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Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt > Tetanus, Brucellosis, Melioidosis, Bartonella, Anthrax > Flashcards

Tetanus, Brucellosis, Melioidosis, Bartonella, Anthrax Flashcards

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1
Q

What is tetanus?

A

Clostridium tetani - gram positive anaerobe

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2
Q

2 toxins released by tetanus

A

Tetansopasmin - enters nerves and CNS (inhibits GABA) -> spasms

Tetanolysin

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3
Q

What is cause of death in tetanus?

A

Autonomic or respiratory involvement

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4
Q

Who gets neonatal tetanus

A

Babies of non-immune mothers

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5
Q

Tetanus Ix? dx? In ICU they should all get?

A

Clinical diagnosis
Tetanus Ig
Wound debridement
Metronidazole
benzos

May need rx of autonomic sx eg Labetalol for HTN / Atropine for bradys
May need paralysis
-Should all get magnesium

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6
Q

Tetanus control

A

Vaccines

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7
Q

Brucellae are? How do you get infected? Key at risk group?

A

gram negative coccobacilli
-Brucella melitensis

Consuming milk / unpasteurised cheese from affected animals

-Farmers/vets at high risk as aerosol infection from the placenta is very infectious

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8
Q

Brucellosis sx?

A

Has relapsing and remitting fever over several months
Often cough and low mood / anorexis

Key feature is focal MSK typically vertebrae, hip or knee

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9
Q

Brucellosis bloods

A

lymphopenia and thrombocytopenia
Often mild rises LFTs

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10
Q

Brucellosis rx without bone / localising disease? with bone/localising?
if kids?

A

Doxy + gent
Doxy+gent+rifampin - if bone/localising

Young kids / pregnant - co-trimox + rifampin

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11
Q

Neurobrucellosis rx

A

Doxy+rifampin+ceftriaxone

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12
Q

Brucellosis control

A

Pasteurize milk / cheese
Can vaccinate animal herds
Slaughter herds which have any positive tests (need to financially compensate)

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13
Q

What causes melioidosis? Found where? Pathogenesis

A

Gram negative bacilli - Burkholderia pseudomallei
Rice paddys in south east asia

Innoculation of contaminated soil/water

cause multiple abscesses or remain latent for years

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14
Q

melioidosis dx? rx?

A

Culture/gram stain blood/pus
Now has lateral flow assay / other RDTs

Requires expensive Abx
-ceftazidime or a carbapenem
-followed by prolonged co-trimox [doxy/co-amox options]

-Mortality remains 20% despite this rx

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15
Q

Malodorous sweat =

A

brucellosis

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16
Q

brucellosis ix?

A

Rose-bengal agglutination test

PCR / serology - best but less good in relapse

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17
Q

Brucellosis most common bug?

A

Brucella melitensis - Goats/sheep reservoir
[Brucella abortus second most]

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18
Q

What global region has highest rates of brucella

A

Mongolia > Middle east

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19
Q

Leading cause of laboratory transmitted infection worldwide

A

Brucella (especially Brucella melitensis)

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20
Q

Presents with:
Night sweats, weight loss
Constipation
Back pain
Key Dx? Other key Sx?

A

Brucella

[Extensive sweating
Back pain]

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21
Q

Brucella vertebrae features Vs TB
Age? sex? where? multiple vertebrae? abscess? type of lesion?

A
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22
Q

Brucella in kids presents different in what way?

A

<15 - often presents with peripheral arthritis
Spondylitis very rare

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23
Q

Which deficiency does Brucella cause worse Sx? who does this affect?

A

Iron deficiency - More common in women

Severe thrombocytopenia
Arthritis
Clinical severity

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24
Q

Blood finding in severe brucella =

A

Thrombocytopenia

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25
Brucellosis bug
Brucella melitensis
26
When do you get outbreaks of melioidosis? Method of inoculation
Rainy seasons -lives in water and soil Usually percutaneous -Can be respiratory / GI
27
Risk factors for severe burkholderia pseudomallei?
Most people who get melioidosis are ASx diabetes excessive alcohol use chronic renal/lung disease [All associated with neutrophil dysfunction]
28
Most common manifestation of melioidosis?
Pneumonia most 50% Skin [ulcers/abscesses] 13% GU 12% No focus 11% [visceral Abscess/bone/joint]
29
Chonic melioid resembles?
TB - often upper lobe cavitary lesion Fever Wt loss Cough (hemoptysis)
30
Most common location for visceral melioidosis abscess
Prostate
31
Scratched by cat - has this lesion then develops painful lymphadenopathy =
Bartonella Henselae - cat scratch disease
32
Cause of this neuroretinitis
Bartonella Henselae - Macular star Some patients develop a star shaped macular exudate (“macular star").
33
Vector for carrions disease? cause?
Lutzomya. verrucarum Bartonella bacilliformis
34
What is this lesion on the back of a calf? Geography
Mular lesions (carrions disease - Bartonella bacilliformis ) Peru, equador, columbia
35
Bartonella type of bacteria? stain?
Gram negative bacilli - giemsa stain Grows at 27 degrees
36
Anaemia, Hepatomegaly, fever, Cardiac murmur, Jaundice, Visit jungle in peru
Bartonella Baciliformis (carions disease)
37
Why anaemia in Bartonella Baciliformis infection?
Infect RBCs
38
Bartonella endocarditis Rx
Doxy + gent
39
Oroya fever Rx
Bartonella Bacilliformis Cipro + ceftriaxone if severe Co-amox if <14
40
Chronic Bartonella bacilliforms causes multiple eruptions rx?
Azithromycin
41
Anthrax bug
Bacillus anthracis - Encapsulated gram-positive rods
42
Different forms of anthrax, associated mortality?
Skin - 1% mortality GI - 50% mortality Pulmonary - inhalation = dead Meningitis -> dead IV - in IVDU forms a black eschlar
43
=? history?
Papule which ulcerates -> dark eschar -> oedema -> tender proximal lymphadenopathy PAINLESS at the site of lesion - look at oedema surrounding
44
Compare anthrax and spider bite
Anthrax - painless lesion + oedema with painful lymph node Loxosceles - Painful lesion without oedema
45
Uncooked meat -> oral pharyngeal ulcerations + significant cervical lymphadenopathy Gastroenteritis + bloody diarrhoea
GI anthrax
46
pt develops rapid appearance of pulm sepsis Hemorrhagic mediastinitis (pleuritis or myocarditis) No pneumonia (increased Mediastinal ganglia). Then develops stridor.
Pulm anthrax
47
IVDU with apparent Bacillus cereus bacteraemia .... Gram-positive in chains
Anthrax
48
Anthrax Ix
Gram stain - blood, CSF, skin lesion (eschar), or oropharyngeal ulcer PCR / other serology
49
cutaenous Anthrax Rx
Penicillin Or Cipro
50
Anthrax post-exposure prophylaxis
Cipro for 60 days Anthrax vaccine over 4 weeks (3 doses)
51
3 main species of Bartonella and 1 things they cause each
Bartonella henselae - cat scratch CSD, BA, peliosis hepatis, endocarditis, bacteremia, neuroretinitis Bartonella bacilliformis - Carrion’s disease B Quintana - BA, endocarditis, trench fever, chronic bacteremia
52
Which bartonella seen in HIV commonly
Bacillary angiomatosis (B hensalae/quintana)
53
Bartonella henselae Rx If visceral involvemetn
Doxy + rifampicin/gent if visceral Azithro for CSD
54
GI/inhalation anthrax rx
cipro + linezolid [+antitoxin] [If ANY possibility of meningitis - meropenem too] then 2 months of cipro/doxy as post exposure
55
CNS anthrax Rx
cipro + linezolid + mero [+antitoxin] [Gram positive smash linez/mero] then 2 months of cipro/doxy as post exposure
56
49M poor controlled t2dm ->amputation 1 week ago Breathing difficulty. Not eating. Difficulty swallowing. Spasms = ? name 2 ddx?
Tetanus Strychnine poisoning HypoCa Neuroleptic malignant syndrome rabies Epilepsy
57
What is trismus? Risus sardonicus? Opisthotonus?
Trismus - lock jaw Risus sardonicus - spasmed smile Opisthotonus - extensive spasm -> arched back
58
Diagnosis of tetanus
1. Trismus (inability to open the mouth) or 2. Risus sardonicus (sustained spasm of the facial muscles) or 3. Painful muscular contractions. CLINICAL not via tests
59
Injury to face * Lower cranial nerve muscles * Facial palsy/stiffness * Trismus * Pharyngeal spasms * Laryngeal spasms, dysphagia, neckstiffness * Paresis of IX/X/III
Cephalic tetanus
60
Wound on limb then spasms of muscles around wound * Pain * Weakness * Increased deep tendon reflexes
Localised tetanus
61
Tetanus Rx name 5 parts
Minimise stimuli - light/sound Benzodiazepines IV Magnesium Ventilate Surgical debridement Metronidazole Tetanus Ig (Human vs equine antitoxin are equal) Autonomic sx rx - eg labetalol / clonidine
62
Management of autonomic dysfunction in tetanus
Hypertension - Labetaol (short-acting) Suppression of catecholamine release- clonidine/morphine
62
Management of autonomic dysfunction in tetanus
Hypertension - Labetaol (short-acting) Suppression of catecholamine release- clonidine/morphine
63
Do you need a tetanus vaccine if you've already had tetanus?
YES There is no naturally-acquired immunity to tetanus. Immunity It can only be acquired only by active or passive immunisation. 3 doses -> boosters every 10 years
64
7d baby Born at full term now refusing to feed. Fever, breath holding, clenched hands, facial muscle spasm, arching back. Umbilical cord necrosis. dx? prevention?
Neonatal tetanus Vaccination of mothers clean delivery practice
65
types of tetanus
localised, neonatal, cephalic generalized present in (80%)
66
Define neonatal tetanus elimination
<1 per 1000 live births in every district each year
67
South/SE Asia - Without local evidence of snakebite sleeping on floor Nocturnal onset of chest discomfort, breathlessness, abdominal pain=? Key Sx?
Elapid - c krait (Bungarus) bites “early morning paralysis”
68
2 main snake families
Viperidae - short thick bodies and tails. Long retractable fangs -vipers, adders, pit-vipers, moccasins, rattlesnakes Elapidae - Long thin bodies, short 'fixed' fangs - cobras, kraits, mambas, coral snakes, Oceanian venomous snakes, sea-snakes
69
What is this called in snake bite
Cyto-toxicity: local swelling, bruising, blistering, necrosis
70
Snake bite then this =? Test with?
Haemato-toxicity (vipers, Oceanian elapids, a few colubrids) WBC20 test
71
snake bite then - unable to protrude tongue + ptosis
Neuro toxicity Elapids (and some vipers)
72
How do you check true ptosis
patient is asked to “look up at my finger” Note raised eyebrows and puckered forehead from contraction of frontalis muscle, hooded pupils, and associated divergent gaze and dilated pupils
73
Bitten by snake -> hypovolaemic shock = which snake
Viper
74
Myocardial toxicity = what type of snake
Vipers (including European adder)
75
Generalised myotoxicity (rhabdomyolysis) = which snake?
Elapids - especially sea snakes
76
How often do you get 'dry' bites with snakes
About 50% - doesn't actually inject venom
77
Pre-hospital Rx snakebite - name 3 aspects
Reassure the victim * Immobilise whole body, especially bitten limb * Remove tight rings, bracelets, anklets * Apply pressure-pad-immobilisation * Transport rapidly but safely and passively to medical care (recovery position) pressure pads -> compresses veins / lymphatics
78
Snake bite in hospital -> give antivenom. What are some considerations?
1- administer antivenom intravenously 2- pre-treat with sub-cutaneous adrenaline (epinephrine) 3- monitor patient closely for signs of early antivenom reaction over next 4 h 4- observe response to antivenom (improved signs, restored blood coagulability, or consider repeat dose) 5 - Tetanus booster
79
Name 3 indications for antivenom
Shock Spontaneous systemic bleeding +/- Incoagulable blood (+ve 20WBCT, INR>1.3) Neurotoxicity Black urine (haemoglobin or myoglobin) Rapidly-progressive local swelling (especially bites on digits)
80
Snakebite -> given antivenom and returns a week later like this? rx?
late serum-sickness type reactions Develop 5-15 days post-antivenom – Treat with histamine H1 blockers (e.g. chlorphenamine) or prednisolone
81
Melioid appearance
Gram -ve rod

Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt (26 decks)

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