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MRCP > Infectious diseases and STIs > Flashcards

Infectious diseases and STIs Flashcards

1
Q

gram positive cocci & how to differentiate them

A

staph (clusters)
strep (chains)
enterococcus

coagulase positive = staph aureus

coag neg = s.epidermis

a-hameolytic = strep viridans (sanguinis, mutans)

b-haemolytic = strep pyogenes, s.agalactiae & enterococci incl s.bovis

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2
Q

gram -ve cocci

A

diplococci: Neisseria meningitidis + Neisseria gonorrhoeae,

Moraxella catarrhalis

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3
Q

gram positive rods

A

ABCD L
* Actinomyces
* Bacillus anthracis, bacillus cereus
* Clostridium [anaerobic: c.diff, perfringens, tetanus]
* Diphtheria: Corynebacterium diphtheriae
* Listeria monocytogenes [SBP, meningitis]
& nocardia

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4
Q

gram negative rods

A

Remaining organisms are Gram-negative rods, e.g.:

  • Escherichia coli
  • Haemophilus influenzae
  • Pseudomonas aeruginosa
  • Salmonella sp.
  • Shigella sp.
  • Campylobacter jejuni

aerobic: enterobacter, proteus, salmonella, shigella, yersinia

anaerobic = bacteroides

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5
Q

chlamydia tx

pregnant and non-pregnant

A

Doxycycline for 7 days
If CI/not tolerated: azithromycin (1g one dose, 500mg OD 2ds)

Pregnancy: can use azithromycin, erythromycin or amoxicillin
Suggest azithromycin 1g stat

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6
Q

toxoplasmosis tx

A

pyrimethamine + sulphadizine

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7
Q

crypto meningitis tx

A

amphotericin B + flucytosine

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8
Q

schistosomiasis tx

A

praziquantel

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9
Q

strawberry cervix, wet mount: motile trophozoites, frothy yellow/green PV discharge

  • what is it?
  • tx?
A

Trichomonas: strawberry cervix, wet mount: motile trophozoites, frothy yellow/green PV discharge
• Mx: oral metro for 5-7ds or one 2g dose

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10
Q

Microscopy: clue cells

A

BV

thin white PV discharge

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11
Q

genital warts tx

A

Genital warts
• 1 keratinised wart: cryotherapy
Multiple non-keratinised: topical podophyllum

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12
Q

red cysts on Z-N stain

A

Cryptosporidiosis
• Modified z-n stain of stool: red cysts
• If immunosuppressed may need: nitazoxanide

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13
Q

fever in returning traveller 1st week

  1. with purpura?
  2. jaundice?
  3. safari + purpura?
A

dengue: purpura
lepto: water and jaundice
tick typhus: safari and purpura

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14
Q 
fever in returning traveller
4 weeks 
- bloody diarrhoea?
- normal wcc, splenomegaly?
- any pres
A

bd: amoebiasis
normal wcc: enteric fever
any: falciparum

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15
Q

amoebiasis tx

A

Invasive amoebiasis: tx with metro or tinidazole, then tx again with diloxanide furoate (because need to then get rid of dormant phase which is res to met or tini)

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16
Q

Rash, headache + 1 or more eschars & history of foreign travel - dx? tx?

A

Rickettsiae:
• Rash, headache + 1 or more eschars & history of foreign travel
○ Weil-felix reaction +ve
○ Tx: tetracyclines (doxycycline etc)
• Except Q fever: pneumonia with no rash (coxiella burnetti)
-ve weil-felix reaction

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17
Q

what does strep pyogenes cause? (5)

A 
Rheumatic fever
Scarlet fever
Most common cause of sore throat in UK
Post strep GN
erysipelas
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18
Q

diarrhoea 3ds after eating - most common cause?

A

Shigella sonnei = most common cause of gastroenteritis

- 3ds after visiting a restaurant get diarrhoea, on 3rd day of illness becomes bloody
- Similar pic to campylobacter
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19
Q

jaundice suffused conjunctivae muscle aches - dx?

A

leptospirosis

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20
Q

sickle cell - 2 organisms cause problems

A
  1. Parvovirus > aplastic anaemia

Salmonella > bone and joint infections

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21
Q

how does cholera cause diarrhoea

A

2nd messenger activation of G proteins&raquo_space; cAMP release

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22
Q

cellulitis abx choice incl pen allergic

A
  • Mild/mod: flucloxacillin
    • Pen-allergic: Clarithromycin, erythromycin (in pregnancy) or doxcycline

Severe: co-amoxiclav, cefuroxime, clindamycin or ceftriaxone.

