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Phase 3b > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What is the most severe and dangerous organism causing malaria?

A

Plasmodium falciparum

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2
Q

Name the other types of malaria

A

Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

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3
Q

Protective factors for malaria

A

Sickle-cell trait

G6PD lack

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4
Q

Symptoms of Plasmodium falciparum

A 
FEVER
Sweats
Rigors
Malaise
Myalgia
Headache
Vomiting
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5
Q

When should you suspect malaria in someone?

A

Someone who lives or has travelled to an area of malaria - AFRICA

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6
Q

Signs of Plasmodium falciparum

A

Anaemia
Jaundice - as bilirubin is released during RBC rupture
Hepatosplenomegaly

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7
Q

Complications of Plasmodium falciparum

A 
Cerebral malaria
Reduced consciousness/coma
Seizures
Acute kidney injury
Disseminated intravascular coagulopathy (DIC)
Severe haemolytic anaemia
Pulmonary oedema/ARDs
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8
Q

Investigations for Plasmodium falciparum

A 
Thick and thin blood films - 3 samples over 3 days
FBC (anaemia/thrombocytopenia)
Clotting (DIC)
Glucose (hypoglycaemia)
ABG/lactate (lactic acidosis)
U&E (renal failure)
Urinalysis (proteinuria, haemoglobinuria)
Blood cultures
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9
Q

Treatment for uncomplicated falciparum malaria

A

Artemether-lumefantrine (Riamet)
Atovaquone-proguanil (Malarone)
Quinine sulphate
Doxycycline or clindamycin

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10
Q

Treatment for severe or complicated falciparum malaria

A

Artesunate IV

Quinine

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11
Q

Prophylaxis for malaria

A 
Mosquito spray (DEET)
Mosquito nets and barriers
Wear long sleeves
Antimalarials - doxycycline, mefloquine, malarone
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12
Q

Side effects of doxycycline?

A

Diarrhoea and thrush

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13
Q

Side effects of mefloquine

A

Insomnia
Seizures
Nausea

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14
Q

Side effects of malarone

A

Abdominal pain
Nausea
Headache

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15
Q

What is HIV?

A

A retrovirus that destroys CD4 T cells and is the cause of aids

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16
Q

How many types of HIV are there?

A

HIV 1 = global epidemic

HIV 2 = West Africa

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17
Q

How does HIV present?

A

The infection initially causes a seroconversion flu-like illness within a few weeks. Remains asymptomatic before the patient becomes immunocompromised and develops AIDS years later.

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18
Q

How is HIV transmitted

A

Unprotected anal, vaginal or oral sex
Vertical transmission: Mother -> Child
Sharing needles/IVDU
Blood transfusion

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19
Q

How does seroconversion/primary infection present?

A 
Short-illness after infection, 2-6 weeks - highest infectivity
Fever
Malaise
Blotchy red rash
Aching limbs
Headache
Diarrhoea
Mouth ulcers
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20
Q

How does the asymptomatic HIV infection present?

A

May last several years
Progressive loss of CD4 cells
30% have generalised lymphadenopathy - nodes >1cm at 2 extra-inguinal sites for 3 months or longer

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21
Q

How does symptomatic HIV infection present?

A 
Pyrexia
Night sweats
Diarrhoea
Weight loss
Opportunistic infections - oral candida, oral hairy leukoplakia, herpes zoster, herpes simplex
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22
Q

How long does it take for HIV => AIDS?

A

5-10 Years

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23
Q

How long does it take for AIDS => Death (without HAART)?

A

2 Years

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24
Q

How is HIV diagnosed?

A

ELISA antibody blood test
PCR testing for HIV RNA/p24 antigen

CD4 count - these cells are destroyed by HIV virus; Normal = 500-,1200. <200 = end stage HIV/AIDS

Viral load - number of HIV RNA per ml of blood; uncontrolled = >500,000, well controlled = <40

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25
Q

What opportunistic infection can HIV present with?

A 
TB
Pneumonia
Pneumocystis jiroveci pneumonia (PCP) - suspect if cough/breathlessness
CMV
M.avium intracellulare (MAI)/ MAC (complex)
Candidiasis
Toxoplasmosis
Cryptococcal meningitis
Herpes simplex virus
Kaposi's sarcoma
Burkitt's lymphoma
CMV retinitis
Oral hairy leukoplakia
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26
Q

What is the treatment for candidiasis?

A

Nystatin

If mucosal = Fluconazole

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27
Q

Treatment for toxoplasmosis?

