Infection Flashcards
(190 cards)
1
Q
Presentation of non-inflammatory diarrhoea
A
Frequent watery stools with little abdo pain
2
Q
Acute causes of diarrhoea
A
Bacterial, viral, amoebic dyssentery
3
Q
Main symptoms of gastroenteritis
A
Diarrhoea and vomiting caused by stomach and intestinal inflammation (viral or bacterial infection most common)
4
Q
Bacterial diarrhoea organisms
A
- E.coli is most common
- Salmonella
- Shigella
- Campylobacter
5
Q
What is the most common cause of diarrhoea
A
Rotavirus
6
Q
How would you assess hydration in a patient with diarrhoea
A
Postural BP, skin turgor and pulse
7
Q
Investigations of diarrhoea
A
- Stool culture
- Blood culture
- Renal function
- Blood count - neutrophilia, haemolysis
- Abdominal X-ray if abdomen is distended and/or tender
8
Q
Differential diagnosis of diarrhoea
A
- Inflammatory bowel disease
- Spurious diarrhoea (secondary to constipation)
- Carcinoma
- Diarrhoea and fever can occur with SEPSIS OUTSIDE THE GUT
9
Q
Treatment of gastro-enteritis
A
Rehydration - oral with salt/sugar solution or IV saline
Antimicrobials (in systemically unwell, immunosuppressed or elderly)
DONT GIVE ROUTINE ANTI-DIARRHOEALS
10
Q
Drugs that cause diarrhoea
A
ANTIBIOTICS - clindamycin, erythromycin, penicillins, tetracyclin, neomycin
LAXITIVES
Digoxin, magnesium salts, omeprazole, cimetidine
11
Q
Chronic causes of diarrhoea
A
Metabolic disorders - thyrotoxicosis, hyperthyroidism, anxiety
Small bowel disease - crohn’s, coeliac
Large bowel disease - ulcerative colitis, colon cancer, IBS, spurious (with constipating drugs - cause impacted stools that only allow watery stools to exit bowel)
12
Q
Presentation of e.coli 0157 infection
A
Frequent bloody stools
13
Q
Complications of e.coli 0157 infection
A
Toxin can cause haemolytic uraemic syndrome
–> haemolytic anaemia and renal failure
14
Q
Bacterial responsible for travellers diarrhoea
A
Enterotoxic e.coli
15
Q
When give antibiotics for gastroenteritis
A
Immunocompromised, severe sepsis or invasive infection, valvular heart disease, chronic illness, diabetes
16
Q
Which bacteria is commonly responsible for diarrhoea after previous antibiotic treatment
A
Clostridium difficile
17
Q
Treatment of clostridium difficile diarrhoea
A
Metronidazole, oral vancomycin
18
Q
Which antibiotics have been blamed for c difficile infection
A
Broad spectrum - 4 Cs
Cephalosporins
Clindamycin
Clarythromycin
Co-amoxiclav
19
Q
Features indicating systemic illness
A
- fever >39.5; dehydration
- diarrhoea and visible blood (= dysentery) for >2 weeks
20
Q
Define sepsis
A
Systemic illness caused by microbial invasion of normally sterile parts of the body
21
Q
Features of systemic inflammatory response syndrome
A
Temperature >38 or 90
RR >20 or PaCO2 12,000 or 10% bands
22
Q
Triggers of SIRS
A
Infection, surgery, trauma, burns, pancreatitis and malignancies (lymphoma)
23
Q
Define sepsis
A
Systemic inflammatory response syndrome triggered by a primary localised infection
24
Q
Signs of sepsis
A
2 or more of SIRS features (tachycardia, hypothermia or hyperthermia, low or high WBC, tachypnoea or low PaCO2)
Resulting from infection
25
Signs of severe sepsis
Sepsis (2 or more SIRS features and infection) alongside signs of organ hypoperfusion - hypoxemia, oliguria, lactic acidosis or acute alteration in mental state
26
Signs of septic shock
Severe sepsis with hypotension OR the requirement for vasoactive drugs DESPITE adequate fluid resuscitation
27
Multi-organ complications of SIRS, sepsis and septic shock
Cardiac - hypotension and tachcardia
Respiratory- tachypnoa, hypoxaemia, respiratory alkalosis, ARDS
Renal - acute renal failure (cytokine mediated vasodilation and hypotension cause decreased renal prefusion)
Haematological - disseminated intravascular coagulation
Lactic acidosis caused by tissue hypoxia from tissue hypoperfusion
28
Investigations to identify trigger the trigger of SIRS or sepsis
- chest Xray
- blood culture
- FBC, U&E, LFT
- arterial blood gas
- urine dipstick
29
Sepsis 6 (give 3 and take 3)
1. Give high flow oxygen
2. Take blood cultures
3. Give empirical antibiotics IV
4. IV fluid resuscitation
5. Check Hb and lactate (ABG or VBG)
6. Monitor urine output accurately
30
Patholophysiology of sepsis
Originates from breach of integrity of host barrier - physical or immunological --> organism enters blood stream causing septic state
- -> uncontrolled inflammatory response
- release of bacterial toxins
- release of mediators (endotoxins, exotoxins...)
