infective diseases Flashcards
Immune reconstitution inflammatory syndrome
Most commonly affects?
HIV positive pts when starting anti retrovirals
CFS makes any underlying infection much worse
Dengue fever
causes
CFs
Ix
Mx
dengue = viral disease transmitted by mosquitos
7 days incubation, Aedes aegypti mozzie
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
CFs
maculopapular rash blanching, spares palms and soles of feet
retroorbital headache
high fever
lymphadenopathy
haemorrhagic manifestations
Raised ALT
can progress onto viral haemorrhagic fever
Ix= serology, bloods show thrombocytopenia
NS1 antigen test
Tx= symptomatic treatment
no antivirals yet
TB vs mycobacterium avian complex treatment
TB - RIPE
MAC - RiCE
TB rifampicin, isoniazid, pyrazinamide, ethambutol
MAC; rifampicin, clarithromycin, ethambutol
give clarithromycin proph when CD4 is less than 100 cells/mm³
Tetanus
cause
CFs
Ix
Mx
tetanospasmin exotoxin released from Clostridium tetani
CFs
lockjaw
fever, headache, fatigue
facial spasms
arched back, extended neck
spasms eg dysphagia
Mx
-supportive
- IM human tetanus immunoglobulin for high-risk wounds
- METRONIDAZOLE
suspected lyme disease- management
IF NO TARGET erythema migrans– ELISA FIRST
do NOT start doxy if suspicious, but no target lesion
if desseminated disease= give ceftriaxone
breast feeding in mothers with hep c
OK
allowed
is there a vaccine for hep c?
NO
incubation period hep c
6-9 weeks
someone wants hep c testing- method for initial diagnosis?
anti-HCV antibody test for initial diagnosis
TO CHECK FOR response to treatment:
viral load
sexually active young women UTI bacteria?
Staphylococcus saprophyticus
cryptosporium infection diagnostic test?
and positive result
managemente of cryptosporium diarrhorea for immunosuppressed
acid-fast staining of stool sample – cryptosporium cysts turn RED on staining
Ziehl-Neelsen stain
Mx= supportive- even if imm suppressed
rickettsiae -
morphology
treatment
Gram-negative obligate intracellular parasites
tetracycline treatment
Burger with a lyme. Bart has a cat.
Borrelia burgdorferi and Bartonella henselae are the causative organisms of Lyme disease and cat-scratch fever.
zanamivir (Relenza) treatment– what underlying condition will made side effects worse/.
asthma– causes bronchospasm
Investigation for HIV Seroconverson illness
what is it
CFs
HIV seroconversion= beginning of HIV infection, 1-4 weeks post infection.
p24 antigen test DETECTS
CFs
Glandular fever type illness. Increased symptomatic severity is associated with poorer long term prognosis. It typically occurs 3-12 weeks after infection
sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
rarely meningoencephalitis
gram positive, catalase and coagulase positive cocci.
Staphylococcus aureus
Gonorrhoea Mx
IM ceftriaxone (good gram negative cover0
Chlamydia testing diagnostic method
Mx
NAAT- vaginal swab
1st line PO doxycycline 7 days
2nd line azithromycin
parasite burden— use thick or thin blood films?
Parasite burden is evaluated from thick blood films,
THIN blood films allow for what?? in malaria
speciation— define the species
bilateral conjunctival suffusion== ?
