Infectious Diseases And GUM Flashcards
Gonnorhea
N.Gonnorhea - Encapsulated and therefore resitant to phagocyosis
Large ASx resevoir - Pharynx/rectal/cervical
Disseminated dx - in females = penicillin sensitive
Opthalmoplegia neonartu - Systemix Abx and Eye drops
> 10% = resistant to Penicillin + quinolones
–> Tx = CEPHLASPORIN - IM CEFTRAXONE + PO azithromycin
Syphillis
Treponem Pallidum
Transmission: SExual > Blood borne.
Diagnosis:
1) Serology = 2 x specific Ag test (EIA or TPHA) + Quantitive PCR
2) Dark ground microscopy - of tissue from Chancre or rash
3) Treponem PCR - Early syphillis Ulcer
In secondary syphillis - haem spread:
- Mucocutaneous - non-itchy rash
- LN
- Neuro - CN palsy/ Meningitis
- Occular - ant. uveitis
- GI - Hepatitis or proctitis
- Rheu - polyarthritis
Tx = Benzylpenicillin or Tetracycline
REINFECTION ??? –> use rapid plasma reagin - all others stay +ve despite txx
Chlamydia
Most common bacterial UTI –> Non-gonnocal urethritis.
Complications:
- Female - PID.
- Male - prostatitis/epididymitis
- Babies - Neonatal conjunctivitis or pneumonitis - Systemic Erythromycin
In UK serovaa D + K most common
Other Complications:
- Trachoma - corneal scarring = Serova A/B/C
- Lymphogranuloma venerum = rectal inflamm + prostatitis - in MSM - Serova L1/L2/L3
Inx - NAATs
Mx in Adults = TETRACYCLINE OR AZITHROMYCINE
Risk factors for Aids
Most common transmission is M+F > MSM > Blood > IVDU
HIV 1 - most common worldwide
HIV2 - Most common in West Africa
RF:
- Seroconversion or adv disease
- concurrent STI
- Concurrent Hep C
- High Viral Load
Maternal –> Fetal RF = BREASTFEEDING reduce transmission by:
- Antiretroviral before 3rd trimester
- Avoid Breastfeeding
- If detect VL @ 36 weeks –> C-section
HIV Mechanism
HIV follows CD4 cells: T-helper, B cells, Macrophages and CNS cells
HIV –> Decreased CD4 and therefore a low CD4:CD8
Markers assoc w/ Progression:
- Low CD4
- High Viral Load
Seroconversion:
- up to 3/12
- General unwekk sx, can ave meningo-encephalitis or arthropathy
- Can’t detect HIV antibody during this time
- Can detect HIV p24 Ag or HIV-1 (at 1 month)
Stages of HIV infection
Stage 1: Seroconversion
Stage 2: ASx
Stage 3: Persistent Generalised LN
Stage 4a: AIDS related complex –> Not AIDS defining disease
Stage 4b: AIDS defining illnesses
HIV - PCP
Q Stem: Persistent cough, with low sats or desat on exercise and HIV (CD4<200)
CXR: Bilat perihilar LN
Inx - Brochoalveolar lavage (BAL) –> Silver stain or immunoflourescence
Mx:
- IV Co-Trimaoxazole or IV pentamidine (Sev dx)
- Steroids - improve prognosis
Prophylaxis - Co-trimox and nebulised pentamidine:
- Prev PCP or CD4 <200 (until >200)
HIV - Pulm TB
Q Stem - may be similar to PCP –> AFRICAN PT or EXPOSURE –> Extrapulm TB or Mycobacterium Avium intracellulare
Atypical features:
- Atypical CXR
- Extrapulmonary Spread
- Atypical organism - Mycobacterium avium intracellulare
HIV - GI disease
Common:
- Oesophageal candida
- oral hairy lukoplakia
- KArposi sarcoma
- gingivitis
- lymphoma
- CMV
- HSV
Diarrhoea:
Cryptosporidium –> porfuse watery diarrhoea
Salmonella –> Atypical severity –> bacteraemia.