- effects of specific excessive mediators (pro-inflammatory vs anti-inflammatory)
31
Effect of excessive pro-inflammatory mediators
Immunoparalysis with uncontrolled infection and multi-organ failure
32
Effect of excessive compensatory anti-inflammatory mediators
Septic shock with multi-organ failure and death
33
Causes of high lactate
Hypoperfusion
Also - mitochondrial toxins, alcohol, malignancy, metabolism errors
34
Rule for fluid administration in patient with severe sepsis/septic shock
30ml/kg fluid challenge
35
What is the empiric antibiotic recommendation for severe pneumonia
IV amoxicillin 1g tds and clarythromycin 500mg bd
36
Spread of HIV
- Sexual transmission
- Injection drug misuse
- blood products
- vertical transmission (from mother to embryo, fetus, baby during pregnancy or childhood
- organ transplant
37
Clinical stage 1 HIV
Asymptomatic
Persistent generalised lymphadenopathy
Normal activity
38
Clinical stage 2 HIV
Weight loss (
39
Clinical stage 3 HIV
```
Weight loss (>10%)
Unexplained chronic diarrhoea
Unexplained prolonged fever (intermittent or constant) >1 month
Oral candidiasis (thrush)
Oral hairy leukoplakia
Pulmonary TB, within past year
Severe bacterial infections
- performance scale 3: bedridden
```
40
Clinical stage 4 HIV
HIV wasting syndrome
HIV encephalopathy
Performance - bedridden
41
What is the difference between AIDS and HIV
Certain infections and tumours that develop due to a weakness in the immune system = AIDS illnesses. If you have no symptoms then you have a HIV infection only.
