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4th Year Medicine 2 > Infectious Diseases (specific infections) > Flashcards

Infectious Diseases (specific infections) Flashcards

1
Q

Acute cholangitis?

A

infection of biliary tree
fever, jaundice, RUQ pain
gram neg organisms from the gut (e.g. coliforms) and anaerobes
treat with amox (covers any gram pos), met (covers any anaerobes), gent (cover the coliforms)

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2
Q

Brain abscess?

A

very rare in UK (more likely to have a primary brain tumour which is also rare)
headache, focal signs, seizures, signs of infection
large variety of organisms depending on origin - was it from ENT or dental infection? trauma to head? neurosurgery etc.
ceftriaxone likely to be used as good for CNS infections

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3
Q

Breast abscess/ mastitis?

A

red, hot, swollen, tender breast
can be from breast feeding or duct ectasia
staphylococci and strep are common
treated with flucloxacillin - keep breast feeding

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4
Q

Candidiasis?

A

yeast/ fungal infection - skin and mucous membranes
presentation depends on location
treated with topical clotrimazole or oral fluconazole

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5
Q

Cellulitis?

A

red, hot, swollen, tender skin
Strep pyogenes or Staph A
Flucloxacillin

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6
Q

Conjunctivitis?

A

this is mainly viral - adenovirus
if bacterial - staph A, strep pneumonia or haemophilus influenzae
treated with topical chloramphenicol

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7
Q

Encephalitis?

A

mainly viral - VZV, HSV, measles
presents with confusion, focal signs, personality changes, seizures, headache
treated with aciclovir

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8
Q

Epididymitis and Orchitis

A

orchitis can be caused by mumps
epididymitis has 2 potenital causes - spread from STI or from UTI
red, hot, swollen, sore testis, cremasteric reflex intact, Preh sign positive (elevating testis relieves pain)
If STI - gonorrhoea - refer to GUM for sensitivities - IM ceftriaxone likely treatment
If UTI - E. coli - follow UTI guidelines - nitrofurantoin for 7 days

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9
Q

Impetigo?

A

superficial skin infection
staph A most commonly
but also strep pyogenes
honey crusted lesions, occurs in children, very contagious
flucloxacillin

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10
Q

Endocarditis?

A

infection of endocardium, mainly occurs on the heart valves
pyrexia, malaise, heart murmur
strep viridans (associated with dental procedures/ poor hygiene), staph epi (prosthetic valves), staph A (IVDU), strep bovis or enterococcus (associated with gut procedures or malignancy)
most is treated with amoxicillin - may add vancomycin, gentamicin or rifampicin
staph A suspected endocarditis should be treated with flucloxacillin

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11
Q

Meningitis?

A

neisseria meningitidis or strep pneumonia, in immunocompromised consider listeria
headache, nausea and vomiting, photo and phonophobia, neck stiffness, fever, myalgia, non-blanching rash
ceftriaxone, dexamethasone
amoxicillin if at risk of listeria (immunocompromised)
vancomycin if travel to area high risk of penicillin resistant organisms
in paeds: if < 3 months cefotaxime plus amoxicillin, if > 3 months first dose cefotaxime then move to ceftriaxone

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12
Q

Osteomyelitis?

A

infection of bone cavity
inflammation at site, fever, fatigue, lethargy
staph A, strep
flucloxacillin

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13
Q

Otitis media?

A

infection of the middle ear
mainly viral
bacterial - strep pneumonia, haemophilus influenzae, moraxella catarrhalis
if bacterial and meets criteria treat with amoxicillin

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14
Q

Pneumonia?

A

signs of LRTI with consolidation on CXR
strep pneumonia is main cause
amoxicillin
if severe CAP give co-amoxiclav, if severe HAP amoxicillin plus gentamicin (gram neg organisms more likely to be involved in hospital)
In aspiration pneumonia - amox, met, gent (want to give broad cover including anaerobes as gut bacteria may be involved)

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15
Q

Septic arthritis?

A

red, hot, swollen, painful joint, fever, limping child
staph A
flucloxacillin

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16
Q

Tonsillitis?

A

most are viral
Fever Pain score for bacterial: cervical lymphadenopathy, fever, tonsillar exudates, presented within 3 days, absence of a cough, severe tonsil inflammation
penicillin V

Do not give amoxicillin as if its EBV (which presents similarly) will get a rash

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17
Q

UTI?

A

frequency, urgency, nocturia, dysuria
E. coli
1st line is nitrofurantoin 2nd line is trimethoprim
treat for 3 days in women and 7 days in men

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18
Q

What is the most common cause of bacterial gastroenteritis?

A

campylobacter jejuni

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19
Q

Campylobacter appearance, transmission, symptoms?

