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Infectious diseases Flashcards

1
Q

How is meningitis investigated?

A
  • lumbar puncture if no signs of raised ICP (ZN stain, cytology, virology, glucose, protein, culture PCR)
  • FBC, CRP, coag, culture, glucose, gases, U&E, lactate, meningococcal and pneumococcal PCR
  • throat swabs
  • sometimes a CT scan
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2
Q

How is meningitis without signs of shock, severe sepsis or signs suggesting brain shift managed?

A
  • dexamethoasone 10mg IV
  • ceftriaxone IV
  • careful fluid restriction
  • Follow SEPSIS6
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3
Q

What signs suggest raised ICP and so you should delay LP in meningitis?

A
  • severe sepsis or rapidly evolving rash
  • severe resp/ cardiac compromise
  • focal neurological signs
  • papillodema
  • continuous or uncontrollable seizures
  • GCS<13
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4
Q

List 5 potential complications of meningitis

A

septic shock, DIC, septic arthritis, haemolytic anaemia, pericardial effusion, subdural effusion, SIADH, seizures, hearing loss, cranial nerve dysfunction

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5
Q

How should suspected TB be investigated?

A
  • CXR
  • 3 sputum samples for MC&S and ZN stain (may need todo bronchial washing)
  • biopsy and needle aspiration for non resp TB
  • HIV, Hep B and C serology
  • FBC, U&E, CRP, coag
  • MRI for leptomeningeal involvement
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6
Q

How is TB screened for?

A

Mantoux test + interferon gamma test

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7
Q

How is active TB managed?

A
  • 6 months isoniazid and rifampicin and 2 months of pyranzinamide and ethambutol
    + pyridoxine with the iso
  • check vision baseline with snellen chart
  • Do LFTs and U&Es to check baseline before starting therapy
  • neg pressure room and PPI
  • notify public health
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8
Q

How is latent TB managed?

A

6 months isoniazid or 3 months rifampicin and isoniazid + pyridoxine
notify public health

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9
Q

Give at least 1 adverse effect for each TB drug?

A

R: hepatotoxic, GI upset, autoimmune reactions, orange urine
I: hepatotoxic, peripheral neuritis, psychotic changes and epilepsy
P: hepatotoxic, GI upset,
E: Optic neuritis, hyperuricemia, GI upset, colourblindness
All: allergic reactions

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10
Q

List 5 common/ important diseases which could cause fever in a returing traveller?

A

malaria, dengue, typhoid, amoeba, viral haemorrhagic fever,

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11
Q

How does malaria present?

A
  • travel history to area of high humidity, rural location, cheap accom, outdoors at night roughly 2 weeks ago
  • non specific symptoms: fever, chills, headaches, cough, myalgia, GI upset
  • signs: hepatomegaly, jaundice, abdo tenderness
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12
Q

What are features of late/ severe malaria?

A

Impaired consciousness, SOB, bleeding, fits, hypovolaemia, hypoglycaemia, AKI, resp distress syndrome

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13
Q

What are the 3 causative organisms of malaria and what are their incubations?

A

Plasmodium falciparum: 7-14 days (most common in africa)
Plasmodium vivax: 12-17 days w/ relapses common due to dormant parasites in liver
Plasmodium ovale: 15-18 days, also relapsing

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14
Q

How should suspected malaria be investigated? (4)

A
  • 3x thick and thin blood films with giemsa stain
  • rapid antigen test
  • FBC, U&E, LFT, G6PD activity (prior to giving primaquine), blood glucose, gases, clotting, lactate (if severe)
  • head CT
  • CXR
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15
Q

How is p. falciparum treated?

A

IV quinine initially (needs ECG monitoring) then oral quinine and doxy for 7 days when they can swallow.
Supportive treatment also
Artesunate may be used in fututre

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16
Q

How is p vivax and ovale malaria treated?

A

Cholorquine (3-4 days) and primaquine (14 days)

Supportive treatment also

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17
Q

How does dengue fever present?

A
  • abrupt onset high fever, severe headache behind eyes, myalgia, N+V, abdo pain
  • macropapular blanching trunchal rash
  • signs of bleeding, organ failure, hypovolaemia in severe disease
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18
Q

What countries is dengue common in and how long is the incubation period?

A

africa/ thailand/ americas
4-10 day incubation
carried by day biting mosquito

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19
Q

How is dengue investigated?

A
  • FBC (high PCV, low platelets, leukopenia), clotting studies (prolongs APTT and PT), U&Es, LFTs
  • Serum IgM and IgG antibody detection by ELISA
  • CXR if pleural effusion suspected
  • blood cultures
  • malaria films
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20
Q

How is dengue managed?

A
  • All supportive:
  • Fever control w/ paracetamol/ tepid sponge/ fans
  • Iv fluid resus and fluid balance monitoring
  • haemorrhage and shock require FFP, platelets and sometimes infusion
  • severe dengue may need ITU
21
Q

How does typhoid present? What is the relevance of their tongue?

A

Gradually increasing fever, malaise, headache, dry cough, abdo pain, diarrhoea, furred tongue with red edges and tip, bradycardia

22
Q

What organism causes thyphoid, what is incubation period and how does it spread?

A

Salmonella typhi
Incubation period is 10-20 days for S typhi and 1-10 days for S paratyphi
Spreads through contaminated water and food

23
Q

How is typhoid investigated?

