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Phase 3b > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

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1
Q

What is the most severe and dangerous organism causing malaria?

A

Plasmodium falciparum

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2
Q

Name the other types of malaria

A

Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

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3
Q

Protective factors for malaria

A

Sickle-cell trait

G6PD lack

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4
Q

Symptoms of Plasmodium falciparum

A 
FEVER
Sweats
Rigors
Malaise
Myalgia
Headache
Vomiting
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5
Q

When should you suspect malaria in someone?

A

Someone who lives or has travelled to an area of malaria - AFRICA

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6
Q

Signs of Plasmodium falciparum

A

Anaemia
Jaundice - as bilirubin is released during RBC rupture
Hepatosplenomegaly

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7
Q

Complications of Plasmodium falciparum

A 
Cerebral malaria
Reduced consciousness/coma
Seizures
Acute kidney injury
Disseminated intravascular coagulopathy (DIC)
Severe haemolytic anaemia
Pulmonary oedema/ARDs
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8
Q

Investigations for Plasmodium falciparum

A 
Thick and thin blood films - 3 samples over 3 days
FBC (anaemia/thrombocytopenia)
Clotting (DIC)
Glucose (hypoglycaemia)
ABG/lactate (lactic acidosis)
U&E (renal failure)
Urinalysis (proteinuria, haemoglobinuria)
Blood cultures
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9
Q

Treatment for uncomplicated falciparum malaria

A

Artemether-lumefantrine (Riamet)
Atovaquone-proguanil (Malarone)
Quinine sulphate
Doxycycline or clindamycin

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10
Q

Treatment for severe or complicated falciparum malaria

A

Artesunate IV

Quinine

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11
Q

Prophylaxis for malaria

A 
Mosquito spray (DEET)
Mosquito nets and barriers
Wear long sleeves
Antimalarials - doxycycline, mefloquine, malarone
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12
Q

Side effects of doxycycline?

A

Diarrhoea and thrush

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13
Q

Side effects of mefloquine

A

Insomnia
Seizures
Nausea

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14
Q

Side effects of malarone

A

Abdominal pain
Nausea
Headache

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15
Q

What is HIV?

A

A retrovirus that destroys CD4 T cells and is the cause of aids

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16
Q

How many types of HIV are there?

A

HIV 1 = global epidemic

HIV 2 = West Africa

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17
Q

How does HIV present?

A

The infection initially causes a seroconversion flu-like illness within a few weeks. Remains asymptomatic before the patient becomes immunocompromised and develops AIDS years later.

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18
Q

How is HIV transmitted

A

Unprotected anal, vaginal or oral sex
Vertical transmission: Mother -> Child
Sharing needles/IVDU
Blood transfusion

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19
Q

How does seroconversion/primary infection present?

A 
Short-illness after infection, 2-6 weeks - highest infectivity
Fever
Malaise
Blotchy red rash
Aching limbs
Headache
Diarrhoea
Mouth ulcers
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20
Q

How does the asymptomatic HIV infection present?

A

May last several years
Progressive loss of CD4 cells
30% have generalised lymphadenopathy - nodes >1cm at 2 extra-inguinal sites for 3 months or longer

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21
Q

How does symptomatic HIV infection present?

A 
Pyrexia
Night sweats
Diarrhoea
Weight loss
Opportunistic infections - oral candida, oral hairy leukoplakia, herpes zoster, herpes simplex
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22
Q

How long does it take for HIV => AIDS?

A

5-10 Years

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23
Q

How long does it take for AIDS => Death (without HAART)?

A

2 Years

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24
Q

How is HIV diagnosed?