A
  • Gram negative bacteria has corkscrew appearance with a bipolar flagella
  • Symptoms usually 2-5 days after infection
  • Faeco-oral route
  • Main route of transmission is thought to be foodborne, most common source is undercooked meat but also contaminated milk or water
  • Diarrhoea (frequently bloody), abdominal pain, fever, headache, nausea and/or vomiting
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20
Q

Salmonella transmission?

A
  • Can get from poultry, meat and raw egg
  • Faeco-oral route
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21
Q

Listeria gastroenteritis transmission?

A
  • “Fridge organism” – lives best at 0-5 degrees
  • Gram positive rod
  • Faeco-oral route
  • Get from deli counters, soft cheeses
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22
Q

Bacillus cereus transmission?

A
  • Gram positive rod
  • Faeco-oral route
  • Classically contracted from fried rice dishes that have been sat at room temperature for hours
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23
Q

Is bacillus cereus gastroenteritis usually serious? How long does it last?

A

generally quick onset of symptoms (8 hours) and then quick resolution
so a mild gastroenteritis

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24
Q

Most cases of E. coli gastroenteritis are caused by what? Why is this signficant?

A
  • Most cases of E. coli gastroenteritis are caused by E. coli 0157 (shiga toxin producing)
  • risk of haemolytic uraemic syndrome
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25
Q

Transmission of E. coli gastroenteritis?

A
  • Faeco-oral route
  • Found in beef, raw milk and can also contract from animal contact
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26
Q

Why do you not give antibiotics in gastroenteritis until culture confirmed?

A

if they have E. coli 0157 giving antibiotics increases risk of HUS so dont want to give antibiotics unless you know it isn’t that

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27
Q

Explain what causes haemolytic uraemic syndrome?

A
  • There is thrombosis in small blood vessels throughout the body, triggered by the Shiga toxin
  • This toxin is mainly produced when infection with E. Coli O157 but can also be produced when infected with the Shigella bacteria
  • Using antibiotics and/ or loperamide increases risk of developing HUS after E. Coli O157
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28
Q

Triad in haemolytic uraemic syndrome?

A

haemolytic anaemia
AKI
low platelet count

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29
Q

Presentation of haemolytic uraemic syndrome?

A
  • Causes a triad of: haemolytic anaemia, AKI, low platelet count
  • Presentation: brief gastroenteritis with bloody diarrhoea then 5 days later – reduced urine output, haematuria or dark brown urine, abdominal pain, lethargy, irritation, confusion, hypertensino, bruising
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30
Q

Management of haemolytic uraemic syndrome?

A
  • This is a medical emergency with a high mortality
  • The disease is self limiting and needs supportive treatment which may include antihypertensives, blood transfusions and/ or dialysis
  • 70-80% patients will make a full recovery
31
Q

Describe clostridium difficile infection and what causes it?

A
  • Gram positive spore bearing bacillus - associated with broad spectrum antibiotics as the spores survive and can then grow in a gut free of all other microorganisms
  • Four C antibiotics to avoid in an elderly patient at risk of C diff: Co-amoxiclav, cephalosporins, ciprofloxacin, clindamycin
32
Q

Management of C difficile infection?

A
  • C difficile infection is the only indication for oral vancomycin (oral vancomycin is not absorbed systemically but obviously want it to stay in the GI tract if that is where infection is)
33
Q

How do you test for C diff infection?

A
  • C diff does not grow well in culture but can test for GDH in stool which the bacteria produces in large quantities
34
Q

Complication of C diff infection?

A
  • C diff can cause a type of inflammation in the colon called pseudomembranous colitis
35
Q

Describe viral gastroenteritis?

A
  • Important viral causes are rotavirus, norovirus, adenovirus and astrovirus
  • Hand hygiene is extremely important as those who are infected shed millions of viral particles but only a few viral particles are needed to make someone else ill
  • Often get asymptomatic shedding hence why people are told to stay off 48hrs after last symptoms
  • Norovirus is also known as winter vomiting, often problems with entire ward outbreaks
  • Rotavirus is common in children under 3 but incidence decreasing as there is now a vaccine
36
Q

List 3 causes of bloody diarrhoea?

A

campylobacter
E. coli (particularly O157)
C diff infection

37
Q

Describe giardiasis and how it is spread?

A
  • This is a microscopic parasite that can live in animals or humans
  • Faeco-oral spread
  • This infection can occur in UK and it is one of the most common gut parasite infections in UK
38
Q

Presentation of giardiasis?

A
  • Infection may be asymptomatic or it can cause a chronic diarrhoea
39
Q

Diagnosis and management of giardiasis?

A
  • It is diagnosed by stool microscopy
  • Treated with metronidazole
40
Q

Describe some principles of gastroenteritis management?

