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Infections Flashcards

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1
Q

What type of bacteria commonly cause septic arthritis?

A

Gram Positives (S.pyogenes, Group G Strept, Pneumococcus)

Gram negative (H.inflenzae, Kingella, N.meningitidis)

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2
Q

What bacteria commonly cause prosthetic joint infections?

A

CoNS
S.aureus
Gram negative bacilli
Streptococci

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3
Q

Define virulence in terms of organisms

A

Ability of an organism to infect

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4
Q

Why are prosthetic joints more likely to develop sepsis?

A

Require fewer bacteria than soft tissue to establish sepsis

Avascular - protected from circulating immunological defences and most Abx

Cement can inhibit phagocytosis and lymphocytic/complement function

Biofilms can easily develop on metal

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5
Q

What Abx should be given prophylactically prior to joint replacement surgery?

A

Cephalosporin

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6
Q

When should prophylactic cephalosporin be given prior to joint replacement surgery?

A

30-60 mins prior to skin incision

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7
Q

What is the cut off as to whether a joint prothesis is salvageable following infection?

A

30 days post op

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8
Q

What is the surgical management of an acute joint prothesis infection?

A

Debride
Antibiotics
Implant
Retained

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9
Q

Following an acute joint prothesis infection, how long are Abx required for?

A

4-6 weeks IV

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10
Q

What Abx are useful for managing a prosthetic joint infection post surgery?

A

Rifampicin

Ciprofloxacin

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11
Q

Define osteomyelitis

A

Progressive infection of bone characterised by new bone formation and loss of the integrity of the bone

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12
Q

What type of bacteria commonly cause osteomyelitis?

A

Anaerobes

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13
Q

Describe the management of osteomyelitis

A

Surgical debridement

May require 4-6week IV Abx

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14
Q

Describe vertebral discitis

A

Infection of the disc space and adjacent vertebral end plates

Can be very destructive
Deformity
Spinal cord instability –> cord compression, paraplegia, disability

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15
Q

Define neutropenia

A

<0.5 x 10^9/L or <1.0 x 10&9/L and falling

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16
Q

What gene is defective in chronic granulomatous disease?

A

Gene which encodes for NADPH oxidase in neutrophils

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17
Q

What are the effects of chronic granulomatous disease?

A

Deficient production of oxygen radicals
Defective intracellular killing

Recurrent bacterial and fungal infections

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18
Q

What is the life expectancy for people with chronic granulomatous disease?

A

40 (due to prophylaxis Abx)

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19
Q

Give 3 causes of cellular immunity suppression

A

DiGeorge Syndrome
Malignant lymphoma
Cytotoxic chemotherapy
Infections

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20
Q

Give 3 examples of immunosuppressive drugs

A 
Corticosteroids
Cyclosporins
Tacrolimus
Alemtuzumab
Rituximab
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21
Q

What condition results in mature B cells not being produced?

A

Bruton agammaglobinuaemia

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22
Q

In what type of leukaemia, is humoral immunity preserved?

A

Acute leukaemia

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23
Q

What will intensive radiotherapy and chemotherapy result in?

A

Hypoglubinaemia

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24
Q

What is the immunological function of the spleen?

A

Splenic macrophages eliminate non-opsonised microbes eg encapsulated bacteria

Site of primary immunoglobulin response

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25
If the spleen is defective, what infections are a person at a greater risk of developing?
S. pneumoniae Haemophilius influnezae type B Neisseria meningitidis
26
What immunoglobulin is found in sweat glands?
IgA
27
Define impaired nutritional status
<75% ideal body weight OR rapid weight loss AND Hypoalbuminaemia
28
If a patient has an impaired nutritional status, what is the effects in terms of their infection risk?
Too few B and T cells | Increased risk of infections
29
Describe pneumocystis jerovecii
Fungal infection | Causes a severe lung infection following transplant
30
Describe aspergillus
Causes infections in patients who have febrile neutropenia or who have had chemotherapy Treat with Abc then add in anti-fungal on d3
31
Describe the clinical importance of recognising a cancer patient with febrile neutropenia
Medical emergency Cancer patient + temperature --> infection until proven otherwise Do blood cultures Bloodstream infections are most troublesome --> systemic infection
32
Define SIRS
``` Sweats Chills Rigors Malaise Tachypnoea (>20/min) Tachycardia (>90bpm) Hypotensive ```
33
Define sepsis
Evidence of infection and organ dysfunction 2 or more: Hypotensive Confusion Tachypnoea >22/min
34
Define septic shock
Sepsis induced hypotension (SBP <90mmHg or reduced by >40mmHg from baseline) requiring inotropic support or hypotension which is unresponsive to adequate fluid resuscitation
35
Define neutropenic sepsis (febrile neutropenia)
Neutrophil count of <0.5 (or <1 if recent chemo) + fever/hypothermia or SIRS or SEPSIS/SEPTIC SHOCK
36
What scoring system can be used to assess the severity of sepsis?
NEWS
37
In what time frame should SEPSIS 6 be implemented in a patient with sepsis?
1 hour
38
What is SEPSIS 6?
1. Blood cultures 2. Urine output 3. Serial lactates 4. High flow O2 5. IV fluid resuscitation 6. IV ABx
39
If a patient is septic, and a skin or soft tissue infection is suspected, what Abx should be added?
Vancomycin
40
If a patient is septic and considered to have an atypical pneumonia, what Abx should be added?
Clarithromycin
41
What bacteria causes gonorrhoea?
Neisseria gonorrhoea
42
Describe Neisseria gonorrhoea
Gram negative intracellular diplococci
43
What symptoms are typically present in a male with gonorrhoea?
Anterior urethritis Purulent urethral discharge Dysuria
44
What symptoms are typically present in a female with gonorrhoea?
Increased vaginal discharge Dysuria Post-coital/intra-menstrual bleeding Lower abdominal pain
45
Describe how gonorrhoea infections are diagnosed
Urethral gram stain (sample from within urethra) Uses the NAAT test Males = urine sample ± rectal/throat swab Females = vulvovaginal swab Combine with testing for chlamydia
46
What systemic condition is associated with disseminated gonorrhoea?
Reactive arthritis
47
Describe the management of gonorrhoea
Ceftriaxone 500mg IM Azithromycin 1g Partner notification
48
What bacteria often co-exists with chlamydia trochomatis?
Mycoplasma genitalium
49
What is the major clinical effect of chlamydia infections?
Mostly asymptomatic (80% F' 50% M) Delays in treatment 16% of women develop PID (tubal infertility, ectopic pregnancy, chronic pelvic pain)
50
What symptoms are typically present in males with chlamydia?
Anterior urethritis Purulent discharge Dysuria
51
What symptoms are typically present in females with chlamydia?
Increased vaginal discharge Dysuria Post-coital/inter-menstrual bleeding Lower abdominal pain
52
How is chlamydia diagnosed?
NAAT test M: first void urine samples F: vulvovaginal swab
53
How is chlamydia treated?
Doxycycline 100mg BD for 1 week | Azithromycin 1g oral stat + 500mg od for 2 days
54
What causes Lymphogranuloma venereum (LGV)?
Invasive serovars L1 L2 L3 of Chlamydia trochomatis
55
What population are more likely to develop Lymphogranuloma venereum (LGV?)
MSM esp if have HIV Frequently associated with other STIs and Hep C
56
Describe the clinical stages of Lymphogranuloma venereum (LGV)
Transient - painless papule (shallow ulcer) at site of inoculation 3-30d post exposure Proctitis - rectal pain, mucupurulent discharge, rectal bleeding, constipation, tenesmus + systemic symptoms Chronic inflammatory response --> fistulae, strictures, granulomatous fibrosis (mimics Crohn's disease)
57
What is the management of Lymphogranuloma venereum (LGV)?
Doxycycline 100mg BD for 21 days
58
What bacteria causes Syphilis?
Treponema pallidum (a motile spirochaete)
59
Describe primary syphilis
Around 21d post exposure, a papule develops at site of inoculation --> ulcerates --> painless, firm ulcer (chancre) Painless regional lymphadenopathy Chancre heals in 2-6 weeks
60
Describe secondary syphilis
Constitutional symptoms appear 6-10wks post primary lesion Fever, sore throat, malaise, arthralgia (due to septicaemia)
61
What are the common signs associated with secondary syphilis?
Widespread skin rash (non-itchy, maculopapular, coppery colour) Generalised lymphadenopathy Condylomata lata - moist wart like plaques found in the perianal area and other moist sites
62
How is syphilis diagnosed?
