Infectious Diseases Flashcards
When taking a travel history what is important to include?
Exactly what area they visited/prophylaxis for malaria or other disease/N vaccinations they had pre-travel such as hepatitis A typhoid and Assyria and the general vaccine schedule/the use of bug repellent or sleeping nets
what are farmworkers susceptible to getting?
Leptospirosis, coxiella, Orf
what are sewerworkers susceptible to getting?
Leptospirosis, hepatitis A, gastroenteritis
what are sex workers susceptible to getting?
HIV hepatitis B HSV gonoccocus syphilis chlamydia
what infectious disease are pet shop owners susceptible to getting?
psittacosis
what are abbatoir workers succeptable to getting?
anthrax
what are canoeists susceptible to getting?
Leptospirosis gastroenteritis
what are swimmers susceptible to getting?
Fungal infection pox viruses leptospirosis gastroenteritis
what are cavers susceptible to getting?
histoprirosis and Marburg
What are trekkers susceptible to getting?
Lyme disease and other tickborne diseases
what are rugby players susceptible to getting?
HSV (from the scrum) fungal infections
what causes leptospirosis?
infected urine - namely from rats but can be from other pets such as dogs, rabbits, cows and sheep (bacteria)
what causes histoplasmosis?
stoplasma capsulatum fungal spores. These spores are found in soil and in the droppings of bats and birds.
What causes a Coxiella?
Coxiella burnetii is most frequently found in ruminants (cattle, sheep!!, and goats) is a bacteria
What causes Orf?
Orf is a viral skin disease that can be spread to humans by handling infected sheep and goats. The disease – caused by a parapoxvirus
what does the following picture show?
orf (nb its self limiting mostly)
What infections are IV drug users susceptible to?
Hepatitis C hepatitis B HIV endocarditis skin and soft tissue infection including antharax , Aspergillus
what infections are alcohol abusers predisposed to?
TB pneumonia HIV
what infections are cannabis users susceptible to?
Pneumonia early COPD lung abscesses
what is Marburg?
Marburg virus is a hemorrhagic fever virus of the Filoviridae family of viruses - transmitted by bats
What infections can dogs transmit?
Campylobacter Toxocara rabies
what infection can cats Transmit?
toxoplasma Bartonella pasteurella
what infection can rodents transmit?
Rat bite fever salmonella
what infections can terrapins and reptiles transmit?
salmonella
what infection can psittacine birds transmit?
chlamydia psittaci
what infection can tropical fish transmit?
Mycobacterium marinum
What infection can wild and domestic fowl transmit?
Avian influenza
what’s infection can agricultural animals transmit?
Coxiella SPP and Salmonella E. coli
what type of virus is the HIV virus and what cells does it target?
retrovirus destroying CD4 + cells
what are the two strains of HIV?
HIV-1 – responsible for the global pandemic HIV two – is less pathogenic mostly limited to West Africa
what are the stages of HIV?
stage I CD4 over 500 well with no symptoms/ stage II CD4 350 – 500 minus symptoms/ stage III CD4 200 – 250 major symptoms with opportunistic diseases/ stage 4 CD4 less than 200 AIDS
what CD4 count is considered a late diagnosis in HIV?
CD4 count less than 350
what are the consequences of a late diagnosis in HIV?
10 times higher death rate within the first year
what is the definition of a viral load?
the actual quantity of the virus per millilitres of patient’s serum
how does the viral load in HIV differ in untreated versus treated patients?
Untreated viral load is greater than 500,000 treated viral load is undetectable
what is the meaning of an undetectable viral load in HIV?
the virus cannot be spread
what is the definition of AIDS?
CD4 count less than 200 or the presence of an AIDS defining illness and any HIV patient ( PCP TB CMV sentinel tumours)
when is HIV detectable post infection?
After four weeks
what is the diagnosis/testing of HIV?
IgG ELISA or serum HIV rapid test (both serological) if those are positive confirm with Western blot test or 4th generation serum test (P 24 antigen)
in a non-HIV person what is the CD4 count?
480 – 1600
what are stage 2/ minor symptoms of HIV?
