Infectious Diseases Flashcards
Name six gram positive bacteria.
Staphylococcus (including aureus, epidermis, viridans) Strep pneumoniae Strep pyogenes Strep viridans Diphtheria C.difficile
Name eight gram negative bacteria.
Bordetella pertussis Escherichia coli, shigella, salmonella Haemophilus influenzae Vibrio cholerae Legionella pneumoniae Heliobacter pylori Chlamydia Neisseria
What are the six subtypes of E.coli infection?
Enterotoxigenic (traveller's diarrhoea) Enteropathogenic Enterohaemorrhagic Enterioinvasive Enteroaggregative Uropathogenic
What type of bacteria is Neisseria?
Gram negative non-flagellated diplococci
What is primary complex TB?
Granuloma + inflammation in the lymphatics and lymph nodes
What are three risk factors for tuberculosis?
HIV
Malnutrition
CKD
What type of bacteria causes tuberculosis?
Acid-fast aerobic mycobacteria
What are the pulmonary symptoms of tuberculosis?
Productive cough + haemoptysis
Weight loss, fever, sweats
Hoarse voice
Pleuritic pain
What does CXR show in a patient with tuberculosis?
Consolidation
Cavitation
Pleural effusion
Thickening/widening of mediastinum
Which nodes are infected in TB following pulmonary infection?
Extrathoracic
Cervical
Supraclavicular
Which patients with TB develop GI symptoms?
Immunocompromised
Ethnic minorities
What can develop after typical TB infection?
Bone/spine involvement Tuberculus meningism Tuberculus peritonitis Pericardial TB Miliary TB
What stain is used to rapidly identify TB mycobacteria in a sample?
Auramine-phenol
How is TB diagnosed?
Sample culture
PCR: rapid and sensitive. Confirms species e.g. TB v non-tuberculus mycobacteria
What is the treatment of TB?
2 months isoniazid, ethambutol, rifampicin, pyrazinamide
4 months isoniazid and rifampicin
What is the treatment of latent TB?
6 months isoniazid or 3 months isoniazid and rifampicin
What are the side effects of rifampicin and isoniazid?
Rifampicin - oral contraceptive not effective. Stains body secretions pink
Isoniazid - polyneuropathy
What are the side effects of ethambutol and pyrazinamide?
Ethambutol - optic retrobulbar neuritis
Pyrazinamide - hepatic toxicity
How is latent TB diagnosed?
Tuberculin skin test shows a raised indurated lesion (delayed hypersensitivity reaction)
What is multidrug resistant TB?
TB that is at least resistant to isoniazid and rifampicin
How is contact screening performed for a TB patient?
Mantoux test
Quantiferon/Elispot - interferon gamma release assay (IGRA)
What colour is sputum in pneumococcal pneumonia?
Rusty
What are three signs of pneumonia on examination?
Lung consolidation on percussion and auscultation
Crackles +/- wheeze
Bronchial breathing
What score is used to grade severity of pneumonia?
CURB-65
What is the treatment of mild, moderate, and severe pneumonia?
Mild - PO amoxicillin (macrolide/tetracycline if allergic)
Mod - PO amoxicillin + macrolide
Severe - IV co-amoxiclav/cefuroxime + macrolide
Give three examples of macrolide antibiotics.
Erythromycin
Clarithromycin
Azithromycin
What are the signs of empyema?
Pleuritic pain
Signs of pleural collection - dull to percussion and decreased air entry
Thoracocentesis of empyema shows what?
pH<7.2
Glucose <3.3mmol/L
Pus
LDH>1000iu
How is hepatitis B transmitted?
Vertical transmission - during parturition or soon after
Horizontal transmission - close contact, sharps, sexual
What is the presentation of acute hepatitis B infection?
Subclinical usually
Fever, jaundice, rash, arthralgia
Extra-hepatic manifestations - PAN or glomerulonephritis
What is the function of the following antigens and antibodies?
1) HBsAg and HBsAb
2) HBeAg and HBeAb
1) Surface antigen = infection
Surface antibody = immunity
2) Envelope antigen = assess phase of infection Envelope antibody = evidence of immune response as appears in the later phase of acute or chronic disease.
What is the function of HBV DNA?
Quantified by PCR, helps determine viral activity
What is the function of HBcAb (core antibody)?
Identifies exposure - previous, current, chronic etc
How is Hepatitis B usually managed?
Usually none, or supportive
What percentage of Hepatitis B patients do not clear the virus?
1-10% - they develop chronic infection and fulminant hepatitis
What patient groups are more at risk of developing chronic hepatitis B infection?
Neonates
Child below 5 years
How is chronic hepatitis B diagnosed?
Moderate rise in aminotransferases and ALP
Ground glass appearance of liver
HBsAg and HBcAb found
What is required for Hepatitis D to replicate?
Hepatitis B
How is chronic Hepatitis B managed?
48 weeks PEGylated alpha-2alpha interferon
Entacavir or tenofovir disoproxil - more likely this as less side effects
In chronic hepatitis B infection, what is a marker of fulminant hepatitis?
Increasing INR
How is hepatitis C transmitted?
Blood/blood products - parenteral
What is the presentation of acute hepatitis C?
Flu-like illness
Jaundice and RUQ pain
What percentage of patients with acute hepatitis C develop chronic disease and end stage liver disease?
66%
33% in first 25 years
What suggests a patient is less likely to clear the virus and will progress to end stage liver disease?
They are asymptomatic in the acute stage.
Co-existing hepatic pathology
HIV
African American
What are the extra-hepatic manifestations of hepatitis C?
Essential mixed cryoglobulinaemia
Membranoproliferative glomerulonephritis
Porphyria cutanea tarda
Autoimmune thyroid disease