A

ELISA antibody blood test
PCR testing for HIV RNA/p24 antigen

CD4 count - these cells are destroyed by HIV virus; Normal = 500-,1200. <200 = end stage HIV/AIDS

Viral load - number of HIV RNA per ml of blood; uncontrolled = >500,000, well controlled = <40

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25
What opportunistic infection can HIV present with?
``` TB Pneumonia Pneumocystis jiroveci pneumonia (PCP) - suspect if cough/breathlessness CMV M.avium intracellulare (MAI)/ MAC (complex) Candidiasis Toxoplasmosis Cryptococcal meningitis Herpes simplex virus Kaposi's sarcoma Burkitt's lymphoma CMV retinitis Oral hairy leukoplakia ```
26
What is the treatment for candidiasis?
Nystatin | If mucosal = Fluconazole
27
Treatment for toxoplasmosis?
Pyrimethamine + sulfadiazine + leucovorin
28
How does Pneumocystis jiroveci pneumonia (PCP) present?
``` Cough Breathlessness Fever Chest pain Fatigue ```
29
Investigations for Pneumocystis jiroveci pneumonia (PCP)
CT scan - diffuse ground glass opacity, consolidation, cysts, nodules Induced sputum/bronchoalveolar lavage
30
Treatment for Pneumocystis jiroveci pneumonia (PCP)
High dose co-trimoxazole
31
Prophylaxis for HIV (recommended in all patients with CD4 <200)
``` Co-trimoxazole for PCP Cervical smears Vaccinations Azithromycin for MAI/MAC if CD4 <50 Isoniazid + Rifampicin for 3 months/ Isoniazid for 6 months Ganciclovir for treating CMV ```
32
Prevention for HIV
``` Blood screening PEP - pre and post exposure prophylaxis Condoms Circumcision Reduce vertical transmission ```
33
Treatment for HIV
HAART - highly active antiretroviral therapy Use of at least three different antiretroviral drugs Nucleoside reverse transcriptase inhibitors (NRTI) Non-nucleoside reverse transcriptase inhibitors (NNRTI) Protease inhibitors (PI) Integrase inhibitors (II)
34
Examples of Nucleoside reverse transcriptase inhibitors (NRTI)
Zidovudine Tenofovir Lamivudine Emtricitabine
35
Side effects of Nucleoside reverse transcriptase inhibitors (NRTI)
``` Anaemia Fever Rash GI disturbance Myalgia Decreased WCC ```
36
Examples of Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Nevirapine Efavirenz Rilpivirine
37
Side effects of Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Steven's-Johnson syndrome/TEN | Hepatitis
38
Examples of protease inhibitors
Lopinavir Ritonavir Squinavir
39
Side effects of protease inhibitors
GI disturbance Headache Rash Peripheral neuropathy
40
Examples of integrase inhibitors
Raltegravir Elvitegravir Dolutegravir
41
Side effects of integrase inhibitors
GI upset | Insomnia
42
What is post-exposure prophylaxis?
Used after exposure to HIV - commenced within 72 hours | 4 week course of Tenofovir + emtricitabine + raltegravir
43
Define gastritis
Inflammation of the stomach | Nausea and vomiting
44
Define enteritis
Inflammation of the intestines | Diarrhoea
45
Define gastroenteritis
Inflammation from stomach -> intestines Nausea and vomiting + diarrhoea
46
Causes of gastroenteritis
Contaminated food and water Viral gastroenteritis Bacterial gastroenteritis
47
Questions to ask when taking a gastroenteritis history
Food and water taken Cooking methods Others affected?
48
Causes of viral gastroenteritis
Rotavirus Norovirus Adenovirus
49
Symptoms of norovirus
Fever | Projectile vomiting
50
Symptoms of rotavirus
Diarrhoea Vomiting Fever Malaise
51
Causes of bacterial gastroenteritis
``` E.coli Campylobacter Jejuni Shigella Salmonella Bacillus cereus Yersinia enterocolitica Staph aureus Giardiasis ```
52
How is e.coli spread?
Through infected faeces, unwashed salads or water
53
Symptoms of E.coli
Abdominal cramps Bloody diarrhoea Vomiting
54
How does E.coli work?
E.coli 0157 produces the shiga toxin => leads to haemolytic uraemic syndrome