Weight loss/shingles and other rashes (seborrhoeic dermatitis pruritic papular eruptions inea corporum or ungium) oral ulcers angular chelitis generalised lymphadenopathy
what is the definition of generalised lymphadenopathy?
Painless enlarged nodes in two or more non-contiguous sites > 1cm)
what symptoms are present in stage 3/major symptoms of HIV?
Fever and night sweats for more than one month diarrhoea for more than one month oral Canada oral hairy leukopenia chronic vaginal candidiasis
what are AIDS defining opportunistic infections?
Sentinel tumours (couples Q sarcoma or lymphoma) TB PCP toxoplasmosis P.jiroveci, CMV
what feature would indicate a toxoplasmosis infection in an AIDS patient?
Changing mental state
what is the management of HIV?
Usually using 2 NRTIs plus and other agent of (integrase inhibitor NNRTR PI) - usually preparations are made with a once-daily tablet containing all three medications
what level of compliance is required in HIV patients?
95%
what are NRTIs? How do they work?
nucleoside reverse transcriptase inhibitor / Prevent the elongation of DNA chains from viral RNA transcriptase
what are NNRTIs? And how do they work?
non-nucleoside reverse transcriptase inhibitor Act near the active site of reverse transcriptase blocking viral replication
what are Pis? And how do they work?
Protease inhibitors/blocks the cleavage of active proteins from poly protein formed by viral transcription
what are fusion inhibitors? (HIV)
Drugs which block viruses from entering the CD4 cells
what are integrase inhibitors? (HIV)
prevents insertion of viral DNA into host DNA
what are side effects of N RTIs?
haemolytic anaemia is all hypersensitivity reactions
what are side effects of NN RT I?
rash liver toxicity drug interactions and sleep disturbances
what is post exposure prophylactic?
drugs given to 0 negative patients who have a high risk of exposure
how do you prescribe postexposure prophylaxis?
A four-week course is given and subsequent testing should be provided
when would you give prophylaxis to patients with HIV?
In patients who have a CD4 count less than 200 prophylaxis is usually needed at the start of treatment in severe patients but once immune system has improved prophylaxis stop
when would you prescribe co-trimoxone?
prophylaxis for PCP and toxoplasma
what are side effects of co-trimoxone?
bone marrow suppression rash
when would you prescribe a nebulised Pentamidine?
PCP prophylaxis
what are side effects of Pentamidine?
highly Tetrogenic and has to be given in a negative pressure side room in case other patients may be pregnant
when would you prescribe azithromycin for prophylaxis in HIV?
for protection against Mycobacterium avarium
when would you prescribe glancyclovir in HIV
it is a treatment and the secondary prophylaxis of CMV
what is important to assure patients with HIV when they find out their diagnosis?
With good compliance of treatment life expectancy is normal
what is vertical transmission?
Transmission of infection from mother to child
what is vertical transmission in untreated HIV?
25 to 40%
what are modes of delivery of vertical transmission?
Breastmilk and at delivery
what is the management of HIV if it is detected antenatal screening?
HAART is started at the end of the first trimester and viral load is measured every two weeks after 30 weeks gestation
can the agile delivery occur in HIV-positive patient?
Yes if the viral load is undetectable otherwise the section is required
what is the management of a neonate who was born with HIV positive mother?
Infant is given an RTI monotherapy for four weeks and only bottle-fed - this is regardless of if viral load is detectable or not
with compliance delivery modifications and neonatal monotherapy what is the risk of transmission of HIV to a neonate?
less than 1%
what virus causes mumps?
An RNA paramyoxyvirus
how is mumps spread?
Respiratory droplets direct contact or contaminated surfaces
what is the incubation period of Mumps?
14 – 18 days
when is mumps most contagious?
1/2 days before the onset of symptoms
a patient presents with: fever and malaise started about three days ago today they noticed that their neck on one side is very swollen what is the most likely diagnosis
mumps
what is the presentation of mumps?
parotitis which can be bilateral – hallmarks in term constitutional symptoms usually proceed peritonitis orchitis commonly occurs in males which can be painful?
what are more severe symptoms which can occur in mumps?
aseptic meningitis – symptoms of meninges am in a 25% of patients whose varieties in 7% of females presenting with fever and abdominal back loin pain
what complications can occur due to mumps?
