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Yr3 - General Medicine > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Define sepsis

A

Life-threatening organ dysfunction causes by a dysregulated host response to infection

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2
Q

Define septic shock

A

Subset of sepsis with profound circulatory and metabolic abnormalities
- associated with greater mortality

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3
Q

Sepsis red flags

A

RR > 25
New need for > 40% O2 to keep saturations over 91%
- 87% in COPD
Systolic BP < 91 mmHg or fall of 40 from normal
HR > 130 bpm
No urine output for 16hrs or < 10ml/hr
New onset delirium
Responds only to voice or pain/unresponsive
Non-blanching rash / mottled / ashen / cyanotic
Neutropenia or chemotherapy in last 6 weeks

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4
Q

Time frame for sepsis 6

A

1 hour

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5
Q

Features of sepsis 6

A 
Oxygen
- sats > 94%
Take blood cultures
Give IV antibiotics
- meropenem IV 1g stat
Fluid challenge
- 500mls Hartmann's or 0.9% saline over 15 mins
Measure lactate
- blood gas
Measure urine output
- hourly fluid balance chart
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6
Q

Common organisms of skin/soft tissue infection and antibiotics used

A

Staphylococci, staph. aureus - Flucloxacillin
Coagulase negative staph - often fluclox/penicillin resistant
Streptococci - Benzylpenicillin/Fluclox
MRSA - Glycopeptide ( Vancomycin, Teicoplanin)
Penicillin allergy
- Doxycycline (tetracycline)
- Meropenem (carbapenem)
- Ceftriaxone (cephalosporin)

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7
Q

Common organisms of musculo-skeltal infection and antibiotics used

A 
Diabetic foot 
- mixed infections - Pseudomonas sp, Enterobacteriacae
- Broad spec penicillin - Tazocin
- Carbapenem
TB
- quadruple therapy
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8
Q

Common organisms of respiratory infection and antibiotics used

A 
Streptococci ( S. pneumoniae)
- Amoxicillin (penicillin)
- Erythromycin, Clarithromycin (macrolide)
H. influenzae
- Co-amoxiclav (amoxicllin + clavulinic acid)
Atypical (Legionella, Mycoplasma)
- Doxycycline
- Levofloxacin (fluroquinolone)
Rhinovirus/adenovirus/enterovirus
- no specific treatment
Influenza 
- Osletamivir
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9
Q

Common organisms of diarrhoea/enterocolitis infection and antibiotics used

A 
Virus (rotavirus, adenovirus)
- no specific treatment
Enterobacteriacae (Campylobacter, Shigella, E.Coli
- usually nil
- if severe:
      - Ciprofloxacin
      - Clarithromycin, Azithromycin
Salmonella spp. (S.typhi/parathyphi)
- Ceftriaxone/Azithromycin
C.difficle
- PO Metronidazole/Vancomycin
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10
Q

Common organisms of visceral infection/ peritonitis and antibiotics used

A 
Enterobacteriacae
- Co-amoxicillin or Ciprofloxacin or Gentamicin
- Metronidazole (anaerobic cover)
If severe/penicillin allergy
- Carbapenem
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11
Q

Common organisms of GU tract infection and antibiotics used

A 
Enterobacteriacae - E.coli, Klebsiella sp, Proteus sp
- mild infection = PO Trimethoprim / Nitrofurantoin / Co-amoxicillin
- mod-severe infection = IV Co-amoxiclav / PO Ciproflaxacin
Pseudomonas aerogenosa 
- Ciprofloxacillin
- Gentamicin
- Tazocin
ESBL/resistant organisms
- Carbapenem
Gonorrhoea (Neiseria gonorrhoea)
- IM/IV Ceftriaxone
Chlamydia trachomatis
- Azithromycin
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12
Q

Common organisms of CNS infection and antibiotics used

A 
S. pneumoniae
- IV Ceftriaxone
N. meningitidis / H. influenzae
- IV Ceftriaxone
Listeria 
- age >55 / immunocompromised = high dose IV amoxicillin
Penecillin allergy 
- Meropenem
Herpes simplex virus (encephalitis)
- IV Aciclovir
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13
Q

