Microbiology Flashcards
Name 3 examples of an URTI?
pharyngitis, sinusitis, and tonsillitis.
Which pulmonary structure is affected in pneumonia?
lung alveoli
Which scoring criteria is used to risk stratify pneumonia?
CURB-65
Examples of LRTI (5)
- Pneumonia
- Bronchitis
- Empyema
- Abscess
- Bronchiectasis
Which is the most common cause of CAP?
Streptococcus pneumoniae
Which gram positive ‘grape-like clusters” bacteria is a common cause of CAP?
o Staphylococcus aureus
List the common causative organisms for CAP (5)?
o Streptococcus pneumoniae (most common) – Gram-positive cocci, chains.
o Haemophilus influenzae
o Moraxella catarrhalis (Gram-negative cocci)
o Staphylococcus aureus (Gram +ve grape-like clusters)
o Klebsiella pneumoniae
Which is the number one most common causative organism for HAP?
o Enterobacteriaceae (most common) – E. coli and Klebsiella – 31%
Name the 2 most common Enterobacteriaceae?
E coli
Klebsiella
Name the common causative organisms of HAP?
o Enterobacteriaceae (most common) – E. coli and Klebsiella – 31%
o S. aureus – 19%
o Pseudomonas spp – 17%
o Acinetobacter baumanii – 4%
o Haemophilus – 5%
o Fungi (Candida spp) – 7%
Which are the most common organisms for pneumonia in neonates (0-1 month)?
E. coli
Group B streptococcus
Listeria monocytogenes
Which pathogen is the K1 antigen associated with?
E coli
Which organism is associated with the following description?
‘Beta-haemolysis on agar, Lancefield Group B, catalase-negative”
Group B streptococcus
Strep Agalactiae
Sputum colour for Streptococcus pneumoniae
Rusty coloured
Type of pneumonia associated with Streptococcus pneumoniae
Lobar
Microscopy findings for Streptococcus pneumoniae
+ve diplococci
Optochin sensitive, Alpha haemolysis on agar
* Draughtsmen colonies
* Urinary antigen positive.
Draughtsmen colonies are associated with which pathogen in pneumonia?
Streptococcus pneumoniae
Which pathogen is the most common cause of bronchpneumonia?
Haemophilus influenzae
Glossy colonies are associated with which organism in pnuemonia?
Haemophilus influenzae
Which type of bacteria is Moraxella catarrhalis?
Gram-negative diplococci
+ve cocci “grape-bunch clusters”
Pneumonia?
Staphylococcus aureus
Which organism is associated with a post-influenza pneumonia?
Staphylococcus aureus
Which pneumonia is associated with alcoholics?
Klebsiella pneumoniae
Define typical pneumonia?
Typical – Classic signs and symptoms, classic CXR changes (Consolidation) and penicillin-responsive.
Define atypical pneumonia?
- Atypical: No/atypical signs and symptoms, not in keeping with CXR and does not respond to penicillin antibiotics (absent cell wall).
- Exhibit extra-pulmonary features e.g., hepatitis, hyponatraemia, arthralgia – managed with macrolides.
Which class of antibiotics are used to manage atypical pneumonia?
Macrolides
Name 4 common atypical pneumonia organisms?
- Legionella
- Mycoplasma pneumoniae
- Coxiella Burnetti (Q fever) from exposure to farm animals.
- Chlamydia Psitacci from exposure to birds
Which pneumonia type is associated with desaturation upon walking around the room?
Pneumocystis Jirovecci (PCP)
Which CXR appearance is associated with Pneumocystis Jirovecci (PCP)?
Bat’s wing appearance on CXR
(Ground-glass shadowing)
What is the management of Pneumocystis Jirovecci (PCP)?
Co-trimoxazole
What is the presentation associated with Pneumocystis Jirovecci (PCP)?
Presentation:
* Dry cough
* Weight loss, malaise
* dyspnoea
- Desaturation upon exertion
Which stain is associated with Pneumocystis Jirovecci (PCP)?
Silver stain
Which type of organisms are more prone to infection following a splenectomy?
encapsulated organisms including Influenzas and S. pneumoniae.
Which organisms are associated with cystic fibrosis patients?
Pseudomonas aeruginosa (worse prognosis) – ceftazidine.
- Burkholderia cepacia.
Halo sign on CT is associated with what respiratory tract infection.
Aspergillus Fumigatus
What is the management for Invasive aspergillosis?
Amphotericin B
What is the diagnostic test for Legionella pneumophilia ?
Urinary antigen testing
What electrolyte abnormality is associated with Legionella pneumophilia ?
Hyponatraemia
What culture is used for Legionella pneumophilia ?
Charcoal Yeast
Which rash is associated with Mycoplasma pneumoniae ?
Erythema multiforme
Which ABx is used to manage Mycoplasma pneumoniae ?
Tetracycline or macrolide
Which investigation is used to diagnose Mycoplasma pneumoniae ?
cold agglutinin test
Which atypical pneumonia is associated with birds?
Chlamydia psittaci
What are the parameters of the CURB-65 score?
CURB-65 Score:
* Confusion
* Urea >7 mmol/L
* RR >30 breaths per minute
* BP <90 systolic or <60 diastolic
* Age 65+
Urea range for CURB-65?
> 7 mmol/L
RR range for CURB-65?
> 30 breaths per minute
BP (systolic and diastolic ranges) for CURB-65?
BP <90 systolic or <60 diastolic
CURB-65 cut off for admission
2
Management for CURB-65 score of 0-1?
Outpatient Abx
Amoxicillin PO 5 days
Management for CURB-65 score of 2? (which 2 ABx)
Amoxicillin PO + Clarithromycin PO
Note: Consider admission
Which ABx are prescribed for CURB-65 score of 3-5?
Co-amoxiclav IV + Clarithromycin IV
Admission and consider ITU
What is the first line ABx treatment for HAP?
Ciprofloxacin + vancomycin
What ABx are indicated for the management of aspiration pneumonia?
Tazocin + metronidazole
Classic presentation of empyema?
Spiking fevers despite ABx management (Due to wall encapsulation and inactivation of ABx due to acidotic pus).
What are the CHESS organisms?
Campylobacter jejuni, Enterohaemorrhagic E. coli, Entamoeba, non-typhoidal salmonella, shigella.
What are the three types of diarrhoea?
Secretory - toxin production - Cl- secretion into the lumen
Inflammatory
Enteric fever
Which proteins are associated with clostridium botulinium?
SNARE proteins
What do SNARE proteins do in Botulinum?
Prevent ACh release
What is the characteristic presentation of C. Botulinum?
Descending paralysis
Which type of clostridium is associated with gas-gangrene?
Perfringens
Which 3 ABx are associated with precipitating C. difficile?
