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Infectious diseases Flashcards

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1
Q

Conditions caused by GAS (strep pyogenes)

A

Pharyngitis
Retropharyngeal abscess
Scarlet fever
Impetigo, erysipelas, cellulitis (inc perianal)
Strep TSS
Rheumatic fever
APSG

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2
Q

Describe scarlet fever rash

A
  • Fine, diffuse “sandpaper” rash - appears 24-48 hrs into illness (after 1st fever) but can be first sign
  • Begins on neck and upper chest, spreads to rest of trunk and extremities, spares palms and soles
  • Prominent in flexor skin creases (Pastia lines [from capillary rupture] - pathognomonic for scarlet fever)
  • Lasts approx 1 week then fades with desquamation of trunk, hands and feet
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3
Q

Features of scarlet fever

A
  • Due to GAS pyrogenic exotoxin
  • Pharyngitis, lymphadenopathy, fever
  • Sandpaper rash, appears 1-2 days post onset of fever
  • Pastia’s lines
  • Strawberry tongue
  • Circumoral pallor
  • Desquamation of trunk, hands and feet with fading of rash (~1 week after onset)
  • Abdo pain, myalgia, malaise
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4
Q

What systemic complication is associated with impetigo? (GAS)

A

Post strep GN (from M serotypes 49, 55, 57,59)
NOT rheumatic fever

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5
Q

CMV (HHV-5) transmission

A

Urine, resp secretions, blood
Vertically - in utero by transplacental passage, passage through infected genital tract, postnatally via breast milk (or donor milk)

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6
Q

CMV cytomegalic inclusion disease signs

A

IUGR
Jaundice, hepatosplenomegaly
Thrombocytopaenia/anaemia
Blueberry muffin rash (also in rubella)
Microcephaly, cerebral atrophy
Chorioretinitis
SNHL
Lethargy, hypotonia, seizures
Periventricular intracebral calcifications (CMV CircuMVents the ventricles)

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7
Q

CMV - SNHL stats

A

10% asymptomatic children (1/3 if symptomatic) will have progressive SNHL +/- neurodisability (also seizures and CP)

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8
Q

Eye signs CMV v rubella

A

CMV - chorioretinitis
Rubella - cataracts

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9
Q

Risk period of CMV infection in pregnancy

A

Early in pregnancy - transmission rate 30-50%

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10
Q

Diagnosis CMV

A

Urine CMV culture/PCR (and other sites) - must be within 2-4 wks to be “congenital”
Infant blood for CMV PCR
Paired maternal and infant serology
+ neuroimaging, opthal, audiology

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11
Q

MRI findings of CMV

A

Ventriculomegaly (hydrocephalus)
Periventricular calcifications

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12
Q

CMV v toxoplamosis MRI

A

CMV - microcephaly, ventriculomegaly, periventricular calcifications, lenticulostriate changes
Toxoplasmosis - hyrocephalus, diffuse cerebral calcifications

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13
Q

Congenital CMV treatment

A

Oral valganciclovir if <28 days AND moderate symptomatic disease (or IV ganciclovir if poor oral absorption)
Must treat for 6 mths
Risk of neutropaenia

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14
Q

TORCH

A

Toxoplasmosis
Other - syphilis, VSV, parvovirus, enteroviruses, Zika, GBS
Rubella
CMV
HSV

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15
Q

Neonatal HSV - risk of transmission

A

High if primary infection og genital herpes near the time of delivery
Low if hx of recurrent herpes
60-80% of pregnant F with HSV + babies have no prior clinical hx of HSV sx

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16
Q

Neonatal HSV presentation

A

45% - skin, eyes, mouth (SEM) - present in 1st 1-2 wks (sx = vesicular lesions, conjunctivitis, keratitis, chorioretinitis)
30% CNS only - present in 2nd-3rd week (sx = irritability, sz, poor feeding, lethargy - haemorrhagic CSF common with HSV)
25% disseminated - present in 1st 1-2 wks (sx = liver, lung, heart, kidney, CNS). Fatal in 50% cases