Infertility mastitis encephalitis and deafness
what are risk factors for mumpd?
and vaccinated either primary vaccine or secondary vaccine close contact living such as uni prisons and soldiers healthcare workers international travellers
what test is required in mumps?
s library at our AGM collected with swab
what is the management of mumps?
supportive with isolation give paracetamol fibre pro then and isolation for five days after the onset of parotitis
what does the following images show?
koplick spots
a patient presents with fever, which has now gone, course and horizon their parent states that they noticed a rash starting on the head which then spread to the trunks and limbs - what is the most likely diagnosis?
measles
what does the following images show?
Measles rash – maculopapular
what is a presentation of measles?
Fever cask arise conjunctivitis koplick spots all appear before the rash a maculopapular rash then starts on the head and spreads to the trunk and extremities
when do complications occur in measles?
Usually only in immunocompromised or malnourished groups children under five (the younger the worse it is) adults over 20 pregnant women
what are complications of measles?
Pneumonialaryngotrachitis otitis media which can lead to deafness and encephalitis
how do you diagnose measles?
Serology IgM and IgG however RNA PCR can also be used
what is the management of measles?
Supportive and vitamin a supplementation in severe cases- in severe cases also treats complications such as pneumonia and encephalitis
what are the consequences of measles in pregnancy?
Stillbirth miscarriage I u GR
what does the following image show?
Rubella maculopapular rash
what is a presentation of rubella
in half of cases it is asymptomatic rash starts behind ears and moves centrifuge elite round the body maculopapular error scimitars discreet and sometimes itchy low-grade fever lymphadenopathy can proceed to the rash by one week (auricular cerviacle occipital) arthralgia can occur in older women
how do you diagnose rubella?
Serum IgM or viral culture with PCR
when is rubella testing necessary?
In pregnancy or if there are complications
what can show on FBC in rubella?
thrombocytopenic
what are complications of rubella (non-congenital)?
arthritis encephalitis thrombocytopenia myocarditis chorio retinitis
what complications can occur in congenital rubella?
deafness congenital heart disease (like PDA) cataracts - less than 8 w impaired hearing - less than 16 w intracerebral calcification ans IUGR and neurological disability can also occur
or what is the management of rubella?
If contracted in pregnancy refer to specialist as termination may be indicated otherwise Ig’s can be given MMR is not safe in pregnancy but wil be given immediately after birth- otherwise supportive
what is the management of a neonate with congenital rubella?
pyramethamine + sulfadiazine For one year
when would you test for rubella immunity?
Prenatal visit routine
What are the most common areas which can get septic?
Lungs abdomen the bloodstream renal/GU
what are the most common pathogens which cause sepsis?
Either gram-negative – pseudomonas or E. coli
or
gram-positive staphylococcus
describe the pathophysiology of sepsis
Immune system is activated and there is the release of inflammatory mediators as well as the release of reactive oxygen is such as Nitrous oxide/endothelium is activated and becomes porous/the coagulation system becomes pro clear regulation/vasodilation, oedema, formation of micro-ember like causes a decrease in oxygenation of organs leading to organ failure and dysfunction
what is the definition of septic shock?
A septic patient with persistent hypotension not responding to fluids and requiring vasopressor’s. Have a mean arterial pressure of less than 65 and a lactate of over two
what are the features of a news 2 score?
tachypnoea/hyper- or hypovolaemia/tachycardias/acutely altered mental state/low oxygen saturations/hypotension/oliguria/mottled or ashen skin – poor Refill/cyanosis INSERT PICTURE
what initial investigations should you perform if you suspect sepsis?
Do buffalo six INSERT PICTURE
what bloods are included in the Buffalo six?
Cultures glucose lactate full blood count renal function tests CRP clotting
what additional investigations apart from the Buffalo six are useful in ? Sepsis?
ECG / liver function tests/venous blood gas check acidosis and lactate/chest x-ray (pulmonary origin) urinealysis (urinary origin) CT (GI origin)
what is the management of sepsis?
IV broad-spectrum antibiotics oxygen if required and more targeted antibiotic therapy once pathogen found
what are symptoms of meningism?
