Infections

Question 1

C. diff

Answer 1

this is a bacterial infection and the most common cause of healthcare associated diarrhoea

Question 2

presentation of C. diff

Answer 2

• diarrhoea +/- blood

- abdominal pain

Question 3

what can C. diff progress to?

Answer 3

• pseudomembranous colitis
• perforation
• toxic megacolon

Question 4

diagnosis of C. diff

Answer 4

• screening for organism

- if positive then culture

Question 5

management of C. diff

Answer 5

• isolate patient
• less severe= metronidazole
• severe= vancomycin

Question 6

presentation of rotavirus

Answer 6

• D&V in children

- dehydration

Question 7

diagnosis of rotavirus

Answer 7

PCR on faeces (sheds)

Question 8

management of rotavirus

Answer 8

• rehydration, self limiting for about a week
• vaccine (live attenuated)
  children can get post-infection Mal-absorption leading to more diarrhoea

Question 9

presentation of norovirus

Answer 9

sudden onset D&V

Question 10

diagnosis of norovirus

Answer 10

faeces and vomit swabs for PCR

Question 11

management of norovirus

Answer 11

rehydration

Question 12

define haemolytic uraemia syndrome (HUS)

Answer 12

affects the blood and blood vessels caused by E. coli0157 producing a verotoxin (can progress to kidney failure)

Question 13

presentation of HUS

Answer 13

• abdominal pain
• fever
• pallor, petechiae and obliguria

Question 14

diagnosis of HUS

Answer 14

• FBC
• renal function/creatinine
• stool culture

Question 15

management of HUS

Answer 15

• dialysis

- blood transfusions

Question 16

define gastroenteritis

Answer 16

infection caused by eating contaminated food

Question 17

presentation of gastroenteritis

Answer 17

• diarrhoea and dysentery
• fever
• vomiting
• cholera “rice-water” like stools

Question 18

diagnosis of gastroenteritis

Answer 18

• stool sample (all stools get salmonella, shigella, E. coli 0157, campylobacter and cryptosporidium and over 4 years gets C. diff)
• FBC
• AXR: thumbprint sign

Question 19

management of gastroenteritis

Answer 19

• rehydration

- antidiarrhoeals e.g. bismuth chelate

Question 20

define parasitic infection

Answer 20

infection with a parasite e.g. giardiasis lamblia (contaminated water)

Question 21

presentation of giardiasis lamblia

Answer 21

abdominal pain, discomfort, nausea

significant malabsorption with weight loss and stearrhoea

Question 22

diagnosis of giardiasis lamblia

Answer 22

stool examination for ova and parasites

Question 23

management of giardiasis lamblia

Answer 23

metronidazole (1 week)

Question 24

define enteric fever

Answer 24

this is caused by salmonella, paratyphoid and typhi (common in Indian subcontinent and SE Asia)

Question 25

presentation of enteric fever

Answer 25

• fever
  -headache
• constipation or diarrhoea
• dry cough
  can complication and progress to bleeding and encephalopathy

Question 26

diagnosis of enteric fever

Answer 26

blood, urine and stool culture

Question 27

management of enteric fever

Answer 27

• isolate patient

- ciproflaxacin, azithromycin, ceftriaxone (fluoroquinolone for resistance)

Question 28

define Whipple’s disease

Answer 28

rare infection with tropheryma whipplei

Question 29

presentation of Whipple’s

Answer 29

arthritis
arthralgia
weight loss

Question 30

diagnosis of Whipple’s

Answer 30

positive PAS (tissue microscopy)

Question 31

management of Whipple’s

Answer 31

trimethroprim

Question 32

define Chaga’s disease

Answer 32

infection with trypanosome cruzi that causes parasympathetic depression

Question 33

presentation of Chaga’s

Answer 33

• fever, fatigue, rash
• nausea, vomiting
  can progress to myocarditis

Question 34

diagnosis of Chaga’s

Answer 34

bloods for parasite or antibody

AXR, CXR

Question 35

management of Chagas

Answer 35

remove parasite e.g. benznidazole

Question 36

how does giving antibiotics in E. coli 0157 risk development of HUS

Answer 36

antibiotic injury to the cell membrane causes massive release of mediators

Question 37

triad in HUS

Answer 37

haemolytic anaemia
AKI
thrombocytopenia