Infectious diseases Flashcards

(42 cards)

0
Q

Hepatitis viruses, how are the spread?

A

HAV - faecal oral
HBV - blood products, IV drug users, sexual intercourse, direct contact
HCV - blood products, IV drug users, sexual intercourse, acupuncture
HDV - with HBV

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1
Q

The hepatitis viruses: DNA or RNA?

A
HAV - RNA
HBV - DNA
HCV - RNA flavivirus 
HDV - incomplete RNA virus (only exists with HBV)
HEV - RNA virus (similar to HAV)
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2
Q

Hepatitis A - what are its symptoms, how long is the incubation period and how can you detect an infection and recent infection?

A

Incubation 2-6 weeks
Prodromal symptoms - fever, malaise, anorexia, nausea, arthralgia
Jaundice +/- hepatomegaly,
AST and ALT rise day 22-40 after exposure and return to normal over 5-20 weeks
IgM rises from day 25 and signifies recent infection
IgG remains detectable for life

Self limiting usually - NEVER results in chronic liver disease

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4
Q

What are the 4 main organisms that cause TB, and what are the features of the bacteria?

A

Mycobacterium tuberculosis
Mycobacterium bovis
Mycobacterium africanum
Mycobacterium microti

They are obligate aerobes, facultative intracellular pathogens, usually infecting mononuculear phagocytes. They grow slowly, 12-18hr generation time and have a high lipid cell wall.

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5
Q

What are the different clinical types of TB?

A

Primary TB -
Alveolar macrophages ingest bacteria, the bacilli proliferative inside and cause release of chemoattractants and cytokienes. This leads to inflammatory cell infiltrate in the lungs and the hilar lymph nodes.
Delayed hypersensitivity reaction occurs resulting in the necrosis and granulomas seen: central areas of necrotic tissue surrounded by epitheliod cells and langhans giant cells

Latent TB - cell mediated immune memory to the bacteria
Reactivated TB - can occur in HIV ,immunosuppression, DM, malnutrition and ageing.

TB can occur in any organ:
Potts disease = TB in bone
Millary TB = a result of haematogenous dissemination of the TB
Lupus vulgaris = skin TB

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6
Q

How do you treat TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

All 4 for 2 months and only R and I for 4 months.
Pyridoxine (vit B6) should be given throughout

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7
Q

What are the side effects of the anti TB drugs?

A

Rifampicin:
Hepatitis (ok if AST rises, need to stop if bilirubin increases), orange discolouration of urine and tears, inactivation of the pill

Isoniazid:
Hepatitis, neuropathy, agraulocytosis

Ethambutol:
Optic neuritis - colour vision is the first to go

Pyrazinamide:
Hepatitis, arthralgia

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8
Q

Hepatitis C - what are its symptoms, how long is the incubation period and how can you detect an infection and recent infection?

A

Early infection is often mild or asymptomatic
85% develop chronic infection - 20-30% develop cirrhosis and 1-3% of those develop HCC

No infection = -ve AntiHCV and -ve HCV RNA
Early acute phase = -ve AntiHCV and +ve HCV RNA
Infection = +ve AntiHCV and +ve HCV RNA
Resolution = +ve AntiHCV and -ve HCV RNA

When treating prognosis is measured using the viral load and patients can have a Rapid Virological response (RVR) an Early Virological response (EVR) or a Sustained Virological response (SVR), people have an undetectable viral load at 4, 12 or over 24 weeks of treatment.

A partial responder is someone who gets an EVR but is not undetectable by 24weeks, and a null responder is someone who doesn’t get an EVR,

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9
Q

What symptoms and signs would make you treat a patient for meningitis?

A

Headaches with leg pains, cold hands and abnormal skin colour
Meningism - neck stiffness, photophobia, Kernig’s sign
Decreased consciousness level
Seizures or focal neurological signs
Petchial rash

Signs of sepsis

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10
Q

What would a lumbar puncture show in bacterial, viral and TB meningitis?

A

Bacterial:
Turbid, 90-1000+ polymorphs.
Glucose 1.5g/l of protein

Viral:
Usually clear with 50-1000 mononuclear cells
Glucose >1/2 of the plasma glucose

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11
Q

What are the different manifestations of herpes simplex virus?

