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MC > Protozoal Infections > Flashcards

Protozoal Infections Flashcards

1
Q

The ________ are well
known for their adverse intra-uterine effects on the
fetus

A 
TORCH organisms (TORCH being an acronym
for toxoplasmosis, rubella, CMV and herpes)
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2
Q

The major protozoal diseases of humans are:

  • blood: _______
  • GIT: _________
  • tissues: ________
A

malaria, trypanosomiasis

giardiasis, amoebiasis, cryptosporidium

toxoplasmosis, leishmaniasis, babesiosis

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3
Q

Four infections—EBV, primary HIV, CMV and
toxoplasmosis—produce almost identical clinical
presentations and tend to be diagnosed as ______ or ______

A

glandular

fever or pseudoglandular fever

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4
Q

a febrile illness caused by the herpes (Epstein–

Barr) virus

A

Epstein–Barr mononucleosis (EBM)

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5
Q

3 froms of EBM

A

the febrile,
the anginose (with sore throat)
glandular (with lymphadenopathy

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6
Q

Age of onset of EBM

A

It may occur at any age but usually between 10 and

35 years; it is commonest in 15–25 years age group.

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7
Q

IP for EBM

A

The incubation period is at least 1 month

but data are insufficient to define it accurately

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8
Q

Transmission of EBM

A

transmitted only by close contact, such as

kissing and sharing drinking vessels.

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9
Q

Progress of the primary infection is checked
partly by specific antibodies (which might prevent
cell-to-cell spread of the virus) and partly by a cellular
__________, which
eliminates the infected cells

A

immune response, involving cytotoxic T-cells

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10
Q

The rash of EBM is almost always related to _____

A

antibiotics

given for tonsillitis

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11
Q

rash associated wtih EBM

A

The primary rash, most

often non-specific, pinkish and maculopapular

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12
Q

The rash of EBM is similar to

A

rubella)

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13
Q

The secondary rash of EBM is most often precipitated

by one of the penicillins, especially____ and ____

A

ampicillin or

amoxycillin

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14
Q

5 clinical manifestations of EBM

1
2
3
4
5
6
A

Exudative pharyngitis (84%)
Petechiae of palate (not pathognomonic) (11%)
Lymphadenopathy, especially posterior cervical
Rash—maculopapular
Splenomegaly (50%)
Jaundice ± hepatomegaly (5–10%)

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15
Q

Lab tests associated with EBM

WCC shows _____
Blood film shows______

A

absolute lymphocytosis

atypical lymphocytes

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16
Q

Lab tests associated with EBM

______ or _____ is positive (although positivity can be
delayed or absent in 10% of cases).

A

Paul–Bunnell or Monospot test for heterophil

antibody

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17
Q

Lab tests associated with EBM

Diagnosis confirmed (if necessary) by

1
2
3

A
  1. EBVspecific antibodies,
  2. viral capsule antigen (VCA) antibodies—IgM, IgG and
  3. EB nuclear antigen (EBN-A).
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18
Q

False positives for the Paul–Bunnell test are
1
2
3

A
  • hepatitis
  • Hodgkin lymphoma
  • acute leukaemia
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19
Q

EBM usually runs an uncomplicated course over ____

weeks. Major symptoms subside within ____weeks

A

6–8

2–3

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20
Q

EBM

Patients should be advised to take about_____ weeks off
work.