Inx - Stool culture or ZN Stain (Cryptosporidium) Or Biopsy
HIV - Neuro diseases
Cerebral Toxoplasmosis:
- Px - Focal Neuro
- Inx: CT - ring enhancing lesions + Toxoplasmosis IgG serology
- Tx: Pyrimethamine + Sulfadiazine
CNS Lymphoma:
- EBV
- Assoc. with EBV
- CT
- Tx = Steroid + Chem
NOTE: distnguish between toxoplasmosis and lymohoma with Thalium SPECT (neg in toxo and pos in lymphoma)
Cryptococcal meningitis:
- Px: Mengitis
- Inx - Cryptocoocal Ag in Blood or CSF
- Tx - Amphotericin or Fluctosine –> Liver/renal fx
Neurosyphillis:
- Myopathy, retinitis, meningitis
- Inx - Syphillis serology
- Tx - IM Procaine penicillin + PO Probenacid
CMV Retinitis:
- CD4< 50
- Px : Blurred or LOV
- Signs: Soft Exudate + Retinal haemorrhage
- Tx: Ganciclovir.
HIV/ AIDS Tx
HAART = 2x NNRTI + (NRTI or PI)
IL-2 can be used to icrease CD4 # if good supression of HIV but poor CD4 count
If Fx respond to Tx –> Salvage therapy = Add Enfuvirtide
Monitoring:
- Clinical assess
- CD4
- Viral Load
- Renal/Hepatic fn
- Cholesterol/BGL
- Lactate
If Viral Load high on 2x ocassions –> Test for Viral Resistance
These patients req >90% Adherence
PEP and PrEP
4 weeks of Truvada / Kahetra
Take within 72 hours –> decrease transmission by 70-80%
PrEP - if high risk but not infected - req LT adherance (As long as exposure)
Live vaccines
Give 4 weeks apart
Human bite organisms and management
Staph A
Strep
Eikonella corrodons
CO-AMOXICLAV
Hep B vaccination response
Measure anti-HBs
> 100 —> no further bad
10-100 —> one additional vax dose
<10 —-> test for current or post infection and and repeat course of 3 vaccines
Urine dip tests
+ nitrates and + luecocytes
Then gram negative - E. coli
If symptomatic and only leukocytes consider a Gram + infection
G+ can’t concert nitrates to nitrites and therefore will be negative on urine dip
Bacterial vaginosis
Fishy discharge
Amsel criteria:
- thin white homogenous discharge
- clue cells on microscopy
- vaginal pH >4.5
- positive whiff test
Management
PO metronidazole
Renal transplant and infection
Think CMV
If imunnosupressed and approx 4/12 after commencement of immunosuppressant then think CMV
Genital warts
HPV 6 + 11 —> predispose to cervical Ca
Single + keratinised- cryotherapy
Multiple and non-keratinised - topical podophyllum
2nd line - topical imiquimod
Rubella in preg
Adult - headache/fever/URTI
1st trimester:
- congenital rubella syndrome
- deafness
- cataract
- pda
- developmental delay
Toxoplasmosis
Parasite from cat faeces
Features:
- primary —> infectious mononucleosis like sx
- reactivation —> CNS multiple ring enhanced lesions
Pregnancy:
- Early - frontal retinochoroiditis, encephalo-myelitis, hydrocephalus or microceph
- late: develop above but as an infant - NORMAL BIRTH
Inx = serology
IgG - previous
IgM - acute
Mx:
Non specific tx
If reactivation —> Pyrimethamine, sulfadiazine + Folinic acid
Pregnancy - Spiramycin
Toxoplasmosis vs CNS Lymphoma
- both increased Immuno deficiency:
Toxo - multiple lesions. Lymphoma- single
Thallium spect: toxo neg. lymphoma +
CMV
Ft:
Intraceebral calc
Helatosplenomegaky
Retinitis - in HIV - CD4 <50 —> IV ganciclovir
Varicella
Primary infection. - chickenpox —> latent in. Sensory ganglia
Reactivation —> dermatomal shingles
Pregnancy:
- if contact and unsure if immune:
VZIG
- untreated —> congenital varicella syndrome = limb hypoplasia + scarring of dermatomes
If adult gets exposed and unsure if exposed —> test IgG —> negative —> VZIg
Parvovirus in preg
Foetal anaemi
Hydrous fetalis - accumulation in fluid in >=2 feral compartments has
Foetal death
Gram +ve mnemonic
|Str|ange |Staph|y’s |act| |list| |enter|ed |my| |new| |Cl| |C|arrier |ba|g
Strep Staph Actinomyosis Listeria Enterrococcus Mycobacteria Pneumococcus Clostridia Corynbacterium - diptheria Bacillus
G+ve Bacilli
CLara DATTA
Clostridia Listeria Diptheria Anthrax TB Tetanus Actinomyces
Strep Pnemo + Viridans
Alpha Knight tournament
Strep Pyogenes
Pyogenie bakery
Strep Agalactiae
Galactic Baby
Staph A
Golden Staph of Aureus
HSV
HSV-1 –> life long carriers
HSV-2 –> used to be known for genitals but now crossover
Can get mengitis or temporal lobe encephalitis.
