Micro Flashcards
Name the most likely offending pathogen:
A child on holiday in Morocco develops a single cluster of plaques and papules several days after swimming in the hotel pool.
a) M.avium intracellulare
b) M.leprae
c) M.marinum
d) M.ulcerans
e) M.chelonae
c) M.marinum
Also associated with aquariums.
Name the most likely offending pathogen:
A 19 year old just returned from her gap year in South America presents with a painless nodule on her right leg which is now showing signs of ulceration.
a) M.avium intracellulare
b) M.leprae
c) M.marinum
d) M.ulcerans
e) M.chelonae
d) M.ulcerans
Transmitted by insects in the tropics. The ulcer is called a Buruli ulcer and requires treatment with rifampicin and streptomycin.
Name the most likely offending pathogen:
A 40 year old man who has previously been diagnosed with HIV presents with a 4 week history of fever, night sweats, weight loss and generalised abdominal pain.
a) M.avium intracellulare
b) M.leprae
c) M.marinum
d) M.ulcerans
e) M.chelonae
a) M.avium intracellulare
Disease may be intrapulmonary or extrapulmonary. Disseminated disease in someone with HIV is an AIDS defining illness.
Mx - clarithromycin, rifampicin, ethambutol and amikacin/streptomycin
Name the most likely offending pathogen:
A 35 year old woman has a long history of skin depigmentation, sensory neuropathy, keratitis and periositis.
a) M.avium intracellulare
b) M.leprae
c) M.marinum
d) M.ulcerans
e) M.chelonae
b) M.leprae
Leprosy is a life long illness with an incubation period of 2-10 years. It affects the skin, nerves, eyes and bone. It can be classified into tuberculoid (has depigmented lesions), lepromatous (neuropathic ulcers and multibacillary), BT (prominent nerve damage) and borderline.
Rx is with rifampicin, dapsone and clofazimine
What are the 5 possible outcomes after exposure to TB infection?
1) Uninfected - may have been insufficient infecting dose or successful mucosal barrier to infection (TST-, IGRA-)
2) Cleared - innate response or resistance (TST-, IGRA-)
3) Contained - localised immune response but blood tests negative
4) Latency - includes those with subclinical active disease, may result from ‘contained’ disease. There is a T cell adaptive response or active immune control with positive blood tests.
5) Active - deactivation of latent infection due to compromised immunity or after primary exposure with decreased IFN gamma and IL12.
Describe the progression of primary active TB infection .
There is the creation of a Ghon focus at the pleural surface which is usually asymptomatic. Macrophages then transport mycobacteria to the lymph nodes to form a primary complex and allowing lymphohaematogenous spread). A granuloma with Langerhans giant cells, tuberculoma or miliary TB may form.
Progressive primary TB is when the Ghon focus ulcerates and spreads to cause a pneumonia. There may also be cavity formation, bronchiectasis and collapse.
Which one of the following describes post-primary TB?
a) Occurs 3 years after a primary infection
b) Is associated with malnutrition and chronic alcohol excess
c) Carries a 1% lifetime risk of occurring.
d) Is not associated with the formation of caseating granulomas.
e) Preferentially affects the lower lobes.
b) is associated with malnutrition and chronic alcohol excess
To call an episode of TB ‘post primary’ it must occur more than 5 years after the initial infection. There is a 5-10% lifetime risk of reactivation of primary TB. It presents in the upper lobes and may lead to cavitation and the formation of caseating granulomas, which heal with calcification and fibrosis.
Which of the following is not a feature of TB meningitis?
a) Non-blanching rash
b) Neck stiffness
c) Personality change
d) Reduced GCS
e) Weight loss
a) non-blanching rash
TB meningitis may present with weight loss, fever, night sweats, headache, neck stiffness, reduced GCS, personality change and focal neurological deficits.