A

4

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21
Q 
Common cx of EBM
1
2
3
4
A

Antibiotic-induced skin rash
Prolonged debility
Hepatitis
Depression

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22
Q

Cardiac cx of EBM
1
2

A
  • myocarditis

* pericarditis

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23
Q

Hema Cx of EBM
1
2
3

A
  • agranulocytosis
  • haemolytic anaemia
  • thrombocytopenia
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24
Q

Respi Cx of EBM

A

upper airway obstruction (lymphoid hypertrophy

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25
Q 
Neuro Cx of EBM
1
2
3
4
A
  • cranial nerve palsies, especially facial palsy
  • Guillain–Barré syndrome
  • meningoencephalitis
  • transverse myelitis
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26
Q

Tx of EBM

Gargle soluble _____ to soothe
the throat

A

aspirin or 30% glucose

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27
Q

EBM Tx

_____ reserved for: neurological
involvement, thrombocytopenia, threatened
airway obstruction. Not recommended for
uncomplicated cases

A

Corticosteroids

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28
Q

Other agents that cause typical EBM syndrome
1
2
3

A
  • HIV infection (acute initial illness)
  • CMV
  • toxoplasmosis
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29
Q

Exudative tonsillitis resembling EBM
1
2
3

A
  • acute streptococcal pharyngitis
  • adenovirus infection
  • diphtheria (unlikely in Australia
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30
Q

Virus associated with CMV

A

The

virus (human herpes virus 5)

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31
Q

Most at risk of CMV
1
2
3

A

1AIDS, and also in recipients of solid

organ transplants and bone marrow grafts

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32
Q

______of AIDS patients are infected with CMV and

A

90%

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33
Q

The
incubation period of CMV ranges from ____ days
and the illness generally lasts about ______weeks

A

20 to 60

2 to 6

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34
Q

CMV perinatal dse Cx

Intrauterine infection may cause serious
abnormalities in the fetus, including:

1
2
3
4
5
A 
CNS involvement (microcephaly, hearing defects, motor
disturbances), 
jaundice, 
hepatosplenomegaly,
haemolytic anaemia and
 thrombocytopenia
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35
Q

Acquired CMV infection

In healthy adults, CMV produces an illness similar
to_____

However, ____ and ______ are rare

A

EBM

cervical lymphadenopathy and exudative
pharyngitis

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36
Q

Fever pattern of CMV

A

The fever often manifests as quotidian
intermittent fever spiking to a maximum in
the mid-afternoon and falling to normal each
day

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37
Q

Acquired CMV Infection:

There is often a relative
lymphocytosis with atypical lymphocytes but
the ______ test is negative

A

heterophil antibody

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38
Q

Acquired CMV Infection diagnosis

Specific diagnosis can be made by
demonstrating rising antibody titres from acute
and convalescent (2 weeks) sera.

What indicates recent infection?

A

A four-fold

increase indicates recent infection.

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39
Q

Acquired CMV Infection diagnosis

Where can the virus be isolated?

A

The virus can be isolated from the

urine and blood.

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40
Q 
Disseminated CMV infection occurs in the
immune-deficient person, notably HIV infection
causing 
1
2
3
A

opportunistic severe pneumonia,
retinitis (a feature of AIDS), encephalitis and
diffuse involvement of the gastrointestinal tract

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41
Q

T or F, CMV infection in immunocompetent needs to be treated with antivirals?

A

F

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42
Q

CMV Infection

In immunosuppressed
patients various antiviral drugs, such as
____, _______, ______
have been used with some benefit. 4

A

ganciclovir, foscarnet and fomivirsen(intraocular)

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43
Q

Toxoplasmosis

The definitive host in its life
cycle is the______ and the ______is an
intermediate host

A

cat (or pig or sheep)

human

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44
Q

Toxoplasmosis infection via?

A

through eating foodstuffs contaminated by

infected cat faeces

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45
Q 
The five major clinical forms of toxoplasmosis
1
2
3
4
5
A
  1. asymptomatic lymphadenopathy
  2. lymphadenopathy with a febrile illness
  3. acute primary infection
  4. neurological abnormalities
  5. congenital toxoplasmosis
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46
Q

MC clinical form of Toxoplasmosis

A

asymptomatic lymphadenopathy

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47
Q

Toxoplasmosis similar to EBM

A

lymphadenopathy with a febrile illness

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48
Q

clinical form of Toxoplasmosis

febrile illness similar to acute leukaemia or EBM; a rash,
myocarditis, pneumonitis, chorioretinitis and
hepatosplenomegaly can occur

A

acute primary infection

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49
Q

Neuro abn asstd with Toxoplasmosis

A

includes headache

and neck stiffness, sore throat and myalgia

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50
Q

this is a rare
problem but if it occurs it typically causes CNS
involvement and has a poor prognosis

A

congenital toxoplasmosis

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51
Q

Diagnosis of Toxoplasmosis?