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23
Q

orf fts

A

In humans - on hands and arms

1. small, raised, red-blue papules
2. Then: increase in size to 2-3 cm& become flat-topped and haemorrhagic

Cause: parapox virus.

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24
Q

what test to dx HIV seroconversion (2 options)

A

Seroconversion: HIV PCR or p24 antigen test (Abs may not be present yet)

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25
Q

leprosy

  • 2 types
  • mx
A

· Mx: rifampicin, dapsone, clofazimine

Low degree of cell mediated immunity → lepromatous leprosy (‘multibacillary’)
• extensive skin involvement
• symmetrical nerve involvement

High degree of cell mediated immunity → tuberculoid leprosy (‘paucibacillary’)

- limited skin disease
- asymmetric nerve involvement → hypesthesia
- hair loss

DETAILS
· granulomatous disease
· primarily affecting the peripheral nerves and skin
· Cause: Mycobacterium leprae.

Features
• patches of hypopigmented skin - buttocks, face, and extensor surfaces of limbs
• sensory loss

The degree of cell mediated immunity determines the type of leprosy a patient will develop.

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26
Q

abx for human bite? animal bite (incl pen allergic)

A

Animal bite: co-amox
- Pen-allergic: doxy + metro

Human bite: co-amox

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27
Q

anthrax

  • fts
  • mx
A

Black painless eschar
Tx with cipro

NOTES
Cause: bacillus anthracis (aerobic)

Fts:

- 2-5ds after inoculation: itchy vesicle
- Rapidly progresses >> painless black eschar (cutaneous malignant pustule but no pus)
- Usually not tender
- Can be oedema ++ around the lesion (can > compartment syn or nec fasc)
- Regional lymphadenopathy
- Can cause GI bleeding
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28
Q 
typhoid 
cause
fts
comps
mx
A

Cause: salmonella (aerobic gram neg rods)

Features
• initially systemic upset(headache/fever/arthralgia)
• relative bradycardia
• abdominal pain, distension
• Constipation
• rose spots: on the trunk in 40%, more common in paratyphoid

Comps

- osteomyelitis (esp sickle cell disease)
- GI bleed/perforation
- meningitis
- cholecystitis
- chronic carriage (1%, more likely if adult females)

DETAILS
- Salmonella group contains many members: most cause diarrhoeal diseases
○ aerobic, Gram-negative rods
○ not normally present as commensals in the gut.

Typhoid: salmonella typhi
Parathyroid: salmonella paratyphi (types A, B & C)
- enteric fevers: systemic symptoms such as headache, fever, arthralgia.

Pathophysiology
• typhoid is transmitted via faecal-oral route (also contaminated food and water)

Tx: cipro

- But if been to asia, probs resistant: azithromycin 
- Severe: IV cef 
- 14ds

3rd week of illness bowel perf

Dx: large volume blood culture

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29
Q

botulism

  • cause
  • what effect does the toxin have
  • fts
  • mx
A

Inhibits release of Ach at synapses
Diff to GBS as botulism descends
As soon as clinical suspicion: give botulism antitoxin & supportive care

NOTES
Tx: botulism antitoxin and supportive care
• Antitoxin only effective if given early: once toxin has bound, its actions cant be reversed

Ft
	• Fully conscious, no sensory disturbance
	• Flaccid paralysis
	• Double vision
	• Ataxia
	• Bulbar palsy

Clostridium botulinum
• Gram +ve anaerobic bacillus
• Produces botulinum toxin: irreversibly blocks release of Ach
• Cause: contam food, IVDU

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30
Q 
meningitis
if in community?
what abx for what type 
if allergic to penicillin?
also give?

contacts of what get what

A

Do an LP if no signs of raised ICP

In community and suspect meningococcal: IM benpen (if doesn’t delay transfer to hospital)

Initial abx
· <3mos: IV cefotaxime + amoxicillin (or ampicillin)
· 3mos-50y old: IV cefotaxmine (or ceftriaxone)
· >50y old: IV cefotaxime/ceftriaxone + amoxicllin/ampicillin

Know the type
· Meningococcal: IV benpen or cefotaxime/ceftriaxone
· Pneumococcal/haemophilus influenzae: IV cefotaxime/ceftriaxone
· Listeria: IV amoxicillin/ampicillin + gentamicin

Hx of immediate hypersens to penicillin/cephalosporins: use chloramphenicol.