Common organisms of endocarditis and antibiotics used

A 
S. viridans group
- Benzylpenicillin +/- Gentamicin
Enterococci (E.facealis)
- Amoxicilin +/- Gentamicin
Staph. aures (IV drug users)
- Flucoxacillin +/- Gentamicin +/- Rifampicin
Culture negative endocarditis
- Ceftriaxone
MRSA / penicillin allergy / penecillin resistant
- Vancomycin
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14
Q

Common organisms of line infection and antibiotics used

A 
Staphylococci, staph. aureus - Flucloxacillin
Coagulase negative staph - often fluclox/penicillin resistant
Streptococci - Benzylpenicillin/Fluclox
MRSA - Vancomycin
Penicillin allergy
- Doxycycline  (tetracycline) 
- Meropenem (carbapenem)
- Ceftriaxone (cephalosporin)
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15
Q

Common organisms of hospital inquired infection and antibiotics used

A 
Enterobacteriacae (E.coli, Klebsiella spp)
- Co-amoxiclav
Pseudomonas spp
- Ciprofloxacin
- Gentamicin
C.difficile
- Metronidazole
- Vancomycin
Multi-drug resistant
- Tazocin
- Carbapenem
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16
Q

Presentation of travel-related illness

A 
Febrile
GI symptoms
- diarrhoea
- vomiting
Jaundice
Reticuloendothelial change
- lymphadenopathy
- hepatosplenomegaly
Respiratory symptoms
- cough
- SOB
Rash
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17
Q

Featuers of travel history

A 
Geographic region within last 12 months
Dates and duration of stay - incubation period
Onset and nature of signs/symptoms
Types of accomodation - rural vs urban
Recrational activities and expsoures
- insects - malaria, rickettsia
- animals - biets, ticks
- freshwater lakes and streams - schistosomiasis
- well/canal - leptospirosis
Food and water drunk - faecal-oral transfer
Sexual history - HIV, Hep B/C
PMH and immunosuppression
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18
Q

Infections develop within 0-10 days of travel

A 
Dengue
Rickettsia
Viral
- infectious mononucleosis
GI
- bacteria
- amoeba
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19
Q

Infections that develop within 10-21 days of foreign travel

A

Malaria
Typhoid
Primary HIV

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20
Q

Infections that develop > 21 days of foreign travel

A 
Malaria
Chronic bacterial infections
- brucella
- coxiella
- endocarditis
- bone and joint infections
TB
Parasitic infections
- helminths
- protozoa
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21
Q

What does a pulse rate slow for the degree of fever suggest?

A

Typhoid fever

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22
Q

Skin changes in infection post foreign travel

A 
Maculopapular rash
- dengue fever
- leptospirosis
- rickettsia
- infectious mononucleosis (EBV, CMV)
- childhood viruses (rubella, parvovirus B19)
- primary HIV infection
Rose spots on chest/abdomen
- typhoid fever
Black nectrotic ulcer with erythematous margins
- tick exposure
Petechiae, ecchymoses or haemorrhagic lesions
- dengue fever
- meningococcaemia
- viral haemorrhagic fever
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23
Q

What does conjunctival suffusion suggest?

A

Leptospirosis

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24
Q

What does splenomegaly post foreign travel suggest?

A 
Mononucleosis
Maleria
Visceral leishmaniasis
Typhoid fever
Brucellosis
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25
Q

What does altered mental state in fever suggest?

A 
Meningo-encephalitis
Post travel
- cerebral malaria
- Japanese encephalitis
- West Nile Viral encephalitis
Common infective causes
- N. meningitis
- Strep. pneumonia
- Herpes simplex virus
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26
Q

Investigations in post foreign travel infections

A

Complete blood count
LFTs
U+Es and electrolytes
Malaria smears +/- antigen dipstick - 3 times over 24-48hrs
Blood cultures - x2
Urinalysis +/- urine culture
Stool culture +/- stool for ova, cysts and parasites (OCP)
CXR
HIV, Hep B/C, Syphillis (treponema) serology
Acute serology tube to be saved in lab

27
Q

Cause of malaria

A 
Blood protozoa transmitted by night-biting Anopheles mosquitoes
Plasmodium species
- P. falciparum - most serious
- P. vivax
- P. ovale - mostly SE Asia
28
Q