A

Diagnosis is by serological tests (to show a four-fold

rise in antibodies), which are sensitive and reliable

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52
Q

T or F

Toxoplasmosis in children:

Children under
5 years may be treated to avoid the possible occurrence
of chorioretinitis.

A

T

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53
Q

Toxoplasmosis Tx

Symptomatic patients are treated
with _________.

Clindamycin is usually used in _____

A

pyrimethamine plus sulphadiazine

pregnant patients.

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54
Q

Mosquito-borne infections have devastating
consequences in tropical regions
while others cause less morbidity and include ____

A

Ross

River fever

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55
Q

Epidemic polyarthritis of Ross River virus, which is

an ______, occurs in all states of Australia

A

alpha virus

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56
Q

Ross River fever

  • All age groups, especially _____ years
  • Incubation period ______
A

20–30

3–21 days (usually 7–11)

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57
Q

Ross River fever

MC sx
1
2
3

A
  1. Polyarthritis (75% of patients
  2. Maculopapular rash
  3. Myalgia
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58
Q

Involvement of arthritis in pts with Ross River fever

A

mainly fingers,

wrists, feet, ankles and knees

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59
Q

poor prognostic sign in pts with Ross River fever

A

tenosynovitis around the

wrists and ankles

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60
Q

Ross River fever

In many patients the illness resolves within 2 to 6
weeks and most feel normal within 3 months, but
some with a more severe arthritis can enter a chronic
phase lasting ____

A

18 months or more

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61
Q

Ddx of Ross River fever

A

other viral infections
that cause arthritis, such as hepatitis B, rubella, Barmah
Forest virus (a mosquito-borne virus) and dengue, and
early rheumatiod arthritis and rheumatic fever.

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62
Q

Tx of Ross River fever

A

Treatment is symptomatic with bed rest and simple

analgesics such as aspirin.

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63
Q

Tx of Ross River fever

Oral CS should always be used

A

Oral corticosteroids are effective but

should be avoided if possible

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64
Q 
Infections in the past 20 years which emerged and have no cure
1
2
3
4
5
A
  1. infant diarrhoea,
  2. Legionella pneumophila,
  3. Lyme borreliosis (Lyme disease),
  4. the Hantaan virus (which can cause a fatal haemorrhagic
    fever) ,
  5. HIV and hepatitis E and C
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65
Q

The deadly haemorrhagic fevers that have broken
out in isolated endemics include the

1
2
3

A
  1. zoonotic African diseases—Ebola haemorrhagic fever,
  2. Marburg haemorrhagic fever and
  3. Lassa fever.
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66
Q

Top 5 deadly infectious diseases:

1
2
3
4
5
A 
1 Acute lower respiratory infections (mostly pneumonia)
2 Diarrhoeal diseases
3 HIV/AIDS*
4 Tuberculosis
5 Malaria
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67
Q

the paramyxoviruses—__________which causes haemorrhagic and pulmonary
complications;

A

Hanta (RNA)

virus,

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68
Q

the ______ family, which are
naturally harboured in fruit bats and include Hendra
virus, Nipah virus and Cedar virus

A

henipavirus

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69
Q

Another serious infection that emerged sporadically
was the so-called ‘flesh eating’ __________
infection, which was a particularly virulent strain
causing localised destruction of soft tissue

A

Streptococcus A

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70
Q

______ caused by a mosquito transmitted
virus and carried by birds has surfaced
in the US and beyond, causing thousands of cases and
hundreds of deaths

A

West Nile encephalitis

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71
Q

malaise + cough + weight loss ±

fever / night sweats ( ± erythema nodosum

A

PTB

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72
Q

is the presence of infection without evidence
of active disease and inability to transmit the
infection.