Also: IV dex (reduce risk of neuro comps
- But don’t give if: septic shock, meningococcal septicaemia, immunocomp, meningitis after surgery

Contacts of meningococcal meningitis
- Oral cipro (1 dose)

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30
Q

meningitis

A
31
Q

cysticerosis - cause, mx

hydatid disease - cause, mx

A

Cysticercosis
• Cause: Taenia solium (from pork) and Taenia saginata (from beef)
• management: niclosamide

Hydatid disease

- Cause: dog tapeworm Echinococcus granulosus management: albendazole
32
Q

melioidosis

  • cause
  • tx
  • RF
  • syms
A

Cause: gram-negative bacterium Burkholderia pseudomallei

Treatment:
• Initial intensive therapy: IV ceftazidime, imipenem, or meropenem for 10–14 days
• Then eradication therapy: oral TMP/SMX (plus doxycycline) for 3–6 months
• Adjunct therapy: abscess drainage.

Risk factors:
• DM (the strongest risk factor)
• Chronic renal, liver, or lung disease (e.g., cystic fibrosis)
• Immunocompromised states (e.g., malignancy, long-term glucocorticoid use)
• Occupational exposure: agricultural work

Sign and symptoms:
• Incubation period: 1-21 days ( mean around 9 days)
• Sym cases can be acute, chronic (> 2 months), or reactivations of latent infection.
• Clinical features depend on the infected organ:

Acute pulmonary infection (most common): wide range of presentations (mild to severe)
• - Localized infection: skin ulcer, nodule, or abscess.
• - Visceral abscesses: esp in prostate, spleen, kidney, and liver.
• - Disseminated infection: ∼ 55% of cases; 20% mortality rate. Manifests with fever and septic shock.

Diagnosis:
• Culture: the mainstay of diagnosis. Gram stain of sputum or abscess pus
• Imaging: Chest radiography: may show signs of acute pneumonia

33
Q

rickettsiae

  • all have 3 fts, what reaction is positive, mx for all
  • 1 is slightly diff in presentaiton and negative reaction of above

causes of:
rocky mountain spotted fever
endemic typhus
epidermis typhus

A

Rash, headache + 1 or more eschars & history of foreign travel
• Weil-felix reaction +ve
• Tx: tetracyclines (doxycycline etc)

Except Q fever: pneumonia with no rash (coxiella burnetti)
• -ve weil-felix reaction

NOTES
= gram –ve obligate intracellular parasites
- Usually rash, headache and fever

Rocky mountain spotted fever
	• Rickettsia ricketsii
	• Tick
	• Headache + fever
	• Rash starts on wrists/ankles > centrally (maculopap > vasculitic)
	• Endemic to east coast of US

Endemic typhus
• R typhi
• Flea
• Rash starts central > peripheral

Epidemic typhys
• R prowazekii
• Human body louse

Ehrlichliosis: ehrlichia, tick.

34
Q

when is p24 antigen test positive in HIV

when is HIV Ab

A

P24 antigen: positive from 1wk to 3-4wk after infection

HIV Ab: most dev at 4-6wk, 99% by 3months
• Most common and accurate. Screening ELISA and confirmatory western blot

35
Q

syphilis - 2 optins for testing; one becomes neg after tx

causes of false positive (8)

A

Serological tests can be divided into:
• cardiolipin tests (not treponeme specific)
• treponemal-specific antibody tests

Cardiolipin tests
• syphilis infection > production of non-specific antibodies that react to cardiolipin
• EG VDRL (Venereal Disease Research Laboratory) & RPR (rapid plasma reagin)
• insensitive in late syphilis
• becomes negative after treatment

Treponemal specific antibody tests
• example: TPHA (Treponema pallidum HaemAgglutination test)
• remains positive after treatment

Therefore, following treatment for syphilis:
• VDRL becomes negative
• TPHA remains positive

