Non-tropical infectious diseases Flashcards
Aspergillus
a) Histology
b) Aspergilloma - presentation, diagnosis, treatment
c) ABPA - presentation, diagnosis, treatment
d) Invasive aspergillosis - presentation, diagnosis, treatment
a) Dichotomously branched septate hyphae
b) A clump of mould usually in the lung, generally in people with underlying cavitating lung disease (e.g. TB, sarcoid) or immunosuppression
- Often asymptomatic but may present with haemoptysis if they invade a blood vessel
- Diagnose by serum IgE for aspergillus, aspergillus precipitins, often found incidentally on CXR (“halo sign”)
- Usually don’t require treatment, but may be surgically removed, and if massive haemoptysis do endobronchial abalation
c) Presents as asthma-type presentation, also brownish sputum
- Raised IgE and eosiniphils
- Treat with steroids + antifungals
d) If invasive aspergillosis, and immunocompromised, aspergillus precipitins may actually be negative
Presents as life-threatening fungal chest sepsis (fever, cough, SOB, high RR, high HR, etc.)
Rx; IV antifungals
Leptospirosis
a) Cause
b) Risk factors
c) Presentation (icteric vs. anicteric)
d) Diagnosis
e) Treatment
f) What reaction to ABx may occur?
a) Leptospira interrogans (a spirochete), usually from rat urine
b) Contaminated water sources, e.g. rowers, wild water rafters, sewage workers, farmers, fishers
c) - Anicteric (90%) - asymptomatic, or flu-like illness
- Icteric (10%) aka Weil’s disease - jaundice due to hepatocellular necrosis, also commonly have AKI, pulmonary manifestations (cough, SOB, massive haemorrhage, ARDS), DIC, and neurological complications (aseptic meningitis, confusion, reduced GCS)
d) - In first 10 days, may culture from blood/CSF
- After day 10, antibody test
e) - Supportive care
- Not much evidence for ABx, but doxycycline and azithromycin often use
f) Jarisch-Herxeimer reaction
- Present with sepsis-like syndrome: fever, tachycardia, hypertension, SOB
- Occurs around 1-12 hours after first antibiotic dose
- Occurs with spirochete infections (more common in syphillis and Lyme disease)
- Self-limiting in most cases
Botulism
a) Risk factors
b) Presentation
c) Treatment
a) - Open wounds/injections (IVDUs)
- Poorly stored/canned food
b) Descending flaccid paralysis
c) Botulism anti-toxin
Anthrax
a) Risk factors
b) Presentation
c) Tests
d) Treatment
a) IVDU, inhalation of animal tanning, contact with affected animal skin
b) - Cutaneous - ulcerated nodule/black scab
- Injection - Soft tissue necrosis at injection site and sepsis
- Inhalational - causes flu like illness then respiratory failure
- Intestinal (from ingestion, rare)
c) Culture for bacillus anthracis
Stool, sputum, blood, etc.
CXR
d) Cipro
Lyme disease
a) Cause and risk factors
b) Presentation - acute, chronic
c) Diagnosis
d) Treatment
a) Borrelia burgdorferi (tick bite)
b) Acute:
- Erythema migrans rash (3 days to 3 months post-tick bite)
- Fever, lymphadenopathy, malaise
- Neuro: CN palsies (particularly facial nerve), meningitis, mononeuritis multiplex, confusion, paraesthesia
- Lyme carditis (myopericarditis, bradycardia, heart block)
Chronic:
- Neurological - polyneuropathy, vertigo, encephalopathy
- Lyme arthritis
- Derm - acrodermatitis chronica atrophicans (unilateral violaceous discolouration, often on dorsum of hand/extensor surfaces)
c) - Tick exposure + erythema migrans rash = treat empirically
- After 8 weeks, ELISA tests will reliably diagnose
- Blood cultures typically negative
d) Oral doxy 3/52
- IV ceftriaxone if CNS involvement present
TB
a) isolation rules
b) travel rules
Pulmonary and laryngeal cases
Smear positive are more infectious
MDR-TB should be isolated for longer
b) 2 weeks post-therapy (provided no MDR and clinically well)
Chickenpox/shingles
a) Management in pregnancy if close contact infected
b) Management of immunocompromised person in contact with infected person
c) Management of high-risk person (immunosuppressed/ pregnant) with active infection
d) Management of antibody negative individuals in contact with infected person (if not pregnant and not immunosuppressed)
a) - Test mother for VZV IgG (serum) if not had chickenpox
- If not present - give VZIG (no live vaccines in pregnancy)
b) - Test patient for VZV IgG (serum) if not had chickenpox
- If not present - give VZIG
c) Aciclovir
d) Varicella zoster vaccine
- e.g. healthcare workers
TB
a) LFT derangement
b) Which patients are at higher risk
If abnormal, stop treatment
Then reintroduce at challenge doses in the order of I-R-P
b) Slow acetylators (autosomal recessive inheritance)
Malignant otitis externa
a) Risk
b) Presentation
c) Cause
a) Diabetes
b) Severe swelling, regional involvement (e.g. facial swelling, CN VII palsy)
c) Pseudomonas
Nigerian student - TB differential
Paragonimiasis
Granulomatous disease in the lungs and GI tract
Rheumatic fever
a) Major criteria: J❤️NES
b) Minor criteria: CAFE PAL
c) Diagnosis
a) Joint involvement
❤️ - myocarditis
Nodules (subcutaneous)
Erythema marginatum*
Sydenham’s chorea
*Look like multiple erythema migrans (target) lesions
b) CRP elevation
Arthralgia
Fever
ESR elevation
Prolonged PR
Amnesia
Leukocytosis
c) Group A strep on throat swab or positive ASOT, plus:
- 2 major criteria, or
- 1 major + 2 minor criteria
Rocky Mountain Spotted Fever
a) Cause, risk factors
b) Presentation
c) Diagnosis
d) Treatment
a) Rickettsia rickettsii
- Tick bites
- Common in Rocky Mountains and in central/south USA
b) - Fever, headache, rash (petechial or maculopapular, starts on hands and feet and works upwards, may develop ecchymoses)
- Hepatitis, myocarditis, glomerulonephritis
(no ‘eschar’ black scab and different epidemiology to tick typhus)
c) Rickettsia antibodies
d) Doxycycline
Renal TB
a) Common presentation
b) Diagnosis
a) - Haematuria, frequency, fevers, night sweats
- Sterile pyuria
- Typically occur 5-10 years after initial TB infection
b) Three first morning urine samples - culture for AFB
Staphylococcal toxic shock syndrome
a) Presentation
b) Causes
c) Treatment
Temp 38.5
Hypotension
Rash, then desquamation esp. palms and soles
3+ organs involved:
- GI
- Renal
- Haem
- Liver
- CNS
b) - Menstrual (50%) - retained tampons, use of highly absorbent tampons
- Non-menstrual - cellulitis, OM, septic arthritis, sinusitis, pneumonia, etc.
c) - Antibiotics - vanc + taz + clinda
- Fluids and vasopressors
- Removal of foreign body e.g. tampon
- Surgical debridement if needed
Syphilis
a)
Management
What is a procaine reaction?
a)
b)
c)
Management with IM benzyl or benzathine or procaine penicillin
Procaine reaction - when accidentally administered IV rather than IM, causing agitation, hallucinations, delusions, impending doom +/- seizures, lasting around 20 mins