Diagnosis of enceph: Viral PCR on CSF + MRI
Mx: IV Aciclovire
VZV
primary infection –> Chickenpox –> latent in sensory ganglia
Reactivation –> Shingles
Complications –> Pneumonitis or cerebral ataxia –> IV antiviral
If pregnant exposure and NOT immine –> VZIG
CMV
Primary –> ASx or Gladnular fever-like or GBS or BElls
> 80% of >60 yr olds have it, but becomes an issue if immunosupressed.
AIDS + CMV –> CMV retinitis, oesophagitis or colitis
Tx - ganciclovir
EBV
Ingectious mononucleosis Burkitts Lymphoma Lymphoma in HIV Nasopharygeal Ca Oral Hairy Leukoplakia
HHV8
KArposis sarcoma
Primary effusion lymphoma
Castlemans disease - lymphoproliferative disorder with enlarged LN
ABx Mechanism of action - non-protein synth inhibitors.
NITtu MET |SUL|tan in CEPtember with a |FLU|id PEN and a CAR
DNA synth inhib:
Nitrofurans
Metronidazole
Tetrahydrofolate inhib:
Sulphonamides - Trimethoprim
Peptidoglycan inhib:
- Cephlasporin
Penicillin
Carbapenems
DNA Gyrus inhib:
Fluroquinolones
ABx Mechanism of Action - Protein synth inhibs
Ma LIfe A-T C-E-Ll
Macrolides - 50s
Linezolid - 50s
Aminoglyclosides - 30s
Tetracycline - 30s
Clindamycin - 50s
Erythromycin - 50s
Linezolid - 50s
Bacteriocidal (BANG Q RIP) vs Bacteriostatic (MS COLT)
Bacteriocidal:
Beta lactams - Penicillin/Carbepenems/Cephlasporin
Aminoglycloside (neomycin/gentamycin/streptomycin)
Nitroimidazole (MEtro)
Glycopeptides (Vanc)
Quinolones (-floxacin)
Rifampixin
Polymixin
BActeriostatic:
Macrolides (erythromycin/arithro/clarithro)
Sulfanamides (trimethoprim)
Chloramphenicol
Oxazolidones
Lincosamide (clindamycin)
Tetracycline
Pregnancy and congenital infections
Rubella Toxoplasmosis CMV VZV Parvovirus
IVDU infections
I.E. - see IE card in cardio
BBV
Soft tissue —> abscess or gangrene or next fasc
Clostridia infections
Botulinism:
- typically transmitted in food with toxin
-IVDU —> wound infection –> prevent ACTH release
-Px: acute descending symmetrical FLACCID paralysis
- can affect CNS —> eventually leads to resp
Fx
-Inx: toxin detection
- Mx: Pencillin/clindamycin + metronidazole & supportive.
