Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

DTM&H > Non-Malarial Fevers and other IDs > Flashcards

Non-Malarial Fevers and other IDs Flashcards

1
Q

What is the causative organism of Mellioidosis?

A

Psuedomallei Burkholderia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you manage Mellioidosis?

A

Ceftazidime 14/7 + 3/12 of co-trimoxazole for eradication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you diagnose Melioidosis?

A

Blood Culture
*** Notify the labs because this requires special lab management due to infectiousness

+ Abdo USS –> look for infection elsewhere
+ CXR –> to look for infection elsewhere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the bacteriology of P. Burkholderia?

A

Gram-negative environmental bacterium

Found in soil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the epidemiology of Meliodosis?

A

South East and South Asia
Australia
Associated with rainy season
Associated w/ Rice Farmers

**3rd most common cause of death in Thailand after HIV and TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name five causes of fever that might not grow on blood culture (or be difficult to grow)

A
  • Leptospirosis
  • Rickettsia
  • Brucella
  • Non-malaria blood parasites
  • Mycobacteria, esp MTB
  • Viruses
    *Arbovirus
    *VHF
    *Influenza
    *Fungi
    *Histoplasma
    *Penicillium marneffei
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does the WHO define sepsis?

A

WHO adult sepsis definition
Suspected infection, SBP ≤ 90
mmHg AND 1 of the following:
* HR > 100 bpm
* RR > 24 br pm
* Temp < 36 or >38

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What fluid resus is appropriate in adults with sepsis?

A

30ml/kg for crytalloid over 3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Does the WHO recommend SIRS or qSOFA to quantify Sepsis?

A

SIRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Does the WHO recommend SIRS or qSOFA to quantify Sepsis?

A

SIRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does Anthrax lesion present?

A

The anthrax lesion begins as a painless papule that lasts 1 to 2 days before becoming a vesicle that later ruptures. It then develops the classic necrotic central ulcer and may be surrounded by smaller peripheral vesicles. Therefore a patient may present with a non-specific localized papulovesicular eruption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes Anthrax?

A

Bacillus Anthracis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Explain the bacteriology of Bacillus Anthracis

A

Gram +ve rod
Spore Forming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does anthrax spread to people?

A
  1. Zoonotic Spread
    Many places have zoonotic endeminicity of anthrax
    Asia, Africa, Australia, USA
  2. Bioterrorism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the three forms of Anthrax presentation?

A

Cutaenous (95%)
Gastrointestinal
Inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does cutenous Anthrax present?

A

Vesicular rash –> necrotic eschar

Surround tissue oedema

Malaise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the differential for cutaenous anthrax?

A

bacterial ecthyma
rickettsial diseases - Scrub typhus etc.
rat-bite fevers
necrotic arachnidism (Spider bite) ulceroglandular tularaemia
bubonic plague.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you diagnose anthrax?

A

Combo of: Gram stain, culture, serology is the TRIFECTA.

HOWEVER -ve culture does not rule out anthrax and you should also do a PUNCH BIOPSY of the lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you manage Cutaenous Anthrax?

A

10/7 of quinolone or doxy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How long should you treat inhaled anthrax/exposure after bioterrorism?

A

60 days!!!!!!!!!!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the risk factors for Mellioidosis?

A

Exposure to soil and surface water
in endemic area
Diabetes mellitus
Alcohol excess (Australia)
Thalassaemia major
Immune suppression (corticosteroid use)
Cancer
Renal failure and kidney stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does Mellioidosis present

A

Sepsis

Basically suspect in any sepsis that does NOT INCLUDE ENDOCARDITIS OR MENINGITIS.
Pulmonary system most often affected, urinary rare but could definitely still be in your differential of urosepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the two presentations of Melioidosis?

A

ACUTE:
Most commonly bacteraemia and/or multifocal pneumonia.

Often associated with abscesses of the liver and spleen.

Mortality 10 to 50% (depends on level of supportive care available).

CHRONIC:
Chronic melioidosis (~15% of cases)
Most commonly a solitary cold abscess (anywhere in the body).
Frequently mistaken for TB. Survival is the norm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is Meliodosis diagnosed?

