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Infectious Diseases And GUM Flashcards

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1
Q

Gonnorhea

A

N.Gonnorhea - Encapsulated and therefore resitant to phagocyosis

Large ASx resevoir - Pharynx/rectal/cervical

Disseminated dx - in females = penicillin sensitive

Opthalmoplegia neonartu - Systemix Abx and Eye drops

> 10% = resistant to Penicillin + quinolones

–> Tx = CEPHLASPORIN - IM CEFTRAXONE + PO azithromycin

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2
Q

Syphillis

A

Treponem Pallidum

Transmission: SExual > Blood borne.

Diagnosis:
1) Serology = 2 x specific Ag test (EIA or TPHA) + Quantitive PCR

2) Dark ground microscopy - of tissue from Chancre or rash
3) Treponem PCR - Early syphillis Ulcer

In secondary syphillis - haem spread:

  • Mucocutaneous - non-itchy rash
  • LN
  • Neuro - CN palsy/ Meningitis
  • Occular - ant. uveitis
  • GI - Hepatitis or proctitis
  • Rheu - polyarthritis

Tx = Benzylpenicillin or Tetracycline

REINFECTION ??? –> use rapid plasma reagin - all others stay +ve despite txx

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3
Q

Chlamydia

A

Most common bacterial UTI –> Non-gonnocal urethritis.

Complications:

  • Female - PID.
  • Male - prostatitis/epididymitis
  • Babies - Neonatal conjunctivitis or pneumonitis - Systemic Erythromycin

In UK serovaa D + K most common

Other Complications:

  • Trachoma - corneal scarring = Serova A/B/C
  • Lymphogranuloma venerum = rectal inflamm + prostatitis - in MSM - Serova L1/L2/L3

Inx - NAATs

Mx in Adults = TETRACYCLINE OR AZITHROMYCINE

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4
Q

Risk factors for Aids

A

Most common transmission is M+F > MSM > Blood > IVDU

HIV 1 - most common worldwide
HIV2 - Most common in West Africa

RF:

  • Seroconversion or adv disease
  • concurrent STI
  • Concurrent Hep C
  • High Viral Load

Maternal –> Fetal RF = BREASTFEEDING reduce transmission by:

  • Antiretroviral before 3rd trimester
  • Avoid Breastfeeding
  • If detect VL @ 36 weeks –> C-section
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5
Q

HIV Mechanism

A

HIV follows CD4 cells: T-helper, B cells, Macrophages and CNS cells

HIV –> Decreased CD4 and therefore a low CD4:CD8

Markers assoc w/ Progression:

  • Low CD4
  • High Viral Load

Seroconversion:

  • up to 3/12
  • General unwekk sx, can ave meningo-encephalitis or arthropathy
  • Can’t detect HIV antibody during this time
  • Can detect HIV p24 Ag or HIV-1 (at 1 month)
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6
Q

Stages of HIV infection

A

Stage 1: Seroconversion

Stage 2: ASx

Stage 3: Persistent Generalised LN

Stage 4a: AIDS related complex –> Not AIDS defining disease

Stage 4b: AIDS defining illnesses

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7
Q

HIV - PCP

A

Q Stem: Persistent cough, with low sats or desat on exercise and HIV (CD4<200)

CXR: Bilat perihilar LN

Inx - Brochoalveolar lavage (BAL) –> Silver stain or immunoflourescence

Mx:

  • IV Co-Trimaoxazole or IV pentamidine (Sev dx)
  • Steroids - improve prognosis

Prophylaxis - Co-trimox and nebulised pentamidine:
- Prev PCP or CD4 <200 (until >200)

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8
Q

HIV - Pulm TB

A

Q Stem - may be similar to PCP –> AFRICAN PT or EXPOSURE –> Extrapulm TB or Mycobacterium Avium intracellulare

Atypical features:

  • Atypical CXR
  • Extrapulmonary Spread
  • Atypical organism - Mycobacterium avium intracellulare
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9
Q

HIV - GI disease

A

Common:

  • Oesophageal candida
  • oral hairy lukoplakia
  • KArposi sarcoma
  • gingivitis
  • lymphoma
  • CMV
  • HSV

Diarrhoea:
Cryptosporidium –> porfuse watery diarrhoea

Salmonella –> Atypical severity –> bacteraemia.

