Infections Flashcards
(80 cards)
1
Q
How do we score sepsis risk?
A
SOFA
qSOFA – 2+ of hypotension, tachypnoea and Alt Mental Status
2
Q
What is the sepsis 6?
A
Give - Abx, Fluid challenge & O2
Take - Serum lactate, blood culture & UO monitoring
3
Q
What tests can be done for sepsis? (other than the sepsis 6)
A
FBC - infection U&E + C -- Renal failure CRP ABG -- Acidosis LFTs -- Liver damage Coag Screen & D-dimer -- DIC Glc -- Hyperglycaemia
4
Q
What are the characteristics of SIRS?
A
High or low temp
Tachycardia
Tachypnoea or low PaCO2
Leukocytosis/Leukopenia
5
Q
How do you detect parasites in gastroenteritis & treat them?
A
Stool microscopy
Duodenal Biopsy
Treat with Metronidazole
6
Q
What form’s of gastroenteritis can cause HUS or seizures?
A
Salmonella can cause both
Enterohaemorhagic E.Coli often causes HUS –> renal failure & Anaemia
7
Q
What causes traveller’s diarrhoea?
A
Enterotoxigenic E.coli
Shigella
Campylobacter
8
Q
What viruses cause gastroenteritis and how do you detect them?
A
Rotavirus
Noravirus
Serum PCR or Stool Antigen tests
9
Q
What causes food poisoning?
A
Staph Aureus Toxin Bacillus Cereus (Reheated rice) Clostridium Perfringens (Undercooked meat)
10
Q
What’s in Oral Rehydration Salts?
A
Glc
Amino acids
NaCl
11
Q
How would you check for Infective endocarditis in a patient with PUO?
A
Look for a new murmur
If found do a TOE
12
Q
How o you test for TB?
A
Mantoux test
Sputum sample for ZN stain & culture
Bone marrow biopsy
13
Q
What do you do if you have a pyrexia of unknown origin and can’t find the cause?
A
Therapeutic Trial:
1) Anti-TB medication, response within 2 wks
2) Steroids, dramatic response within 48hrs
14
Q
Pyrexia of Unknown Origin along with haematuria, what do you do?
A
- Renal US for cancer
- Renal biopsy & Auto-Abs for Polyarteritis
15
Q
What type of HIV causes the epidemic?
A
Type 1 HIV Group M
16
Q
What cells does HIV target?
A
CD4+ cells e.g. macrophages, Th cells, monocytes, brian & skin
17
Q
What are the drugs involved in cART for HIV?
A
- Nucleoside Transcriptase Inhibitors
- Non-nucleoside Transcriptase Inhibitors
- Integrase Inhibitors
- Protease Inhibitors
cART is 3 drugs from atleast 2 classes in 1 pill
18
Q
What does an acute HIV infection look like?
A
Mostly asymptomatic
Some get seroconversion illness:
- Looks like glandular fever
- But EBV -ve
19
Q
What conditions suggest an HIV test?
A
- Thrush
- Unexplained wt loss or lymphadenopathy
- Guillain Barre
- Dementia
- Aspergillosis
- Anal or lung cancer
20
Q
What conditions define AIDS?
A
- PML
- Kaposi’s Sarcoma
- Cervical Cancer
- CMV retinitis
- Pneumocytis Pneumonia
- TB
- NHL
- Cryptococcal Meningitis
- Cryptosporidiosis
21
Q
How do you test for HIV?
A
Serum/Salivary ELISA for Abs & antigens
Babies need Viral Genome Detection (as they have the mum’s antibodies regardless of inf)
22
Q
What are the common HAIs and how do you get them?
A
C.diff & Salmonella by Faecal-oral transmission
Staph Aureus by Direct transmission
TB & Neisseria Meningitidis by Droplet transmission
Group A strep & Viruses by penetrating injury
23
Q
What methods do you have for sterilization?
A
- Gas (Ethylene Dioxide)
- Autoclave
- Hot Air Oven
- Ionising Radiation
24
Q
How might C.Diff present?
A
- Pyrexia
- Diarrhoea
- Characteristic Smell
- Abdo Pain
- Leukocytosis
- pseudomembranous colitis
25
What causes Rabies and how does it present?
Lyssavirus
Non-specific symptoms, mania, hydrophobia, increased saliva/tears & decreased ability to swallow
They die of resp failure
26
How do you test for an treat Rabies?
PCR
PEP (Human Rabies Immunoglobulin & rabies vaccine)
27
How does Lyme's disease present
Early - Erythema Migrans
Late:
- Acrodermatitis Chronica Atrophicans
- Neuroborrelliosis
- Arthritis
- Lymphocytoma
- Perimyocarditis or heart block
28
How do we detect and treat lyme's disease?