Cephalosporins, Ciprofloxacin (fluoroquinolones), Clindamycin
Which type of colitis is associated with C Difficile?
Pseudomembranous colitis
Which IL is released in response to staph aureus enterotoxins?
IL-1/2
Traveller’s diarrhoea affects which part of the GI tract?
Jejunum and Ileum
Which pathogen is associated with EHEC?
0157:H7 STEC
Which toxin is produced by O157:H7 E coli?
Shiga-like toxin
What are the manifestations associated with EHEC?
Microangiopathic anaemia
Thrombocytopenia
Acute renal failure
HUS
Dysentery
Which type of E.coli is associated with paedaitrics?
EPEC - Infantile (Paeds)
Rose spots are associated with what type of bacteria?
Salmonella Typhi (+paratyphi)
What is the clinical presentation of Salmonella Typhi?
Enteric fever: constipation, fever, rose spots, splenomegaly.
Where does Salmonella Typhi replicate?
Peyer’s Patches
What is the management for C. Botulinum?
Antitoxin
Which is the first line ABx for c. difficle?
vancomycin
Which ABx is prescribed for the management of Salmonella Typhi?
IV ceftriaxone then PO azithromycin
What are the three types of Shigella?
Flexneri (MSM)
Sonnei
Dysenteriae
Rice water stools are associated with what type of diarrhoea?
Vibrio Cholera
Which enterotoxins are associated with Vibrio Cholera?
Enterotoxin A and B
Which type of diarrhoea is associated with Shigella?
Bloody
Which type of diarrhoea is associated with Campylobacter Jejuni?
Bloody
What associated conditions are associated with Campylobacter Jejuni?
GBS
Reactive arthritis
Which ABX is prescribed for Campylobacter Jejuni?
Erythromycin or cipro for the first 5 days.
What are the common sources of Listeria Monocytogenes ?
Refrigerated food, unpasteurised dairy (monocyto-cheese!) – cold enhancement.
What is the common source for Yersinia Entero-colitica?
Undercooked pork
What are the symptoms of Yersinia Entero-colitica?
Fever, abdominal pain, diarrhoea (terminal ileitis)
What are the complications associated with Yersinia Entero-colitica?
Erythema nodosum and reactive arthritis
Flask-shaped ulcers on histology is associated with what protozoan infection?
Entamoeba Histolytica
On histology, what is the characteristic finding associated with Entamoeba Histolytica infection?
Flash-shaped ulcers
How many trophozoite nuclei is associated with Entamoeba Histolytica?
4
What is the presentation of Entamoeba Histolytica?
Dysentery
Flatulens
Tenesmus
Which ABx is indicated for the management of Entamoeba Histolytica?
Metronidazole
What is the hepatic complication associated with Entamoeba Histolytica?
Liver abscess
Pear-shaped trophozoites are associated with what protozoan infection?
Giardia Lamblia
Giardia Lamblia is associated with what characteristic finding ?
Pear-shaped trophozoites with 2 nuclei
What is the ABx of choice for Giardia Lamblia?
Metronidazole
What is the presentation of Giardia Lamblia?
Causes malabsorption of fat - foul-smelling non-bloody diarrhoea
Which stain is used to detect Cryptosporidium Parvum?
Kinyoun Acid Fast stain
What is present in the stool for a Cryptosporidium Parvum infection?
Oocytes
Which ABx of choice is used to manage Cryptosporidium Parvum?
Paromycin
Name 3 causes of viral diarrhoea?
Norovirus
Adenovirus
Rotavirus
What are the causes of complicated UTI?
- Complicated – Functionally/structurally abnormal tract, men, catheters, pregnant.
UTI of the bladder is termed what?
Cystitis
Why are women predisposed to developing UTIs?
Shorter urethra
Which is the most common causative organism for UTIs?
E coli
Which is the second most common cause of UTI?
Klebisella
Name a nitrite negative staphylococcus that is a a common cause of UTI in young women?
Staphylococcus saprophyticus
Which bacteria is urease-positive and is associated with struvite stones?
Proteus
What type of renal stones are produced as a result of urease activity?
Struvite stones
Which causative organisms is implicated in indwelling catheter-associated UTI?
Candida
Which 4 factors promote a UTI?
- pH< 5
- High urea levels
- Hyperosmolality
- Urinary proteins – Tamm–Horsfall glycoproteins, nitrites, and urea
Presentation of UTI?
- Dysuria
- Frequency
- Hesitancy, urgency
- Suprapubic pain or discomfort
- Bladder spasms
- Haematuria
- Foul-smelling cloudy urine
What are the features of a UTI in older/frail patients?
Mental status changes – unexplained lethargy, disorganised speech or altered perception, delirium + falls.
Features of UTI in <2 years old?
Fever, vomiting, not eating.
Features of Pyelonephritis
Systemically unwell, fever, rigours + loin pain
What 2 positive findings on a urine dipstick is consistent with a diagnosis of uti?
Nitrite
Leukocyte
Which urinanalysis parameter is specific for UTI?
Nitrites
What urine MC&S culture finding is diagnostic of UTI?
> 104 colony forming units
For complicated UTI, what is the duration of ABx?
7 days
What are the ABx of choice for a lower UTI?
nitrofurantoin / trimethoprim / cephalexin
What is the Mx for · Pyelonephritis?
Admit, IV co-amox + gent
Which organisms are associated with SSIs?
S. aureus (MRSA + MSSA), E. coli, Pseudomonas
Clue cells are associated with which STI?
Bacterial vaginosis
Chancre is associated with which STI?
Syphillis
Gumma is associated with what?
Tertiary Syphillis (ulcerative deep subcutaneous nodule)
What is the pathogenic sign associated with TV?
Strawberry cervix
Klebsiella granulomatis is associated with what?
Donovan bodies
What type of bacteria of gonorrhoea?
Obligate intracellular gram-negative diplococcus
Which protein facilitates adhesion of gonococci to epithelial cells?
CR3
What are the uncomplicated manifestations of gonorrhoea in men?
Gonococcal urethritis
Post-gonococcal urethritis
Rectal proctitis - mainly in MSM
What is the uncomplicated manifestation of Gonococcal disease in women?
Mucopurulent cervicitis
What are the complicated manifestations of Gonococcal disease in men?
Epididymytiis
Prostatitis
What is the complicated manifestation of Gonococcal disease in women?
Pelvic inflammatory disease
What is Ophthalmia neonatorum?
Ophthalmia neonatorum (neonatal conjunctivitis) develops if left untreated when transmission to the child in the birth canal.
What is the complication of disseminated gonococcal infection?
Septic arthritis
Endocarditis
Sepsis
How is gonococcal disease confirmed?
1st line -Smears for NAAT
Which 1st ABx is indicated for the management of gonococcal disease?
Ciprofloxacin 500 mg oral – single dose (STAT)
If antimicrobial susceptibility is not known, what is the ABx of choice for gonococcal diseases?