A

Latent TB infection (LTBI)

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73
Q

reactivation rate in pts with LTBI

A

10%

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74
Q

LTBI

The _______is primarily intended to identify these people with a view to prophylaxis therapy.

A

tubercular skin test

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75
Q

Tx of LTBI

A

The standard preferred
regimen is isoniazid (10 mg/kg up to 300 mg (o) daily
for 6–9 months).

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76
Q

MC site of extrapulmonary TB in Australians

A

lymph nodes (the commonest, especially in young adults and children)

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77
Q

This disorder follows diffuse dissemination of
tubercle bacilli via the bloodstream especially in those
with chronic disease and immunosuppression

A

Miliary TB

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78
Q

Miliary TB

It can occur within ____ of the primary infection or much
later because of reactivation

A

3 years

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79
Q

CXR of miliary TB

A

The classic chest X-ray is multiple

1–2 mm nodules in lung fields

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80
Q

The lifetime risk of TB disease in children with LTBI is in the order of

A

5–15%.

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81
Q

Children with LTBI should be considered for

prophylaxis with a course of _____

A

isoniazid

82
Q

_____ is the more common form in
young children.______ is more common in
adolescents

A

Primary disease

Reactivation

83
Q

New and promising diagnostic for PTB

A

immunochromatographic finger-prick test

84
Q

Tb Dx

________—less sensitive than culture

A

NAAT/PCR test

85
Q

TB Dx

_______ test should be performed
prior to BCG vaccination in all individuals over
6 months of age

A

A tuberculin (Mantoux)

86
Q

Mantaux test results

<5 mm—_______

A

negative

87
Q

T or F

Mantaux may be negative in
presence of very active pulmonary infection

A

T

88
Q

Mantaux test results

5–10 mm

A

typical of past BCG vaccination

89
Q

Mantaux test results

> 5 mm

A

significant in immunocompromised,

close contacts and HIV infection

90
Q

Mantaux test results

> 10 mm

A

positive = tuberculosis infection

(active or inactive

91
Q

Mantaux test results

active or inactive
• >15 mm

A

highly significant for ‘normal’ people

92
Q

The BCG vaccination should be given if the

reaction is ______ induration

A

<5 mm

93
Q

T or F

Do not give BCG for a reaction >5 mm.

A

T

94
Q

BCG vaccination is recommended for:

  • ATSI neonates in regions of high incidence
  • neonates born to patients ______
  • children <5 years ______
A

with leprosy or family history of leprosy

travelling for long periods to
countries of high TB prevalence

95
Q

BCG vaccination should be considered for:

  1. neonates in household with immigrants or
    visitors recently arrived from countries of high
    prevalence (e.g. ________)
  2. children and adolescents <16 years with
    continued exposure to active TB patient and
    where_______
A

South-East Asia

isoniazid therapy is contraindicated

96
Q

T or F

tuberculin
test not necessary for neonates <14 days

A

T

97
Q

BCG vaccination is contraindicated for:

• tuberculin reactions \_\_\_\_\_\_
• immunocompromised or malignancies involving
bone marrow lymphatics
• high-risk HIV infection
• significant \_\_\_\_\_
• generalised skin diseases, \_\_\_\_\_\_\_
• pregnancy
• previous infection
A

> 5 mm

fever or intercurrent illness

including keloid
tendency

98
Q

WHO Tx strategy for patients with MDR TB

A

‘DOTS plus’ to control MDR-TB

99
Q

______mg daily is recommended for adults

taking isoniazid

A

Pyridoxine 25

100
Q

A _____regimen is also an option if DOT is employed.