Inx - Stool culture or ZN Stain (Cryptosporidium) Or Biopsy

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10
Q

HIV - Neuro diseases

A

Cerebral Toxoplasmosis:

  • Px - Focal Neuro
  • Inx: CT - ring enhancing lesions + Toxoplasmosis IgG serology
  • Tx: Pyrimethamine + Sulfadiazine

CNS Lymphoma:

  • EBV
  • Assoc. with EBV
  • CT
  • Tx = Steroid + Chem

NOTE: distnguish between toxoplasmosis and lymohoma with Thalium SPECT (neg in toxo and pos in lymphoma)

Cryptococcal meningitis:

  • Px: Mengitis
  • Inx - Cryptocoocal Ag in Blood or CSF
  • Tx - Amphotericin or Fluctosine –> Liver/renal fx

Neurosyphillis:

  • Myopathy, retinitis, meningitis
  • Inx - Syphillis serology
  • Tx - IM Procaine penicillin + PO Probenacid

CMV Retinitis:

  • CD4< 50
  • Px : Blurred or LOV
  • Signs: Soft Exudate + Retinal haemorrhage
  • Tx: Ganciclovir.
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11
Q

HIV/ AIDS Tx

A

HAART = 2x NNRTI + (NRTI or PI)

IL-2 can be used to icrease CD4 # if good supression of HIV but poor CD4 count

If Fx respond to Tx –> Salvage therapy = Add Enfuvirtide

Monitoring:

  • Clinical assess
  • CD4
  • Viral Load
  • Renal/Hepatic fn
  • Cholesterol/BGL
  • Lactate

If Viral Load high on 2x ocassions –> Test for Viral Resistance

These patients req >90% Adherence

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12
Q

PEP and PrEP

A

4 weeks of Truvada / Kahetra

Take within 72 hours –> decrease transmission by 70-80%

PrEP - if high risk but not infected - req LT adherance (As long as exposure)

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13
Q

Live vaccines

A

Give 4 weeks apart

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14
Q

Human bite organisms and management

A

Staph A
Strep
Eikonella corrodons

CO-AMOXICLAV

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15
Q

Hep B vaccination response

A

Measure anti-HBs

> 100 —> no further bad

10-100 —> one additional vax dose

<10 —-> test for current or post infection and and repeat course of 3 vaccines

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16
Q

Urine dip tests

A

+ nitrates and + luecocytes
Then gram negative - E. coli

If symptomatic and only leukocytes consider a Gram + infection

G+ can’t concert nitrates to nitrites and therefore will be negative on urine dip

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17
Q

Bacterial vaginosis

A

Fishy discharge

Amsel criteria:

  • thin white homogenous discharge
  • clue cells on microscopy
  • vaginal pH >4.5
  • positive whiff test

Management
PO metronidazole

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18
Q

Renal transplant and infection

A

Think CMV

If imunnosupressed and approx 4/12 after commencement of immunosuppressant then think CMV

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19
Q

Genital warts

A

HPV 6 + 11 —> predispose to cervical Ca

Single + keratinised- cryotherapy

Multiple and non-keratinised - topical podophyllum

2nd line - topical imiquimod

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20
Q

Rubella in preg

A

Adult - headache/fever/URTI

1st trimester:

  • congenital rubella syndrome
  • deafness
  • cataract
  • pda
  • developmental delay
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21
Q

Toxoplasmosis

A

Parasite from cat faeces

Features:

  • primary —> infectious mononucleosis like sx
  • reactivation —> CNS multiple ring enhanced lesions

Pregnancy:

  • Early - frontal retinochoroiditis, encephalo-myelitis, hydrocephalus or microceph
  • late: develop above but as an infant - NORMAL BIRTH

Inx = serology
IgG - previous
IgM - acute

Mx:

Non specific tx

If reactivation —> Pyrimethamine, sulfadiazine + Folinic acid

Pregnancy - Spiramycin

Toxoplasmosis vs CNS Lymphoma

  • both increased Immuno deficiency:

Toxo - multiple lesions. Lymphoma- single

Thallium spect: toxo neg. lymphoma +

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22
Q

CMV

A

Ft:

Intraceebral calc
Helatosplenomegaky
Retinitis - in HIV - CD4 <50 —> IV ganciclovir