A
  • Isolation and infection control
  • Stool sample for microscopy culture and sensitivities
  • Assess for dehydration
  • Oral fluid challenge – if fail may need to stay in for IV fluids
  • Slowly introduce food
  • Stay off work/ school until no symptoms for 48 hours
  • Antidiarrhoeals e.g. loperamide and anti-emetics e.g. metoclopramide are generally not recommended
  • Antibiotics should only be given in patients that are at risk of complications and once the causative organism is confirmed
41
Q

List 4 post-gastroenteritis complications?

A
  • Lactose intolerance (transient- clears in a few months)
  • IBS
  • Reactive Arthritis
  • GBS
42
Q

When should antibiotics be given in gastroenteritis?

A
  • Antibiotics should only be given in patients that are at risk of complications and once the causative organism is confirmed
43
Q

Describe typhoid infection?

A
  • Enteric Fever/ Typhoid fever is most common in those returning from Indian subcontinent and SE Asia
  • Typhoid is caused by salmonella typhi
  • Spread by faeco-oral route
  • High temperature, headache, aches and pains, constipation, cough
  • As progresses lose appetite, nausea, abdominal pain and diarrhoea
44
Q

Describe travellers diarrhoea?

A
  • The passage of three or more unformed stools per day in a resident of an industrialised country travelling in a developing nation
  • Common causes are E. coli and campylobacter infection
  • Disease is usually self limiting
45
Q

Describe amoebiasis?

A
  • This is more common in areas where living conditions are crowded and unsanitary- common in parts of Africa, Latin America and Asia
  • Amoebiasis is caused by amoeba and presents with diarrhoea but if untreated can get an amoebic liver abscess, usually contracted from contaminated water
  • Can be treated with metronidazole
46
Q

What can be given as prophylaxis for contacts of meningitis?

A

oral ciprofloxacin or rifampicin

47
Q

Explain what whooping cough is?

A
  • This is an upper respiratory tract infection caused by Bordetella pertussis (a gram negative bacteria)
  • It is called whooping cough because the coughing fits are so severe that the patient is unable to take any air between coughs and subsequently makes a loud whooping as they forcefully suck in air after the coughing finishes
48
Q

Who is vaccinated against whooping cough?

A
  • Children and pregnant women are vaccinated against pertussis, the vaccine becomes less effective a few years after each dose
49
Q

Presentation of whooping cough?

A
  • Starts with mild coryzal symptoms, a low grade fever and sometimes a mild dry cough
  • More severe coughing fits start after a week or more
  • These involve sudden and recurring attacks of coughing with cough free periods in-between
  • Coughing fits will continue until completely out of breath at which point there will be a loud inspiratory whoop
  • Patients can cough so hard they faint, vomit or develop a pneumothorax
  • Should note that all patients will whoop, and infants with pertussis may present with apnoeas as opposed to a cough
50
Q

How may whooping cough present differently in infants?

A

they may have apnoeas as opposed to a cough

51
Q

Diagnosis of whooping cough?

A
  • Nasopharyngeal or nasal swab with PCR testing or bacterial culture can confirm the diagnosis within 2-3 weeks of the onset of symptoms
  • Where the cough has been present for more than 2 weeks patients can be tested for anti-pertussis toxin immunoglobulin G, this is tested for in the oral fluid of children aged 5 to 16 and in the blood of those over 17
52
Q

Management of whooping cough?

A
  • Pertussis is a notifiable disease – public health need notified of each suspected and confirmed case
  • A person is infectious from 6 days after they were infected until 3 weeks after the coughing bout starts (antibiotics can reduce length of time someone is infectious)
  • Management involves supportive care and antibiotics
  • Macrolide antibiotics e.g. azithromycin, erythromycin and clarithromycin can be beneficial in the early stages (within the first 21 days) or in vulnerable patients
  • Co-trimoxazole in an alternative to macrolides
  • Close contacts with an infected patient are given prophylactic antibiotics if they are in a vulnerable group e.g. pregnany, unvaccinated infants or healthcare workers in contact with these groups
53
Q

How long does whooping cough last?

A
  • Symptoms typically resolve in eight weeks but can persist for months – hence the name “100 day cough”
54
Q

What is a key complication of whooping cough?

A

key complication of whooping cough is bronchiectasis

55
Q

What is malaria?

A

This is an infectious disease caused by the plasmodium family – a type of protozoan parasite
There are 4 main types:
- Plasmodium falciparum (this is most serious and accounts for about 75% of the cases of malaria in the UK)
- Plasmodium vivax
- Plasmodium ovale
- Plasmodium malariae

56
Q

Who gets malaria?

A
  • Will occur in travellers to area where malaria is known to be present
  • Extremely unlikely that a patient in UK would have it if they have never been to an endemic area
  • Malaria is spread through bites from the female anopheles mosquitoes that carry the disease
57
Q

Malaria life cycle?