42
Immunology of HIV
HIV infects and destroys cells of the immune system especially CD4 positive T-helper cells. CD4 receptors are also present on the surface of macrophages and monocytes, cells in the bran and skin
43
Natural history of HIV infection
Over course of infection, CD4 count declines and HIV viral load increases. As the CD4 count falls the risk of developing infections an tumours increases
Acute infection --> asymptomatic --> HIV related illnesses --> HIV defining illness --> death
44
Opportunistic infections that affect those with HIV
- Pneumocystis jiroveci pneumonia
- Candidiasis
- Mycobacterium avium complex
- Cryptosporidiosis
- cerebral toxoplasmosis, TB, CMV disease REACTIVATION
45
AIDS defining conditions
TB, pneumocytis, kaposi's sarcoma, cervical cancer, non-hodgin lymphoma
46
What is seroconversion in relation to HIV
Approximately 30-60% of patients have a seroconversion illness - when HIV antibodies first develop
Abrupt onset 2-4 weeks post exposure, self limiting 1-2 weeks
Symptoms are generally non-specific and differential diagnosis includes wide range of common conditions
47
Symptoms of HIV seroconversion
```
Flu like illness
Fever
Malaise and lethargy
Pharyngitis
Lymphadenopathy
Toxic exanthema
```
--- Looks like glandular fever
48
Treatment of HIV
Antiretroviral therapy - lifelong
49
Side effects of anti-viral therapy for HIV
- Lipodystrophy,
- Hyperlipidaemia
- Insulin resistance
- Marrow toxicity,
- Neuropathy
- Rashes
- Diarrhoea
50
HIV and pregnancy risk of transmission
Minimised by effective antivirals
Caesarean section reduces transmission where viral load is detectable
Give neonate antiretroviral therapy for 4 weeks
Need to avoid breast feeding
51
Tests to diagnose HIV infection
Antigen/antibody detection
--> ELISA assays allow simultaneous detection of antibody and antigen
Need to confirm with at lease one additional antibody/antigen test and determine whether HIV-1 or HIV-2
Avidity testing
--> indicates whether infection acquired in last 3-4 months
52
How to determine the viral load in HIV
HIV genome detection - quantification of HIV RNA
53
How to monitor the effectiveness of HIV treatment
Viral load - HIV genome detection
54
How to diagnose an infant with HIV
Viral load quantifies HIV RNA - child will have passively acquired maternal antbody
55
Define meningism
Symptom complex characterised by headache, photophobia and vomiting with muscle spasm leading to neck rigidity (stiffness on passive neck flexion)
MENINGISM MAY OCCUR IN ABSENCE OF MENINGITIS
56
Causes of meningism
Meningitis, sub-arachnoid haemorrhage or infection accompanied by bacteraemia, some viral infections (influenza)
57
Define meningitis
Inflammation of the meninges due to infection - leads to signs of meningeal irritation
58
Pathogenesis of meningitis
1. Attachment of mucosal epithelial cells
2. Transgression of the mucosal barrier
3. Survival in the blood stream
4. Entry into the CSF
5. Production of overt infection in the meninges with or without brain infection (encephalitis)
59
Bacterial meningitis causative organisms
```
Neisseria meningitidis (meningococcus);
Streptococcus pneumoniae (pneumococcus)
```
E.coli and group B streptococci in neonates
60
Viral causative organisms of meningitis
Enteroviruses - echoviruses, parechoviruses, coxsackie viruses A and B
Mumps - rare due to MMR vaccine
Herpes simplex virus
61
Non-infective causes of meningitis
Tumour cells in the CSF may produce an aseptic meningitis
Certain drugs or chemicals or by some diseases of unknown aetiology (sarcoidosis, SLE)
62
Presentation of bacterial meningitis
Headache, photophobia, neck stiffness and vomiting
Fever (or recent fever) with clouding of consciousness
May be nerve palsies of CN VI, VII and VIII
Usually acute onset and rapid progression
63
What skin change may be noticed in a patient with meningitis
Skin and conjunctival petichiae which occur in about 60% of patients with meningococcal infections but can also occur in other bacterial meningitides and with viral meningitis and endocarditis
Other rashes - vasculitis, macular/maculo-papular, purpuric, pruritic or vescicular
64
Kernig's sign
Hip flexed, the patient cannot be straigthened due to hamstring spasm in meningism
65
How would you demonstrate neck stiffness
Attempt to flex the neck to touch the chin to the chest
66
Investigations for suspected meningitis
Blood cultures
Lumbar puncture - if there are focal neurological signs or papilloedema need to exclude a space occupying lesion with a CT
FBC
Routine urea and electrolytes for renal function
LFTs
67