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23
Q

Varicella

A

Primary infection. - chickenpox —> latent in. Sensory ganglia

Reactivation —> dermatomal shingles

Pregnancy:
- if contact and unsure if immune:
VZIG
- untreated —> congenital varicella syndrome = limb hypoplasia + scarring of dermatomes

If adult gets exposed and unsure if exposed —> test IgG —> negative —> VZIg

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24
Q

Parvovirus in preg

A

Foetal anaemi

Hydrous fetalis - accumulation in fluid in >=2 feral compartments has

Foetal death

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25
Gram +ve mnemonic |Str|ange |Staph|y's |act| |list| |enter|ed |my| |new| |Cl| |C|arrier |ba|g
``` Strep Staph Actinomyosis Listeria Enterrococcus Mycobacteria Pneumococcus Clostridia Corynbacterium - diptheria Bacillus ```
26
G+ve Bacilli CLara DATTA
``` Clostridia Listeria Diptheria Anthrax TB Tetanus Actinomyces ```
27
Strep Pnemo + Viridans
Alpha Knight tournament
28
Strep Pyogenes
Pyogenie bakery
29
Strep Agalactiae
Galactic Baby
30
Staph A
Golden Staph of Aureus
31
HSV
HSV-1 --> life long carriers HSV-2 --> used to be known for genitals but now crossover Can get mengitis or temporal lobe encephalitis. Diagnosis of enceph: Viral PCR on CSF + MRI Mx: IV Aciclovire
32
VZV
primary infection --> Chickenpox --> latent in sensory ganglia Reactivation --> Shingles Complications --> Pneumonitis or cerebral ataxia --> IV antiviral If pregnant exposure and NOT immine --> VZIG
33
CMV
Primary --> ASx or Gladnular fever-like or GBS or BElls >80% of >60 yr olds have it, but becomes an issue if immunosupressed. AIDS + CMV --> CMV retinitis, oesophagitis or colitis Tx - ganciclovir
34
EBV
``` Ingectious mononucleosis Burkitts Lymphoma Lymphoma in HIV Nasopharygeal Ca Oral Hairy Leukoplakia ```
35
HHV8
KArposis sarcoma Primary effusion lymphoma Castlemans disease - lymphoproliferative disorder with enlarged LN
36
ABx Mechanism of action - non-protein synth inhibitors. NITtu MET |SUL|tan in CEPtember with a |FLU|id PEN and a CAR
DNA synth inhib: Nitrofurans Metronidazole Tetrahydrofolate inhib: Sulphonamides - Trimethoprim Peptidoglycan inhib: - Cephlasporin Penicillin Carbapenems DNA Gyrus inhib: Fluroquinolones
37
ABx Mechanism of Action - Protein synth inhibs Ma LIfe A-T C-E-Ll
Macrolides - 50s Linezolid - 50s Aminoglyclosides - 30s Tetracycline - 30s Clindamycin - 50s Erythromycin - 50s Linezolid - 50s
38
Bacteriocidal (BANG Q RIP) vs Bacteriostatic (MS COLT)
Bacteriocidal: Beta lactams - Penicillin/Carbepenems/Cephlasporin Aminoglycloside (neomycin/gentamycin/streptomycin) Nitroimidazole (MEtro) Glycopeptides (Vanc) Quinolones (-floxacin) Rifampixin Polymixin BActeriostatic: Macrolides (erythromycin/arithro/clarithro) Sulfanamides (trimethoprim) Chloramphenicol Oxazolidones Lincosamide (clindamycin) Tetracycline
39
Pregnancy and congenital infections
``` Rubella Toxoplasmosis CMV VZV Parvovirus ```
40
IVDU infections
I.E. - see IE card in cardio BBV Soft tissue —> abscess or gangrene or next fasc Clostridia infections Botulinism: - typically transmitted in food with toxin -IVDU —> wound infection --> prevent ACTH release -Px: acute descending symmetrical FLACCID paralysis - can affect CNS —> eventually leads to resp Fx -Inx: toxin detection - Mx: Pencillin/clindamycin + metronidazole & supportive. Tetanus: - travels via motor neurone —> CNS. —> block NT release - Px = trismus, opisthotonos, dysphasia ( RIGID paralysis) Inx - clinical + PCR Mx - anti-tetanus Ig + metronidazole
41
Splenectomy
