Infections Flashcards
(45 cards)
1
Q
Bacteria - other
1. DDx for eschar
2. Gram positive cocci
3. GP bacilli (rods)
4. Bacteria with branchiing filaments
5. Gram neg cocci
6. Gram neg bacilli
A
- Burn, anthrax, cutaneous diphtheria, tick bite, ecthyma, ecthyma gangrenosum
- GPC - Staph, Strep
- GP bacilli - Corynebacterium, Clostridium, Bacillus anthracis, Erysipelothrix
- Nocardia, Actinomyces
- Neisseria gonorrhoea, Neisseria meningitidis
- Pseudomonas, Bartonella, Burkholderia pseudomallei
2
Q
Bacteria - Staph
1. Cx/serious disorders a/w Staph
2. Re impetigo
- Risk factors
- DDx non bullous impetigo
- DDx bullous impetigo
- Mgmt measures
2. Ecthyma
- who gets it
- clinical pres
- Rx
3. Staph folliculitis - mgmt
4. SSSS
- cause
- presentation
- mgmt
- compare SSSS vs TEN
5. TSS
- Risk factors
- Which staph toxin
- Which strep toxin
-Criteria
- In strep, associated with?
A
- Bacteraemia / sepsis, OM, septic arthritis, IE, TSS, SSSS
- Impetigo - see page
- Non B: IBR, eczema, HSV, candida, tinea
- B: bullous IBR, thermal burn, HSV, acute contact derm
- Decolonisation. Hygiene. Bleach baths. Return to school 24hr after Rx (cover sores) - see page
- ssss page
- RF: tampon use, post partum, diaphragm contraception, extremes of age. Nasal packing, surgical mesh
- TSST1
- SPE A, B, C
- 1) fever >38.9, 2) BP <90, 3) diffuse macular erythema, 4) desquamation 1-2/52 later, 5) involvement 3+ organs (GIT, MSK, renal, liver, plt, cns), 6) negative Ix for other causes (cultures)
- A/W soft tissue infection eg nec fasc
3
Q
Bacteria - Strep
1. Cx/serious disorders a/w Strep
2. Invasive GAS - mgmt household contacts and why
3. Examples of iGAS infections
4. Scarlet fever
- typical presentation
- Cx
5. General strep Ix
6. Perianal/VV strep
- can you get general strep Cx?
- will also swab positive where?
- Rx?
- clinical presentation
7. Cellulitis - risk factors for recurrence
A
- Scarlet fever, rheumatic fever, post strep GN, guttate psoriasis. TSS. Bacteraemia / sepsis, OM, septic arthritis, IE
- rch - at risk of iGAS within 7/7. Empiric Rx - cefalex 10/7, azithro 500 5/7
3.Bacteraemia, STSS, nec fasc, pneumonia, empyema, OM, meningitis - high fever. Sandpaper like fine erythema, ‘sunburn with goosebumps’. Transverse red lines in skin folds ‘pastia lines’. Bright red tongue ‘strawberry tongue’. Resolves w desquamation
- myocarditis, hepatitis, arthritis, meningitis, OM, RF, GN
- ASOT (repeat 2/52 later), anti DNAse B. Urinalysis - RBC, casts. Throat swab
- yes can get strep Cx
- throat
- cefalex 5/7
- bright well demarcated erythema. Pain w defecation. Constipation
- Cellulitis: lymphoedema, DVT, PVD, chronic venous insufficiency, oedema, prev venectomy
4
Q
Infection - other
1. Sporotrichoid spread
2. DDx widespread maculopapular rash
A
- Bacterial: Staph, Strep, Nocardia, Tularaemia
Fungal: Sporotrichosis, chromoblastomycosis
Typical mycobacterial: leprosy, TB
Atypical mycobacterial: M marinum
Parasitic: Leishmaniasis
Viral: cowpox - Viral - measles, rubella, EBV CMV, roseola, dengue, RRV, BFV
Bacterial - scarlet fever, TSS, secondary syphilis
Inflam - Kawasaki, GVHD, Stills
Drugs
5
Q
Bacteria - other
1. Nec fasc
- types
- Risk factors
- immediate mgmt
2. IE
- Osler vs Janeway lesions
3. Clostridium
- Organisms (TBD)
- Gas gangrene. When to think about it. mgmt
4. Erythrasma
- Organism
- Woods, reason
- RF
5. Pitted keratolysis
- RF
- Wood’s fluorescence
A
1
- Polymicrobial, monomicrobial (GAS), marine organisms, fungal
- Diabetes, immunosuppression, cardiac or PVD, renal failure, penetrating injury, IVDU, recent surgery, preexisting ulcers
- see notes
2.