A

Pyrimethamine + sulfadiazine + leucovorin

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28
Q

How does Pneumocystis jiroveci pneumonia (PCP) present?

A 
Cough
Breathlessness
Fever
Chest pain
Fatigue
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29
Q

Investigations for Pneumocystis jiroveci pneumonia (PCP)

A

CT scan - diffuse ground glass opacity, consolidation, cysts, nodules

Induced sputum/bronchoalveolar lavage

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30
Q

Treatment for Pneumocystis jiroveci pneumonia (PCP)

A

High dose co-trimoxazole

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31
Q

Prophylaxis for HIV (recommended in all patients with CD4 <200)

A 
Co-trimoxazole for PCP
Cervical smears
Vaccinations
Azithromycin for MAI/MAC if CD4 <50
Isoniazid + Rifampicin for 3 months/ Isoniazid for 6 months
Ganciclovir for treating CMV
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32
Q

Prevention for HIV

A 
Blood screening
PEP - pre and post exposure prophylaxis
Condoms
Circumcision
Reduce vertical transmission
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33
Q

Treatment for HIV

A

HAART - highly active antiretroviral therapy
Use of at least three different antiretroviral drugs

Nucleoside reverse transcriptase inhibitors (NRTI)

Non-nucleoside reverse transcriptase inhibitors (NNRTI)

Protease inhibitors (PI)

Integrase inhibitors (II)

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34
Q

Examples of Nucleoside reverse transcriptase inhibitors (NRTI)

A

Zidovudine
Tenofovir
Lamivudine
Emtricitabine

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35
Q

Side effects of Nucleoside reverse transcriptase inhibitors (NRTI)

A 
Anaemia
Fever
Rash 
GI disturbance
Myalgia
Decreased WCC
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36
Q

Examples of Non-nucleoside reverse transcriptase inhibitors (NNRTI)

A

Nevirapine
Efavirenz
Rilpivirine

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37
Q

Side effects of Non-nucleoside reverse transcriptase inhibitors (NNRTI)

A

Steven’s-Johnson syndrome/TEN

Hepatitis

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38
Q

Examples of protease inhibitors

A

Lopinavir
Ritonavir
Squinavir

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39
Q

Side effects of protease inhibitors

A

GI disturbance
Headache
Rash
Peripheral neuropathy

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40
Q

Examples of integrase inhibitors

A

Raltegravir
Elvitegravir
Dolutegravir

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41
Q

Side effects of integrase inhibitors

A

GI upset

Insomnia

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42
Q

What is post-exposure prophylaxis?

A

Used after exposure to HIV - commenced within 72 hours

4 week course of Tenofovir + emtricitabine + raltegravir

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43
Q

Define gastritis

A

Inflammation of the stomach

Nausea and vomiting

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44
Q

Define enteritis

A

Inflammation of the intestines

Diarrhoea

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45
Q

Define gastroenteritis

A

Inflammation from stomach -> intestines

Nausea and vomiting + diarrhoea

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46
Q

Causes of gastroenteritis

A

Contaminated food and water
Viral gastroenteritis
Bacterial gastroenteritis

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47
Q

Questions to ask when taking a gastroenteritis history

A

Food and water taken
Cooking methods
Others affected?

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48
Q

Causes of viral gastroenteritis

A

Rotavirus
Norovirus
Adenovirus

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49
Q

Symptoms of norovirus

A

Fever

Projectile vomiting

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50
Q

Symptoms of rotavirus

A

Diarrhoea
Vomiting
Fever
Malaise

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51
Q

Causes of bacterial gastroenteritis

A 
E.coli
Campylobacter Jejuni
Shigella
Salmonella
Bacillus cereus
Yersinia enterocolitica
Staph aureus
Giardiasis
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52
Q

How is e.coli spread?

A

Through infected faeces, unwashed salads or water

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53
Q

Symptoms of E.coli

A

Abdominal cramps
Bloody diarrhoea
Vomiting

54
Q

How does E.coli work?

A

E.coli 0157 produces the shiga toxin => leads to haemolytic uraemic syndrome

55
Q

What is the most common bacterial cause of gastroenteritis

A

Campylobacter Jejuni

56
Q

How is Campylobacter Jejuni spread

A

Raw food
Untreated water
Unpasteurised milk

57
Q

Symptoms of Campylobacter Jejuni

A

Abdominal cramps
Diarrhoea often with blood
Vomiting
Fever

58
Q

Treatment for Campylobacter Jejuni

A

Azithromycin or ciprofloxacin

59
Q

Treatment for Shigella

A

Azithromycin or ciprofloxacin

60
Q

How is Shigella spread

A

Faeces contaminating drinking water
Swimming pools
Food

61
Q

Symptoms of Shigella

A

Bloody diarrhoea
Abdominal cramps
Fever

62
Q

How is Salmonella spread?

