Other Important Infections

Question 1

What are the risk factors for shingles?

Answer 1

Increasing age, HIV and other immunosuppressive conditions/meds

Question 2

What are the features of shingles

Answer 2

• Prodromal period: Burning pain over affected dermatome for 2/3 days. May get headaches, lethargy
• Rash: Initially erythematous but becomes vesicular. Well demarcated by dermatome

Question 3

What is the management of shingles?

Answer 3

• Patient is still infectious until lesions have crusted over.
• Paracetamol and NSAID are first line analgesia but can use neuropathic agents as second line.
• Prescribe aciclovir within 72 hours

Question 4

What are the complications of shingles?

Answer 4

• Post herpetic neuralgia (most resolve within 6 months)
• Herpes zoster ophthalmicus
• Herpes zoster oticus (Ramsey hunt syndrome)

Question 5

What are the features of Ramsey hunt syndrome?

Answer 5

• Auricular pain,
• Facial nerve balsy,
• Vesciaular rash around ear - shingles,
• Vertigo
• Tinnitis
• Treat with aciclovir and steroids

Question 6

What is the treatment for animal and human bites?

Answer 6

1st line - Co-amoxiclav
Pen allergic - Doxy and metronidazole

Question 7

What is anthrax?

Answer 7

Bacterial infection caused by bacillus anthracis. Presents with painless black eschar, oedema and GI bleeding treat with ciprofloxacin

Question 8

What is cutaneous larva migrans?

Answer 8

Helminth infection causing an intensely itchy, wavy, red rash. Diagnosis is clinical and treatment is with albendazole

Question 9

Describe features of the cytomegalovirus

Answer 9

• Tends to only cause infections in immunocompromised.
• It can cause: CMV mononucleosis, retinitis (common in HIV patients), CMV encephalitis, pneumonitis or colitis

Question 10

What is infective mononucleosis?

Answer 10

Glandular fever. It is caused by the epstein barr virus (human herpes 4) 90% of the time. It can also be caused by CMV or HHV-6

Question 11

What is the presentation of Glandular fever

Answer 11

• Sore throat,
• Lymphadenopathy in both anterior and posterior neck chains (tosillitis is only anterior)
• Pyrexia
• Palatal petechiae,
• Splenomegaly,
• Hepatitis,
• Lymphocytosis
• Haemolytic anaemia

Question 12

What are the investigations for infectious mononucleosis?

Answer 12

• Heterophile antibody test (monospot)
• FBC
• HIV test

Question 13

What is the management of EBV?

Answer 13

• Rest, fluids, analgesia
• Avoid contact sport for 4 weeks minimum to avoid splenic rupture

Question 14

What is Lemierre’s syndrome?

Answer 14

Infectious thrombophlebitis of the internal jugular vein. Often secondary to a bacterial sore throat leading to a peritonsilar abscess.
This can lead to a thombus of the IJV. It can present with history of a sore throat followed by neck pain/stiffness

Question 15

Describe features of leprosy

Answer 15

Granulomatous disease affecting peripheral nerves and skin caused by mycobacterium leprae.
Can present with hypopigmentation lesions and sensory loss
Diagnose with skin biopsy. Treated with antibiotics

Question 16

Describe features of lyme disease

Answer 16

Early features: Erythema migrans, headache, lethargy, fever, arthralgia/
Late features (> 30 days): Heart block, peri/myocarditis, facial nerve palsy, redicular pain and meningitis

Question 17

What are the investigations and treatment for lyme disease?

Answer 17

Investigations - ELISA antibodies to borrelia burgdorferi but diagnose clinically if erythema migrans is present.
Treatment: Doxycycline but ceftriaxone if disseminated disease