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MRCP: Infectious Diseases > Zoonotic / Parasites / Protozoa > Flashcards

Zoonotic / Parasites / Protozoa Flashcards

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1
Q

What is the bacteria behind Lyme disease?

A

Borrelia Burgdorfei

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2
Q

What are the early features of Lyme disease?

A

Early features (within 30 days)
- Erythema migrans
‘bulls-eye’ rash is typically at the site of the tick bite
headache
lethargy
fever
arthralgia

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3
Q

How does erythema migrains develop in Lyme disease?

A

Typically develops 1-4 weeks after the initial bite
more than 5 cm in diameter and slowly increases in size
present in around 80% of patients.
systemic features

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4
Q

What are later features of Lyme disease?

A

Heart block
Perimyocarditis

Facial nerve palsy
Radicular pain
Meningitis

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5
Q

How is Lyme disease diagnosed?

A

Can be diagnosed clinically if erythema migrans is present

First line investigation: enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi are the first-line test

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6
Q

What should you do if you Lyme ELISA is negative, but still consider possible diagnosis?

A

Repeat ELISA in 4-6 weeks time

If over 12 weeks an immunoblot should one completed

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7
Q

How should Lyme disease be treated?

A
  1. Doxycycline
  2. Amoxicillin (as an alternative - i.e. if pregnant)

Ceftriaxone if disseminated disease

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8
Q

What is a Jarisch-Herxheimer reaction?

A

After initiating therapy: fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)

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9
Q

What are the two forms of trypanosomiasis?

A

African trypanosomiasis (sleeping disease)
American trypanosomiasis ( Chagas disease)

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10
Q

How does trypanosomiasis spread?

A

Tsetse fly

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11
Q

What are that cause of African trypanosomiasis?

A

Trypanosoma gambiense in West Africa
Trypanosoma rhodesiense in East Africa

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12
Q

What are the features of African trypanosomiasis (sleeping disease) ?

A

Trypanosoma chancre - painless subcutaneous nodule at site of infection
intermittent fever
Enlargement of posterior cervical lymph nodes

Later:
central nervous system involvement e.g. somnolence, headaches, mood changes, meningoencephalitis

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13
Q

How do you treat African trypanosomiasis?

A

early disease: IV pentamidine or suramin

later disease or central nervous system involvement: IV melarsoprol

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14
Q

What is the cause of chagas disease?

A

Trypanosoma cruzi.

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15
Q

What is the classification of trypanosomiasis?

A

trypanosomiasis is a protozia

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16
Q

How does Chagas disease present?

A

95% asymptomatic in acute early phase
Chagoma - erythematous nodule at site of infection
periorbital oedema
Myocarditis –> dilated cardiomyopathy (chronic)
GI: Megaoesphagus, megacolon
causing dysphagia and constipation

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17
Q

What is the treatment of Chagas disease?

A

Acute:
azole or nitroderivatives such as benznidazole or nifurtimox

chronic disease management involves treating the complications

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18
Q

How should Malaria be investigated?

A

Thick blood film - most sensitive for diagnosis
Thin blood film - diagnosis of species

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19
Q

What other features do you seen on a blood count of malaria?

A

Thrombocythaemia is characteristic
Normochromic normocytic anaemia
Normal white cell count
Reticulocytosis

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20
Q

What type of organism is toxoplasmoisis Gondi?

A

intracellular protozoan

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21
Q

How do you manage toxoplasmosis in immunocompetent patients?

A

Does not require treatment unless severe infection / immunocompromised

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22
Q

What is the treatment of toxoplasmosis? And when do you treat?

A

pyrimethamine plus sulphadiazine for at least 6 weeks

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23
Q

Congenital toxoplasmosis. How is it acquire? Presentation?

A

Congenital toxoplasmosis is due to transplacental spread from the mother. It causes a variety of effects to the unborn child including

Neurological damage:
- cerebral calcification
- hydrocephalus
- chorioretinitis

Ophthalmic damage
- retinopathy
- cataracts

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24
Q

What are the features of severe malaria falciparum ?