What are the disadvantages of:
a) The tuberculin skin test
b) Interferon gamma release assays
For diagnosing TB?
a) Looks at delayed hypersensitivity reaction - has poor sensitivity
b) Cannot distinguish between latent and active infection
Name one side effect of:
a) Rifampicin
b) Isoniazid
c) Pyrazinamide
d) Ethambutol
a) Enzyme inducer, orange secretions
b) Peripheral neuropathy
c) Decreased excretion of uric acid, drug induced hepatitis
d) Optic neuritis
All = hepatotoxicity
Name 4 second line medications for TB.
Injectables - capreomycin, kanamycin, amikacin
Quinolones - moxifloxacin
Ethionamide, cycloserine (bacteriostatic)
Linezolid
Causes of pneumonia:
A 35 year old alcoholic who has a fever and haemoptysis. Gram negative rods are found on sputum culture.
a) Streptococcus pneumoniae
b) Haemophilus influenzae
c) Moraxella catarrhalis
d) Staphylococcus aureus
e) Klebsiella pneumoniae
f) Legionella pneumophilia
g) Mycoplasma pneumoniae
h) Chlamydia pneumonia
I) Chlamydia psittaci
j) Bordatella pertussis
e) Klebsiella pneumonia
Also found in elderly patients. Patients often have high fever, chills and ‘currant jelly sputum’. They have an increased tendency towards abscess formation, cavitation, empyema and pleural adhesions.
Causes of pneumonia:
An 8 year old boy with a fever, malaise and cough after a 2 week history of laryngitis and coryza. An obligate IC bacterium is found on sputum culture.
a) Streptococcus pneumoniae
b) Haemophilus influenzae
c) Moraxella catarrhalis
d) Staphylococcus aureus
e) Klebsiella pneumoniae
f) Legionella pneumophilia
g) Mycoplasma pneumoniae
h) Chlamydia pneumonia
I) Chlamydia psittaci
j) Bordatella pertussis
h) Chlamydia pneumonia
May cause and upper or lower resp tract infection. Has an incubation period of 3-4 weeks. Cough and malaise may persist for several weeks despite antibiotic treatment. Laryngitis is a common feature of a chlamydia pneumoniae pneumonia.
Causes of pneumonia:
A 65 year old woman with rusty coloured sputum, left lower lobe consolidation and a gram positive diplodocus grown on culture.
a) Streptococcus pneumoniae
b) Haemophilus influenzae
c) Moraxella catarrhalis
d) Staphylococcus aureus
e) Klebsiella pneumoniae
f) Legionella pneumophilia
g) Mycoplasma pneumoniae
h) Chlamydia pneumonia
I) Chlamydia psittaci
j) Bordatella pertussis
a) Streptococcus pneumoniae
Most common during the winter and in high risk groups (children under 2 years, adults over 65y and smokers/alcohol abuse). The pneumococcal vaccine is offered to those 65 and over and other adult high risk groups.
Causes of pneumonia:
An 80 year old immobile patient who has just recovered from one week of influenza now has a new onset fever with tachypnoea and shortness of breath. She is admitted to hospital and an X ray shows cavitation. A sputum culture grows gram positive cocci in grape like clusters.
a) Streptococcus pneumoniae
b) Haemophilus influenzae
c) Moraxella catarrhalis
d) Staphylococcus aureus
e) Klebsiella pneumoniae
f) Legionella pneumophilia
g) Mycoplasma pneumoniae
h) Chlamydia pneumonia
I) Chlamydia psittaci
j) Bordatella pertussis
d) Staphylococcus aureus
Often occurs after viral illness. Most common in infants and debilitated patients. Presents with a short prodrome of fever followed by rapid onset of respiratory distress.
Causes of pneumonia:
A 4 year old child with a persistent low grade fever, dry cough and malaise. She also complains of aching joints. She has a rash formed of individual target lesions.
a) Streptococcus pneumoniae
b) Haemophilus influenzae
c) Moraxella catarrhalis
d) Staphylococcus aureus
e) Klebsiella pneumoniae
f) Legionella pneumophilia
g) Mycoplasma pneumoniae
h) Chlamydia pneumonia
I) Chlamydia psittaci
j) Bordatella pertussis
g) Mycoplasma pneumoniae
This is a common atypical cause of pneumonia. It leads to a dry cough and systemic symptoms. The fever is rarely high and there is prominent fatigue on exertion and malaise. It is also associated with arthralgia, erythema multiforme, Steven Johnson syndrome and a cold agglutinin positive autoimmune haemolytic anaemia.