Causes of false positive cardiolipin tests (positive VDRL, negative EIA/TPPA):
	- pregnancy
	- SLE, anti-phospholipid syndrome
	- TB
	- leprosy
	- malaria
	- HIV
Other treponemal infections (yaws, pinta)
36
Q

causes of genital ulcers (7) - diffs between them

A

Painful: herpes much more common than chancroid
Painless: syphilis much more common than LGV

NOTES
Genital herpes: multiple painful ulcers
Syphilis primary chancre: a painless ulcer

Chancroid: painful ulcer w sharply defined, ragged, undermined border + unilat painful LN enlargement

LGV: small painless pustule > ulcer. Then painful inguinal LN. then proctocolitis

Other causes of genital ulcers
- Behcet’s disease
- carcinoma
granuloma inguinale: Klebsiella granulomatis

37
Q

amoebiasis cause

A

entamoeba histolytica

38
Q

aspergilloma
- after CXR, Ix?
0 tx

A

1ST line immune response to aspergillus: macrophages
Tx voriconazole
CT: halo sign

If suspect aspergilloma from CXR, next test: serology for aspergillus precipitins

NOTES
= mycetoma (mass like fungal ball)
- Often in existing cavity in lung (TB, cancer, CF)

Usually asym
But can have cough, haemoptysis

Ix

- CXR: round opacity, crescent sign
- High titres of aspergillus precipitins
39
Q

trimethoprim mech of action, 2 SE and use in preg

A

Mechanism: interferes w DNA synth by inhibiting dihydrofolate reductase
- So can interact w methotrexate (also inh DHR)

Adverse effects
• myelosuppression
• transient rise in creatinine

Use in pregnancy

- Teratogenic risk in first trimester (folate antagonist)
- Manufacturers advise avoid during pregnancy

DETAILS
More on Cr
trimethoprim competitively inh the tubular secretion of creatinine
-&raquo_space; in a temporary increase which reverses upon stopping the drug
- It blocks the ENaC channel in the distal nephron > hyperkalaemic distal RTA (type 4)

40
Q

mycoplasma

  • complications (7)
  • fts
  • why is it important to recognise its atypical
  • mx
  • dx
A

Tx: doxycycline or macrolide
Ass w erythema multiforme, cold AI haemolytic anaemia

Notes
important to recognise atypical pneumonia: may not respond to penicillins or cephalosporins due to it lacking a peptidoglycan cell wall.

Features
• prolonged and gradual onset
• flu-like sym then dry cough
• CXR: bilateral consolidation

Complications
• cold agglutins (IgM): haemolytic anaemia, thrombocytopenia
• erythema multiforme, erythema nodosum
• meningoencephalitis, GBS and other immune-mediated neurological diseases
• bullous myringitis: painful vesicles on the tympanic membrane
• pericarditis/myocarditis
• GI: hepatitis, pancreatitis
• renal: acute glomerulonephritis

Investigations

- diagnosis is generally by Mycoplasma serology
- positive cold agglutination test
41
Q

easy rules of nrti v pi - what do they end in

A
  • NRTIs: end in ‘ine’
  • Pis: end in ‘vir’
    NNRTIs: nevirapine, efavirenz
42
Q

measles v rubella

A

Characteristic features of measles include
- a prodromal illness with fever, cough and conjunctivitis.
- Koplik spots, characteristic lesions of the oral mucosa, may appear during the prodromal phase before the rash.
○ However, while Koplik spots are specific to measles, they are not always present which can make the clinical diagnosis more difficult.
- The rash then starts behind the ears or on the face and spreads to the chest.

Measles can cause severe complications in pregnancy as it is a state of immunocompromise

- complications such as pneumonia are more common. 
- Public Health England recommends taking a thorough vaccination history at booking. 
- Post-exposure prophylaxis with human normal immunoglobulin is recommended for susceptible pregnant women who have been exposed to measles.