Ceftriaxone 1 g IM
When should a test of cure be arranged for gonococcal disease following ABx management?
7 days
What type of pathogen is Chlamydia trachomatis ?
Obligate intracellular gram-negative pathogen
What is ascending chlamydia?
Pelvic inflammatory disease.
Which chlamydia serovars result in trachoma?
Serovars A-C
What are the clinical features of trachoma?
rachoma is a serious ocular illness that is endemic in Africa and Asia – Characterised by chronic conjunctivitis and can cause blindness.
What are the consequences of chlamydia serovars D-K?
Genital chlamydia, ophthalmalgia neonatorum
Lymphogranuloma venereum is caused by which pathogen?
Chlamydia trachomatis
Which chlamydia serovars are associated with Lymphogranuloma venereum ?
L1-L3
What is the first line of investigation for chlamydia?
Vulvovaginal/endocervical/Genital swab
Which cell type is observed on direct microscopy for chlamydia?
Neutrophils
What is the first line drug for the management of Chlamydia (dose and duration)?
Doxycycline 100 mg BD for 7 days
Which drug is indicated for the management of chlamydia for pregnancy and breastfeeding women (dose included)
Azithromycin 1 g single dose
What are the complications associated with Chlamydia infection?
- Pelvic inflammatory disease – leading to tubal factor infertility, ectopic pregnancy, and chronic pelvic pain.
- Epididymitis
- Reiter’s syndrome
- Adult conjunctivitis, ophthalmalgia neonatorum.
LGV is caused by which organism?
Chlamydia Trachomatis
What is the characteristic primary stage for Lympho-Granuloma Venereum ?
Painless genital ulcers or papules
What is the second stage of Lympho-Granuloma Venereum ?
Unilateral or bilateral tender inguinal/femoral lymphadenopathy (buboes) (2 weeks to 6 weeks).
- Lymphoproliferative reaction – binding occurs via heparin sulphate receptors.
- Anorectal Syndrome: Proctitis, proctocolitis-like symptoms – pain during urination, rectal bleeding, pain during passing stools, abdominal pain, anal pain, tenesmus.
- Rare complications: Hepatitis, Meningocepahlitis, pneumonitis.
What are the clinical manifestations of LGV?
Necrosis and rupture of the lymph nodes.
- Anogenital fibrosis and strictures.
- Anal fistulae – rectal symptoms (pain, tenesmus, bleeding).
- Genital elephantiasis.
Genital elephantiasis is associated with what STI?
Lympho-Granuloma Venereum
What is the management for LGV?
Doxycycline 100 mg BD for 21 days.
What is the causative organism for syphillis?
Treponema pallidum
What is the causative organism of Chandcroid?
Haemophilus ducreyi
Haemophilus ducreyi causes which disease?
Chancroid
Which STI is characterised by a ‘school of fish’ or ‘Railroad track’ apperance?
Chancroid
What is the clinical presentation of Chandcroid?
Painful ulcers (multiple)
erythematous papules at the site of inoculation
What type of agar is implicated for the diagnosis of chancroid?
Chocolate agar culture
Which ABx is used for the maangement of chancroid?
Azithromycin STAT dose 1 gm.
Which bacteria is implicated in pathogenesis of Dnovanosis/Granuloma inguinale?
Klebsiella granulomatis
On a Giemsa-stained smear which histological feature is characteristic of Donovanosis/Granuloma Inguinale?
Donovan bodies
What is the classic appearance of the painless papule or subcutaneous nodule in Donovanosis/Granuloma Inguinale?
Beefy red appearance
What are Donovan bodies are associated with Donovanosis?
Large mononuclear (pund) cells - gram-negative intracytoplasmic cysts
What is the management for Donovanosis?
Azithromycin 1 g followed by 500 mg daily
What causes Brucellosis?
Brucella species (Mediterranean fever)
How is brucellosis transmitted?
Unpasteurised milk, and dairy products, undercooked meat, skin penetration of those in contact with livestock (Animal to human transmission e.g., sheep, pigs, cattle and dogs).
How is Brucella transported throughout he body?
Brucella organisms are phagocytosed by circulating macrophages and PMNs – transported into the lymphatic system and replicated locally.
Spinal tenderness and cyclical fever following the consumption of unpastuerised milk is associated with which disease?
Brucellosis
What is the presentation of Brucellosis?
Presentation:
* Headache
* Cyclical fever (peaks in the evening)
* Migratory arthralgia
* Myalgia
* Asthenia
* Anorexia, fatigue, malaise, weakness
* Spinal tenderness – sacroiliitis, spondylodiscitis
* Septic arthritis
* Miscarriage
* Epidiymo-orchitis
FBC findings of Brucellosis
Neutropenia + Anaemia
What serologic testing is used for Brucellosis?
Standard agglutination testing, ELISA, and Rose Bengal testing.
What medium is used to grow Brucellosis?
Castaneda medium.
On radiography, what characteristic sign is observed in Brucellosis associated lumbar vertbrae?
Pedro pons signs
Which antibody is associated with brucellosis?
- Anti-O polysaccharide antibody
What ABx is indicated for the management of Brucellosis?
Doxycycline + streptomycin/rifampin/gentamicin for 4-6 weeks.
What are the complications associated with Brucellosis?
Endocarditis, meningoencephalitis, osteomyelitis.
How is Rabies transmitted?
Transmission – Through saliva via a bite by an infected mammal (e.g., bats, dogs).
What is the first stage of Rabies?
First few days – tingling sensation at the bite site.
What is stage 2 of rabies?
Stage 2:
Non-specific viral prodrome (flu-like illness): Fever, malaise, headache, sore throat – progress to anxiety, agitation, and frank delirium.
What is stage 3 of rabies?
- Encephalitic form (85%): Hydrophobia or aerophobia – spasms develop as a result of stimuli; autonomic dysfunction, increased deep tendon reflexes, nuchal rigidity and positive Babinski sign.
- Progresses to hyperactivity stage.
- Paralytic form (less common) – Weakness, altered mentation, ongoing fevers, and bladder dysfunction.
What is stage 4 of Rabies?
Stage 4:
Coma stage (within 10 days of stage 3) – hydrophobia, prolonged apnoea periods and flaccid paralysis.
* Cardiopulmonary failure.
What is the first line investigation for suspected Rabies?
IgM antibodies
On autopsy what characteristic feature is seen in patients with Rabies?
Negri bodies
(dense, ovoid, intracytoplasmic inclusions – observed within neurones of the CNS).
What post-exposure prophylaxis is available for Rabies?
Rabies IgG post-exposure (before symptoms) + full rabies vaccination course.
What is the causative organism of the plague?
Yersinia pestis
What is the primary vector for the plague?
