Infectious Diseases Flashcards
Hep A is an RNA virus, how is it spread? What is the incubation period?
Faecal - Oral spread or by shellfish
Incubation period is 2-6 weeks
Name four risk factors for Hepatitis
Personal contact
IVDU
MSM
Health workers
Give 5 symptoms of Hepatitis A
Nausea Malaise Arthralgia Jaundice Pale Stools/Dark Urine
What investigations would you do for Hepatitis A, and what would they show?
Immunoglobulins (raised IgG for acute infection)
LFTs (ALT raised, potential damage to synthetic function)
USS to exclude other diagnoses
How is Hepatitis A managed?
Supportive Avoid alcohol Vaccine available (works for one year or twenty with booster)
Hep B is a DNA virus, how is it spread? What is it’s incubation period?
Spread by blood products, sexual contact or vertically
Incubation is 1-6 months
Give 6 symptoms of Hep B
Nausea Malaise Arthralgia Urticaria Jaundice RUQ Ache
Describe the following Hep B Serology: HbsAg, HbeAg, Antibodies to core antigen, Antibodies to surface antigen
HbsAg - present 1-6 months after exposure (if persists past 6 months then it is chronic)
HbeAg - present 1.5-3 months after exposure (implies high infectivity)
Antibodies to core antigen imply past infection
Antibodies to surface antigen imply vaccination
Describe the management of Hep B
Supportive
Immunise sexual contacts
Any signs of chronic liver inflammation - 48/52 of retrovirals such as Peginterferon Alfa-2a
State two complications of Hep B
Cirrhosis
Hepatocellular Carcinoma
Hep C is a RNA virus, how is it spread? What is its incubation period?
Spread is via IVDU, Blood Transfusions and Sexual
Incubation is 6-9 weeks
How would acute Hep C present?
Often asymptomatic, may just be jaundiced
How would chronic Hep C present?
Over 80% of cases are chronic
Malaise, Weakness, Anorexia
Name three possible investigations for Hep C
LFTs
PCR of the virus to confirm ongoing infectivity
If PCR +ve then do a liver biopsy to assess damage
Describe the management of Hep C
Stop alcohol/smoking
Start anti-virals
NO VACCINE AVAILABLE
What is Hep D?
A co - infection for Hep B (as it is an incomplete RNA virus)
How would you investigate Hep D?
You would test for Anti Hep B antibody, and then if that was positive, proceed to do the Anti Hep D antibody
How would you manage Hep D?
Peginterferon Alfa-2a has limited success so a liver transplant may be required
Describe three features of Hep E’s pathophysiology/epidemiology
RNA virus similar to Hep A
Common in Indochina
Associated with pigs
Describe the pathophysiology of Meningitis
Inflammation of the leptomeninges (arachnoid and pia) by virus/bacteria/non infective causes
Give four risk factors for Meningitis
Young Age
Immunosupression
Crowding
Spinal Procedures
Name the causative organisms of bacterial meningitis in neonates
Group B Strep
E.Coli
Name the causative organisms of bacterial meningitis in adults
Haemophilus Influenza
Strep Pneumoniae
Neisseria Meningitidis
Name the causative organisms of bacterial meningitis in the elderly
Strep Pneumoniae
What is Aseptic Meningitis? Give 4 examples
When no bacteria can be cultured
Viral Infections, Fungal Infections, TB, Partially treated meningitis
Give 4 causes of non infective Meningitis
Malignant Cells (Leukaemias, Lymphomas)
Medication (NSAIDs, Trimethoprim)
Sarcoidosis
SLE
Give 5 symptoms of Meningitis
Fever Nausea Headache Nuchal Rigidity Photophobia
What are some differentials for Meningitis?
Intracranial Abscess
SAH
Encephalitis
What investigations should be performed if Meningitis is suspected?
Immediate Lumbar Puncture - as long as no signs of rasied ICP or thrombocytopenia (pre abx) FBC, CRP Blood Culture ABG Coagulation Screen EEG (if seizing)
sss
Describe the management of viral Meningitis
Supportive
IV Aciclovir if Herpes Simplex Virus is suspected
Describe the management of bacterial Meningitis
Supportive
IV Ceftriaxone AND Dexamethasone
If over 50 add Amoxicillin
Immunise any close contacts within the past week with single dose ciprofloxacin
Give 3 complications of Meningitis
Cerebral Oedema
SIADH
Waterhouse Friderichson Syndrome
What is Cellulitis?
Infection of the dermis and deep subcutaneous tissue with poorly demarcated borders
Likely due to Streptococcus Pyogenes or Staphylococcus Aureus
Give 4 risk factors for Cellulitis
Previous Cellulitis
Venous Insufficiency
Alcoholism
IVDU
How would Cellulitis present?