- Osler: painful papules fingers
Janeway: nontender erythematous papules palms. Can culture organism
3. Clostridium
- Tetani, Botulinum, Diphtheria
- Gas gang. Trauma, penetrating inj. Pain, swelling, d/c. Crepitus. XR - gas. Mgmt - debride. IV penicillin
4.
- C minutissimum
- Coproporphyrin III. Coral red fluoresce
- RF: obesity, humidity, hygiene, hyperhidrosis, diabetes
5.
- RF: occlusion, humidity, hyperhidrosis
- No fluoresce
6
Q
Meningococcaemia
1. Microscopy appearance
2. Transmission, incubation
3. Clinical presentations
4. Cx
5. Urgent mgmt
6. Close contact mgmt
7. Vaccines
A
- GN diplococcus
- Respiratory. 2-10 days
- Meningococcal meningitis. Headache, neck stiff, photophob. Systemic
- Meningococcaemia. Petechiae, MP rash, purpuric lesions. Systemic Sx. Haemorrhagic bullae
- Sepsis, arthritis, DIC, pericarditis, deafness, peripheral neuropathy, MSK problems
- Hospital. Admission. LP. ABx - IV ceftriaxone 2g BD. Isolation, droplet precautions. Notifiable
- Empiric cipro 500mg stat
- 3 vax, diff serovars
7
Q
Pseudomonas
1. Microscopy
2. Clinical presentations
A
- Gram neg rod
- Green nails. Folliculitis (hot tub folliculitis). Ecthyma gangrenosum. Pseudomonas hot foot. Otitis externa. Pseudomonas pyoderma
8
Q
Bartonella
1. Organisms and their diseases
2. Tell me a bit about bartonellosis / Carrion disease
3. Tell me a bit about cat scratch disease
A
- B henselae -cat scratch
B quintana - trench fever
B bacilliformis - Carrion disease - Acute - Oroya fever. Systemically unwell, drop Hb from haemolysis, immunodeficiency. Recover ~10 wks
Chronic - varruga peruana. Vascular lesions, red papules and nodules. Painless - Recent bit or scratch. lNopathy can last weeks to months. May suppurate. Red papule at site
Cx: arthritis, osteolytic lesions, LNopathy, encephalopathy, pneumonia
Rx azithro
9
Q
Bacillary angiomatosis
1. Organism/s
2. Who gets it
3. Clinical pres
4. Ix
5. Mgmt
A
- B henselae or quintana
- HIV
- Violaceous angiomatous papules and nodules
- Swab bacterial. Bartonella serology. Tissue bartonella PCR. Biopsy hhisto
- Doxy or erythro
or
azithro
10
Q
Melioidosis
1. Exposure/transmission
2. Risk factors
3. Clinical pres
- how many have skin Sx
- how many present w sepsis
4. Ix/workup
5. Rx
6. Systemic sites which can be affected
A
- Soil, surface water. Occupational, recreational.
Wet weather - more inhalational. Military - Diabetes, immunosuppressed, male, CKD, pulmonary disease, malignancy
- Nonspecific. ‘Great mimicker’. 10-20% have skin Sx. ~50% p/w sepsis.
Skin - solitary nonhealing ulcer or inflamed skin patch - Swab. Biopsy. culture.
Ix for other involvement - BC, CXR, abdominal imaging - Initial IV 10-14/7 ceftazidime or mero then 12/52 oral eradication (bactrim). Consider surg drainage
- Pulm - pneumonia, abscess
MSK - OM, septic arthritis
CNS - encephalomyelitis
GU - renal, prostate
11
Q
Non venereal treponematoses
1. Forms of disease. Brief description
2. Organism
3. does serology differentiate?
