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investigation of specific infections Flashcards

1
Q

what is the main function of testing?

A

to identify the cause, treatment and risk of the patient

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2
Q

what is the issue with testing?

A

no test is infallible - there will be a positive and negative error rate for all

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3
Q

when should you not do a test?

A

if it does not add to the management or prognosis

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4
Q

what types of sampling are there?

A

local and general

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5
Q

what is local sampling?

A

it is sampling from the source of infection - assist with the diagnosis and identify appropriate treatment

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6
Q

what is general sampling?

A

it is part of sepsis investigation and includes blood cultures such as FBCs, U&Es, LFTs, clotting and CRP

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7
Q

what is meningitis?

A

it is inflammation of the meninges that is caused by bacteria, viruses, mycobacteria, fungi and parasites

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8
Q

how would you identify meningitis?

A

through a lumbar puncture to sample CSF, blood cultures - CRP, glucose, LFTs, U&Es and FBCs, blood culture for bacterial PCR for N meningitidis or S pneumoniae, and CSF cryptococcal antigen or TB culture PCR in immunosupressed

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9
Q

what is encephalitis?

A

it is inflammation of the brain that is usually viral - herpes

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10
Q

how would you test for encephalitis?

A

CSF requesting viral PCR specifically

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11
Q

`what is the cause of brain abscesses?

A

there is a wide aetiology including bacteria, mycobacterial, fungal and parasitic

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12
Q

what can help to identify brain abscess?

A

the history - ear, sinuses, blood and post op

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13
Q

what should be discouraged in identifying brain abscess?

A

lumbar puncture as it is rarely positive and high risk

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14
Q

what should be done to identify brain abscess?

A

local sampling
pus - biopsy or drainage - gram, culture, sensitivity and PCR
blood cultures

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15
Q

what are the characteristics of healthy CSF?

A

the opening pressure should be 5-20 cmH20
the appearance should be clear
the WBC count should be <3x10^6/L
there should not be any cell differentiation
the protein should be from 0.2-0.5g/L
the glucose in CSF:blood should be 0.6

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16
Q

what are the characteristics of CSF in viral infection?

A

the opening pressure should be normal or slightly raised
the appearance should be clear
the WBC count should be <1000x10^6/L
the cell differentiation should be mainly lymphocytes
the protein should be <1g/L
the glucose in CSF: blood should be >0.6

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17
Q

what are the characteristics of CSF in bacterial infection?

A 
the opening pressure >30cmH20
the appearance of CSF turbid 
the WBC count >500x10^6/L
the cell differentiation is mainly polymorphs 
the protein >1g/L
the glucose in CSF:blood <0.4
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18
Q

what are the characteristics of CSF in fungal and TB infection?

A

the opening pressure if variable - however if it is a crypto fungal infection it is greatly increased
the appearance of CSF is variable
the WBC is variable
the cell differentiation is mainly lymphocytes
the protein is <0.5g/L
the glucose in CSF:blood is less than 0.4

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19
Q

what are the two most common infections of the ear?

A

acute otitis media and externa

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20
Q

how will you manage media?

A

clinical diagnosis - viral or bacterial

if the ear drum is perforated then send a pus sample off

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21
Q

how will you manage externa?

A

ear swab to identify the cause and sensitivity

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22
Q

what is the most common nose infection?

A

sinusitis/rhino-sinusitis
majority are viral or secondary bacterial
caused by upper respiratory tract flora

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23
Q

what is the management if suspected sinusitis?

A

swab in all cases - except severe as this is unhelpful

severe cases - pus from operative sinus lavage and FBC and blood cultures

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24
Q

what are the most common throat infections?

A

pharyngitis - viral and bacterial sore throat

diphtheria

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25
Q

what is the management if suspect pharyngitis?

A

majority are viral
only swab if evidence of bacterial - looking for B-haem streps
the additional tests would be diphtheria swab, EBV serology, pus swab if quinsy abscess

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26
Q

what are the four most common respiratory infections?

A

influenza, pneumonia, pulmonary Tb and atypical infection in the immunocompromised

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27
Q

what is the epidemiology of influenza?

A

it can be seasonal and sporadic or epidemic and highly transmissible

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28
Q

it is not necessary to test everyone for influenza, who is tested?

A

those who may require treatment and those at risk of transmitting it

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29
Q

how do you test for influenza?

A

nose and throat swabs for immunofluoresence / PCR

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30
Q

what is beneficial about PCR?

A

the sensitivity is over 90% and the specificity is over 99% - fast, scalable and cost friendly

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31
Q

what is pneumonia?

A

it is a clinical diagnosis based on respiratory symptoms, signs and chest XR changes

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32
Q

how is pneumonia severity assessed?

A

using CURB65 - score out of 5

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33
Q

what is low CURB65?

A

it is a low risk of 0-1 out of 5 where there is no investigations required

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34
Q

what is a moderate to severe risk of pneumonia?

A

a CURB of 2-5 where there is sputum, blood cultures, atypical screen and might include serum

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35
Q

what is an atypical screen?

A

screening urine for legionella antigen and nose or throat for mycoplasma PCR

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36
Q

what does pulmonary TB require as a disease?

A

exposure and then reactivation at a later stage in life with pulmonary symptoms

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37
Q

what is the exposure testing in TB?

A

there is mantoux and IGRA - interferon gamma releasing assay which rely on an intact immune system

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38
Q

how would you investigate the pulmonary symptoms of TB?

A

microscopy and culture for 8 weeks, PCR - rapid, costly, lower sensitivity

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39
Q

what needs to be considered in the immunosupressed?

A

haemato-oncology - in chemo and solid organ transplants
steroids, diabetes, CKD and underlying disease
travel

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40
Q

what can cause infection in immunosupressed?

A

viral - RSV - viral PCR
fungal - aspergillus - aspergillus antigen and culture
pneumocystis - PCP PCR

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41
Q

what is needed to guide immunosupressed investigations?

A

history as they are not routinely done - best investigated by deep respiratory samples using BAL

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42
Q

what are some localised skin infections?

A

impetigo, erysipelas and cellulitis

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43
Q

what is an extensive severe infection of skin?

A

necrotising fasciitis

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44
Q

what are some methods of investigation for localised skin infections?

A

wound swabs, send blister or abscess fluid, needle aspirates in cellulitis, blood cultures

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45
Q

what are the issues with these investigation of localised skin infections?

A

wounds swabs are not helpful if the skin is intact
needle aspirates are poor as they only determine the pathogen in 10-30% of cases
blood cultures are only positive in the most sever 5% of infections - if sepsis then send off

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46
Q

what is necrotising fasciitis?

A

it is a rapidly spreading synergistic infections that is surgical emergency with high mortality

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47
Q

what comprises the management of NF?

A

debrided tissue and pus

48
Q

what is debridement of tissue and pus?

A

it is the removal of dead or infected tissue and pus

49
Q

what is MCS for pus?

A

microscopy culture and sensitivities

50
Q

what blood cultures are done for BF?

A

2 sets

FBCs, U&Es, LFTs and CRP

51
Q

what types of diabetic foot infection are there?

A

non-infected wounds or ulcers
mild infection
moderate or severe deep infection

52
Q

what is the presentation of non infected diabetic foot ulcer?

A

exudate, smelly and weeping - not evidence of infection therefore no swabs

53
Q

what is the management for mild foot infections?

A

wound swabs

these only have a 49% sensitivity and 62% specificity

54
Q

what is the management for a deep foot infection?

A

debride wound then collect and clean

bone or tissue sample by a specialist

55
Q

what types of UTIs are there?

A

lower or upper UTIs - cystitis or pyelonephritis
prostatitis
epididymo-orchitis

56
Q

in lower or upper UTIs what does microbiology do?

A

supports the clinical diagnosis, identified the organism and the treatment

57
Q

what makes a UTI probable?

A

if there is dysuria and frequency then >90%

58
Q

what is identified in urine samples?

A

WBC, RBC, epithelial cells, bacterial growth and sensitivity

59
Q

how would you interpret a urine sample for lower or upper UTIs?

A

Krass criteria - threshold for significant bacteriuria

60
Q

what is automated analysis with respect to UTIs?

A

it is microscopy to predict a culture positivity

61
Q

how is urine collected for UTIs?

A

MSU - midstream urine
CSU - catheter
Bag
SPA - suprapubic aspiration - usually in neonates if suspected UTI

62
Q

what is the prevalence of prostatitis?

A

50% of patients with recurrent UTIs and 90% with febrile UTIs have prostatitis

63
Q

what are the methods of investigation for prostatitis?

A

imaging, post prostatic massage, blood and urine tests

64
Q

what is epididymo orchitis?

A

it is inflammation of the epididymis and/or testes due to infection such as UTI or STI or enteric bacteria

65
Q

what is urine tests used for for EO?

A

cultures, chlamydia and gonorrhoea NAAT/PCR

66
Q

what is NAAT?

A

nucleic acid amplification test

67
Q

what is the management if EO is severe?

A

there is bloods, cultures and USS with potential drainage

68
Q

what are the main GI infections?

A

diverticulitis, cholangitis or cholecystitis, liver abscesses, H pylori or infectious diarrhoea

69
Q

what can cause infectious diarrhoea and give examples?

A

viral gastroenteritis - rota or norovirus
bacteria - salmonella - campylobacter, shigella, E coli and Vibrio
parasitic - giradia, goreign travel parasites and cryptosporidium
C difficile

70
Q

how does the lab work with infectious diarrhoea?

A

uses clinical details and risk factors to help

71
Q

what is the characteristic of most viral or bacterial infection?

A

it is self limiting diarrhoea

72
Q

what is the management of infectious diarrhoea?

A

stool sample - public health, transmission and treatment purposes

73
Q

what other investigations are there in infectious diarrhoea?

A

parasites will have 3 samples
bloods for FBC, clotting, U&Es, LFTs and CRP
cultures and abdominal imaging used plane film or CT

74
Q

in H pylori infection what what tests are used, and what are their relative specificities and sensitivities to guide AB treatment?