Rattus rattus, and rattus novegicus
Which is the efficient vector for the plgue?
Xenopsylla cheopis
What are the two types of plague?
Bubonic
Pneumonic
What is the first line ABx for the plague?
Aminoglycosides
Which ABx is prescribed for plague meningitis?
Chloramphenicol
What type of bacteria causes leptospirosis?
Gram-negative spirochete bacterium Leptospira
How is leptospirosis transmitted?
Transmitted through exposure to the urine of infected animals (e.g., cattle, pigs, and horses).
contaminated soil and water – organism shed in the infected animal’s urine; swimming.
What is the Anicteris syndrome of Leptospirosis?
Anicteric syndrome – Self-limiting and non-specific flu-like illness – headache, cough, non-pruritic rash, fever, rigours, myalgia, anorexia, and diarrhoea
- Aseptic meningitis (immune stage, recurrence).
- Associated with uveitis.
- Conjunctival hyperaemia (Conjunctival erythema without purulent discharge).
Which zoonotic infection is associated with conjunctival hyperaemia and aseptic meningitis?
Leptospirosis
What causes Weils disease?
Leptospira
What zoonotic infection is characterised by the following presentation (hint: Rat urine)?
- Severe infection – fever, renal failure, jaundice (scleral icterus, and conjugated hyperbilirubinemia), haemorrhage, and respiratory distress’?
Weils disease
What is the Ix of choice for leptospirosis?
- Positive PCR of blood or urine
- Nuclei acid detection
- Positive serologic testing
- IgM and IgG antibodies against Leptospira organisms.
What antibiotic therapy is indicated for leptospirosis?
Amoxicillin, doxycycline, ampicillin or erythromycin.
What is the complication associated with leptospirosis during pregnancy?
Can cross the placenta Miscarriage in the first two trimesters (<24 weeks) or stillbirth/IUD.
What is the causative organism implicated in Anthrax?
gram-positive spore-forming rod (Bacillus anthracis);
How is Anthrax transmitted?
Under-cooked meat contaminated with spores - exposure to livestock
What are the three types of anthrax?
Inhalation
GI
Cutaneous
What dermatological presentation is characterised by Anthrax?
Non painful eschar
A non-painful Eschar is associated with which zoonotic infection?
Anthrax
What CXR findings are found on imaging for Anthrax?
Widened mediastinum, and hilar adenopathy
What is the ABx of choice for anthrax?
- Doxycycline or ciprofloxacin
What is the causative organism for Lyme disease?
Borrelia burgdorferi
What type of bacteria is Borrelia burgdorferi?
Spirochete
How is Lyme disease transmitted?
By tick-bite of the Ixodes genus
What is the first presenting sign of Lyme disease?
Erythema migrans rash - appears as a targetoid appearance
What are the neurological manifestations of Lyme disease?
Facial nerve palsy
Lymphocytic meningitis
Radiculopathy
What are the cardiovascular manifestations of Lyme disease?
Myopericarditis + heart block
What is the appearance of the rash in stage 1 of Lyme disese?
Bullseye rash
What is stage 2 of Lyme disease?
Stage 2 (3-12 weeks): General malaise, fever, neurological features (dizziness, headache), muscle pain and cardiac symptoms (chest pain, palpitations, and dyspnoea).
- Cranial neuropathy – diplopia, eye pain.
- Arthritis
- Bell Palsy (5%)
FACE pneumonic for Lyme disease presentation
FACE: facial nerve palsy, arthritis, carditis, erythema migrans.
What is the diagnostic investigation for confirming Lyme Disease?
Serum antibodies for B burgdorferi
What is the antibiotic of choice regarding the management of lyme disease?
Doxycycline for 10 days
What additional investigation is implicated to monitor complications of Lyme Disease?
ECG for heart block
What causes Q fever?
Coxiella Burnetti
How is Coxiella Burnetti transmitted (vectors)?
Cattle/sheep
What is the fatal presentation of Q fever?
- Fatal interstitial pneumonia – dry cough, fever, no rash
- Myopericarditis.
What are the chronic presenting features of Q fever?
- Q fever fatigue syndrome
- Bone marrow necrosis
- Vascular prosthesis infection
ABx for Q fever?
- Doxycycline 100 mg BD for 14 days.
How is Leischmania transmitted?
Protozoan disease transmitted by infected sandflies
What is the commonest subtype for Leishmania?
Cutaneous disease
What is the presentation of cutaneous Leishmania?
- Asymptomatic papules, multiple papules, or nodules at the site of inoculation – enlarge and transform into well-circumscribed ulcers with a raised violaceous border.
- Heal within 2-5 years with a secondary depressed depigmented scar (‘poor healing ulcer’ + past travel).
Which type of Leishmania is characterised by non-ulcerative painless nodules?
Diffuse cutaneous
Which type of Leishmania is ulcerative?
Mucosal disease
What type of Leishmania is characterised by splenomegaly, fever and pancytopenia?
Visceral Disease (Kala-Azar)
What are the strains of Leishmania that cause Kala-Azar?
L. donovani, L. infantum, and L. chagasi.
What type of disease arises due to Leishmania Donovani ?
Disfiguring Dermal disease - invasion of the reticuloendothelial system
What is the gold-standard investigation for Leishmania?
Giemsa-stained samples from biopsies or impression smears + splenic aspirate.
What drug is first line for Leishmania?
Amphotericin B.
How is Trypanosoma transmitted (vector)?
Tsetse fly
What is the cause of Trypanosoma?
Flagellate, unicellular protozoan.
Sleeping sickness is also known as what?
Trypanosoma
What is the presentation of Trypanosoma ?
Presentation:
* Fever
* Sleep disturbance.
* Headaches
* Irritability
* Extreme fatigue
* Swollen lymph nodes
Trypanosoma cruzi causes what disease?
Chagas disease
What is the management for Trypanosoma ?
Pentamidine
What is the cause of Cat Scratch Disease?
Bartonella Hensalae
What is the appearance of Bartonella Hensalae ?
Curved, gram-negative rod
How is Bartonella Hensalae transmitted?
Scratches, bites, licks of open wounds, fleas (typically by cats).
What is the presentation of Bartonella Hensalae (Cat Scratch Disease) in immunocompetent individuals?
- Macule at the site of inoculation Pustular
- Regional adenopathy
- Systemic symptoms: Fever, night sweats, weight loss.
Similar to TB
What is the presentation of Cat Scratch Disease in Immunocompromised patients?
Bacillary Angiomatosis
What is the presentation of Bacillary Angiomatosis ?
- Skin papules
- Disseminated multi-organ and vasculature involvement.
- Leads to the bursting of blood vessels in various organs and tissues.
What is the management of Bacillary Angiomatosis ?
Erythromycin, doxycycline – add rifampicin
What is the cause of Rat Bite Fever?
Streptobacillus moniliformis or Spirillum minus.
What is the presentation of rat bite fever?
Presentation (comes on 2-10 days after bite):
* 1st: Fevers, polyarthralgia, maculopapular purpuric rash
* 2nd: Endocarditis (Looks like septic arthritis).
What drug is used to manage rat bite fever?
Penicillin
What are the three types of Helminths?
Nematodes (round worms)
Cestodes (Tapeworks)
Trematodes (Flukes)
Hookworms are what type of Helminth?
Nematodes
Name three types of nematodes:
- Hookworms
- Ascarids
- Strongyloides
Name 2 types of cestodes (tapeworms)
Hydatid
Pork/beef/fish tapeworm
Schistosomiasis is what type of Helminths?
Trematodes (flukes)
What tapeworm is associated with pigs?
Taenia solium
Taenia solium tapeworm is associated with what complication?
neurocysticercosis (brain cysts) – most common cause of adult-onset epilepsy
Tapeworm species for cows?
Taenia saginata
Which drug is used to treat tapeworm?
Praziquantel
What type of Helminth causes autoinfection?
Strongyloides
Which larvae are formed from pinworms in Strongyloides ?
rhabditiform larvae
rhabditiform larvae form which auto infection larvae?
Filariform larvae
What is the main symptom associated with Strongyloides ?
Malabsorption
What is the management for Strongyloides ?
Ivermectin
Asacaris is associated with what two stages?
- Respiratory stage – eggs ingested, larvae hatch in the GI tract, are absorbed and then migrate to the lungs to grow.
- Gastrointestinal stage – Larvae are coughed up and re-swallowed to the gastrointestinal tract to mature.
What is the gastrointestinal stage of Ascaris lumbricoides?
Larvae are coughed up and re-swallowed to the gastrointestinal tract to mature
What is the definitive host for Hydatid cysts?
Dogs
What is the main complication associated with Hydatid cysts?
Mass effect or cyst rupture
What is the management for a hydatid cyst?
require surgery, long-term albendazole, praziquantel.
How is Schistosomiasis transmitted?
Cercariae invade human skin when in contact with contaminated water
Where do Schistosomiasis adult worms migrate?
To the mesenteric venules or the venous plexus in the bladder
What are the complications of Schistosomiasis ?
Damage is caused by the laying of eggs - migration of eggs through the bladder or bowel causes damage and increases the risk of squamous cell carcinoma of the bladder
What hepatic complication is associated with Schistosomiasis ?
- Retrograde passage of eggs into the liver causes cirrhosis (synthetic function is preserved)
How is Schistosomiasis diagnosed?
Microscopy – Urine: S. haematobium; Stool – S mansoni, S japonicum.
What is filarisis?
A nematode infection spread by blackflies and mosquitoes - adult worms release larvae taken up by a vector
What is the main clinical presentation of Filariasis caused by adult worms?
lymphatic filariasis (scrotal swelling, elephantiasis)
What is the main complication caused by microfilariae?
onchocerciasis (depigmentation, river blindness)
On ultrasound what is the diagnostic feature associated with Filariasis?
Dance sign - loa loa migration
What is the commonest yeast?
Candida
What are the two classifications of fungal infections?
Yeast versus mould
What is the cause of tinea?
- Dermatophyte e.g., trichophyton rubrum
What is Tinea corporis?
Ringworm
What is the complication of Tinea pedis?
Athlete’s foot
How is onychomycosis managed?
Terbinafine and nail lacquers
Which organism is responsible for Pityriasis ?
Malassezia globosa/furfur
What is the diagnostic investigation for candida?
Periodic-acid Schiff stain
On microscopy what is the characteristic feature associated with Candida?
Pseudohyphae (germ tube)
What is the management for C. albicans?
Fluconazole
What is the management for invasive candida disease?
amphotericin-B
What are the risk factors for candidiasis?
- Very low birth weight infants
- Immunocompromised patients
- Patients on ITU with lines
- Invasive candidiasis common in patients receiving TPN.
What are the systemic disease complications associated with candida?
- Eyes – Candida endophthalmitis.
- Chronic oral candidiasis - Angular cheilitis.
- Spleen and liver
- Generalised candidiasis – cutaneous – intertrigo.
- Invasion - Upper GI perforation - Leakage of candida into the mediastinum = me
What agar plate is used to grow candidiasis?
Sabouraud agar
What serology marker is specific for candidiasis?
Beta-D glucan
What is the management for candidial infections?
1st line: Antifungals (>2 weeks antifungals from 1st -ve blood samples).
- Echinocandin (do not penetrate the CNS, use Ambisome instead)
-Fluconazole
Aspergillus fungal balls can colonise the cavity secondary to which infection?
TB
What is the microscopy stain for aspergillus?
Methenamine silver
Which antigen is specific for aspergillus?
Galactomannan
Which agar is used to grow Aspergillus?
Czapek dox agar.
What is the first-line antifungal agent of choice for Aspergillus infefctions?
Voriconazole (>6 weeks treatment)
1st line: Ambisome/Amphotericin B.
Which fungal infection has a predilection to the CNS?
Cryptococcus neoformans
How is Cryptococcus neoformans transmitted?
Bird droppings and decaying wood
What stain is used for Cryptococcus neoformans?
Indian Ink staining (halo)
What sign is sign in Indian Ink staining for cryptococcus neoformans?
Halo sign
What are the complications of Cryptococcal Neoformans?
Cryptococcal meningitis
Can cause hydrocephalus - repeat LP
Which test is used to as confirm the definitive diagnosis of Cryptococcal Neoformans?
Cryptococcal antigen in CSF/serum
CD4 count to predispose Cryptococcal Neoformans
CD4 <200
Which drug is indicated for the management for Cryptococcal Neoformans?
flucytosine
What is the cause of Mucormycosis?
Rhizopus
What are the features of Mucormycosis?
- Features: Swelling, black lesions, ulcers, see in diabetes (poorly controlled diabetics)
- Retro-orbital extension proptosis, chemosis, ophthalmoplegias and blindness.
What is the management for Mucormycosis?
Surgical emergency - resection of necrotic tissue
High-dose amphotericin B
What is the diagnostic test for tinea or tricophyton?
- Nail/skin sample – Potassium hydroxide KOH
Which antigen is associated with candida infections?
Beta-d-glucan
Which antigen is associated with aspergillus?
Galactomannan
Which antigen is associated with cryptococcus?
Glucuronoxylomannan
Which enzyme is inhibited by azoles?
Lanosterol 14-a demethylase
What class of drug is amphotericin B and nystatin?
Polyene
Mechanism of action for polyenes?
Binds to ergosterol - creates transmembrane channels
Which antifungal inhibits DNA synthesis?
Flucytosine
Which enzyme is inhibited by flucytosine?
thymidylate synthetase
Which organism is implicated in tyhphoid?