A
  • It is spread by the female anopheles mosquito biting mainly at night time
  • The mosquito bites an infected person and the malaria parasite reproduces in the gut of the mosquito producing thousands of sporozoites
  • When that mosquito bites another human sporozoites are injected into the person and travel to the liver
  • They mature into merozoites which enter the blood and infect red blood cells
  • In the red blood cells the merozoites reproduce over 48 hours after which they rupture releasing more merozoites into the blood causing a haemolytic anaemia
  • This is why infected people spike fevers every 48 hours as this is when more malaria is being released
58
Q

Fever that spikes every 48 hours?

A

malaria - due to the merozoites reproducing in RBCs over 48 hours before rupturing out into bloodstream

59
Q

Presentation of malaria?

A
  • The incubation period is usually 1-4 weeks but some types of malaria can lie dormant in the liver for years
  • Fever, sweats and rigors
  • Malaise
  • Myalgia
  • Headache
  • Vomiting
  • Pallor due to anaemia
  • Hepatosplenomegaly
  • Jaundice as bilirubin is released during the rupture of red blood cells
60
Q

Diagnosis of malaria?

A
  • Diagnosis is made using a malaria blood film
  • To exclude malaria you need to send 3 samples over 3 consecutive days – this is due to the 48 hour cycle of malaria being released into the blood from RBCs
61
Q

Management of malaria?

A
  • All patients with falciparum malaria need admitted as they can deteriorate quickly
  • Artesunate and quinine dihydrochloride are main drugs for severe malaria
62
Q

Malaria prophylaxis?

A
  • Sprays (with 50% DEET), nets and barriers for mosquitoes
  • Antimalarials are 90% effective: 3 types are malarone (most expensive but best side effect profile), mefloquine (side effects of psychotic disorders, seizures and bad dreams), doxycycline (sun sensitivity, broad spectrum antibiotic)
63
Q

Explain what surgical site infection is?

A
  • This is infection occurring in the incision from an invasive procedure
64
Q

Timeframe for surgical site infection?

A
  • Typically appears 5-7 days post-procedure but can develop up to 3 weeks after (especially if a prosthesis is inserted)
65
Q

Presentation of surgical site infection?

A
  • Presentation: spreading erythema, localised pain, pus or discharge from the wound, persistent pyrexia
66
Q

Management of surgical site infection?

A
  • Should take wound swabs
  • Management: any sutures/ clips should be removed allowing for drainage of pus and wound packing if required, empirical antibiotics should be started
67
Q

Explain what necrotising fasciitis is and the types?

A
  • This is a flesh-eating diseasing defined as necrotising infection involving any layer of the deep soft tissue compartment (dermis, subcutaneous tissue, fascia or muscle)
  • Very uncommon but high mortality
  • It can be classified into 4 types
  • Type 1- polymicrobial infection with aerobic and anaerobic bacteria (usually in patients with immunocompromise or chronic disease)
  • Type 2- Group A streptococcus infection which occurs in any age group and in otherwise healthy individuals
  • Type 3 – gram negative monomicrobial infection – related to seawater and fish contamination
  • Type 4- fungal infection
68
Q

Presentation of necrotising fasciitis?

A
  • Difficult to diagnose in early stages as it mimics cellulitis
  • Important early clues are pain, tenderness and systemic illness out of proportion to the localised physical signs
  • Days 2-4 there may be bullae which can become haemorrhagic, tense oedema, subcutaneous tissue has hard wooden like feel, fascial planes and muscles groups are no longer palpable, skin becomes discoloured progressing to grey which breaks down, crepitus
  • Days 4-5 patient becomes hypotensive with septic shock, confused and apathetic
69
Q

What is Fournier’s gangrene?

A

Fournier’s gangrene is a rapidly progressive form of infective necrotising fasciitis of the perineal, genital or perianal regions

70
Q

Diagnosis of necrotising fasciitis?

A
  • This is clinical – if there is strong clinical suspicion of NF exploratory surgery is required regardless of test results
  • During surgery diagnosis is made of macroscopic features e.g. grey necrotic tissue, lack of bleeding, thrombosed vessels
71
Q

Management of necrotising fasciitis?

A
  • May need resuscitation and IV fluids
  • Likely need ICU referral
  • Surgical debridement and broad spectrum antibiotics
72
Q

What is gangrene?

A
  • This occurs when there is death and decay of body tissue
  • This is caused by lack of blood supply and is caused by 3 major mechanisms: infection, vascular or trauma
  • Can be dry (associated with loss of the blood supply e.g. PVD) or wet (associated with infection)
73
Q

What is gas gangrene?

A
  • This is caused by infection with clostridium perfringens
  • There is skin gangrene and the bacteria produces air so feel crepitus on palpation
74
Q

Antibiotic for neutropenic sepsis?

A

tazocin - (tazobactam and pipericillin) - covers gram positive and gram negative including pseudomonas

4th Year Medicine 2 (14 decks)

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