55
What is the most common bacterial cause of gastroenteritis
Campylobacter Jejuni
56
How is Campylobacter Jejuni spread
Raw food Untreated water Unpasteurised milk
57
Symptoms of Campylobacter Jejuni
Abdominal cramps Diarrhoea often with blood Vomiting Fever
58
Treatment for Campylobacter Jejuni
Azithromycin or ciprofloxacin
59
Treatment for Shigella
Azithromycin or ciprofloxacin
60
How is Shigella spread
Faeces contaminating drinking water Swimming pools Food
61
Symptoms of Shigella
Bloody diarrhoea Abdominal cramps Fever
62
How is Salmonella spread?
Raw eggs Meat Poultry
63
What type of bacteria is bacillus cereus?
Gram positive rod
64
How is bacillus cereus spread?
Spread through inadequately cooked food => reheated rice
65
What else can bacillus cereus cause?
IVDU for infective endocarditis
66
Presentation of bacillus cereus?
Causes abdominal cramp and vomiting within 5 hours Watery diarrhoea after 8 hours Resolved within 24 hours
67
What type of bacteria is Yersinia enterocolitica
Gram negative bacillus
68
How is Yersinia enterocolitica spread
Raw or undercooked pork | Milk
69
Symptoms of Yersinia enterocolitica
``` Watery or bloody diarrhoea Abdominal pain Fever Lymphadenopathy Right sided abdominal pain -> mesenteric lymphadenitis ```
70
How does staph aureus work?
Produces enterotoxins in eggs, meat and dairy
71
Symptoms of staph aureus
Diarrhoea Perfuse vomiting Abdominal cramps Fever
72
Treatment for giardiasis
Metronidazole
73
What type of bacteria is giardiasis?
Giardia lamblia parasite - flagellated protozoan
74
How is giardiasis transmitted
Oral ingestion of cysts via faecal-oral route mainly swallowing water whilst swimming, drinking tap water or lettuce
75
Symptoms of giardiasis
Chronic diarrhoea Frequent belching Abdominal pain Bloating
76
Investigations for giardiasis
Stool microscopy - cysts and trophozoites Stool antigen test (ELISA) - +ve for cell wall String test Baseline FBC
77
Investigations for gastroenteritis
Stool microscopy/culture
78
Prevention of gastroenteritis
Hygiene | If abroad, avoid unbottled water, salads
79
Treatment for gastroenteritis
Maintain oral fluid/hydration Severe symptoms: Anti-emetics e.g. metoclopramide Anti-diarrhoeals e.g. Loperamide
80
Complications of gastroenteritis
Lactose intolerance Irritable bowel syndrome Reactive arthritis Guillain-Barre syndrome
81
Causes of hepatitis
``` Alcohol Viral hepatitis Autoimmune hepatitis Non-alcoholic fatty liver disease Drug-induced (e.g. paracetamol overdose) ```
82
Symptoms of hepatitis
``` Abdominal pain Fatigue Itching Muscle and joint aches Nausea and vomiting Jaundice Fever ```
83
Are hepatitis A-E all notifiable diseases?
Yes
84
How is hepatitis A transmitted?
Faecal-orally or shellfish
85
Which hepatitis are RNA viruses?
A, C, D and E
86
Which hepatitis are DNA viruses?
B
87
Symptoms of hepatitis A
``` Nausea and vomiting Anorexia Vomiting Jaundice Cholestasis - dark urine and pale stools Hepatosplenomegaly ```
88
Tests for hepatitis A
AST and ALT rise IgM rises IgG is detectable for life
89
Treatment for hepatitis A
Basic analgesia | Vaccination
90
Where is hepatitis A found?
Endemic in Africa and South America
91
How is hepatitis B transmitted
Blood or bodily fluids (IVDU) Sexual intercourse Mother -> Child = vertical transmission
92
Where is hepatitis B found?
East, Africa, Mediterranean
93
Symptoms of hepatitis B
``` Nausea and vomiting Anorexia Jaundice Hepatosplenomegaly Arthralgia ```
94
Complications of hepatitis B
Cirrhosis | Hepatocellular carcinoma
95
Investigations for hepatitis B
``` HBsAg HBeAg HBcAb HBsAb HBV DNA ```
96
What does HBSAg show?
Surface antigen = Active infection
97
What does HBeAg show?
E antigen = Implies high infectivity
98
What does HBcAb show?