Salmonella typhi and parathyphi
How is typhoid transmitted?
HINT - 4F’s
Flies
Fingers
Fomites
Faeces
What is the incubation period for typhoid?
1-2 weeks
Which toxin determines virulence in thyphoid?
Vi antigen (Polysaccharide capsule), O antigen, and flagellar H antigen
Where do the bacteria in typhoid proliferate in the gut?
Peyer’s patches (causes intestinal necrosis)
What are the 5’s regarding the clinical presentation of Typhoid fever?
Rose spots
Hepatosplenomegaly
Solid stools
sphygomothermic dissociation
What is Faget’s sign in Typhoid disease?
Low heart rate and fever - sphygothermic dissociation
What is the clinical presentation of typhoid?
5S’s: Rose spots, hepatosplenomegaly, solid stools, sphygomothermic dissociation (low HR + fever aka Faget’s sign).
* Arthralgia
* Nausea, and vomiting initially Diffuse abdominal pain, bloating, anorexia and diarrhoea severe.
* Enterocolitis
* Constipation
* Dry cough – due to pneumonia
* Bowel perforation as a complication
What is the complication associated with Typhoid?
Bowel perforation
What is the pattern of fever in typhoid?
Step-ladder pattern
What dermatological manifestation is associated with typhoid?
Rose spots
What two antibiotics are implicated in the management of typhoid?
IV ceftriaxone
followed by PO azithromycin
What is the prophylaxis for typhoid?
Vaccine against S typhi
How is Dengue transmitted?
Females Aedes mosquito
Rose spots are associated with which enteric fever?
Typhoid
‘Breakbone’ fever is associated with which tropical disease?
Dengue
What is dandy fever?
A seven day fever associated with dennue
Which virus causes dengue?
Flavivirus
How many serotypes are associated with Dengue?
4 (DENV1-4)
Dengue infects which cell type?
Dermal macrophages and dendritic cells
What is the first phase of dengue?
Febrile phase
What are the characteristic features associated with the febrile phase of dengue?
- Sudden-high grade fever
- Facial flushing, skin erythema (sunburn rash)
- Myalgia, arthralgia, retro-orbital headache, sore throat, conjunctival injection
A sunburn rash is associated with which type of tropical disease?
Dengue
What is the critical phase of Dengue?
Increased capillary permeability + defervescence (fever drops)
Leukopenia
Thrombocytopenia
Complications - shock and organ dysfunction
What is the major complication associated with Dengue?
Dengue Haemorrhagic Fever/Shock Syndrome
What is the management of Dengue?
Self-limiting
How is malaria transmitted (vector name)?
Female anopheles mosquito
What are the 5 types of malaria?
P vivax
P. Ovale
P. malariae
P. Falciparum
P knowlesi
How is Malaria classified by species?
Falciparum versus non-falciparum
Which is the most severe type of malaria?
P Falciparum (most common)
Which type of fever is associated with ovale, vivax and Knowlesi?
Tertian fever - every 48 hours
Which feature on blood film is seen on non-falciparum malaria?
- Schuffner’s dots on blood film.
What is the management of non-falciparum malaria?
Chloroquine then primaquine (to kill hypnozoites asleep in liver).
What type of fever is associated with falciparum malaria?
Tertian fever - every 48 hours
Which is the investigation of choice for diagnosing falciparum malaria?
Thick and thin giemsa blood smears
Thick smears detect what?
Malaria
Thin smears detect what in malaria diagnosis?
Species and quantifies parastiaemia
What is detected on Giemsa staining on thick and thin smears?
Maurer’s cleft on film
What is the threshold for severe parasitaemia for child malaria?
> 2%
What is the threshold for severe parasitaemia in adults?
> 10%
Name 2 malaria antigen detection tests
- Paracheck-PF (Detects plasmodium HRP-II)
- OptiMAL-IT (Detects parasite LDH).
What is the drug of choice for mild malaria?
Artemesin-combination therapy (Riamet – Artemether + lumefantrine).
What is the drug of choice for severe malaria?
IV Artesunate
What are the side effects associated with quinine?
Cinchorism (tinnitus, dizziness, N&V), arrhythmias, hyperinsulinemia (causes hypoglycaemia)
What is the drug of choice for malaria in children?
oral malarone, QDS 3 days.
What are the features of severe falciparum malaria?
- Impaired consciousness or seizures
- Renal impairment
- Acidosis (pH<7.3)
- Hypoglycaemia (<2.2 mmol/L)
- Pulmonary oedema or ARDS.
- Anaemia (Hb <8g/dL)
- Spontaneous bleeding/DIC
- Shock (BP <90/60 mmHg)
- Haemoglobinuria (Without G6PDD)
- Other indications for IV therapy - >2% parasitaemia OR schizonts.
The hypnozoite stage is associated with which type of malaria?
Vivax
What term denotes an infected hepatocyte?
Schizont
What is the virology of SARS-COV2?
Enveloped single-stranded positive sense virus
Which viral protein binds to ACE2 to the pulmonary cell surface (SARS-COV2)?
Spike protein
The SARS-COV2 spike protein binds to what pulmonary cell surface marker?
angiotensin-converting enzyme 2
Which cytokines are released in a cytokine storm in response to SARS-CoV2?
il-1, il-6, TNF-alpha
What pulmonary complication is associated with Covid?
ARDS
Which corticosteroid is first line to treating SARS-COV2?
Dexamethasone
Which 2 antivirals are indicated in the management of SARS-COV2?
- Remdesivir /Molnupiravir– Nucleoside analogue that inhibits the action of RNA polymerase.
- Paxlovid – Targets protease
What is the molecular target of Paxlovid?
Protease
Which 2 monoclonal antibodies are implicated in the management for SARS-COV2?
- Sotrovimab
- Tocilizumab
What is the target of Tocilizumab ?
IL-6 receptor
Sotrovimab - target?
Binds to the spike protein of SARS-COV2
What is the natural reservoir for influenza A?
Ducks
What are the two types of influenza?
A and B
How does influenza bind to the cell membrane?
haemagglutinin to bind to sialic acid
What term describes an accumulation of point mutations resulting in antigen change?
Antigenic drift
What term describes a recombination of genomic segments of two co-infecting flu strains?
Antigenic shift
What is the target of amantadine?
Targets the M2 ion channel for influenza A
What class of drug is baloxavir (target)?
Polymerase inhibitors
Tamiflu inhibits which enzyme?
Neuraminidase
Name 2 neuraminidase inhibitors?
- Oral oseltamivir (Tamiflu)
- Inhaled Zanamivir (Relenza – used in patients with underlying respiratory disease).
Which beta-lactam antibiotic is indicated for the management for skin infections?
Flucloxacillin
Name a broad-spectrum penicillin?