How long does it take for a blood culture result
It takes at least 6 hours and usually 12-48 hours incubation before an organism becomes detectable
68
CSF microbiology tests for meningitis
```
Gram stain (ZN if appropriate)
Differential cell count (neutrophil polymorphs or lymphocytes)
Antigen detection test
Bacterial culture
PCR for viruses if appropriate
PCR for bacteria if appropriate
```
69
CSF biochemistry tests for meningitis
Glucose
| Protein
70
Examples of non-inflammatory diarrhoea
Secretory toxin mediated
- cholera increases cAMP levels and Cl secretion
- enterotoxigenic E.coli
71
Meningism
Neck stiffness
Photophobia
Vomiting
Headache
72
Causes of meningism
Meningitis
Subarachnoid haemorrhage
Infection +/- bacteraemia - UTI, influenza, tonsilitis
Non-infective - tumour in CSF, sarcoid, SLE
73
Bacterial infective organisms for meningitis in infants
E.coli
| Group B streptococcus
74
Bacterial meningitis organisms
Neiserria meningitidis
| Strep. Pneumoniae
75
Viral causes of meningitis
Enteroviruses
- echoviruses
- parexovirus
- coxsackie A&B
- polio (Rare)
Mumps
HSV
76
Investigations for suspected meningitis
```
Blood culture
Lumbar puncture
PCR
FBC
UandE
LFT
```
77
CSF findings in bacterial meningitis
Turbid (cloudy)
Neutrophils predominant cell type
Less glucose
More protein
78
CSF findings in viral meningitis
Clear --> cloudy
Lymphocytes predominant cell type
Normal glucose
Moderate increase in protein
79
CSF findings in TB meningitis
Clear --> turgid
Lymphocytes predominate or mixed
Less glucose
Large increase in protein
80
What features may suggest a bacterial cause of meningitis
(Meningism)
FEVER
CLOUDING OF CONSCIOUSNESS
RASH
81
Antibiotic therapy for bacterial meningitis
Benzylpenicillin - good at penetrating into the CSF
Possibly give dexamethasone to reduce likelihood of developing neuro sequelae
82
Epidemiology of neisseria meningitidis
In scotland most are caused by groups B and C but C has reduced to menC vaccine
Outbreaks commonly occur where large numbers of young people mix
83
Meningococcal infection presentation
Acute onset of meingism, systemic upset and a skin rash, usually petichial
84
Fulminant meningococcal septicaemia is characterised by...
Rapid deterioration in consciousness, fever, septicaemic shock with renal failure and disseminated intravascular coagulation
85
Mortality of meningococcal septicaemia
50% of patients die within the first 24 hours of illness
86
What are the early symptoms of meningococcal sepsis
Cold hands and feet
Leg pains
Abnormal skin colour
Purpuric rash
87
What to do if suspect meningococcal inection
Parenteral PENICILLIN 3-4 MU prior to transfer to hospital
If patient acutely unwell when arrive in hospital administer high dose CEFTRIAXONE prior to LP but after blood culture
BENZYLPENICILLIN has lower spectrum so consider after results of blood culture
When discharging RIFAMPICIN or CIPROFLOXACIN to eradicate carriage from nasopharynx
88
Most common cause of meningitis in adults
Streptococcus pneumoniae
89
Predisposing factor for pneumococcal meningitis
```
Pneumonia
Sinusitis
Endocarditis
Head trauma
Alcoholism
Splenectomy
```
90
Microbiology of pneumococcal meningitis
Gram positive diplicocci and alpha haemolytic
91
Treatment of pneumococcal meningitis
High dose ceftrioxone on admission
Benzylpenicillin is effective for pneumococcal meningitis
Ceftrioxone in benpen resistant
92
Complications of pneumococcal meningitis
Death (30-50% mortality)
In those who survive: loss of hearing, hemiparesis, hydrocephalus, seizures - dexamethasone reduces likelihood of this occurring
93
Prevention of pneumococcal meningitis
Pneumococcal vaccine - pneumovax
Covers 23 serotypes
Recommended for all >65
Splenectomy, diabetes, chronic renal disease, cardio-respiratory disease, HIV infection
Prevenar in childhood
94
What does the hib vaccine work against
Haemophilus influenzae type B - causes meningitis, arthritis, epiglottitis
Given to all 2 months old+
--- uncommon now
95
Epidemiology of viral meningitis
Most cases young women or children
Enteroviruses - echoviruses and coxsackie most common cause in UK, occurring usually in late summer, early autumn
Mumps uncommon due to MMR, polio uncommon, HSV and EBV especially in immunocompromised
96
Clinical presentation of viral meningitis
Non-specific prodromal illness followed by rapid onset of headache, photophobia, low grade fever and stiff neck
Usually lucid and alert
Encephalitis - lethargy, confusion, seizures, focal neurological signs
97
Investigation for suspected viral meningitis
PCR of CSF for enterocytes, herpes simplex, mumps etc.