Presentation of malaria

A

Abrupt onset of rigors followed by high fevers, malaise, severe headache and myalgia, vague abdominal pain, N+V
Diarrhoea
Jaundice and hepatosplenogmegaly
Bloods
- anaemia, thrombocytopenia, leukopenia, abonormal LFTs

29
Q

Complications of untreated P. falciparum

A 
Hypoglycaemia
Renal failure
Pulmonary oedema
Neurologic deterioration
Death
30
Q

Presentation of typhoid fever

A 
Sustained fever
Anorexia
Vague abdominal discomfort
Constipation or diarrhoea
Dry cough
31
Q

Findings on examination for typhoid fever

A

Pulse-temperature dissociation
Hepatosplenomegaly
Rose spots

32
Q

Labatory findings for typhoid fever

A

Non-specific

  • leuocpenia
  • lymphopenia
  • raised CRP
33
Q

Diagnosis and treatment of typhoid fever

A

Isolation of organism in cultures of blood, stool, urine, bone marrow or duodenal aspiraties
IV Ceftriaxone 2g OD
- once sensitivities known PO Ciprofloxacin 500mg BD or PO Azithromycin 500mg OD

34
Q

PUO

A

Pyrexia of unknown origin

35
Q

Definition of PUO

A

Temperature > 38 on multiple occasions
Illness > 3 weeks duration
No diagnosis despite > 1 week worth of inpatient investigation

36
Q

Common causes of PUO

A 
Infective
- TB
- abscess
- infective endocarditis
- brucellosis
Autoimmune/connective tissue
- adult onset Stills disease
- temporal arteritis
Neoplastic
- leukamias
- lymphomas
- renal cell carcinoma
Other
- drugs
- emboli
- hyperthyroidism
- adrenal insufficiency
37
Q

Management of PUO

A

Establish diagnosis
Do no start empirical antibiotics/steriods/anti-fungals without speaking to senior
Rhematology/haematology review
Stable patients managed in outpatients following period of observation in hospital

38
Q

Epidemiology of Tuberculosis

A

Caused by mycobacterium tuberculosis

Endemic in many parts of Asia, Africa, South America and Eastern Europe

39
Q

Pathogenesis of TB

A 
Transmitted by aerosol inhalation 
- causes pulmonary infection
- haematogenosus spread to body
Initial infection can be asymptomatic
- can be latent for many years 
Lifetime reactivation risk is 10-15%
- usually due to immunosuppression, advancing age or HIV infection
40
Q

Classification of TB

A

Active
- classified by affected site - pulmonary, pericardial. abdominal, miliary
Latent
- asymptomatic
- identified by screening - CSR and interferon gamma

41
Q

What does QuantiFERON test involve

A

Assess amount of interferon gamma relased by T cells when they are exposed to proteins found of mycobacteria - pre-exposed cells release more interferon
Does not differentiate between active and latent TB
Patients with immunosuppression may not release interferon gamma causing false negatives

42
Q

What does T-spot test involve

A

Lymphocytes isolated and tested directly

Postive test does not mean patient has active TB

43
Q

What does TB screening involve

A

Used in asymptomatic patients with risk factors for latent TB

  • immigrants from high prevalence countries
  • healthcare workers
  • HIV positive patients
  • patients starting immunosuppression
44
Q

Treatment of latent TB

A

3 months rifampicin and isoniazid or 6 months rifampicin alone
- balance reduced risk of reactiviation and risk of hepatotoxicity

45
Q

Common symptoms of TB

A

Non-resolving cough
Unexplained persistent fever (low or high grade)
Drenching night sweats
Weight loss

46
Q

Common signs of TB

A 
Clubbing
Cachexia 
Lymphadenopathy
Hepto/splenomegaly
Erythema nodosum
Crepitations or bronchial breathing
Pericardial rub
47
Q

Imaging for TB

A 
CXR
- mediastinal lymphadenopathy
- cavitating pneumonia
- pleural effusion
CT
- lymphadenopathy
- lesions in viscera
MRI
- leptomeningeal enhancement in TB meningitis
48
Q