High risk of encapsulated organisms: - s.pneumonia - H.influenza - N.mengitidies - campylobacter canimorous - malaria - babesiosis ``` Immunisation: HiB N.mengitides Pneumonia Annual influenza ``` Prophylaxis: Abx prophylaxis up to 16yrs Or 2yrs post splenectomy
42
Sickle cell disease
Functional hyposplenism In particular: Pneumococcus/meningococcus —> sepsis OM due to salmonella Increase morbidity and mortality from malaria —> haemolytic and infarctive crisis
43
Toxic shock syndrome:
Toxin mediated Staph or strep From indwelling foreign body - tampon or Surgical Ft: - macular rash —> disseminated - shock Inx: clinical suspicion and r/o other causes Mx: - Abx - specific and clindamycin or linezolid - consider MrSA - if nec fasc —> surgical debridement
44
Live attenuated vax |y|ou |m|usnt |p|rescribe BCG |I|ncase |T|hey |r|IP |S|tat Don’t prescribe in HIV
Yellow fever MMR POLIO BCG INFLUENZA TYPHOID ROTAVIRUS SHINGLES
45
Infectious mononucleosis
Glandular fever - EBV Ft: - sore throat - exudative tonsillitis - malaise - splenomegaly - widespread maculopalukar rash Inx: - monospot test (Paul burnnell test) - high lymphocytes = atypical on blood film - raised transaminasss Mx: Supportive Avoid ampicillin —> maculopap rash If airway comp —> steroids Complications: ``` Splenic rupture Haemolytic anaemi Thrombocytopenia GBS Meningitis ```
46
Diphtheria
Spore forming G+ bacteria Transmission = resp droplets Px - patient from endemic area or missed vaccines - temp / ant cervical LN / soft tissue oedema —> bulls neck - membranous pharyngitis —> airway obstruct Inx - throat culture swab Mx: - diphtheria anti-toxin + penicillin or erythromycin - immunisations - notify public health
47
Lenierres disease
Caused by fuspbacter Tonsillitis Septic emboli —> IJV thrombosis and abscess
48
Atypical pneumonia causes
Do not conform to lobar pattern ``` Mycoplasma pneumonia Legionella Chlamydia pneumonia Chlamydia psitaccia Coxellia burnetti ```
49
Meningitis
CSF bacteria - cloudy - neutrophils - high protein. Low glucose Viral - clear - lymphocytes - glucose normal - high protein ``` tb - cloudy - lymphocytes Glucose low - protein very high ``` ``` Cryptococcal - clx - leukocytes Glucose N Protein N - ZN stains/India ink ``` Bacteria - gram stain Virus - viral pcr tB - ZN again Crypto - ZN stain ``` Mx - benzylpenicilin in communit - cefuroxime or cefotaxime Ampicillin if >55 Ampicillin and gent if listeria ``` Contacts: If meningococcus —> ciprofloxacjn
50
Encephalitis
Most common UK cause HSV1 > HSV2 Inx - CSF PCR + MRI TX - Aciclovir
51
Brain abscess
Q stem - think of Route of entry OM/dental surgery/ sinusitis/CNS infection Mx: cephalosporin + metro
52
GI Infection - Staph A
Rapid onset. - 4-6 hours
53
GI infection - E Coli
Most common travellers diarrhoea 12-72 hours Can cause HUS
54
Amoebiasis
Transmission faeces - oral Q stem. - area of poor sanitation Amoeba multiply in gut —> Bloody diarrhoea - invasive colitis dysentery Amoebic liver abscess —> anchovy paste ours Inx: stool microscopy —> trophozites Mx: metronidazole + diloxanide furoate
55
Giardiasis
Travellers diarrhoea Chronic watery diarrhoea Inx Stool microscopy —> cysts SB biopsy —> trophozites Mx: Metronidazole or tinidazole
56
Tropical sprue
Get post infection malabsorption - 2/12 E. coli / klebsiella / enterobacter
57
Cryptosporidium GI infection
Water Bourne protozoan infection Watery diarrhoea ZN STAIN —> red cysts Mx: - tx HIV —> increase WCC
58
C Diff
