MRCP Infectious disease Flashcards
Measles hallmarks
Podrome:
koplik spots (buccal white)
fever
conjunctivitis
cough
Followed by:
Rash behind ear or face spreading down
Features of primary syphillis
chancre - painless ulcer at the site of sexual contact -
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)
Features of secondary syphillis
Secondary syphilis mneumonic: TWO
Trunk rash, warts, oral ulcers
systemic symptoms: fevers, lymphadenopathy
symmetrical rash on trunk, palms and soles
buccal ‘snail track’ ulcers (30%)
rash may become condylomata lata (painless, warty lesions on the genitalia )
Features of tertiary syphillis
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis
Argyll-Robertson pupil
TB sputum MCS
Zeihl neelson stain for AFB
Why is primaquine and chloroquine given in plasmodium VIVAX and OVALE
Primaquine
- clears hypnozites
Chloroquine
- treating symptomatic erythrocytic stage of malaria (anaemia and swining fever)
Organism causing IE in IVDU
Staph aureus
IVDU and new TR
endocarditis
TR- PSM + giant CV waves in JVP
Antibiotics that cause c.diff
CLINDAMYCIN
CIPROFLOXACIN
CARBAPENEM
Cephalosporins
CO-AMOX
Chancre
painless ulcer on site of sex
When should ART be started and prophylaxis for PCP
ART as soon as possible
PCP prophylaxis when CD4 <200
Strongyloides hallmark
nematode
rash on buttock
eosinophilia
abdo pain
diarrhoea
urticaria
Mx: ivermectin or albendazole
Actinomyosis hallmarks
fungal infection (anaerobic)
endogenous flora
from tooth extraction
lumpy jaw
sulfur granules
prolonged amoxicillin
Nocardiasis hallmarks
difficult to differentiate from actinomyoces spp
Gram-positive filamentous rod
paraffin bait to culture
- uses as carbon source for growth
painless swelling —> ulceration
Mx: cotrimoxazole
oocytes on ZN Stain
Cryptosporidium HIV related diarrhoea
Dengue fever hallmarks
Flavivirus
Mosquito transmission
generalised maculopapular rash
low plt and wcc
fever
viral infection that can progress to viral haemorrhagic fever
BREAK BONE FEVER
Warning signs of dengue and management
abdominal pain
hepatomegaly
persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)
Mx: supportive
What is loeffler syndrome
Strongyloide larvae migrate to the lungs a pneumonitis
when is co-trimoxazole used
PCP in HIV
Cyclospora cayetanensis
(traveller diarrhoea)
How long would HIV becomes AIDS if left untreated
10 years
What is the tirad of HUS and what is the diagnostic method
E.coli 0157 SHIGA TOXIN
- AKI
- MAHA (coombs+shistocyte fragment RBC)
- Thrombocytopenia
Stool MCS for e.coli
Diagnosis and management of MAC
blood cultures
mx:
Mycobacterium
Azithromycin
Clarithromycin
dendritic corneal ulcer
HSV keratitis
Which RBC receptor does malaria vivax bind to?
Duffy
note: people with lack of this receptor are resistant to vivax infection
note: people with sickle, thalassaemia and G6PD are resistant to malaria
First line treatment for toxoplasmosis
pyrimethamine and sulfadiazine and folic acid
note: pyrimethamine is folate antagonist
What is the mechanism of action of vancomycin
prevents formation synthesis of polymers for bacterial cell wall
What is the mechanism of action of gentamicin
binds irreversibly to ribosome subunit preventing protein synthesis
Mechanism of action of metronidazole
causes oxidative damage to bacterial DNA
M
Mechanism of action of macrolide and clindamycin
inhibitrs ribosomal translocation
What is the adverse reaction of vancomycin
red man syndrome
flushing of face neck torso
What cancers are HPV 16 and 18 associated with
cervical
anal
Which antibiotic should be added on top of ceftriaxone for listeria meningitis?