leptospirosis
Anthrax CFs and treatment
black eschar that is typically painless; it is treated with ciprofloxacin
regional lymphadenopathy
farmer of livestock
rabbit bite + regional lymphadenopathy +pus discharge from lymph
tularaemia
uncomplicated uti treatment in pregnancy
NITROFURANTOIN unless close to term
meningeal tuberculosis. treatment
RIPE + prednisolone
Non specific (non gonococcal) urethritis treatment
PO Doxy
or
PO azithromycin
grey coating on tongue + fever
causative org
gram pos or neg
CFs of this condition
diptheria
Gram positive rod bacterium Corynebacterium diphtheriae
CFs grey skin, bulky cervical lymphadenopathy
heart block, bradycardia
Diptheria
CFs
Ix
Tx
-recent visitors to Eastern Europe/Russia/Asia
-sore throat with a ‘diphtheric membrane’ :grey, pseudomembrane on the posterior pharyngeal wall
-bulky cervical lymphadenopathy
may result in a ‘bull neck’ appearance
-neuritis e.g. cranial nerves
-heart block
Investigations
culture of throat swab: uses tellurite agar or Loeffler’s media
Management
intramuscular penicillin
diphtheria antitoxin
Gonorrhoea treatment
Gonorrhoea - intramuscular ceftriaxone
salmonella (non-typhoid) Abx
ciprofloxacin
Chlamydia Abx
Doxy or azithromycin
PID abx
Oral ofloxacin + oral metronidazole
OR
IM ceftriaxone + oral doxycycline + oral metronidazole
syphilis Abx and what reaction can happen after first dose
IM Benzathine benzylpenicillin or doxycycline or erythromycin
Jarisch-Herxheimer reaction can occur after initial dose
CFs HoTN, fever, headache. Mx for this is reassure and antipyretic
canpylobacter abx
clarithryomycin
chikungunya cause
cfs
tx
alphavirus from mosquitoes
CFs
flu symptoms
high fever
sometimes maculopaupular rash
sore joints
Tx= no cure
symptomatic relief
Pneumocystis jiroveci penumonia treatment
and staining
co-trimoxazole= mix of trimethoprim and sulfamethoxazole
silver stain
IV pentamidine in severe cases
steroids if hypoxic
Pneumonia, peripheral blood smear showing red blood cell agglutination →
Mycoplasma pneumoniae
Mycoplasma pneumoniae
CFs
Tx
bil CXR consolidation
dry cough
Ix
serology
agglutination test
can cause GBS or encephalitis
Tx
doxycycline or a macrolide
Ix for mono
Heterophile antibodies - infectious mononucleosis
infectious mononucleosis causes
CFs
Tx
causes; commonly EBV/HHV4,. less freq=cmv, vhh6
triad of sore throat, pyrexia and lymphadenopathy
rash if take amoxicillin
Ix= heterophile antibody test
and bloods
supportive Mx
symptomatic tx
avoid contat sports 4 weeks due to risk of splenic rupture
qwhat is
Aspergilloma
CFs
Ix
tX
COLONISese previous existing lung cavity
Eg previous TB, previous lung ca, CF
presents with haemoptysis, weight loss, cough
may be asymptomatic
Ix= high titre positive aspergillus precipitins
Tx= surgical excision
pregnancy - chicken pox exposure before 20 weeks
BEFORE 20WEKS GESTATION if NOT immune/== give VZIG
varicella antibody test asap if unsure
> 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure
Hep b vaccine;
> 100
10 - 100
< 10
> 100 - adequate response. booster at 5 years
10 - 100 - one further dose
< 10 - re do all 3 doses
Toxoplasmosis infection Mx
if immunocompeteint== no treatment needed
IF EYE INVOLVEMENT OR
if HIV infected/immunosuppressed– can cause cerebral toxoplasmosis
CT: usually single or multiple ring-enhancing lesions, mass effect may be seen
management: pyrimethamine plus sulphadiazine for at least 6 weeks
GRAM POSITIVE COCCI
GRAM NEGATIVE COCCI
gram positive cocci:
staphylococcus, streptococcus, enterococcus
Gram negative cocci
N meningitidis, n gonorrhoea, catarrhalis mox
GRAM POSITIVE COCCI
GRAMP NEGATIVE COCCI
gram positive cocci:
staphylococcus, streptococcus, enterococcus
Gram negative cocci
N meningitidis, n gonorrhoea, catarrhalis moxg
GRAM POSITIVE COCCI 3
GRAMP NEGATIVE COCCI 3
gram positive cocci:
staphylococcus, streptococcus, enterococcus
Gram negative cocci
N meningitidis, n gonorrhoea, catarrhalis moxG
GRAM POSITIVE RODS
GRAM NEGATIVE RODS
GRAM POSITIVE RODS: ABCDL
actinimyces
bacillus
clostridium
diptheria cornybacterium
Listeria
GRAM NEGATIVE RODS
food poisoning: campylobater, shigella, salmonella, e coli
h influenzae
p areginosa
Tx times and abx for active TB
RIPE
for 2 months
THne: RI(+P) for 4 months
Tx latent tb and how to find out if pt has latent TB
Latent Tb= positive Mantoux test and positive Interferon-gamma release assay
Tx= RI or I only
most common cause of viral menigitis
coxsackie/echovirus- enteroviruses
most common cause of bacterial meningitis
strep pneumoniae
If patient gets syphilis for a second time (after prev infection), what test will show this?