A

3-times-weekly

101
Q

It presents either as a primary lesion or through

the chance finding of positive syphilis serology

A

Syphilis

102
Q

Congenital syphilis is rare where there is

general serological screening of ______

A

antenatal patients

103
Q

Syphilis

The primary lesion or_____ usually develops at
the point of inoculation after an incubation period
averaging 21 days.

A

chancre

104
Q

Untreated, early clinical syphilis usually resolves
spontaneously within ______, leading to latent
disease, which may proceed to late destructive lesions

A

4 weeks

105
Q

The most common feature of the secondary
stage of infection is a _____, which is present in about
80% of cases

A

rash

106
Q

rash typical of secondary syphilis

A

The rash is typically a symmetrical,
generalised, coppery-red maculopapular eruption on
the face, trunk, palms and soles and is neither itchy
nor tender.

107
Q

difference of secondary syphilis from other diseases

A

It can resemble any skin disease except

those characterised by vesicles.

108
Q

Positive serology in a patient without symptoms or
signs of disease is referred to as _____ and is
the commonest presentation of syphilis in Australia
today

A

latent syphilis

109
Q

Tertiary manifestation of syphilis (follows >2 years’
latency), which is very rare, may be ‘benign’ with
development of __________ in
almost any organ, or more serious with cardiovascular
or CNS involvement

A

gummas (granulomatous lesions)

110
Q

Syphilis should not be overlooked as a cause of ___ or ______

A

oral or

anorectal lesions

111
Q

T or F,

In patients with AIDS and syphilis, standard regimens
for syphilis are not always curative.

A

T

112
Q

Lymphadenopathy in a patient with HIV

infection may be due to coexisting _____

A

secondary syphilis

113
Q

Spirochaetes can be demonstrated by microscopic
examination of smears from early lesions using dark
field techniques and provide an immediate diagnosis in
symptomatic syphilis. The _______ can be used on this smear.

A

direct fluorescent antibody techniques (FTAABS)

114
Q

Serologic tests for syphilis

  1. __________—not specific for syphilis but useful for screening
  2. _________)—
    specific tests, with the latter being sensitive and
    widely used
  3. ______—very sensitive
A

reagin tests (VDRL and RPR)

treponemal tests (TPPA, TPI, EIA, FTA-abs

PCR (blood or CSF)

115
Q

_______can be a difficult problem to
diagnose but must be considered in the differential
diagnosis of fever, especially in patients with a history
of cardiac valvular disorders

A

Infective endocarditis

116
Q

Course of IE

A

insidious course and is

referred to as subacute (bacterial) endocarditis

117
Q 
Reason why there is increasing incidence of IE
1
2
3
4
A 
1. elderly people with degenerative valve
disease, 
2. more invasive procedures,
3.  IV drug use and
4. increased cardiac catheterisation
118
Q

Responsible organisms for IE

• \_\_\_\_\_\_\_ (50% of cases) most
susceptible to penicillin
• Streptococcus bovis
• Enterococcus faecalis
• \_\_\_\_\_\_\_ (causes 50% of acute form)
A

Streptococcus viridans

Staphylococcus aureus

119
Q

Responsible organisms for IE

  • _______ (IV drug users)
  • Staphylococcus epidermidis
  • _______ (Q fever)
  • _____ (Gram –ve bacilli) (5–10% of cases)
A

Candida albicans/Aspergillus

Coxiella burnetii

HACEX group

120
Q

Infective endocarditis without cardiac murmur
is frequently seen in _____ who develop
infection on the _____

A

IV drug users

tricuspid valve.