Headache neck stiffness photophobia nausea vomiting fever
what is the most common cause of aseptic meningitis?
enteroviruses – Coxsackie virus echo virus poliovirus and herpesviruses – HSV two (HSV-1 more commonly causes encephalitis), varicella
which group of people are most likely to get viral meningitis?
Infants and young children young adults older people those who had exposure to insect vectors
apart from symptoms of meninges them what other symptoms would coxsackie a cause?
herpangia - insert picture
apart from symptoms of meninges them what other symptoms would echovirus - 9 a cause?
Maculopapular rash
apart from symptoms of meninges them what other symptoms would HSV 2 a cause?
genital herpes
what investigations should you perform in a patient with meningism?
bacterial Gram stain and culture of bloods / csf ulture + stain viral culture (blood, csf) PCR head CT/MRI, glucose, VBG, FBC, LFT, coag, lactate - septic screen Serum HIV
what is the management of aseptic meningitis?
initially it is really hard to distinguish between viral and bacterial meningitis so broad-spectrum antibiotics should be used until causative agent is found. Treatment from viral meningitis is supportive unless HSP VZV (acyclovir) or CMV (gancyclovir) is found
you do a lumbar puncture the CSF appears clear has a normal opening pressure white blood cell count of less than eight a normal protein level and a normal glucose level how would you consider this CSF?
normal
you do a lumbar puncture the CSF appears turbid has a high opening pressure white blood cell count >1000 a high protein level and a low glucose level how would you consider this CSF?
bacterial
you do a lumbar puncture the CSF appears clear has a normal opening pressure white blood cell count <300 with predominantly lymphocyted a moderately raised protein level and a normal glucose level how would you consider this CSF?
viral
you do a lumbar puncture the CSF appears clear has a slightly high opening pressure white blood cell count of <500 a high protein level and a slightly low glucose level how would you consider this CSF?
fungal
describe how different pathogens affect CSF?
Insert picture
what are the most common causes of bacterial meningitis?
Streptococcus pneumoniae nisseria meningitidis haemophilus influenza B
patient has all the classic symptoms of meningitis along with confusion and has started having seizures what does this indicate about the meningitis
serious bacterial
what is the initial management of bacterial meningitis?
Until the causative agent is found to give broad-spectrum antibiotics with dexamethasone then give targeted therapy
who is most at risk of fungal meningitis?
Immunosuppressed HIV infants and neonates people exposed to disturbed soil bat caves neurosurgery patients neutropenic patients
which fungal agents usually cause meningitis?
Cryptococcal histoplasma coccidioal candida
what is the typical presentation of fungal meningitis?
is a much more progressive chronic/subacute presentation of progressive headaches slowly becoming more severe symptoms of meningitis them personality and behavioural changes decrease visual acuity and papilloedema/symptoms of increased ICP typically in cryptococcal infections
when word symptoms of hydrocephalus present in fungal meningitis? And what are the symptoms?
coccidioal infections/ impaired cognitive function confusion in coordination gait disturbances urinary incontinence
what is the management of fungal meningitis?
IV fluconazole with PO therapy for maintenance afterwards if there is hydrocephalus CSF drainage
what is required in the diagnosis of fungal meningitis?
three fungal cultures as well as CT/MRI CSF studies including antigen/antibody tests
how is hepatitis B transmitted?
Vertical – mother to baby 90% transmission without preventative measures horizontal – sexual blood transfusions needles or sharp injuries household transmission from shared razors or toothbrushes
how do you diagnose hepatitis B?
Surface antigen test or IgM (not current Infection)
what antibody is used for evidence of an immune response in hepatitis B?
HBe AB
what is the definition of a chronic infection in hepatitis B?
infection lasting more than six months
what is the management of acute hepatitis B?
nothing it is usually self-limiting and treatment is not usually indicated
what is a complication of acute hepatitis B?
Fulminant liver failure
How would you check for fulminant liver failure in the patient with hepatitis B?
checking INR this is the main marker
when is a chronic hepatitis B most likely to occur?
Acquired from vertical transmission in adult hood the chance of it becoming chronic is 5%
what is usually done to prevent vertically acquired hepatitis B from becoming chronic?