4. Rx
A
- Bejel: primary: papule or ulcer. Secondary: MP eruption, LNlpathy. Tertiary: gumma
Yaws: Primary - mother yaw, papule ulcerates heals w scar. Secondary - daughter yaws. Crops, near orifices. Infectious ++
Tertiary: abscesses, necrotic, ulcerate
Pinta: primary - papules/plaques at inoculation. Secondary - widespread pintids, dyspigmentation, scaly papules.
Tertiary: vitiligo like lesions - T pallidum
- No. Clinical Dx
- Azithro 30mg/kg max 2g stat
12
Q
Actinomycosis
1. RF
2. Clin presentation
3. Key path features
A
- Dental procedures
- Lumpy jaw. Nodules, abscess. Drain ‘sulfur granules’ - clumps of bacteria
- Sulphur granules
13
Q
Leprosy
1. Likelihood of acquiring infection if exposed?
2. Lepromatous leprosy - clinical features
3. Tuberculoid leprosy - clinical features
4. What would you look for O/E
5. Classification systems
6. Types of lepra reactions
7. Types of Ix
8. Pt workup Ix
9. Histopath lepromatous vs tuberculoid
10. Mgmt principles
A
- 5-20% (MJA)
- SMILES G CORP
- SHAG
- Sensation - pain, temperature, touch.
Neuropathic changes - muscle atrophy, vasomotor alterations, flexion contractures
Peripheral nerve enlargement
Motor power - reduced
Clinical signs above - WHO - pauci and multibacillary
Ridley Jopling - spectrum - Type 1 - reversal/upgrading. Acute neurology. Rx - pred
Type 2- ENL - type of vasculitis. Rx - thalidomide - Slit skin smear. Biopsy histo, IHC for PGL1. PCR. Serology - antiPGL Ab
Histamine; pilocarpine; lepromin - USS nerve, NCS. Nerve Bx. MRI nerve. touch testing. Sweat test
- Lepromatous: widespread infiltrate. Virchow cells - foamy macrophages. Sheets of histiocytes. ONion skin appearance of nerves.
Tuberculoid: perineural granulomas. Lymphocytic infiltrate - Multi vs pauci bacillary (12 vs 6/12)
clofazimine, rif, dapsone.
Notifiable.
F/U 5yrs, risk relapse
14
Q
Cutaneous TB
1. How many infections lead to clinical disease?
2. How common is cutaneous tb?
3. Risk factors
4. True cutaneous TB:
- Endogenous (LSMOG)
- Exogenous (T/VC)
5. Tuberculids (3)
6. New pt workup
7. Path stains
8. Path features, how to differentiate from sarcoid
9. Rx
A
- 5-10%
- Uncommon. 8-24% cases are extrapulmonary. 1.5-3% of these are cutaneous
- HIV. Kids. Immunosuppression. diabetes, malnutrition, overcrowding
- Endogenous:
-Lupus vulgaris: most common. Red brown plaque, scale, fibrosed. Endogenous or ex.
-Scrofuloderma: contiguous spread from lN. Painless swellings, ulcers
-Miliary: unwel pts. Multiple papules, pustules, necrosis, umbilication
-Orificial: autoinoculation around orifices. Immsupp pts
-Gumma: uncommon. Fluctuating nodules
Exogenous:
- TB chancre: no prior exposure. Papulonodule -> ulcer
- TBVC: prev exposure. Verrucous plaque - Immune reactions to haematogenous dissemination of TB
EI: lobular panniculitis
Lichen scrofulosorum: numerous erythematous perifollicular papules
Papulonecrotic tuberculid:cyclic eruptions painless papules, pustules. Resolve w scarring - Palpate lNopathy. LNbx
- Lungs - cxr, ct, sputum
- Abdo - USS, CT, MRI
- Bones - XR
- Breast granulomatous mastitis
- Bloods. Biopsies - culture, AFB. PCR
Tuberculin skin test
- ZN, Fite
- Tuberculoid epithelioid granulomas, giant cells, caseation necrosis.
Sarcoid - won’t have peripheral rim lymphocytes. ZN neg - RIPE
Rif 600mg daily, Izoniaz 300mg daily, pyrazinamide 30mg/kg/day, ethambutol 15mg/kg/day for 2/12. THEN RI for 4/12
15
Q
M ulcerans
1. Features suspicious for infection
2. Mgmt
A
- Long incubation. Painless ulcer. Deep necrotic base. Undermined edges. Solitary. can involve bone
- ID ref
Abx - rif 600mg OD + clarithro 500mg BD 8/52
Notifiable
Paradoxical worsening (stops mycolactone) - mgmt with pred
+/-: hyperbaric. Surgical
16
Q
M marinum
1. Clinical
2. Incubation
3. ix
4. Mgmt
A
- Nodule, pustule. Solitary red to violaceous papule, nodule, plaque. Crusted ulcer
- Average 2-3/52. Can be up to 8/52
- Tissue - PCR, culture
- Clarithro 500mg BD, continue Rx 1-2/12 after resolution of lesions
17
Q
Rickettsial
1. Important ones in Australia
2. General disease course
3. Complications
4. Typical histopath
5. type of organism
6. Tick paralysis - mechanism, Sx
7. Ix for Dx and Cx
8. Rx
9. How to remove a tick
10. Tell me about alpha gal
A
- Rickettsia australis - QLD tick typhus. Spotted fever. Ixodes holocyclus
Orientia tsutsugamushi - scrub typhus. Larval trombiculid mite
R honei - FISF - Bite -> fever in first few days. headache, myalgias, N/V, abdo pain -> D3-6 rash, MP, petechial. Eschar. LNopathy
- Pneumonitis, encephalitis, hypotension, DIC, death, renal failure, thrombocytopaenia
- Lymphocytic vasculitis, RBC extravasation
- GN rod
- Tick inject holocyclotoxins. Diplopia, lethargy, nystagmus, flulike Sx, unsteady gait. Must be attached for days for enough toxin in adults
- Paired serology and PCR from swab, Bx. Bx. Basic, ESR CRP
Cx: CXR, CT chest, MRI B. LP. USS abdomen
Convalescent serology 2-4/52 post, increase in titre 4fold - doxy 100mg BD 7/7 OR azithro 250-500mg 7/7. Ix don’t delay Rx
- see notes
- see notes
18
Q
HIV
1. Examination features to support Dx of acute HIV1
2. Features of established HIV
3. Ix you would do
4. What is IRIS?
A
- Fever, LN, weight loss
Myalgia, arthralgia. Night sweats, pharyngitis
Morbilliform exanthem. Oral and genital ulcers. Acute retroviral syndrome resembles mono - HIV related infections
Bacterial. Viral. Fungal. Parasitic. Ectoparasites
Noninfectious (seb derm, psoriasis)
Pruritic papular eruption - Confirm Dx - HIV serology (window period, false neg, can last up to 3/12), PCR
Exclude DDx - EBV, CMV, other viral
Assoc - full sti screen - Immune reconstitution inflammatory syndrome. After starting ART - paradoxical exacerbation of infection, inflamamtory diseases, neoplasm. ~15% pts.