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17
Q

Neonatal HSV workup

A

HSV culture of mth, nasopharynx, eyes, anus
HSV culture and PCR of skin and mucosal lesions
HSV PCR of blood and CSF
LFTs
CXR
Opthal
Neuroimaging - MRI

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18
Q

Neonatal HSV treatment

A

Skin, eyes, mouth (SEM) - IV acyclovir 14 days
CNS or disseminated - IV acyclovir min 21 days + 6 mths PO acyclovir suppressive therapy

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19
Q

Hep B - chronic infection and complications rate of perinatal infections

A

90% become chronically infected if contract perinatally
25% develop cirrhosis and/or liver cancer in adult life

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20
Q

Maternal hep B Ag status - risk of transmission

A
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21
Q

Hep B - prevention of maternal transmission

A

1) Universal screening - if high initial, test viral load
2) Infants born to HbsAg pos Mo -> Hep B vaccin and HBIG within 12 hrs of birth
3) 3 further doses of Hep B vaccine as per immunisation schedule
4) Infant testing at > 9 mths to monitor surface antibody and rule out infection (ie HBsAg neg)
5) +/- tenofovir anti-viral Rx in Mo

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22
Q

Parvovirus B19 - complication of neonatal infection

A

Fetal anaemia, cardiac failure, hydrops

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23
Q

Treatment for parvovirus B19

A

No intervention available to prevent infection
Test fetus -> if positive, intrauterine transfusion to prevent foetal anaemia/hydrops
Monitor for anaemia postnatally

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24
Q

Presentation of neonatal parechovirus

A

Sepsis features - high fever, tachycardia, irritability, mottling, poor perfusion
Other - mottled red rash (erythrodermic), abdo distension, oedema, hepatitis
Presentation more severe than appears from bloods
Test via PCR (throat/rectal swabs)
Nb HPeVs-3 outbreak 2015

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25
Condition?
Parechovirus - septic, oedematous, mottled red rash, abdominal distension
26
Congenital rubella - antenatal risk period
Highest risk if maternal infection pre-conception or 1st trimester (up to 50%)
27
Congenital rubella syndrome - classic triad
SNHL (58%) Eyes - cataracts, retinopathy, micropthalmia (43%) Cardiac - PA stenosis, PDA
28
Antenatal risk of VSV
Highest between 8 and 20 wks gestation - more likely to have birth defects then
29
VSV - clinical signs
Cicatricial skin scarring (dermatomal distribution) Limb hypoplasia Microcephaly, cortical atrophy Seizures Cataracts Chorioretinitis, micropthalmia, nystagmus Neuro defects
30
VSV treatment for exposed pregnant women
If immune compromised -> give VZ IG ASAP - until 10 days post exposure If not available - give IVIG Do NOT give VSV vaccine if pregnant (live vaccine)
31
Treatment for neonatal exposure to maternal VSV
>7 days before delivery - no treatment <7 days before ->2 days post - give VZIG If under 28 weeks - give VZIG (maternal antibodies would not have crossed placenta)
32
Toxoplasmosis - how caught + presentation
Risk factors - ats, kitty litter, gardening, eating unwashed/raw vegetables or undercooked meat Self limited non-specific illness in immune competent hosts Crosses placenta 4-8 wks after maternal infection
33
Toxoplasmosis - risk of maternal infection
1st trimester - low risk (10-15%) but complications +++ 1nd trimester - 30% 3rd trimester - 60%, but low complication rate
34
Congenital toxoplasmosis - clinical features
85% normal at birth Of these, 85% if untreated will have 1 or more episodes of chorio-retinitis Hearing loss 10-30%, developmental delay 20-75% Only 75% of congenitally infected produce detectable IgM
35
Toxoplasmosis - antenatal diagnosis
Maternal IgM detectable within 1-2 wks, undetectable by 6-9 mths IgG avidity (bonding of antigen and antibodies) Fetal antibody - unlikely before 20 weeks Amniotic fluic PCR - good after 18 weeks gestation
36
Toxoplasmosis - antenatal treatment
If maternal infection but fetus not affected - Spiramycin If Mo and fetus infected - Pyrimethamine plus Suphadiazine
37
Neonatal diagnosis of toxoplasmosis (if sx)
Paired maternal and infant serology (IgM, IgG, IgG avidity) PCR on blood +/- CSF CSR, neuro imaging, opthal, audiology Monitor IgG and IgM over time
38
Condition?
Toxoplasmosis
39
Toxoplasmosis - treatment in infant
Treat until 12 mths - Pyrimethamine (haem toxicity - monitor) - Sufadiazine - Folinic acid (leucovorin) Monitor FBC due to risk of neutropaenia Neurodevelopmental, opthal, audiology f/u
40
GBS - presentation
Early onset <5-7 days - sepsis, pneumonia, meningitis 10% Late onset >5-7 days - occult bacteraemia, meningitis 30%, osteoarticular involvement Very late onset >90 days - usually in premature or prolonged hospital stay
41
Neonatal syphillis - signs
Osteochondritis/periostits Snuffles, haemorrhagic rhinitis Skin - bullous lesions, palms/soles involved (desquamating rash), mucous patches Unexplained large placenta Nephrotic syndrome (rare - usually 2-3 mths old) Hepato/splenomegaly, jaundice Non-immune hydrops fetalis
42
Infant syphilis workup
Serology - trepenemal (TPPA aka acquired antibodies from Mo) + RPR - level of disease response Long bone xrays - periosteal reactions LP - SCF VDRL, protein, cell count Skin lesions/placenta - darkfield microscopy for spirochetes Check if Mum had full STI evaluation (HIV, hep B&C) Treatment if confirmed/suspected - 10 days IV benpen F/U infant serology 3&6 mths
43
Condition?
Herpetic whitlow May treat with acyclovir Do NOT burst lesions
44
HHV-6 - symptoms
Roseola (6th disease, exanthema subitum) Fever 3-5 days, then abrupt cessation of fever Then macular-to-maculopapular rash Seizures can occur in febrile stage Other: Nagayama spots, irritability, LOA, diarrhoea, URTI sx, lymphadenopathy, palpebral/periorbital oedema (Berlinger sign)
45
Quantitiative HIV RNA viral load reverse transcriptase (RT) CPR
1st line to diagnose infectivity. In adults and older kids, ELISA and Western blotting can be used to detect HIV specific antibodies. Can be performed within 24 hrs of infection. A positive virologic result should be confirmed with repeat testing with a 2nd sample ASAP after result is available.
46
UTI bugs
F: E Coli, Klebsiella, Proteus M: E Coli, gram + organisms
47
UTI treatment in infant
Neonate - amox + gent Infant - ceftriaxone
48
Duration IV treatment meningitis > 1mth
N meningitidis - 5 days S pneumoniae - 10-14 days H influenzae - 7 days GBS - 14-21 days Gram neg bacilli - 21 days Listeria - 21 days
49
Cerebellar ataxia + oculucutaneous telangectasia - ?dx
Ataxia telangiectasia - Ataxia usually presents before age 5 yrs - Telangiectasia most common in bulbar conjunctivae, but also ears, neck and ACF - AFP is raised