A

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

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25
What are the complications of malaria?
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)
26
What is the treatment of malaria falciparum?
First line therapy: Artemisinin + combination Artemether plus lumefantrine Artesunate plus amodiaquine Artesunate plus mefloquine Artesunate plus sulfadoxine-pyrimethamine Dihydroartemisinin plus piperaquine
27
What is the treatment of severe malaria falciparum?
Intravenous artesunate
28
How are people infected with Strongyloides stercoralis?
Infected larvae in soil gain access by penetrating the skin
29
What are the features of Strongyloides stercoralis?
Diarrhoea Abdominal pain/bloating Papulovesicular lesions on soles of feet and buttocks Larva currens: pruritic, linear, urticarial rash If the larvae migrate to the lungs a pneumonitis similar to Loeffler's syndrome may be triggered
30
What is the shape of Strongyloides larvae?
rhabditiform larvae.
31
What is the treatment for strongyloides?
1. Ivermectin (best) 2. Albendazole Ivermectin is a single dose agent Albendazole require multiple doses
32
What causes"thread worm" and what are its features?
Enterobius vermicularis / Pin worm Perianal itching Assymtomatic in 90%
33
How is thread worm investigated?
sticky plastic tape to the perianal area and sending it to the laboratory for microscopy to see the eggs
34
How do you treat thread worm ?
Bendazoles
35
What causes hookworm?
Ancylostoma duodenale Necator americanus
36
What are the features of hookworm?
Larvae penetrate skin of feet; gastrointestinal infection → anaemia Thin-shelled ova
37
What are the features of loa loa?
auses red itchy swellings below the skin called 'Calabar swellings', may be observed when crossing conjunctivae
38
How is loa loa transmitted?
Deer fly Mango fly
39
What is the treatment of loa loa?
Diethylcarbamazine
40
What are the features of trichnerella spirals?
Features include fever, periorbital oedema and myositis (larvae encyst in muscle)
41
How is trichnerella spiralis treated?
Bendazoles
42
What is river blindness? How is it spread?
Onchocerca volvulus Spread by female black flies
43
How is onchocera volvulus treated?
Ivermeticin rIVERblindness = Ivermeticin
44
What are the features of Amoebiasis?
Profuse blood diarrhoea * there is a long incubation period
45
How is amoebiasis tested?
"Hot stool test" - test for stool within 15 minutes stool microscopy may show trophozoites if examined within 15 minutes or kept warm (known as a 'hot stool') - otherwise moves into cyst form and not easily diagnosed
46
How is amoebiasis treated?
Metronidazole invasive amoebiasis should be followed by a luminal amoebicide to eradicate the cystic stage which is resistant to metronidazole and tinidazole/diloxanide furoate (which are used against the invasive stage)
47
What type of organism is rickettsia?
Gram-negative obligate intracellular parasites
48
What diseases does rickettsia cause?
Rocky Mountain spotted fever - Rickettsia ricketsii Q fever -Coxiella burnetti Enedemic typhus - Rickettsia typhus and rickettersia prowazekki
49
What is the organism and vector for Rocky Mountain spotted fever?
Tick Rickettsia ricketsii
50
What is the organism and vector for Q fever?
Coxiella Brunetti There is no vector
51
What is the organism and vector for endemic typhus?
Rickettsia prowazekii - Human body louse Rickettsia typhi - Flea
52
How is rickettsia treated?
Tetracyclines
53
What is the bacteria behind leptospirosis?
Leptospira interrogans
54
What is the vector for leptospirosis?
Infective rat urine People get it in: - Sewage worker - Farmers - Vets - Abbatoir workers
55
What is Weil's disease? What causes it?
Leptospirosis Always consider in hepatorenal failure Early phase is due to bacteraemia and lasts around a week: -Mild or subclinical - Fever - Flu-like symptoms - Subconjunctival suffusion (redness)/haemorrhage Second immune phase may lead to more severe disease (Weil's disease): - Acute kidney injury (seen in 50% of patients) - Hepatitis: jaundice, hepatomegaly - Aseptic meningitis
56
How should leptospirosis be investigated?
Serology: antibodies to Leptospira develop after about 7 days PCR Culture
57
What is treatment for leptospirosis?
high-dose benzylpenicillin or doxycycline
58
What is the presentation of rickettsia typhus? ricketsii? and conorii?