rapid plasma reagin test
all other tests will remain positive for LIFE after the first infection
LEPTOSPIROSIS
cause= infected rat urine- sewage worker
urine cultures become positive 2nd week of infection
CFs
-bilateral conjunctivitis
- flu symptoms
- bilateral calf pains and high fevers
longer infection- later stage can cause aseptic meningism, AKI, hepatitis
Tx= high dose benzylpenicillin or doxycycline
Negative non-treponemal test + positive treponemal test is consistent with treated or untreated syphilis?
Negative non-treponemal test + positive treponemal test is consistent with successfully treated syphilisq
Following treatment for syphilis: TPHA remains positive, VDRL becomes negative
most common bacterial cause strep throat
Strep pyogenes
severe parasitaemia treatment
eg fulminant malaria:
if uncomplicated falciparum malaria AND
if SEVERE falciparum malaria
IV artesunate
and exchange transfusion
if uncomplicated falciparum malaria– give artemether plus lumefantrine
if SEVERE falciparum malaria; give IV artesunate
avoid which mediation for malaria prophylaxis in epileptics?
avoid MEFLOQUINE
leprosy
CFs
tx
CFs:
hyposthesia over lesions
Thickened cord like structures
patches of hypopigmented skin
Tx: leprosy on dominican republic of congo- DRC
dapsone
Rifampicin
clofazimine
treat legionella peumonia-
macrolides
clarythromicib
tetanus affects gaba or ach
gaba
Praziquantel used to treat ??
schistosomiasis
Cysticercosis = tapeworm
treatment?
bendazoles
min time before live vaccines can be given back to back
4 weeks
which antiviral drug INDUCES P450
and which type of antiviral drug
INHIBITS P450
INDUCER= nevirapine (an NNRTI)
INHIBITOR= proteasome inhibitors, potent inhibitor = ritonavir
most dangerous complication of chicken pox in adults
varicella pneumonia== give IV aciclovir
chest can be unremarkable
how does Strongyloides stercoralis gain access to the body and treatment of it
CFs
Strongyloides stercoralis gains access to the body by penetrating the skin
=rhabditiform larvae
SO STRONG it can penetrate skin
Ix= ivermctin
CFs
erythematous, serpiginous, urticarial rash on his buttocks and also on the soles of his feet. There is no regional lymphadenopathy.
travellers diarrhoea/food poisoning/illness incubation periods
Long bloody diarrhoea- 3-4 weeks or more - amoebiasis
Long watery diarrhoea 1 week - giardiasis
Shorter bloody diarrhoea - Campylobacter
V Short bloody diarrhoea - E. Coli
V short vomiting– staph aureus
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
schistomiasis
cfs
cause
tx
parasitic flat worm infection
acute schistosomiasis syndrome also called?
Katayama fever
Japanese encephalitis
caused by flavivirus
viral encephalitis
cfs
seizures headache confusion
fever
parkinsonian features (indicate basal ganglia ivolvement)
Tx= supportive
vaccine exists
who to offer HPV vaccine to apart from teenagers
men under 45yo who have sex w men
genital ulcers
Painless=?
granuloma inguinale:
granuloma inguinale: Klebsiella granulomatis*
painless= syphilis and lymphogranuloma venereum (chalmydia, tenesmus, proctitis)
painful- chancroid
genital ulcers
LGV - Chlamydia trachomatis.
Granuloma inguinale - Klebsiella granulomatis.
Syphilis - Treponema pallidum.
Chancre - Treponema Pallidum.