Risk factors: - increased age - Clindamycin > cephalosporin > cipro > coamox - acid suppression e.g ppi Markers of severity: WCc >15 Raised Cr > 50% baseline Temp >38.5 Evidence of sever colitis Mild: - <3 stools/day - WCc N Mod - 3-5 stools - WCc <15 Sev: - >5 stools - WCc > 15 - creatinine / temp as above - High lactate —> very poor prognosis Inx: stool culture = 2 stage —> PCR/EIA For GDH —-> + —-> EIA for toxin —-> + then treat Mx; Mild = PO METRO Mod = PO VANC Sec = PO VANC AND IV METRO
59
Hytadid disease
Dog tapeworm - echincoccus Larvae enter blood Mature in liver and for cysts Can disseminate —> lungs and brain Liver cyst rupture —> life threatening anaphylaxis Inx: Liver US + serology Mx: Surgical removal of cyst Bendazole or praziquantel
60
Leptospirosis
Urine of infected animals —> broken skin Q stem: - occupational exposure - sewage worker or agriculture - social exposure - fishing or water sports Px: Headache temperature neck stiff - initial Then get a vasculitic rash Can get weils disease: jaundice + renal impairment + proteinuria Inx: Culture - blood CSF urine Serology PCr Mx: Tetracycline + penicillin
61
TB
RF: - HIV - Contact - Origin - Institution Drug resistant TB - incomplete/wrong tx : - E.Europe, Russia + central Addia - MDR-TB = resitant to R + I - XDR-TB - resistant to R + I + Fluroquinolone Inx: Mantoux test = point of care = est for latent TB: - False neg: Lymphoma, miliary TB, Sarcoid, HIV, CKG 4, v. young IFN-gamma: - if + Mantoux --> distinguish between IMMS or exposure Best = ZN stain for AAFB Mx - RIPE Rifamp --> Red-orange body secretion Isoniazid - INH --> Iron increase, neuropathy, hepatitis Pyrazinamide --> hyperuricacidaemia --> Gout Ethambutol --> Eyes --> optic neuritis + colour vision loss Give 3/12 of R + I (+/- P) or 6/12 of I (+/-P) if CNS + cardiac infecton --> 10/12 of RI and extra two of PE --> 12/12 AND STEROIDS Tx neuropathy with Vit B6 = PYROXIDINE BCG Vax if: - neonate with first degree relatives from high risk - Neonate with FHx of TB - Neonate recent arrval from high risk - Unvaccinated and mantoux neg with occupational risk - Remember live attenuated --> therefore CI HIV
62
Non-TB mycobacter
all mycobacter except: M. TB M. Bovis M. Africanum Risk if : - Established chronic lung disease - bronchitis or emphysema - Cavitation from Prev TB - Immunocomp Inx: if pulm dx --> 2 specimens 7 days apart Mx: as for TB but longer Mycobacter Avium complex - common - includes m.avium and m.intracellulare. Causes dx in 2 was: 1) dx resembles TB in elderly smoker w/CLD 2) Nodular infilitrates + bronchiectasis w/o CLD ( looks like CLD but no CLD) - Lady Windemere syndrome Tx: - TB tx - Prophylaxis in HIV if CD4< 50 - AZITHROMYCIN
63
Malaria - Causativ agents
Plasmodium Falciparum - mst severe --> death P. Ovale P. Vivax P. Malariae Transmission: - Blood transfusion - Mosquitos
64
Malaria Px + Inx
Px: - Constitutional symptoms - Headache - PRE HEPATIC JAUNDICE --> due to haemolysis Complications: - Cerebral malaria - focal neuro - not meingitis - Pulm oedema/ARDS - Sev haemoytic anaemia - hypoglycaemia - Sepsis - Splenomegaly Inx: - THICK FILM --> trophozites - Shiztones can be seen on this film and i present SEVERE - Ag test can distinguisg between types Markers of severity: - Parasitaemia >2% - Shiztones present - Multiorgan involvement
65
Malaria Mx
P.Falciparum: Severe dx --> IV Artesunate Not Severe --> PO Quinine Non-falciparum: 1) Azythromycine or Lumefantrine 2) Primaquine (Check G6PD deficiency first)
66
Typhoid ( Salmon dinner on sketchy micro) - SEAGULL