Amoxicillin/ampicillin
over 60 or immunosuppressed
Which virus causes viral meningitis (school teacher)
enterovirus species
What is the most effective way in reducing risk of HIV in newborn child
post natal zidovudine to the baby
Anopheles mosquito
malaria
Aedes mosquito
dengue
yellow fever
zika
Orienta tsutsugamushi causes
scrub typhus
causes eschar on bite site
fever, headache, joint pain
lymphadenopathy localised
tick (Chigger) bite. campers in australia
Key travel related infection
Haemorrhagic fever
Rickettsial
Lyme
HIV
Typhoid
Dengue
Main sub saharan african infections
plasmodium falciparum
HIV
rickettsia
ebola
Main south asian infection
falciparum, vivax and ovale
dengue
typhoid (salmonella)
HIV
Tetanus hallmarks
acute neurological
- muscle spasm
- autonomic dysfunction
Due to neurotoxin from c.tetani bacteria
urgent anti-tetanus immunoglobulin !!!
Typhoid fever hallmarks
fever
bradycardia
rose spots (macularpapular rash on chest and abdo)
GI bleed from ulcered peyer’s patch in ileum
abdo pain
—-> hepatosplenomegaly
Mx: IV ceftriaxone
Diptheria management
ANTITOXIN
+ + macrolide/benpen
Side effect of tenofovir
kidney disease
COPD/immunocomprosed vaccination
yearly influenza
pneumococcal 5 yearly
Brucellosis hallmark
Bruisedddd Bruce
Zoonosis: Brucella spp
farm animal/unpasteurised milk
FARMERS!!!
Presentation:
ache and pain
fever
weight loss
depression
hepatosplenomegaly
LYMPHADENOPATHY
Mx:
- doxy and rifampicin for 6 weeks
- and aminoglycoside for 2 weeks
Management of brucella
doxycycline
rifampicin
gent/cotrimox
triple therapy for 6 weeks
Malaria prophylaxis drug
doxycycline
malarone
primaquine
Note: give malarone in epileptic as others reduces seizure threshold
Investigation of choice to confirm new HIV
ELISA for HIV antibody and p24 antigen test
note: PCR is for viral load in monitroing
Abx of choice for ?meningitis in over 60 years and penicillin allergy
chloramphenicol
with co-trimoxazole
What does increasing PR interval suggest in infective endocarditis
uncontrolled infection
need urgent surgery
Incubation periods for common organisms
1-6 hrs: Staphylococcus aureus, Bacillus cereus
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
Catch scratch disease
Baronella henselae
cat scratch or bite
lymphadenopathy
self limiting
tame hensel cat
Chlamydia serotypes
Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serovars L1, L2 and L3
- proctocolitis
‘Normal’ Chlamydia resulting in urethritis and pelvic inflammatory disease is caused by Chlamydia trachomatis serovars D through K.
Epidemic typhus
Rickettsia prowazekii
measle like eruption
rural poor hygiene
Salmonella typhi organism type
gram -ve rod
What is the way to contract strongyloides
soil indwelling
walking barefooted is risk
vague abdo pain, eosinophilia, malabsorption
What defines treatment failure of MDRTB?