IG’s and HBV immunisation given in pregnancy and towards the end of pregnancy antivirals are given
one should treatment be given in hepatitis B?
In chronic infections during the clearance phase or the reactivation phase
described the phases of hepatitis B infection?
Tolerant phase: HBV has high levels in the body liver remains unaffected and there is no indication for treatment / clearance phase: there is an immune response with inflammation which can cause cirrhosis liver enzymes (a LT) are elevated there is indication for treatment inactive phase: there is immune control patients liver is usually fine but may require cirrhosis monitoring there is no indication for treatment reactivation phase: the immune system cannot control the hepatitis B and there is a more rapid progression of fibrosis ALT is deranged and there is indication for treatment
what are the treatments for hepatitis B?
Pegylated interferon alpha injected weekly for 48 weeks (mainstay of Mx used for patients who have good LF) and Tenevofir or entecavir PO daily long terms (for patients who cant handle interferon)
what is the impact of hepatitis C in terms of public health?
The third largest cause of end-stage liver disease
what is the main mode of transition for hepatitis C?
historic patients may have gotten hepatitis C from blood transfusions as virus was recognised in the 1980s more current infections through IV drug use parenterally
what is the presentation of hepatitis C in its acute infection?
Most patients are asymptomatic or have very minor symptoms 15% will have a typical hepatic illness with malaise nausea right upper quadrant pain and subsequent jaundice
what is the significance of being asymptomatic in the acute phase of hepatitis C?
if you are completely asymptomatic you have a much higher chance of developing a chronic infection
what is the presentation of hepatitis C in a patient with chronic infection?
until there is cirrhosis the infection is mainly asymptomatic with intermittent right upper quadrant pain and as it worsens malaise and fatigue
how do you diagnose hepatitis C?
Serologic enzyme immunoassay and confirmation with immunoblot assay if those two tests are positive then do HCVRNA PCR to check for current infection
apart from diagnostic viral tests what other investigations are required in chronic hepatitis C?
Baseline and serial LFT and liver fibrosis assessment using a fibre scan this negates the need for a biopsy in advanced fibrosis/cirrhosis six monthly hepatocellular carcinoma screening using ultrasound scan and alpha-fetoprotein levels any evidence of portal hypertension do regular ODD to screen for varicies
what is a liver fibroscan?
Transient elastography which looks at liver stiffness in cirrhosis it will be way more thick
what are some extrahepatic manifestations of chronic hepatitis C?
Essential mixed cryoglobuminea membranoproliferative glomerulonephritis porphyria cutanea tardia atuoimmune thyroid disease
what is a treatment for hepatitis C?
The aim of treatment is curative unlike with hepatitis B (undetectable viral load 12 weeks after the end of treatment = curative) direct acting antiviral drugs are used mixing to or more the AAS drug classes
what are some examples of DAAS used in hepatitis C?
ledip-ASVIR sofo-BUVIR Grazo-PREVIR
What are some side effects of Ribavarin?
anaemia and associated symptoms insomnia agitation and anxiety
when is ribavarin indicated in Hep C?
in decompensated cirrhosis
what is drug induced fever?
Drugs that cause fever due to effects of pharmacological activity or altered thermoregulation or contaminants or indirect induction or hypersensitivity reactions
what drugs cause fever due to pharmacological activity?
Antibiotics: penicillin, Pan Am’s cephalosporin error through Myerson nitrofurantoin isoniazid or cytotoxic agents
what drugs cause fever due to altered thermoregulation?
Atropine catecholamines(decrease sweating) thyroxine drugs
what drugs cause fever indirectly?
anticoagulants heparin
what drugs most commonly cause fever?
Antihistamine barbiturates me thou doper penicillin phenytoin salycates
which common drugs cause fever?
ibruprophen allopurinol heparin penicillins nitrofurantoin or through myosin, penance cephalosporin me thou doper nifedipine coltopril
what is malaria caused by?
a parasitic infection caused by Plasmodium most importantly Plasmodium falciparum - most severe
what are the symptoms of malaria?