Enteroviruses can also be detected in throat swabs and faeces
Test for HIV if appropriate NB may be part of seroconversion so test would be negative
98
Treatment of viral meningitis
Enteroviruses and parenchoviruses - symptomatic and will recover within 72 hours
If chronic infection occurs (e.g. Patient immunocompromised) need IV immunoglobulin
Give aciclovir IV for herpes simplex
99
Prognosis of viral meningitis
Most make complete recovery without long term sequelae
Mumps could cause deafness, orchitis or testicular atrophy
100
What is the most important cause of meningitis with HIV infection
Cryptococcus neoformans - found in bird droppings
101
Presentation of fungal meningitis
More commonly is a sub-acute onset of symptoms with low grade fever, headache, nausea, lethargy, confusion and abdo pain
Meningism is less common
102
Treatment of fungal meningitis
Parenteral amphoterecin sometimes in combo with flucytosine
Or high dose fluconazole
103
Prevention of fungal meningitis in those with HIV
Secondary prevention: Long term chemoprophylaxis with fluconazole for all with HIV following an episode of cryptococcal meningitis
104
What conditions predispose neonates to meningitis
Low birth weight
Prolonged rupture of membranes
Maternal diabetes mellitus
105
What are the most common bacteria implicated in neonatal meningitis
Group B strep (gram +ve cocci)
E.coli
Listeria monocytogenes
106
Presentation of neonatal meningitis
Early within 3 days of birth: marked respiratory distress, bacteraemia, and high mortality - organism acquired at birth from mother's genital tract
Late >week after birth: bacteria and meningitis - spread by cross infection from other mothers, babies or health care workers
107
Diagnosis of neonatal meningitis
Neonatal CSF and blood cultures; maternal blood cultures;
CSF, EDTA blood, faeces and nasopharyngeal secretions for viral
108
Treatment for neonatal meningitis
Parenteral ampicillin and gentamycin or cefotaxime
109
Prevention of neonatal meningitis
Chemoprophylaxis to prevent neonatal group B strep infection is given to high risk mothers during labour using amoxycillin or co-amxiclav
At risk: prolonged interval between membrane rupture and delivery (>18hours), intrapartum fever
110
Bacterial causes of pneumonia
```
Streptococcus pneumoniae
Staph aureus (post influenza)
Mycoplasma pneumonia (common in young adults)
Chlamydia psittaci (bird owners!)
```
110
How would you assess the severity of community acquired pneumonia
```
CURB-65
Confusion
Urea >7mmol/L
Respiratory rate >30
BP 65
```
```
2 = consider admit
2-5 = severe pneumonia
```
111
Complications of pneumonia
```
Pleurisy, pleural effusion, empyema
Lung abscess
Abnormal pulmonary fas exchage
Bronchiectasis = permanent dilatation of bronchi that need physio to help clear sputum
Aspiration pneumonia
```
112
Risk factors for contracting tuberculosis
```
HIV - screen for
Overcrowding
Chronic lung disease
From S. Asia or Africa
Malnutrition
```
113
Treatment of tuberculosis
Isoniazid and rifampicin for 6 months
| Pyrazinamide and ethambutol for 1st 2 months
114
Symptoms of tuberculosis
SOB
Cough and sputum
Haemoptysis
Crackles
Blood-borne spread - malaise, weight loss, fever, night sweats
115
Side effects of the drugs used to treat tuberculosis
Pyrazinamide --> gout
Ethambutol --> optic neuropathy
Isoniazid --> hepatitis, peripheral neuropathy
Rifampacin --> orange/iron bru urine and tears; induces liver enzymes so changes effectiveness of prednisolone, anti-convulsants, oral contraceptives
116
Define hospital acquired pneumonia
Pneumonia occuring greater than 48hours after admission to hospital
117
Causative organisms for hospital acquired pneumonia
Usually gram negative and drug resistant:
- klebsiella
- serratia
- enterobacter
- pseudomonas
118
Signs and symptoms of infective endocarditis
```
Fever
Roth spots
Osler nodes
Murmur - new or changed
Janeway lesions
Anorexia
Nail haemorrhage
Embolism
```
May have SOB and fatigue and chest pain
119
Modified duke criteria for infective endocarditis
Major -
Blood cultures are positive for IE
Evidence of endocardial involvement - echocardiography, new valvular regurgitation
Minor -
Predisposition including heart condition or injecting drug use
Fever
Vascular phenomena
Immunologic phenomena - glomerulonephritis, osler's nodes, roth's spots, rheumatoid factor
Microbiological evidence
Need 2 major, 1 major and 3 minor or 5 minor criteria
120
Causative organisms for infective endocarditis
Staph aureus - treat with gent and fluclox or vancomycin
Strep viridans - treat with benzylpenicillin and gentamycin
121
Which organism is likely to be infecting a man with cystic fibrosis
Pseudomonas aeruginosa
Burkholderia cepacia
Staph aureus
Haemophilus influenzae
122
Most common causative organism for lobar pneumonia
Streptococcus pneumoniae
123
Organisms responsible for pneumonia in previously young and healthy person
Streptococcus pneumoniae
Mycoplasma pneumoniae
Legionella pneumonia
Chlamydia psittachi
124
Signs of left lobar pneumonia
```
Tachypnoea
Tachycardia
Fever
Cyanosis
Decreased chest expansion
Dullness to percussion
Bronchial breathing at left base
```
125
Investigations for suspected lobar pneumonia
```
Sputum analysis for culture
CRP and ESR
Blood culture
Chest xray
Acute and convalescent serology
```
126
Organisms which present with typical features of pneumonia
Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis (smoking)
Klebsiella pneumonia (alcoholism)
127
Gram +ve diplococci that causes acute lobar pneumonia
Strep. Pneumoniae
128
Why is haemophilus not penicillin sensitive
Produce beta-lactamase that can break down penicillins
129
Atypical pneumonia
```
Legionella
Mycoplasma
Coxiella burnitii
Chlamydia psittaci = psittacosis
Bordatella pertussis
TB
```
130
Legionella pneumonia
Aerosol spread
Severe systemic illness that may include abdominal pain and diarrhoea, lymphopenia and hyponatraemia
131
Viral pneumonia
Influenza A and B
| Varicella zoster and herpes zoster
132
Which antibiotics should you use in a hospital acquired pneumonia
Cefrazidime - only cephalosporin active against pseudomonas
Gentamicin - good gram neg cover
Vancomycin - good gram pos cover
133
Define pyrexia of unknown origin
Temperature persistently above 38 for more than 3 weeks, without diagnosis despite initial investigation during 3 days of inpatient care or after more than 2 outpatient visits
134
Investigations for pyrexia of unknown origin
Sputum or other specimens for mycobacterial stains and culture
Antigen detection - in blood, CSF, nasopharyngeal aspirate, urine
Nucleic acid detection
Serological tests - antibody detection for viruses, dysmorphic fungi and some bacteria and protozoa
Imaging of the abdomen by ultrasonography or computed tomography
Echocardiography
135
Differential diagnosis of acute diarrhoea and vomiting
Infectious - Gastroenteritis, C. Difficile, Acute diverticulitis, sepsis, pelvic inflammatory disease, pneumonia (atypical), malaria
Non-infectious:
GI - inflammatory bowel disease, bowel malignancy, overflow from constipation
Metabolic - diabetic ketoacidosis, thyrotoxicosis, uraemia
Drugs - NSAIDs, cytotoxic agents, antibiotics, PPI
136
Investigations for pyrexia of unknown origin
Sputum or other specimens for mycobacterial stains and culture
Antigen detection - in blood, CSF, nasopharyngeal aspirate, urine
Nucleic acid detection