Tetanus:
- travels via motor neurone —> CNS. —> block NT release
- Px = trismus, opisthotonos, dysphasia ( RIGID paralysis)
Inx - clinical + PCR
Mx - anti-tetanus Ig + metronidazole
Splenectomy
High risk of encapsulated organisms:
- s.pneumonia
- H.influenza
- N.mengitidies
- campylobacter canimorous
- malaria
- babesiosis
Immunisation: HiB N.mengitides Pneumonia Annual influenza
Prophylaxis:
Abx prophylaxis up to 16yrs
Or 2yrs post splenectomy
Sickle cell disease
Functional hyposplenism
In particular:
Pneumococcus/meningococcus —> sepsis
OM due to salmonella
Increase morbidity and mortality from malaria —> haemolytic and infarctive crisis
Toxic shock syndrome:
Toxin mediated
Staph or strep
From indwelling foreign body - tampon or
Surgical
Ft:
- macular rash —> disseminated
- shock
Inx: clinical suspicion and r/o other causes
Mx:
- Abx - specific and clindamycin or linezolid
- consider MrSA
- if nec fasc —> surgical debridement
Live attenuated vax
|y|ou |m|usnt |p|rescribe BCG |I|ncase |T|hey |r|IP |S|tat
Don’t prescribe in HIV
Yellow fever
MMR
POLIO
BCG
INFLUENZA
TYPHOID
ROTAVIRUS
SHINGLES
Infectious mononucleosis
Glandular fever - EBV
Ft:
- sore throat
- exudative tonsillitis
- malaise
- splenomegaly
- widespread maculopalukar rash
Inx:
- monospot test (Paul burnnell test)
- high lymphocytes = atypical on blood film
- raised transaminasss
Mx:
Supportive
Avoid ampicillin —> maculopap rash
If airway comp —> steroids
Complications:
Splenic rupture Haemolytic anaemi Thrombocytopenia GBS Meningitis
Diphtheria
Spore forming G+ bacteria
Transmission = resp droplets
Px
- patient from endemic area or missed vaccines
- temp / ant cervical LN / soft tissue oedema —> bulls neck
- membranous pharyngitis —> airway obstruct
Inx - throat culture swab
Mx:
- diphtheria anti-toxin + penicillin or erythromycin
- immunisations
- notify public health
Lenierres disease
Caused by fuspbacter
Tonsillitis
Septic emboli —> IJV thrombosis and abscess
Atypical pneumonia causes
Do not conform to lobar pattern
Mycoplasma pneumonia Legionella Chlamydia pneumonia Chlamydia psitaccia Coxellia burnetti
Meningitis
CSF
bacteria
- cloudy
- neutrophils
- high protein. Low glucose
Viral
- clear
- lymphocytes
- glucose normal
- high protein
tb - cloudy - lymphocytes Glucose low - protein very high
Cryptococcal - clx - leukocytes Glucose N Protein N - ZN stains/India ink
Bacteria - gram stain
Virus - viral pcr
tB - ZN again
Crypto - ZN stain
Mx - benzylpenicilin in communit - cefuroxime or cefotaxime Ampicillin if >55 Ampicillin and gent if listeria
Contacts:
If meningococcus —> ciprofloxacjn
Encephalitis
Most common UK cause HSV1 > HSV2
Inx - CSF PCR + MRI
TX - Aciclovir
Brain abscess
Q stem - think of
Route of entry
OM/dental surgery/ sinusitis/CNS infection
Mx: cephalosporin + metro
GI Infection - Staph A
Rapid onset. - 4-6 hours
GI infection - E Coli
Most common travellers diarrhoea
12-72 hours
Can cause HUS
Amoebiasis
Transmission faeces - oral
Q stem. - area of poor sanitation
Amoeba multiply in gut —> Bloody diarrhoea - invasive colitis
dysentery
Amoebic liver abscess —> anchovy paste ours
Inx: stool microscopy —> trophozites
Mx: metronidazole + diloxanide furoate
Giardiasis
Travellers diarrhoea
Chronic watery diarrhoea
Inx
Stool microscopy —> cysts
SB biopsy —> trophozites
Mx:
Metronidazole or tinidazole
Tropical sprue
Get post infection malabsorption - 2/12
E. coli / klebsiella / enterobacter
Cryptosporidium GI infection
Water Bourne protozoan infection
Watery diarrhoea
ZN STAIN —> red cysts
Mx:
- tx HIV —> increase WCC
C Diff
Risk factors:
- increased age
- Clindamycin > cephalosporin > cipro > coamox
- acid suppression e.g ppi
Markers of severity:
