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Finals!!! > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

HIV pathophysiology + transmission + RF

A
  • HIV = RNA retrovirus
  • HIV binds to CD4 –> lymphoid tissue –> replication –> repletion and loss of function of CD4+ cells
  • Transmission- sexual, perinatal, blood transfusion, needle stick
  • RF- STI, MSM, sexual contact, Africa, Asia, IVDU
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2
Q

Natural History of HIV

A
  1. Primary infection. ASx. ++HIV RNA
  2. Acute retroviral syndrome (2-3w) - Rapid decline in CD4+ and increase in HIV RNA. Pharyngitis, fever, LNs, headache, hepatosplenomegaly, weight loss, candida, N+V, myalgia, neuro Sx.
  3. Recovery and seroconversion (2-4w). More CD4, less HIV load
  4. ASx chronic HIV (3y). Gradual decline in CD4
  5. Symtomatic HIV (CD4 <200mm3)
  6. Death around 10-11y after infection
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3
Q

HIV Ix- Dx, monitoring

A
  • Dx- ELISA = direct serum/ salivary anti-HIV Abs –> confirmed by Western blot
  • Initial appointment:
    • Bedside- urinalysis, smear, STI screening
    • Bloods- FBC, U+Es, LFTs, BM, lipids, plasma HIV RNA, CD4 count, HIV drug resistance, mantoux
  • Monitoring: Bloods- FBC, U+Es, LFTs, lipids, glucose, HIV RNA, CD4 count
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4
Q

HIV management

A
  • HAART = Highly active antiretroviral therapy.
  • Indications- CD4 <350, AIDs defining illness, preg, +HBV
  • Regimes:
    • 1x NNRTI (efacirenz) + 2x NRTIs (emtricabine + tenofovir)
    • 1x PI + 2x NRTIs
  • Aim= Undetectable viral load within 4 months
  • PEP= Post-Exposure Prophylaxis. Start ASAP, continue 28d
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5
Q

HIV complications

A
  • CD4 >500: Acute retroviral syndrome, genital candida, LNs
  • CD4 200-500: Strep pneumonia, TB, HZV, oral candida, Kapos’s sarcoma, oral hairy leukoplakia, cervicl cancer, lymphoma, anaemia
  • CD4 <200: PCP, miliary TB, peripheral neuropathy, HIV associated dementia
  • CD4 <100: Disseminated HSV, toxoplasmosis
  • CD4 <50: Disseminated CMV, primary CNS lymphoma
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6
Q

Infection and transmissin of typhoid + prevention

A
  • = Salmonella typhi. Faecal oral spread.
  • Travellers to endemic areas eg India
  • Prevention:
    • Food and water hygeine
    • Vaccination
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7
Q

Presentation and complications of thyphoid

A
  • Malaise
  • Headache
  • Cough and sore throat
  • Constipation and diarrhoea
  • Rose spots on trunk
  • Chills
  • Temp >40
  • Relative bradycardia
  • Bleeding: epistaxis, bruising, splenomegaly, abdo pain
  • CNS- Coma, meningism, cerebellar signs, fits
  • Complications- Osteomyelitis, GI bleed, cholecystitis, meningism
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8
Q

Ix and Tx of thyphoid

A
  • Ix:
    • Bedside- NEWS, urine/ stool culture
    • Bloods- Culture, LFTs, FBC (leukocytes)
    • Clearance= 6 consecutive clear urine and stool cultures
  • Tx: Notifiable
    • Cons- fluid restriction
    • Med- Ciprofloxacin 10d PO (IV if severe), IV dexamethasone STAT if severe
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9
Q

Transmission and RF for Dengue Fever

A
  • Mosquito bourne RNA virus (bitten early in day)
  • Endemic- Africa, Americas, SE Asia, W Pacific, E Meditterranean
  • RF: High pop density, urban, poor public hygiene, malnourishment, mosquito exposure
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10
Q

Clinical presentation of Dengue Fever

A
  1. Febrile Phase
    • Severe headache + pain behind eyes
    • Myalgia, arthralgia
    • Lymphadenopathy
    • Hepatomegaly
    • Rash- petichiae –> confluent. Tornique test
  2. Critical Phase
    • Severe abdo pain, vomiting, haematemesis
    • Tachypnoea, relative bradycardia
    • Haemorrhagic shock- bleeding gum, GI bleeding
    • Fatigue
    • Vasc permeablity
    • Severe shock and encephalopathy
  3. Recovery phase
    • Fatigue and depression
    • Pruritis
    • Bradycardia
    • Rash- maculopapular/vasculitis
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11
Q