50
Pin worm/threadworm
Enterobius vermicularis - Eggs = bean shaped - Adult females = pin shaped. - Presents as white threads in stool
51
Whipworm
Trichuris - Occurs in tropics - Ass. with poor hygiene & poverty - Usually asymptomatic, but can have symptoms if heavy parasite burden - Eggs = barrel shaped - Complications = rectal prolapse
52
Hookworm
Necator americanus - Chronic infection leads to anaemia and poor gth - Often ass. with eosinophilia
53
Necator americanus - regions
Hookworm Africa, Americas, Indonesia, Sth Pacific
54
Necator duodenale - regions
Hookworm Mediterranean countries, Iran, India, Pakistan, Far East
55
Hookworm varieties
Necator americanus Ancylostoma duodenale Ancylostoma braziliense (cats and dogs) Ancylostoma caninum (dogs)
56
Roundworm varieties
Ascaris lumbrocoides (humans) Ascaris suum (pigs) Trichuris (whipworm)
57
Pinworm/threadworm
Enterobius vermicularis
58
Hep C - method of transmission
IV blood exposure Mucous membranes possible but less efficient
59
Abx treatment CAP > 2 mths
High dose amoxicillin - studies have shown equivalent outcomes to parenteral therapy for moderately severe CAP
60
Dengue
Flavivirus - Aedes aegypti mosquito - Sx: high temp, myalgias, retro-orbital headache - Also: thrombocytopaenia and mild bleeding (petechiae, epistaxis) at defervescence common - Dengue haemorrhagic fever can lead to distributive shock - Similar to Chikungunya, but C does not have bleeding sx
61
Plasmodium vivax
- Malarial illness - Mild cf P faciparum - May occur despite prophylaxis - Dormant hepatic phase, so may present some mths/years after initial infection - Ix = thick and thin blood films, but PCR and antigen testing is possible
62
Enterotoxigenic e coli
- Most common form of traveller's diarrhoea - Sx = watery diarrhoea and abdominal cramping +/- vomiting +/- fever - If high fever or bloody diarrhoea, think campylobacter jejuni or S typi
63
CXR - myocarditis
Enlarged cardiac shadow Bilateral patchy opacification (from HF/viral infection)
64
Pathogenic mosquitos
- Aedes aegyptes - Dengue fever and Zika - Anopheles - malaria - Tsetse flies - trypanosomiasis - Sandflies - leishmaniasis - Ixodes ticks - Lyme disease
65
Endocarditis prophylaxis - when indicated
- Prosthetic cardiac valve - Previous IE - CHD if unrepaired cyanotic defect (or persistent defect post repair), for 6 mths post op - heart transplant with valvulopathy - RHD if extraction, periodontal, replanting avulsed teeth, other surgery
66
Commonly associated bacteraemia in malaria
Salmonella
67
Thick and thin blood smear - used to detect what?
Malaria - Thin - measures parasite density AND identification of parasite (through RBC morphology) - Thick - parasite density. RBC lysed so does NOT identify particular parasite.
68
Indications for IvIG
- Dermatomyositis (reduces MAC in plasma, and C3b and MAC deposited in endomysial capillaries) - Guillain-Barre syndrome (hastens recovery) - ITP (superior to corticosteroids) - Kawasaki's (used with aspirin reduces risk of CA aneurysms)
69
Otitis externa - bugs
P aeruginosa S epidermidis S aureus
70
Diagnosis?
Varicella zoster virus Would be itchy but NOT painful (cf otitis externa)
71
Enterococcus fecalis
- Gram positive cocci - Causes UTIs in pts with indwelling catethers or underlying renal tract abnormalities - Cephalosporin resistant
72
Bacterial tracheitis - bug
- Staph aureus - most common - Moraxella catarrhalis - more severe disease - Strep pneumoniae
73
Viral causes of paralysis
Poliovirus type 3 Enterovirus 71
74
HHV-6
- aka roseola infantum, exanthem subitum, 6th disease - 3-5 days fever, resolves abruptly following by rash - acute febrile illness with or without rash with fever, fussiness, rhinorrhoea
75
IV agent for neonatal candiasis
Amphoterocin B
76
Features of GAS perianal infection
Perianal erythema Fever Intensely itchy Pain on defection Mucopurulent anal discharge
77
PFAPA (Marshal syndrome) - acronym
Periodic fever with aphthous stomatitis, pharyngitis and adenitis NOT associated with amyloidosis
78
Periodic fever syndrome associated with amyloidosis
Familial mediterranean fever
79
Granulomatosis infantiseptica
- Caused by listeria when severe in utero infection - Causes abscesses in fetal liver, lungs, kidney, spleen and brain - Stillborn or die shortly after birth
80
Meningococcal serotypes
A - linked with outbreaks in Africa and Asia B - most common C - 2nd most common W135 - responsible for small outbreaks internationally, increasingly common in Aust Y - uncommon in Austraia
81
HFM virus
Coxsackie A16
82
ESKAPE organisms (multi-drug resistant organisms)
Enterococcus faecium Staphylococcus aureus Klebsiella pneumoniae Acinetobacter baumannii Pseudomonas aeruginosa Enterobacter spp.
83
Leishmania - method of transmission
Sandflies

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