meningococcus, pneumococcus, gonococcus

Question 1

What is the antibiotic of choice for meningococcal septicaemia?

Answer 1

IV benpen 1.8g 4 hourly (high dose)

Question 2

Who should have eradication of meningococcus when someone gets it?

Answer 2

Eradicate household asymptomatic carriage- because might have GIVEN it to the person who got sick
Ceftriaxone, cipro or rifampicin

Question 3

What should you consider if there is recurrent N meningitidis infection?

Answer 3

Terminal complement deficiency states (C6,7,8)

Question 4

What is the benefit and drawback of Meningococcus polysaccharide compared with Group C conjugate?

Answer 4

Tetravalent (covers A,C,Y,W 135 not just C)

But no long lasting immunity, need boosters, and doesn’t reduce nasal carriage/transmission risk.

Question 5

What is the evidence for steroids in meningitis?

Answer 5

Dexamethasone in acute meningitis before or with first antibiotic dose
Reduces case-fatality in pneumococcal meningitis 21%
So give 10mg IV then 6 hourly for 4 days

Don’t give if have had a dose of abx in the ambulance

Question 6

What should you do if gram stain show gram positive diplococci?

OR history otitis media or sinusitis or recently treated with a beta lactam….

OR if gram positive cocci resembling staph

OR if cannot do an LP - contraindicated

Answer 6

Could be Pneumococcal meningitis
ADD VANCOMYCIN

MIC to penicillin and ceftriaxone should be determined for all isolates- MIC over 0.125–>vanc + cef
MIC under 0.125 –>benpen

Question 7

What is the value of a pneumococcal urinary antigen?

Answer 7

High negative predictive value

Question 8

What is empirical therapy for meningitis?

Answer 8

Dex + ceftriaxone

If immunocompromised, over age 50, alcoholic, pregnant, or debilitated to cover listeria ADD BENZYLPENICILLIN

Question 9

When should you add vanc in meningitis empirical?

Answer 9

Gram stain show gram positive diplococci

OR history otitis media or sinusitis or recently treated with a beta lactam….

OR if gram positive cocci resembling staph

OR if cannot do an LP - contraindicated

Question 10

If immediate penicillin allergy in suspected meningitis-

Answer 10

Vanc + cipro or moxi

Question 11

Listeria meningitis treatment-

Answer 11

benpen and if allergic then bactrim

Question 12

What bug causes scarlet fever?

Answer 12

Strep

Question 13

What bugs cause toxic shock syndrome?

Answer 13

Staph or strep

Question 14

Treatment for disseminated gonococcus infection?

Answer 14

Ceftriaxone

Remember synovial cultures may initially be negative, later positive.

Question 15

What organisms cause cellulitis?

Answer 15

beta haemolytic strep (group A,B,C,G)
S aureus
Pasteurella with dog or cat bite
Aeromonas wtih freshwater especially if male and have cirrhosis or cancer
Vibrio if seawater
Clostridia if immunocompromised
Mycobacteria marinum if water exposed
Erisepelothrix if shellfish

Question 16

Cellulitic leg but pain much worse than the leg looks?

Answer 16

Necrotising myofascititis!!

Question 17

Management of necrotising fasciitis?

Answer 17

surgical
broad spectrum antibiotics

IVIG improves mortality in s pyogenes

empirical is meropenem plus vanc plus clindamycin
clinda reduces bacterial toxin prodution. Dont need penicillin

Question 18

Management of STAPH toxic shock syndrome?

fever, rash, shock, vomiting, non purulent conjunctivitis

Answer 18

BC usually negative!

Fluclox and clindamycin

Question 19

Management of STREP TSS?

Answer 19

BC usually positive for strep pyogenes

Benpen and clindamycin

Question 20

Effect of hydrocortisone in sepsis?

Answer 20

Shock reversed more quickly but more episodes superimposed infection.

Question 21

How long do you have to isolate a meningococcus?

Answer 21

24 hours after antibiotics

Question 22

What gives red man ?

Answer 22

Vanc
(works by binding to D-ALA-D-Ala moieties, preventing polymerisation of peptidoglycans)
Thought secondary to mast cell degranulation that is non IgE mediated

Question 23

Types of nec fasc

Answer 23

Type 1 - mixed aerobes and anaerobes (often post surgery in diabetics)
Type 2 - Strep pyogenes