Summary of infectious diseases Flashcards
The infectious disease history
PC HPC *EPIDEMIOLOGICAL HISTORY* -travel, vaccine and prophylaxis history, occupation, food/ drink, reacreational, sexual, animal contacts, special medical procedures, contacts PMH -relevant to infectious disease DH FH SH SE (systemic enquiry) -RS, CVS, GIT, GUT, CNS, MS, SS
Travel - commonest problems
Diarrhoea -E.coli, Salmonella, Campylobacter, viral Respiratory Tract Infections -usually viral, Legionella UTIs Skin/ soft infections (insect bites) Hepatitis (A) Malaria Typhoid Dengue Viral haemorrhagic fever Avian Influenza Middle Eastern Repiratory Syndrome - Coronavirus
Malaria - high rates
Central, E, W, Africa
S Africa (regional)
South Asia
SE Asia
Typhoid - high rates
Central, E, W Africa
South Asia
SE Asia
Dengue - high rates
Central America
South Asia
SE Asia
Australia/ S. Pacific
Viral haemorrhagic fever - high rates
Sporadic in E & West Africa
Eastern Europe and Central Asia
Avian Influenza - high rates
SE Asia
Middle East
MERS CoV
Middle East
Vaccine and prophylaxis history
Prophylaxis -malaria for recent travel Vaccines -travel (Hep A; typhoid; Neisseria) -general (childhood schedule)
Occupation
• Health Care Workers -blood borne viruses, LRTIs, diarrhoea • Farm Workers -leptospirosis, coxiella, orf • Sewage Workers -Leptospirosis, Hep A, gastroenteritis • Sex Workers -HIV, HepB, HSV, gonococcus, syphilis, chlamydia etc. • Pet Shop owners -psittacosis • Abbatoir Workers -anthrax • Military
Sexual history
• Recent partners – new? • Number of partners • Male or Female or Both • CSW? • Use of condoms • Travel sexual history (of index and partner) • STI’s? STI screens? – HIV, Hepatitis B, EBV, CMV, gonococcus, chlamydia, syphilis, HSV, also UTI
Sports
• Canoeists -leptospirosis, gastroenteritis • Cavers -histoplasmosis, marburg • Trekkers -lyme disease, other tick-borne diseases • Rugby Players -HSV, fungal infections • Swimmers -fungal infections, pox viruses, leptospirosis, gastroenteritis
Drug abuse
IV drugs -Hep C, Hep B, HIV, endocarditis, skin and soft tissue infection including anthrax, aspergillus Cannabis smokers -pneumonia, early COPD, lung abscess Alcoholism -TB, pneumonia, HIV
Pets
• Dogs -Campylobacter species, Toxacara, rabies • Cats -Toxoplasma • Rodents -rat bite fever, salmonella • Terrapins -salmonella • Psittacine Birds -chlamydia psittaci • Tropical Fish -mycobacterium marinum • Wild and Domestic Fowl -avian influenza • Agricultural animals (city farms etc) -coxiella spp., salmonella, E.coli (e.g. 0157)
Relevant past medical history
• Head Injury -meningitis (especially pneumococcal) • Cancer • Use of immunosuppression -CMV, VZV, PCP, neutropenic sepsis (bacteria, fungi) • Splenectomy -pneumococcal bacteraemia • Dentistry -endocarditis • Previous history of infectious disease -especially meningitis, pneumonia, cellulitis
Special medical procedure
• Blood Transfusions/Blood products -HIV, HBV, HCV, malaria!, prions • IV cannula -skin and soft tissue sepsis (bacterial) • Prosthetic joints or heart valves -serious persistent bacterial infections • IUCD -actinomycosis • Body piercing -skin sepsis
Contacts
• Tuberculosis
• Sexually transmitted infections including
HIV
• Meningococcal Disease
• Shingles, Chicken Pox
• Measles, Rubella, Mumps
• Diarrhoea (viruses, food borne outbreaks)
Principles of infection exam and tests
Response to infection
-systemic: fever/ malaise, vital signs, CRP/ white cells, rashes
-local: inflammation, destruction, abscess
-specific: antibody or cell mediated
Isolate pathogen
-sterile site: blood, CSF, urine, bone/ joint
-non sterile site: skin, gut, resp tract
Diagnosing infection
Isolate a pathogen -PCR -stool sample -culture bacteria -blood test Detect specific immune response -e.g. Hep A serological response (anti-HAV IgM --> anti-HAV IgG) -e.g. tuberculin skin test "Mantoux" or "Heaf" (T cell response)