Typhus: Black eschar at site of original inoculation rash e.g. maculopapular or vasculitis complications: deranged clotting, renal failure, DIC Rickettsia: macular rash or hands and feet then spreads Conorii: rash initially in axilla then spreads
59
What is the causative organism in cat scratch disease?
Gram negative rod Bartonella henselae
60
What are the features of cat scratch disease?
Features fever history of a cat scratch regional lymphadenopathy headache, malaise
61
What are the features of Q fever?
typically prodrome: fever, malaise causes pyrexia of unknown origin transaminitis atypical pneumonia endocarditis (culture-negative)
62
Treatment for Q fever?
Doxycycline
63
What are the features of brucella?
non-specific: fever, malaise hepatosplenomegaly sacroiliitis: spinal tenderness may be seen complications: osteomyelitis, infective endocarditis, meningoencephalitis, orchitis leukopenia often seen Wet hay smell of sweat
64
What is the treatment of brucella?
Doxycycline and streptomycin
65
What stain is used on bartonella?
Warthin-Starry staining
66
Most common bacteria from animal bites?
Pasteurella multocida.
67
How best to treat animal bites?
1. Metronidazole If allergic: Doxycycline + metrondiazole
68
How are human bites treated?
Co-amoxiclav
69
What are the features of cutaneous leishmaniasis?
Crusted lesion at site of bite May be underlying ulcer
70
What cause cutaneous leishmaniasis?
Leishmania tropica Leishmania mexicana
71
What is the difference between South or Central American cutaneous leishmaniasis and Africa /Indian cutaneous leishmaniasis?
South / Central America required treatment due to risk of mucocutaneous Leishmaniasis
72
What causes mucocutaneous leishmaniasis?
Leishmania braziliensis
73
What causes visceral leishmaniasis?
Leishmania donovani
74
What causes visceral leishmaniasis?
fever, sweats, rigors massive splenomegaly. hepatomegaly poor appetite*, weight loss grey skin - 'kala-azar' means black sickness pancytopaenia secondary to hypersplenism
75
How should visceral leishmaniasis be diagnosed?
Bone marrow aspirate or Splenic biopsy
76
What bacteria are found in human bites?
Streptococci spp. Staphylococcus aureus Eikenella Fusobacterium Prevotella Risk of Hep C and HIV should be considered
77
How is brucella diagnosed? How is it stained?
Brucella serology Rose Bengal plate test can be used for screening but other tests are required to confirm the diagnosis
78
What are the features of blackwater fever?
Large intravascular haemolysis resulting in haemoglobinuria Anaemia Jaundice Acute kidney injury. Urine is classically black or dark red in colour
79
What are the most common non falciparum malarias?
Plasmodium vivax - Central America / India Plasmodium ovale - Africa Plasmodium malariae
80
What are the features of Plasmodium vivax/ovale?
Cyclical fever every 48 hours + General malaria features: - Fever - Splenomegally - Headache
81
What are the features of Plasmodium malariae?
General malaria features: - Fever - Splenomegally - Headache Nephrotic syndrome
82
What is treatment for non-falciparum Marla?
WHO recommend either an artemisinin-based combination therapy (ACT) or chloroquine In areas which are known to be chloroquine-resistant an ACT should be used ACTs should be avoided in pregnant women patients with ovale or vivax malaria should be given Primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse
83
How can toxoplasmosis present in immunocompetent individuals?
Acute toxoplasmosis in the immunocompetent patient can mimic acute EBV infection (low-grade fever, generalised lymphadenopathy with prominent cervical lymph nodes and malaise) and should be suspected with negative EBV serology. Pregnancy testing and counselling is paramount due to the risk of congenital toxoplasmosis
84
Look at malaria prophylaxis table
Looks at malaria prophylaxis takle
85
What infection do you get from rabbits?
Tularaemia is a zoonotic infection involving the microorganism F. tularensis produces an erythematous papulo-ulcerative lesion at the site of the bite with reactive and ulcerating regional lymphadenopathy.
86
How do you treat F. tularensis ?
Doxycycline
87
Why is Plasmodium knowlesi difficult to treat?
P. knowlesi has the shortest erythrocytic replication cycle, leading to high parasite counts in short periods of time

MRCP: Infectious Diseases (15 decks)

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