin or Teicoplanin
69
C.Diff - Causes - Tx
``` The C's -Ciprofloxacin Co-amoxiclav Carbapenems Clindamycin (the worst) Cephalosporins ``` STOP OFFENDING ABx Metronidazole, Vancomycin for sev

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