19
Q
HPV
1. Broad classification
2. Anogenital warts risk factors
3. Transmission. Target in the skin
4. Buschke Lowenstein. What is it. Cx
5. Trick to identify mucosal warts
6. Path buzz words
7. Schedule for 9 valent HPV vax
8. Anogenital warts in pregnancy - counselling, mgmt
9. Wart Rx:
- Imiquimod
- TCA
- Cryo
- Podophyllin
- DCP
- SA
10. EV - brief
A
- Alpha - pathogenic in normal hosts
Beta - a/w EV - Early age sexual intercourse, MSM, uncircumcised, no barrier contraception, more sexual partners
- Contact - skin to skin, contaminated surfaces, autoinoculation. Basal keratinocytes
- Giant condylomata acuminata. A/W HPV 6, 11. Cx: fistulas, abscess, local invasion, SCC
- 5% acetic acid soak for 3-5 mins. ‘Aceto whitening’
- Papillomatosis, hyperkeratosis. Hypergranulosis. Koilocytes (vacuolated cells with hyperchromatic shrivelled nuclei)
- On NIP single dose. For adults 3x doses
- See notes
- See notes
- Genetic. AR. EVER1 and EVER2. Polymorphic widespread lesions. Risk scc ~50%
20
Q
Fungal - superficial
1. Tinea nigra
2. Piedra
3. Pit versi
- Types malassezia
- Microscopy appearance
- Rx options
4. Clinical features
5. Effect of sebum on dermatophyte
6. Tinea capitis
- Risk factors
- Look at table in notes on kerion
- Endothrix organisms
- Ectothrix organisms and fluorescence
- Oral Rx
7. types of tinea pedis
8. Types tinea unguium
9. Tinea unguium treatment options
A
- F GROS
- Branching hyphae and yeast. Spag and mball
- see notes
- Annular lesion, central clearing, peripheral scale, pustules. Vesicular
- Inhibitory. So - scalp infections pre-pubertal. Hand - looks different on palms, lack of sebaceous glands
- Animal exposure, scalp shaving, overcrowding, poor hygiene
- TV SGYR
- Micro CADFG. Yellow green fluorescence for VM FACD
- Trichophyton - Terbinafine 250mg OD 4/52. Paeds dosing
Microsporum - griseo. 20mg/kg/day 6-8/52 - MJA 8-12/52
- Moccasin, interdigital, inflammatory, ulcerative
- Distal/lateral subungual, superficial white, prox subungual
- See notes
21
Q
Mucocutaneous candidiasis
1. Risk factors
2. Types oral candidiasis
3. Mgmt approach and Rx options:
- Vulvovaginal candidiassi
- Mucocutaneous candidiasis
A
- Immunosuppressed, diabetes, smoking ABx, HIV, extremes of age, dentures, nutritional deficiency
- Pseudomembranous, chronic atrophic, chronic hyperplastic, glossitis
22
Q
Chromoblastomycosis
1. DDx
2. histopath buzz word
3. Where/who acquire
4. Clinical pres
5. Rx
A
- Mycobacterial, tertiary syph, blastomycosis, leish
- Medlar bodies - pigmented round, resemble copper pennies. Within giant cells and extracellular
- Tropical and subtropical. Farmers, miners
- Verrucous, granulomatous plaque, central clearing and scarring
- Itraconazole 200-400mg daily 6/12 at least
23
Q
Mycetoma / Madura foot
1. Broad classification
2. Acquired?
3. Clinical
4. Rx
A
- Eumycotic (true fungi), Actinomycotic (filamentous bacteria)
- Soil. Tropical and subtropical
- Unilateral painless lesion, swells, draining sinuses. Grains - masses of colonies
- Targeted to organism
- Eumycotic: antifungal
- Actinomycotic: ABx
24
Q
Sporotrichosis
1. Organisms
2. Histopath buzz words
3. Rx
A
- S schencki, Mexicana, braziliensis, globosa
- Cigar shaped yeast forms. Asteroid bodies (yeast cell w surrounding eosinophilic fringe)
- Itraconazole 100-200mg/day 3-6/12
25
Lobomycosis
1. Where
2. Organism
3. Path buzz word
4. Mgmt
1. Central and south america. Contact w dolphins, marine environment. Soil
2. Lacazia loboi
3. Thick walled yeast cells 'brass knuckles'
4. Excision. Antifungals usually ineffective
26
Histoplasmosis
1. Organism
2. Transmission
3. Clincial
4. Path
5. Rx systemic
1. Histoplasma capsulatum
2. Inhaled. Inoculation
3. Nonspecific. Ulcers, papules, plaques, molluscum like
systemic
4. Intracellular yeast forms
5. IV amphotericin B then itraconazole
27
Blastomycosis
1. Organism
2. Transmission
3. Cutaneous Sx
4. Histopath
5. Rx systemic
1. Blastomyces dermatitidis
2. Inhaled. Pulmonary infection
3. Verrucous plaques. Heal from centre w cribriform scarring
4. Round yeast forms, characteristic broad based budding. Thick double contoured walls
5. IV amphotericin B
28
Coccidioidomycosis
Thought to be the most virulent of all fungi
1. Location / where infections
Polymorphous features
2. Path
3. Transmission
4. RF for dissemination
1. SW US, north mexico, central and south america
2. Characteristic endospore containing spherules
3. Inhaled, dust particles
4. Risk factors for dissemination: immunosuppressed, pregnancy
-- Mexican 5x risk, African American 25x risk, Filipino 175x risk!