Ix and Tx of Dengue

A
  • Ix- FBC, PTT, LFTs, U+Es, ABG (metabolic acidosis), culture, dengue IgM/G + PCR, CXR
  • Tx= supportive- paracetamol, IVT, blood trans
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12
Q

Organisms and transmission of Malaria

A
  • Organisms transmitted by female Anopheles mosquito:
    • Plasmodium Falciparum
    • P. Vivax (can be dormant)
    • P. Ovale (can be dormant)
    • P. Malariae
  • Endemic areas: Africa, Asia, S America, Caribbean, Middle East, Oceana
  • Life cycle: Sporozoites –> 1st vector –> 1st human –> liver –> blood –> 2nd vector –> 2nd human
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13
Q

Presentation of malaria

A
  • Fever: Chills –> hot stage –> sweating. Temp spikes throughout day (P.vivax/3, p. malariae= 2)
  • Rigors
  • Headache
  • Diarrhoea
  • Cough
  • Shock
  • Jaundice, Hepatosplenomegaly
  • Hypoglycaemia
  • Anaemia (haemolysis)
  • Fever
  • Low GCS/ coma
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14
Q

Ix and Tx of malaria

A
  • Ix:
    • Bedside- urinalysis
    • Bloods- FBC, clotting, glucose, U+Es, lactate, ABG, culture, thick and thin blood film x3
  • Tx:
    • Uncomplicated p. Ovale, P. vivax, P. malariae –> chloraquine, malarone, quinine, riamet
    • Uncomplicated P. Falciparum –> NOT CHLORAQUIN. Riamet, malarone, doxy, clindamicin
    • If unknown, Tx as per P. Falciparum
    • Supportive- paracetamol + complications
  • Prevention- Awareness, bite prevention, chemoprophylaxis, Dx
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15
Q

What is Lyme Disease and how does it present?

A
  • Tick Bourne infection caused by Borrelia burgdorferi
  • Presentation:
    • Tick bite –> erythema migrans around bite. Circular, spreading, Bull’s eye
    • Systemic- fever, chills, headache, myalgia, arhralgia, lymphadenopathy
    • Myocarditis, heartblock
    • CN palsy, meningitis, ataxia, amnesia
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16
Q

Ix, Tx and prevention of Lyme Disease

A
  • Dx based on signs, Sx and RF
  • Tx:
    • Rash- Doxycycline/ amoxicillin
    • Later Sx- high dose ben pen, ceftriaxone
  • Prevention- cover limbs, insect repellant, tick collars for pets, prophylaxis in endemic areas
17
Q

Definition of PUO

A
  • = Temp >38.3 for >3w with no obvious despite appropriate Ix. Possible sources:
  • Bacterial - Abscess, TB, endocarditis, osteomyelitis, hepatobiliary inf
  • Viral - HSV, CMV, EBV, HIV
  • Fungi
  • Neoplasm - lymphoma, leukaemia, CUP
  • Drugs - Beta lactams, isoniazid
  • AI - JIA, mixed CT disease, hyperthyroid, sarcoid
  • Vasc - GCA, PAN, PE
  • IBD
18
Q

Primary and Secondary Immunosuppression

A
  • Primary
    • Ab deficiency (IgG/M/A)
    • Selective T cell deficiency - di George
    • Mixed T and B cells - SCID
  • Secondary
    • HIV
    • Drugs- steroids, ciclosporin, methotrexate, cisplatin
    • Malig - leukaemia, myeloma
    • Metabolic- renal/liver failure, trauma
    • Ig Loss- nephrotic syndrome
    • Splenectomy
    • Transplant recipient
19
Q

Drugs that increase risk of C. Diff and Tx of C. Diff

A
  • Drugs that increase risk:
    • Co-amox
    • Clindamicin
    • Cephalosporins
    • Ciprofloxacins
    • PPIs
  • Tx:
    1. Metronidazole
    2. Vancomycin (severe)
20
Q

MRSA Tx

A
  • Swabs- nose, armpits, groin, buttocks
  • Tx:
    • Rifampicin + Fusidic Acid
    • Clindamicin

Finals!!! (19 decks)

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