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MBChB > Infections > Flashcards

Infections Flashcards

1
Q

What type of bacteria commonly cause septic arthritis?

A

Gram Positives (S.pyogenes, Group G Strept, Pneumococcus)

Gram negative (H.inflenzae, Kingella, N.meningitidis)

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2
Q

What bacteria commonly cause prosthetic joint infections?

A

CoNS
S.aureus
Gram negative bacilli
Streptococci

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3
Q

Define virulence in terms of organisms

A

Ability of an organism to infect

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4
Q

Why are prosthetic joints more likely to develop sepsis?

A

Require fewer bacteria than soft tissue to establish sepsis

Avascular - protected from circulating immunological defences and most Abx

Cement can inhibit phagocytosis and lymphocytic/complement function

Biofilms can easily develop on metal

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5
Q

What Abx should be given prophylactically prior to joint replacement surgery?

A

Cephalosporin

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6
Q

When should prophylactic cephalosporin be given prior to joint replacement surgery?

A

30-60 mins prior to skin incision

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7
Q

What is the cut off as to whether a joint prothesis is salvageable following infection?

A

30 days post op

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8
Q

What is the surgical management of an acute joint prothesis infection?

A

Debride
Antibiotics
Implant
Retained

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9
Q

Following an acute joint prothesis infection, how long are Abx required for?

A

4-6 weeks IV

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10
Q

What Abx are useful for managing a prosthetic joint infection post surgery?

A

Rifampicin

Ciprofloxacin

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11
Q

Define osteomyelitis

A

Progressive infection of bone characterised by new bone formation and loss of the integrity of the bone

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12
Q

What type of bacteria commonly cause osteomyelitis?

A

Anaerobes

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13
Q

Describe the management of osteomyelitis

A

Surgical debridement

May require 4-6week IV Abx

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14
Q

Describe vertebral discitis

A

Infection of the disc space and adjacent vertebral end plates

Can be very destructive
Deformity
Spinal cord instability –> cord compression, paraplegia, disability

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15
Q

Define neutropenia

A

<0.5 x 10^9/L or <1.0 x 10&9/L and falling

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16
Q

What gene is defective in chronic granulomatous disease?

A

Gene which encodes for NADPH oxidase in neutrophils

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17
Q

What are the effects of chronic granulomatous disease?

A

Deficient production of oxygen radicals
Defective intracellular killing

Recurrent bacterial and fungal infections

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18
Q

What is the life expectancy for people with chronic granulomatous disease?

A

40 (due to prophylaxis Abx)

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19
Q

Give 3 causes of cellular immunity suppression

A

DiGeorge Syndrome
Malignant lymphoma
Cytotoxic chemotherapy
Infections

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20
Q

Give 3 examples of immunosuppressive drugs

A 
Corticosteroids
Cyclosporins
Tacrolimus
Alemtuzumab
Rituximab
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21
Q

What condition results in mature B cells not being produced?

A

Bruton agammaglobinuaemia

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22
Q

In what type of leukaemia, is humoral immunity preserved?

A

Acute leukaemia

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23
Q

What will intensive radiotherapy and chemotherapy result in?

A

Hypoglubinaemia

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24
Q

What is the immunological function of the spleen?

A

Splenic macrophages eliminate non-opsonised microbes eg encapsulated bacteria

Site of primary immunoglobulin response

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25
Q

If the spleen is defective, what infections are a person at a greater risk of developing?

A

S. pneumoniae
Haemophilius influnezae type B
Neisseria meningitidis

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26
Q

What immunoglobulin is found in sweat glands?

A

IgA

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27
Q

Define impaired nutritional status

A

<75% ideal body weight OR rapid weight loss
AND
Hypoalbuminaemia

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28
Q

If a patient has an impaired nutritional status, what is the effects in terms of their infection risk?

A

Too few B and T cells

Increased risk of infections

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29
Q

Describe pneumocystis jerovecii

A

Fungal infection

Causes a severe lung infection following transplant

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30
Q

Describe aspergillus

A

Causes infections in patients who have febrile neutropenia or who have had chemotherapy

Treat with Abc then add in anti-fungal on d3

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31
Q

Describe the clinical importance of recognising a cancer patient with febrile neutropenia

A

Medical emergency

Cancer patient + temperature –> infection until proven otherwise

Do blood cultures

Bloodstream infections are most troublesome –> systemic infection

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32
Q

Define SIRS

A 
Sweats
Chills 
Rigors
Malaise 
Tachypnoea (>20/min)
Tachycardia (>90bpm)
Hypotensive
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33
Q

Define sepsis

A

Evidence of infection and organ dysfunction

2 or more:
Hypotensive
Confusion
Tachypnoea >22/min

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34
Q

Define septic shock

A

Sepsis induced hypotension (SBP <90mmHg or reduced by >40mmHg from baseline) requiring inotropic support or hypotension which is unresponsive to adequate fluid resuscitation

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35
Q

Define neutropenic sepsis (febrile neutropenia)

A

Neutrophil count of <0.5 (or <1 if recent chemo) + fever/hypothermia or SIRS or SEPSIS/SEPTIC SHOCK

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36
Q

What scoring system can be used to assess the severity of sepsis?