29
Paracoccidioidomycosis
1.Transmission
2. Mucosal features
3. histopath
1. Inhaled. Pulmonary
2. Ulcers - 'moriform stomatitis' - painful facial and oronasal mucosal ulceration
3. Large, thick-walled organisms with multiple narrow-based buds - leads to an outline resembling 'mariner's wheel'
30
Protothecosis
1. Type of organism
2. Transmission
3. Clinical
4. Mgmt
1. Achlorophyllic algae
2. Direct inoculation
3. Immcompetent: plaque, nodule, ulcer
Immsupp: may have widespread involvement, algaemia
4. Difficult. Excision. Amphotericin
31
HHV
1. List/name the HHV and their infections
2. Characteristic histopath feature of CMV
3. Rubella - enanthem
4. Rubella - Cx
5. Unilateral laterothoracic exanthem - clinical sign. histopath
6. Gianotti Crosti. Presentation; what to tell parents
1. HHV1, 2 - HSV
HHV3 - VZV
HHV4 - EBV
HHV5 - CMV
HHV6 - roseola infantum
HHV7 - pityriasis rosea
HHV8 - Kaposi sarcoma
2. Owls eye appearance of endothelial cells (enlarged cell, purplish inclusion body surrounded by clear halo)
3. Forcheimer spots
4. In utero infection - miscarriage, stillbirth, congenital malformations.
Deafness.
Hepatitis, myocarditis, pericarditis, haemolytic anaemia
5. Statue of liberty sign. Eccrine gland infiltration w lymphocytes
6. Self limited response to diff viruses. URT Sx, then monomorphic skin coloured to pink red oedematous papules hands, legs, extensors. Self resolves, no Rx needed
32
HSV
1. Transmission. When is it shed
2. Discuss HSV during pregnancy / recommendations
3. What if HSV acquired in last 3/12 of pregnancy?
4. List Ix
5. Histopath features
6. Triggers for reactivation
1. Direct contact saliva, secretions. Sexual contact. Asymptomatic shedding
2. Reduce risk transmission: no oral sex from partner w coldsores, partners w genital HSV consider suppressive Rx. Pregnant pts suppressive Rx.
3. LSCS recommended
4. Swab PCR, Tzanck smear, biopsy
5. Nuclear margination (of chromatin), moulding, MNGC
6. Triggers: emotional stress, UVR, fever, menstruation, immunosuppression, dental or surg procedure
33
VZV
1. Transmission / how infectious?
2. What is Hutchinson's sign
3. Sx of ocular involvement?
4. Complications / systemic involvement
5. What is maternal varicella syndrome, when is this a risk
6. Pregnant women post exposure prophylaxis options
7. What is Shingrix, who is eligible
8. Rx options for post herpetic neuralgia
1. Droplet, direct contact. HIGHLY infectious. From 1-2/7 before skin lesions until all crusted
2. Vesicles/ involvement of nasal tip, dorsum, root, medial canthus indicates increased risk ocular involvement (shared branch nasociliary)
3. Conjunctivitis, keratitis, scleritis, uveitis, acute retinal necrosis
4. Ocular - as above
CNS - encephalitis, ataxia
Pneumonia 10-30% mortality if untreated
Haem - thrombocytopaenia
Hepatitis
GNephritis
Arthritis
Myocarditis
Pancreatitis. Orchitis. Vasculitis
Post herpetic neuralgia
Scarring
5. Maternal infection within first 20wks. 2% risk of syndrome. LWB, spont abortion, scarring, ocular abnormalities, CNS underdevelopment, microcephaly, hypoplastic limbs