Usually unilateral and in lower limb
May have an area of damaged skin
Localised Erythema/Pain/Swelling
May have systemic symptoms
State 4 investigations you could do for suspected Cellulitis
Skin Swab
CRP
Fine Needle Aspirate
Culture
Give 3 features of a Cellulitis Management plan
Supportive (Rest, Elevation, Analgesia)
Flucloxacillin 500mg QTS (or Erythromycin if pen allergic)
Emollient to keep skin hydrated
Describe the pathophysiology of Malaria
Parasite infection from Plasmodium species of Mosquito (female only)
Most common is Falciparum followed by Vivax and Ovale
Sporozoites travel to the liver and become Merozoites
Give 4 clinical presentations of Malaria
High Fevers
Malaise
Headache
Myalgia
Name 2 signs OE of Malaria
Jaundice
Hepatosplenomegaly
Give three diagnostic techniques for Malaria
Microscopy - 3 thick and thin blood films
Rapid Diagnostic Test of Parasite Antigen
LFTS
How would you treat Malaria (P.Vivax and P.Ovale)?
Chloroquine
Primaquine (prevention of relapse - test for G6PDH first)
How would you treat Malaria (P.Falciparum)?
Artesunate
Give 3 risk factors for Gastroenteritis
Poor Personal Hygiene
Immunocompromised
Achlorhydria
What are the incubation periods of different Gastroenteritis infectants?
Viral - a day
Bacteria - Few hours to 4 days
Parasites - 7-10 days
Diagnosis of Gastroenteritis is normally clinical, but what investigations could you do?
Stool - Microscopy, Culture and Staining
Blood Tests
Imaging (if bowel distension)
What is the management of Gastroenteritis?
Supportive
Anti- Motility if required (eg Loperamide)
What is Osteomyelitis?
Infection of the bone marrow which can affect the cortex and periosteum (necrosis) via spread through Haversian Canals.
What are the most common pathogens causing Osteomyelitis?
Staphylococcus Aureus (most common)
Haemophilus Influenza
Escherichia Coli
Give four risk factors for Osteomyelitis
Trauma, Diabetes, IVDU, Peripheral Arterial Disease
How would Osteomyelitis of a long bone present?
Acutely febrile, Painful immobile limb
How would Osteomyelitis of vertebrae present?
Back pain worse at rest
Localised Oedema
Localised tenderness
What is Potts Disease? How would it present?
Osteomyelitis of the vertebrae, specifically as a result of TB
Causes vertebral body collapse, and abscess formation
What investigations would you do for suspected Osteomyelitis? What would they show?
FBC - Elevated white cells and inflammatory markers
Blood culture/bone culture
MRI - Bone marrow oedema
How would you manage acute osteomyelitis?
Extensive surgical cleaning
Flucloxacillin for 4-6 weeks
How would you manage chronic osteomyelitis?
Extensive surgical cleaning
Antibiotics for 3-6 months
Describe the pathophysiology of Infective Endocarditis in 3 steps
1) Turbulent flow damages endothelium
2) Platelets and fibrin adhere to give non bacterial thrombotic endocarditis
3) Circulating bacteria adhere to vegetation on the valves
What are the common causative organisms of Infective Endocarditis
Staph Aureus now most common
Staph epidermis if post valve replacement
May be fungal in immunocompromised/IVDU
Give three risk factors for Infective Endocarditis
Skin Breaches
Immunocompromised
Valvular Disease
Give 3 symptoms of Infective Endocarditis
Fevers
Rigors
Night Sweats
Give 3 signs of Infective Endocarditis
Splinter Haemorrhages
Janeway Lesions
New/Modified Cardiac Murmurs (usually Aortic Regurg)
A common complication of Infective Endocarditis is the formation of an Aortic Root Abscess, how would this present?
Prolonged PR Interval
AV block
Left Ventricular Failure
What investigations would you do for suspected Infective Endocarditis?
Trans-Oesophageal Echocardiography
Blood Cultures
ECG
CXR
How would you manage Infective Endocardtis?
Initial empirical treatment with Amoxicillin and Gentamicin while awaiting sensitivity results
Surgery indicated if heart failure or valvular obstruction
Staph - Flucloxacillin
Strep - BenPen
How is Typhoid fever transmitted? What is it’s incubation period?
Transmission is faecal-oral
Incubation is 6-30 days
Give 4 symptoms of Typhoid Fever
Fever
Malaise
Anorexia
Dry cough
Give 3 signs characteristic of Typhoid Fever
Faget’s Sign (Bradycardia and Fever)
Rose Spots
Hepatosplenomegaly