positive cultures after 4 months of therapy
Salmonella vs Shigella food
Salmonella- meat/egg/poultry
Shigella-faeco-oral i.e street fruit etc
Botulism
eating contaminated food (e.g. tinned) or intravenous drug use
neurotoxin (exotoxin) often affects bulbar muscles and autonomic nervous system
triad: blurred vision, dysphagia, muscle weakness
Neisseria meningitidis grams stain
gram -ve cocci
Listeria meningitis gram stain
gram +ve rod
strep pneumonia meningitis gram stain
gram -ve cocci
EBV hallmarks
glandular fever/mononucleois
fever, pharyngitis, tender LN
Parvovirus B19 hallmark
slapped cheek
children
Mumps hallmarks
epididymo-orchitis
meningism
Rubella hallmarks
maculopapular rash from face to whole body
lymphadenopathy: suboccipital and postauricular
Life cycle of malaria
hypnozoites- dormant liver stage of vivax and ovale -> relapse
priaquine and chloroquine given for vivax and ovale to eradiate hypnozoite and prevent relapse
note: falciparum treatment: fansidar (pyrimethamine + sulfadoxine) or tetracycline given after quinine therapy
Pre or Post Splenectomy immunisation
4-6 weeks or 2 weeks
pneumococcal vaccine
haemophilus ingluenzae B
Meningococcus
risk of encapsulated sepsis
Management of cryptospordium in HIV patients and non HIV patients
HIV: start ART
Non HIV: supportive
Which live vaccine should be avoided in HIV patients
BCG - risk of TB
Chronic diarrhoea, weight loss, arthralgia, hyperpigmentation of skin
Whipple’s
Side effect of NNRTI
wide spread rash
hepatitis
night night (vivid dreams)
Side effect of NRTI
lipoatrophy
B RAMP
Bone marrow supp
Rash
Acidosis
Megaloblastic anaemia (zdv)
Peripheral neuropathy
Pancreatitits
Which statin is preferred in hyperlipidaemia in HIV patients
pravastatin (not CYP450 dependent)
What is the test for contact tracing for TB exposure
mantoux
screen for latent TB
When is IGRA test used
if mantoux test is +ve
for active TB
What are the symptoms of seroconversion of HIV
point at which the body produces antibodies to HIV
fever
malaise
lymphadenopathy
generalised rash
Eikenella corrodens gram stain
gram -ve rod
What is the cause of multiorgan complication of diptheria
bacterial exotoxin
Dermatophyte that produces microconidia (spores)
Trichophyton spp
athlete’s foot
Vector for african trypanosomiasis
tsetse fly
Hallmark leishmania (visceral and cutaneous)
sandflies
days to months incubation
- erythematous nodule bite site
- golden crust forms
Cutaneous
- skin biopsy
- treat with sodium stilbogluconate
Visceral (kala-azar)
- bone marrow/lymph node/splenic biopsy
- treat with amphotericin B, sodium stilbogluconate
Side effect of protease inhibitors
HIL
hyperlipidaemia/hyperglycaemia
gI intolerance
lypodystrophy
especially ritonavir
note: rifampicin decreases PI concentration
Side effect of integrase inhibitor
nausea
diarrhoea
headache
Hypercholesterolaemia
Encapsulated bacteria
NHS
neisseria
haemophilus
strep
penile ulcers
Painful
- Chancroid (thailand sex worker) - gram neg rod
- HSV (multiple ulcer + tender LN + recurrence) - no growth on gram stain
Painless
- syphillis (single ulcer)
- LGV (regional LN)
- granuloma inguinale (donovanosis) - painless spreading friable ulcer
Treatment for acute epididymo-orchitis
> 35 and not STI (enteric cause)
- olfloxacin first line
<35 and STI cause
- ceftriaxone
Legionella hallmarks
hyponatraemia
deranged LFT
diarrhoea
Malaria prophylaxis in epileptic
give malarone
ALA (amoebic liver abscess) treatment
due to entamoeba histolytica
metronidazole or tinidazole
Hantavirus endemic in…
south korea
scandinavia
hanta hangook
HIV - FBC abnormalities
Normocytic anaemia
Thrombocytopenia
Macrocytosis with ART
Prophylaxis for meningococcus contact
cipro first line
alternative: azithromycin
Management for gonorrhoea
IM ceftriaxone single dose
alternative:
- PO cefixime and azithromycin
Management for chlamydia
doxycycline
alternative:
azithromycin or erythromycin
Note: doxy and olfloxacin CI in pregnancy
HIV oesophageal candidiasis management
PO fluconazole 14 days
How does early viral meningitis differ from late presentation
early may be polymorphic
late is lymphocytic
Listeria meningitits
Lymphocytic
Partially treated bacterial meningitis…
present with lymphocytic meningitis
What is low CSF glucose
<60% of serum
Treatment of TB meningitis
RIPE + streptomycin
like MDRTB
NOTE: ZN stain may be -ve in CSF due to small amount
Parvovirus 19 in adults seen in…
sickle cell anaemia
symmetrical polyarthritis
aplastic crisis
Treatment for dengue
supportive
How does hep B serology differ between recovered hep B vs hep B carrier
hep B carrier still has surface ANTIGEN
Both has hep B core IgG
Management of EBV
supportive
avoid contact sport in first month due to risk of splenic rupture
Treatment of toxoplasmosis
if pregnant/newborn/immunocompro
pyrimethamine and sulphadiazine
CMV transmission by..