A

**challenging to diagnose

**microbiological diagnosis; clinical diagnosis is NOT sufficient

** classic ‘safety pin’ sign on gram stain (gram -ve)

In all Patients, sample:
- blood
- urine
- throat swab / rectal swab

WARN THE LAB

Culture on Ashdown agar plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What antibiotic resistance pattern is seen in melioidosis?
'Gentamicin resistant but sensitive to co-amoxiclav' **this is important because Burkoholderia Pseudomallei looks very similar to pseudomonas on culture, but pseudomonas is often gent sensative but co-amox resistant SO if you get this report form the lab then suspect you have melioidosis
26
How do you treat melioidosis?
INITIAL: Ceftazidime 150mg/kg QID for at least 10 days + absence of fever for 48h ERADICATION: Cotrimoxazole (weight based) for 12-20 weeks. Risk of relapse w/out eradication is 25% B. pseudomallei is intrinsically resistant to many first line antibiotics!!!! If you don’t think of melioidosis, then you have a 90% chance of getting the empirical antibiotic choice wrong!! In endemic settings, failure to respond to broad spectrum antibiotics such as ceftriaxone is a reason to suspect melioidosis and empirical ceftazidime should be started
27
Your patient with suspected melioidosis gets started on Ceftazidime. On day 3 you do a liver USS and note that patient has developed a new collection in their liver. How should you proceed?
1. Keep the current antibiotic regime 2. Large, accessible collections should be drained, but multiple small abscesses in the liver and spleen need not be drained (and it may be dangerous to do so, if radiological guidance is unavailable). !!!!It is common for collections to grow / enlarge while on appropriate therapy. It is common for patients to develop new lesions while on appropriate therapy
28
What education should all melioidosis patients be given upon successful completion of treatment/discharge home?
Relapse rate of 5% despite carriage elimination
29
Name 5 diseases caused by Spirochetes
30
What is Yaws? What is Bejel? What is Pinta?
A series of spirochete infection causing skin diseases which can resemble syphilis (same family) and have 4 stages of disease if untreated
31
What is the bacteria responsible for Yaws? Bejel? Pinta?
Y: Treponema Pallidum Pertenue B: Treponema Pallidum Endemicum P: Treponema carateum
32
Where does Yaws occur? Bejel? Pinta?
Yaws: Hot humid climates (does not spread well in dry/cold) South America Thailan, Indonesia, India, Papua New Guinea have current outbreaks Bejel: Central and outh Africa, Middle East, Turkey, Burkina Faso Pinta: South and Central America
33
Which age group does Yaws affect? Bejel? Pinta?
Yaws = children <15 Bejel = anyone, F>M, maternal to child transmission via breastfeeding is commonly mentioned Pinta = Young adults
34
Which of these disease (Yaws, Bejel, Pinta) causes skin damage only, with NO other organ dysfunction?
Pinta (painted skin)
35
Which of these disease (Yaws, Bejel, Pinta) causes bone and cartilage damage, but no other organ damange?
Yaws
36
Which of these disease (Yaws, Bejel, Pinta) causes bone, cartilage, eye, cardiac and neuro damage?
Bejel
37
How do you diagnose Yaws/Pinta/Bejel?
Syphilis Serology Dark Field Micrscopy IgM/IgG
38
How do you treat Yaws / Bejel / Pinta?
IM Benzathine Penicillin 2.4U IM STAT
39
What organism causes Leptospirosis?
Leptospira interrogans
40
How does Lepto spread to humans?
Normally found in rodents (and also sheep, cow, dogs etc), and is excreted in their urine. Human become infected when they come into contact with the urine when it enters through broken skin or mucous membranes
41
What are the phases of Leptospirosis?
1. ASYMPTOMATC 2. LEPTOSPIRAEMIC PHASE (septicaemia) - muscle pain (esp. backs of legs) - fever, rigors, weakness 3. LEPTSPIRURIC PHASE (immune mediated) - immune attack aganinst spirochetes: FEVER ±renal/eye/hepatic/CNS invovlement