Amoxicllin
Which beta-lactam is indicated for the management of ESBL?
Carbapenems (e.g.., meropenem)
Which glycopeptide antibiotics are indicated for gram-positive coverage in MRSA or C diff infections?
Vancomycin
Teicoplanin
What class of antibiotic is vancomycin?
Glycopeptide
What is the molecular target for tetracycline?
30S Ribosomal subunit
Gentamicin, amikacin are what class of drug?
Aminoglycoside
Aminoglycosides target which part of the cell?
30s ribosomal subunit
Name 3 macrolide antibiotics
Erythromycin, clarithromycin, azithromycin
What are the adverse effects associated with aminoglycosides?
Ototoxic + nephrotoxic
Which class of antibiotic is indicated for penicillin allergy?
Macrolides
Which class of antibiotic is indicated from for gram-positive atypical pneumonia?
Macrolides
Molecular target for macrolides?
50s ribosomal sub-unit
Molecular target for chloramphenicol?
50s ribosomal sub-unit
What ABx is indicated for the management for bacterial conjunctiivits?
chloramphenicol
What are the adverse effects associated with chloramphenicol?
Aplastic anaemia/grey baby risk
What is the molecular target of oxazolidinones?
23s component of 50s ribosomal subunit
What class of drug is linezolid?
Oxazolidinones
What class of drug is ciprofloxacin?
Fluoroquinolones
What is the target of Fluoroquinolones?
DNA gyrase
Name an anti-protozoal and anaerobic antibiotic?
Metronidazole
Which drug inhibits RNA synthesis and indicated in the management of mycobacteria e.g., TB?
Rifamycin
Adverse effects associated with Rifamycin?
Orange secretions
What is the drug target of colistin?
Polymyxin
What adverse effect is associated with polymyxin?
Nephrotoxic
Daptomycin is what class of drug?
Cyclic lipopeptide
What class of drug is trimethoprim?
Diaminopyrimidines
What drug is recommended for vancomycin-resistant enterococcus?
Daptomycin
What are the narrow spectrum antibiotics?
Flucloxacillin, metronidazole, gentamicin.
What kind of antibiotic is Flucloxacillin?
Narrow-spectrum
Name 5 anti-pseudomonal drugs?
Tazocin, ceftazidime, ciprofloxacin, meropenem, gentamicin.
What is the common mechanism implicated in trimethoprim resistance?
Bypass antibiotic-sensitive step in pathway
Example of enzyme-mediated drug inactivation for AMR?
beta-lactamases
Common mechanism for tetracycline resistance?
Impairment of accumulation of the drug
What is the common skin organism?
S. aureus
What is the common organism implicated in pharyngitis?
β-haemolytic Streptococcus
Which antibiotic is indicated for the management of β-haemolytic Streptococcus?
Phenoxymethylpenicillin
Which antibiotic is indicated for mild CAP?
Amoxicilin
Which antibiotic is indicated for the management of severe CAP?
Co-amoxiclav + clarithromycin
Which antibiotic combination is indicated for HAP?
Co-amox + gent or tazocin
Which antibiotic is indicated for bacterial meningits?
Ceftriaxone
(+ amox if RFs for listeria – young/old)
Antibiotic regiment for community UTI?
Trimethoprim / nitrofurantoin
Antibiotic regiment for nosocomial UTI?
Co-amoxiclav or cephalexin
Which broad-spectrum ABx are recommended fro severe sepsis?
Broad-spectrum antibiotics e.g., Tazocin / ceftriaxone, metronidazole ± Gent
Which ABx are indicated for the management of neutropenic sepsis?
Tazocin or gentamicin
Which antibiotic is indicated for the mdianagement of colitis and clostriidum difficile?
Oral vancomycin
Prion disease is characterised by which particles?
Protein-containing particles
Prion disease is associated with which chromsome?
Chromosome 20
Abnormal folding of prion protein in prion disease results in the formation of what?
Beta-sheet configuration
Which codon is implicated in prion disease?
Codon 129
What is the management for symptomatic prion disease?
Clonazepam for myoclonus (or valproate/levetiracetam).
Which drugs delay prion conversion?
Quinarine, pentosan, tetraycline.
Which EEG changes are observed in sporadic CJD?
Triphasis changes
What are the post-mortem findings associated with sporadic CJD?
- Spongiform vacuolation
- PrP amyloid plaques
What MRI finding is observed in variant CJD?
Posterior thalamus highlighted on MRI-T2 (pulvinar sign)
Pulvinar sign is seen in which type of CJD?
Variant CJD
Florid post-mortem plaques is seen in which type of CJD?
Variant CJD
Which type of CJD is most common?
Sporadic
What is the mean onset of sporadic CJD?
45-75years
When does death arise in sporadic CJD?
Death within 6/12 of symptoms beginning
What are the symptoms associated with sporadic CJD?
Rapid, progressive dementia with myoclonus, cortical blindness, akinetic mutism and lower motor neuron signs
Which type of CJD is associated with bovine spongiform enecephalopathy?
Variant CJD
Which type of CJD is associated with psychiatric symptoms as the initial presentation including anxiety, paranoia, and hallucinations?
Variant CJD
Which type of CJD is associated with cannibalism?
Kuru
Which type of CJD is associated with Dysarthria progressing to cerebellar ataxia?
Inherited
What is the viral serology of acute Hep-A infection?
Anti-HAV IgM
Which viral serology is observed in acute infection of HepB?
HBsAg +
Anti-HBc +
IgM anti-HBc +
HBsAg +
Anti-HBc +
IgM anti-HBc +
HepB status?
Acute infection
HBsAg +
Anti-HBc +
HepB Status?
Chronic infection
Anti-HBc +
Anti-HBs +
HepB Status?
Previous infection
Which two antibodies are implicated in previous infection of HepB?
Anti-HBc
Anti-HBs
Which antibody is implicated in previous vaccination against HepB?
Anti-HBs
Which two serology viral-specific parameters are associated with HepB?
Surface (HBsAG)
Core
Which is the gold-standard HepB viral protein indicative of chronic infection?
Serum HBsAg
Viral hepB vaccine is associated w what marker?
Anti-HBs
Which type of HSV is associated with cold sores?
HSV-1
Which type of HSV is associated with genital ulceration?
HSV-2
Which anti-viral is used for the treatment of HSV?
Aciclovir OR Valaciclovir
What is the diagnostic test for HSV?
swab from lesion for HSV PCR
Which virus is implicated in the chickenpox?
Varicella-Zoster virus
What are the complications associated with Varicella zoster?
· scarring
1. pneumonitis
2. Ramsay Hunt syndrome – facial palsy + vesicles in ear
3. Encephalitis
4. Post-herpetic neuralgia
What are the three neonatal clinical features for chickenpox?
