Microbiology

Question 1

Legionella pneumophillia??

Answer 1

“Water tanks”
Air-conditioning systems
Foreign holidays

Question 2

Features strongly suggesting Legionella pneumophillia??

Answer 2

Legionella:
-recent foreign travel
-flu-like symptoms
-hyponatraemia
-pleural effusion

Question 3

Legionella pneumophillia VS Mycoplasma pneumoniae??

Answer 3

LP: Lymphopenia| HypoNa | Diagnostic: Urinary antigen

MP: Hemolytic anemia | Erythema multiforme | Encephalitis|Peri/Myocarditis | Diagnostic: Serology

Question 4

Fit Pt with toxoplasmosis, treatment??

Answer 4

Immunocompetent patients with toxoplasmosis don’t usually require treatment

Question 5

Immunocompromised pt having toxoplasmosis??

Answer 5

Can develop cerebral abscess or chorioretinitis..
Treat with pyrimethamine plus sulphadiazine for at least 6 weeks

Question 6

35-year-old male presents with a facial droop. On neurological examination, a lower motor neuron facial nerve lesion is localised. He describes a rash over his forearm 3 weeks ago which settled. What is the most like diagnosis?

Answer 6

LYME DISEASE

Question 7

Investigations to be carried out for Lyme disease?

Answer 7

-Diagnosed clinically if erythema migrans is present; an indication to start antibiotics..
-ELISA antibodies to Borrelia burgdorferi are the first-line test
-If negative ELISA and Lyme disease is still suspected in people tested within 4 weeks from symptom onset, repeat the ELISA 4-6 weeks after the first ELISA test. If still suspected in people who have had symptoms for 12 weeks or more then an IMMUNO BLOT test should be done
-If positive or equivocal ELISA, then an immunoblot test for Lyme disease should be done..

Question 8

How do you manage asymptomatic Lyme disease/tick bites?

Answer 8

If tick is still present then the best way to remove it is with fine tipped tweezers, as close to the skin as possible and pulling upwards firmly.. Wash the area.. No antibiotics

Question 9

How to manage a confirmed/suspected Lyme disease??

Answer 9

-Doxycycline (early disease) {If pregnant or any other CI, then Amoxil}
-Ceftriaxone if disseminated disease
{Erythema migrans is an enough indication to start AB}
-Jarisch-Herxheimer reaction is sometimes seen after initiating therapy: fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)

Question 10

Cholera management?

Answer 10

-Oral rehydration
-AB: Doxycycline, Ciprofloxacin

Question 11

Cholera features?

Answer 11

-Profuse ‘rice water’ diarrhoea
-Dehydration
-Hypoglycaemia