Weakness myalgia arthralgia anorexia more severe symptoms of diarrhoea seizures and altered mental state jaundice anuria/oliguria suggest falsiparum
described the life-cycle of Plasmodium?
Mosquito takes a blood meal and injects sporozoites these travel to the liver cell which gets infected and many parasites again to develop forming a schizont which eventually raptures and enters the bloodstream a trophozite forms which either forms a gametocyte which then gets transferred to mosquite when it bites you or reforms schizont
how do you diagnose malaria?
Geima stained Thick and thin blood smears identifying parasite rapid diagnostic tests of antigen or enzyme and PCR are also used as well as a normal blood tests for baselines
how do you treat malaria?
Chloroquine or hydroxychloroquine
what drug is used for malaria prophylaxis?
Doxycycline
What are the notifiable diseases?
insert picture
Who do you report notifiable diseases to?
Public health England and also the office for standards in education if the patient is under eight and there is a case of any notifiable disease in a school or nursery or two or more cases of food poisoning plus the consultant for communicable diseases control this is under the health protection notifications act of 2010
What pathogenic causes Legionella?
gram-negative bacteria Legionella
How is the Legionella infection contracted?
Contaminated water either aerosols such as contaminated air-conditioning or from aspiration when drinking
what is the presentation of Legionella?
Typical pneumonia symptoms (productive cough to snow. Hypoxaemia tachycardia fever headache crackles) history of recent residential plumbing repair use of whirlpool spas use of non-municipal water supply
how do you diagnose Legionella?
sputum culture and Gram stain
how do you manage Legionella?
flurochloroquines or macrolides - both if severe
what causes typhoid disease and how is it contracted?
Salmonella typhi transmitted feco orally - most commonly in the Indian subcontinent
what is the presentation of typhoid?
prolonged febrile illness – High-grade with normal white blood count bradycardia rose spots (see picture below) generalised flulike symptoms with GI symptoms
how do you diagnose typhoid?
blood cultures
what is the management of typhoid?
If you suspect typhoid to treat with broad-spectrum antibiotics such as ceftriaxone and azithromycin then targeted antibiotics should be used
what is a complication of typhoid? And how do you treat it?
encephalopathy treated with high-dose dexamethasone
what is most common mode of transmission of HIV in children?
At birth in the birth canal through breastfeeding and can occur and utero but this is the most uncommon
How do you diagnose HIV in children?
DNA PCR is diagnostic if over 18 months of age/before 18 months you cannot diagnose HIV you can only assess for negative diagnosis/and negative diagnosis: completion of an antenatal antiviral is too negative PCR is one negative PCR after 18 months - the reason for this is that maternal antibodies are still present before 18 months and so positive results may occur
how quickly can HIV develop into AIDs in an untreated child?
one year
what are mild symptoms of HIV in children?
lymphadenopathy parotitis hepatosplenomegaly thrombocytopenia
what are moderate symptoms of HIV in children?
Recurrent bacterial infections candidiasis chronic diarrhoea lymphocytic interstitial pneumonitis
what are severe symptoms of HIV in childhood?
opportunistic infections severe failure to thrive encephalopathy malignancy
what is the management of HIV in children with a CD4 count between 200 and 350?
2 NRTI + 1 NNRTI
what is the management of HIV in children with the CD4 counts over 350?
2 NRTI + one protease inhibitor
what vaccinations should be given to HIV patients?
All normal Vaccinations should be given and PCP vaccination should be given over the age of four but no BCG vaccination
a child presents with a lacy reticular exanmem on their extremities and torso and face, their parents say that in the week prior they had a slight fever and cold like symptoms what is the most likely diagnosis?
slapped cheek syndrome (insert picture)
what pathogen causes slapped cheek syndrome?
parvovirus B19
apart from prodromal symptoms and slapped cheek/rash what other symptoms can be presence in slapped cheek syndromes?
Self-limiting arthralgia of the small joints of the hands wrists knees or ankles
what causes the slapped cheek appearance and what does this mean for immunocompromised patients?
Immune complexes are what causes the red cheek appearance so in immune deficient patients the classic symptoms of a slapped cheek are not present
what are complications which can arise from parvovirus B19 infection?