A
  1. Genital/ oral herpes
  2. Gingiovostomatitis - ulcers in the mouth
  3. Herpetic whitlow - vesicles on the fingers
  4. Eczema herpeticum - HSV infection of eczematous skin
  5. HSV meningitis - uncommon but self limiting
  6. HSV keratitis - corneal dendritic ulcers
  7. Systemic infection - fever, sore throat lymphadenopathy, if not immunocompromised may go unnoticed, can be life threatening
  8. HSV encephalitits - usually HSV1. spreads from cranial nerve ganglia to frontal and temporal nerves. Fever, fits, odd behaviour. PCR on CSF. NEEDS IV ACICLOVIR ASAP
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12
Q

What are the complications of influenza?

A

Bronchitis, pneumonia, sinustitis, otitis media, encephalitis, pericarditis
Reye’s syndrome - coma and high LFTs

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13
Q

What does toxoplasmosis do to the eye?

A

Granulomatous uveitits
Necrotizing retinitis
If congenital presents with choriodretinitis, posterior uveitis and may cause cataract

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14
Q

How does congenital CMV present?

A

Jaundice, hepatosplenomegly purpura,

Mental retardation, cerebral palsy, epilepsy, and eye problems

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15
Q

How can you distinguish between patients who have been infected with hep B and are now carriers, those currently infected and those who have been vaccinated?

A

Test different things:
Liver function tests - abnormal when someone is acutely infected or they have the chronic disease.

HepB surface antigen - is only detected when patients are infected as its found on the virus.
+ve incubation, acute infection and chronic infection

HepB e antigen - detected when the virus is replicating.
+ve incubation and acute infection. If the virus is reactivating in chronic infection

Anti HepB core IgM - acute antibody against the core.
+ve acute infection and some chronic infections

Anti HepB core IgG - chronic antibody against the core.
Present in acute infections, chronic infections and fully recovered infections.

Anti HepB surface - is a sign of immunity
+ve in fully recovered infections and vaccinated patients

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16
Q

How do the two different modes of transmission of Hep B affect the end result?

A

Vertical transmission from mother to fetus is the most common mode of transmission.
90% of the children have no acute episode and therefore dont clear the virus so have the chronic infection

If a adult patient develops an acute infection >90% will clear the virus.

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17
Q

What are the complications of Hep B?

A
Fulminant hepatic failure
Replapse
Prolonged cholestasis 
Chronic hepatitis 
Cirrhosis 
Hepatocellular carcinoma -10 fold if HepB Surface antigen +ve, 60 fold increase if HepB surface antigen and HepB e antigen +ve
Glomerulonephritis
Cryoglobulinaemia
18
Q
Glandular fever:
What causes it?
How do you test for it?
What happens with the bloods?
What are the complications?
A

Epstein Barr virus
Mono spot test
Blood film shows lymphocytosis
Complications:
CNS - meningitis, encephalitis, ataxia, cranial nerve lesions, GBS, chronic fatigue
Thrombocytopenia, ruptured spleen, upper airways obstruction, hepatitis, myo or pericarditis, renal failure, autoimmune haemolysis, erythema multiforme.

DO NOT GIVE AMPLICILLIN OR AMOXICILLIN TO PTS WITH A SORE THROAT, IF THEY HAVE EBV THEY WILL DEVELOP A SEVERE RASH

19
Q

What bacteria grow gram +ve cocci in clusters?

A

Staphlococcus aureas or coagulase negative staphs (epidermidis)

20
Q

What bacteria grow gram +ve cocci in chains?

A

Streptococcus - group a, or beta haemolytic strep

21
Q

What bacteria grow gram +ve cocci in pairs?

A

Streptococcus pneumoniae or enterococcus

22
Q

What bacteria grow as gram +ve rods?

A

Small and thin - diphtheroid or propionibacterium (contaminants in blood cultures normally)

Large with spores - clostridium or bacillus

23
Q

What bacteria grow as gram -ve cocci?

A

Neisseria meningitides and Neisseria gonorrhoeae

Moraxella spp

24
Q

What bacteria grow as gram -ve rods?