Serological tests - antibody detection for viruses, dysmorphic fungi and some bacteria and protozoa
Imaging of the abdomen by ultrasonography or computed tomography
Echocardiography
137
Which foods are associated with transmission of salmonella spp and campylobacter
Raw eggs (salmonella only)
Undercooked meat or poultry
Unpasteurised milk or juice
Unpasteurised soft cheeses
138
What is raw seafood likely to transmit
Norovirus
Vibrio spp
Hepatitis A
139
First investigations for malaria
Think and thin blood film for malaria parasites, FBC, urinalysis
140
What is topical sprue
Malabsorption syndrome with no defined aetiology; gardia lamblia infection may progress to a malabsorption syndrome that mimics topical sprue
141
Which blood component is usually raised in parasitaemia
Oesinophilia - hookworm, schistosomiasis
142
Presentation of schistosomiasis
Transient rash
Fever
Hepatosplenomegaly
Induces transient respiratory symptoms with infiltrates in the acute stages and, when eggs reach the pulmonary vasculature in chronic infection, can result in shortness of breath with features of right heart failure due to pulmonary hypertension
143
Investigation of oesinophilia
```
Stool microscopy
Terminal urine
Duodenal aspirate
Slit lamp examination
Serology
```
144
Consequence of varicella zoster virus in pregnancy
Neonatal infection, congenital malformation and serious infection in the mother
145
What is the effect of cytomegalovirus in pregnancy
Neonatal infection and congenital malformation
146
Which maternal infections can cause neonatal conjunctivitis
Neisseria gonorrhoea
| Chlamydia trachomatis
147
Effect of maternal malaria
Fetal loss
Intrauterine growth retardation
Severe malaria in mother
148
Clinical features of parvovirus B19
Small children --> slapped cheek followed by a maculopapular rash then resolution
Gloves and socks syndrome in young adults
Arthropathies in adults and children
Impaired erythropoeisis in adults with haematological disease or immunucompromised
HYDROPS FETALIS - CAN CAUSE SPONTANEOUS ABORTION
149
What is the effect of cytomegalovirus
Congenital infection
Infectious mononucleosis
Hepatitis
Disease in immunocompromised patients - retinitis, encephalitis, pneumonitis, hepatitis, enteritis
Fever with abnormalities in haematological parameters
150
What is the effect of epstein-barr virus
```
Infectious mononucleosis
Burkitt's lymphoma
Nasopharyngeal carcinoma
Oral hairy leucoplakia (AIDS)
Other lymphoma
```
151
Which herpes virus infection causes kaposi's sarcoma
HHV-8
152
Complications of mumps
```
Encephalitis
Transient hearing loss
Encephalitis
Labyrinthitis
Electrocardiographic abnormalities
Pancreatitis
Arthritis
Infertility in males
```
153
Infectious mononucleosis
Acute viral illness characterised by pharyngitis, cervical lymphadenopathy, fever and lymphocytosis most commonly caused by epstein barr virus
But CMV, HHV-6, HIV-1 and toxoplasmosis can produce a similar clinical syndrome
154
Common complications of infectious mononucleosis
```
Severe pharyngeal oedema
Anti-biotic induced rash when use amoxicillin
Prolonged post-viral fatigue
Hepatitis
Jaundice
```
155
Uncommon complications of infectious mononucleosis
Neurological - cranial nerve palsies, meningoenchephalitis
Haematological - haemolytic anaemia, thrombocytopenia
Cardiac - myocarditis, ECG abnormalities, pericarditis
Ruptured spleen, respiratory obstruction, agranulocytosis
156
Which malignancies are associated with EBV
```
Nasopharyngeal carcinoma
Burkitt's lymphoma
Primary CNS lymphoma
Hodgkin's disease
Lymphoproliferative disease in the immunocompromised
```
157
How would you investigate for EBV
Monospot test - heterophile antibody is present during acute illness and convalescence
158
Management of EBV