Persistent parvovirus B19 causes severe anaemia due to chronic red-cell aplasia
what can happen if a pregnant woman contracts parvovirus B19?
Fatal anaemia which can be so severe it is fatal to the foetus
what can happen if patients who has haematological disorders contracts parvovirus B19?
in patients with increased red blood cell turnover aplastic crises can occur
what investigations are required in parvovirus B19 infection?
FBC and reticulocytes counts especially if they are immunosuppressed or pregnant / serology for IgM in anyone presenting with complicated parvovirus infection
what is the management of parvovirus B19?
Usually supportive care with simple analgesia rest and hydration in complicated parvovirus haematological referral is required and may receive IVIG and red blood cell transfusions
what causes toxic shock syndrome?
streptococci either Streptococcus pyogenes MRSA or Streptococcus aureus
what other two types of toxic shock syndrome?
menstrual toxic shock non-menstrual toxic shock
what are the causes of menstrual toxic shock?
during menstruation there is extended use of a single tampon or use of highly absorbable tampons
what causes non-menstrual toxic shock?
postpartum, associated with infections such as mastitis associated with abortion episiotomy endomitritis infected abdominal wounds
what are symptoms of toxic shock syndrome?
non-specific symptoms of severe infection can become life-threatening within 24 to 72 hours can have a diffuse erythematous rash in Streptococcus and the desquamation rash on hands and feet in staphylococcus
how do you diagnose toxic shock syndrome?
Assess for sepsis microscopy and culture of blood CSF and throat you can also include pleural or peritoneal fluid if they have symptoms of myocarditis or peritonitis
apart from sepsis what is a complication of toxic shock syndrome?
diffuse bilateral infiltrates consistent with RDS seen on chest x-ray
what is the diagnostic test for toxic shock syndrome
staphylococcus antibody or streptococcal endotoxin
what is the management of toxic shock syndrome?
Aggressive fluid resuscitation empirical antibiotic therapy vasopressor support if there is refractory hypo gastric protection with PPI and H2 agonist DVT prophylaxis regular insulin and glucose control transfer to ICU surgical depriving may be necessary targeted antibiotic therapy with or without IVIG if streptococcal infectiontension
how is poliovirus transmitted?
gastrointestinal faecal oral transmission
what is the presentation of poliovirus?
Usually asymptomatic or manifests as a minor GI symptoms (lasting no longer than 5 days) , may also present with meningitis symptoms, however it can present as a major illness
what symptoms of a major illness of the poliovirus?
acute flaccid paralysis proceeding to asymmetrical lower limb weakness and flaccidity the maximum extent of paralysis is reached within a week some patients progress to life-threatening bulbar polite paralysis and respiratory compromise - will also have the accompnying GI symptoms
what is post poliomyelitis syndrome?
develops years or even decades following acute poliomyelitis
what is the presentation of post-poliomyelitis syndrome?
fatigue weakness wasting of the muscles usually involving muscles previously affected by the original illness
what are risk factors for polio?
Lack of vaccination for sanitisation endemic areas immunosuppressant patients (may get polio from the vaccine as it is live attenuated vaccine)
what signs will you find on a child with progressive acute flaccid paralysis?
decreased sensation decreased deep tendon reflexes atrophy of the muscles of the affected limb which can lead to deformity
how do you diagnose polio?
Clinical initial diagnosis confirmed by the isolation of poliovirus from stools NB specimen collection will be handled by local health authorities
how would you investigate child who had acute flaccid paralysis from poliovirus?
Spinal-cord MRI electromyography or nerve conduction studies - used to rule out other causes of paralysis
what is the management of poliovirus?
Simple: oral rehydration or IV fluids and monitor for acute flaccid paralysis acute flaccid paralysis: early mobilisation and physiotherapy monitoring for bulbar poliomyelitis bulbar polio: intubation and ventilation
how do you manage
poliomyelitis?
ongoing physiotherapy and mobilisation
What is Kawasaki disease?
and acute febrile self-limiting systemic vasculitis
what is the diagnostic criteria for Kawasaki disease?
Five days of fever that is refractory to antibiotic therapy and 4/5 following symptoms: bilateral conjunctiva will infection polymorphous rash mucous membrane changes extremity changes cervical lymphadenopathy
describes the classic mucous membrane changes that occur in Kawasaki disease?
