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FRACP > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

Standard TB therapy

A 
2 months daily: 
isoniazid 
rifampicin 
pyrazinamide
ethambutol

4 months daily or 3x week:
Isoniazid
Rifampicin

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2
Q

Isoniazid side effects

A

Rash
Hepatits
Peripheral neuropathy
Lupus like syndrome

Pyridoxine may help prevent peripheral neuropathy
adjust for kidney
safe in pregnancy + BF

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3
Q

Rifampicin side effects

A

Rash
Hepatits
GI
colours body fluids orange (rifampicin/orangutan)
Drug interactions ** protease inhibitors and NNRTIs**

not safe in pregnancy

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4
Q

Pyrazinamide

A 
Hepatitis ***
rash, GI 
hyperuracaemia & gout 
hyperglycaemia 
renal adjustment

only works in acidic environment - good for the caseating bit
shortens the 9 month course to 6 months

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5
Q

Ethambutol

A

optic neuritis
rash
regular testing of VA and colour
adjust for kidney

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6
Q

Treatment of latent TB

A

12 week DOT isoniazid + rifampicin
9 months isoniazid alone (HIV on ART)
pregnancy + HIV or recent exposure (otherwise defer)
4 months rifampicin (isoniazid resistant)

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7
Q

TB meningitis

A

9-12 month course

+ steroids

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8
Q

MDR TB

A

isoniazid
rifampicin
fluoroquinalone
amikacin

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9
Q

BCG

A

used in endemic countries to prevent disseminated meningitis in children
does not prevent primary infection or reactivation

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10
Q

Risk factors for non-TB Mycobacterial infection

A 
low CD4
IL-12
IFN-y
STAT1
lung disease - COPD/bronchiectasis
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11
Q

Mycobacterium avium complex

A
  • pulmonary disease
  • middle age older adult male smokers COPD
  • nonsmoking postmenopausal women with pectus-excavatum, MV prolapse, scoliosis and joint abnormalities
  • nodular bronchiectatic disease
  • most common cause of NTBM lymphadenitis
  • disseminated disease CD4<50
  • clarithromycin or azith, ethamb, rifampicin
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12
Q

Mycobacterium kanasii

A

mimics pulmonary TB
risk factors: COPD, cancer, HIV, EtOH, immunosuppression
isoniazid, ethamb, rifamp

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13
Q

Systemic candiadiasis

A 
catheter
neutropenia
malignancies
organ transplantation 
broad spectrum antis
immunosuppression 
chemo
haemodialysis 
TPN
major abdo surgery
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14
Q

Candidaemia

A

Echinocandin:

  • anidula, capso, micafungin
  • POOR organ penetration to UTI, meninges, endophthalmitis*
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15
Q

Candiduria

A

fluconazole

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16
Q

Candida glabrata

A

resistant to azoles

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17
Q

Candida kruseii

A

resistant to fluconazole

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18
Q

Candida parapsilosis

A

usually always catheter related
resistant to echinocandins
use fluconazole

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19
Q

ABPA

A

hypersensitivity reaction that occurs with colonisation of the larger airways with aspergillus

RFs: CF/COPD

Asthma like sx, fleeting pulmonary infiltrates, peripheral eosinophilia, elevated IgE, serum aspergillus antibodies

Rx: Steroids + irta/voriconazole

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20
Q

Aspergilloma

A

surgical management

antifungals for symptomatic, non-surgical candidates

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21
Q

Invasive or disseminated aspergillosis

A

RFs: transplant, neutropenia, steroids+++ICU

invades pulmonary vasculature
CNS, heart, GI, skin

Blood cultures frequently negative, Dx Bx
Galactomannan antigen assay detects serum antibodies to cell wall antigens

Rx Voriconazole
amphotericin B, echinbocandins, posaconazole

22
Q

Mucormycosis

A

Rhizopus, Mucor spp
Pts with uncontrolled DKA
Desferoxamine for iron overload
Severe burns or trauma

rhinocerebral
rapidly fatal

epixtaxis
occular findings -> proptosis, periorbital oedema, decr VA
black eschar in th enose or palate
broad irregular ribon like hypae with right angle branching

