MIC

Question 1

Superficial fungal infections

Answer 1

Candida - yeast
Dermatophytes- filamentous fungi

Question 2

Types of candida

Answer 2

Candida – a yeast

C. albicans is the most common
C. glabrata common, less susceptible to azoles

C. auris, unusual but often ‘resistant’
Worldwide emergence, MOH notifiable

Question 3

___________ recurrent infection in HIV

Answer 3

Candidiasis

Question 4

Predisposing factor of candidiasis

Answer 4

Antibiotics
Immunocompromised
Infancy, old age, pregnancy

Question 5

Management of candidiasis

Answer 5

Address precipitating factors

Stop antibiotics
Good hygiene, dry skin, fresh nappies
Reduce steroids
Test for HIV
Topical or systemic antifungal drugs
- Clotrimazole
- Azoles
- Echinocandins (anidulafungin)

Question 6

Dermatophytes

Answer 6

Filamentous fungi
SKIN HAIR NAIL FUNGAL INFECTION

Sources:
humans, animals, or environment

Ring worm’ – skin
‘Athlete’s foot’ – soles, and toe webs

Question 7

Systemic candiasis

Answer 7

Antibiotics
Immunocompromised
Infancy, old age, pregnancy

In addition, …
1) GIT perforation / surgery
2) Intravascular line
3) Preterm neonates

Question 8

Aspergillosis

Answer 8

A filamentous fungus
Aspergillus fumigatus is the most common
… many other species

Invasive aspergillosis
- Immunocompromised patients
**Neutropaenia ***
Cultures less predictive
Biopsy more specific
Antigen tests

Question 9

CLOSTRIDIUM

Answer 9

Clostridium perfringens (gas gangrene, see prev lecture)

Clostridium tetani - tetanus

Clostridium botulinum - botulism

Question 10

Clostridium tetani found in

Answer 10

Found in animal faeces, contaminated soil

Question 11

Cause of tetanus

Answer 11

Superficial cut, contaminated splinter, thorn prick in gardeners….

Question 12

Presentation of tetanus

Answer 12

Descending involvement of the nervous system –toxin causes
sustained excitation of motor neurons, causing motor spasms

Stiffness
Lockjaw
sardonic grin (a sneering grin)
Opisthotonus (extreme arching of the back)

Question 13

Clostridium botulinum

Answer 13

Cause of botulism (relaxation of muscle)

Severe, often fatal food poisoning

Question 14

Presentation of botulism

Answer 14

Eyes affected first (double vision, drooping eyelids)

Descending motor loss with flaccid paralysis

Speech and swallowing difficulty

Breathing difficulty

Death from cardiac or respiratory failure

Question 15

VIETNAMESE TIME BOMB

Burkholderia pseudomallei

Answer 15

Reported cases of melioidosis in American soldiers who fought in the Vietnam war
(onset of infection 62 years later

Question 16

Burkholderia pseudomallei – what is the significance?

Answer 16

Major cause of death

Question 17

Burkholderia pseudomallei risk factors

Answer 17

diaebets

alcohol excess

renal disease

chronic lung disease

Question 18

Fungi diagnostic test

Answer 18

microsopy

culture and sensitivity

Question 19

Leptospirosis spread through

Answer 19

Spread through the urine of infected animals, which can get into water
or soil and can survive for weeks to months. (especially rats urine)

Question 20

Leptospirosis – how do humans get infected?

Answer 20

Humans can become infected through:

*Contact with urine / body fluids from infected animals.

*Contact with water, soil, or food contaminated with the urine of infected animals.

Bacteria -> through skin or mucous membranes (eyes, nose, mouth), especially if the skin is broken from a cut or scratch.

Drinking contaminated water can also cause infection.

Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as floodwaters.

Person to person transmission is rare.

Question 21

Leptospirosis – risk factors

Answer 21

it is an occupational hazard for people working outdoors or with animals, such as:

*Farmers
*Mine workers
*Sewer workers
*Slaughterhouse workers
*Veterinarians and animal caretakers
*Fish workers
*Dairy farmers
*Military personnel

The disease has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers.

Question 22

Leptospirosis – clinical features

Answer 22

High fever
*Headache
*Rigors
*Myalgia
*Vomiting
*Jaundice (!!)
*Red eyes (!!)
*Abdominal pain
*Diarrhoea
*Rash

If a second phase occurs, it is more severe; the person may have hepatorenal failure (Weil’s disease),
meningitis, bleeding, haemoptysis.