42
Lepto can present as anicteric or icteric. Describe both of these clinical syndromes
Anicteric: - Aseptic meningitis in 50% of patients, usually for a few days - Cranial nerve palsies / encephalitis (LOC is pretty uncommon) - Mild delirium also seen. - Death is extremely rare in anicteric cases Icteric: * Abdominal pain with diarrhoea or constipation (30%), hepatosplenomegaly, nausea, vomiting, and anorexia. * Uveitis (2-10%) can develop early or late in the disease. Reported as late as 1 year after initial illness. * Subconjunctival haemorrhage most common ocular complication >90% * Renal symptoms, hematuria, proteinuria, oliguria 50% * Pulmonary manifestations occur in 20-70% * Adenopathy, rashes, and muscular pain also are seen
43
What is Weil Syndrome?
A complication of Lepto: Jaundice, renal dysfunction, hepatic necrosis, pulmonary dysfunction, and hemorrhagic diathesis. (<5%)
44
Give 5 differentials for Lepto
Dengue Hantavirus Viral hepatitis Malaria Meningitis EBV and CMV HIV Rickettsial disease Typhoid fever (not exhaustive list)
45
How do you diagnose lepto?
Culture (hard to grow anything) MAT ELISA IgM (Gold standard! Look for a 4 fold increase!) Antibody test RDT in the works but not available yet
46
How do you manage Lepto?
Mild leptospirosis: doxycycline, amoxicillin. Severe leptospirosis: parenteral penicillin/cephlosporins or erythromycin Doxycycline prophylaxis weekly for short term exposures Vaccination if very high risk (ie. regularly work with rats)
47
How can you prevent lepto?
Control of livestock infection with good sanitation, immunization. Preventing animals from urinating in waters where humans have contact. Disinfecting contaminated work areas. Providing worker education. Protective equipment when handling infected animals or tissues Public health measures: Case finding in suspected outbreaks. Implementing control measures: identify infected area and avoid entering water and leisure activities
48
What is Brucellosis?
A gram negative infection causing chronic fever and anorexia
49
Name three bacteria implicated in Brucellosis
Brucella Abortus Brucella suis Brucella Melitensis
50
How is brucella transmitted?
Aerosolised Ingested (goats milk classically)
51
What kind of bacteria is Brucellla
Gram negative cocobacillus
52
Where might you find Brucellosis?
Mediterranean, middle east, north africa
53
How does brucellosis present?
Intermittent fever, often over several months Anorexia Weight loss Faget's sign GI symptoms Arthralgia OTHER: - spinal disease: back pain, painful discs, vertebral involvement (L4) - monoarthrtis - orchitis
54
What are the clinical Syndromes of Brucellosis?
1. Asymptomatic 2. Acute < 1month 3. Subacute/relapsing 1-6 months 4. Chronic > 6 months 5. Hypersensitivity Also consider focal symptoms
55
How is brucellosis diagnosed?
Agglutination test (Re: Prozone effect, whereby in very high cases of antibody the agglutination test might actually be NEGATIVE! beware flase negatives) Culture - Blood, CSF
56
How do you manage Brucellosis?
Uncomplicated: 6 weeks of two Abx: Doxy +streptomycin (gold standard) OR Doxycycline + Rifampicin If chronic or complicated (e.g. bony involvement) treat for 3 months
57
How often should you follow up your Brucella patients?
3 monthly for the first year **relapse is likely to occur in the first 3 months
58
How do you manage brucellosis in children?
<8 y/old: * gentamicin 5 days * cotrimoxazole 3 weeks ≥8 y/old * gentamicin 5 days * doxycycline 3 weeks
59
How can you prevent brucellosis?
Improved husbandry encourage milk pasteurisation Encourage cessation of consumption of raw liver Vaccinate animals Test and Trace + PEP (Doxycycline)
60
What bacteria is respobsible for Anthrax?
Bacillus anthracis
61
What bacteria are considered highly dangerous 'group 3' pathogens, which you must inform the labs of before you send?
