Infectious Diseases / GUM Flashcards
Legionella pneumophilia is best diagnosed by ?
Urinary Antigens
Management of Legionella
Erythromycin/clarithromycin
Chagas disease - organism?
Trypanosoma cruzi
Syphilis - organism?
Spirochaete - Treponema pallidum
Infection is characterised by primary, secondary and tertiary stages
Primary features of Syphilis
Chancre - painless ulcer at the site of sexual contact
Local non-tender lymphadenopathy
Secondary feature of Syphilis
Occurs 6-10 weeks after primary infection
Systemic symptoms: fevers, lymphadenopathy
Rash on trunk, palms and soles
Buccal ‘snail track’ ulcers
Condylomata lata (painless, warty lesions on the genitalia )
Treponema pallidum particle agglutination assay (TPPA)
Indirect agglutination assay used for detection and titration of antibodies against Treponema pallidum.
IgG antibodies to syphilis can remain elevated
Candidiasis in immunocompromised patients - treatment?
High dose fluconazole
VDRL + and TPHA +
Active infection
VDRL - and TPHA +
Past infection
VDRL + and TPHA -
False positive
SLE, malaria, HIV, TB
Chancroid
STI caused by Haemophilus ducreyi.
Painful ulcers
Painful lymphadenopathy
Lymphogranuloma venereum
Chlamydia trachomatis
Leprosy - define
Granulomatous disease - peripheral nerves and skin
Mycobacterium leprae
Management of Leprosy
Triple therapy
Rifampicin
Dapsone
Clofazimine
Leptospirosis - define
Spirochaete - Leptospira interrogans
Classically being spread by contact with infected rat urine.
Investigation for Leptospirosis
Serology: antibodies to Leptospira develop after about 7 days
PCR
Culture
Coagulase-positive
Causes skin infections, abscesses, osteomyelitis, toxic shock syndrome
Staphylococcus aureus
Coagulase-negative
Cause of central line infections and infective endocarditis
Staphylococcus epidermidis
Tick-borne encephalitis
Flavivirus
Supportive management
Risk of vertical transmission for hepatitis C
6%
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
Dengue
Severe dengue (dengue haemorrhagic fever)
Form of disseminated intravascular coagulation (DIC) resulting in:
Thrombocytopenia
Spontaneous bleeding
Periodic acid-schiff staining
Used on jejunal biopsy specimens to diagnose Whipples disease
Silver staining
Pneumocystis jiroveci on sputum samples
Ziehl-Neelsen stain (acid-fast stain) of the stool
Red cysts of Cryptosporidium
Relative bradycardia
Abdominal pain, distension
constipation/diarrhoea
Rose spots: present on the trunk
Typhoid fever - Salmonella enterica
Management of PCP
Co-trimoxazole
IV pentamidine in serious cases
Aerosolized pentamidine - risk of pneumothorax
Norovirus - investigation
Faecal/Vomitus Viral PCR
Chikungunya
Alphavirus disease caused by infected mosquitoes
Africa, Asia and Indian subcontinent
Severe joint pain and abrupt onset of high fever
HIV, once stable, should be monitored with ?
Viral load every six months
CD4 counts annually
Management of Typus
Doxycycline
Infectious mononucleosis
Epstein-Barr virus
Sore throat
Pyrexia
Lymphadenopathy
Infectious mononucleosis - investigation
Heterophil antibody test (Monospot test)
Other features of Infectious Mononucleosis
Palatal petechiae
Splenomegaly
Hepatitis, transient rise in ALT
lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
Haemolytic anaemia secondary to cold agglutins (IgM)
Loiasis - define
Filarial infection caused by Loa Loa
Pruritus / Urticaria
Calabar swellings: transient, non-erythematous, hot swelling of soft-tissue around joints
‘Eye worm’
Treatment for Loa Loa
Ivermectin
Giardiasis - treatment
Metronidazole
Giardiasis - bloody or non-bloody
Non-bloody
Yellow fever - define
Type of viral haemorrhagic fever (also dengue fever, Lassa fever, Ebola)
Zoonotic infection: spread by Aedes mosquitos
The biopsy results show the presence of inclusion bodies in the colonic mucosa - what organism and treatment?
