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1
Q

What is the most common cause of malaria?

A

plasmodium falciparum

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2
Q

List notifiable diseases.

A

Inform the Public Health Consultant

  • Anthrax
  • Cholera
  • Diphtheria
  • Dysentery
  • Encephalitis
  • Food poisoning
  • Leprosy
  • Mumps
  • Measles
  • Meningococcal sepsis
  • Malaria
  • Ophthalmia neonatorum
  • Plague
  • Poliomyelitis
  • Rabies
  • Rubella
  • Scarlet fever
  • Tetanus
  • TB
  • Typhus
  • Viral haemorrhagic fever
  • Whooping cough/ pertussis
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3
Q

List the malaria species.

A

all PLASMODIUM

  • p.vivax
  • p.oval
  • p.malariae
  • p.falciparum
  • p.knowlesi
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4
Q

What is the 1st vector in the malaria life cycle?

A

female Anopheles mosquito

injects plasmodium protozoa into first human host

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5
Q

How do you diagnose malaria?

A

3x serial thin and thick blood films stained with Giemsa stain

  • low cost
  • high sensitivity and specificity
  • an individual can have malaria despite a negative film
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6
Q

What blood results would you expect in malaria?

A 
FBC - thrombocytopenia, anaemia 
U&Es - renal failure 
clotting - DIC
glucose - hypoglycaemia 
ABG/lactate - lactic acidosis 
urinalysis - haemoglobinuria, proteinuria, casts
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7
Q

What do you see on blood film with plasmodium falciparum?

A

sausage-like gametocytes in RBC ghosts

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8
Q

When do patients infected with plasmodium falciparum present?

A

within 1month of the mosquito event

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9
Q

What are the common PC of falciparum malaria?

A
  • prodromal headache
  • malaise
  • myalgia +/- anorexia

–> then followed by 1st fever paroxysm

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10
Q

What are the signs of falciparum malaria?

A
  1. anaemia (haemolysis of parastized RBCs)
  2. jaundice
  3. hepatosplenomegaly
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11
Q

What is the central event in severe p.falciparum malaria?

A

sequestration of parasitized erythrocytes in the microvasculature of vital organs

mortality 100% if untreated

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12
Q

What is falciparum resistant to?

A
  • chloroquine

- Fansidar = pyrimethamine + sulfadoxine

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13
Q

How do you treat uncomplicated p.vivax, p.ovale, p.malariae ?

A

chloroquine base followed by Primaquine (to treat liver stage and prevent relapse)

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14
Q

How do you treat uncomplicated p.falciparum malaria?

A

combination therapy preferably containing artemisinin derivatives (recommended by WHO)

e.g. Artemether-lumefantrine

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15
Q

What prophylaxis precautions should travellers take against malaria?

A
  • avoid mosquitos
  • wear long sleeves between dusk and dawn
  • use repellent e.g.DEET
  • long-lasting insecticidal bed-nets
  • anti-malarial tablets
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16
Q

List some prophylactic anti-malarial treatments.

A
  1. little/no chloroquine resistance:
    - proguanil + chloroquine
    (because there is quite a lot of resistance with proguanil alone)
  2. chloroquine resistant p. falciparum:
    - mefloquine
    - doxycycline
    - proguanil + atovaquone
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17
Q

What are the SEs of chloroquine?

A
  • psychosis
  • headache
  • retinopathy
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18
Q

What are the SEs of Malarone?

A
  • abdo pain
  • nausea
  • headaches
  • dizziness
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19
Q

Where/when do the plasmodium merozoites undrgo asexual reproduction ?

A

RBCs

  • sporozoites from mosquito saliva go into blood stream of initial human host –> travel to liver –> mature into merozoites –> merozoites invade RBCs –> undergo asexual reproduction
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20
Q

What is the most common imported tropical disease into the UK?

A

malaria

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21
Q

What are the differential diagnoses for malaria?

A
  • typhoid
  • dengue fever
  • influenza
  • HIV
  • hepatitis
  • meningitis/encephalitis
  • viral haemorrhagic fevers
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22
Q

Inw hat condition should primaquine not be given ?

A

G6PD

  • it can cause haemolysis
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23
Q

What is the hallmark histological finding for TB?

A

caseating granulomata

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24
Q

How do you diagnose TB?