direct bodily fluid
transfusion
transplant
immunocompromised
Adult bacterial meningitis caused by…
neisseria
strep pneumonia
Meningococcal meningitis caused by..
neisseria meningitides
how should deranged LFT in anti TB treatment be managed
stop RIPE
once LFT normalised re-introduce in order of IRP
What does strep pyogenes cause
cellulitis
nec fasc
Chronic hep B management with decomp CLD
Entecavir
Leprosy hallmark
Mycobacterium leprae
granulomatous of peripheral nerve
Sensory loss–> burns
skin biopsy: multiple acide alcohol fast bascilli
Mx: rifampicin, dapsone, clofazimine
How is Toxoplasma contracted
cat faeces
How is cryptococcus contracted
bird faeces
Cryptococcal meningitis management…
amphotericin B with fluconazole
Brucella gram stain
-ve coccobacilli
Cholera hallmarks
sudden onset
profuse diarrhoea
rice water stool
shell fish/contaminated water
Most common cause of treatment failure in HIV
pooor compliance
In needle stick injury with patient infected with hep C…
monthly hep C PCR surveillance
if positive then treat with inteferon
pneumocytis jirovecii pneumonia hallmarks
IVDU/HIV
lymphopenia
high LDH
desat on exertion
ELEVATED 1,3 BDG (from cell wall)
CXR- bilateral interstitial shadowing
Hep C hallmarks
HIV and alcohol associated
Ix:
- hep C antibody
- HCV PCR
- Genotype 1->4
- US if fibrosis seen
- fibroscan/biopsy
treatment:
- protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used
used to be IFN/peg IFN
What is a complication of PCP
pneumothorax
immunised hep B vs previous infection
vaccination: hep B surface antibody present but no core antibody
What should be checked prior to primaquine treatment
screen for G6PD
risk of haemolysis with primaquine
Malaria treatment
Severe falviparum/nonfalciparum
- IV artesunate
Non severe disease:
- oral ACT or chloroquine
Percentage of untreated syphillis going onto tertiary syphillis
30%
Treatment of syphillis
STAT IM benzathine penicillin for primary
Management of tropical sprue
tetracycline
(target bacterial overgrowth)
Management for ESBL- ECOLI
Meropenem
Teicoplanin affective against…
gram +ve
Investigation of choice for tertiary neurosyphillis
TPPA (may be positive in yaws too)
VDRL test (non treponeme specific test)
- marker of disease activity
LP and syphillis serology
Isolation protocol for MDRTB
negative pressure isolation room
- limit droplet spread
EBV and cancer associations
nasopharyngeal carcinoma
Gastric cancer
Menongococcal meningitis community SOS treatment
IM benpen
When should steroid be given in meningitis
pneumococcal meningitis
Shigella mode of transmission
person to person
bloody diarrhoea in nursery
How long does TB bacteria take to double in numbers
18-24 hrs
Tapeworm management
proglottids in faeces
Mx: niclosamide
Ricketssial infection hallmarks
- Rocky mountain spotted fever
- rickettsia rickettsii
- USA - mediterranean spotted fever
- Rickettsi corni - scrub typhus
- Orienta tsutsugamushi - african tick bite fever
- rickettsia africae from africa
Sx: rash, lymphadenopathy, splenomegaly, eschar —> regional lymphadenopathy due to draining eschar
Mx: doxycycline
Mx: doxycycline
Needle stick injury with HIV +ve patient
1 month of 3 ART
What should be monitored whilst on IV quinine for severe falciparum
BM
(insulin release causing hypoglycaemia)
Management of hep A
supportive
self limiting
Lyme disease investigation
no need if classical target lesion and evidence of tick bite
If unsure—> ELISA
P.vivax prevalent countries
sub saharan
central america
india
p.ovale prevalent country
sub saharan africa
Severe loiasis management
note: severe case —> albendazole (as DEC may trigger encephalitis)
When is mebendazole indicated
pinworm
whipworm
roundworm
hookworm
Thick and thin blood film
Thick: parasite burden
Thin: identify parasite
Hallmark of malarial fevers
swining intermittent
TB isolation rule
Pulmonary TB
Smear positive most infective
Likely/confirmed MDRTB
Cerebral malaria is associated with…
falciparum
blackwater fefver- haemolysis, dark urine
Anti-malaria prophylaxis…
still presents with risk of malaria infection
Ancylostoma braziliense hookwork hallmarks
barefoot beach visits or direct soil contact.