Core antibodies = Implies past infection
99
What does HBsAb show?
Surface antibodies = Implies vaccination
100
How is hepatitis B treated?
Antivirals - pegylated interferon alpha-2a/tenofovir/entecavir Stop alcohol/smoking
101
How is hepatitis C transmitted?
Blood and bodily fluids
102
Complications of hepatitis C
25% get cirrhosis | 4% get hepatocellular carcinomas
103
Tests for hepatitis C
LFT's Hepatitis C antibody Hepatitis C RNA confirms diagnosis
104
Treatment for hepatitis C
Antivirals - pegylated interferon alpha-2a
105
How does hepatitis D work?
Only survives in patients who also have hepatitis B infection Attaches to HBsAg
106
How is hepatitis E transmitted
Faecal-orally
107
Where is Hepatitis E found?
Very rare in the UK/ common in Indochina
108
Who does type 1 autoimmune hepatitis occur in?
Adults
109
Who does type 2 autoimmune hepatitis occur in?
Children
110
Antibodies in type 1 autoimmune hepatitis?
ANA/anti-actin/anti-SLA/LP
111
Antibodies in type 2 autoimmune hepatitis?
anti-LKM1/anti-LCl
112
Treatment for autoimmune hepatitis
Prednisolone | Azathioprine
113
Define infective endocarditis
Infection of the endocardium of the heart
114
What two symptoms indicate endocarditis?
Fever + new murmur
115
What valves are most commonly affected?
Tricuspid valves - mitral & aortic
116
Risk factors for infective endocarditis
``` Valvular heart disease Valve replacement Previous infective endocarditis Hypertrophic cardiomyopathy IV drug abuse ```
117
Causes of infective endocarditis
Staph aureus Strep viridans Enterocci HACEK organisms - Haemophilus, actinobacillus, cardiobacterium, eikenella corrodens, kingella kingae
118
Most common causative organism of infective endocarditis
Staph aureus
119
Symptoms of infective endocarditis
``` Fever Rigors Night sweats Weight loss Clubbing Loss of appetite New murmur -> murmurs in 85% Roth's spots Osler's nodes Glomerulonephritis Janeway lesions Splenomegly Arthritis Haematuria Anaemia ```
120
Most common murmur in infective endocarditis?
Aortic regurgitation
121
Differential diagnosis in infective endocarditis
``` SLE Cardiac tumours Lyme disease Antiphospholipid syndrome Reactive arthritis ```
122
What criteria is used to classify infective endocarditis
Duke's criteria
123
What is the major criteria in Duke's critera?
Positive blood culture (typical organism in two separate cultures or persistently +ve blood cultures) Endocardium involved - positive echocardiogram, new valvular regurgitation
124
What is the minor criteria in Duke's criteria?
Predisposition (cardiac lesion/ IV drug abuse) Fever >38 oC Vascular signs Positive blood culture - which don't meet major criteria
125
How many of major and minor criteria's do you need to diagnose infective endocarditis
2 major or 1 major + 3 minor or 5 minor
126
Investigations for infective endocarditis
Blood cultures - take 3 sets Blood tests - normochromic, normocytic anaemia, high ESR/CRP Chest x-ray = Cadiomegaly Urinalysis - Haematuria ECG - long PR interval Echocardiography - TTE 1st line => then TOE
127
Treatment for staphs native valve in infective endocarditis
Flucloxacillin -> Vancomycin instead if penicillin allergic
128
Treatment for staphs prosthetic valve in infective endocarditis
Flucloxacillin + rifampicin + gentamicin
129
Treatment for streps in infective endocarditis
Benzylpenicillin
130
Treatment for enterocci in infective endocarditis
Amoxicillin + gentamicin
131
Treatment for HACEK in infective endocarditis
Amoxicillin + gentamicin (for 2 weeks)
132
Complications of infective endocarditis
``` Heart failure Infection (uncontrolled) Systemic embolisation Splenic anuerysms Myocarditis/pericarditis Renal failure ```

Phase 3b (18 decks)

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