Rubella
Similar rash
No or much milder prodrome
Less high fever

43
Q

fever, urticarial rash, hepatosplenomegaly, bronchospasm - likely dx

A

katayama fever - acute schiso

44
Q

mycoplasma dx

A

serology

45
Q

c.botulinum v tetani presentation

A

C.botulinum: flaccid paralysis

C.tetani: spastic paralysis

46
Q 
diphtheria
- cause
- fts
Ix 
mx
A

PC: severe tonsillitis + neck swelling
Comps: myocarditis, rhythm abnormalities (esp heart block)

NOTES
Cause: gram positive, Corynebacterium diphtheriae
- produces exotoxin
- Transmitted via resp droplets

Diphtheria toxin > diphtheric membrane on tonsils (caused by necrotic mucosal cells)
- Systemic distribution can > necrosis of myocardial, neural and renal tissue

Possible presentations
• recent visitors to Eastern Europe/Russia/Asia
• sore throat w ‘diphtheric membrane’ - grey, pseudomembrane on the posterior pharyngeal wall
• bulky cervical lymphadenopathy (‘bull neck’)
• neuritis e.g. cranial nerves
• heart block - ass w poor prognosis

Ix: culture of throat swab: uses tellurite agar or Loeffler’s media

Management
• intramuscular penicillin
• diphtheria antitoxin

47
Q

PCP

  • mx?
  • when do you need prophylaxis
  • dx
  • common comp
  • extrapulm fts?
A

PCP: tx co-trimoxazole, add in steroids if hypoxic (eg pO2 <9)

Key bits

- Pneumothorax is a common comp
- CD4 <200 = should have prophylaxis
- Extrapulmonary manifestations are rare but incl: hepatosplenomeg, lymphadenopathy & choroid lesions 
- Def dx = BAL w silver stain

Notes

- Fts: SOB, dry cough, fever, v few chest signs
- CXR usually bilat interstitial infiltrates but can get lobar consol or be normal
- Sputum often negative
- Often need BAL to see PCP (silver stain)
- Need IV pentamidine in severe cases; or can give aerolised pentamidine (less effective and risk of pneumothorax)

Details

- Pneumocystic jiroveci = unicellular eukaryote 
- Co-trimoxazole = trimethoprim + sulfamethoxazole
48
Q

crypto diarrhoea mx

A

supportive tx

may need nitazoxanide if immunosuppressed

49
Q

immunosuppressed and exposed to chickenpox - mx?

A

If immunosuppressed and exposed to chickenpox: check for varicella Abs
- If negative (or can’t test): give VZ Ig

NOTES
Criteria to benefit from prophylaxis
1. Sig exposure to chickenpox or herpes zoster
2. Immunosuppressed (steroids longterm, methotrexate, other immunosup; neonates; pregnant)
3. No antibodies to varicella (NB shouldn’t delay getting Ig past 7ds of initial contact)

50
Q

amphotericin B

  • mech of actino
  • SE (5)
  • use
A
  • Binds with ergosterol forming a transmembrane channel that leads to monovalent ion (K+, Na+, H+ and Cl) leakage > cell death
    • SE: Nephrotoxicity, flu-like symptoms, hypokalaemia, hypomagnaseamia, hepatic failure
      Used for systemic fungal infections
51
Q

reversal of sleep wake cycle = what ID disease

A

Reversal of sleep wake cycle + behavioural changes = trypanosomiasis (african sleeping sickness

52
Q 
African trypanosomiasis (sleeping sickness)
- fts
mx 
spread by?
where?
A

)

NOTES
African trypanosomiasis (sleeping sickness)
Gambiense in west africa
Rhodesiense east africa - more acute course
Both spread by tsetse fly

Fts

1. Painless SC nodule at site of infection (trypanosoma chancre)
2. Intermittent fever
3. Enlarged LNs (post cervical)
4. Later: CNS involved (somnolence, headache, mood change, meningoenceph)

Early: IV pentamidine or suramin
Late or cns: IV melarsoprol

53
Q 
American trypanosomiasis (chagas' disease)
cause
fts
mx
where
A 
American trypanosomiasis (chagas' disease)
Trypanosoma cruzi

Acute

- Most asym
- But can see erythematous nodule at site of infection + periorbital oedema

Chronic

- Heart: myocarditis > dilated cardiomyopathy (apical atrophy) + arrthymias
- GI: megaoesophagus, megacolon [dysphagia, constipation]

Mx:
- Acute: azole or nitro deriv EG benznidazole or nifurtimox
Chronic: tx the complications

54
Q

lyme disease

  • classic ft?
  • other fts
  • organism
  • spread by
  • Ix
  • Mx
A

Cause: borrelia burgdorferi (spirochaete)
Spread: ticks

Fts

- Erythema migrans (bulls eye rash): 1-4wks after bite. Painless
- Systemic fts: headache, lethargy, fever, arthralgia
- Later: CV (heart block, peri/myocarditis), neuro (facial nerve palsy, meningitis, radicular pain)

