Zoonoses

Question 1

What virus causes rabies?

Answer 1

Rhabdovirus

Question 2

How is rabies transmitted?

Answer 2

Saliva or CNS tissue - bite of an infected animal

Question 3

What is the incubation period of rabies?

Answer 3

2 weeks to several months

Question 4

What are features of rabies?

Answer 4

• Malaise, headache & fever, Progressing to mania, lethargy & coma
• Over production of saliva & tears
• Unable to swallow & ‘hydrophobia’
• Death by respiratory failure

Question 5

What are the prodromal features of rabies?

Answer 5

• Headache
• Malaise
• Odd behaviour
• Agiation
• Fever
• Itch around the bite

Question 6

What is the mortality rate of untreated rabies?

Answer 6

100%

Question 7

What syndromes can prodromal rabies progress to?

Answer 7

• ‘Furious rabies’ - hyperactivity and terror, hydrophobia, aerophobia
• ‘Paralytic rabies’ - flaccid paralysis in the bitten limb -> coma -> death

Question 8

What neurological condition occurs due to rabies infection?

Answer 8

Encephalitis

Question 9

How would you investigate someone with rabies?

Answer 9

• Clinical picture + exposure
• Viral PCR/CSF antibodies - late confirmation

Question 10

How would you manage someone with rabies

Answer 10

Immediate post bite-prophylaxis

• Soak/wash hand >15 mins
• Human rabies immunoglobulin + Vaccinations

Question 11

What organisms causes brucellosis?

Answer 11

• B. Melitensis
• B. Suis
• B. Abortus

Question 12

Which brucella species has the most virulence in man?

Answer 12

B. melitensis

Question 13

What is the incubation period for brucellosis?

Answer 13

5-30 days

Question 14

What are symptoms of brucellosis?

Answer 14

• Fever
• Anorexia
• Sweats
• Weight loss
• Malaise
• Localised infection - spetic arthritis, spondylitis, meningitis, endocarditis, orchitis

Question 15

What are features of acute brucellosis?

Answer 15

• High ‘undulant’ fever
• Weakness, headaches
• Drenching sweats
• Splenomegaly

Question 16

What are feautres of chronic brucellosis?

Answer 16

• Flu-like symptoms/Malaise
• Depression
• Chronic arthritis
• Endocarditis
• Epididymo-orchitis
• Rarely meningism
• Splenomegaly

Question 17

How would you investigate brucellosis?

Answer 17

• Bloods - FBC, LFTs, Blood culture
• CSF culture
• Synovial fluid culture

Question 18

How wouldyou treat brucellosis?

Answer 18

• Long acting Doxycycline for 2-3 months + Rifampicin, or + intramuscular gentamycin for first week(s)
• Consider Co-trimoxazole in CNS disease

Question 19

What is the causative organism of leptospirosis?

Answer 19

L. icterohaemorrhagica

Question 20

How is leptospirosis spread?

Answer 20

Contact with rat urine

Question 21

What is the incubation period of leptospirosis?

Answer 21

2-20 days

Question 22

How does leptospirosis present?

Answer 22

• Abrupt fever
• Myalgia/myositis
• Cough
• Chest pain +/- haemoptysis
• Can have jaundice, meningitis, uveitis, and renal failure

Question 23

What is weil’s disease?

Answer 23

Leptospirosis illness - Triad of

• AKI
• Jaundice
• Bleeding

Question 24

When should you think of leptospirosis as a cause of infeciton?

Answer 24

The farmer with protracted flu-symptoms is more likely to have leptospirosis than brucellosis

• Fever in a cattle farmer
• Exposure to water or rats

Question 25

How would you investigate for leptospirosis?

Answer 25

* **Bedside** - ECG, urinalysis * **Bloods** **-** FBC, U+E's, LFTs * **Specific -** ELISA serology, PCR, Culture

Question 26

How would you treat leptospirosis?

Answer 26

* **Abx** * **Mild** - doxycycline * **Severe** - penicillin

Question 27

What is the causative organism for lyme disease?

Answer 27

Borrelia burgdorferi

Question 28

How is lyme disease spread?

Answer 28

Ixodes tick species

Question 29

What is usually the first sign of lyme disease?

Answer 29

Erythema migrans

Question 30

What is characteristic of the rash seen in lyme disease?

Answer 30

Circular - starts at the sight of bite

Question 31

What is the following?

Answer 31

Erythema migrans - target rash

Question 32

What are features of early lyme disease?

Answer 32

* **Erythema migrans** * **Pain/pruritis** * **Lymphadenopathy** * **Fever** * **Malaise** * **Headache**

Question 33

What are features of early disseminated lyme disease (occuring weeks - months after bite)?

Answer 33

* **Lymphocytoma** - Bluish-red plaque/nodule * **Neuroborelliosis** * **Carditis**

Question 34

Where should you check for lymphocytoma in lyme disease?

Answer 34

* **Earlobes** * **Nipples** * **Genitals**

Question 35

What are the following?

Answer 35

Lymphocytomas - lyme disease

Question 36

What are features of neuroborelliosis?

Answer 36

* Lymphocytic mengitis * Ataxia * Amnesia * Facial/cranial nerve palsies * Neuropathy * Encephalomyelitis

Question 37

What is the classic triad of features of neuroborelliosis?

Answer 37

* **Facial nerve palsy** * **Radicular pain** * **Lymphocyic meningitis**

Question 38

What carditic disorders can occur in lyme's disease?

Answer 38

* **2nd/3rd degree HB** * **Myocarditis**

Question 39

What are features of late disseminated lyme disease?

Answer 39

* Acrodermatitis chronica atrophicans (ACA) * Lyme arthrtis

Question 40

What is acrodermatitis chronica atrophicans?

Answer 40

Red to bluish discolouration on the extensor surfaces of extremities, which ultimately becomes atrophic. Peripheral neuropathy is also common with this complication

Question 41

In what population does ACA (as a complication of lyme disease) occur in?

Answer 41

Europeans - due to B. afzelii

Question 42

How would you investigate someone with suspected lyme disease?

Answer 42

* **Clinical diagnosis** - erythema migrans * **Bedside** - ECG * **Bloods** - Serology, ELISA * **Other** - LP and CSF culture

Question 43

How would you treat suspected lyme disease?

Answer 43

* **EM** - doxycycline/amoxicillin/phenoxymethylpenicillin * **Neuroborelliosis** - IV ceftriaxone/IV Benpen/IV doxycycline