6. VZV Immunoglobulin subcut. IVIg. Varicella vaccination. Oral aciclovir
7. Recombinant non live vaccine. NIP adults >65, atsi >50, immunocompromised >18. 2 doses 2-6/12 apart
8. Lignocaine 5% patch 12hr on 12 hr off. 8% capsaicin patch. EMLA. Gabapentin, pregab. nerve blocks. Psych techniques
34
EBV
1. EBV associated conditions (SLEIGH CLM)
2. What do you recommend to pple with mono?
3. Poss Cx of mono?
1. Severe mosquito bite allergy
Lipschutz ulcer
Extranodal NK/T cell lymphoma
Infectious mononucleosis
Gianotti Crosti
HV LPD
Chronic active EBV infection
Lymphomatoid granulosis
Mucocutaneous ulceration
2. Avoid contact sports. Splenomegaly common, risk rupture
3. Significant enlargement of oropharyngeal lymphoid tissue can cause airway compromise
Hepatitis, thrombocytopaenia, haemolytic anaemia, GN, CNS disturbances
35
HHV6 / Roseola infantum
1. Who gets it and when
2. Does everyone get clinical manifestations?
IF they do, what?
1. Kids 6mo to 3yr. In spring
2. 30% get clinical Sx.
Fever. Rashlasts 24-48hr. Rose red MP.
Nagayama spots - red papules soft palate
Ulcers uvula, palatoglossal junction
36
Enteroviruses
1. Most common viruses?
Can look like anything. A few key presentations
2. HFMD - clinical pres?
3. Herpangina - clinical pres?
1. Echovirus, coxsackievirus
2. Vesicles palms, soles, buttocks. ~50% erosive stomatitis
3. Painful vesicles, erosions mouth. LNopathy
37
Measles
1. Type of virus
2. Transmission, incubation
3. Clinical pres
4. Complications
5. Rx
6. Immunisation
1. RNA virus
2. Respiratory droplets. 10-14/7
3. Cough, conjunctivitis, coryza, Koplik spots (grey white papules buccal mucosa) - before the rash
Macpap rash cephalocaudal
4. ENT: otitis media
CNS: encephalitis. SSPE
CVS: myocarditis, pericarditis
Resp: pneumonia. croup
GI: diarrhoea, dehydration, mouth ulceration
Eyes: conjunctivitis, corneal ulceration
5. Supportive. Vit A daily for 2 days200 000IU for >12yo
Vax within 3/7 of exposure. IVIg within 6/7 exposure
6. MMRV 12 mo, 18mo
38
Parvovirus
1. Type of virus
2. Tropism for what type of cell? what is Cx of this?
3. Two clinical presentations?
4. Extracutaneous features of parvo
5. Cx of foetal B19
1. ssdna (single dad slapping child)
2. Erythroid progenitor cell. Transient aplastic crisis in at risk pts
3. Slapped cheek / erythema infectiosum: prodromal Sx, erythema cheeks. Then lacy reticulated rash
Papular purpuric gloves and socks. Oedema and erythema hands, feet, petechiae, purpura
4. Arthritis, transient aplastic crisis in at risk individuals, anaemia, thrombocytopaenia, pan cytopaenia
5. Range from limited anaemia to hydrops (severe oedema), spont miscarriage, stillbirth
39
Mpox
1. Transmission
2. Clinical presentation
3. Other features
4. DDx for Mpox
5. General mgmt key points
6. Antivirals
7. Vaccination
1. Droplet. skin to skin. mucosal
2. 5 days flu like (fever, malaise, headache, myalgia, arthralgia, LNopathy)
Rash - maculopapules -> vesicles -> pseudopustules -> crusting and atrophic scarring