What are the five components of the CURB 65 score?
One point for each of:
- confusion (AMTS < 8)
- urea > 7
- RR > 30
- BP < 90/60
- age > 65
A 35 year old IVDU presents to A&E with a one week history of headache, fever and malaise. He feels nauseous but has not vomited. On further questioning he appears to be confused. A lumbar puncture is done and the CSF is analysed. There is a normal glucose and protein but India Ink stain reveals encapsulated organisms.
What is the offending organism and how is it treated?
Cryptococcus neoformans.
Transmitted as inhaled spores but pneumonitis often not found in patients and will first present as fungal meningitis. Associated with CD4 count less than 100. CSF culture is more reliable than blood culture.
Cryptococcal CNS infection is fatal if left untreated. Treatment is with an antifungal such as amphotericin B or fluconazole.
Causes of pneumonia:
A 60 year old man with COPD presents with a cough productive of purulent sputum. This grows a gram negative coccus on culture.
a) Streptococcus pneumoniae
b) Haemophilus influenzae
c) Moraxella catarrhalis
d) Staphylococcus aureus
e) Klebsiella pneumoniae
f) Legionella pneumophilia
g) Mycoplasma pneumoniae
h) Chlamydia pneumonia
I) Chlamydia psittaci
j) Bordatella pertussis
c) Moraxella catarrhalis
The second most common cause of infectious exacerbations of COPD. M.catarrhalis colonises the upper airways and in children may cause otitis media.
History of crackles and rattling lung sounds with a ground glass appearance in multiple lobes on CXR.
Pseudomonas aeruginosa - associated with CF
Aerobic gram negative bacillus which leads to a rapid decline in lung function in patients with CF.
Burkholderia cepacia
A 55 year old male who has just had a liver transplant presents with hepatitis in the donor organ and a fever. Acute rejection of the graft is suspected but no antibodies to the graft tissue are found. A liver biopsy is taken and on histology of the tissue there are owl’s eyes inclusions present in the cells. What is the treatment?
This is CMV, which may be an exogenous infection or reactivation in patients who are immunocompromised. They present with fever, interstitial pneumonitis, graft failure, hepatitis, oesophagitis, gastritis and CMV retinitis (in HIV).
PCR blood or tissue can be performed or histology done as above.
Treatment is with either ganciclovir, which inhibits viral DNA polymerase, or IV foscarnet, a pyrophosphate analogue.
Treatment for an atypical pneumonia caused by legionella.
Macrolide and rifampicin
Pick the most appropriate option based on the clinical scenario:
A 23 year old medical student returns from his elective in Ghana with multiple painless ulcers on his penis. He denies unprotected sex with sex workers but did have a girlfriend whilst he was there. Culture on chocolate agar shows a gram negative coccobacillus.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
c) Chancroid
Caused by Haemophilus ducreyi. Tropical ulcer disease mainly found in Africa which may lead to multiple painless ulcers.
Pick the most appropriate option based on the clinical scenario:
A 21 year old woman presents to the GUM clinic with vulvovaginitis. She complains of soreness and itching and has noticed a cottage cheese looking white discharge over the past few days. She is not currently sexually active. She washes with shower gel twice a day as she goes to the gym a lot and sometimes douches if she ‘feels unclean’.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
j) Candidiasis
Candida albicans. Fungal infection that may or may not be sexually transmitted as it can occur as part of the normal vaginal flora. Hygiene practices or immunodeficiency can cause infection. Treat with oral or topical antifungals e.g. Clotrimazole
Pick the most appropriate option based on the clinical scenario:
An 18 year old woman presents with a number of small, smooth bumps over her vulva. She does not have a boyfriend but she has recently been ‘sleeping with’ a guy she knows from halls.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
e) Genital warts - caused by HPV 6 or 11 (dsDNA)
They may present as single or multiple bumps which are either small, smooth and flat or large, pink, cauliflower like lumps which can be papular, planar, pedunculated or keratinised.