23
Q

Cryptococcosis

A

commonly meningioenphepahalitis
when skin (molluscum) , prostate, bone lesions are found, typically disseminated disease (perform LP)
histo, antigen in CSF
latex agglutinatination more sensitive in HIV pts

high OP
lymphocytic pleocytosis
low glucose

steroids + antifungals
frequent LPs or VP shunt

maintenance therapy for 6-12 months
HIV: 12 months + CD4>100 for >3months

24
Q

Cryptococcal meningitis

A

Amphotericin B + flucytosine / fluconazole
oral fluconazole maintenance

steroids

25
Q

Histoplasmosis

A

asymptomatic acute and chronic pulmonary disease
granulomatous mediastinal disease + fibrosing mediatinitis, broncholithiasis, pulmonary nodules (histoplasmomas)

acute progressive disease: hepatosplenomegally and pancytopenia

small yeasts can bee seen within neutrophils on film

26
Q

Sporotrichosis

A

skin
gardening
papule develops weeks after inoculation and ulcerates
track along lymphatics

27
Q

WHich oral abx achieve good CSF penetration?

A

Chloramphenicol,
rifampicin,
trimethoprim+sulfamethoxazole
metronidazole achieve good CSF penetration when taken orally

28
Q

Encephaliitis

A

alteration in mental status for 24hours or more
fever, focal neurological deficit, seizure, CSF pleocytosis, abnormal EEG or neuroimmaging

all patients should undergo neuroimaging

29
Q

Toxoplasma encephalitis

A

HIV infection and in other immunocompromised patients, cerebral infection with Toxoplasma gondii usually presents with multiple ring-enhancing brain lesions on magnetic resonance imaging (MRI).

sulfadiazine

30
Q

which malaria has chloroquine resistance?

A

Falciparum

Vivax

31
Q

PJP prophylaxis

A

CD4 <200

glucocorticoids >20mg daily for >month + other immunosuppression
ALL
CLL: 
alemtuzumab
Idelisamib

temozolomide & radiotherapy
Solid organ - 12months, lifelong lung
HCT - cytarabine/fludarabine high dose steroids

Bactrim DS MFW

32
Q

Toxoplasmosis

A

CD4 <100 & positive serology

Bactrim DS

33
Q

MAC

A

CD4 <50

Azith 1200mg weekly

34
Q

latent TB

A

Isoniazid for 9 months

35
Q

cobicistat & doutegravir

A

inhibit tubular secretion of creatinine

36
Q

tenofovir

A

Hep B and HIV

37
Q

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)

A 
Abacavir 
Tenofivir 
Lamivudine 
Emtricitabine
Zidovudine
38
Q

NNRTIs

A 
'-vir-'
class effect: nausea, rash SJS, abnormal liver function
efavirenz - psych sx
etravirine - hyperlipidaemia, DRESS
nevirapine - LFTs,
39
Q

Protease inhibitors

A

-navir”

40
Q

Prizaquintel

A

schistosomiasis, clonorchiasis, opisthorchiasis, tapeworm infections, cysticercosis, hydatid disease, and other fluke infections

41
Q

Tinidazole

A

Amoebic liver abscesses

42
Q

echinocandins

A

glucan synthesis inhibitors

fungolytic to yeasts and fungostatic to filamentous fungi

43
Q

Carbapenums generally do not cover-

A

MRSA
VRE
Enterococcus faecium

44
Q

azoles

A

inhibit ergosterol synthesis

triazoles

imidazoles

45
Q

polyenes

A

amphotericin B

bind ergosterol

46
Q

fluconazole

A

excellent yeast cover

no mould cover

47
Q

itraconazole

A

extended cover, but inconsistent bioavailability limits use in critically ill pts

48
Q

Voriconazole

A

first-line agent for the treatment of invasive aspergillosis, but its bioavailability is unpredictable and genetically determined, it is associated with unique side effects, and it lacks activity against the Mucorales, the agents of mucormycosis

49
Q

posaconazole and isavuconazole

A

broadest spectrum of activity

50
Q

ketoconazole

A

imidazoles
largely been replaced by the triazoles because of superior pharmacokinetics, improved safety profiles, and higher efficacy for the treatment of systemic mycoses

51
Q

Mechanism of action of amphotericin B

A

disruption of fungal cell wall synthesis because of its ability to bind to sterols, primarily ergosterol, which leads to the formation of pores that allow leakage of cellular components

FRACP (12 decks)

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