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Year 3: Immunity; Infection > Management of Common Infections > Flashcards

Management of Common Infections Flashcards

1
Q
A
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2
Q

How (and why) do you collect urine sample when investigating a UTI? [1]

A

Mid stream (avoid contamination of bacteria around urethra)

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3
Q

Describe how you would step up investigations for following UTIs:

  • Asymptomatic bacterial infection
  • Pyelonephritis
  • Urosepsis
A

Asymptomatic bacterial infection:
- DIpstick
- MSU Culture

Pyelonephritis
- DIpstick
- MSU Culture
- Renal US or renal CT

Urosepsis
- DIpstick
- MSU Culture AND Blood culture
- Renal US or renal CT +/- abdomonal CT

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4
Q

Describe the overall managment plan for following:

  • Asymptomatic bacterial infection
  • Pyelonephritis
  • Urosepsis
A
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5
Q

When would you treat asymptomatic bacteria? [4]

A

Normally - don’t, but do if:
- Immunosuppresed
- Abnormal anatomy
- Children
- Prenant

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6
Q

Which bacteria causing UTIs are strongly associated with renal calculi? [1]

A

Proteus mirabilis
Consider imaging

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7
Q

If you find S. aureus as a cause of UTI - what other pathology would you have a suspicion of? [1]

A

S. aureus isn’t usual uropathogen - have suspicion for endocarditis
- endocarditis -> renal abscess -> urine

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8
Q

What is important to think about nitrofurantoin when treating UTIs? [1]

A
  • Need a eGFR > 60 otherwise won’t get into urine and effect
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9
Q

How long does usually fever last in pyelonephritis? [1]

A

3/4 days

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10
Q

Under what conditions would warrant further investigations w UTI? [5]

A
  • UTI in child
  • UTI in a man
  • Recurrent UTIs
  • Persistent symptoms
  • Urinary catheter
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11
Q

Define:

  • Cellulitis
  • Erysipelas
  • Impetigo
A

Cellulitis:
- Infection of dermis AND subcut tissue
- Typically indistinct edge

Erysipelas:
- Infection of dermins only
- Demarcated edge

Impetigo
- Infection usually of epidermis around mouth

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12
Q

Which organsims most commoly cause impetigo? [2]

A

Staph aureus
Streptococcus pyogenes

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13
Q

What is the usual treatment for skin & soft tissue infections? [1]

A

Flucoxacillin (high activity agaisnt staph aureus / strep pyogenes)

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14
Q

What is key to think about SSTIs? [1]

A

If pain is disproportinate to degree of skin change - if so: necrotising fascitis?

Fascia doesn’t have rich blood supply - so little lymphocytes

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15
Q

What is key to thing about cellulitis infection? [1]

A

Highly unlikely that is bilateral - think of a differential diagnosis

Bilateral cellulitis does not exist

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16
Q

Give three differentials for a hot red leg [3]

A

Cellulitis
DVT
Drug reaction
Gout
Insect bites
Exacerbation of lymphoedema

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17
Q

How do you assess for Mycoplasma pneumonia? [1]

A

PCR

18
Q

Describe how atypical pneumonias present differently to typical resp infections

A
  • Illness often milder
  • WBC often less elevated
  • May be associated with abnormal LFTs & hyponatraemia
  • Extra-pulmonary manifestations more common: at the time of resp. infection - e.g. myalgia; post-pulm. Infection -
    e.g. mycoplasma and ADEM, deafness, skin rashes etc
19
Q

Most atypical pneumonias are more mild - except for which one? [1]

A

Legionella infection

20
Q

What are the general principles for CAP:

  • Low severity [1]
  • Moderate severity [2]
  • High severity [3]
A

Low severity
- single antibiotic

Moderate severity:
- amoxicillin & a macrolide (azithromycin, clarithromycin, and erythromycin)

High severity
- β-lactamase stable β-lactam (e.g. co-amox) & a macrolide

21
Q

A patient presents with CAP - under what conditions would you give pip-taz? [3]

A

If they have pseudomonas infection:
-CF; bronchiectasis

22
Q

A patient comes back from the Gulf with a resp. infection - what should you consider? [1]

A

MERs

23
Q

How do you test for infections for [3]
- Pneumococcal
- Legionella
- Mycoplasma

A

Pneumococcal
- Urinary antigen - if haven’t been able to isolate strep pneumonia from another site

Legionella:
- Urinary antigen

Mycoplasma:
- PCR

24
Q

How do you differentiate between the symptoms of meningitis and encephaltiis?

