Micro Flashcards by Anthony Rayner

Visceral Leishmaniasis

Leishmania donovani

Kala-azar = black sickness - grey skin

MASSIVE SPLENOMEGALY

fevers, rigors, sweats, poor appetite, wt loss, hepatomegaly

pancytopenia secondary to hyposplenism

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Cutaneous Leishmaniasis

tropica/mexicana

crusted lesion at site of bite

may be underlying ulcer

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Mucocutaneous Leishmaniasis

Braziliensis

Skin lesions may spread to involve mucosae of nose and pharynx etc.

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Leishmaniasis

Caused by

Spread by

Intracellular protozoa leishmania

Sand flies

Novy-Macneal-Nicolle medium

Tx = sodium stibogluconate

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African trypanosomiasis

Sleeping sickness

Spread by tsetse fly

West Africa (Gambiense)

East Africa (Rodesiense) - more acute

Trypanosoma chancre

Enlarged posterior cervical LNs, CNS involvement (SOMNOLENCE)

Mx:

Early - IV pentamide or suramin

Late/CNS involvement - IV melarsoprol

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American trypanosomiasis

Chagas disease

Trypanosoma cruzi

Periorbital oedema may be seen

Chronic changes = heart and GIT

myocarditis

Tx: azole or nitroderivatives (benzidazole or nifurtimox)

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Amoebiasis

Caused by?

Spread by?

Features?

Tx?

Entamoeba hystolitica

faecal oral route

Amoebic dysentry:

profuse bloody diarrhoea and trophizites on stool microscopy

Amoebic liver abscess:

single mass in R lobe, fever and RUQ pain

FLASK SHAPED ULCER

Tx: METRONIDAZOLE and paromycin in luminal disease

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Leptospirosis

Caused by?

Spread via?

Features?

EMQs?

Mx:

spirochaete leptospira interogans

Spread via contact with infected rat urine

Fever, flu like

RENAL FAILURE
JAUNDICE

SUBCONJUNCTIVAL HAEMORRHAGE

Headache

EMQs: sewage worker, farmer, vet, abattoir

Mx:

High dose BENPEN or DOXY

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Brucellosis/Maltese fever

Syptoms

Non specific, incl osteomyelitis and meningoencephalitis

severely debilitating often chronic

fever, profuse sweating SMELLS LIKE HAY

joint and muscle pain

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Brucellosis/Maltese fever

Incubation and transmission

G -ve faculative intracellular bacteria

3-4w - 7-10m

Contact with infected animals e.g. farmer, vet, abattoir

Consumption of infected products e.g. infected unpasteurized milk, cheese

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Brucellosis/Maltese fever

Dx and Tx

BM culture, blood culture, serology

Prolonged therapy (4-6w)

TETRACYCLINE or DOXYCYCLINE plus STREPTOMYCIN

Rifampacin and amikacin can also be used

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Plague

Yersinia pestis

Bubonic, pneumonic or septicaemic

Dx: PCR

Tx: streptomycin, doxycycline, gentamicin

If meningitis: chloramphenicol

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Borellia

Relapsing fever

Doxycycline

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Rickettsia

ticks, fleas, lice

Rocky mountain spotten fever

African tick bite fever

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Schistosoma Haematobium

Urinary schistosomiasis

Swimmers itch, returned from africa

RF for SCC of the bladder

Features: frequency, haematuria, bladder calcification

Mx: single oral dose PRAZIQUANTEL

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Sporadic CJD

somatic prnp mutation or spontaneous conversion of PrPc to PRPsc

Rapid, progressive dementia

Cortical blindness

Mean age 46-75

Survival = 6m

EEG - periodic triphasic changes

MRI - normal

CSF - 14-3-3

PM - spongiform vacuolation, PrP amyloid plaques

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Acquired CJD

Variant CJD

Iatrogenic CJD

Kuru

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Variant CJD

Exposure to BSE

Younger, 30y, survival = 14m

EEG - non specific slow waves

MRI - posterior thalamus highlighted = PULVINAR SIGN

PM - PrPsc 4T in CNS and lymphoreticular tissue, florid plaques

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Iatrogenic CJD

Innoculation with human prions e.g. surgery

Progressive ataxia –> dementia

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Kuru

Canabalistic prion exposure

Progressive cerebellar syndrome

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Inherited CJD

Familial CJD

Gerstmann–Sträussler–Scheinker syndrome

Fatal familial insomnia

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P. falciparum

Severe infection and complications

Severe infection:

schizonts on a blood film

parasitaemia > 2%

hypoglycaemia

acidosis

temperature > 39 °C

severe anaemia

Complications:

cerebral malaria: seizures, coma

acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown

ARDS

hypoglycaemia

DIC

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P. falciparum Tx

Uncomplicated

Severe

Oral ACT e.g.

artemether plus lumefantrine

artesunate plus amodiaquine

artesunate plus mefloquine

artesunate plus sulfadoxine-pyrimethamine

dihydroartemisinin plus piperaquine

Severe:

IV artesunate

IV quininie

If parasite count > 10% then exchange transfusion

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Vivax

fever every 48h

Film: schuffer dots

Tx:

Primaquine and chloroquine to destroy hypnozoites

Oral ACT

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Ovale

Fever every 48h Film: Schuffer dots Primaquine and chloroquine to destroy hypnozoites Oral ACT