A
Coliforms - E coil, klebsiella, enterobacter, proteus 
Pseudomonas 
Haemophilus influenzae
Salmonella, shigella, campylobacter
Legionella, pertussis
25
What bacteria grow as gram -ve rods, anaerobes
Bacteroides | Actinomyces
26
How is E coli O157 diagnosed?
Stool culture
27
How is legionella infection diagnosed?
Urine antigen test
28
Can a patient who is allergic (gets a rash) to cephalosporins be treated with penicillins?
Yes
29
What can a patient who is allergic (gets a rash) to penicillins be treated with?
Anything put penicillins, can be treated with cephalosporins
30
If a patient gets an anaphylaxis reaction to a B lactam can what can they be treated with?
No betalactams at all - NO penicillins, no cephaolsporins, no carbapenems Can be treated with macrolides, gent, quinolones and trimethoprim
31
What antibiotics can a pregnant women have? (if shes not allergic to anything)
No tetracyclines (doxycycline) or quinolones (ciprofloxacin) No trimethoprim in first trimester No nitrofurantoin immediately pre labour Yes to penicillins and cephalosporins (the older the better as we don't have info on the newer ones) Gent etc - need advice
32
What antibiotics are macrolides?
Clarithromycin etc
33
What do macrolides and aminoglycosides have in common?
They do not penetrate the CSF
34
What class of antibiotic is vancomycin?
A glycopeptide
35
Is Hep C an acute or chronic disease?
85% develop chronic condition Infection = +ve anti HepC and +ve HepC RNA No infection = -ve anti HepC and -ve HepC RNA Resolved infection = +ve anti HepC and -ve HepC RNA Acute early infection = -ve anti HepC and +ve HepC RNA
36
Lymphogranuloma venerum: Bacterial that causes it Symptoms Treatment
Chlamydia trachomatis - invades lymphatic tissue Papules or ulceration + a single non indurated ulcer Lymphadenopathy - groove sign Buboes form and burst Proctitis Elephanitits of genital tract Treat with doxy BD for 3 weeks
37
Chancroid: Bacteria Symptoms Treatment
Haemophilus ducreyi Incubation 3-10 days High incidence in africa/ asia Causes single of multiple non indurated painful ulcers Treat with azithromycin stat or ciprofloxicin BD for 3 days
38
``` Chlamydia Bacteria Initial sites of infection Symptoms Treatment ```
Chlamydia trachomatis - gram -ve cocci/ rod Infects epithelial cells of urethra, cervix, rectum, pharynx, and conjunctivia Men- urethral discharge, dysuria, proctitis, epididymoorchitis, conjuctivitis Women - dysuria, vaginal discharge, intermenstrual bleeding, PID, fitz- hugh - curtis syndrome, reactive arthritis Diagnosis with NAAT Treat with doxy 100mg BD for 7 days or azithromycin 1g stat
39
Gonorrhoea What cells does it infect? Symptoms Treatment
Infects columnar epithelium of urethra, endocervix, rectum, pharynx, conjuctiva Men- urethral discharge, dysuria, tender inguinal lymph nodes, Women - vaginal discharge, dysuria, abnormal bleeding, MUCOPURULENT discharge extra genital - pharyngitis, rectal pain, skin, joint and heart valves affected. Treat with ceftriaxone 250mg IM stat
40
What is the characteristic symptom of Anthrax infection?
Local cutaneous black pustule | Oedema, fever, hepatosplenomegaly,
41
What does Clostridia perfinges infect?
Skin, causes gas gangrene
42
How are the different stages of syphilis classified?
Primary = primary chancre at site of sexual contact. Painless but very infectious Secondary = 6 weeks to 6months after infection. Rash, malaise, lymphadenopathy, fever, condylomata, hepatitis, heptosplenomeglay, meningism, nephrosis Tertiary = follows >2yrs of latency Gummas (granulomas) in the skin mucosa, bones, joint, viscera, Quaternary = Vascular - ascending aortic aneurysm, AR Neurosyphilis Meningovascular - cranial nerve plasies, stroke Dementia, psychoses Tabes dorsalis - ataxia, numb legs, chest and bridge of nose, up going plantars, charcots joint Argyll robertson pupil Latent syphilis occurs if the secondary illness is not treated, is classed as early latent if 2 yrs. Will have +ve bloods