· Purpura fulminans
· Visceral infection
· Pneumonitis
What is the management for adult chickenpox at risk of complications?
Aciclovir or Valaciclovir
What is the management for neonatal chickenpox?
Aciclovir or Valaciclovir
What is the post-exposure prophylaxis for chickenpox?
VZIG
What is the first-line antiviral for CMV?
Ganciclovir (IV)/valganciclovir
What is the immunocompromised features of CMV?
- Encephalitis
- Retinitis
- Pneumonitis
- Colitis
- Marrow suppression
What is the post-transplant test for CMV infection?
Nucleic acid testing from blood sample
What is the causative organisms for Glandular fever?
Epstein-Barr virus
What is the triad of features associated with glandular fever?
· Triad of fever, pharyngitis, posterior cervical lymphadenopathy
What does EBV predispose to?
Burkitt lymphoma
Which post-transplant disease is associated with EBV infection?
Post-transplant lymphoproliferative disease
Which monoclonal antibody is prescribed in post-transplant immunocompromised individuals?
Rituximab
Rituximab targets which CD marker?
CD20
What is the diagnostic investigation for glandular fever?
Monospot for heterophile antibodies
What is the cause of roseola infantum?
HHV-6
What is the most common cause of febrile convulsions?
HHV-6
What is the cause of Karposi’s sarcoma?
HHV-8
HHV-8 can cause what three features in immunocompromised patients?
- Kaposi’s sarcoma (Pathognomonic for HIV)
- Primary effusion lymphoma (associated with EBV coinfection)
- Castleman’s disease (non-cancerous growth in the LNs).
What is the causative virus implicated in Castleman’s disease?
Human herpesvirus 8
JC virus can cause what complication in immunocompromised patients?
Progressive multifocal leukoencephalopathy
What is the causative virus for Progressive multifocal leukoencephalopathy?
JC virus
What causes BK haemorrhagic cystitis in bone marrow transplant?
BK virus
What complication of BK virus is associated following bone marrow transplant?
haemorrhagic cystitis
What is the management of haemorrhagic cystitis ?
Cidofovir
What is the common viral cause of encephalitis in immunocompromised children?
Adenovirus
Which antiviral agent is used in the management of adenovirus?
Cidofovir
How is HepC transmitted?
blood product spread- transfusions, sharing needles
Which hepatitis strain causes cirrhosis and hepatocellular carcinoma?
HepC
Which Hep virus co-infects with Hep B?
Hep D
What is the management of HepD virus?
Peginterferon-⍺
Which Hep strain is associated with severe disease in pregnancy?
HepE
Which drug is used to treat HepE virus?
Ribavirin
Which lesions present on the soft palate are seen in Rubella Virus?
Forchheimer sign
Which congenital cardiac complication is associated with Rubella?
Patent ductus arteriosus
Which virus causes hydrops foetalis?
Parvovirus b19
Cause of fifth disease?
Parvovirus b19
Which Buccal mucosa spots are seen in Measels?
· Koplik’s spots
What are the three complications associated with Mumps virus?
· Epididymo-orchitis (can lead to infertility)
· Pancreatitis
· Meningitis
What virus is responsible for Molluscum contagiousum?
Poxvirus
A flesh-coloured papule with a central umbilication is characteristic of what?
Molluscum contagiosum
What is the first line medication for the management for molluscum contagiosum?
Imiquimod 5% cream, podophyllotoxin
Which HPV strains are associated with anogenital warts?
6 and 11
What is the primary syphillis?
Chancre - primary painless solitary genital ulcer appearing 1-12 weeks following transmission
Which type of bacteria is responsible for syphillis?
Gram-negative spirochete
trepenoma pallidum
What is secondary syphyllis?
Systemic bacteraemia symptoms e.g., maculopapular rash, condylomata lata, lymphadenatophy
What is Tabes dorsalis?
A progressive degenerative disease of the dorsal column
What pupil is associated with syphilis?
Argyll-Robertson Pupil
What microscopy is used for syphillis?
Darkfield microscop y and serology
What non-treponemal test is used to diagnose acute syphilis?
Rapid plasmin reagin (RPR)
Venereal disease research laboratory
What treponemal test is used to diagnose syphillis and remain positive for years?
Enzyme immunoassay - T-pallidum haemoggluatination
What is the first-line management for syphilis?
IM benzathine penicillin
What reaction occurs within 24 hours of antibiotic for syphillis?
Jerish-Hersxheimer
What are the causative organism for chancroid?
Haemophilus Ducreyi
What is the gram-stain pattern is seen in chancroid?
Railroad track appearance
Which STI is associated with painful ulcers?
Chancroid
Negri bodies are associated with what?
Rabies
Which prion disease is associated with cannabiliism?
Kuru
Variant CJD is associated with what?
Bovine spongiform encephalopathy
What is catalase status for streptoccous?
Catalase negative
What type of streptoccous is pyogenes?
Beta-haemolytic group A
What type of streptoccous is associated with Agalactiae?
Beta-haemolytic Group B
Name two types of alpha-haemolytic streptoccous?
Viridans
Pneumoninae
Most common cause of meningitis in neonates?
Group B streptococcus
Gram-negative rods e.g., E.coli, and listeria monocytogenes
Most common cause of meningitis in infants (>3 months <3 years)?
Streptococcus pneumoniae, N meningitis, S. agalactiae
Most common cause of meningitis in age >10 and <19
N meningitis, streptococcus pneumoniae
Most common viral cause of meningitis?
Coxsackie, echovirus
Mumps e..g, HSV-2
What are the most common fungal cause of meningitis?
Cryptocococcus neoformans
What is the managemnt for cyrptococcus neoformans?
Flucytosine
What is the first line management for severe meningitis?
IV ceftriaxone and corticosteroids (do not prescribe corticosteroids if meningococcal septicaemia)
What additional antibiotic is added to ceftriaxone for bacterial meningitis in the eldelry?
Amoxicillin
What is the most common cause of encephalitis?
HSV-2
What is the first line drug to manage encephalitis?
IV acyclovir
What is the first line antiviral for CMV infections?
Ganiciclovir
What heart defect is associated with rubella?
Patent ductus arteriosus
Hydrocephalus, cerebral calcifications, and chorioretinitis is associated with which neonatal infection?
Toxoplasmosis
What is the most common form of neonatal herpes simplex?
SEM
What is the management for positive Rubella infection <18 weeks?
Termination of pregnancy
What drug is given to the mother for PCR positive toxoplasmosis?
Spiramycin
Hutchinson’s teeth is seen in what?
Neonatal herpes
What are the adverse fetal complications associated with Zika firus?
Club foot,
IUGR
Ventricular calcifications
Which type of CJD can be diagnosed by a tonsillar biopsy?
Variant
Which type of prion disease is associated with bovine spongiform encephalopathy?
vCJD