WCc >15
Raised Cr > 50% baseline
Temp >38.5
Evidence of sever colitis
Mild:
- <3 stools/day
- WCc N
Mod
- 3-5 stools
- WCc <15
Sev:
- > 5 stools
- WCc > 15
- creatinine / temp as above
- High lactate —> very poor prognosis
Inx: stool culture = 2 stage
—> PCR/EIA For GDH —-> + —-> EIA for toxin —-> + then treat
Mx;
Mild = PO METRO
Mod = PO VANC
Sec = PO VANC AND IV METRO
Hytadid disease
Dog tapeworm - echincoccus
Larvae enter blood
Mature in liver and for cysts
Can disseminate —> lungs and brain
Liver cyst rupture —> life threatening anaphylaxis
Inx: Liver US + serology
Mx:
Surgical removal of cyst
Bendazole or praziquantel
Leptospirosis
Urine of infected animals —> broken skin
Q stem:
- occupational exposure - sewage worker or agriculture
- social exposure - fishing or water sports
Px:
Headache temperature neck stiff - initial
Then get a vasculitic rash
Can get weils disease: jaundice + renal impairment + proteinuria
Inx:
Culture - blood CSF urine
Serology
PCr
Mx:
Tetracycline + penicillin
TB
RF:
- HIV
- Contact
- Origin
- Institution
Drug resistant TB - incomplete/wrong tx :
- E.Europe, Russia + central Addia
- MDR-TB = resitant to R + I
- XDR-TB - resistant to R + I + Fluroquinolone
Inx:
Mantoux test = point of care = est for latent TB:
- False neg: Lymphoma, miliary TB, Sarcoid, HIV, CKG 4,
v. young
IFN-gamma:
- if + Mantoux –> distinguish between IMMS or exposure
Best = ZN stain for AAFB
Mx - RIPE
Rifamp –> Red-orange body secretion
Isoniazid - INH –> Iron increase, neuropathy, hepatitis
Pyrazinamide –> hyperuricacidaemia –> Gout
Ethambutol –> Eyes –> optic neuritis + colour vision loss
Give 3/12 of R + I (+/- P) or 6/12 of I (+/-P)
if CNS + cardiac infecton –> 10/12 of RI and extra two of PE –> 12/12 AND STEROIDS
Tx neuropathy with Vit B6 = PYROXIDINE
BCG Vax if:
- neonate with first degree relatives from high risk
- Neonate with FHx of TB
- Neonate recent arrval from high risk
- Unvaccinated and mantoux neg with occupational risk
- Remember live attenuated –> therefore CI HIV
Non-TB mycobacter
all mycobacter except: M. TB M. Bovis M. Africanum
Risk if :
- Established chronic lung disease - bronchitis or emphysema
- Cavitation from Prev TB
- Immunocomp
Inx:
if pulm dx –> 2 specimens 7 days apart
Mx:
as for TB but longer
Mycobacter Avium complex - common
- includes m.avium and m.intracellulare.
Causes dx in 2 was:
1) dx resembles TB in elderly smoker w/CLD
2) Nodular infilitrates + bronchiectasis w/o CLD ( looks like CLD but no CLD) - Lady Windemere syndrome
Tx:
- TB tx
- Prophylaxis in HIV if CD4< 50 - AZITHROMYCIN
Malaria - Causativ agents
Plasmodium Falciparum - mst severe –> death
P. Ovale
P. Vivax
P. Malariae
Transmission:
- Blood transfusion
- Mosquitos
Malaria Px + Inx
Px:
- Constitutional symptoms
- Headache
- PRE HEPATIC JAUNDICE –> due to haemolysis
Complications:
- Cerebral malaria - focal neuro - not meingitis
- Pulm oedema/ARDS
- Sev haemoytic anaemia
- hypoglycaemia
- Sepsis
- Splenomegaly
Inx:
- THICK FILM –> trophozites
- Shiztones can be seen on this film and i present SEVERE
- Ag test can distinguisg between types
Markers of severity:
- Parasitaemia >2%
- Shiztones present
- Multiorgan involvement
Malaria Mx
P.Falciparum:
Severe dx –> IV Artesunate
Not Severe –> PO Quinine
Non-falciparum:
1) Azythromycine or Lumefantrine
2) Primaquine (Check G6PD deficiency first)
Typhoid ( Salmon dinner on sketchy micro) - SEAGULL
traveller returning from indian subcontinent
Seagull - harbors in GBladder
Transmission is faeco-oral –> there increase risk if DECREASED STOMACH H+
Ft:
- Rose spots
- Hepatosplenomegaly
- Fever
- Abdo pain
- Diarrhoea ( Pea soup)
- Change in mental state
- OM in sickle cell dx.
