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MRCP: Infectious Diseases > Tropical Medicine > Flashcards

Tropical Medicine Flashcards

1
Q

What is the bacteria behind diptheria?

A

Corynebacterium diphtheriae

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2
Q

What is the pathophysiology of diptheria?

A

Produces exo-toxin, produced by a β-prophage
Exotoxin inhibits protein synthesis by catalyzing ADP-ribosylation of elongation factor EF-2

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3
Q

What are the clinical features of diptheria?

A

Diptheria membrane on tonsils caused by necrotic mucosal cells.(Pseudomembrane)
Bulky cervical lymphadenopathy
Neuritis
Heart block

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4
Q

What are viral haemorrhage fevers?

A

Dengue fever
Ebola
Lassa fever
Yellow fever

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5
Q

What are the features of dengue fever?

A

Fever
Headache - retrobulbar headache
Myalgia, bone pain and arthralgia (‘break-bone fever’)
Pleuritic pain
Facial flushing (dengue)
Maculopapular rash
Haemorrhagic manifestations e.g. - positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis

Red flags:
- abdominal pain
- hepatomegaly

persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)

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6
Q

What causes dengue fever?

A

Dengue virus is a RNA virus of the genus Flavivirus
Transmitted by the Aedes aegypti mosquito
incubation period of 7 days

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7
Q

What are severe haematological features of dengue fever?

A

Disseminated intravascular coagulation (DIC) resulting in:
thrombocytopenia
spontaneous bleeding
around 20-30% of these patients go on to develop dengue shock syndrome (DSS)

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8
Q

How should dengue fever be investigated and managed ?

A

serology
nucleic acid amplification tests for viral RNA
NS1 antigen test

Typically:
1. lymphopaenia
2. Thrombocytopenia
3. Raised aminotransferases

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9
Q

What is leprosy?

A

Granulomatous disease primarily affecting the peripheral nerves and skin. It is caused by Mycobacterium leprae.

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10
Q

What are the features of leprosy?

A

Patches of hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs
sensory loss

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11
Q

What are the types of leprosy, and their course?

A

Low degree of cell mediated immunity → lepromatous leprosy (‘multibacillary’)
- Extensive skin involvement
- Symmetrical nerve involvement

High degree of cell mediated immunity → tuberculoid leprosy (‘paucibacillary’)
- Limited skin disease
- Asymmetric nerve involvement → hypesthesia
hair loss

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12
Q

What is the treatment of leprosy?

A

Triple therapy: rifampicin, dapsone and clofazimine for 12 months

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13
Q

What is shistosomiasis What are the two forms of schistosomiasis?

A

Schistosomiasis Haematobium
Schistosomiasis Mansoni
Schistosomiasis japonicum

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14
Q

What are the features of an active schistosomiasis infection?

A

Swimmers’ itch
Acute schistosomiasis syndrome (Katayama fever)
- fever
- urticaria/angioedema
- arthralgia/myalgia
- cough
- diarrhoea
- eosinophilia

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15
Q

What is the life cycle of schistosomiasis haematobium?

A

Deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation. The calcification seen on x-ray is actually calcification of the egg clusters, not the bladder itself.

pseudopapillomas in the bladder, they can cause an obstructive uropathy and kidney damage.

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16
Q

What are schistosomiasis haematobium at risk of long term?

A

Squamous cell carcinoma of the bladder

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17
Q

How is schistosomiasis haematobium treated?

A

Single oral dose of praziquantel

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18
Q

What is the life cycle of schistosomiasis mansion / japoncium?

A

Worms mature in liver - hepatosplenomegally/ splenomegaly due to portal system obstruction
Then inhabit the distal colon

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19
Q

What is the life cycle of schistosomiasis mansion / japoncium?

A

Worms mature in liver - hepatosplenomegally/ splenomegaly due to portal system obstruction
Then inhabit the distal colon

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20
Q

What are schistosomiasis mansion / japoncium at risk of long term?

A

Liver cirrhosis
Variceal disease
Cor Pulmonale

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21
Q

What bacteria causes botulism?

A

Clostridium botulinum

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22
Q

How does botulinum toxin work?

A

It is a neurotoxin: irreversibly blocks the release of acetylcholine

23
Q

How can a patient get botulism?

A

Eating contaminated food

24
Q

What are the features of clostridium botulism?

A

Patient usually fully conscious with no sensory Disturbance
Flaccid paralysis
Diplopia
Ataxia
Bulbar palsy

25
Q

How is botulism treated?

A

Botulism antitoxin

26
Q

What is meloidosis / whitmore’s disease?