121
Q

Warning signs for development
of endocarditis

  • _______ of heart murmur
  • _______ of a new murmur
  • Unexplained _____and cardiac murmur
A

Change in character

Development

fever

122
Q

In IE:

The ‘classic tetrad’ of clinical features:

A

7 signs of
infection, signs of heart disease, signs of embolism,
immunological phenomena

123
Q

Dxtic tests in pts with IE

FBE and ESR

A

ESR ↑, anaemia and leukocytosis

124
Q

Dxtic tests in pts with IE

urine: ____ and _____

A

proteinuria and microscopic haematuria

125
Q

Dxtic tests in pts with IE

blood culture: positive in about _____ 7 (at least 3
sets of samples—aerobic and anaerobic culture)

A

75%

126
Q

Dxtic tests in pts with IE

echocardiography—to visualise vegetations (______
more sensitive than TTE)
• chest X-ray
• ECG

A

TOE

127
Q

IE Tx

Bactericidal antibiotics are chosen on the basis of _________

A

the results of the blood culture and antibiotic sensitivities.

128
Q

How many blood cultures should be sent for IE dx

A

Four blood cultures should be sent to the laboratory within the first hour of admission and treatment should seldom
be delayed longer than 24 hours

129
Q

Abx for IE
1
2
3

A

Benzylpenicillin, gentamicin and flucloxacillin/

dicloxacillin are recommende

130
Q

Abx for IE

____ is indicated in certain circumstances

A

Vancomycin

131
Q

The evidence for prophylaxis of endocarditis is not

clear, and current international practice is :

A

not to treat
low-risk cardiac abnormalities having procedures
with a low incidence of bacteraemia

132
Q

Pts at low risk for IE: No need for abx

patients with murmurs not due to ____

isolated_____,

pacemakers,

implanted defibrillators,

previous _______

previous CABGS,

_____without regurgitation,

complete surgical or device closures of_________

A

valve disorders,

secundum ASD

rheumatic fever without valve dysfunction,

mitral valve prolapse

congenital heart defects

133
Q

Procedures requiring prophylaxis for IE

Dental: invasive dental surgery—any procedure
causing ________

A

bleeding from gingiva, bone or mucosa

134
Q

Procedures requiring prophylaxis for IE

genitourinary procedures in the presence ___

A

of infection

135
Q

example of GU procedures with high infection risk

A

D&C, IUCD, urethral
dilatation, circumcision, prostatic surgery,
vaginal delivery in presence of infection or
prolonged labour

136
Q

Procedures requiring prophylaxis for IE

respiratory tract procedures—
1
2
3
4
A

tonsillectomy/ adenoidectomy,
rigid bronchoscopy, nasal and
sinus surgery

137
Q

Will you give IE Prophylaxis?

incision and drainage of local abscess, for
example, boils, perirectal, dacryocystitis

A

Yes

138
Q

What organisms to cover for dental procedures?

A

Dental procedures and URT interventions ( S.viridans

and Streptococcus cover

139
Q

Abx Dental procedures and URT interventions

____________1 hour beforehand (if not on long-term
penicillin)

A

amoxycillin 2 g (50 mg/kg up to adult dose)

orally,

140
Q

Abx Dental procedures and URT interventions

(amoxy) ampicillin 2 g (50 mg/kg up to adult
dose) IV just before procedure commences or IM
30 minutes before if having a _____

A

general anaesthetic

141
Q

Abx Dental procedures and URT interventions

if hypersensitive to penicillin: ____ or _____

A

clindamycin or

vancomycin

142
Q

Organisms to cover for GU procedures

A

Enterococci prophylaxis

143
Q

Prophylaxis for GU Procedures

A

• amoxy/ampicillin (child: 50 mg/kg up to 2 g) IV
(just before procedure)
or
• amoxy/ampicillin 2 g (child 50 mg/kg up to 2 g)
IM, 30 minutes beforehand

144
Q

Prophylaxis for GU Procedures

If hypersensitive to penicillin: ______

A

vancomycin or teicoplanin plus gentamicin.

