Miscellaneous

Question 1

Psittacosis

Answer 1

Zoonotic disease transmitted through inhalation of infectious material (Bird faeces, cage litte) with exposure to chlamydophila psittaci causing atypical pneumonia.
- Symptomatic 5-14 days after tranmission
- Fever, headache, myalgia, non-productive cough, diarrhoea
- Diagnosis with Throat PCR

Question 2

Hypersensitivity Pneumonitis

Answer 2

Complex syndrome caused by immunological reaction to inhaled agent
- Chills, fever, malaise, cough, shortness of breath mimicking infective process.
- Affected industries - Farming, Poultry, Water-contamination, grain processing, plastics, textiles

Question 3

Q-Fever

Answer 3

Zoonotic infection with Coxiella Burnetti.
- Most common abattoir-associated infection in Australia.
- Symptoms of either cholestatic hepatitis or atypical pneumonia. Can have rare complications of bone or joint infection, endocarditis
- Diagnosis by Serology or PCR
- Usually resolves within 2-6 weeks.
- Rx - Doxycycline 100mg PO BD x 14 days.

Question 4

Ross River Virus

Answer 4

Zoonotic transmission through mosquito bite
- Location - Found in NT, FNQ, PNG, Indonesia, Western pacific islands
- Animal reservoir in marsupials for mosquito to get infected prior to transmission to human.
- Incubation 3 days to 3 weeks but commonly 7-14 days.
- Symptoms - Arthralgia, myalgia, fever, fatigue, raised red rash
- Recover - within 2-6 weeks of onset of symptoms. Rash and fever can disappear within first 2 weeks but arthralgia and myalgia can last for longer.
- Unlikely to have second infection
- Children experience milder symptoms than adults.

Question 5

Brucellosis

Answer 5

• Zoonotic transmission of Brucella bacteria from Sheep, pigs, camels
• Brucella Suis in pigs most common source. Transmitted via cuts or open wounds or contact with body fluids of infected pigs.
• Incubation - 5 - 60 days normally, but can occur 6 months after exposure.
• ## Symptoms - Fever, sweating loss of appetite, lethargy, headaches, back pain. Spontaneous abortion

Question 6

Allergic Rhinitis

Answer 6

Mild
- Oral or intranasal antihistamine.
- Oral - Loratadine 10mg PO OD / Cetirizine 10mg PO OD
- IN - Azelastine (Azep)1mg/mL nasal spray 1 both nostrils BD / Levocabastine (Zyrtec) 0.5mg/ml nasal spray 2 both nostrils up to QID.
Moderate or severe
- Oral or intranasal antihistamine + Intranasal corticosteroid.
- IN Corticosteroid - Beclometasone 100microg BN BD for 4 weeks then reduce to OD
Marked rhinorrhoea? - Add intranasal ipratropium Bromide (Atrovent) 44microg ii BN TDS PRN
Persistent ocular symptoms? Antihistamine eye drop.
Coexisting asthma?consider Monteleukast (Singulair) (10mg adults, 4mg Children 2-5yo, 5mg Children >= 6yo)
Consider referral to allergy specialist for consideration of allergen immunotherapy.
Trial treatment with follow up in 4 weeks and review compliance if nil improvement in symptoms.
No use of intranasal decongestants recommended. Not to be used more than 3-5 days. Can cause Rhinitis medicamentosa which can take several weeks to reverse.

Bacterial Infection suspected?
- Amoxicillin 500mg PO TDS x 5 days
- Penicillin?
- Non-severe Cefuroxime 500mg PO BD x 5 days
- Severe? Doxycycline 100mg PO BD x 5 days.

Note: Serious conditions that mimic rhinitis include nasal tumours and CSF leakage.

Question 7

Sarcoidosis

Answer 7

Multisystem granulomatous disoder of unknown aetiology. Presence of noncaseating granulomas in affected organs.
- Affect young adults with one or more of the following abnormalities
- Bilateral hilar adenopathy
- Pulmonary reticular opacities
- Skin, joint or eye lesions.

Pulmonary symptoms
- Cough, dyspnoea, chest pain, fatigue, malaise, fever, weight loss

Diagnosis
- No definitive test. Diagnoses requires the following three elements
- Compatible clinical and radiographic manifestations.
- Exclusion of other diseases that may present similarly
- Histopathologic detection of noncaseating granulomas.

Question 8

ACEi-associated cough

Answer 8

15% of patients commenced on ACEi will experience cough
- Unsure physiological cause. Hypothesized to be associated with bradykinin accumulation leading to stimulation of afferent C-fibers in the airway

• Onset - Usually within 1 week of instituting therapy but can be delayed to 6 months
• Tickling, scratchy sensation in throat.
• Resolves withon 1-4 days of discontinuing therapy, but can take up to 4 weeks.

Treatment
- Discontinue ACEi. Likely switch to ARB instead.

Question 9

Risk conditions for pneumococcal disease

Answer 9

Will need 13vPCV on diagnosis -> 23vPPV 12 months -> 23vPPV 5 years after 1st dose of 23vPPV

• Previous invasive pneumococcal disease
• CSF leak
• Chronic Respiratory Disease
• Chronic Liver disease
• Cardiac Disease
• Extremely premature birth
• Trisomy 21
• Diabetes
• Smoking
• Harmful use of alcohol