Strawberry tongue read it dry for assuring injected lips injected pharynx
described the characteristic extremity changes that occur in Kawasaki disease?
Desquamation of fingers and toes
what is a serious complication of Kawasaki disease?
cardiac involvement with myocarditis pericarditis and aneurysms
what occurs in week one of Kawasaki disease?
fever conjunctivitis mucous membrane changes lymphadenopathy and rash
what occurs in week two of Kawasaki disease?
red oedematous palms and soles of feel + desquamation
what occurs in weeks 3 to 8 Kawasaki disease?
Cardiovascular signs/gallop rhythm plus myocarditis pericarditis and the formation of aneurysms
how do you investigate Kawasaki disease?
Clinical signs and symptoms with high level of suspicion plus SBC: raised WCC raised PLT anaemia raised CRP ESR echocardiogram to check for coronary artery aneurysm
what is the management of Kawasaki disease presenting within less than 10 days or with high risk factors the complications?
IV I and high-dose aspirin, if there is no response to 2 doses of IVIG try corticosteroids or infliximab
what is the management of Kawasaki disease presenting over 10 days from onset or without any high risk for complications?
low dose asprin
what is the ongoing management of Kawasaki disease?
is low risk of complications discontinue low-dose aspirin and provide follow-up there are aneurysms give antiplatelet if there is a large aneurysm give antiplatelet with anticoagulant and beta-blocker
a patient presents the sore throat and low-grade fever they’re having dysphasia dysphonia a creepy cough and this Nokia on examination of the throat you find that there is a grey membrane covering their tonsils and pharynx what is most likely diagnosis?
Diphtheria
what does the image below show?
Classic bull neck appearance caused by severe lymphadenopathy which occurs because of the grey pseudo-membrane forming over the tonsils and pharynx which thickens and spreads
what causes the pseudo-membrane in diphtheria?
diphtheria toxin’s cause necrosis of tissue forming the grey pseudo-membrane
how do you diagnose diphtheria?
Culture and microscopy (antibody levels can aid the diagnosis)
what does the image below show?
cutaneous diphtheria shallow painful tender erythematous skin lesion which is often ulcerated which is also covered by a grey brown pseudo-membrane
how do you get cutaneous diphtheria?
when there has been a cut in the skin which then gets infected by the diphtheria it is more common in people their skin conditions such as eczema or in the extremities such as hands or feet
what is the management of diphtheria?
Requires hospitalisation in isolation administered diphtheria antitoxin and antibiotic therapy if severe consider airway protection and ventilation cutaneous diphtheria can be treated as an outpatient everyone has been exposed to diphtheria requires diphtheria toxoid immunisation
what is hand foot and mouth disease?
A common childhood bacterial infection commonly associated by Coxsackie virus usually occurring in children younger than 10
what is the presentation of hands and mouth disease?
Low-grade fever loss of appetite sore throat cough abdominal pain diarrhoea general malaise occasionally arthralgia sores appearing around the mouth then on the palms of hands and soles of feet and buttocks lesions healing within one week
what is the management of hand foot and mouth disease?
analgesia and antipyretic’s, topical anaesthetics such as Lidocaine and adequate fluid and nutritional support
what is scarlet fever?
a bacterial illness that develops in some people who have strep throat most commonly children 5 to 15 years old
child presents with a red rash appeared on their face and neck which is now spread to their trunk arms and legs looks a lot like sunburn and feels like some paper which is flashed around the Facebook pale around the mouth you also notice a strawberry tongue (most common in early disease) red lines in the folds of skin in the groins armpit et cetera you notice that their skin has started to peel (occurs about after one week of unfettered symptoms) there are also general malaise symptoms such as high-grade fever sore red throat Uetc - what is the most likely diagnosis?
scarlet fever
What does the image below show?
scarlet fever of the face
What does image below show?
strawberry tongue with white membrane of scarlet fever
how do you investigate scarlet fever?
throat swab with culture
What is the management of scarlet fever?
Antibiotics and children can return to school after 24-hour is of taking antibiotics