A
  1. Mantoux test
    - diagnosis of latent TB
    - if +ve consider interferon gamma testing
  2. Sputum sample
    - diagnosis of active TB
    - send for MC&S for acid-fast bacilli - they resist acid on Ziehl-Neelsen staining
  3. Other sample e.g. pus, urine, ascites…
    - diagnosis of active non-respiratory TB
    - send samples for culture
    - incubate up to 12 weeks on Lowenstein-Jensen medium
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25
What are CXR findings for TB?
- consolidation - cavitation - fibrosis - calcification
26
What is the Tuberculin skin test?
assesses immunity - if +ve = immune to TB - may also indicate previous exposure/BCG
27
What is the causative organism of TB?
Mycobacterium tuberculosis
28
How is TB spread?
inhalation of infected droplets
29
What are the risk factors for acquiring TB?
1. close contact with TB pts 2. ethnic minority groups 3. homeless, alcoholics and other drug abusers 4. the elderly 5. children 6. HIV pts + other immuno-compromised pts 7. chronic comorbidities
30
How do people with primary TB commonly present
it is usually asymptomatic
31
What are the general symptoms seen in TB?
- malaise - night sweats - anorexia - fatigue - fever - FTT - PUO
32
What systems can TB affect? List some symptoms.
1. pulmonary TB - general symptoms - haemoptysis, cough, purulent and blood stained sputum, pleurisy 2. GU - 'sterile' pyuria - dysuria, frequency, loin pain, haematuria 3. Bone - vertebral collapse and Pott's vertebra 4. CNS - TB meningitis - non specific; headache, vomiting, altered behaviour 5. Skin - lupus vulgaris (jelly nodules on face and neck) - erythema nodosum 6. GI - abdo pain, ascites 7. lymph nodes - lymphadenopathy 8. cardiac - pericardial effusion
33
What essential things must you do with a new diagnosis of TB?
- contact tracing | - public health notification
34
what investigations must be carried out before commencing ethambutol?
test colour vision (Ishihara chart) and visual acuity as ethambutol can cause optic neuritis/toxicity
35
What is the treatment rigimen for TB ?
8 weeks on 4 drugs: 1. Rifampicin 2. Isoniazid 3. Pyrazinamide 4. Ethabutol 16 weeks on 2 drugs (continue for another 8 weeks!): 1. Rifampicin 2. Isoniazid
36
What are the SEs of rifampicin?
- orange discolouration of body secretions and urine - deranged LFTs - inactivation of the pill
37
What are the SEs of isoniazid?
- polyneuropathy (give pyridoxine as alternative)
38
What are the SEs of pyazinamide?
- arthralgia - gout - hepatitis
39
What are the SEs of ethambutol?
- optic neuritis (colour vision is the first to deteriorate)
40
What are the CXR findings for primary TB ?
- apical lung lesion | - left lower lobe infiltration/effusion
41
What is miliary TB?
occurs after haematogenous dissemination | CXR: millet seeds all over the lung fields
42
What is the most common worldwide cause of HIV?
heterosexual sexual intercourse transmission
43
What vaccinations should HIV patients receive?
- hep A | - hep B
44
What type of virus is HIV?
reverse transcriptase RNA retrovirus
45
What other infections disease is common in HIV patients?
TB
46
What infectious diseases should all newly diagnosed HI patients be tested for?
- toxoplasma - CMV - hepatitis B/C - syphilis
47
What are the characteristic findings of toxoplasmosis on CT/MRI?
ring-shaped enhancing lesions | particularly in the thalamus
48
What is the main CNS pathogen in AIDS?
toxoplasma gondii
49
List the different types of SOL HIV patients get.
1. neoplastic - primary cerebral lymphoma - B cell lymphoma 2. non-neoplastic - cryptococcal meningitis - toxoplasmosis
50
List the main opportunistic infections in HIV .
- TB - pneumocystic jiroveci - candidiasis - toxoplasmosis - cryptococcal meningitis - CMV retinitis - cryptosporidium
51
What is the characteristic finding on fundoscopy for CMV retinitis?
'mozerella pizza' sign
52
What is pneumocystis jiroveci and how do you treat it?
- the chief life-threatening fungal opportunistic infection | - treat with co-trimoxazole + prednisolone
53
You have a young HIV patient with decreased exercise tolerance - what do you suspect?
infection with pneumocystis jiroveci
54
What are CT thorax findings of pneumocystis jiroveci?
ground-glass opacity consolidation nodules cysts
55
When should a HIV patient be prescribed co-trimoxazole as primary prophylaxis against pneumocystis jiroveci?
CD4<200
56
How do you treat oral candida?
Nystatin
57
What is HAART?
highly-active anti-retroviral therapy - -> involves the use of at least 3 anti-retroviral drugs - -> combo often involves 2x reverse transcriptase inhibitors and 1x integrase/protease inhibitor
58
What are the different classes of anti-retroviral drugs used in the treatment of HIV?
'RIP' 1. reverse transcriptase inhibitors - nucleoside/non-nucleoside 2. protease inhibitors 3. integrase inhibitors
59
Give an example of a nucleoside reverse transcriptase inhibitor (NRTI).
Zidovudine
60
Give an example of a non-nucleoside reverse transcriptase inhibitor (NNRTI).
Nevirapine
61
Give an example of an integrase inhibitor.
Raltegravir
62
What is the mechanism of action of protease inhibitors/.
- slow cell-to-cell spread | - lengthen the time to the first clinical event
63
List an example of a protease inhibitor.
Saquinavir
64
What type of hepatitis must you have to acquire hep D?
hep B
65
What type of virus is hep A?
RNA virus
66