If a throat culture yields B-haemolytic strep then a course of penicillin should be administered
When pharyngeal oedema is severe, a short course of corticosteroids may help
Warn to avoid contact sports due to risk of splenic rupture
159
Complications of cytomegalovirus
Meningoencephalitis, guillan barre syndrome, acute haemolytic anaemia, thrombocytopenia, myocarditis and amoxicillin induced rash
Immunocompromised - hepatitis, oesophagitis, colitis, pneumonitis, retinitis, encephalitis, polyradiculitis
160
Which virus is associated with cruise ship outbreaks
Norovirus - vomiting is prominent symptom
161
Infections caused by staph aureus
Repiratory - pneumonia, empyema, lung abscess
Cardiac - endocarditis, pericarditis
Blood stream - septicaemia and metastatic abscesses
CNS - meningitis, brain abscess
Bone and joint - osteomyelitis and septic arthritis
Enterocolitis
Toxic shock syndrome - toxic shock syndrome
Skin - wound infections, bullous impetigo, scalded skin syndrome
162
Treatment of scarlet fever
Caused by strep pyogenase - benzylpen or orally available penicillin
163
Organism responsible for food poisoning from rice
Bacillus cereus
164
Most common cause of bacterial gastroenteritis
Campylobacter jejuni - nausea, vomiting, significant diarrhoea, frequently containing blood
165
Complications of campylobacter jejuni
Reactive arthritis and guillian barre
166
Usual antibiotic choice if you choose to treat bacterial gastroenteritis
Ciprofloxacin
167
Malaria in humans is caused by
Plasmodium falciparum
168
Presentation of plasmodium falciparum infection
Insidious onset with malaise, headache and vomiting; cough and mild diarrhoea are also common
Fever
Jaundice occurs due to haemolysis and hepatic dysfunction
The liver and spleen enlarge and may become tender
Anaemia and thrombocytopenia occur rapidly
Cerebral malaria is shown as confusion, seizures or coma
169
Diagnosis of HIV
Detect HIV RNA in serum or immunoblot assay
170
What is the differential diagnosis of primary HIV
```
EBV
CMV
Streptococcal pharyngitis
Toxoplasmosis
Secondary syphilis
```
171
AIDS-defining conditions
```
Oesophageal candidiasis
Cryptococcal meningitis
Cerebral toxoplasmosis
Chronic mucocutaneous herpes simplex
Pulmonary or extrapulmonary tuberculosis
Pneumocystis jirovecii
Invasive cervical cancer
Kaposi's sarcoma
HIV associated dementia
Non-hodgkin lymphoma
```
172
Gram positive cocci in chains that causes infective endocarditis
Viridans streptococci
173
Appearance of strep pyogenes
Gram positive cocci - 2 together and not in chains
174
Appearance of e.coli under the microscope
Gram negative bacilli
175
Which organism looks like bunch of grapes on stains
Staph aureus
176
Treatment of strep viridans infective endocarditis
IV benzylpenicillin for 2 weeks
177
Could you give someone with HIV a live vaccine
No
178
Gram positive cocci in chains that causes infective endocarditis
Viridans streptococci
179
Appearance of strep pyogenes
Gram positive cocci - 2 together and not in chains
180
Appearance of e.coli under the microscope
Gram negative bacilli
181
Which organism looks like bunch of grapes on stains
Staph aureus
182
Treatment of strep viridans infective endocarditis
IV benzylpenicillin for 2 weeks
183
Could you give someone with HIV a live vaccine
No
184
Best antibiotic for gram negative sepsis with septic shock
Tazocin
185
Best antibiotic for gram negative sepsis with septic shock
Tazocin
186
Best antibiotic for gram negative sepsis with septic shock
Tazocin
187
Best antibiotic for gram negative sepsis with septic shock
Tazocin
188
Best antibiotic for gram negative sepsis with septic shock
Tazocin
189
Best antibiotic for gram negative sepsis with septic shock
Tazocin