A

NEWS

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37
Q

In what time frame should SEPSIS 6 be implemented in a patient with sepsis?

A

1 hour

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38
Q

What is SEPSIS 6?

A
  1. Blood cultures
  2. Urine output
  3. Serial lactates
  4. High flow O2
  5. IV fluid resuscitation
  6. IV ABx
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39
Q

If a patient is septic, and a skin or soft tissue infection is suspected, what Abx should be added?

A

Vancomycin

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40
Q

If a patient is septic and considered to have an atypical pneumonia, what Abx should be added?

A

Clarithromycin

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41
Q

What bacteria causes gonorrhoea?

A

Neisseria gonorrhoea

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42
Q

Describe Neisseria gonorrhoea

A

Gram negative intracellular diplococci

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43
Q

What symptoms are typically present in a male with gonorrhoea?

A

Anterior urethritis

Purulent urethral discharge

Dysuria

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44
Q

What symptoms are typically present in a female with gonorrhoea?

A

Increased vaginal discharge

Dysuria

Post-coital/intra-menstrual bleeding

Lower abdominal pain

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45
Q

Describe how gonorrhoea infections are diagnosed

A

Urethral gram stain (sample from within urethra)

Uses the NAAT test
Males = urine sample ± rectal/throat swab
Females = vulvovaginal swab

Combine with testing for chlamydia

46
Q

What systemic condition is associated with disseminated gonorrhoea?

A

Reactive arthritis

47
Q

Describe the management of gonorrhoea

A

Ceftriaxone 500mg IM
Azithromycin 1g

Partner notification

48
Q

What bacteria often co-exists with chlamydia trochomatis?

A

Mycoplasma genitalium

49
Q

What is the major clinical effect of chlamydia infections?

A

Mostly asymptomatic (80% F’ 50% M)

Delays in treatment

16% of women develop PID (tubal infertility, ectopic pregnancy, chronic pelvic pain)

50
Q

What symptoms are typically present in males with chlamydia?

A

Anterior urethritis
Purulent discharge
Dysuria

51
Q

What symptoms are typically present in females with chlamydia?

A

Increased vaginal discharge
Dysuria
Post-coital/inter-menstrual bleeding
Lower abdominal pain

52
Q

How is chlamydia diagnosed?

A

NAAT test
M: first void urine samples
F: vulvovaginal swab

53
Q

How is chlamydia treated?

A

Doxycycline 100mg BD for 1 week

Azithromycin 1g oral stat + 500mg od for 2 days

54
Q

What causes Lymphogranuloma venereum (LGV)?

A

Invasive serovars L1 L2 L3 of Chlamydia trochomatis

55
Q

What population are more likely to develop Lymphogranuloma venereum (LGV?)

A

MSM esp if have HIV

Frequently associated with other STIs and Hep C

56
Q

Describe the clinical stages of Lymphogranuloma venereum (LGV)

A

Transient - painless papule (shallow ulcer) at site of inoculation 3-30d post exposure

Proctitis - rectal pain, mucupurulent discharge, rectal bleeding, constipation, tenesmus + systemic symptoms

Chronic inflammatory response –> fistulae, strictures, granulomatous fibrosis (mimics Crohn’s disease)

57
Q

What is the management of Lymphogranuloma venereum (LGV)?

A

Doxycycline 100mg BD for 21 days

58
Q

What bacteria causes Syphilis?

A

Treponema pallidum (a motile spirochaete)

59
Q

Describe primary syphilis

A

Around 21d post exposure, a papule develops at site of inoculation –> ulcerates –> painless, firm ulcer (chancre)

Painless regional lymphadenopathy

Chancre heals in 2-6 weeks

60
Q

Describe secondary syphilis

A

Constitutional symptoms appear 6-10wks post primary lesion

Fever, sore throat, malaise, arthralgia (due to septicaemia)

61
Q

What are the common signs associated with secondary syphilis?

A

Widespread skin rash (non-itchy, maculopapular, coppery colour)

Generalised lymphadenopathy

Condylomata lata - moist wart like plaques found in the perianal area and other moist sites

62
Q

How is syphilis diagnosed?

A

IgG and IgM detected using treponemal enzyme immunoassay

63
Q

Describe tertiary syphilis

A

Develops in 1/3 of people with untreated latent syphilis

Commonly involves the bones, but can involve any organ

64
Q

Describe the treatment of syphilis

A

Penicillin injections
Doxycycline if have penicillin allergy
Repeat bloods 3/12

65
Q

Give examples of bacterial STIs

A

Chlamydia
Gonorrhoea
Lymphogranulosa venerum
Syphilis

66
Q

What HPV strains cause genital warts?

A

6 and 11

67
Q

What causes the risk of developing genital warts following exposure to HSV to increase?

A

Smoking
Pregnancy
Immunocompromised

68
Q

Gardasil protects against which strains of HPV?

A

6, 11, 16 18

69
Q

How can genital warts be treated?