Treatment can be at home with podophyllotoxin cream (contraindicated if pregnant) or cryotherapy or imiquimod in clinic.
Pick the most appropriate option based on the clinical scenario:
A 24 year old man with 2 weeks of mucopurulent urethral discharge, dysuria and epididymal tenderness after a one night stand 2 weeks ago.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
b) Gonorrhea
Often asymptomatic, it can present in men with mucopurulent urethral discharge, dysuria and epipdidymal tenderness or swelling or in women with discharge and pain. It may also cause dysuria in women if urethral infection occurs.
Urethral smear is 95% sensitive and culture will show an obligate IC gram negative diplococcus (Neisseria gonorrheae)
Treatment is with IM ceftriaxone 250mg single dose or cefixime PO 400mg once. If resistant give spectinomycin.
Complications include post gonococcal urethritis in men (adj tetracycline), rectal proctitis (MSM), prostatitis, gonococcal septic arthritis (F, pregnant, menstruation) and PID.
Pick the most appropriate option based on the clinical scenario:
A 30 year old woman with a history of risky sexual behaviour brings in her 5 day old neonate after noticing a strange crust over his eyes.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
b) Gonorrhea - this is opthalmia neonatorum, secondary to gonorrhea infection picked up whilst travelling through the birth canal. Both mother and baby should be treated.
Complement deficiency in the child may lead to disseminated gonococcal septicaemia with a rash and arthritis.
Pick the most appropriate option based on the clinical scenario:
A 27 year old homosexual man presents with pain, tenesmus and bleeding. He has had multiple recent sexual encounters both receiving and giving anal sex.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
f) lymphogranuloma venerum
Lymphatic infection with chlamydia serovars1-3. Can present in many ways but in MSM there are usually rectal symptoms e.g. Pain, tenesmus, bleeding, mucous discharge and proctitis.
Identify with NAAT and PCR. Management is with doxycycline 100mg BD for 3 weeks and erythromycin 500mg QDS for 3 weeks (can use azithromycin weekly 1g instead of erythromycin).
Pick the most appropriate option based on the clinical scenario:
A 25 year old woman comes in for routine STI screening. She is hoping to start trying for a baby with her husband. They usually use condoms but were previously having UPSI when she was on the pill. A swab shows an obligate IC pathogen which is gram negative. She has had no symptoms. The doctor advises a course of azithromycin 1g stat with doxycycline 100mg BD for 1 week.
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
a) Chlamydia
Chlamydia trachomatis is asymptomatic in 80% of women and 50% of men. 10% of under 25s are affected. If there are symptoms these include discharge, a sterile pyuria and deep dyspareunia in women or urethritis/epididymoorchitis in men.
The virus exists as stable EC elementary bodies with active IC reticulate particles. There are many serovars but D-K cause genital infection and opthalmia neonatorum.
Complications include tubal infertility, PID, chronic pelvic pain, Reiters (urethritis, arthritis, conjunctivitis), epididymitis and Fitz Hugh Curtis syndrome. Doxycycline should be avoided in pregnancy as it can lead to disturbed bone growth and tooth discolouration. In this case erythromycin may be given instead at 500mg QDS for 1 week.
Pick the most appropriate option based on the clinical scenario:
A 22 year old man presents to the GUM clinic with a painful swelling in his left inguinal area. He said that he had a genital ulcer a week ago aswell, but he was not bothered by this as it was painless. He has a fever of 39C and looks unwell.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
f) Lymphogranuloma venerum
This is early LGV stage 2 which occurs 2-25 weeks after infection. LGV may begin as a painless non indurated genital ulcer with balanitis, proctitis, or cervicitis. Later on, painful unilateral inguinal buboes form, which are prone to rupture. There may be fever, malaise, protocolitis and increased lymphoid tissue.