CMV colitis - IV Ganciclovir
Cerebral Toxoplasmosis - treatment
Sulfadiazine and pyrimethamine
Treatment of strongyloidiasis
Ivermectin + Albendazole
Most common fungal CNS infection in patients with HIV
Cryptococcal meningitis
India ink test positive
Q fever - define + features
Coxiella burnetii
Fever, malaise
Transaminitis
Atypical pneumonia
Endocarditis (culture-negative)
Q fever - management
Doxycycline
Amoebiasis - define
Entamoeba histolytica - spread by the faecal-oral route
Amoebic dysentery
Pofuse, bloody diarrhoea
There may be a long incubation period
Oral metronidazole - ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
Amoebic liver abscess - treatment
Oral metronidazole
A ‘luminal agent’ (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
Lyme disease - define
Spirochaete - Borrelia burgdorferi
Features of Lyme disease
Headache, lethargy, fever, arthralgia
Erythema migrans
Heart block
Treatment of Lyme Disease
Doxycycline if early disease.
Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)
Ceftriaxone if disseminated disease
Meningitis: causes
0-3 months
Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes
Treatment of Typhoid
Quinolones
Ciprofloxacin
Main technique used to screen for latent tuberculosis
Mantoux
Management fo Cytomegalovirus retinitis
IV ganciclovir
Herpes simplex virus (HSV) in pregnancy - treatment?
Oral Aciclovir
Treatment of choice for MRSA septicaemia
IV Vancomycin
Vancomycin
Teicoplanin
Linezolid
Severe hepatitis in a pregnant woman
Hepatitis E
Type 1 Necrotising fasciitis
Mixed anaerobes and aerobes
Type 2 Necrotising fasciitis
Streptococcus pyogenes
Gonorrhoea - organism
Gram-negative diplococcus
Neisseria gonorrhoeae
Gonorrhoea - treatment
Single dose of IM ceftriaxone 1g
Treatment for Chlamydia
Doxycycline
Treatment for Trichomonas vaginalis
Metronidazole
Treatment for Gardnerella vaginalis
Metronidazole
Investigation of choice for Chlamydia
Nucleic Acid Amplification Test (NAAT)
Cutaneous leishmaniasis is typically diagnosed using?
Punch Biopsy
Leishmaniasis - vectors
Sandflies
First line treatment for early Lyme disease
14-21 day course of oral doxycycline
Q fever
Coxiella burnetii
Fever, malaise
Pyrexia of unknown origin
Transaminitis
Atypical pneumonia
Endocarditis (culture-negative)
Treatment for Q Fever
Doxycycline
Plasmodium vivax - where
Central America and the Indian Subcontinent
Plasmodium ovale - where
Africa
Cyclical fever every 48 hours
Plasmodium vivax/ovale
Cyclical fever every 72 hours
Plasmodium malariae
Relapse with Malaria - subtypes?