Investigations for TB

A

Culturing bacteria
- 6 weeks so ATT usually started after samples taken
Pulmonary TB
- sputum samples or induced sputum
- seen on microscopy = smear positive - high bacterial load and high infectivity so start ATT immediately
Meningeal TB
- lumbar puncture for TB culture and TB PCR
Lymph node TB
- core biopsy of lymph node
Pericardial TB
- pericardiocentesis - but often not practical
GI TB
- colonscopy and bowel biopsy / USS guided omentum biopsy

49
Q

Histological appearance of TB

A

Caseating/necrotising granulomatous inflammation

50
Q

Paradoxical reaction in TB

A

Increase in inflammation as bacteria die -> woresening symptoms
- usually occurs at start of treatment
If TB is affecting sites where additional swelling cannot be tolerated

51
Q

Features of TB meningitis

A

1% of TB patients
All patients with millary TB should have lumbar puncture to exclude TB meningitis
- shows high protein, low glucose and lymphocytosis
MRI shows leptomeningeal enhancement
12 month treatment with steriods

52
Q

Symptoms of TB meningitis

A 
Varied
Personality change
Headache
Meningitic
Coma
53
Q

Features of pericardial TB

A

Result in pericardial effusion and tamponade
Signs include pericardial rub or kussmauls sign
6 months treatment - steroids at start

54
Q

Features of Miliary TB

A

Characteristic appearance on CXR/CT
Widespread and found in multiple sites
Neuroimaging and lumbar puncture to exclude CNS involvement
ATT started as soon as determined whether CNS involvement

55
Q

Multi Drug Resistant TB

A 
Consider in 
- patients who have had incomplete treatment for TB previously
- patients from abroad
Treatment based on sensitivities 
Infection control paramount
- negative pressure room
56
Q

Standard ATT treatment for TB

A 
2 months
- Rifampicin
- Isoniazid
- Ethambutol
- Pyrazinamide
- plus pyridoxine (vitamin b)
4 months
- Rifampicin
- Isoniazid
- plus pyridoxine (vitamin b)
57
Q

Side effects of TB treatment

A 
Rifampicin
- urine/tears turn orange
- drug induced hepatitis +
Isoniazid
- peripheral neuropathy - reduced by pyridoxine
- colour blindness
- drug induced hepatitis ++
Ethambutol
- optic neuropathy/reduced visual acuity
Pyrazinamide
- drug induced hepatitis +++
58
Q

Monitoring for TB treatment

A

Measure baseline LFTs and visual acuity
Monitior LFTs
- if deranged stop treatment and gradually reintroduce drugs once normalised
- liver friendly regime - amikacin, levofloxacin and ethambutol for 24 months

59
Q

Screening for bacterial STIs performed in

A

All patients who are already know to have a sexually transmitted/transmissible infection
All patients who request testing
Any patient identified as high risk of STI from history

60
Q

Tests for asymptomatic patients STI

A

First pass urine (men)
Vulvo-vaginal swab
Pharyngeal swab
Rectal swab

61
Q

Additional tests for symptomatic STI patients

A

Urethral / vaginal / anal discharge - charcoal swab for Gonococcal culture
- Posterior fornix for Trichomonas vaginalis and Candida culture
Oral/genital ulceration - for HSV 1 and 2 PCR
Conjunctivitis

62
Q

Baseline investigations for all new HIV diagnoses

A

Confirmatory HIV test
CD4 count
HIV viral load
HIV resistance profile
HLA B*5701 status
Serology for syphilis, hepatitis A, B, C
Toxoplasma IgG, measles IgG, varicella IgG, rubella IgG
FBC, U&Es, LFTs, bone profile, lipid profile
Schistosoma serology - if spent >1 month in sub-Saharan Africa
Cervial cytology - annually

63
Q

HIV patients with low CD4 counts

A

Susceptible to infection
CD4 < 200
- Co-trimoxazole 480mg PO OD - primary prophylaxis against PCP
CD4 < 50
- Azithromycin 1250mg PO once weekly - MAI
- opthalmology with dilated fundoscopy - evidence of intra-ocular infections such as CMV retinitis

64
Q

Vaccinations for those with HIV

A

Hepatitis B
Pneumococcus
Annual influenza

Yr3 - General Medicine (9 decks)

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