What is the mode of transmission of hep A?
1. faecal-oral | 2. shellfish
67
What blood results would you see with hep A?
- raised ALT and AST (v high ALT) - raised IgM with active infection - raised IgG detectable for life
68
What sort of virus is hep B?
double-stranded DNA virus
69
How is hep B transmitted?
- due to percutaneous/mucosal contact with infectious blood or bodily fluids - can be vertical or horizontal
70
What are the symptoms of acute hep B infection?
- fatigue - malaise - N&V - jaundice - dark urine - pale stools - RUQ abdo pain - joint pain
71
List the 4 phases of chronic hep B infection.
1. immunotolerant phase - early phase - v high HBV DNA but normal LFTs 2. active phase - v high HBV DNA and fluctuating ALT - most develop HBe-Ag +ve chronic hep B 3. inactive phase - seroconvert spontaneously to anti-HBe - low HBV DNA and normal LFTs 4. reactive phase - flare up
72
What antibodies do you develop after having the hep B vaccination,
These individuals will have antibodies to HBsAg alone
73
What investigation would you do to stage hep B disease.
liver biopsy
74
What groups of people are at risk of getting hep B?
- IVDU - hospital workers - male-male sex - sex with infected partner - sharing razors/toothbrush with infected individual - haemodyalisis patients - infants born to infected mums (vertical transmission)
75
What blood results are specific for hep B?
- HBsAg - HBeAg - anti-HBe - anti-HBs - anti-HB core
76
What are the treatment options for hep B?
1. 1st line - interferon - 1 weekly injections for 1 year 2. 2nd line - tinofovir PO - (antiretroviral)
77
Which type of hepatitis is the main reason for liver transplants in the west?
hep C
78
What type of virus is hep C?
RNA flavivirus
79
What fraction of HIV patients have concurrent HCV?
1/3
80
Which types of hepatitis are there vaccinations for?
1. hep A 2. hep B (NO vaccination for C D E)
81
How do you treat hep C?
protease inhibitor (boceprevir/tolaprevir) + ribavirin + interferon alpha
82
What other organ system does hepatitis commonly affect (in addition to liver)?
kidneys | - check urine annually
83
What type of virus is hep D?
incomplete RNA virus
84
How is Hep BD infection prevented?
hep B vaccination
85
What blood results warrant investigation for anti-HDV antibodies?
positive HBsAg
86
Which other viruses (apart from hepABCDE) cause hepatitis where the liver is not the primary infection site?
- CMV - EBV - adenovirus - herpes simplex virus
87
Which type of hep causes an acute infection?
hep A
88
Which types of hep cause chronic infections?
hep B | hep C
89
What investigations should you do for ?hepatitis ?
- FBC - U&Es - LFTs - clotting - hepatitis serology - imaging with USS/CT/MRI
90
What type of virus is hep E?
RNA virus (similar to HAV)
91
What is hep E associated with ?
pigs
92
What is the route of transmission of hep E?
faecal-oral route --> commonly via contaminated water and domestic pigs
93
What advice would you give to the GP if they suspected bacterial meningitis in a patient?
1. call an ambulance | 2. give 1.2g IM/IV benzylpenicillin if available
94
What are the worrying signs with bacterial meningitis?
- headache - pyrexia - neck stiffness - altered mental state
95
what is Kernig's sign?
pain + resistance on passive knee extension with hip fully flexed seen in meningitis
96
What rash is seen in meningitis?
non-blanching petechial rash
97
What ABx therapy would you give in suspected meningitis where causative organism is unknown?
<55y/o - cefotaxime 2g/6hr IV | >55y/o - cefotaxime 2g/6hr IV + ampicillin 2g/4hr IV
98
What prophylactic treatment can you give to household contacts in droplet range/those who have kissed the patient's mouth in meningitis?
``` rifampicin - 600mg/12hr PO for 2 days OR ciprofloxacin - 500mg PO ```
99
Who must you inform if you diagnose a case of meningitis?
Public Health England
100
What are the predominant cells in CSF of bacterial meningitis?
neutrophils
101
What are the predominant cells in CSF of TB and viral meningitis/.
lymphocytes
102
What are the main causative organisms in bacterial meningitis?
meningococcus and pneumococcus
103
What % parasitaemia is seen in severe malaria?
>2%
104
What is CURB65?
- confusion - urea >7mmol/L - RR >30 - BP <90 systolic - >65y/o score: 0-1 = possible treatment at home 2 = treatment in hospital 3 = consider ITU
105
What is the classic history of patient acquiring legionella pneumophilia?
it colonizes water tanks kept <60 degrees e.g. hotel air conditioning and hot water systems
106
What are the typical blood results in legionnaire's disease?
- lymphopenia - hyponatraemia - deranged LFTs
107
How do you manage gastroenteritis?
supportive therapy - maintain oral fluid intake - +/- oral rehydration can give antiemetics if severe disease butnot in dysentery
108
When would you give ABx in gastroeteritis?
only give if patient systemically unwell, immunosuppressed or elderly
109
What inflammatory reaction can HAART cause?
immune reconstitution inflammatory syndrome (IRIS)
110
How do you treat oesophageal candidiasis?
fluconazole
111
What is the investigation of choice in suspected toxoplasma infection (HIV pt)?
MRI
112
How does infection with toxoplasma gondii present?
- symptoms of a SOL - fiiting - focal neurological deficit - confusion - personality change

infectious diseases (1 decks)

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