Plasmodium Vivax/Ovale
Should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse
Brucellosis - define
Zoonosis - Middle East and in farmers, vets and abattoir workers
Features of Brucellosis
Fever, malaise
Hepatosplenomegaly
Sacroiliitis
Osteomyelitis, infective endocarditis, meningoencephalitis, orchitis
leukopenia often seen
Treatment for Brucellosis
Doxycycline and streptomycin
Investigation for Brucellosis
Brucella serology is the best test for diagnosis
Rose Bengal plate test can be used for screening
Drug of choice for contact prophylaxis - bacterial meningitis
Within 7 days of contact
Ciprofloxacin - Single dose
HHV-8
Kaposi’s sarcoma
Nucleoside analogue reverse transcriptase inhibitors (NRTIs)
Lamivudine, Abacavir and Zidovudine
Gram-positive bacilli (or rods)
ABCDL
Actinomyces
Bacillus anthracis
Clostridium, Corynebacterium
Diphtheria
Listeria monocytogenes
Gram positive cocci
Streptococci
Staphylococci
Gram-negative cocci
NNM
Neisseria (Neisseria meningitides, Neisseria gonorrhoea)
Moraxella
Vancomycin Resistant Enterococcus (VRE) can be treated with
Linezolid, daptomycin and tigecycline
Investigations for Mycoplasma pneumoniae
Mycoplasma serology
Positive cold agglutination test → peripheral blood smear may show red blood cell agglutination
Management of Mycoplasma pneumoniae
Doxycycline
or
Macrolide (e.g. erythromycin/clarithromycin)
Management of Leprosy
Triple therapy:
Rifampicin, dapsone and clofazimine
Confirmatory investigation of TB
Multiple respiratory samples
(3 deep cough sputum samples, preferably including 1 early morning sample)
for TB microscopy and culture
Two choices for treating latent tuberculosis:
3 months of isoniazid (with pyridoxine) and rifampicin
or
6 months of isoniazid (with pyridoxine)
Diagnosis of PCP
Bronchoalveolar lavage (BAL)
Silver stain shows characteristic cysts
Extended Spectrum Beta-Lactamases (ESBL) - Treatment
Carbapenems - Meropenem
Mucocutaneous leishmaniasis - organism
Leishmania braziliensis
Most common complication of mumps in post-pubertal males.
Orchitis
Gold standard for diagnosis - Visceral leishmaniasis (kala-azar)
Bone marrow or splenic aspirate
Most common cause of epilepsy worldwide
Neurocysticercosis
Management is with praziquantel or albendazole and prednisolone.
Which Hepatitis carries a significant mortality during pregnancy?
Hepatitis E
Amoebiasis - organism
Entamoeba histolytica
Treatment of Amoebiasis
Oral metronidazole
A ‘luminal agent’ (to eliminate intraluminal cysts) e.g. (diloxanide furoate)
Treatment of Cutaneous larva migrans
Anthelmintic agents:
Ivermectin or albendazole
Treatment of non-typhoidal Salmonella gastroenteritis.
Ciprofloxacin
Treatment of Legionnaires
Macrolides or fluoroquinolones (such as levofloxacin)
Management of Influenza
First line: oseltamivir
Second line: zanamivir
Management of PCP in someone who is hypoxic
Co-trimoxazole + steroids
Vancomycin - class
Glycopeptide antibiotic
Treatment of Gram-positive infections, particularly MRSA
Mantoux test (6-15)mm indicates:
1.Prior BCG vaccination
2.Latent TB
3.Previous history of TB
Treatment of Chlamydia
Doxycycline
Most common cause of necrotising fasciitis is
Type 1 : polymicrobial infection
Type 2 necrotising fasciitis - most commonly caused by:
Streptococcus pyogenes
Candidiasis in immunocompromised patients - treatment?
High dose fluconazole
Treatment of paragonimiasis (lung fluke infection)?
Praziquantel
Treatment of Mycoplasma pneumoniae
Doxycycline or a macrolide
Bed bugs - organism
Cimex lectularius
Management of Typhus
Doxycycline
Treatment of Staphylococcus aureus bacteraemia
IV Flucloxacillin 2 weeks
Treatment of Visceral leishmaniasis
Sodium stibogluconate
2nd line - Amphotericin B
Human herpes virus 5 (HHV 5)
Cytomegalovirus (CMV)
Drug of choice for lymphatic filariasis
Diethylcarbamazine
Treatment for Cryptosporidiosis
Supportive for immunocompetent patients
Nitazoxanide/Rifaximin - immunocompromised
Main/Serious complications of Typhoid
Bowel perforation and haemorrhage
Syphilis: management
Intramuscular benzathine penicillin
2nd line: doxycycline
Treatment of choice for tropical trypanosomiasis
Benznidazole
Treatment of Botulism
Botulism antitoxin and supportive care
Risk of infection following splenectomy:
Streptococcus pneumoniae. Haemophilus influenzae type B, Neisseria meningitidis
What type of feeding is recommended in the UK to all babies with HIV +ve mothers
Formula feeding
CIprofloxacin is used to treat which GI infections?
Salmonella
Shigella
Campylobacter