moving skin rash
itchy
Abx of choice for MRSA cellulitis
Vancomycin
or
teicoplanin
CMV encephalitis treatment
Ganciclovir
Bacillus cereus
cereal (Rice based dishes)
D+V within 8 hrs of eating
resolve in 1-2 days
Mycoplasma pneumoniae
Cold agglutinin
erythema multiforme
dry cough
What is the most common side effect of ribavirin for chronic hep c
anaemia
Ascariasis hallmarks
Ascaris lumbricoides
eggs hatch in small intestine
larvae enter liver to heart and lungs–> back to digestive tract where they mature into adult worm
Sx: asthma like symptoms
Myconic keratitis
Fungal infection of eye
associated with trauma
ulceration in cornea
Antifungals- amphotericin B, itraconazole, natamycin
Cause of hairy leukoplakia in HIV
EBV
Which malaria prophylaxis can cause acute psychosis
mefloquine
Rabies hallmarks
dog and bat bite
Presentation:
encephalitis
hallucination and confusion
hydrophobia (DOES NOT WANT WATER)
Mx:
- if already immunised: for 2 further vaccine
- if not immunised: for immunoglobulin and full vaccination
Campylobacter from…
contaminated CHICKEN
CC
Which vaccine is not a live vaccine
Diptheria
CMV hallmarks
presents similar to EBV
in severe- pneumonitis, colitis, retinitis
Investigation for cryptococcal stain
india ink stain
Treatment for adult chicken pox
present within 72 hrs of onset of rash:
- oral aciclovir
- if severe then IV
Where should you swab for gonorrhoea
mucosal site of symptoms
HIV entry to cell
binds to CD4 primary receptor via gp120
with help of co-receptor CCR5
Pregnant mum exposed to chicken pox
Urgent IgG
If -ve give VZIG
Tropical sprue hallmarks
chronic diarrhoea
malabsorption
travel to tropics
steatorrhoea
Animal bite
co-amox
Hepatitis vaccines
A and B
Severe cellulitis management in penicillin allergy
Clindamycin
Cause of hyatid disease (pulmonary and liver cyst)
Echinococcus granulosus
Yellow fever hallmarks
viral haemorrhagic fever (also dengue fever, Lassa fever, Ebola).
zoonotic infection: spread by Aedes mosquitos
incubation period = 2 - 14 days
- mild flu-like illness lasting less than one week
- if severe jaundice, haematemesis may occur
Staph aureus gram stain
coagulase positive
gram positive coccus in clusters
Hep A presentation
bout of intense diarrhoea that resolves
then jaundice, nausea anorexia
Immune reconstitution inflammatory syndrome in HIV and TB
Active TB patients who are immunocompromised -> no symptoms
HIV started on ART -> boost immune -> exaggerated response
also associated with cryptococcus and kaposi
Mx: steroids
What is klebsiella granulomatis associated with
granuloma inguinale
Treatment for Rickettsia
Doxycycline
Pregnant: chloramphenicol
Chance of contracting HIV from needle stick
1/300 chance
How does clarithromycin affect INR
increases INR as alters warfarin
Prosthetic joint replacement septic arthritis causes…
early infection- s.aureus
chronic delayed- s.epidermidis
Hand foot and mouth disease
coxackie virus
type 16
self limiting
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