Bacillus anthracis Brucella abortus Brucella canis Brucella melitensis Brucella suis Burkholderia pseudomallei Coxiella Burnetti Rickettsia Typhi (mooseri) Salmonella Typhi/paratyphi Shigella dysinteriae Yersinia Pestis
62
Describe the bacteriology of Anthrax
Gram positive rod, usually squared ends 'Safety pin' appearance Spore forming
63
How does anthrax spread
Cutaenous - spores enter into broken skin Gastro - bacteria is consumed from infected food Pulmonary - inhalation of spores; most often secondary to biothreat
64
How does cutaenous anthrax present?
Ulcerating lesion with significant peri-odema and a vesicle ring --> after several days develops into an eschar
65
How does gastro anthrax present?
Rare, maybe underdiagnosed orpharyngeal ulceration and odema intestinal oedma, pain, ascites, peritonitis, shock mortality >80%
66
How does pulmonary anthrax present?
* Haemorrhagic adenopathy/mediastinitis * Pleural effusions * Bacteraemia * Meningitis will accompany as disease progresses
67
How do you manage anthrax?
CUTANEOUS: 60 days of Doxycycline or ciprofloxacin GASTRO/INHALATION: 60 days of doxycycline or ciprofloxacin PLUS rifampicin, chloramphenicol or clindamycin
68
What PEP should you use in anthrax?
Cipro or doxy for 30/7 ± Vaccine (currently used by british and american military)
69
What bacteria causes Plague?
Yersinia pestis
70
How does plague spread (i.e. what is the vector?
Oriental/Tropical Rat Flea Xenopsylla (also guinea pigs in peru and camels in the middle east and chipmunks in USA)
71
What are the three main Biovars of plague?
Orientalis Antiqua medievalis
72
What 3 clinical forms of plague are there?
Bubonic Pneumonia Septicaemic --> disseminated; causes symptoms anywhere including GI and CNS
73
Which form of plague can be spread from person to person?
Pneumonic Plague
74
How can you manage plague?
ANTIBIOTICS AND SUPPORTIVE CARE Cipro, Levo, moxiflox, streptomycin, doxy all useful
75
How does Bubonic plague present?
* Incubation 2-7 days * Malaise * High fever * Pain or tenderness over lymph nodes, enlarge to be called buboes - Groin is the most common site * Bacteraemia initially intermittent then constant. * DIC * Shock/Convulsions **death occurs within 2-4 days
76
What is the pathophysiology of bubonic plague?
Enters into the skin from a flea bite --> taken up by macrophages --> enters into lymph nodes where bubo forms --> if untreated leads to lymphatic necrosis and haemoatongenous spread to other locations --> GIT, CNS etc.
77
What is the CFR of untreated plague? - Pnuemonia - Bubonic
Pneumonic: 100% CFR if unterated Bubonic: 66% if untreated, 13% if treated
78
How does Pulmonary plague spread?
Large droplet spread **The only form of plague that is tranmissible from human to human
79
How does pulmonic plague present?
* Fever, lymphadenopthy, cough, chest pain, haemoptysis * CXR: patchy bronchopneumonia, cavities or confluent consolidation - Sputum purulent and contains bacilli. -100% mortality without treatment. 50% with (CDC)
80
How do you diagnose plague?
1. Bubo aspirate --> microscopy and culture: Small gram negative Cocobacilli 2. Bloods: thrombocytopenia, deranged LFTs and U+Es, neutrophilia 3. Yersinia Pestis F1 antigen
81
How do you treat plague?
Supportive Antibiotics Streptomycin im 30mg/kg 2 doses daily 10days But: limited availability, side effects-renal, hearing. **penicllins really do not work
82
How can you prevent Plague outbreaks?
1. vaccine in high risk groups 2. PEP (co-trimoxazole, as per, in high risk groups) 3. Flea control 4. Rat control
83
What are the case definitions for a Plague Outbreak?
84
What guidelines might help you manage a septic patient in an LMIC?
Follow WHO IMAI or SSC guidelines (guideline for the management of poorly patients with limited resources)

DTM&H (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions