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Infectious Diseases Flashcards

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1
Q

VRE treatment options

A

Teicoplanin, Linezolid, daptomycin, Tigecycline

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2
Q

ESCAPPM organisms (Class C = inducible beta-lactamase activity)

A

Enterobacter
Serratia marcescens
Citrobacter freundii
Acinetobacter
Providencia
Proteus
Mroganella morganii

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3
Q

Mechanism by which ESBL arises

A

Mutation in old beta lactase genes

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4
Q

Treatment of ESBL organisms

A

Carbapenems, colistin, amikacin, cirpofloxacin
Fosfamycin or nitrofurantoin for cystitis

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5
Q

Moxifloxacin

A

Very broad
Poor against pseudomonas
Good tissue penetration and bioavailability
Associated with c.diff

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6
Q

When to use metronidazole in aspiration pneumonia

A

Terrible gums/foul smelling sputum
Severe alcohol abuse
Lung abscess with fluid level
Empyema or complete whiteout

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7
Q

K1 Klebsiella Pneumonia epidemiology, associations and treatment

A

New strain emerging in Asia (esp. Taiwan)
Assoc with community acquired liver abscesses, bacteraemia and endophthalmitis
More common in diabetics
Treat with ceftriaxone

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8
Q

Absolute indications for surgery in I.E

A

Severe AR or MR
Cardiac failure related to valve
Fungal or highly resistant organism
Perivalvular abscess or fistula
Prosthetic valve I.E

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9
Q

Streps most likely to cause I.E

A

Mutans
Bovis
Sanguis

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10
Q

Culture negative I.E causes

A

3 negative blood cultures after 7 days
Fastidious organisms
Q fever
Bartonella
Strep
Legionella
Whipples
Mycoplasma hominis
Chlamydia
Fungi
Brucella

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11
Q

Flesh eating bugs

A

GAS (pyogenes)
Clostridium myonecrosis
Vibrio vulnificus
Staph aureus
Mycobacterium ulcerans

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12
Q

Presentation of gonococcal septic arthritis

A

Triad of
Tenosynovitis
Dermatitis
Polyarthralgias without purulent arthritis

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13
Q

Whipples disease presentation, diagnosis and treatment

A

Due to tropheryma whipelii
Migratory large joint arthritis
Weight loss, diarrhoea, abdominal pain
Diagnose with small bowel biopsy
Ceftriaxone then long-term Bactrim

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14
Q

Bartonella presentato and management

A

Cutaneous lesion at site after 3-10 days
Regional LN after 2 weeks
Resolves 1-4 months
Diagnose with serology, warthin-starry stain, PCR, culture
Tx: none, macrolides or tetracyclines

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15
Q

Treatment for ricketts

A

Doxy

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16
Q

Anthrax presentation and management

A

Inhalation
Sudden deterioration with SOB and hypoxia
Haemorrhagic mediastinitis –> widened mediastinum on CXR +/- pleural effusion, meningitis, low BP
Organism cultured from sputum/nasal swab
Treat with doxy/ amox/ cipro

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17
Q

Plague

A

Yersinia pestis
Reservoir: Bats, rats, prairie dogs
Transmission via fleas
Tx: streptomycin (aminoglycoside), doxy, cipro

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18
Q

Botulism mechanism of action, presentation and management

A

Toxins A, B and E bind to pre-synaptic nerves and prevent release of acetylcholine
Presents with cranial nerve onset then symmetrical descent
No sympathetic or sensory involvement
Diagnosis clinical + EMG
Treatment supportive +/- antitoxin, penicillin

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19
Q

HIV risk factors for transmission

A

Ulcerative STI
HSV co-infection
High plasma viral load
Circumcision decreases risk
Genetics: CCR5 D32 homozygotes resistant to infection

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20
Q

HLA factors with rapid HIV disease progression

A

HLA A23, B37, B49

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21
Q

Tests to do before starting HIV treatment

A

HIV genotype (not completely necessary anymore)
HLAB5701 - abacavir hypersensitivity

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22
Q

HIV tenofovir side effects

A

Renal toxicity (decreases GFR and can cause fanconi syndrome)
Decreased BMD

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23
Q

HIV Abacavir side effects

A

3-5% allergic reaction (GI symptoms, rash, cough, leukopenia)
HLA B5701strong association
Doubles MI risk

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24
Q

HIV Dolutegravir + bictegravir side effects

A

Insomnia
Headaches
Dizziness

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25
HIV efavirenz side effects
40% get CNS side effects (Vivid dreams, sleep change, headache) Rash Teratogenic
26
HIV INSTIs + TAF side effects
Weight gain Increased lipids Increased BP DM
27
REPRIEVE trial in HIV
Adding pitavastatin as primary prophylaxis to HIV therapy decreased MACE by 35% in low to medium risk patients
28
HIV attachment
Utilizes GP120 and GP41 Then co-receptors CCR5 and CXCR4
29
HLA with good prognosis in HIV
HLAB57
30
PEP in HIV
Start within 72 hours, 28 day course Check serology at 4-6 weeks and 3 months 2 drug or 3 drug regime
31
Pneumocystis presentation, imaging and diagnosis
Unicellular fungus - doesn't respond to antifungals Presentation: Progressive exertion dyspnoea (95%) Fever Non-productive cough May present with or develop pneumothorax Imaging: Reticulonodular opacities Basal and apical sparing Diagnosis: Sputum PCR, BAL (silver stain), serum beta-D glucan (useful rule out test)
32
PJP treatment
Bactrim - affects folate pathway Add steroids IF HYPOXIC
33
Cryptococcus in HIV
Neoformans most common Meningitis most common presentation -Subacute headache and fever -Meningeal features are late -Behavioural change and confusion
34
LP findings in cryptococcus infection
High opening pressures Increased WCC and protein Decreased glucose
35
Cryptococcus meningitis treatment
LP is therapeutic - may need repeating +/- shunt Amphotericin + flucytosine for one week Then high dose fluconazole for 8 weeks
36
Monkeypox management
Supportive Tcovirimat if severe disease (inhibits HP37 protein - prevents formation of enveloped virus)
37
Who gets Monkeypox vaccination
Post exposure MSM or high risk e.g. HIV Sex workers High risk + travelling to a country with an outbreak (4-6 weeks prior) Anyone at risk of a poor outcome e.g. immunocompromised
38
Monkeypox presentation
Anogenital lesions most common Rectal pain Sore throat and/or oral lesions Pruritic rash - nodules
39
Malaria lifecycle
Mosquito injection sporozoites --> multiply in liver --> infected cells burst and release Merozoites which invade RBCs --> asexual division into schizonts --> fever at time of schizont rupture
40
Most lethal type of malaria
Falciparum
41
Malaria presentation
Fever, myalgia, headache, GI symptoms
42
Diagnosis of malaria
Thick and thin films - repeat after 8-12 hours if high suspicion ICT -Rapid -Not dependent on expertise -Decent for falciparum and vivax
43
Treatment of severe malaria
Assume chloroquine resistant falciparum - treat with IV artusenate or IV quinine
44
Treatment of standard malaria
Artemether + lumefantrine Atovaquone + proguanil Quinine sulfate + doxy Follow with primaquine for vivax and ovale
45
What to do before starting primaquine therapy
Exclude G6PD deficiency
46
Doxycyline side effects
Photosensitivity Vaginal thrush
47
Mefloquine side effects
Neuropsychiatric Epilepsy Cardiac conduction abnormalities
48
Typhoid presentation
Fever Abdo pain Constipation (not diarrhoea) Hepatosplenomegaly Neuropsychiatric Relative bradycardia Rose spots = feint salmon-coloured, maculopapular, truncal distribution
49
Complications in typhoid
Onset 3rd/4th week Intestinal perforation Bone and joint Endocarditis Splenic or liver abscess Endovascular
50
Diagnosis of typhoid
Blood + stool culture Leukopenia + anaemia Abnormal LFTs, mild elevation in CK
51
Typhoid management
Azithro/cipro/ceftriaxone Add dexamethasone if severe
52
Chronic salmonella typhi carriers and complications
Increased if biliary abnormalities or concurrent bladder infection with schistosoma Associated with gallbladder cancer
53
Dengue presentation
Fever Headache and retro-orbital pain Rash
54
Dengue diagnosis
Leukpenia, neutropenia, thrombocytopenia Mild transaminitis Arbovirus IgM serology
55
Dengue management
Supportive Avoid aspirin/NSAIDs
56
Amoebiasis presentation
Entamoeba histologica Cysts remain viable for weeks-months in most environments outside the body Intestinal disease: -acute dysentry -fulminant colitis and perforation -Extra-intestinal disease: liver, lung, brain abscess
57
Amoeba diagnosis
3 x spool specimens for cysts and trophozoites Serology: Antibodies found in 99% of patients with liver abscesses
58
Amoeba management
Metronidazole Paromomycin or diloxanide
59
COVID mechanism of infecting cells
Through ACE2 receptor in lungs
60
Droplet spread
large compared to airbone Transmit <1m Coughing + sneezing Direct mucous membrane contact
61
Airborne spread
Small droplets 1-10um Transmit over distances >1m Disperse rapidly and widely within closed environments and ventilation systems Aerosol generation: intubation, news, brunch, CPR, turning prone
62
Meningococcus subtypes
A, B, C, X, Y, W-135, L B, C and Y most common in developed countries Men C = 30%
63
Meningococcaemia management
IV ben pen 4 hourly for 3 days Chemoprophylaxis for household contacts - aim to eradicate asymptomatic carriage - ceftriaxone, cipro, rifampicin
64
Meningococcal vaccination schedule
ACWY at 12 months + 14-16 years Men B: ATSI, asplenia, complement deficiency or those on eculizumab
65
Treatment of pneumococcus meningitis
MIC >0.125mg/L - cef and vanc MIC <0.125mg/L - ben pen
66
Necrotising myofasciitis risk factors and presentation
RF: DM, IVDU, alcoholism, local trauma, surgery, bowel pathology Presentation: Severe pain >>> clinical signs High fever
67
Necrotising myofasciitis organisms and management
Polymicrobial- mixed anaerobes, strep, staph, enterobacter Management Surgery Broad spec abs (mero/penicillin/clinda) IVIg - decreases mortality in Group A strep
68
Toxic shock syndrome causes
Staph -Blood culture negative -Assoc. with tampon use -Fever, V/D, shock within 24 hours, diffuse macula-erythematous rash, non-purulent conjunctivitis Treat with fluclox and clinda Strep -Blood culture usually strep progenies Primary infection: wound or skin Treat with ben pen and clinda
69
Risk organisms if asplenia/hyposplenia
N meningiditis S pneumoniae H influenzae Capnocytophaga canimorsus Malaria
70
Abx prophylaxis in asplenia/hyposplenia
Amox 250mg daily Self-medication if unwell: Amox 3 g stat
71
Early infections following SCT (1-4 weeks pre-engraftment)
HSV Gram positive bacteraemia Gram negative bacteraemia Candida Aspergillus Respiratory viruses
72
Post-engraftment SCT infections (4-12 weeks)
CMV BK virus Toxoplasma gondii
73
Late infections post SCT (12-52 weeks)
VZV Strep pneumoniae Haemophilus N meningiditis
74
Infections across multiple risk periods following SCT
PJP Adenovirus Nocardia Mycobacterium HHV-6 EBV Legionella Listeria
75
Nocardia presentation and management
Gram posiitve, blanching Increased risk if impaired cell mediated immunity Found in environment, soil, organic matter, water Rash and lymphadenopathy Pulmonary and CNS infections Management Surgical debridement Bactrim/imipenem/ceftriaxone
76
Toxoplasmosis presentation and management
Increased risk if impaired T cells Cats shed oocyst --> tachyzoite in human intestine --> cyst in tissues Clinical: CNS, myocardial, pulmonary, chorioretinitis (ocular pain and decreased VA), congenital Management Pyrimethamine/folic acid and sulfadiazine or clinda
77
Aspergillus syndromes
Pulmonary - fever, pleuritic pain, cough, haemoptysis. Imaging shows infarcts, nodules, consolidation Cerebral - severely immunocompromised, sinusitis and bone erosions ABPA Aspergilloma
78
Aspergillus imaging signs
Halo sign around pulmonary lesion -Suggests haemorrhage and angioinvasion Crescent sign - cavitation
79
Aspergillus management
Voriconazole Surgery if isolated lesion, especially if further immunosuppression planned
80
Risks with alemtuzumab
Anti CD52 T cell suppression so risk of moulds, CMV, PCP
81
Infectious risk with TNF inhibitors
Risk of TB reactivation
82
Occupational Hep C exposure
PEP not recommended PCR detects virus 10days to 6 weeks after infection Increased risk if PCR positive source
83
Occupational Hep B exposure
Risk related to Hep B e antigen status of source Give Hep B immunoglobulin and Hep B vaccine
84
Occupational HIV exposure
Give PEP ASAP after exposure -low risk exposure: 2 drug -high risk exposure: 3 drug Test at 6 and 12 weeks post commencement of PEP
85
C.diff toxins
Toxin A: enterotoxin Toxin B: cytotoxin - disrupts intercellular tight junctions
86
C. diff management
Vancomycin, fadaxomycin, FMT Bezlotoxumab for prevention of recurrence
87
Schistosomiasis epidemiology and presentation
Middle East, Africa, Latin America Snail is host - larvae infect skin in fresh water Presentation with pruritic rash within days, febrile illness 6-8 weeks later, fibrotic response in urinary tract or gut months to years later
88
Schistosomiasis diagnosis
EOSINOPHILIA Serology Terminal urine microscopy for eggs Stool microscopy
89
Schistosomiasis management
Praziquantel
90
Strongyloides diagnosis and management
Stool microscopy (Havada culture), serology, eosinophilia Treat with ivermectin or albendazole
91
Rabies hosts and mechanism of infection
Hosts are wolves, foxes, coyotes, racoons, cats. Infection via contact with respiratory secretions e.g. bite Viral replication in muscle, retrograde neural spread to CNS, widespread infection via peripheral nerves
92
Rabies presentation
Prodrome of fever, headache, malaiase Encephalitis, hydrophobia, delirium, agitation, arrhythmias, autonomic dysfunction Ascending flaccid paralysisR
93
Rabies management
Wound care Post exposure rabies immunoglobulin (half into wound) and vaccination days 0, 3, 7, 28
94
Live vaccines
My Very Happy Japanese BOY MMR VZV HSV Japanese encephalitis BCG Oral typhoid/rotavirus Yellow fever
95
Candida kruzei resistance
Resistant to fluconazole
96
Strep bovis association
Bowel malignancy - needs colonoscopy

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