A

Topical podophyllotoxin (2x daily for 3 consecutive days of the week)
Ablative treatment
Imiquimod

70
Q

Describe the virus that causes molluscs contagiosum

A

Large DNA Pox virus

71
Q

Describe the papule associated with molluscs contagiosum infections

A

Small, benign, smooth papules with central umblication

72
Q

What are the two types of herpes simplex virus?

A

HSV 1 and 2

73
Q

Describe primary infection of HSV

A

First time infected with either HSV1/2

Multiple painful, shallow ulcers

Tender inguinal lymphadenopathy

Systemic symptoms of viraemia - fever, malaise, headaches

74
Q

Describe non-primary infection of HSV

A

Previously infected with HSV1/2 then acquire the other

A degree of cross-protection –> milder illness

75
Q

Describe recurrent infection of HSV

A

Reactivation of previous HSV1/2 infection

HSV2 reactivation occurs more commonly than HSV1 reactivation

76
Q

How is HSV diagnosed?

A

PCR - distinguishes between HSV1/2

77
Q

Describe the treatment of HSV

A

Primary infection = aciclovir 400mg TDS for 5 days

Recurrence = aciclovir 800mg TDS for 2 days

Suppression = aciclovir 400mg BD 6-12 months

78
Q

What is the leading cause of meningitis in children?

A

N.meningitidis

79
Q

What is the leading cause of meningitis in adults?

A

S.pneumoniae

80
Q

What is leading cause of meningitis in children between 3 months and 6 years?

A

H.influenzae

81
Q

In what population of people, does listeria need to be considered as a potential cause of meningitis?

A

Over 60s

Immunocompromised

82
Q

What bacteria, that can cause meningitis, is described as being a gram positive bacilli?

A

Listeria

83
Q

What bacteria, that can cause meningitis, is described as being a gram positive diplococci?

A

S.pneumoniae

84
Q

What bacteria, that can cause meningitis, is described as being a gram negative diplococci?

A

N.meningitidis

85
Q

What are risk factors for developing pneumococcal meningitis?

A 
>60yrs
Immunosuppression
Alcohol dependency 
Middle ear infection 
Previous head trauma
Surgery
86
Q

What CSF results are associated with bacterial meningitis?

A

Raised neutrophils
Low glucose
High proteins

87
Q

What CSF results are associated with viral meningitis?

A

Raised neutrophils
High proteins
Normal glucose

88
Q

What Abx should be given pre-hospital if a patient is suspected of having meningitis?

A

Benzyl penicillin
Ceftriaxone
Chloramphenicol

89
Q

Describe the immediate management of a patient with meningitis

A

ABC
Blood cultures
Abx + dexamethasone
LP (CT if needed)

90
Q

What Abx should be given to a patient with meningitis?

A 
Ceftriaxone
Amoxicillin 
Benzyl penicillin 
\+ Vancomycin (pneumococcus meningitis) 
\+ Gentamicin (listerosis)
91
Q

Why are patients with meningitis given dexamethasone?

A

Prevents complications such as deafness/hydrocephalus

Given at the start of Abx therapy (continue for 4 days)

92
Q

If a patient has meningitis, who needs to be informed?

A

Public Health

93
Q

What Abx should be given as prophylaxis to close contacts of a patients with meningitis?

A

Ciprofloxacin

94
Q

Once a patient has recovered from meningitis, what test do they require?

A

Audiology hearing test

95
Q

What viruses commonly cause the common cold?

A

Rhinovirus

Coronavirus

96
Q

What virus causes acute bronchitis?

A

RSV

97
Q

What virus causes pharyngitis?

A

Adenovirus

98
Q

What virus causes bronchiolitis?

A

RSV

99
Q

What virus causes croup?

A

Parainfluenza virus

100
Q

What viruses causes pneumonia?

A

Influenza

RSV

101
Q

How can you differentiate as to whether pharyngitis is more likely to be viral or bacterial?

A

Nasal symptoms = viral

No nasal symptoms = bacterial

102
Q

What virus causes glandular fever?

A

EBV

103
Q

Describe croup

A

Seal like barking cough
Caused by parainfluenza virus especially 1+3
Supportive treatment

104
Q

Describe bronchiolitis

A

Lower respiratory tract infection of young children
Wheeze and tachycardia
7-10d duration, cough persists up to 3 weeks
RSV is the most common cause
Most children infected by 2 (re-infection is common but less severe)

105
Q

Describe RSV

A

Affects immunocompromised, adults with chronic lung disease, elderly

106
Q

What is Ribivirin? What side effects are associated with it? When is it used?

A

Broad spectrum antiviral

Anaemia, abdominal pain, depression/suicidal thoughts

Given to high risk children (pre-term, <6months, oxygen requirement under 2s, cardiopulmonary disease in under 2s)

107
Q

What influenza viruses cases flu?

A

Influenza virus A-C

108
Q

Give complications associated with flu

A 
Acute otitis media
Sinusitis
Secondary bacterial pneumonia
Exacerbation of underlying disease
Dehydration
109
Q

What causes epidemics of flu?

A

Antigenic drift

110
Q

What causes pandemics of flu?

A

Antigenic shifts

MBChB (14 decks)

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