Dx:
- Erythema migrans = clinical dx = start abx
- No EM: ELISA Abs to BB
○ If done within 4wks of syms and negative but still suspect it: repeat 4-6wk after 1st ELISA
○ If still suspect in syms for 12wks or more: immunoblot test
○ If ELISA positive or equivocal: immunoblot (western blotting)

Mx

- Early disease: doxy (if CI: amoxicllin)
- Disseminated: ceftriaxone

Jarisch-herxheimer sometimes after start tx (fever, rash, tachycardia after 1st dose)

55
Q

what disease can acute toxo present as in normal pts

A

· Acute toxo in normal pt can mimic acute EBV infection + should be suspected if EBV serology is negative
○ Need to pregnancy test due to risk of congenital toxo
○ Low fever, lymphoadenopathy w prominent cervical LNs, malaise, sore throat

Glandular fever: worst sore throat ever.

56
Q

chikungunya

  • how to differentiate from dengue (3)
  • fts
  • tx
  • cause
  • where from
A

NB: similar to dengue but:

- more joint pain
- no rash usually
- Normal bloods (dengue can cause low plts)

NOTES
Symptoms:
- severe joint pain + abrupt onset of high fever
- Others:
○ general flu-like illness of muscle ache, headache, and fatigue.
○ A rash may develop
○ swelling of the joints is not uncommon.

Similar to dengue but more joint pain which can be debilitating.

Treatment: Relief of symptoms.

DETAILS
· Alphavirus disease
· caused by infected mosquitoes.
· Africa, Asia and Indian subcontinent - few cases in Southern Europe recently

56
Q

HIV post exposure prophylaxis
what drugs
how long for
when do you test

A

· HIV transmission rate from 1 needle stick 0.3%
· Viral load determines the risk of HIV transmission after a needle stick
· Oral ART for 4 weeks
Combo ART (tenofovir, emtricitabine and ritonavir/lopinavr), repeat HIV test in 12wk (as takes this long to dev Abs)

57
Q

Man w gonorrhoea, tx w ceftriaxone, syms continue - cause

A

: co-existent infection w chlamydia

58
Q

live attenutated vaccines (7)

who is CI from having them

A
  • BCG, MMR, flu, oral rotavirus, oral polio, oral typhoid, yellow fever

Live attenuated vaccines are CI in pts w CD4 <200 (risk of vaccine-ass disease)

59
Q

visceral leishmaniasis
fts
dx
where from

A

Visceral leishmaniasis (kala-azar)
• mostly caused by Leishmania donovani (visceral reaction to jason donovan)
• Mediterranean, Asia, South America, Africa
Fts
• fever, sweats, rigors
• massive splenomegaly. hepatomegaly
• poor appetite*, weight loss
• grey skin - ‘kala-azar’ means black sickness
• pancytopaenia secondary to hypersplenism
• the gold standard for diagnosis is bone marrow or splenic aspirate
*occasionally patients may report increased appetite with paradoxical weight loss

60
Q 
HIV drugs 
Types of drug - end bit of name
integrase inh
PI
NRTI

Mech of drugs
• Integrase inhibitors

A 
Types of drug
	• Gravir = integrase inh
	• 'Vir' = PI
	• 'ine' = NRTI
	• NNRTI = nevirapine, efavirenz

Mech of drugs
• Integrase inhibitors (gravirs): block the enz that inserts the viral genome into the DNA of the host cell

61
Q

staph aureus pneumonia

- 2 characteristic fts

A

cavitating lesions when it causes pneumonia

After flu

62
Q

HUS presentation

- bacterial cause

A

E. coli O157:H7 causes HUS
- Bloody diarrhoea, acute renal failure w high urea and hamolytic anaemia (schistocytes on blood film)

NOTES
E. coli O157:H7
- severe, haemorrhagic, watery diarrhoea
- high mortality rate
- can be complicated by haemolytic uraemic syndrome
often spread by contaminated ground beef.