Malariae

Fever every 72h Nephrotic syndrome Tx: ACT/chloroquine

Tinea capitis

Scalpringworm Causes scarring/alopecia Dx: green fluorescence under wood's lamp Tx: Oral antifungals Terbinatine for tricophyton tonsurans Griseofulvin for micosporym canis Topical ketoconazole

Tinea corporis

RIngworm Trichyphyton rubrum Tx: oral fluconazole

Tinea pedis

Athletes foot

Candida Dx

culture mannan abs

Aspergillus

Pneumonia in immunocomp Dx: elisa, pcr, b glucan

Cryptococcus

Immunocomp (HIV) Meningitis - insidious onset Dx: cryptococcal antigen in serum/csf

Better test for haemophilus than chocolate agar

latex particle agglutination and PCR

GOld std dx for leptospirosis

microscopic agglutination test

Neisseria meningitides virulence factors

capsule, endotoxin and IgA1 protease

Recurrent aseptic meningitis =

mollaret's meningitis (HSV 1+2)

Higouménakis' sign and clutton joints

congenital syphilis

giemsa stain

klebsiella granulomatis Donovanosis

maculopapular rash, low platelets, hyponatraemia and raised liver enzymes

Rocky mountain fever

SE of trimethoprim

megaloblastic anaemia and hyperkalaemia

Candidaemia dx

blood b-D glucan

castaneda medium

brucellosis

oseltamivir zanamivir laninamivir peramivir

neuraminidase inhibitors

spaghetti and meatballs

pityriasis versicolor

tx sporothrix schenkii

fluconaxole and oral KI

mississippi river

histoplasma capsulatum

cauliflower warty lesion

phialophora verrucosa

plasma amylase

mumps

COPD pneumonia

moraxella catarrhalis

brucellosis tx

doxy and gent

lyme tx

doxy

tonsillar biopsy, useful for..?

variant CJD

best test for Hep C

RNA PCR (VL)

which genotype of hep c is less likely to respond to tx

genotype 1

winterbottom's sign

Trypanosoma brucei gambiense posterior cervical LNs

T. cruzi tx

bennximidazole or nfurtimox

Falciparum film

maurer's clefts

Salmonella Tx traveller's diarrhoea tx

cipro clarithromycin

incubation \<1w

meningococcus diptheria influenza scarlet fever

incubation 1-2w

malaria dengue typhoid measles

incubation 2-3w

mumps rubella chicken pox

incubation \>3w

IM CMV viral Hep HIV

Hep C tx

Peg-IFNa Ribavirin Protease inhibitor (e.g. boceprevir, simeprevir, telaprevir)

Most common cause of diarrhoea in HIV

cryptosporidium

RSV prevention

Ribavirin aerosol (guanosine analogue) Palivizumab is a monoclonal antibody against RSV

CMV tx

Gancyclovir

Varicella zoster tx

Valaciclovir

Influenza A

Amantidine

Tx for severe resistant herpes

Foscarnet

Macrolides treat:

legionella/mycoplasma, bartonella, campylobacter, diptheria, c.psittaci/pneumoniae/trachomatis

Cause of exanthem subitum

HHV6

Naturally ocurring cytokine, inhibits HIV fusion to CD4+

MIP-1a

Tx for severe sytemic infection before organism has been identified

CEFUROXIME

slums, river water

cryptosporidium parvum

Rat bite, 10d later - fever, malaise, headache and myalgia

spirilluminus

undulant fever, bone pain, malaise (3w)

brucellosis

Brucella from goats from cattle

Melitensis (g-ve coccobacilli) Abortus

itchy scaly rash on soles of feet

trichophytum rubrum

pityrosporum orbiculare

pityriasis versicolor

pigeon racing

cryptococcus

Post viral reactive arthritis

Rubella P B19 HBV

Post bacterial reactive arthritis

Dysentry: Shigella, salmonella, yersinia, campylobacter Urethritis: chlamydia, ureaplasma Other: GAS, N. gonorrhoeae, brucella, TB (Poncet's)

Post infectious reactive arthrirtis

Lyme disease Rheumatic fever

Well defined ovoid shape with a surrounding sclerotic margin bit little involcrum in tibia

brodie's abscess

clutton's joints

syphilis

drug induced fever

abx e.g. co-trimoxazole

DDx ring enhancing lesions

brain abscess toxoplasmosis tuberculoma CNS lymphoma

anatomical abnormalities of the renal tract and also cavitating pneumonia

klebsiella

broad spect abx for UTI

ampicillin

pseudomonal infxn

ceftazidime

haemorrhagic cystitis in kids

adenovirus

schistosoma mansoni

bowel and liver diarrhoea

schistosoma haematobium

bladder painless haematuria scc of bladder

microfilariae in peripheral blood, marked eosinophilia and Sx affecting LNs

Wucheria bancrofti

undercooked pork 'eating competition' periorbital oedema, conjunctivitis, 3w hx chills gastric bx = encysted larvae

Trichinella spiralis

small pale bodies in stools, mild epigastric pain

taenia saginata

Dark urine

P. falciparum

tear drop trophozites

giardia

machado guerrero test positive

Trypanosoma cruzi

chorioretinitis, hydrocephalus, seizures and hepatosplenomegaly

congenital toxoplasma