In late disease, LGV causes inguinal lymphadenopathy, genital elephantiasis, frozen pelvis, fistulae, abscess formation, genital ulcers, rectal strictures and lymphorroids.
Mx - doxy BD 100mg 3/52 and erithromycin 500 QDS 3/52.
Pick the most appropriate option based on the clinical scenario:
A 50 year old previous female sex worker presents to A&E with confusion. She appears to be having difficulty walking and the doctors assume she is drunk, although she doesn’t smell of alcohol.
When she is finally assessed in triage the nurse notices that her pupils are small and do not react to light. She does not report any medical history, except for an admission to hospital to be investigated for meningitis after she reported a maculopapular rash. She was given a course of antibiotics and then discharged.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
d) Syphilis
This is a history of secondary and now tertiary syphilis. Syphilis is caused by the obligate gram negative spirochaete bacterium Treponema palladium. It is associated with HIV infection. This woman’s high risk history for transmission of STIs makes this a likely cause.
Primary syphilis presents with an indurated painless ulcer 1-12 weeks after infection. The ulcer has a clean base and serous exudate. This chancre usually lasts for 4-6 weeks. There may be regional lymphadenopathy.
Months later there may be a secondary presentation with a systemic bacteremia, symmetrical maculopapular rash, aseptic meningitis, CN palsy, optic neuritis, acute nerve deafness, uveitis or alopecia.
If left undertreated years later there will be a tertiary infection. This lady has neurosyphilis which presents after between 2 and 30 years with ‘general paresis of the insane’, caused by chronic meningoencephalitis causing atrophy, tabes dorsalis and Argyll Robertson pupils.
Other tertiary presentations include gumma and cardiovascular infection leading to aortitis.
What are the symptoms of congenital syphilis?
Hepatosplenomegaly, rash, fever, neurosyphilis and pneumonitis. These symptoms usually present within the first few years of life.
What is the treatment for primary syphilis?
Single dose IM benthazine penicillin or doxycycline.
May induce a Janisch Heimer reaction - fever, headache and myalgia after antibiotics are given. Clears within 24h.
Pick the most appropriate option based on the clinical scenario:
A 45 year old woman presents to the GUM clinic concerned because she has been having fishy smelling discharge. She has tried washing with all sorts of soaps and products but she still produces a white/grey discharge.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
h) Bacterial vaginosis
This lady has BV, probably induced by hygiene practices that interfere with the normal vaginal flora, such as douching. There is a decrease in the number of lactobacilli. The Whiff test can be done where KOH is added to the slide, which produces a fishy odour.
Clue cells may also be visualised on microscopy. These are vaginal epithelial cells which look stippled as they are covered with bacteria.
Pick the most appropriate option based on the clinical scenario:
An Indian man who has just arrived in the UK goes to register at his local GP. At his health check, the man shares that he is concerned about some patches that have appeared around his genitals. O/E these are beefy, red and large and he says they have been growing since he first noticed them.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
g) Donovanosis - this is caused by the gram negative bacillus Klebsiella granulomatis. It is found in Africa, India and in aboriginal populations.
It presents with papules or nodules which progress to large red expanding ulcers. On Giemsa stain, Donovan bodies can be seen.
Treatment is with azithromycin.
Pick the most appropriate option based on the clinical scenario:
A woman attends GUM clinic because of unusual discharge. Wet microscopy reveals a flagellated protozoan.
a) Chlamydia
b) Gonorrhea
c) Chancroid
d) Syphilis
e) Genital warts
f) Lymphogranuloma venerum
g) Donovanosis
h) Bacterial vaginosis
i) Trichomoniasis
j) Candidiasis
k) Molluscum contagiosum
I) Trichomoniasis
Caused by the flagellated protozoan trichomonas vaginalis. This can cause an asymptomatic infection in men or cause urethritis. It is associated with an increased risk of HIV. Treatment is with metronidazole.