A

Meningitis
- Symptoms of headache, neck stiffness & photophobia

Encephalitis:
- Symptoms associated with altered cerebral function (e..g Seizures, weakness, behaviour change, drop in GCS etc)

25
Q

What are the implications of dinstinction betwen mengintis vs encephalitis with regards to treatment? [2]

A

Likely causes e.g. in UK encephalitis viral > bacterial

Treatment e.g. viral meningitis does NOT need treatment, enceph DOES

26
Q

What are the different ways of classify infective endocarditis? [3]

A

Native vs. prosthetic valve
Indolent vs. acute
Culture positive vs. culture negative

27
Q

Under what conditions would you suspect Streptococcus gallolyticus causing infective endocarditis? [1]

A

Due to GI malignancy

28
Q

Under what conditions would you suspect Viridans streptococci causing infective endocarditis? [1]

A

Dental disease

29
Q

Under what clinical picture would you suspect Salmonella typhi infection? [1]

What would you use to treat? [2]

A

Fever; malaise; abdominal pain; diarrhoea; constipation; travel history where there is poor sanitation

Treat early because can lead to septiciaemia and death :(

With a cephalosporin (e.g cefuroxime) or fluoroquinolone

30
Q

What are the three most common causes of viral meningitis? [3]

A

Enteroviruses (e.g., coxsackievirus)
Herpes simplex virus (HSV)
Varicella zoster virus (VZV)

31
Q

Viral meningitis is generally self-limiting. How do you treat HSV and VZV if needed? [1]

A

Viral PCR testing can be performed on a CSF sample. Aciclovir is used to treat HSV and VZV.

32
Q

The causes of bacterial meningitis include: [5]

A

Neisseria meningitidis
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
Group B streptococcus (GBS) (particularly in neonates as GBS may colonise the vagina)
Listeria monocytogenes (particularly in neonates)

33
Q

What does a non-blanching rash indicate with meningitis? [1]

A

Where there is meningococcal septicaemia, children can present with a non-blanching rash. Other causes of bacterial meningitis do not usually cause the non-blanching rash.

34
Q
A
35
Q

Children seen in the primary care setting with suspected meningitis and a non-blanching rash should receive an urgent dose of [] (IM or IV) while awaiting transfer to hospital (it should not delay transfer).

A

Children seen in the primary care setting with suspected meningitis and a non-blanching rash should receive an urgent dose of benzylpenicillin (IM or IV) while awaiting transfer to hospital (it should not delay transfer). Where there is a true penicillin allergy, transfer should be the priority rather than other antibiotics.

36
Q

Typical antibiotics are to treat bacterial meningitis include

Under 3 months – [] plus [] ([] is to cover listeria)
Above 3 months – []

PLUS

[]

A

Typical antibiotics are:

Under 3 months – cefotaxime plus amoxicillin (amoxicillin is to cover listeria)
Above 3 months – ceftriaxone

PLUS

Steroids (e.g., dexamethasone) are also used in bacterial meningitis to reduce the frequency and severity of hearing loss and neurological complications.

37
Q

When treating bacterial meningitis - what drug should be given if suspect penicillin-resistant pneumococcal infection? [1]

A

Vancomycin should be added if there is a risk of penicillin-resistant pneumococcal infection (e.g., recent foreign travel or prolonged antibiotic exposure).

38
Q

Significant exposure to meningococcal infection puts contacts at risk. This risk is highest with close prolonged contact within 7 days before the onset of the illness. The risk to contacts decreases 7 days after the diagnosis.

Post-exposure prophylaxis is guided by the local health protection team when they are notified of the diagnosis. The usual choice is a single dose of [] given as soon as possible after the diagnosis.

A

Post-exposure prophylaxis is guided by the local health protection team when they are notified of the diagnosis. The usual choice is a single dose of ciprofloxacin given as soon as possible after the diagnosis.

39
Q

Describe the Eron classification for the assessment of the severity of cellulitis [4]

A

The Eron classification assesses the severity of cellulitis:

Class 1 – no systemic toxicity or comorbidity
Class 2 – systemic toxicity or comorbidity
Class 3 – significant systemic toxicity or significant comorbidity
Class 4 – sepsis or life-threatening infection

40
Q

Patients with cellulitis who are penicillin allergic can be given [3]

A

Patients with cellulitis who are penicillin allergic can be given clarithromycin, erythromycin (in pregnancy) or doxycyline

Year 3: Immunity; Infection (16 decks)

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