145
Q

_______ are those diseases and infections that are
naturally transmitted between vertebrate animals
and humans

A

Zoonoses

146
Q

Think of a zoonosis in patients presenting with a __________

A

flu-like

illness and features of atypical pneumonia

147
Q

Considerations for rash

A

Consider rickettsial illness such as leptospirosis,

Q fever, Lyme disease

148
Q

Considerations for Cough or atypical pneumonia

A

Consider Q fever, psittacosis, bovine TB

149
Q

Considerations for Arthralgia/arthritis

A

Consider Lyme disease, Ross River fever

150
Q

Considerations for Meat workers

A

Consider Q fever, leptospirosis, orf, anthrax

151
Q

Considerations for Papular/pustular lesions

A

Consider orf, anthrax (black)

152
Q

Other names for Brucellosis

A

Brucellosis (undulant fever, Malta fever

153
Q

IP for acute brucellosis

A

Incubation period 1–3 weeks

154
Q

Classic fever pattern of acute Brucellosis

A

undulant

155
Q

Cx of brucellosis

A

Complications such as epididymo-orchitis,

osteomyelitis and endocarditis can occur

156
Q

brucellosis

Localised infections in sites such as 
1
2
3
4
5
6
 are possible but uncommon
A

bones, joints, lungs, CSF, testes and cardiac valves

157
Q

Symptoms of chronic brucellosis are virtually
indistinguishable from ______ and
can present with ____

A

chronic fatigue syndrome

FUO.

158
Q

Diagnosis of brucellosus

• \_\_\_\_\_\_\_ if febrile (positive in 50% during
acute phase) 10, 13
• \_\_\_\_\_\_\_\_\_(rising titre)—acute
and convalescent (3–4 weeks) samples
• \_\_\_\_\_\_—sensitive and rapid
A

Blood cultures

Brucella agglutination test

Brucella PCR testing

159
Q

Adult Tx of brucellosus

Adults: _______ or __________

A

doxycycline 100 mg (o) bd for 6 weeks +
rifampicin 600 mg (o) daily for 6 weeks

gentamicin 4–6 mg/kg/day IV statim then daily
for 2 weeks (monitor

160
Q

Tx of brucellosus

Children:

A

cotrimoxazole + rifampicin
or
gentamicin

161
Q

% relapse of brucellosus

A

10%

162
Q

How to prevent brucellosus

A

Involves eradication of brucellosis in cattle, care

handling infected animals and pasteurisation of milk

163
Q

T or F

No vaccine is currently available for use in humans to prevent brucellosus

A

T

164
Q

It is
the most common abattoir-associated infection in
Australia and can also occur in farmers and hunters.

A

Q fever

165
Q

Agent causing Q fever

A

Coxiella burnetii

166
Q

Q fever

______ is not a major feature but can occur if the
infection persists without treatment

A

Rash

167
Q

Q fever

Persistent infection may cause _______ or ______ so patients with valvular disease are at
risk of endocarditis

A

pneumonia or

endocarditis

168
Q

What is the culture of Brucella IE

A

culture is negative

169
Q

fever + headache + prostration

A

Q fever

170
Q

Diagnosis of Brucellosis

• Serodiagnosis is by antibody levels in acute phase
and 2–3 weeks later _______ increase)
• Coxiella burnetii _____

A

(4-fold

PCR

171
Q

Tx of Brucellosis

A

Doxycycline 100 mg (o) bd for 14 days

172
Q

Tx of Brucellosis

For endocarditis or chronic disease

A

prolonged course of doxycycline plus clindamycin or

rifampicin

173
Q

Tx of Brucellosis

Children: >8 same antibiotics according to
weight; <8________ (instead of doxycycline

A

cotrimoxazole

174
Q

The disease can be prevented in abattoir workers by

using _____

A

Q fever vaccine

175
Q

In Australia it is almost exclusively an
occupational infection of farmers (especially with
flooded farmland in tropics) and workers in the meat
industry.