A
  • Blood cultures (gram neg bacillus)
  • FBC, U&E, LFT
  • blood films for malaria
24
Q

How is typhoid managed? (4)

A
  • IV ceftriaxone or azithromycin
  • steroids in severe disease
  • supportive
  • side room, PPE, careful handwashing and faeces disposal
  • surgery if bowl perforates
25
What organism causes amoeba and what country is it prevalent in?
entamoeba histolytica | south and central america, west africa, SE asia
26
How long is incubation period and how does amoeba present?
Incubation 7 days- 4 months Usually presents as dysentery (severe diarrhoea with blood and mucus). Liver amoebiasis presents later w/ pyrexia, sweating, RUQ pain and abdo tenderness, hepatomegaly, weight loss, cough
27
How do you diagnose amoeba?
History+Specific stool E. histolytica testing (culture, antigen testing or PCR- 4-6 samples may be needed before a positive result) USS or CT looking for liver abscesses
28
What is uses to treat dysentery and liver amoeba?
both PO metronidazole
29
Give 3 causes of viral haemorrhagic fever (VHF)?
All subtypes of RNA virus eg ebola, zika, dengue, yellow fever, crimean congo etc
30
How does VHF present?
- incubation of 2-21 days - flushing, conjunctival injection, fever, malaise, flu like illness, petechial haemorrhages - later mucous membrane haemorrhage, hypovolaemia, hypotension, shock, circulatory collapse
31
How should VHF be investigated?
- clotting studies - FBC: leukopenia and thrombocytopenia - LFTs, U&Es, LFTs (raised) - D Dimers often high - antibody test to identify virus
32
How should VHF be managed?
- notify public health - barrier nursing, side rooms, visitor restriction (v contagious) - supportive management (keep FFP on standby) - monitor and support major organs - no specific management
33
Give 4 common bacterial causes of pyrexia with unknown origin
- TB where dissemination has occurred there may be no localising signs and normal CXR - Endocarditis (can be culture negative) - Abcesses can have no localising symptoms, but may be from previous surgery, trauma, perinephric abcesses can have normal urinalysis - hepatobillary infections - osteomyelitis (usually causes pain) - discitis
34
Give 3 viral causes of pyrexia of unknown origin
- CMV - EBV - HIV Can all cause prolonged febrile illness with no prominent organ manifestation esp in elderly
35
State 2 factors that predispose you to disseminate fungal infections
immunosurpression, broad spectrum abx, IV devices and paraenteral nutrition
36
Which cancers are most associated with pyrexia of unknown origin?
- lymphoma - leukaemia - renal cell carcinoma - mets from breast, liver, colon, pancreas
37
Name 2 drugs which could cause a pyrexia
B lactam abx procainamide isoniazid phenytoin
38
Which autoimmune diseases could cause pyrexia of unknown origin?
- RA - crohns and sarcoidosis (granulomatoid diseases) - vasculitis (GCA, PMR)
39
Give 2 non infective, non neoplastic, non autoimmune causes of pyrexia of unknown origin?
- hyperthyroidism - peripheral pulmonary emboli - thrombophlebitis - kikuchis disease (necrotising lymphadenitis- self limiting)
40
What specific investigations could be done to investigate pyrexia of unknown origin?
- Labelled white cell scan - blood, urine, sputum, stool, CSF cultures - hybrid PET CT - skin biopsies or rashes - lymph node aspirations or biopsies
41
What are the 3 principles of antimicrobial stewardship? give an eg of each
- persuasive (education, consensus, opinion leaders) - restrictive (formulary restriction, prior authorisation, automatic stop orders) - structural (computerised records, rapid lab tests, quality monitoring, expert systems)
42
Define pyrexia of unknown origin
temp of >38 on multiple occasions for 3 weeks with no identified cause despite 1 week in patient investigations
43
How should suspected HIV be investigated?
- HIV test (antigen and antibody testing, positive a few weeks after infection and get results on same day) - CD4 count - HIV viral load (PCR) - HIV resistance profile - syphillis and hep abc serology - routine bloods - taxoplasma, measles, varicella and rubellla IgG - TB cultures often
44
Name 4 conditions and infections associated with severe HIV infection?
- kaposi sarcome - TB - PCP (pneumocystis jiroveci pneumonia) - taxoplasmosis - CMV - lymphoma - herpes - candida - cryptococcal meningitis
45
How is HIV managed?
Nucleoside receptor transcriptase inhibitor x2 (tenofovir, lamivudine) + non NRTI or protease inhibitor or integrase inihbitor or CCR5 (entry) inhibitor AND hep B, pneumococcal and flu vaccines AND co trimoxazole for PCP prophylaxis if your CD4 is <200 AND opthalmology assesment for CMV retinitis if your CD4 count is <50 Also education about condoms etc is important
46
What extra is needed to treat TB if there is pericardial, meningeal or spinal involvement?
Steroids- the start of the anti TB meds will cause bacteria death and inflammation which will be bad in these places
47
Describe the pathogenesis of TB
- inhaled infectious droplets - engulfed by alveolar macrophages and primary ghon focus forms - some may get taken around body and to lymph nodes where t mediated immunity will contain the infection - 5% will progress to active primary disease soon after - latent infection then heals or self cures or lays dormant until reactivation due to immunocompromise causing post primary TB
48
Describe the differences between active and latent TB
active- cxr abnormal, sputum samples positive, symptoms (cough, fever, weightloss, nightsweats), infectious, mantoux and IFN gamma positive latent- mantoux and IFN gamma positive, cxr usually normal, sputum cultured negative, no symptoms, not infectious
49
How is meningitis with signs of raised ICP, severe sepsis or a rapidly evolving rash managed?
- critical care input - secure airway - bloods and culutres - fluid resus - dexamethasone and ceftriaxone IV - neuro imaging when stable - delay LP - catheter - blood gasses - source isolation until ceftriaxone for 24 hrs - notify microbio and public health

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