A 5 year old child presents to the GP with an itchy rash on his arm. It is erythematous and looks like a reddened area formed around normal looking skin. He has recently begun swimming lessons at his local leisure centre. What is the diagnosis?
Ringworm I.e. tinea infection
Caused by trichophyton or microsporum, this is a fungal infection caused by a dermatophyte fungus. Different presentations have different names e.g. Tinea capitis on the scalp or athlete’s foot. The fungus thrives in damp conditions like swimming pool changing rooms.
What is the name of the fungus that causes pityriasis infections?
Malassezia globosa/furfur
Outline four different presentations of aspergillosis infection.
1) Allergic bronchopulmonary aspergillosis = inflammation of lungs, presenting with cough and wheeze
2) Aspergilloma - ball of fungus in lungs, causing cough with or without haemoptysis and shortness of breath
3) Chronic pulmonary aspergillosis - infection longer than 3 months which leads to cavitation, weight loss, cough, fatigue and shortness of breath
4) Invasive - associated with immunocompromise, spread from lungs causing fever, chest pain and cough
Diagnosis of cryptococcus neoformans.
India ink shows encapsulated yeast I.e. Cell with a halo. There is antigen in either the serum or the CSF.
Treatment for invasive fungal infection e.g. Cryptococcal meningitis
Amphotericin B
Three possible drug classes to treat yeasts with examples.
Azoles e.g. Fluconazole
Polyenes e.g. Amphotericin (targets cell membrane integrity)
Echinocandins e.g. Caspofungin (targets cell wall)
A 23 year old woman presents to A&E with a 3 day history of fever, dysuria, malaise and pain. On examination she has some lymphadenopathy and a vesicular rash. One week ago she had sex with a new sexual partner and she thinks she may have caught something. What complications is she at risk of?
This is a primary genital herpes infection. The first presentation of herpes is usually severe, with subsequent milder recurrences in times of stress or illness.
Complications from primary infection include herpes meningitis (4-8% of primary infections) and sacral ridiculomyelitis, which presents with urinary retention. Aciclovir within the first 5 days of primary infection may shorten the length of the presentation and alleviate some symptoms. The course is for 5 days.
What are the symptoms of herpetic keratitis?
Unilateral/bilateral conjunctivitis with pre-auricular lymphadenopathy
Name 3 potential complications of primary genital herpes infection during the 3rd trimester of pregnancy.
Possible complications:
- foetal loss
- long term ocular and neural sequelae
- fulminant hepatitis
- multi organ failure
- skin, eye and mouth lesions a week post partum
- disseminated disease from 4 days post partum
Describe the clinical course of herpes encephalitis.
90% of infections are due to HSV-1. 50% occur in those over 60 years old.
Begins with a flu-like prodromal illness which lasts for about 2 weeks. This is followed by focal neurology, confusion, behavioural changes, altered consciousness. May eventually lead to seizures and death.
Treat urgently with IV aciclovir 10mg/kg TDS.
What is Mollaret’s meningitis?
Benign recurrent aseptic meningitis associated with HSV-2.
Herpes gladiatorum
Painful blisters with inguinal lymphadenopathy
Herpes whitlow
Painful red finger (abscess)
What is the pattern of infection in VZV in the first 48h after exposure?
Viral replication in lymph nodes with subsequent replication in the liver and spleen. Vesicular rash occurs 48h after exposure.
Describe the rash of chickenpox.
Dew on rose petal rash.
Name 3 syndromes that may be complications of VZV infection.
1) Guillain Barré = rapid onset ascending muscle weakness with numbness and tingling.
2) Ramsay Hunt = acute peripheral facial neuropathy associated with erythematous vesicular rash of the ear.
3) Reye’s syndrome = rapidly progressing encephalopathy with vomiting, personality change, confusion, seizures and loss of consciousness.
What are Tzanck cells?
Multinucleated giant cells found on histology with VZV infection.