63
Q

most common comp from repeated gonorrohea infection

A

infertility due to PID

64
Q

rabies

  • fts
  • mx if immunised, if not immunised
A

Features

- prodrome: headache, fever, agitation
- hydrophobia: water-provoking muscle spasms 
- hypersalivation
- Negri bodies: cytoplasmic inclusion bodies found in infected neurons

Following an animal bite in at-risk countries:
- the wound should be washed
- if already immunised: 2 further doses of vaccine
- not previously immunised: human rabies Ig + full course of vaccination.
○ If possible, the dose should be administered locally around the wound

DETAILS

- viral disease
- causes an acute encephalitis
- RNA rhabdovirus (specifically a lyssavirus)
- has a bullet-shaped capsid

Cause

- Most: dog bites
- But can be transmitted by bat, raccoon and skunk bites.

Following a bite the virus travels up the nerve axons towards the CNS in a retrograde fashion.

Mortality

- 25,000-50,000 people across the world each year
- The vast majority of the disease burden falls on people in poor rural areas of Africa and Asia. 
- Children are particularly at risk.

‘no risk’ of developing rabies following an animal bite in the UK and the majority of developed countries.

If untreated the disease is nearly always fatal.

65
Q 
dengue fever
- classic fts 
- bloods (3)
- dx (3 optins)
mx
A

retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

Investigations
• Bloods: leukopenia, thrombocytopenia, raised aminotransferases
• diagnostic tests
○ serology
○ nucleic acid amplification tests for viral RNA
○ NS1 antigen test

Treatment

- entirely symptomatic e.g. fluid resuscitation, blood transfusion etc
- no antivirals are currently available
MORE 
Dengue fever
	• fever
	• headache (often retro-orbital)
	• myalgia, bone pain and arthralgia ('break-bone fever')
	• pleuritic pain
	• facial flushing (dengue)
	• maculopapular rash
	• haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis
	• 'warning signs' include:
		○ abdominal pain
		○ hepatomegaly
		○ persistent vomiting
		○ clinical fluid accumulation (ascites, pleural effusion)

Severe dengue (dengue haemorrhagic fever)
• A form of DIC resulting in:
○ thrombocytopenia
○ spontaneous bleeding
• 20-30% of these go on to dev.dengue shock syndrome (DSS)

66
Q

cholera

  • cause
  • fts (3)
  • mx
A 
Cause: Vibro cholerae - Gram negative bacteria
Features
	• profuse 'rice water' diarrhoea
	• dehydration
	• hypoglycaemia
Management
	• oral rehydration therapy
antibiotics: doxycycline, ciprofloxacin
67
Q

strep pyogenes causes 8 diseases

A

Causes: rheumatic fever, scarlet fever, post-strep GN, erysipelas, impetigo, cellulitis, type 2 nec fasc, pharyngitis/tonsillitis

68
Q

meningeal TB

A

RIPE for 12mos + prednisolone

69
Q

fts of severe falciparum
& mx

what ft may indicate co-existent bacterial infection

A 
Features of severe 
	• schizonts on a blood film
	• parasitaemia > 2%
	• acidosis
	• temperature > 39 °C
	• severe anaemia
	• comps
Complications
	• cerebral malaria: seizures, coma
	• acute renal failure: blackwater fever, secondary to intravascular haemolysis
	• ARDS 
	• hypoglycaemia
DIC

Severe falciparum malaria
- parasite counts >2% usually need parenteral treatment irrespective of clinical state
- IV artesunate
- if parasite count > 10% consider exchange transfusion
shock may indicate coexistent bacterial septicaemia - malaria rarely causes haemodynamic collapse

70
Q

tetanus mx

A

If had 5 doses of tetanus vaccine with last one <10y ago: do NOT need vaccine booster or Ig (no matter how bad the wound is)

Full course of vaccines, last dose >10y ago:

- Tetanus prone wound: 1 more dose of vaccine
- High risk: 1 more vaccine dose & Ig

If vaccine history unknown/incompolete:
- All get booster dose
If tetanus prone or high risk: also give Ig

71
Q

disseminated gonorrhoea fts (3)

A

· Disseminated infection = tenosynovitis, migratory polyarthritis + dermatitis

72
Q

shigella abx and indiciations for them

A

cipro

• antibiotics if severe disease, who are immunocomp or with bloody diarrhoea - cipro

73
Q

e.coli causes 3 types of illness

A
  • diarrhoeal illnesses
    • UTIs
    • neonatal meningitis

MRCP (16 decks)

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