Main case 1 Flashcards
Travellers diarrhoea bugs
Yersinia spp Campylobacter spp EHEC E. coli 0157:H7 Shigella spp Salmonella spp
Travellers diarrhoea tests
Stool for culture/ova/parasite Urine culture Blood culture FBC U&Es CRP LFT HIV test (salmonella, shigella, campylobacter may indicate)
Shigella and most travellers diarrhoea
Notifiable, but if no sepsis or dehydration can be managed at home
Resolve after 5-7 days
Inc oral fluids, rehydration salts
Only need Abx if Shigella bacteraemia with +ve blood culture
Commonly faecal-oral from contaminated food and water
Campylobacter can be associated with
Guillan-Barre syndrome, 1-3 weeks after infection
Progressive weakness of the limbs, cranial nerves and resp muscles requiring ventilation
Candida albicans in the sputum
Represents colonisation or contamination from oral Candida, doesn’t need to be covered by an antifungal if found when patient has eg pneumonia
Common cause of candidaemia
Gut flora
- if epithelial lining becomes damaged microscopically (eg sepsis) or macroscopically (eg perforation, obstruction, necrosis)
Central/arterial lines may be another reason, but more common in preterm neonates
Superficial fungal infections
Thrush - Candida
Tinea eg athlete’s foot (pedis) or ringworm (capitis)
Fungal nail infection - onychomycosis
Deep fungal infections
Immunocompromised-
Invasive Candida eg candidaemia if central line
Invasive Aspergillus fumigatus - transplants or chemo
Pneumocystis jirovecii pneumonia (PCP) - HIV
Cryptococcal meningitis - HIV or other immunosuppression, from Cryptococcus neoformans
Primary varicella zoster infection (chickenpox)
Widespread, itchy, vesicular rash (starting face/trunk)
Malaise, fever
Breathlessness, low SATs, tachypnoea
- affecting lungs causing pneumonitis
Other complications: bacterial infection of skin lesions, encephalitis, neuro problems, hepatitis, myocarditis
Immunocompromise
Diabetes
HIV
Haematological disorders and malignancies
Extremes of age
Pregnancy
Systemic inflam conditions eg rheumatoid arthritis
Immunosuppressive meds
Risk factors for varicella pneumonitis
Smoking
Pregnancy
Compromised immune system
Chronic lung disease
Antiviral for VZV
Aciclovir
Antiviral for influenza
Oseltamivir
Herpes viruses
EBV - glandular fever, cancers eg Burkitt’s lymphoma
CMV - if immunocompromised eg tissue rejection
Herpes simplex virus 1 and 2 - ulcers
Test for chickenpox immunity
VZV IgG
If VZV IgG negative and pregnant, course of action?
Give VZV immunoglobulin (antibodies)
- provides temporary passive immunity
VZV risk in pregnancy
Highest in 1st trimester for foetus
Highest in 3rd for mother
TORCH infections
Associated with congenital abnormalities TOxoplasma Rubella CMV Herpes viruses
Measles
Fever, malaise Conjunctivitis Cough Koplik spots - blue/grey, inside buccal mucosa Maculopapular rash starting on face
Complications of measles
Bacterial pneumonia
Otitis media
Acute encephalitis
Primary HIV infection
Generalised rash Pharyngitis Lymphadenopathy Headache Mouth ulcers Flu-like symptoms
Causes of eosinophilia
Asthma Haematological malignancies Eczema Parasites - usually helminths Drug allergy
Malaria prophylaxis
Doxycycline
also atovaquine, mefloquine
UK helminths
Pinworm - enterobius vermicularis
Diphyllobothrium latum or fish tape worm