Chancroid - Haemophilus ducreyii.
reheated rice poisoining organism
bacillus cereus
BV fishy smell causative organism
Gardnerella vaginalis
gram positive coccobacilli
Tx= po metronidazole
Tetanus treatment
if pt has had all 5 doses within last 10 years= no further action needed
If had all 5 doses over 10 years ago:
-Tetanus prone wound= give booster vaccine
- High risk wound= give vaccine booster AND tetanus ig
If vaccine status unknown:
- ALL tetanus prone = give vaccine booster
- if High risk wound= give booster vaccine AND tetanus ig
what is Jarisch-Herxheimer reaction
reaction in in syphilis pt post intial dose of ABx
HoTN, fever, headache
Tx= reassure and antipyretic
aciclovir MOA
DNA polymerase inhibitor
kaposi sarcoma causative virus
HHV 8
contraindicated vaccines in HIV positive adults
and which vaccines can be given in HIV if cd4 >200
cholera
influenza nasal
polio oral
BCG
Vaccines that can be used if CD4 > 200
MMR
varicella
yellowfever
what is leishmaniasis
Leishmaniasis is caused by the intracellular protozoa Leishmania, which are spread by the bites of sandflies. Cutaneous, mucocutaneous leishmaniasis and visceral forms are seen
Looks like an ulcer
CFs
grey skin
hepatospleomegaly
fever sweats rigors
poor appetite
pancytopenia secondary to hypersplenism
Dx= punch biopsy
meningococcal meningitis mx
close contact mx
do not delay for LP
at GP: give IM benzylpenicillin
IV acces <50 give cefotaxime
> 50 give cefotaxime + amoxicillin
close contacts - po ciprofloxacin or rifampicin
lymph node biopsy with warthin starry staining ==?
bartonella heneslae- cat scratch disease
which medication is used to
treat immunocompromised patients with cryptosporidiosis
Nitazoxanide
neuro complication of cryptococcus
cryptococcus treatment =
neuro=
india ink test positive
Lymphogranuloma venereum ( caused by which STi
chlamydia
flu like illness → brief remission→ followed by jaundice and haematemesis
yellow fever
council man bodies
flu symptoms
can have brief remission before jaundice, haemetemesis
acute epiglottitis causative organism
h influenzae
Clostridium botulinum
What does this cause
CFs
Tx
causes botulism
CFs
apyrexic
flacid, descending paralysis
high risk in food poisoning and IVDUs
can affect bulbar mms
Tx= botulism antitoxin
What immune response component is the first line of action against aspergillosis? (different to aspergilloma)
macrophages
Syphilis, Lymphogranuloma venereum (LGV) and donovanosis (granuloma inguinal) painfull or pain less ulcers
these all cause PAINLESS genital ulcers
Non specific (non gonococcal) urethritis management
oral doxy one week
enteric fever
transmission moa
cause
cfs
tx
enteric fever= typhoid
transmitted via faeco oral route
rocky mountain spotted fever causative org
rickettsia ricketssi
how often to give dex during bacterial meningitis tx
6 hourly
which organism most associated w reactivation or Herpes simplex
strep pneumonia
most common organism in animal bites =?
Pasteurella multocida.
Tx= co amox
what is an exotoxin and are they gram positive or negative, and with which exceptions
exotoxins are secreted by bacteria
mostly gram POSITIVE
except cholera and e coli
what are enterotoxins
act on GI
to cause d and v
most common cause of visceral larva migrans?
toxicara canis
live vaccines
LIVE VACCINES:
I MoP YR, BoT- influenza, MMR, oral Polio, Yellow fever, oral Rotavirus, BCG, oral Typhoid
erythromycin MOA
inhibit 50s
HIV testing: when
can test from 4 weeks post exposure
TO TEST:
P24 = combined antigen and antibody test
brucellosis
Middle East and in farmers, vets and abattoir workers.
sheep cattle pigs
Features
non-specific: fever, malaise
hepatosplenomegaly
sacroiliitis: spinal tenderness may be seen
complications: osteomyelitis, infective endocarditis, meningoencephalitis, orchitis
leukopenia often seen
Diagnosis
Rose Bengal plate test can be used for screening
!!!!!Brucella serology is the best test for diagnosis
blood and bone marrow cultures may be suitable in certain patients, but these tests are often negative
Tx= doxy and streptomycin
most common org cause of central line infections
staph epidermis
atypical lymphocytes seen ==?
infective mono
listeria treatment
amoxicillin
Brain CT problems in HIV
Toxoplasmosis
Lymphoma
Progressive multifocal leukoencephalopathy (PML)
Lymphoma: Single lesion. Solid enhancement
Toxoplasmosis : Multiple lesion, Ring, or nodular enhancement
PML: Single or multiple lesions. No enhancement no mass effect
pregnancy and HIV
all pregnant women should be offered antiretroviral therapy regardless of whether they were taking it previously
vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
a zidovudine infusion should be started 4 hours before beginning the caesarean section
Neonatal antiretroviral therapy
zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.
