ID Flashcards
2 conditions to delay ART in HIV
Tuberculous meningitis
Cryptococcus meningitis
Window period for HIV - how long, why, how to overcome
First 2-4 weeks, No Ab formation, can’t test for on ELISA
New tests pick up p24, or can test for VL (high within 5 days)
A/E to tenofovir
Nephrotoxicity
Myelosuppresion
WHich tenofovir has higher A/E profile
TDF higher ris
A/E of Abacavir
Hypersensitivity to HLA-B57*01
HIV treatment with depression/CNS toxicity in first few weeks
Efavirenz
HIV medication highest risk of SJS
Nevirapine
Integrase inhibitors - how to identify, A/E
Gravir
Weight gain
CCR5 antagonist
Maraviroc. Not useful as HIV can switch to binding CCR4
lamuvidine A/E
Lamuvidine - pancreatitis
When to use PRed in PJP pneumonia
PaO2 70 –> use Pred in addition to bactrim
CMV manifestations in HIV
Retinitis - Opthal
Colitis - inclusion bodies
CNS disease
Causes of enhancing CNS lesions in HIV
Toxoplasmosis
- +ve serology, enhancing lesions, CD4 <200
- Rx - bactrim
Primary CNS lymphoma
- CD4 < 50
Viral association Karposi’s
HHV8
Binding and fusion of HIV - important proteins
Binding - GP120 and GP41
FUsion - CCR5/CXCR4 coreceptors
HIV in pregnancy
Mothers - ART
At delivery
- C section
- VL > 1000 –> Anti-HIV IgG
PEP timeline
Must be < 72 hours
PEP for known source
Sexual
- VL +ve = ART for 28 days, VL- = leave
Occupational
- VL +ve - ART for 28 days
- VL -ve - x2 drugs for 28 days
PEP unknown source
x2 drugs 28 days
Elevated opening pressure
Cryptococcus meningitis
Management of PJP
Bactrim
Pred if PaO2 < 70
Treatment of syphilis
Benziathine penicillin (long acting)
Rx of gonorrhoea
Ceftriaxone and azithromycin
Rx of chlamydia
Doxycyline
Can use azithromycin as alternative
Immunocompromsied, fevers, blistering rash, neutrophilic infiltrate on biopsy
Sweet’s syndrome
Gram positive diplococci
S pneumoniae
Gram negative diplococci
N meningitidies
Gram positive rods
BLANC
Bacillus
Listeria
Actinomyces
Nocardia
CLostridia/Corynebacteria
Gram negative coccoid rods
H influenzae
Bordatella pertussis
Ecythema gangrenosum cause
Pseudomonas
Treatment of cryptococcus
L-amb + 5FC (2 weeks)
8 week tail fluconazole
Treatment of invasive aspergillus
Voriconazole
Filamentous gram +ve rods (2)
Nocardia
Actinomyces
Nocardia is acid fast positive and grows well in aerobic conditions
Presentations of Nocardia
Pulmonary
CNS - parenchymal abscess
Cutaneous
Rx of nocardia
Bactrim
Neutropenic patient, abdo pain, bowel wall thickening and mucosal enhancement?
Typhilitis
RIsk factors for PTLD
EBV serostatus
Degree of immunosuppression
1st line treatment for PTLD
Lower immunsuppression
Pathophys of PTLD and 2nd line treatments
Aberrant clonal EBV positive B cell proliferation due to excessive T cell suppression
Rx - CD20 depletion (rituximab)
Daptomycin ineffective in?
Lungs - inactivated by surfactant
What to do with ABx in pneumococcal resistance?
Treatment failure rare, usually have SIE for MIC so increase dose
Proteus what?
Citrobacter what?
In ESCAPPM
Proteus Vulgaris
Citrobacter freundii
Gene transfer through direct cell to cell contact, usually through sex pillus
Conjugation
Transfer of genetic material between bacteria by means of viral vector
Transduction
Vector called bacteriophage
Amb Class B CRO
- Example
- WHere?
NDM-1
New Dehli
Amber Class C
- Example
AmpC enzymes
ESCAPPM organisms
Oxa-48 B lactams - ?where
North Africa and Mediterranean
CRE most common in USA
KPC
Management of CRO
Colitistin + tigecycline + 3rd agent
Recurrent viral self resolving viral meningitis - cause?
Mollaret’s
HSV-2
Which conditions would be indications for TOE in suspected ?IE
Bacteraemia
IVDU
High risk cardiac condition
Indeterminate TTE
Indications for IE Prophylaxis
High risk heart condition - rheumatic, prosthetic valve
High risk surgery - dental, tonsillectomy, surgery at site of known infection
TB interferon test - how does it work?
Patient’s plasma re-exposed to TB antigen - T cells will produce IFNy which can be detected
Uncomplicated P falciparum treatment
Simple - artemether + lumefantrine
Severe - significant organ involvement, parasite count > 100,000 or >10% - IV artesunuate
Treatment of P vivax/ovale
Add primaquine to standard treatment, beware G6PD deficienc
Malaria PPx
Doxycycline 1 day before and 4 weeks after
Malarone - Atuovacone + proguanil
C’s of measles
Prodrome - fevrs, cough, coryzal, conjunctivitis
K(c)oplik’s spots
Craniocaudal rash
Live vaccines
MMR BOY Japenese RITZ
BCG
Oral Polio
Yellow fever
Japanese encephalitis
Rotavirus
Typhoid
Zoster/Varicella
Chigger mites
Scrub typhus