Bacteria

Question 1

Leprosy PB Treatment (first line)

Answer 1

6/12 Rif monthly Dapsone daily (Clofazamine also given to simplify, but this is contentious as causes darkened skin)

Question 2

Leprosy MB Treatment (first line)

Answer 2

12/12 Rif monthly, Dapsone and Clofazamine daily

Question 3

Leprosy Facts

Answer 3

M leprae are found in nasal droplets of highly infected individuals and thought to enter th ebody through URT

Question 4

Leprosy Facts

Answer 4

Affinity for cooler sites of body, peripheral nerves and skin, rarely eyes, mucus membranes, testes, bones and viscera

Question 5

Leprosy Incubation

Answer 5

Long, 3-5 years, to >20 years

Question 6

Leprosy TT

Answer 6

High CMI Low bacteria = PB

Question 7

Leprosy LL

Answer 7

Low CMI High bacteria = MB

Question 8

Leprosy Borderline

Answer 8

At highest risk for reactions

Question 9

Leprosy Skin

Answer 9

> 95% of patients with leprosy will have a skin lesion

Question 10

Leprosy Symptoms

Answer 10

Numbness in hands and feet, deformities, painless ulcers or burns, nasal stuffiness, ptosis

Question 11

Leprosy TT Skin

Answer 11

Well defined, asymmetrical, not many, may mimic ringworm, anaesthesia, often affecting buttocks, face and extensor surfaces of limbs (cooler parts of body)

Question 12

Leprosy BT Skin

Answer 12

Ill defined, satellite lesions

Question 13

Leprosy BB Skin

Answer 13

Central healing area, looks more like ring

Question 14

Leprosy BL Skin

Answer 14

Symmetrical and more diffuse

Question 15

Leprosy LL Skin

Answer 15

Nodules and infiltration, associated nasal stuffiness, discharge, epistaxis, oral lesions, hoarseness

Question 16

Leprosy Nerve signs

Answer 16

Thickening, hand burns, muscle wasting, claw hand, foot ulcers

Question 17

Leprosy Eye signs

Answer 17

Lagophthalmitis (inability to close eyes causes dryness), reduced corneal sensation - abrasions, acute or chronic iritis, cataract

Question 18

Leprosy WHO Disabiity grading Eyes

Answer 18

2 = reduced vision (unable to count fingers at 6m) or lagophthalmos

Question 19

Leprosy WHO Disability grading Hands

Answer 19

1 = palmar sensory loss, 2= wounds, claw hand, or loss of tissue

Question 20

Leprosy WHO Disability grading Feet

Answer 20

1 = sole sensory loss, 2= wounds, loss of tissue, foot drop

Question 21

Leprosy Split skin

Answer 21

Forehead, eyebrows, ear lobes - ZN staining

Question 22

Leprosy Three cardinal signs

Answer 22

Definite loss of sensation in hypopigmented or reddish skin patch; thickened peripheral nerve with loss of sensation/motor fx supplied by nerve; or presence of AFB on slit smear

Question 23

Leprosy Diagnosis

Answer 23

At least one cardinal sign

Question 24

Leprosy WHO PB Definition

Answer 24

5 lesions or less

Question 25

Leprosy WHO MB Definition

Answer 25

6 lesions or more

Question 26

Leprosy AE Dapsone

Answer 26

Hypersensitivity more common in Asia and G6PD deficiency

Question 27

Leprosy AE Clofazamine

Answer 27

Hyperpigmentation, ichythyosis (fish scale skin)

Question 28

Leprosy AE Rifampicin

Answer 28

Orange body fluids

Question 29

Leprosy PB Treatment endpoints

Answer 29

30% will still have active skin lesions afer 6 months

Question 30

Leprosy MB Treatment endpoints

Answer 30

BI falls 1 unit per year - look at appearances of AFBs (how broken do they look?)

Question 31

Leprosy Treatment (second line)

Answer 31

Mino/Oflox/Clari OR monthly Rif/Moxi/Mino - newer agents Bedaquiline and Telacebec

Question 32

Leprosy Chemoprophylaxis for household

Answer 32

Single dose Rifampicin

Question 33

Syphilis Screening

Answer 33

Unless testing and treatment of syphilis in pregnancy are universally available, over half of pregnancies in women with syphilis will result in an adverse outcome

Question 34

Syphilis RPR testing

Answer 34

Sens 85-95% Spec 95-98%

Question 35

Syphilis MTCT

Answer 35

Primary 60%, Secondary 90%, Early latent 40%, Late latent <10%, causes 7.7% of avoidable stillbirths, although risk lower with late latent, most women are late latent, therefore most transmissions occur in asymptomatic women

Question 36

Syphilis Treatment

Answer 36

Primary, Secondary, Early latent IM Benzathine penicillin 2.4m units stat; Late latent x3 (no evidence to support this)

Question 37

Syphilis WHO elimination congenital syphilis

Answer 37

>95% antenatal ateenders screened, >95% seropositive treated, incidence of congenital syphilis <50 per 100,000 births

Question 38

Brucella Diagnosis

Answer 38

GNCB intracellular on any sample inc BC, PCR, Serum agglutination ELISA >1:160 (>1:320 endemic), Rose Bengal (total Ab agglutination, not B canis)

Question 39

Brucella Transmission

Answer 39

Low infective dose 10-100 bacteria, inhale or ingest. Commonest bacterial zoonosis worldwide - unpasteurised dairy, undercooked meat, contact with mucus membranes, aerosolisation during butchery, Lab-acquired

Question 40

Brucella Epidemiology B melitensis

Answer 40

SE Europe, ME, Sth America, SE Asia, dairly products

Question 41

Brucella Pathogenesis

Answer 41

Circulates in reticuloendothelial system (similar to dimorphic fungi) go to LN, bone marrow, liver/spleen

Question 42

Brucella Treatment

Answer 42

Difficult (intracellular) Doxy 45d and Streptomycin 10d (or Gent) (relapse 5%) - second line Doxy and Rif 45d (relapse 16%)

Question 43

Brucella Symptoms

Answer 43

Nonspecific, undulent fever (over weeks), migratory arthralgia, hepatosplenomegaly, thrombocytopaenia, elevated LFTs

Question 44

Brucella Complications

Answer 44

Endocarditis, sacroilitis, epididymoorchitis, OM, spondylodiscitis (Pedro Pons' sign - erosion anterosuperior vertebrae)

Question 45

Brucella Prevention

Answer 45

Animal vaccines, wear PPE, adequately cook meat, pasteurise dairy