3. Tender LNopathy. Proctitis. tonsilitis
4. Syphilis, HSV, disseminated gonorrhoea, molluscum, other poxvirus, LGV, chancroid
5. Full contact/iso. Hand hygiene. Notifiable. Contact tracing. Supportive mgmt for Cx.
**see JAAD table in notes
6. Cidofovir. Tecovirimat
7. Smallpox vax offers cross protection.
Jynneos - PrEP and PEP (within 4/7)
2 doses 28 days apart. 14 days until efficacy
40
Molluscum
1. Type of virus
2. Complications
3. Histopath buzzwords
4. Rx options
1. Poxvirus
2. Id REaction, secondary infection, scarring
3. Large intracytoplasmic inclusion bodies - Henderson-Patterson bodies
endophytic squamous proliferation
4. No Rx
Cantharidin, podophyllotoxin, SA, retinoids, tca, cryo, curettage, EDC, manual extraction, IL candida antigen
41
Kawasaki
1. DDx
2. Criteria / clinical features
3. Poss Cx
4. Poss Ix
5. Specific mgmt
1. TSS, SSSS, TEN
2. Fever >39 for 5/7
Conjunctivitis - non purulent
Rash - polymorphous
Adenopathy
Strawberry tongue. Hyperaemia, lip fissures
Hand and feet erythema, oedema
Erythema perineum
3. Myocarditis, pericardial effusions, aneurysms, valvular disease
CNS: irritability , aseptic meningitis, SNHL
MSK: arthralgia, arthritis
GI: abdo pain, diarrhoea
GU: Urethritis, meatitis
4. Basic bloods. Septic w/u. ECG, TTE
5. IVIg 2g/kg single dose over 8-12/24
Asprin 30-100mg/kg/day divided 4 doses for 14 days. Maintenance 3-5mg/kg for 6-8/52
42
HTLV1
1. Type of virus
2. Conditions a/w HTLV1 (SPASTIC)
3. Clinical description of infectious dermatitis
1. Retrovirus
2. Seb derm, paraperesis, adult T cell leukaemia/lymphoma, scabies, tinea, infective dermatitis, corneal opacities, HTLV1 associated uveitis
3. Exudative papular rash with crusting
43
Syphilis
1. Natural Hx of untreated syphilis?
2. Cutaneous manifestations secondary syphilis
3. Extracutaneous features secondary syphilis
4. Features tertiary syphilis
1. Infection -> 3/52 incubation, then primary syphilis / chancre -> lasts a few weeks -> 3-10/52 later, secondary syphilis -> resolve 3-12/52 -> enter latent
May/may not develop tertiary
~25% relapse from latent back to secondary
2. Roseola like rash (roseola syphilids)
Geeralised macpap, copper coloured papulosquamous eruption. Corymbose arrangement.
Corona veneris scalp margin
Necklace of venus - PIhypo neck
PP pap and plaques w Collarette of biett
Condylomata accuminatum
'Nickel and dime' annular plaques on face
Oromucosal snail track ulcers. Perleche. Split papules. Plaques muqueses.
Patchy nonscarring moth eaten alopecia. Lues maligna
3. LNopathy, malaise, fever, weight loss, headache, sore throat, conjunctivitis, arthritis, HSmegaly
4. Tertiary. Gummas, destructive. CV - endarteritis. Neurosyphilis. Tabes dorsalis - diplopia, lightning pains, loss vibration position sense, ataxis, Argyll robertson upils
44
Syphilis two
1. Features congenital syphilis
2. Consequences of pregnancy infection
3. Ix
4. Causes false positive nontreponemal
5. Causes false negative
6. Rx
1. marasmic - cachexia. Lsions similar to secondray
Pemphigus syphiliticus
Snuffles - nasal discharge
Fissures perioral, perianal
Pseudoparalysis of Parrot
2. Spont abortion, stillbirth, infant death, congenital syphilis
40% healthy child
3. Nontreponemal: VDRL, RPR. Done first. titres correlate w disease activity
Treponemal: TPPA, TPHA
Other sti screen
Ophthal exam
4. Biologic false pos: pregnancy, APLA syndrome, AICTD, lymphomas, ilicit drug use
False pos: endemic syphilis, borrelia
5. HIV infection. Prozone phenomenon
6. Early - benzathine benzylpenicillin 2.4million units IM
or doxy 200mg daily 2/52 or azithro 2g stat
Late - benzathine as above weekly for 3 doses
45
Look at:
gonorrhoea
chancroid
LGV
donovanosis