A

Raw eggs
Meat
Poultry

63
Q

What type of bacteria is bacillus cereus?

A

Gram positive rod

64
Q

How is bacillus cereus spread?

A

Spread through inadequately cooked food => reheated rice

65
Q

What else can bacillus cereus cause?

A

IVDU for infective endocarditis

66
Q

Presentation of bacillus cereus?

A

Causes abdominal cramp and vomiting within 5 hours
Watery diarrhoea after 8 hours
Resolved within 24 hours

67
Q

What type of bacteria is Yersinia enterocolitica

A

Gram negative bacillus

68
Q

How is Yersinia enterocolitica spread

A

Raw or undercooked pork

Milk

69
Q

Symptoms of Yersinia enterocolitica

A 
Watery or bloody diarrhoea
Abdominal pain
Fever
Lymphadenopathy
Right sided abdominal pain -> mesenteric lymphadenitis
70
Q

How does staph aureus work?

A

Produces enterotoxins in eggs, meat and dairy

71
Q

Symptoms of staph aureus

A

Diarrhoea
Perfuse vomiting
Abdominal cramps
Fever

72
Q

Treatment for giardiasis

A

Metronidazole

73
Q

What type of bacteria is giardiasis?

A

Giardia lamblia parasite - flagellated protozoan

74
Q

How is giardiasis transmitted

A

Oral ingestion of cysts via faecal-oral route mainly swallowing water whilst swimming, drinking tap water or lettuce

75
Q

Symptoms of giardiasis

A

Chronic diarrhoea
Frequent belching
Abdominal pain
Bloating

76
Q

Investigations for giardiasis

A

Stool microscopy - cysts and trophozoites
Stool antigen test (ELISA) - +ve for cell wall
String test
Baseline FBC

77
Q

Investigations for gastroenteritis

A

Stool microscopy/culture

78
Q

Prevention of gastroenteritis

A

Hygiene

If abroad, avoid unbottled water, salads

79
Q

Treatment for gastroenteritis

A

Maintain oral fluid/hydration
Severe symptoms: Anti-emetics e.g. metoclopramide
Anti-diarrhoeals e.g. Loperamide

80
Q

Complications of gastroenteritis

A

Lactose intolerance
Irritable bowel syndrome
Reactive arthritis
Guillain-Barre syndrome

81
Q

Causes of hepatitis

A 
Alcohol
Viral hepatitis
Autoimmune hepatitis
Non-alcoholic fatty liver disease
Drug-induced (e.g. paracetamol overdose)
82
Q

Symptoms of hepatitis

A 
Abdominal pain
Fatigue
Itching
Muscle and joint aches
Nausea and vomiting
Jaundice
Fever
83
Q

Are hepatitis A-E all notifiable diseases?

84
Q

How is hepatitis A transmitted?

A

Faecal-orally or shellfish

85
Q

Which hepatitis are RNA viruses?

A

A, C, D and E

86
Q

Which hepatitis are DNA viruses?

87
Q

Symptoms of hepatitis A

A 
Nausea and vomiting
Anorexia
Vomiting
Jaundice
Cholestasis - dark urine and pale stools
Hepatosplenomegaly
88
Q

Tests for hepatitis A

A

AST and ALT rise
IgM rises
IgG is detectable for life

89
Q

Treatment for hepatitis A

A

Basic analgesia

Vaccination

90
Q

Where is hepatitis A found?

A

Endemic in Africa and South America

91
Q

How is hepatitis B transmitted

A

Blood or bodily fluids (IVDU)
Sexual intercourse
Mother -> Child = vertical transmission

92
Q

Where is hepatitis B found?

A

East, Africa, Mediterranean

93
Q

Symptoms of hepatitis B

A 
Nausea and vomiting
Anorexia
Jaundice 
Hepatosplenomegaly
Arthralgia
94
Q

Complications of hepatitis B

A

Cirrhosis

Hepatocellular carcinoma

95
Q

Investigations for hepatitis B

A 
HBsAg
HBeAg
HBcAb
HBsAb
HBV DNA
96
Q

What does HBSAg show?

A

Surface antigen

= Active infection

97
Q

What does HBeAg show?

A

E antigen

= Implies high infectivity

98
Q

What does HBcAb show?

