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Immunosupression/Other infectious diseases Flashcards

(49 cards)

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1
Q

How do you diagnose malaria?

A

Serial blood films

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2
Q

What is malaria?

A

A plasmodium protazoa taht is injected by female mosquitos and multiplies in red blood cells causing haemolysis, seuestrian and cytokine release. People present with fever, sweating and impaired GCS

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3
Q

How do you treat malaria?

A

Chloroquinine (don’t use if they have been taking this for prophylaxis)

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4
Q

What is the advice on malaria prophylaxis?

A

Malarone or mefloquine taken before, during and after trip

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5
Q

What are the main side effects on chloroquinine?

A

Headach, psychosis

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6
Q

How do diagnose someone whose chest X ray suggests TB?

A

Sputum samples for MC + S and acid fast bacilli

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7
Q

What is the histology of TB lesions like?

A

Causeating granulomas

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8
Q

What does a positive mantoux test mean?

A

Immunity, previous exposure of BCG

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9
Q

What conditions might you get a false negative on the mantoux test?

A

Immunosupressive states such as lymphoma, AIDs, Sarcoid, miliary TB

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10
Q

What does a very strongly positive mantoux test mean?

A

Active infection with TB

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11
Q

What tests do you need to do before you start treatment for someone with confirmed TB?

A

FBC
Renal function
Liver function
Colour vision and visual acuity (ethambutol can cause irreversible occular toxicity)

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12
Q

What is the treatment for TB?

A

Rifampicin
Isoniazid
Pyrizinamide
Ethambutol

All 4 for 2 months and then rifampicin and isonizid for a further two months

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13
Q

What are the main side effects of rifampicin?

A

hepatitis (small rise in AST is ok but stop if the bilirubin increases by too much) Orange discolouration of body fluids

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14
Q

What is the interaction between rifampicin and the cotraceptive pill?

A

Rifampicin is a potent enzyme inducer so inactivites the pill

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15
Q

What are the main side effects of isonizad?

A

Hepatitis, neuropathy, agranulocytosis

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16
Q

What are the main side effects of ethambutol?

A

Optic neuritis (colour vision is the first to go)

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17
Q

What are the main side effects of pyrazinamide?

A

Hepatitis, arthralgia

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18
Q

What is the test for genital herpes?

A

PCR

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19
Q

What is the treatment for genital herpes?

A

Aciclovir oral

Analgesia

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20
Q

How do you diagnose suspected herpes simplex encephalitis?

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A

Urgent PCR on CSF

21
Q

how do you treat herpes simplex enchephalitis?

22
Q

What is the incubation period of varicella zoster?

23
Q

When are you infectious with a varicella zoster infection?

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A

4 days before the rash until all lesions have scabbed over

24
Q

What treatment do you give for the pain associated with shingles?

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A

paracetamol and aciclovir

25
What does the blood film of glandular fever show?
Lymphocytosis | atypical lymphocytes with large and irregular nuclei
26
How do you diagnose EBV?
FBC (20% or more atypical lymphocytes) | Monospot test
27
When do you do a monospot test for EBV?
2 - 5 weeks after the onset of glandular fever
28
What is the monospot test?
Horse red blood cells agglutinate in the presence of hetrophile antibodies - most adults with EBV will have developed these after 2 - 5 weekjs of having the infection
29
When would you do EBV specific antibodies?
immunocmprised | monospot negative but strong suspicion
30
What is toxoplasmosis?
A protazoal infection spread through undercooked food or water infected with oocytes from infected cats. Infection in humans is life long and asymptomatic but if a patient becomes immunosupressed active infection can occur.
31
What are the symptoms of toxoplasmosis?
1. Chorioretinitis - Results from congenital infection that does not become apparant until reactivation 2. Encephalitis or focal neurological defect
32
What are the risk factors for getting toxoplasmosis?
``` Immunosupression Exposure during pregnancy High risk areas (central and south america) Raw meat xposire to cat faeces ```
33
What investigations do you do in someone who you think has toxoplasmosis?
``` 1. Anti toxoplasma IgG This indicated prior infection 2. Anti toxoplasma IgM - Indicates active infection 3. CT or MRI brain for any patients with decreases consciousness or focal neurological defects ```
34
Who gets screened for toxoplasmosis?
1. Anyone with HIV | 2. Heart transplant recipients (heart is the most common to see toxoplasmosis)
35
How do you treat someone with HIV who has a positive IgG for toxoplasmosis?
Prophylaxis with trimethoprim/sulfamethoxacole (this also work as prophylaxis against PCP pneumonia). This can be discontinued if the patient is taking ART and has a CD4 count of greater than 200 for more than 3 months
36
What prophylaxis do you get as a recipient of a heart transplant for toxoplasmosis?
If a positive donor and negative recipent - pyrimethamine + Sulfadiazine + calcium folinate for 3 months Lifelong - trimethoprim/sulfamethoxacole
37
How do you treat active toxoplasmosis in immunocomprimised patients?
1. Pyrimethamine 2. Sulfadiazine 3. Calcium folinate 6 weeks
38
What is cytomegalovirus?
A beta herpes virus that infects most people but primary infection is usually asymptomatic. It then becomes latent in host cell. Reactivation can occur in patients who are severely immunosupressed
39
What are the symptoms of CMV in an immunosuppressed patient?
``` Malaise Fever Diarrhoea Nausea and vomiting Visual floaters and blindness ```
40
What do you see on fundoscopy of patients with CMV?
Areas of infarction, haemorrhage, peri vascular sheathing and retinal opacification (pizza pie retinopathy)
41
How do you treat CMV is immunocompromised people?
ganciclovir IV
42
What investigations do you do for CMV?
FBC, creatanine, LFTs Serology using ELISA for CMV IgM Nucleic acid testing is the most sensitive method for detecting CMV
43
What is the treatment for latent TB?
3 months of isoniazid (with pyridoxine) and rifampicin | OR 6 months of isoniazid with pyroxidine
44
What kind of vaccination is the BCG vaccine?
Live attenuated mycobacterium bovis. It offers limited protection against leprosy also.
45
What are contraindications to the BCG vaccine?
``` Previous BCG Past history of tuberculosis HIV Pregnancy Positive mantoux test ```
46
What is the causitive organism in lyme disease?
Borrelia burgdorferi
47
What investigation do you do if you suspect lyme disease?
Serology for borrelia burgdorferi
48
How does lyme disease present?
Joint pain, facial nerve palsy, palpitations, heart block, myocarditis
49
What is the treatment for lyme disease?
Doxycycline (amox in pregnancy) if early disease | Ceftrixone if dissemintaed

Infectious Diseases (11 decks)

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