Question 23

Toxoplasmosis – serious implications

Answer 23

Mother-to-child (congenital)
*If a woman has been infected before becoming pregnant, the unborn child will generally be
OK due to maternal antibody.
*If a woman is pregnant and becomes newly infected with Toxoplasma during or just before
pregnancy, congenital transmission can occur.

*The earlier in pregnancy when transmission occurs, the more severe the damage to the baby

Potential results can be :

*miscarriage

*stillborn child

*a child born with signs of toxoplasmosis (retinitis, brain damage with calcification,
microcephaly, jaundice, hepatosplenomegaly)

*Infants infected before birth often show no symptoms at birth but may develop them later in life with potential vision loss, mental disability, and seizures.

• immunocompromised patient -> reactivation of Toxoplasma infection

Symptoms - fever, confusion, headache, seizures, nausea,
and poor coordination.

Question 24

Toxoplasmosis – signs & symptoms

Answer 24

Generally, asymptomatic or mild, self-limiting illness in
the immunocompetent.

Question 25

WHERE IS MALARIA FOUND?

Answer 25

Transmitted in tropical & subtropical areas where :
*Anopheles mosquitoes can survive & multiply

*Malaria parasites can complete their growth cycle in the mosquitoes

Highest transmission found in Africa (south of the Sahara) and parts of Oceania
(eg. Papua New Guinea)

Generally in warmer regions closer to the equator
*Transmission will be more intense
*Malaria is transmitted year round

Question 26

Test send for malaria

Answer 26

Fbc (purple top) for thin and thick film

3 sets of blood films taken every 12-24 hours, if all 3
sets are negative, malaria can be ruled out.

Question 27

Malaria in pregnancy

Answer 27

P. falciparum (cause severe malaria) especially, may cause severe disease in the mother and foetus.

*Maternal anaemia
*Severe malaria in mother
*Foetal loss
*Premature delivery
*Intrauterine growth retardation
*Low-birth-weight baby

Question 28

Parasites

Answer 28

OCP

Question 29

What is scabies?

Answer 29

Scabies is an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies.

Scabies is found worldwide and affects people of all races and social classes. Scabies can spread rapidly under crowded conditions where close body and skin contact is frequent. Institutions such as nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks. Child-care facilities also are a common site of scabies infestations.

Question 30

How soon after infestation do symptoms of scabies begin?

Answer 30

If a person has never had scabies before, symptoms may take 4-8 weeks to develop. It is important to remember that an infested person can spread scabies during this time, even if he/she does not have symptoms yet.

In a person who has had scabies before, symptoms usually appear much sooner (1-4 days) after exposure.

Question 31

signs and symptoms of scabies infestation?

Answer 31

The most common signs and symptoms of scabies are intense itching (pruritus), especially at night, and a pimple-like (papular) itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks. The rash also can include tiny blisters (vesicles) and scales. Scratching the rash can cause skin sores; sometimes these sores become infected by bacteria.

Tiny burrows sometimes are seen on the skin; these are caused by the female scabies mite tunneling just beneath the surface of the skin. These burrows appear as tiny raised and crooked (serpiginous) grayish-white or skin-colored lines on the skin surface. Because mites are often few in number (only 10-15 mites per person), these burrows may be difficult to find. They are found most often in the webbing between the fingers, in the skin folds on the wrist, elbow, or knee, and on the penis, breast, or shoulder blades.

The head, face, neck, palms, and soles often are involved in infants and very young children, but usually not adults and older children.

Persons with crusted scabies may not show the usual signs and symptoms of scabies such as the characteristic rash or itching (pruritus).

Question 32

How did I get scabies?

Answer 32

Scabies usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies. Contact generally must be prolonged; a quick handshake or hug usually will not spread scabies. Scabies is spread easily to sexual partners and household members. Scabies in adults frequently is sexually acquired. Scabies sometimes is spread indirectly by sharing articles such as clothing, towels, or bedding used by an infested person; however, such indirect spread can occur much more easily when the infested person has crusted scabies.

Question 33

Can scabies be treated?

Answer 33

Yes.

Question 34

Endocarditis treatment

Answer 34

weeks of antibiotics

valve surgery if:

Heart failure
Uncontrolled infection- persistnt sepsis/persistent bacteremia
septic ….