DO NOT BREAST FEED
egg allergy cannot have ?vaccine
yellow fever and influenza
egg yolk ==yellow
mumps meningitis CSF glucose :
low =- approx 2
other viral meningitis forms= eg adenovirus. enterovirus= glucose not that low
urine dip nitrate positive or negative
gram positive
gram negative
gram positive= will test nitrate NEGATIVE
gram negative = nitrate positive
= opposite
most common cause of viral meningitis = ?
enteroviruses eg coxsackie
which hepatitis is most common in pregnant women
hep E
rabies vaccine and management if bitten
if bitten in UK- no risk
BITTEN IN high risk country
prev immunised= 2 booster vaccine doses
not immunised= full course of vaccine
PLUS prophylactic abx
gram+ve bacterium, catalase +ve, coagulase +ve organism
staphy aureus
Streptococcus viridans and Streptococcus pyogenes are both catalase negative.
Staphylococcus epidermidis is catalase positive but coagulase negative.
amantadine MOA
amanda does not want to take off her coat
inhibits uncoating (M2 protein) of virus in cell. Also releases dopamine from nerve endings
pneumonia +erythema multiforme=?
mycoplasma
causative organism in Q fever
Coxiella burnetti
hyposplenism/ spleen removal need for immunisations
pneumococcal, Hib and meningococcus type C
annual flu jab and
life long Penicillin V cover
2 weeks prior or after splenectomy
Alongside Streptococci spp. and Staphylococcus aureus, which of the following organisms is most likely to be isolated in HUMAN BITE
Eikenella
wet hay smell when sweats, cheese
brucella melentenis
Amantadine MOA
inhibits uncoating (M2 protein) of virus in cell. Also releases dopamine from nerve endings
Lemierre’s Syndrome= ?
infectious thrombophlebitis of IJV
occurs secondary to a bacterial sore throat caused by Fusobacterium necrophorum leading to a peritonsillar abscess.
RISK of septic pulmonary emboli
EBV is a type of ??? virus
EBV is a type of herpes virus
A 42-year-old man from Southern India presents with chronic swelling of both lower legs, they are brawny and indurated with marked skin trophic changes. Which one of the following organisms is the most likely origin of this disease process?
Wuchereria bancrofti
BANCROFT = posh= brawny and skin trophic changes
first line treatment in hydatid disease?
albendazole
what conditions (4) can cause False positive VDRL/RPR:
‘Some Times Mistakes Happen’ (SLE, TB, malaria, HIV)
what abx to give for botulism and tetanus
BBBenPen for BBBBBotulism
Metro for Tetro
severe malaria if parasitaemia <????%
Parasitaemia > 2% is a feature of severe malaria
management of latent TB
3 months R +I+P
OR
6months of
I +P
predom bacterialcidal abx
CORe - ChlORamphenicol
Medical - Macro
TRAinee - TeTRAcycline
to
SPecialty - SulPhonamide
TRaInee - TRImethoprim
which abx promotes acquisition of MSRA
ciprofloxacin
abx for cholera
doxy or cipro
common cause campylobacter
chicken
which conditions can be affected by Jax heimer reaction
syphilis
HIV
lyme disease
post HIV exposure proph
1 month 3 anti retrovirals
marked eosinophilia of lamina propria= ?
eosinophilic gastroenteritis
threadworms causative organism
enterobius vermicularis
what to check when checking if hep b vaccine works
Anti-HBs
most common cause of visceral larva migrans
toxocara canis
yersinia =?
treatment
bacterial cause of diarrhoea
sensitive to quinolones, tetracyclines, co trimoxaxole
eg gentamicin ( if no renal problems), ofloxacin, ciprofloxacin
bacterial vaginosis morphology
Gram positive coccobacilli
Abx for severe diabetic foot infection/ ulcer - even if shows some fungal /anaerobic growth
IV CO AMOX – broad