A

Infection caused by the gram-negative bacterium Burkholderia pseudomallei

Found in trophic and subtropic regions

Endemic in soil and fresh surface water

Sign: Incubation period: 1-21 days ( mean around 9 days)

27
Q

What is the treatment of meloidosis / whoitmore’s disease?

A

Initial intensive therapy: IV ceftazidime, imipenem, or meropenem for 10–14 days
Followed by eradication therapy: oral TMP/SMX (plus doxycycline) for 3–6 months
Adjunct therapy: abscess drainage.

28
Q

How do you differentiate between zika, chickengunya and dengue?

A

Zika is prevalent in South America.
Chikengunya debilitating joint pain - abrupt onset fevers

29
Q

How is Zika virus spread?

A

Mosquito

30
Q

Complications of Zika virus?

A

Guillain barre
Microcephally

31
Q

What is leishmaniasis? How is it spread?

A

An intracellular Protozoa. It is spread by bites from sandflies

32
Q

What are the types of leishmaniasis and where are they acquired?

A

Cutaneous leishmaniasis: Leishmania tropica or Leishmania mexicana - South and Central America

Mucocutaneous leishmaniasis
caused by Leishmania braziliensis - India and Africa

Visceral leishmaniasis (kala-azar)
mostly caused by Leishmania donovani
occurs in the Mediterranean, Asia, South America, Africa

33
Q

What are the features of visceral leishmaniasis?

A

Fever, sweats, rigors
Massive splenomegaly. hepatomegaly
Poor appetite (increased appetite and weight loss), weight loss
Grey skin - ‘kala-azar’ means black sickness
Pancytopaenia secondary to hypersplenism
the gold standard for diagnosis is bone marrow or splenic aspirate

34
Q

How is diphtheria treated?

A

Management
intramuscular penicillin
diphtheria antitoxin

35
Q

How is diphtheria grown / investigated?

A

Culture of throat swab: uses tellurite agar or Loeffler’s media

36
Q

What is the commonest and most severe type of malaria?

A

Falciparum malaria

37
Q

What are the features of severe malaria?

A

Schizonts on a blood film
Parasitaemia > 2%
Hypoglycaemia
Acidosis
Temperature > 39 °C
Severe anaemia
complications as below

38
Q

What are the complications of malaria?

A

Cerebral malaria: seizures, coma
Acute renal failure: blackwater fever, secondary to Intravascular haemolysis, mechanism unknown
Acute respiratory distress syndrome (ARDS)
Hypoglycaemia
Disseminated intravascular coagulation (DIC)

39
Q

What is the treatment of severe malaria?

A

Intravenous artesunate

40
Q

When is plasma exchange indicated in malaria?

A

Parasite count > 10%

41
Q

what are the features of yellow fever?

A

flu-like illness → brief remission→ followed by jaundice and haematemesis.

high fever, rigors, nausea & vomiting. Bradycardia may develop

42
Q

features of cholera?

A

profuse ‘rice water’ diarrhoea
dehydration
hypoglycaemia

43
Q

What type of bacteria is vibrio cholera?

A

Gram negative bacteria

44
Q

Treatment of cholera?

A

Management
oral rehydration therapy
antibiotics: doxycycline, ciprofloxacin

45
Q

How is typhoid transmitter?

A

Faecal oral route

46
Q

What are the features of typhoid?

A

initially systemic upset as above
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid

47
Q

What causes typhoid? What causes paratyphoid?

A

Salmonella typhi and Salmonella paratyphi (types A, B & C)

48
Q

What are the complications of typhoid?

A

osteomyelitis (especially in sickle cell disease where Salmonella is one of the most common pathogens)
GI bleed/perforation
meningitis
cholecystitis
chronic carriage (1%, more likely if adult females)

49
Q

What are the features of katamya fever?

A

fever
urticaria/angioedema - red itchy bumpy rash on ankles / feet
arthralgia/myalgia
cough
diarrhoea
eosinophilia

50
Q

What are the features of rabies?

A

prodrome: headache, fever, agitation
hydrophobia: water-provoking muscle spasms
hypersalivation
Negri bodies: cytoplasmic inclusion bodies found in infected neurons

51
Q

What cytoplasmic inclusions do you see in rabies?

A

Negri bodies

52
Q

What type of virus is rabies?

A

RNA rhabdovirus (specifically a lyssavirus) and has a bullet-shaped capsid
Travels up the neurone in a retrograde fashion

53
Q

What is the main feature of tetanus?

A

Opisthontonus - that picture.. you know the one

54
Q

In non-falciparum malaria, what additional treatment is needed to prevent relapses?

A

Primaquine

MRCP: Infectious Diseases (15 decks)

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