traveller returning from indian subcontinent Seagull - harbors in GBladder Transmission is faeco-oral --> there increase risk if DECREASED STOMACH H+ Ft: - Rose spots - Hepatosplenomegaly - Fever - Abdo pain - Diarrhoea ( Pea soup) - Change in mental state - OM in sickle cell dx. Inx: - Culture --> G- BACILLUS Tx: - Ciprofloxacin - if recent travel to |A|sia then give |A|zithromycin There is a live attenuated Vax
67
Ameobiasis
Faeco-oral --> therefore RF is poor sanitation Amoeba multiply in gut: - Bloody diarrhoea - Dysentry - Liver abscess --> Assoc. pain ---> Anchovy paste --> if discharges into abdo cavity --> peritonitis Inx: - Stool microscopy ---> Amoebic trophazites Mx: - Metronidazole + Diloxanide Fuorate
68
Plase positive in VDRL/RPR SomeTimes Mistakes Happen
SLE TB MAlaria HIV
69
Non falciparum malaria treatment
If pt from a chloroquine resistant area —> artemisinin based tx If not —> chloroquine Use orimaquine to get rid of liver hypnoZites
70
Disseminated gonnococal infection
Migratory arthritis + tensosynovitis + Dermatitis
71
Anthrax - Eschar tx
Tx = Ciprofloxacin
72
Cat scratch disease causative agent
Bartonella.
73
Tx of Pubic lice
permithrin cream full body wash --> rpt at 1/52 --> rretest 1/52 after.
74
HSV in preg
Primary attack >28 weeks --> C-sec if not: - Aciclovir from 36 weeks
75
PElvic inflammatory dx
Causes: - most commonly chlamidyia - N. gonnorhea - contact pr + swab - mcyoplasma genitaiium 0 mycoplasma hominus Px: - Lower abdo pain - fever - deep dyspareunia - dysuria/menstrual irref - discharge - cervical excitation - Prehepatits = Fitz-hugh curtis syndrome inx: - test for chlamiyia/gonnorhea Mx: PO olfoloxacin + PO metro Im Cef + PO doxy + PO metro if IUD --> consider removal complcition - infertility - chronic pain - ectopics
76
Malaria chemoprophylaxis
Chloroquine - common south east asia - Chlroquine resistance: - Atovaquone - proguanil - mefloquine - Doxy ``` Pregnant women: - Avoid if possible if not: - Chloroquiene - proguanil + Folate MAlorone ``` DOXY CI and MEFLOQUINE + Cautio
77
Japanese encephalitis
Flavivirus Transmitted by mosquitos found in rice paddy fields Can px with low GCS and PARKINSONIAN FEATURES Diagnosis - PCR or serology Mx - supportive
78
Measles presentation
diffuse rahs Koplik spots on cheek mucosa
79
Yellow fever
Presents similair to. Dengue haemorrhagic fever
80
PCP
Investigatuon is beta D-glucagan - prwsent in fungal cell wall
81
Which malria infections can be dormant?
P. Ovale and P. Vivax
82
What to do if r\aised ALT following TB treatmentr
if ALT >5x ULN --> STOP ALL
83
HEaf Test - TB
grade 0: no response - nothing Grade 1: 1 - 4 dots - unequivocal Grade 2: coalesce to form ring with normal skin in middle - Prev BCG Grade 3: Coalesce with abnormal skin - active disease Grade 4 Solid lesion >10mm +/- ulceration/vesicles = active dx
84
HIV Drugs rule of thumb with names
-navir- N"avir" trust a protease inhibitor NRTI -ine- NNRTI - others
85
Hantar Virus
HEamorrhagic dx with renal fx endemic ins outh asia/korea
86
Loa Loa treatment
DEC Diethylcarbamazine
87
Visceral vs cutaneous Leishmaniasis
both caused by sand fly. Visceral lleishmaniasis almost always assoc. by hepto/splenomegaly
88
Leishmaniasis
Caused by SAND fly 3 types: Cutaneous: - Leishamni tropica or mexicana - PApule at site of bite --> Ulcer Mucocutaneos: - Brazilienis - Similair to above + mucosa Visceral (Kala=azar): - Donovani - med/asia/south america/africa - HEPATOSPLENOMEGALY - systmically unwell. - GREY SKIN - (Black sickness)
89
Leptospirosis management
Doxy or. Benpen
90
Whipples dx Management
IV Ceftriaxon

MRCP (20 decks)

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