Inx:
- Culture –> G- BACILLUS
Tx:
- Ciprofloxacin
- if recent travel to |A|sia then give |A|zithromycin
There is a live attenuated Vax
Ameobiasis
Faeco-oral –> therefore RF is poor sanitation
Amoeba multiply in gut:
- Bloody diarrhoea
- Dysentry
- Liver abscess –> Assoc. pain —> Anchovy paste –> if discharges into abdo cavity –> peritonitis
Inx:
- Stool microscopy —> Amoebic trophazites
Mx:
- Metronidazole + Diloxanide Fuorate
Plase positive in VDRL/RPR
SomeTimes Mistakes Happen
SLE
TB
MAlaria
HIV
Non falciparum malaria treatment
If pt from a chloroquine resistant area —> artemisinin based tx
If not —> chloroquine
Use orimaquine to get rid of liver hypnoZites
Disseminated gonnococal infection
Migratory arthritis + tensosynovitis + Dermatitis
Anthrax - Eschar tx
Tx = Ciprofloxacin
Cat scratch disease causative agent
Bartonella.
Tx of Pubic lice
permithrin cream full body wash –> rpt at 1/52 –> rretest 1/52 after.
HSV in preg
Primary attack >28 weeks –> C-sec
if not:
- Aciclovir from 36 weeks
PElvic inflammatory dx
Causes:
- most commonly chlamidyia
- N. gonnorhea - contact pr + swab
- mcyoplasma genitaiium
0 mycoplasma hominus
Px:
- Lower abdo pain
- fever
- deep dyspareunia
- dysuria/menstrual irref
- discharge
- cervical excitation
- Prehepatits = Fitz-hugh curtis syndrome
inx:
- test for chlamiyia/gonnorhea
Mx:
PO olfoloxacin + PO metro
Im Cef + PO doxy + PO metro
if IUD –> consider removal
complcition
- infertility
- chronic pain
- ectopics
Malaria chemoprophylaxis
Chloroquine - common
south east asia - Chlroquine resistance:
- Atovaquone
- proguanil
- mefloquine
- Doxy
Pregnant women: - Avoid if possible if not: - Chloroquiene - proguanil + Folate MAlorone
DOXY CI and MEFLOQUINE + Cautio
Japanese encephalitis
Flavivirus
Transmitted by mosquitos found in rice paddy fields
Can px with low GCS and PARKINSONIAN FEATURES
Diagnosis - PCR or serology
Mx - supportive
Measles presentation
diffuse rahs
Koplik spots on cheek mucosa
Yellow fever
Presents similair to. Dengue haemorrhagic fever
PCP
Investigatuon is beta D-glucagan - prwsent in fungal cell wall
Which malria infections can be dormant?
P. Ovale and P. Vivax
What to do if r\aised ALT following TB treatmentr
if ALT >5x ULN –> STOP ALL
HEaf Test - TB
grade 0: no response - nothing
Grade 1: 1 - 4 dots - unequivocal
Grade 2: coalesce to form ring with normal skin in middle - Prev BCG
Grade 3: Coalesce with abnormal skin - active disease
Grade 4 Solid lesion >10mm +/- ulceration/vesicles = active dx
HIV Drugs rule of thumb with names
-navir- N”avir” trust a protease inhibitor
NRTI -ine-
NNRTI - others
Hantar Virus
HEamorrhagic dx with renal fx
endemic ins outh asia/korea
Loa Loa treatment
DEC
Diethylcarbamazine
Visceral vs cutaneous Leishmaniasis
both caused by sand fly.
Visceral lleishmaniasis almost always assoc. by hepto/splenomegaly
Leishmaniasis
Caused by SAND fly
3 types:
Cutaneous:
- Leishamni tropica or mexicana
- PApule at site of bite –> Ulcer
Mucocutaneos:
- Brazilienis
- Similair to above + mucosa
Visceral (Kala=azar):
- Donovani
- med/asia/south america/africa
- HEPATOSPLENOMEGALY
- systmically unwell.
- GREY SKIN - (Black sickness)
Leptospirosis management
Doxy or. Benpen
Whipples dx Management
IV Ceftriaxon
