microbiology Flashcards by Sarah Gibb

what are the features of herpes simplex virus 1?

Type 1 acquired in childhood
HSV1 is cause of oral lesions
70% UK adults have been infected
Transmitted via infected oral secretions during close contact
Frequently asymptomatic
Clinical manifestations varies

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what are the features of primary gingivostomatitis?

caused by HSV1
Disease of pre-school children
Primary infection
Systemic upset
affects Lips, buccal mucosa, hard palate
Vesicles 1-2mm
Ulcers

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how is primary gingivostomatitis treated?

aciclovir

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is herpes forever?

yes

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what are the features of herpes cold sores?

Reactivation from nerves causes active infection
Various stimuli
Aciclovir therapy or suppression
Not all reactivations are symptomatic
Aciclovir does not prevent latency

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name a complication of HSV?

encephalopathy leading to temporal lobe necrosis

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how is HSV confirmed?

swab lesion then detection of viral DNA by PCR

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which virus causes herpangina?

coxsackie virus

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what are the features of herpangina?

Vesicles/ulcers on soft palate
Similar patient age range to 1ry HSV gingivostomatitis

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how is herpangina diagnosed?

clinically or PCR

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what causes hand, foot and mouth disease?

coxsackie virus

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what is an alternative kind of mouth ulcer?

apthous ulcer

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what are the features of an apthous ulcer?

non-viral and self limiting
recurring and painful
confined to mouth
no systemic disease
begin in childhood, usually go by 30s
each ulcer lasts less than 3 weeks

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what are some recurrent ulcers associated with systemic disease?

Behcets disease
IBS
reiters disease
skin disease

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what are the features of behcets disease?

Recurrent oral ulcers
Genital ulcers
Uveitis.
It can also involve visceral organs such as the gastrointestinal tract, pulmonary, musculoskeletal, cardiovascular and neurological systems
Commonest in Middle East and Asia

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what is the clinical pres of a sore throat?

pain at the back of mouth

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what is the clinical pres of acute pharyngitis?

inflammation of the part of the throat behind the soft palate (oropharynx)

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what is the clinical pres of tonsilitis?

inflammation of the tonsils

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which scores are used to determine if abx should be prescribed in a sore throat?

feverPAIN and Centor clinical prediction

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which disease should be considered if sore throat and lethargy persist in patient aged 15-25?

glandular fever (EBV)

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what are some complications of tonsilitis and pharyngitis?

Otitis media (most common)
Peritonsillar abscess (quinsy)
Parapharyngeal abscess
Lemierre Syndrome (Suppurative thrombophlebitis of jugular

when should there be an imediate referral in sore throat?

Stridor, breathing difficulty, clinical dehydration, systemically unwell

how should a sore throat be managed?

Self Care advice: giving simple advice
Prescribing antibiotics ONLY where appropriate
Identify and manage immunosuppressed people
Identifying those who need admission/referral
-Throat cancer is suspected (persistent sore throat,
especially if there is a neck mass)
-Sore or painful throat lasts for 3 to 4 weeks. There is
pain on swallowing or dysphagia for more than 3
weeks
-Red, or red and white patches, or ulceration or
swelling of the oral/pharyngeal mucosa persists for
more than 3 weeks
-Stridor / respiratory difficulty is an emergency

which pathogen commonly causes a bacterial sore throat?

strep pyogenes (group A strep)

how is strep pyogenes treated?

penicillin

what type of bacteria is strep pyogenes?

gram positive cocci chains beta-haemolysis (complete)

what are some late complications of strep pyogenes?

Rheumatic fever -3 weeks post sore throat -fever, arthritis and pancarditis Glomerulonephritis -1-3 weeks post sore throat -haematuria, albuminuria and oedema

which drugs can cause neutropenia?

carbimazole

who is at risk of neutropenia?

people with chemotherapy, known/suspected leukaemia, asplenia, aplastic anaemia or HIV with low CD4, or on an immunosuppressant

how is neutropenia confirmed?

urgent FBC and withhold drug until results are available seek imediate specialist advice

if feverPAIN score is 4/5 which drug should be considered?

phenoxymethylpenicillin

what happens to the throat in a diptheria infection?

the pseudomembrane in the posterior pharynx can become very large and may obstruct airway

how is diphtheria diagnosed?

a sample of the resp tract secretions

how is diphtheria treated?

antitoxin and supportive penicillin/erythromycin

what are the symptoms of infectious mononucleosis (glandular fever)

Disease of young adults Fever Enlarged lymph nodes Sore throat, pharyngitis, tonsillitis Malaise, lethargy Jaundice/hepatitis Rash Haematology Leucocytosis (lymphocytosis) Presence of atypical lymphocytes in blood film Splenomegaly Palatal petechiae

what are the complications of infectious mononucleosis?

Protracted but self limiting illness Anaemia, thrombocytopenia Splenic rupture Upper airway obstruction Increased risk of lymphoma, especially in immunosuppressed.

what is the clincical pres of candida albicans (thrush)

white patches on red, raw mucous membranes in throat/ mouth

what can cause candida albicans?

endogenous (post antibiotics, immunosuppressed, smokers, inhaled steroids)

what is the treatment for candida albicans?

nystatin or fluconazole

what is acute otitis media?

An upper respiratory infection involving the middle ear by extension of infection up the Eustachian tube Predominantly disease of infants and children Presents with earache

what is an infection of the middle ear

usually viral with a secondary bacterial infection

which bacteria usually causes a middle ear infection?

Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes.

how is a middle ear infection diagnosed?

– swab of pus if eardrum perforates

how is a middle ear infection treated?

80% resolve in 4 days with no abx first line- amox second line- arythromycin

what is otitis externa?

inflammation of the outer ear canal

what are the clinical features of otitis externa?

Redness and swelling of the skin of the ear canal It may be itchy (especially in the early stages) Can become sore and painful There may be a discharge, or increased amounts of ear wax If the canal becomes blocked by swelling or secretions, hearing can be affected

what are the bacterial causes of otitis externa?

Staphylococcus aureus Proteus spp Pseudomonas aeruginosa

what are the fungal causes of otitis externa?

Aspergillus niger Candida albicans

how is otitis externa managed?

Topical aural toilet Swab to microbiology and prescription of antimicrobial reserved for unresponsive or severe cases Treat depending on culture results -Topical clotrimazole (trade name canesten) -Gentamicin 0.3% drops

what is the first line abx in acute sinusitis?

phenoxymethypenicillin second line- doxycycline

what usually causes acute sinusitis?

Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes