infection Flashcards
(201 cards)
1
Q
dysuria
frequency
urgency
suprapubic pain
whats these symptoms of
A
UTI- that causes cystitis - inflammation of the bladder
2
Q
whats often the only symptoms of a uti in the frail elderly
A
confusion
3
Q
whats a sign of pyelonephritis
A
fever
loin/ supraoubic/ back pain
unwell/vomit
hameaturia
renal angle tenderness on examination- where the hilum of kideny is
4
Q
what do you need to look for if the patient has pyelonephritis
A
signs of sepsis
5
Q
what investigations do you do for suspected uti
A
urine dipstick = nitirites certain and leukocytes
if got either these then send midstream urine sample off to microbiology lab for culture and sensitivity
6
Q
what in a urine dipstick prove uti
A
nitirites - treat as uti
nitirites and leukocytes = treat as uti
leukocytes byself= treat uti if got clinical signs
7
Q
what investifation to do for uti suspect
A
urine dipstick
if nitiries/leukocytes present senf midstream sample to microbiology for sensitivity and culture
8
Q
whats the main bacterial cause of uti
A
e.coli
9
Q
what are risk facotrs for uti
A
woman
urinary catheter
women with incontinece/poor hygeine
sex - spreads bacteria from back around perineum
10
Q
how do you. manage uti
A
woman = 3 days anitbiotics
5-10 days if immunosupressed woman, got abnormal anatomy or impaired kidney function
7 days if man, pregnant, catheter related uti
main abx= trimethoprim
or nitrofurantoin
others:
pivmecillinam
amoxicillin
cefalexin
11
Q
what do you do for pregant women with uti
A
7 days abx of nitrfurantoin (not third trimester as cause haemolytic anemia in newborn)
or
2nd line = cefalexin/amoxicllin
trimethoprim = safe but not in first trimester or someone who has med that affect folic acid (anti epileptics)
12
Q
how do you manage pyelonephritis
A
if signs sepis send to hosp
community =
7 days of either cefalexin, trimethoprim, co-amoxiclav, ciprofloxacin
if preg and not needed hosp then cefalexin
13
Q
red hot or swollen
tight/ tense skin
oedematous
bullae formed
golden yellow crust
thickened skin
whats this signs of
A
cellulitis
14
Q
whats golden yellow crust sign of
A
cellultitis
- staphycoccus aureus infection
15
Q
whats differentials of cellulits presentation
A
acute gout
ruptured bakers cyst
dvt
septic arthritis
16
Q
what the causes of cellultis
A
bacteria
staphycoccus aureus
group a streptococcus=> streptococcus pyogenes
group c streptococcus=> streptococcus dysgalactiae
consider mrsa if in nursing home/ in out hosp
17
Q
how do you classify cellulits
A
eron classification
1= no systemic toxicity nor comorbidities
2= systemic toxicity or comorbididites
3= sign sustemic toxicity or sign. co morbidities
4= sepsis or life threatening infction
3 and 4 go to hosp or also if frail/ v young, immunocompromised
18
Q
how treat cellulitis
A
flucloxacillin
19
Q
when do you suspect that sinusitis is bacterial cause
A
lastsed for over 10 days
purulent nasal discharge
discoloured nasal dicharge
sevre loval pain
38 degrees over
deterioration after initally mid
20
Q
whats the causes of sinusitis
A
bacterial or viral
usually tigfgered by a upper resp viral infection
21
Q
nasal blockage
discolpured / purulent nasal discharge
facial pain
facial pressure
mucosal oedema
fever/ tender over sinuses
whats this
A
sinusitiss
22
Q
what do you treat sinutisit with
A
get better over 2-3 weeks itself
symptoms less than 10 days no abx- offer paracetmaol/ibruprofen
symtpoms lasted over 10 days = give 2 weeks of nasal steroid spray hgih dose
symtoms last over 10 days and likely bacteral = offer antibitotcs= pehnoxymethylpenicillin first line for 5 days
if not improved after2-3 days give co-amoxiclav
if penicillin allergy consider:
clarithromycin
erythromycin = if preg
doxycyline
23
Q
sinusitis, otis media and tonsillitis are commonly caused by viral or bacterial infection
A
viral
24
Q
whats the bacterial casues of sinusitis, otis media and tonsillitis
A
group A streptoccocus - strep pyogenes
or if not then streptococcus penumoniae
others:
haemophilus influenzae
morazella catarrhalis
staphylcoccus aureus
25
how long does it take otis media to resolve
3-7 days byself
26
s and s of oitis media
buldging red tympanic membrane
if mebrane ruptured then discharge
tugging ear
ear pain
slight hearing loss
fatigue
fever
27
treatemnt for otis media
if systmeiccal unwell, more serious illness or high risk of getting comolications then give antibitocs
= amoxcillin first line for 5-7 days
not repsonded after 2 days give co-amoxiclav
or penicllin allergy give erythromycin- if preg
clarithromycin
28
s and s of tonsillitis
tonssilar exudate
fever
sore throat
hard to swalow
swollen tonsils
cough
headache
fatigue
earache
lymphadenopathy
29
tonsillits is commonly caused by viral or bacteira
viral
30
if bacterial tonsillits what most common cause
group a streptococcus- strep pyogenes
31
how do you know if the tonsillitis is likely to be bacterial of cause
centor crtieria
get a poijt for each and if over 3 then 40-60% likely bacteria and so give abx
absent cough
fever 38 or over
tonsillar exudate
tender anterior cervical lymph nodes
32
if suspect bacterial tonsillitis how do you treat
phenoxymethylpenicillin for 10 days
broader spectrum=
clarithromycin
erythromcin
doxycyline
33
what should you have a low threshold of suspicion for when inflammed joint
septic arthritis
34
rapid onset
often one joint- odten knee
red
swollen
hot joint
stiff and dec range of movement
systemic symtpoms- fatigue, fever, sepsis
whats these suggest
septic arthritis
35
what differentials are there of symtpms of septic arthriti
gout - urate crustals. negatively birefringent
pseudogout- calcium pyrophosphate crystals positively birefringent
reactive arthritis- triggered by uretritis and gastroenteritis and associated with conjunctivitis
haemarthrosis
36
what investigations do you do for septic artrhtisi
aspirate joint
may be purulent fluid
send off to lab for crystal microscopy, antibiotic sentivities, gram staining, culutre
37
what treatment give for septic arthrtis
empirical iv antibiotics to start
3-6 weeks on antibitocs
flucloxacillin and rifampicin
or vancomycin and rifampicin if penicillin allergy
38
whats the risk facotrs of septic arthritis
recent joint replacment
dog bite/ big cut
infection elsewhere in body and travleed to joint
39
what pathogen can casue septic arthrtis
staphylcoccus aureus - most common
neisseria gonhorrea
group a strep- strep pyogenes haemophilus influenzae
e coli
40
whats urinary tract infection
involves infection in bladder casuing inflam of bladder- cystitis and can spread to kindyes= pyelonephritits
41
risk factors of uti
women
catheter
poor hygein, incontinece women
sex
42
presentation of lower uti
dysuria= pain, burning, stinging when pass urine
suprapubic pain / discomfort
frequency
urgency
incontinence
confusion = esp elferly only sign sometomes
43
presentation of pyelonephritis
fever= more rpominen t
loin, suprapubic pain, back pain = bilateral and unilateral vomiting
loss appetite
haematuria
renal angle tenderness on examination
44
dipstick = nitrites
gram negative bacteria break down nitrates to nitrites
treat as uti
45
leukocytes and nitrites in dipstick
treat as uti
46
only leukocytes in dipstick
if clinical evidecne treat as uti
47
investigations for uti
send midstream urine sample to lab for culture and sensitivity testing
48
main cause of uti
e coli
gram negative aerobic rod shaped bacteria
49
what other organisms can cuase uti
e coli- most common
klebsiella pneumonia
enterococcus
psudomonas aeruginosa
staphylcoccus saprophyticus
candida albicans- fungal
50
antibiotics cna give for uti
trimethoprim
nitrofurantoin
pivmecillinam
amoxicillin
cefalexin
51
how long to give antibiotcs for uti
3 days= women simple lower uti
5-10 days, women immunospuressed, abnormal anatomy, impaired kidney function
7 days men and pregant women and cather uti
52
pt has uti and has catheter in. treatment
antibiotcs for 7 days
replace catheter
53
treatment for pregant women with uti
7 days antibiotics
even if asymptomatic
urine for culutre
1st= nitrofurantoin
2= cefalexin/amoxicillin
54
uti in pregnant women increases risk of what
increase risk of pyelonnephritits
premature rupture of membranes
pre term labour
55
what antibiotcs avoid when in pregnant women for uti
nitrofurantoin
avoid 3rd trimester
can casue haemolytic anemia of newborn
trmethoprim. avoid 1st trimester or throughout if on meds that affects folic acid
56
what antibiotic causes haemolytic anemia in newborn
nitrofurantoin - used first line uti ipregancy
57
whats sepsis
life threatening organ dysfunction caused by dysregulated host repsonse to infection
infection in blood
large immune repsonse to infection systemic inflammation
affects organ fucntio n
58
pahtolphysiology sepsis
macrophages, lymphocytes recognise pathogen= cytokines = activcate other parts immune system= no = vasodilation, inflam throughout body
endothelilal lining increase permeability= fluid into ecm= oedema = dec intravascualt volume and harder for o2 to get to tissues through fluid
active coagulation = fibrin block bv and so dec o to tissues
platelets get consumed= thrombocytopenia haemorrhages= disseminated inravascualr coagulapathy
blood lactate increase= anerobic resp
59
investigations for sepsis
fbc= wbc and neutrophila
u and e= aki
lft= see function and source infection
crp= show inflamm
clotting= may show DIC
blood culture= show if bacteraemia
blood gas= lactate, ph , glucos e
urine dipstick and culture possibly
cxr maybe
ct= intra abdo infection/absess
lumbar puncture - menigitis,encephalitis
60
risk factors for sepsis
patient prone to infection, on immune supresion
under 1 or over 75
chronic ocnditions- diabetes, copd
chemo, steroids, immunsupressants
surgery, recent truama, burns pregnancy, post partum
indwelling med device- catheter, central line
61
whats spetic shock
low bp so less ocygen to tissues
have systolic bp lower than 90 depsite having fluid resus hyperlactameia - lactate ore than 4
62
how to treat septic shock
iv fluid to increase bp and tissue perfusion
if dont work then inotropes= noradrenalin = to increase bp and stimulate cv system
63
what organ dysfucntion can occur in sevcere sepsos
hypoxia
oliguria
aki
thrombocytopenia
coagualtion dysfucntion
hypotension
hyperlactameia - more than 2
64
pt has lactate more than 4
infection present
oliguria
systolic bp 85
what is this
septic shock
lactate more than 4 and systolic bp less than 90
65
presentation of sepsis
high or low temp
tachycardia
tachypnoea!
low o sats
low bp
decreased consiousness
confusion/drowsy
o/e
signs of infection- cellulitis, cough, dysuria, discharge form owund
non blanching rash- menigiococcus septicaemia
low urine output
mottle skin
cyanosisis
arhtmia - new AF
66
management of sepsis
sepsis 6 give three
take three
treat pt wtihin an hour of presenting
blood test
urine output
blood culture
give
oxygen - sats want 94-98% or 88-92% in copd
broad spectrum antibiotcs
iv fluid
67
whats neutropenic spesosi
spesis and neutrophils count less than 1
68
ccauses of neutropenia
chemo
clozapine- schitophrenia
methotrexate- RA
hydroxychloroquine- RA
sulfasalazine -RA
carbimazole- hyperthyroid
quinine- malaria
infliximab and rituximab- monoclononal antibodies for immunosupression
69
treat neutropneia sepsis
any temp over 38 as neutropenic sepsis in anyone on meds that cause neutropenia / immunosupressed
]give broad spectrum antibiotcs= tazobactam and piperacillin= tazocin
other sepsis rx
70
what antibiotic use to treat neutropneic sepsis
tazocin= piperacillin and tazobactam
71
test for legionella
urinary antigen test
72
how is folic acid synthesisied in bacteria
PABA--> DHFA --> THFA --> folic acid
73
staphylcoccus gram stain
staphylcoccus = gram +ve cocci
74
enterococcus gram stain
enterococcus = gram +ve cocci
75
streptococcus gram stain
streptococcus = gram +ve coccic
76
gram +ve cocci
streptococcus
staphylcoccus
enterococcus
77
gram +v rods
corney mikes list of basica of cars
corneybacteria
mycobacteria
listeria
bacillus
nocardia
78
corney bacteria shape and gram stain
gram +ve rod
79
listeria shape and gram stain
gram +ve rod
80
mycobacteria shape and gram stain
gram +ve rod
81
bacillus shape and gram stain
gram +ve rod
82
nocardia shape and gram stain
gram +ve rod
83
gram +ve anerobes
CLAP
clostridium
lactobacillus
actinomyces
propionibacterium
84
clostridium type and gram stain
gram +ve anerobe
85
lactobacillus type and gram stain
gram +ve anerobe
86
actinomyces type and gram stain
gram +ve anerobe
87
propionibacterium type and gram stain
gram +ve anerobe
88
casues of atypical pneumonaia
atypical- doesnt show up on gram stain or cant be cultured in normal way
legions of psittaci MCQ
legionella pneumophila
chlamydia pscittaci
mycoplasma pneumoniae
chlamydophila pneumoniae
Q fever- coxiella burneti
89
legionella pneumonphila type bacteria
atypical-often a casue of atypical pneumonia
90
chlamydia pscittaci type bacteria
atypical - often a casue of atypical pneumonia
91
mycoplasma pneumonia type of bactiera
atypical - often a casue of atypical pneumonia
92
chlyamydophila penumonia type of abcteira
atypical- often a casue of atypical pneumonia
93
q fever- coxiella brunetti type of bactiera
atypica- often a casue of atypical penumonai
94
common gram -ve bacteria
neiserria meningitidis
neiseria gonorrhea
haemophilus influenza
E coli
klebsiella
psudomonas aerguinosa
moraxella catarrhalis
95
neiserria meingitidis type bactiera
gram -ve- coccus
96
neisseria gonorrhea type of bactiera
gram -ve - diplococci
97
klebsiella type bacteria
gram -ve - rod shaped
98
e coli type of bactieria
gram -ve rod shaped
99
hameophilus influenza type of abctieria
gram -ve aneorbic cocobaciullus
100
pseudomonas aeruguinsosa type of bacteria
gram -ve rod shpaed
101
moraxella catarrhalis type of bacteira
gram -ve
diplococcus
102
whats MRSA
staphylcoccus aureus bactiera resistant to beta lactam abx- penicllins, carbapenems, cephalosporins
103
how to eradict mrsa from body sruface and abx use if infected with it
if in hosp and got it on skin eradicate with chlorhexadine wash
abx:
doxycycline
clindamycin
vancomycin
teicoplanin
linezolid
104
exteneded spectrum betal lactamase bacteria
typical bactiera and abx treat
bacteria developed reisistnace to beta lactam abx = produce beta lactamase
tend to be e coli and klebsilla - can typically casue uti and penumonia
abx: carbapenems- meropenem / imipenem
105
common intra abdominal infections
appendicitits
acute diverticulitits
ascending cholangitits
cholecystitis- with 2 infection
spontaenous bacterial peritonitits
intra abdo abscess
106
common casues of intra abdo infectins
e coli
enterococcus
streptococcus
anaerobes- clostridium bacteroides
klebsiella
107
how to trat intra abdo infection
broad sprectum abx unless have culture
cover gram +ve and gram -ve and anaerobes
108
co amoxiclav good for what and dont cover what
good: gram +ve
gram - ve
anaerobic
x pseudonomas
atypical bacteria
109
quinolones good for what and dont cover what
good: gram +ve
gram -ve
atypical
x anaeroboes
usually pair with metroidazole cus that covers anaerobes when have intra abdo infection
110
metronidazole good for what and dont cover what
anaerobes
x aerobic
111
gentamicin good for what and dont cover what
gram -ve
some gram +ve- staphylcoccis
bactericidal so kill the bacteria andnot jus slow it down so often use stat dose of it if not in the regimes if pt is severely septic to provide strong gram -ve bactericidal action
112
vancomycin good for what and dont cover what
gram +ve
MRSA
often with metroidazole + gentamicin in pen allergy
113
cephalosporins good for what and dont cover what
broad spectrum gram +ve
gram -ve
x anaerobic
avoid due to risk of c diff infection
114
tazocin and meropenem good for what and dont cover what
tazocin = piperacilllin + tazobactam
both tazocin and meropenem ar eheavy hitting abx
gram +ve
gram -ve
anaerobic
x atypical
MRSA
and tazocin also doesnt cover ESBLS
use for pts very ill and other abx havnt worked
115
common regimes for itra bado infection
co amoxiclav by self
amoxicillin + gentamicin + metronidazole
metronidazole + vancomycin + gentamicicn = pen allergy
ciprofloxacin + metronidazole= pen allergy
116
spontaenous bacterial periotinitis
abx treat
typically due to liver fdailure
1st line= tazocin
cephalosportins ( cefotaxime) often used
levofloxacin + metronidazole= pen allergy
117
influenza =is what virus dna or rna
RNA
3 types A,B,C
A has H and N subtypes
H1N1= swine flu
H5N1= avian flu
118
when can get a vaccination for influenza
yearly
65 and over
young children
pregnant women
health care workers and carer
chronic health conditions - asthma, copd, heart failure, diabetes
119
presentation influenza
occur abrupttly - usally 2 days after exposrue
fever
corzyal symptoms
cough- can productive
fatigue and lethargy
muscle and joint aches
headache
sore throat
anorexia
gi symtpom
ocular symtpms- photophobia, pain on eye movmemnt
complcaited influenza= lrti, signs of exaserbation of underylting condition
120
daingosis of influenza
treat based on hx, rf for complications and cloinical
cxan do viral nasal/throat swab pcr
DO WITH PEOPLEW ITH COMPLCIATED influenza
121
treatment influenza
healthy pt wth not at risk of complcaitions- self care
if at risk of complciations: start treatment within 48hrs onset symtpoms to be effective:
oral oseltamivir 75mg BD 5 days
or
inhaled zanamivir 10mg BD 5 days
if pt high risk of complications (chronic disease/ immunosupression)
ca give post exposure prophylaxis- seen person with flu and then get this treatment to try reduce risk of developing flu and complciations :
given within 48hrs of close contact with influenza:
oral oseltamivir 75mg OD 10 days
or
inhaled zanamivir 10mg OD 10 days
122
complcaition of influenza
exaserbation of health condition- copd, heart failure
febrile convulsions in young childnre
encephalitits
viral pneumonia
secondary bacterial pneumonia
otitis media, sinusitis, bronchitits
123
HIV
human immunodeficency virus
RNA retrovirus
binds to CD4 cells and releases its RNA into and destorys CD4 T cells
124
transmmission hiv
bodily secretions
sexual transmission - unprotected ana, vaginal, oral sex
mother - child- any point pregnancy, birth, breast feeding = vertical trasnmission
mucous membranes, blood, open wound expiresure to infected blood/bodily fluids= sharing needles, needle stick injury and blood splash in eye
125
presentation of hiv
active HIV= acute seroconversion illness = like glandular fever - fever, swollen glands, muscle aches and tirdness
chronic infection: the immune system controls it and so CD4 recovers and viral load goes down- asymptomatic but cant get rid of it so chronic infection
then over time the hiv infects and kills cd4 and so cd4 decreases and viral load increases and then eventaually when CD4 below 200 have AIDS
126
AIDS defining conditions
got any of these then think they are immunocompromised cus shouldnt be getting these infections normlaly
candidiasis- oesophageal, bronchial
PCP
kaposi sarcoma
cytomegalo virus
lymohpma
TB
toxoplasmosis
MAC disease
crytpococcal disease- fungal
127
screenin HIV
any risk facotr then test for it
do it immediately then do in 3 months cus antibody test can be -ve for 3 months after exposure
need verbal consent to do it
HIV RNA= tests viral load
PCR for p24 antigen - can show postive before the ab
antivody blood test
128
treatment for HIV
key mechanism is inhibiting reverse trasncriptase
3 drugs- at leas 2 diff classes
2 NRTIs + protease inhibitor/integrase inhibitor = eg. triumeq =Abacavir / Dolutegravir / Lamivudine
NRTI= nucelotide reverse transcriptase inhibitors eg tenofovir + emtrictiabine
on it for life long
give to anyone with HIV (not based off cd4 count)
once normal CD4 count and undetectable viral load trat any physical conditions as they are hiv negative
once undetectable viral load then wont pass it on
if CD4 below 200 = give prophylactic co-trimoxazole to prtoetec agasint PCP
monritor rf for cv as with hiv have increase risk of CVD
cervical smears yearly as increase risk HPV and cervical cancer
vaccines- keep up to date and dont use live vaccine
129
pt has CD4 count below 200
what do
once CD4 count below 200 also give prophylactic co trimoxazole to protect agasint pcp
130
what vaccines avoid with pt with HIV
dont give live vaccine
131
what need to know about reproductive health if got HIV
use protection even if both +ve
if viral load undtectable transmission is vvvvv unliekly
partneers recommened to have regular hiv test
undetectable viral load then can consider unprotected sex and pregancy
caesaerean section fot pt with hIV - can consider vaginal birth if viral load undtetcable
if mum has hiv give the new born baby HAART for 4 weeks to prevent vertical trasnmission
only consider breast feeding if viral load is undetectable
132
gastroentereitis
inflammation of stomach = vomiting
inflammation of intestines= diarrhoea
133
most common casue of gastroenteritis
viral
134
casues of viral gastroentertitis
norovirus
rotavirus
adenovirus- less common but more subacute diarrhoea
135
which e.coli casues gstroentertisi (one to rmebeer there are other strains)
e.coli 0157 = produces shiga toxin
136
tranmission of e.coli
contact with infected faces, unwashed salfs, contaminated water
137
presentation of gastroenteritis casued by ecoli
abdo crams
vomiting
bloody diarrhoea
shiga toxin can aslo desotry blood cells and casue HUS
138
treament of gastroenteritis casued by ecoli
no abx! - increases risk of HUS as releaseing the toxin into the blood more by destorying the bacterira
139
key points on E COLI casuing gastroentertis
only certain strains
e coli 0157 produces shiga toxin
trnasmission via cotnact with infected faeces, unwashed saldas and contaminated water
presentation= vomiting, abdo cramps, blood diarrhoea
can casue HUS if its shiga toxin
dont give abx as increase risk HUS
140
most comon casue of travellers diarrhoea
campylobacter jejuni
141
most common casues of bacterial gastroenteritis
campylobacter jejuni
142
campylobacter jejuni transmission and type of bacteria
gram -ve, spiral/curved
transmission: raw/uncooked pultry, untreated water, unpasterurised milk
143
presentation of campylobacter jejuni
incubation 2-5 days
resolves 3-6 days
abdo cramps
diarrhoea- often with blood
vomiting
fever
144
treat gastroenteritis caused by campylobacter jejuni
if severe and know its campylo abx or if have rf eg HIV, hearrt faiure
azithromycin/ciprofloxacin
145
brief summary of campylobacter jejuni gastroenteritis
most common casue travellers diarhroea and most common casue bacterial gastroenteritis
transmission via raw/ uncooked pultyr, untreated water and unpasterusied milk
presentation:
incubation 2-5 days
resolved 3-6 days
abdocramps
diarrhoea offten bloody
fever
vomitin
treat
abx if severe/ rf- hiv heart failure
azithromycin/ciprofloxacin
146
shigella transmission
faces contaminiating drinking water/ swimming pool/ food
prodduced shiga toxin
147
presentation shigella
incubation 1-2 days
reoslvies 1 week without rx
bloody diarrhea
abdo crmaps
fever
148
treat shigella
severe abx
ciprofloxacin/ azithromycin
149
shigella breigf summary
prouduces shigella toxin
trnasmission faeces contaminating food, wter, swimmming pools
incubation 1-2 days
resovles 1 week
bloody diarrhoea
abdo cramps
fever
if severe abx azitrhomycin/ciprofloxacin
150
salmonella transmission
raw eggs/ uncooked pultry and contaminated fiid with infected faeces
151
presentation salonella
incubation 12 hrs-3 days
resovles 1 week
water diarrhia - can be assciated with blood/mucus
abdo pain
vomiting
152
treat salmonella
if severe abx
153
bacillus cereus type and transmission
gram +ve rod
transmission:
inadequately cooked food esp grows on food that been cooked and not immediately put in fridfge eg. rice left at room temp
produces toxin - cereulide
154
presentation bacillus cereus
abdo cramp
vomiting within 5 hrs
diarrhoea after 8hrs
resolives within 24 hrs
can also be casue of infective endocarditis in drug users (staphylcoccus aureus most common casue in durg users)
155
breife summary baciullus cereus casuing gastroenterisi
GRAM +VE ROD
produces toxin cereulide
most common due to food not put in frisge after cooking 0 eating rice
short incubation period
after ingestion vomit 5hrs afte
after 8hrs diarrhoea (the toxin got the the intestines)
resove 24 hrs
156
pt vomit 5 hrs after eating some food.
then theyget dirahhoea 8 hrs after eating
bacillus cereus
5-8-24
157
yersinia enterocolita type and transmission
gram -ve bacillus
PIGS- raw/ undercooked pork
contamination of urine/faeces from other mammabls
158
presentation yersinia eneterocolita
incubation 4-7 days
lasts 3 weeks or more
watery/bloody diarrhoea
abdo pain
fevers
lymphadenopathy !! = adults and older children can present with r abdo pain due to meseneteric lymphadentitis = may present thereore similar to appendicitis
159
pt fevers
abdo pain
r abdo pain
watery/bloody diarrhwa
ate pork
yersinia enterocolitia
160
what gastroenteritis may present similar to appendicitis
yersinia enterocolitia- can casue mesenteric lymphadentitis
161
which gastroenteritis cause can cause lyphadenopathy
yersinia enterocolitia
162
staphycoccus aureus transmission gastroenteritis
produces enterotoxin - causes the issues
fiod- eggs, meat , diary
163
presentation stapyloccus aruesus gastroenteritis
diarrhoea
profuse vomiting
abdo cramps
fever
occurs eithin hrs of ingestion
resolves 12-24 hrs
164
giardiasis gastroenteritsi transmision and type
parasite
in mammals and they form cysyts with the parasite inthen they infect food etc= faeco oral transmission
165
presentation giardiasis gastroenteritis
non
or
chronic diarrhoa
166
diagnose giardiaisis
stool microscopy
167
treat giardiasis gastroenteritis
metronidazole
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general treamtnet gastroentneritis
asses dehdration
if can oral fluids
if cant then iv fluids
small food
no school/work for 48 hrs after symptoms compellty resoves
try not to use antidiarhoa/ anti emetic
- can if mild/ mod symptoms eg. loperamide/ metacloprmide
dont use antiemetics/ antidiarrhoal fro shiggella/ ecoli 0157 or if blood diarrhia / fever
169
meningitis
inflammation of meninges
170
whats meningiococcal septicaemia
casued by neisseria menigitis in the blood
neisseria meningitis is also called menigiococcus
mengioniococcus in the blood stream casues a non blanching rash - the rash means the infection has casues disseminated intravascualr coagulopathy and subcutaenous haameorrhage
neisseria menigitis/ menigiooccus can casue mengitis+/ mengiococcal septicaemia = both are med emergencies
menigiococcal menigitis = bacteria infectig the menginges and csf
171
bacterial meningitis - casues
common casues are neisseria menigitis = mengiococcus
streptoccocus penumonia - pneumococcus
neonates= group B streptococcus
if got menigiococcal septicameia too then have the non blanching rash can poorer prognosis
172
casue of non blanching rash
= DIC and subcutaenous haemorrhage
meningiococcal septicaemia
but loads other causes:
Conditions you are born with, such as:
Osler-Weber-Rendu syndrome.
Ehlers-Danlos syndrome.
Pseudoxanthoma elasticum (a condition affecting the elastic tissue of the blood vessels and other parts of the body).
Infections picked up during pregnancy whilst still in the womb, such as cytomegalovirus and rubella.
Conditions acquired after you were born, such as:
Severe bacterial infections such as sepsis, infection with one of the germs that cause meningitis (meningococcal disease).
Allergy-based conditions such as Henoch-Schönlein purpura.
Disorders of the connective tissue that connects and binds other bits of the body together, such as systemic lupus erythematosus and rheumatoid arthritis.
As a side-effect of medicines such as steroids and sulfonamides (antibiotics).
Other causes, such as ageing of the skin, injury (trauma), lack of vitamin C (scurvy) and poor blood supply, especially to the legs.
Conditions that cause increased pressure, such as coughing or vomiting.
Thrombocytopenic purpura
Conditions resulting from problems with platelet production, such as:
Bone marrow failure - for example:
Leukaemia.
Aplastic anaemia (anaemia caused by problems with production of the platelets and other blood cells by the bone marrow).
Myeloma.
Cancer deposits replacing the bone marrow.
Medicines such as co-trimoxazole (an antibiotic) and chemicals.
Conditions that increase the breakdown of platelets, such as:
Immune thrombocytopenia.
Systemic lupus erythematosus.
Viral infections.
Conditions affecting the blood clotting (coagulation) system, such as:
Disseminated intravascular coagulation which causes excessive blood clotting in small blood vessels).
Haemolytic uraemic syndrome (destruction of blood cells associated with kidney disease and kidney damage).
Enlarged spleen.
Conditions causing dilution of the platelets, such as rapid transfusion of large quantities of stored blood.
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presnetation menigitits
viral milder
fever
neck stiffness
vomiting
headache
non blanching rash= menigiococcal septicaemia
photophobia
altered consiosness
eizures
neonates and babies:
hypotonia
hypothermia
poor feeding
bulgding fontaelle
lethargy
174
what the two tests can do for menigitis
kernigs test=
psotive then painful =>
pt on back, flex knee and hip 90 degrees. slowly straighten knee but keep hip flexes 90 degrees. = stretched meniges and if meningitis get spinal pain/ resistanc with movement
Brudzinskis test= on back, dr lifts the pts head and neck off the bed and flex their chin to chest- psotive test when casues pt to involutnaruly flex hips and knees
175
investifation mengitits
LP for CSF- ahve bacterial culture, glucose, protein, cell count, viral PCR do before starting abx but if pt ancutely unwell then dont delay the abx
(do LP for all childrne uner 1 onth with fever. do for children 1-3 omths f fever and unwell. do for children unde r1 yr old if unexplaine dfever and serious illness)
blood culture
fbc
renal fucntion
coagualtion- esp ifDIC suspected
bloods for menigiococcoal PCR if susect meningiococcal disease
blood glucose- do same time LP glcuose so can compare
176
management for bacterial meningitis
prior to hosp transfer give IV/IM benzylpenicillin
- do fot all children with suspected mingintis with non blanching rash
- do fot adults with severe spesi- low bp, altered consiousness, poor cap fill time/ hosp over 1hr away
under 1 yr=300mg
1-9yrs= 600mg
over 10 and adults 1200mg
abx=>
of under 3 months= cefotaxime + amxocillin (listeria)
over 3 months= ceftriaxone
+ vancomycin if at risk of penicillin ressitatn penumococcal eg. if recent forgein travel or proplonged abx exposure
+ give steroids- dexamethoasone 4 times day for 4 days tp reduce frequency and severity of hearing loss and neuro damage
notifable disease
177
casues of viral meningitis
enterovirus
hepres simpplex virus
varicella zoster virus
= less severe viral compared to bacteria
178
treament viral menigitis
supportive
if herpez simplex virus casue then can give aciclovir
179
complcaitions menignits
HEARING LOSS
seizures + epilepsy
cognitive impairment and learning disability
memory loss
focal neruo defecit - limb weakness/ spastiticty
180
what does LP show for mengitings
bacteria in csf they use up glucose and relase lots protien = low glucose, high prtoein
virus in csf they dont use glcuose but may release small amount protein
the immune system in repsonse to bacteria relase neutrophils
in response to virus release lymphoctyes
181
bacterial LP menigitis
cloudy
hgih protein over 1.5 g/l
low glucose under 0.5
over 1000 white cell and neutrophils
psotive bacterial culture
182
vrial LP mengitits
clear
mild raised/normal prtoein
normal glucose - 0.6-.08
over 1000 wcc lymphoctyes
negative culture
183
cause of malaria
plasmodium family of protozoan parasite
spread by bite from female anopholes mosquiti that carries the disease
184
types of malaria
p. falciparum = most severe
daily/contionous fever
subsaharan africa, tropics
present within 4 weeks of return but can present up to a year after
most common in uk pop
plasmodium vivax
india, s e asia, s america, e africa
less sevre
teritan fever
can present several months after
prophylaxis ineffective
p ovale
p malariae
185
lifecycle of malaria
infected blood sucked by mosquito --> reproduce in gut of mosquito => sporozoites = malaria spores
--> bite human and inject sporozoites in
--> goes to liver
--> can lie dormant in liver as hypozonoites for severeal years in vivax and ovale
--> merozointes in liver and then enter blood and ifect rbc-->
merozoites reproduce in rbc - 48hrs ish (not falciparum its quicker for that)
--> rupture rbc= haemolytic anemia
186
presentation malarai
fever- daily/continuous in falciparum/ tertian in vivax
headache
malasie
myalgia
sweats
rigors
vomiting
pallor-anemia
hepatosplenoemgaly
jaundice
incubation 1-4 weeks
can like dormant for years some types though
if fever within 1yr travel always consider malaria
187
how to daongose malaria
blood film
3 samples over 3 consecuative days to exclude malaria- cus can be negative if the parasites not released from the rc that day
188
managment of malaria
treat if falciparum
treat if vivax can
189
treatment for malaria casued by falciparum
hosp
if uncomplciated malaria:
malarone= proguanil + atocaquone
riamet = artemether + limefantine
quinine sulphate
doxycyline
if severe / complicated:
artesunate = most efective but not lsicensed
quinine dihydrochloride
190
treatment for vivax malaria
artemether and lumefantine/chorquine
then primaquine to eliminate hypozonite stage
check no G6PD deficiency before primaquine given- primaquine causes rbc burst
191
complications of p falciparum malaria
seizures
AKI
pulmonary oedema
cerebral malaria
decreased consiousness
DIC
severe hameolytic anemia
multi organ failure and death
192
malaril prophylaxis what used
nets, sprays, antimalraials
malarone = proguanil + atovaquone
- take daily- 2 days before, during and 1 week after
best se profile
mefloquine
- once weekly- 2 weeks before, during, 4 weeks after
se= bad dreams, psycotic disorders and seizures
doxycyline
-daily, 2 days before, during, 4 weeks after
se= cus broad spectrum abx can casue diarrhoea and thrush
can casue senstive to sun- rash and sunburn
193
abx that inhibit cell wall synthetis
with beta lactam ring
penicillins- flucloxacillin, tazocin, Pen V, amoxicillin, co- amox, benzylpenicillin
carbapenems- meropenem
cephalosporins - ceftriaxon
194
abx that inhibit cell wall sysnthesis and dont have a beta lactam ring
vancomycin
teircoplanin
- these are glycoprotiens
195
abx that inibit folic acid metabolism
sulfamethoxaole = blocks DHFA => THFA
trimethorpim = blocks THFA=> folic acid
used in combo= co-trimoxazole
196
metronidazole does what
inhibits nucelic acid synthesis but only in anearobes
197
abx that inhibit protein syntheissi by targeting ribosomes
macrolides=> erythromycin, clarithromycin, aziathromycin
clindamycin= linosamide drug
tetracyclines= doxycyline
gentamicin
chloramphenicol
198
erythromycin
clarithromycin
aziathromycin
what type abx
macrolides = inhibit protein syntheisis by targeting ribosomes
199
meropenem what abx
carbapenems
200
ceftriaxon what abx
cephlasporins
201
ciprofloxacin
levofloxacin
moxifloxacin
nalidixic acid
what type abx
quinolones