A

antibody test - sens 92% and spec 83%
stool antigen sens 95% and spec 94%
urea breath test sens 88-95% and spec 95-100%
biopsy urease treatment sens 90-95% and spec of 95-100%

75
Q

what is the issue with antibody test?

A

it is insensitive - it does not tell us if the infection is past or active

76
Q

why use the stool antigen test?

A

non invasive, cheap and simple

77
Q

why use the breath test?

A

gold standard for test of cure

however is patient experience dependent and expensive

78
Q

what is the issue with the biopsy urease test?

A

it is invasive with cross reactions

79
Q

what must be ensured before H pylori testing?

A

PPIs must be stopped

80
Q

what is the aetiology of liver abscess?

A

pyogenic bacteria, hydatid or amoebic - history will guide this

81
Q

what should happen with pus? - liver abscess related

A

drain - if safe to do so

82
Q

what is OCP and how is it managed? - liver abscess related

A

it is ova, cysts and parasites and stool samples

83
Q

what is used for bloods for liver abscess?

A

FBCs, U&Es, LFTs and CRP

84
Q

what other investigations are done in liver abscess?

A

imaging including USS and CT and if appropriate hydatid serology

85
Q

what are the bloods done for cholangitis or cholecystitis?

A

FBCs, LFTs, amylase, clotting, U&Es

86
Q

what imaging is done for cholecystitis or cholangitis?

A

USS or CT

87
Q

what can also be done in cholecystitis or cholangitis?

A

bile fluid or pus if aspirated or drained

88
Q

what is diverticulitis?

A

inflammation of abnormal pouches of the LI

complicated or uncomplicated

89
Q

what is complicated diverticulitis?

A

abscess, perforation, obstruction or fistula

90
Q

what can be sampled in diverticulitis?

A

pus from the abscess, blood

91
Q

what bloods are done in diverticulitis?

A

LFTs, FBCs, U&Es, clotting and amylase

92
Q

what imaging can be done in diverticulitis?

A

CT

93
Q

what types of vascular infections are there and what are some examples?

A

heart valves - endocarditis that it prosthetic or native

vessels - mycotic aneurysms, prosthetic vascular graft infections

94
Q

what directs management of endocarditis?

A

blood cultures as there is 96% positivity

95
Q

how are blood cultures done in suspected endocarditis?

A

three sets of cultures over first 24 hours with FBC, CRP, LFTs and U&Es

96
Q

what other investigations are there for endocarditis?

A

echocardiography - transthoracic echo - sensitivity of less than 60% but spec of 98%
transoesophageal - sens and spec of over 94%

97
Q

what is always done for suspected PVE?

A

transoesphageal echocardiography

98
Q

what is done for specific organisms in endocarditis?

A

serology - coxiella, chlamydia, brucella and bartonella

valve tissue MCS and PCR if replaced

99
Q

what blood cultures are done for suspected PVGI or mycotic aneurysm?

A

three sets over first 24 hours

lower culture positivity rate than endocarditis

100
Q

what further investigations are there for PVGFi and mycotic aneurysm?

A

imaging such as WBC, PET and CT

looks at fluid around the graft and fistulae

101
Q

what else can be done with fluid around a graft?

A

cultured and PCR

102
Q

what is hepatitis A, B and C?

A

they are viruses

103
Q

what is the identification of hep based on?

A

serology (and PCR)

104
Q

what does serology comprise?

A

detection of antibody from the bodys immune response and antigen which is a component of the organism

105
Q

what is the bodys immune repsonse?

A

acute IgM and chronic IgG

106
Q

what does PCR detect?

A

the presence of DNA or RNA from an active or dead organism but generally indicates is active

107
Q

what rises suddenly at the start of Hep A infection?

A

fecal HAV

108
Q

what gradually increases over the infection of hep A?

A

IgG Anti-HAV

109
Q

what increases and then drops over the course of hep a infection?

A

IgM anti-HAV

110
Q

what are characteristics of the course of Hep A infection?

A

incubation period of 15-35 days
acute disease of 2-12 weeks
jaundice symptoms
convalescence and recovery of over 3 months

111
Q

what is the course of a Hep B infection?

A

you are infected
the incubation period until are infectious is 2weeks-3months
this is when symptoms start as the antigen rises
IgM starts to be made - anti HBc which then drops back to nothing at 6-12 months
from around 3-6 months the IgG anti Hbc start to rise and stay high so you are immune for life / 20 years

112
Q

what rises and then drops suddenly, with continuing fluctuations through a Hep C infections?

A

alanine transaminase

113
Q

what rises and then plateaus in hep C infections?

A

total anti-HCV antibody

114
Q

what types of syphilis are there?

A

early, latent and late and congenital

115
Q

what is early and late?

A

early could be primary or secondary and late is tertiary - cardiovascular, gummatous and neuro

116
Q

how is syphilis detected?

A

PCR superseded by microscopy and serology

117
Q

what is involved in serology?

A

treponemal specific and non treponemal specific antibodies, screening test including IgM for primary infections, expressed as a dilution (ratio)

CP (38 decks)

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