ELISA serology & immunoblot test
Oral Doxycycline
29
What causes Leptospirosis?
L. Icterohaemorrhagica (rats)
L. Hardjo (cattle)
Mostly got through contaminated water
30
How does leptospirosis present?
Flu like illness
Can develop Weil's Disease:
- AKI
- Jaundice
- Bleeding
31
How do you detect and treat leptospirosis?
ELISA Serology
PCR
Culture
Doxycycline
IV penicillin if severe
Dialysis if AKI
Mechanical Ventilation if needed
32
Where do you get brucellosis?
Cattle & Dairy
33
How does brucellosis present and how do we treat it?
Non-specific symptoms incl drenching sweats & a high undulant, resistant fever
Can develop joint pain
Arthritis, endocarditis & Epididymo-orchitis
Doxycycline for 2-3months + 1wk of rifampicin or gentamicin
CNS manifestations? --> Add Co-trimoxazole
34
what are the symptoms of influenza?
Abrupt high fever >3days + 2 of:
- Sorethroat or rhianorrhoea- Myalgia
- Cough
- Malaise
- Headache
35
Complications of influenza?
Acute Bronchitis
secondary bacterial pneumonia
Also Guillain Barre, Myocarditis, Viral pneumonia & exacerbating underlying illness
36
When would you treat Influenza and why?
If complicated or very sick give:
| Neuraminidase inhibitors i.e. Oral Oseltamavir or Inhaled Zanamivir
37
How is flu transmitted?
Droplet
Direct
Indirect on surfaces
Birds
38
What are the surface antigen of influenza virus
N - Neuraminidase - allows virus to break out of host cell
| H - Haemaglutinin - enters host cells
39
How does the influenza virus change?
Antigenic drift - Small molecular changes year on year
Antigenic Shift - Sudden combining of 2 strains --> epidemics
40
How do we test for influenza?
- Viral swab for PCR & Molecular detection
- CXR (rule out pneumonia)
- Blood culture (for other infections)- Pulse oximetry & resp rate for monitoring
- U&Es, FBC & CRP
41
What are the major types of Aspergillus infection?
- Acute Invasive Aspergillosis
- Allergic Bronchopulmonary Aspergillosis
- Chronic Pulmonary Aspergillosis
- Pulmonary Aspergilloma
- Influenza Ass Aspergillosis
42
How do we test for aspergillosis?
CT chest, PCR & bronchoalveolar lavage if a neutropenic patient
Otherwise if you suspect it you can do Sputum culture and aspergillus specific IgE/G
43
How do you treat aspergillosis
Voriconazole
| Isavuconazole
44
How do we test for and treat candida?
Blood culture & PCR
Echinocandin & fluconazole
45
How does cryptococcus present?
LRT infection with constitutional symptoms
Moves to brain causing headache, confusion, AMS, visual problems & Coma
Typically HIV associated
46
How do you test for and treat Cryptococcus?
Blood Culture & Antigen testing
LP for culture, antigen testing & india ink
Amphotericin B & flucytosine (induction) & Fluconazole (maintenance)
47
How do you treat Malaria?
Falciparum --> Riamet (Artemether & Lumafantrine)
Complicated --> IV artesunate
Non-falciparum --> Chloroquine
Vivax or Ovale --> Add Primaquine
48
Complications of Malaria?
```
Algrid Malaria
Anamia
Jaundice
Blackwater Fever
Pulm Oedema
Cerrbal Malaria
DIC
Hypoglycaemic
Acidosis
```
49
How do you test for malaria and its complications?
Rapid Antigen Test
Thick & Thin blood films
QBC
```
FBC, U&Es + creatinine, LFTs & urinalysis
ABG & Lactace (for acidosis)
Glc (Hypoglycaemia)
Clotting screen
Blood culture (concominant sepsis)
```
50
How do we treat hair infections and what causes them?
Topical Abx
Oral Abx
Surgery
Staph Aureus and sometimes Strep Pyogenes
51
What toxins cause Toxic Shock Syndrome & SSSS?
```
TSS = TSST1
SSSS = Toxin A or B
```
Both from Staph Aureus
52
What causes Necrotizing Fasciitis and what are the risk factors?
Type 1 - Mixed inf -- Staph, Strep, Clostridium, enterococci & Gram -ve bacilli
Type 2 - Strep Pyogenes
```
IVDA
DM
PVD
Surgery
Trauma
```
53
How does Necrotizing Fasciitis present and how do we treat it?
Rapid swelling, redness, pain & decreased sensation
Haemorrhagic bullae, necrosis & Crepitus
Systemic Sx e.g. fever malaise etc
Supportive
Surgery
Broad Spec Abx (Clindamycin, Gentamicin & Flucloxacillin)
54
How do you treat TSS?
GEt a blood culture & isolate the toxin
```
Remove the causative agent (e.g. tampon)
Fluids
Inotropes
Abx
+/- IV immunoglobulins
```
55
What causes pyomyositis, how does it present and what are the risk factors?
Staph Aureus
Fever, Muscle pain & Woody stiffness
Immunocompromise (by any means) & Rheumatological disease are RFs
56
How do you test for and treat pyomyositis?
Blood culture
CT or MRI to isolate muscle loss & abscess
IV Abx & Drainage of abscess
57
What are the risk factors for surgical site infections and what causes them?
.DM Smoking Obese Malnutrtion Steroids
Staph Aureus
Pseudomonas
E Coli
58
What causes IV catheter infections and what's the big risk should someone get one?
Staph Aureus
Endocarditis, so do an echo
59
What causes Infectious Tenosynovitis and how would it present?
.Staph Aureus --> Strep --> Mycobacterium or fungi if chronic
Semiflexed fingers
Swollen finger
Tender tendon
Pain on extension
60
What are the risk factors for septic bursitis, how do you test for and treat it?
```
IVDA
Immunocompromise
DM
Renal Disease
Rheamtic disease
Alcoholism
```
61
How does typhoid present?
Early you get a high fever, malaise, neutrophilia, bradycardia, headache, constipation & cough
Wk2 develops into peaked fever, rose spots, diarrhoea, abdo pain, tachycardia & neutropenia
Late presentations include intestinal bleeds, perforations, peritonitis & metastatic inf
62
What causes typhoid, how do you test for it and how do you treat it?
Salmonella Typhi
Blood, marrow, urine & stool cultures
FBC & LFTs
Supportive care
Oral Azithromycin or IV Ceftriaxone if severe
63
How is typhoid transmitted?
Faecal oral route
64
How is dengue fever transmitted?
Aedes Aegyptii Mosquitos
65
How does dengue fever present?
Abrupt fever & Maculopapular Rash
+/- headache, arthralgia, myalgia, petichiae & purpura
66
How do you diagnose and treat Dengue fever?
PCR & Serology
Clinical diagnose can be made with:
- +ve tourniquet test
- Leukopenia
- thrombocytopenia
- Elevated Transaminases
Treat with supportive fluids, FFP & Platelets
Prevent with Dengvaxia Vaccine
67
What spreads Schistosomiasis?
Fresh water (snails) spread Schistosoma Haematobium (Africa) and Japonicum (japan)
68
How does Schistosomiasis present
Early - Swimer's itch
Wks -- Katayama Syndrome (Fever, urticaria, lymphadenpathy, diarrhoea, abdo pain, cough & hepatosplenomegaly)
1-2months -- Cystitis causing haematuria or dysentery +/- portal hypertension
69
How do you test for and treat Schistosomiasis?
Stool & Urine Microscopy for Ova
Rectal Biopsy
Antibody Tests
Praziquantel +/- prednisalone if severe
70
what cause typhus & how does it present?
Rickettsia Conorii or Africae
Spread by ticks
Abrupt fever, headache, confusion, jaundice & rash (+/- bleeds/thrombosis)
71
How do we test for and treat typhus?
Serology & PCR (can also do FBC, LFT CRP & U&Es)
Tetracycline
72
What are the viral hemorrhagic fevers and how do they present?
Ebola & Lassa Fever
Abrupt High fever, myalgia & conjunctivitis plus other non-specific signs e.g. headache, prostration, pleuritic pain and malaise
73
How would you manage viral haemorrhagic fevers?
High security inf unit and supportive therapy
74
What spread Zika virus?
Aedes Mosquitos
Sex
Transfusion
75
How would you tell fungal vs bacterial vs viral meningitis?
Fungal pretty much only comes along with HIV
Bacterial vs viral on LP:
- Bacterial = High protein / Low Glucose / High pressure / Neutrophilia
- Viral = Low protein / Normal glucose / Normal Pressure / Lymphocytosis
76
What cause fungal meningitis?
Cryptococccus
77
What causes bacterial meningitis?
Neonates - E coli or
Kids - Haemophilus Influenzae
Adults - Strep Pneumoniae or N Meningitidis
78
How do you treat bacterial meningitis?
Neonates (Ecoli or ) & kids (H Influenzae) -- Cefotaxime
Adults (Strep Pneumoniae or N Meningitidis) -- Ceftriaxone
79
What viruses cause Meningitis?
HSV
| Enteroviruses (Coxsackie, Echovirus etc)
80
How do you treat viral meningitis?
Aciclovir