A

Leptospirosis

176
Q

Leptospirosis

Early diagnosis is important to prevent it passing into the ______

A

immune phase

177
Q

IP for Leptospirosis

A

Incubation period 3–20 days (average 10)

178
Q

Leptospirosis

Some may develop the immune phase (after an
asymptomatic period of 1–3 days) with aseptic meningitis
or jaundice and nephritis

What is this called?

A

icterohaemorrhagic

fever, Weil syndrome

179
Q

abrupt fever + headache + conjunctivitis

A

leptospirosis

180
Q

Tx of Lepto

1
2
3

A 
• Doxycycline 100 mg (o) bd for 5–7 days
or
• benzylpenicillin 1200 mg IV, 6 hourly for 5–7
days
or
• ceftriaxone 1 g IV daily for 5-7 days
181
Q

Very infective, it is caused by a spirochaete,
Borrelia burgdorferi, and transmitted by Ixodes ticks,
so that people living and working in the bush are
susceptible.

A

Lyme disease

182
Q

Pathognomonic rash of Lyme

A

The pathognomic sign is erythema migrans—a
characteristic pathognomonic rash, usually a
doughnut-shaped, well-defined rash about 6 cm in
diameter at the bite site.

183
Q

Stages of Lyme

1
2
3

A

Stage 1: erythema migrans, flu-like illness
Stage 2: neurological problems such as limb
weakness and cardiac problems
Stage 3: arthritis

184
Q

Tx of Lyme

A

Treatment
• Remove tick
• A typical regimen for adults is doxycycline
100 mg bd for 21 days or amoxycillin

185
Q

Most patients are bird fanciers. ____ accounts

for 1–5% of hospital admissions for pneumonia

A

Psittacosis

186
Q

MR from Psittacosis

A

Mortality can be as high as 20% if untreated.

187
Q

Psittacosis Dx
1
2

A
  • Serology—rising antibody and PCR

* Chest X-ray

188
Q

Psittacosis Tx

A

• Doxycycline 200 mg (o) or clarithromycin 250 mg,

12 hrly for 14 days (o)

189
Q

Listeriosis is caused by_____

A

Listeria monocytogenes

190
Q

Where can Listeria monocytogenes be found?

A

food and has been found in many fresh and processed

foods

191
Q

Pts at high risk for Listeriosis

A

high-risk groups such as pregnant women, the
immunocompromised, frail aged, and very young
but especially neonates and fetuses

192
Q

Tx of Listeriosis

A

Amoxycillin 1 g (o) 8 hourly or IV for 10–14

days

193
Q

A total of ______ of patients with tetanus have no

identifiable wound of entry

A

10–20%

194
Q 
Gas gangrene (clostridial myonecrosis) is caused
by entry of one of several clostridia organisms, for
example, \_\_\_\_\_\_\_\_\_\_, into devitalised
tissue, such as exists following severe trauma to a leg
A

Clostridium perfringens

195
Q 
Management Clostridium perfringens
• Refer immediately to surgical centre for
debridement
• Start \_\_\_\_\_
•\_\_\_\_\_\_ if available
A

benzylpenicillin 2.4 g IV, 4 hourly + clindamycin

Hyperbaric oxygen

196
Q

Botulism is food poisoning caused by the neurotoxin

of _____

A

Clostridium botulinum

197
Q

Suspect botulism if cranial nerve weakness

with normal sensation. ______ and _______ quickly develop

A

General muscle paralysis and

prostration

198
Q

Mycoplasma Tx

Adolescents and young adults:

treat with _____
or
with _____

A

doxycycline (first line) 200 mg statim then
100 mg daily for 14 days

roxithromycin 300 mg (o) daily for 14 days

199
Q
  • Related to cooling systems in large buildings

* Incubation 2–10 days

A

Legionella pneumophila (legionnaire disease)

200
Q

Tx of Legionella

Patients can become very prostrate with
complications—treat with _______

A

azithromycin (o or IV)
or erythromycin (IV or o) plus (if very severe) add
ciprofloxacin or rifampicin for 14 to 21 days

MC (90 decks)

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