A

Core antibodies

= Implies past infection

99
Q

What does HBsAb show?

A

Surface antibodies

= Implies vaccination

100
Q

How is hepatitis B treated?

A

Antivirals - pegylated interferon alpha-2a/tenofovir/entecavir

Stop alcohol/smoking

101
Q

How is hepatitis C transmitted?

A

Blood and bodily fluids

102
Q

Complications of hepatitis C

A

25% get cirrhosis

4% get hepatocellular carcinomas

103
Q

Tests for hepatitis C

A

LFT’s
Hepatitis C antibody
Hepatitis C RNA confirms diagnosis

104
Q

Treatment for hepatitis C

A

Antivirals - pegylated interferon alpha-2a

105
Q

How does hepatitis D work?

A

Only survives in patients who also have hepatitis B infection

Attaches to HBsAg

106
Q

How is hepatitis E transmitted

A

Faecal-orally

107
Q

Where is Hepatitis E found?

A

Very rare in the UK/ common in Indochina

108
Q

Who does type 1 autoimmune hepatitis occur in?

109
Q

Who does type 2 autoimmune hepatitis occur in?

110
Q

Antibodies in type 1 autoimmune hepatitis?

A

ANA/anti-actin/anti-SLA/LP

111
Q

Antibodies in type 2 autoimmune hepatitis?

A

anti-LKM1/anti-LCl

112
Q

Treatment for autoimmune hepatitis

A

Prednisolone

Azathioprine

113
Q

Define infective endocarditis

A

Infection of the endocardium of the heart

114
Q

What two symptoms indicate endocarditis?

A

Fever + new murmur

115
Q

What valves are most commonly affected?

A

Tricuspid valves - mitral & aortic

116
Q

Risk factors for infective endocarditis

A 
Valvular heart disease
Valve replacement
Previous infective endocarditis
Hypertrophic cardiomyopathy
IV drug abuse
117
Q

Causes of infective endocarditis

A

Staph aureus
Strep viridans
Enterocci
HACEK organisms - Haemophilus, actinobacillus, cardiobacterium, eikenella corrodens, kingella kingae

118
Q

Most common causative organism of infective endocarditis

A

Staph aureus

119
Q

Symptoms of infective endocarditis

A 
Fever
Rigors
Night sweats
Weight loss
Clubbing
Loss of appetite
New murmur -> murmurs in 85%
Roth's spots
Osler's nodes
Glomerulonephritis
Janeway lesions
Splenomegly
Arthritis
Haematuria
Anaemia
120
Q

Most common murmur in infective endocarditis?

A

Aortic regurgitation

121
Q

Differential diagnosis in infective endocarditis

A 
SLE
Cardiac tumours
Lyme disease
Antiphospholipid syndrome
Reactive arthritis
122
Q

What criteria is used to classify infective endocarditis

A

Duke’s criteria

123
Q

What is the major criteria in Duke’s critera?

A

Positive blood culture (typical organism in two separate cultures or persistently +ve blood cultures)
Endocardium involved - positive echocardiogram, new valvular regurgitation

124
Q

What is the minor criteria in Duke’s criteria?

A

Predisposition (cardiac lesion/ IV drug abuse)
Fever >38 oC
Vascular signs
Positive blood culture - which don’t meet major criteria

125
Q

How many of major and minor criteria’s do you need to diagnose infective endocarditis

A

2 major or
1 major + 3 minor or
5 minor

126
Q

Investigations for infective endocarditis

A

Blood cultures - take 3 sets
Blood tests - normochromic, normocytic anaemia, high ESR/CRP
Chest x-ray = Cadiomegaly
Urinalysis - Haematuria
ECG - long PR interval
Echocardiography - TTE 1st line => then TOE

127
Q

Treatment for staphs native valve in infective endocarditis

A

Flucloxacillin -> Vancomycin instead if penicillin allergic

128
Q

Treatment for staphs prosthetic valve in infective endocarditis

A

Flucloxacillin + rifampicin + gentamicin

129
Q

Treatment for streps in infective endocarditis

A

Benzylpenicillin

130
Q

Treatment for enterocci in infective endocarditis

A

Amoxicillin + gentamicin

131
Q

Treatment for HACEK in infective endocarditis

A

Amoxicillin + gentamicin (for 2 weeks)

132
Q

Complications of infective endocarditis

A 
Heart failure
Infection (uncontrolled)
Systemic embolisation
Splenic anuerysms
Myocarditis/pericarditis
Renal failure

Phase 3b (18 decks)

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