IgG and IgM detected using treponemal enzyme immunoassay
63
Describe tertiary syphilis
Develops in 1/3 of people with untreated latent syphilis Commonly involves the bones, but can involve any organ
64
Describe the treatment of syphilis
Penicillin injections Doxycycline if have penicillin allergy Repeat bloods 3/12
65
Give examples of bacterial STIs
Chlamydia Gonorrhoea Lymphogranulosa venerum Syphilis
66
What HPV strains cause genital warts?
6 and 11
67
What causes the risk of developing genital warts following exposure to HSV to increase?
Smoking Pregnancy Immunocompromised
68
Gardasil protects against which strains of HPV?
6, 11, 16 18
69
How can genital warts be treated?
Topical podophyllotoxin (2x daily for 3 consecutive days of the week) Ablative treatment Imiquimod
70
Describe the virus that causes molluscs contagiosum
Large DNA Pox virus
71
Describe the papule associated with molluscs contagiosum infections
Small, benign, smooth papules with central umblication
72
What are the two types of herpes simplex virus?
HSV 1 and 2
73
Describe primary infection of HSV
First time infected with either HSV1/2 Multiple painful, shallow ulcers Tender inguinal lymphadenopathy Systemic symptoms of viraemia - fever, malaise, headaches
74
Describe non-primary infection of HSV
Previously infected with HSV1/2 then acquire the other A degree of cross-protection --> milder illness
75
Describe recurrent infection of HSV
Reactivation of previous HSV1/2 infection | HSV2 reactivation occurs more commonly than HSV1 reactivation
76
How is HSV diagnosed?
PCR - distinguishes between HSV1/2
77
Describe the treatment of HSV
Primary infection = aciclovir 400mg TDS for 5 days Recurrence = aciclovir 800mg TDS for 2 days Suppression = aciclovir 400mg BD 6-12 months
78
What is the leading cause of meningitis in children?
N.meningitidis
79
What is the leading cause of meningitis in adults?
S.pneumoniae
80
What is leading cause of meningitis in children between 3 months and 6 years?
H.influenzae
81
In what population of people, does listeria need to be considered as a potential cause of meningitis?
Over 60s | Immunocompromised
82
What bacteria, that can cause meningitis, is described as being a gram positive bacilli?
Listeria
83
What bacteria, that can cause meningitis, is described as being a gram positive diplococci?
S.pneumoniae
84
What bacteria, that can cause meningitis, is described as being a gram negative diplococci?
N.meningitidis
85
What are risk factors for developing pneumococcal meningitis?
``` >60yrs Immunosuppression Alcohol dependency Middle ear infection Previous head trauma Surgery ```
86
What CSF results are associated with bacterial meningitis?
Raised neutrophils Low glucose High proteins
87
What CSF results are associated with viral meningitis?
Raised neutrophils High proteins Normal glucose
88
What Abx should be given pre-hospital if a patient is suspected of having meningitis?
Benzyl penicillin Ceftriaxone Chloramphenicol
89
Describe the immediate management of a patient with meningitis
ABC Blood cultures Abx + dexamethasone LP (CT if needed)
90
What Abx should be given to a patient with meningitis?
``` Ceftriaxone Amoxicillin Benzyl penicillin + Vancomycin (pneumococcus meningitis) + Gentamicin (listerosis) ```
91
Why are patients with meningitis given dexamethasone?
Prevents complications such as deafness/hydrocephalus | Given at the start of Abx therapy (continue for 4 days)
92
If a patient has meningitis, who needs to be informed?
Public Health
93
What Abx should be given as prophylaxis to close contacts of a patients with meningitis?
Ciprofloxacin
94
Once a patient has recovered from meningitis, what test do they require?
Audiology hearing test
95
What viruses commonly cause the common cold?
Rhinovirus | Coronavirus
96
What virus causes acute bronchitis?
RSV
97
What virus causes pharyngitis?
Adenovirus
98
What virus causes bronchiolitis?
RSV
99
What virus causes croup?
Parainfluenza virus
100
What viruses causes pneumonia?
Influenza | RSV
101
How can you differentiate as to whether pharyngitis is more likely to be viral or bacterial?
Nasal symptoms = viral | No nasal symptoms = bacterial
102
What virus causes glandular fever?
EBV
103
Describe croup
Seal like barking cough Caused by parainfluenza virus especially 1+3 Supportive treatment
104
Describe bronchiolitis
Lower respiratory tract infection of young children Wheeze and tachycardia 7-10d duration, cough persists up to 3 weeks RSV is the most common cause Most children infected by 2 (re-infection is common but less severe)
105
Describe RSV
Affects immunocompromised, adults with chronic lung disease, elderly
106
What is Ribivirin? What side effects are associated with it? When is it used?
Broad spectrum antiviral Anaemia, abdominal pain, depression/suicidal thoughts Given to high risk children (pre-term, <6months, oxygen requirement under 2s, cardiopulmonary disease in under 2s)
107
What influenza viruses cases flu?
Influenza virus A-C
108
Give complications associated with flu
``` Acute otitis media Sinusitis Secondary bacterial pneumonia Exacerbation of underlying disease Dehydration ```
109
What causes epidemics of flu?
Antigenic drift
110
What causes pandemics of flu?
Antigenic shifts

MBChB (14 decks)

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