Year 3 Pathologies > Infection > Flashcards

Infection Flashcards

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1
Q

What is Mastitis?

A

Painful inflammatory condition of breast

Can lead to formation of breast abscess which is a complication

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2
Q

What are the causes of Mastitis?

A

Infectious Causes :
- Lactational or duct ectasia (milk stasis)
- MC cause is Staph. aureus

Non-infectious causes :
- Idiopathic granulomatous Inflammation
- Foreign body reaction

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3
Q

H&E of Mastitis

A
  • Coryzal symptoms (common cold symptoms)
  • Nipple discharge
  • Redness
  • Tenderness
  • Abscess

Severe signs:
- Infected nipple fissure
- Not improving
- Positive breast milk culture

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4
Q

Investigations for Mastitis

A

Breast milk culture and clinical diagnosis

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5
Q

Management of Mastitis

A

Lactational / Non-severe :
- Continue breastfeeding
- Warm compress
- Analgesia

Severe or not improving after milk removal :
- Oral flucloxacillin for 10-14 days

Non-lactational :
- Co-amoxiclav 3x a day for 10-14 days

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6
Q

Management of breast abscess

A
  • Incision and drainage (+culture)
  • IV/PO antibiotics (typically doxycycline)
  • Analgesia
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7
Q

What is Sepsis?

A

Life-threatening organ dysfunction caused by dysregulated host response to infection

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8
Q

What is septic shock?

A

A more severe form of sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’

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9
Q

How is the quickSOFA score used in sepsis?

A

qSOFA score

RR > 22/min
Altered mentation
Systolic BP < 100mmHg

Adults with suspected infection with qSOFA score >= 2 at heightened risk of mortality

Within ICU for SOFA score is used

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10
Q

Red Flags for Sepsis

A
  • Responds only to voice or pain/unresponsive
  • Acute confusional state
  • Systolic BP <= 90mmHg or drop >40 from normal
  • HR > 130
  • RR > 25
  • Needs oxygen to keep SpO2 >= 92%
  • Non-blanching rash, mottled/ashen/cyanotic
  • Not passed urine in last 18h/ UO < 0.5ml/kg/hr
  • Lactate >= 2mmol/L
  • Recent Chemo
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11
Q

Management of Sepsis

A

If any of the red flags are present the ‘sepsis six’ should be started straight away:

  1. Administer oxygen : keep above 94% or 88-92% if at risk of CO2 retention
  2. Take blood cultures
  3. Give broad spectrum antibiotics
  4. Give IV fluid challenges
  5. Measure Serum Lactate
  6. Measure accurate hourly urine output
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12
Q

What is a Breast Abscess?

A
  • Lobules fill with fluid
  • Oestrogen causes fluid production
  • Post-menopause, Oestrogen falls, less fluid, fewer cysts
  • HRT can lead to cysts
  • More common > 35
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13
Q

H&E of Breast Abscess

A
  • Well circumscribed mass
  • Sudden enlargement
  • Fluctuant
  • No systemic symptoms
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14
Q

Investigations for Breast Abscess

A
  • <40 : USS
  • > 40 : USS + MMG
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15
Q

Management of Breast Abscess

A

If large and painful
- USS-guided aspiration

If solid lesion is seen after - biopsy

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16
Q

What is Candidiasis?

A
  • Thrush
  • Overgrowth of Candida species (C. albicans)
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17
Q

RF for Candidiasis

A
  • Young
  • Dentures
  • Abx
  • Steroids
  • Chemo
  • COCP
  • DM
  • Malnutrition
  • Xerostomia
  • HIV/AIDS
  • Pregnancy
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18
Q

H&E of Candidiasis

A

Pseudomembranous plaques
- Whitish plaques, can be scraped off
- Asymptomatic
- Cotton feeling, pain/tenderness, odynophagia, decreased taste, angular chelitis

Atrophic with dentures
- red lesions with no plaques

Hyperplastic
- Non-scrapable plaques

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19
Q

H&E of Vulvovaginal Candidiasis

A
  • Thick white discharge “cottage cheese”
  • Vulvar itching and burning
  • Dyspareunia
  • Dysuria
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20
Q

Investigations for Candidiasis

A

Microscopy
- Branched pseudohyphae

KOH
- Hyphae

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21
Q

Management of Candidiasis

A

Oral
- Topical antifungal - nystatin

  • Systemic antifungal - fluconazole (NOT IN PREGNANCY)
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22
Q

Management of Vulvovaginal Candidiasis

A

Uncomplicated
- 150mg oral fluconazole
- Pessaries
- Vaginal creams/ointment

Complicated
- 150mg oluconazole in 2/3 doses
- Intravaginal boric acid OR flucytosine cream

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23
Q

H&E of Chicken Pox

A
  • Fever, sore throat
  • Rash - crusts over

Severe
- Congenital varicella syndrome - blueberry muffin rash
- Meningitis, encephalitis, varicella pneumonitis

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24
Q

H&E of Shingles

A
  • Dermatomal erythmatous maculopapular rash

Severe

  • Ramsey-Hunt syndrome - unilateral paralysis, hearing problems, rash in hair
  • Post-hepatic neuralgia
  • Herpes zoster opthalmicus
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25
Management of Varicella Zoster
Conservative for less severe - Self-limiting - Calamine lotion - Paracetamol Oral Antivirals - Acyclovir, valaciclovir, famiciclovir If more severe, give IV antivirals If pregnant, separation, prophylaxis
26
What is Hepatitis A + aetiology?
Typically a benign, self-limiting disease, with a serious outcome being very rare Incubation period - 2-4 weeks RNA picornavirus Transmission is by faecal-oral spread, often in institutions Doesn’t cause chronic disease
27
H&E of Hepatitis A
- Flu symptoms - Jaundice - RUQ pain - Tender hepatomegaly
28
RF of Hepatitis A
- Endemic region - Close contact - MSM - IVDU
29
Investigations for Hepatitis A
LFTs Serum Bilirubin U&Es Viral screen - IgM anti-HAV, IgG anti-HAV
30
Management of Hepatitis A
Vaccine - booster dose 6-12 months after initial dose Supportive care
31
Who should be vaccinated for Hep A?
- Travelling or going to reside in areas of prevalence, over 1yo - Chronic liver disease - Hameophillia - Gay sex - IVDUs - Occupational risk e.g. sewage workers/ zoo workers
32
What is Hep B?
Double-stranded DNA hepadnavirus, spread through exposure to infect blood or body fluids Vertical transmission from mother to child Incubation period is 6-20 weeks
33
Complications of Hep B
- Chronic hepatitis (5-10%) : ground-glass hepatocytes may be seen - Fulminant liver failure (1%) - Hepatocellular carcinoma - Glomerulonephritis - Polyarthritis nodosa - Cryoglobulinaemia
34
H&E of Hep B
Fever and Jaundice
35
RF for Hep B
- Infant exposure to HBV-infected mother - High-risk sexual behaviour - Endemic region - Family history - Close contact - IV drug use - History of incarceration
36
Investigations for Hep B
LFTs : Elevated transaminases FBC (may have microcytic anaemia from GI bleeding) U&Es Coagulation profile Viral screen - HBsAg - Antibody to HBsAg - Anti-HBc (antibody to core antigen) - HBeAg (presence after 3 months indicates chronic infection) - Anti-HBe - HBV DNA
37
Who to vaccinate for Hep B?
Children and at-risk groups Test for anti-HBs 1-4 months after primary immunisation (only in those at risk of occupational exposure and CKD patients
38
What does Anti-HBs levels show?
> 100 - indicates adequate response, no further testing required, booster after 5 years 10-100 - suboptimal response - one additional vaccine dose should be given, if immunocompetent no further testing < 10 - non-responder, test for current/ past infection, give further vaccination course (i.e. 3 doses again), if fails to respond then HBIG would be required for protection
39
Management of Hep B
Antiviral therapy - pegylated inteferon-alpha - tenofovir - entecavir - telbivudine
40
What is Viral Gastroenteritis?
Typically a self-limiting condition lasting less than 14 days Person-person transmission responsible for infection in most sporadic cases Foodborne and waterborne epidemic outbreaks have potential to involve large numbers of people Mostly caused by norovirus
41
H&E of Viral Gastroenteritis
- Diarrhoea - Nausea - Vomiting - Cramping abdominal pain - Fever and malaise - Volume depletion
42
RF for Viral Gastroenteritis
- Exposure to contaminated food or water - Contact with infected people
43
Investigations for Viral Gastroenteritis
Clinical diagnosis Bloods before IV fluids - FBC : anaemia may be a sign of chronic cause, raised Hb can indicate severe dehydration - U&Es : serious volume depletion = low K or renal impairment - Stool culture if diarrhoea > 14 days, bloody, severe pain, foreign travel, or suspicion of non-viral
44
Management of Viral Gastroenteritis
- Oral rehydration - Anti-emetics if uncontrollable vomiting and unable to tolerate fluids : cyclizine or ondanestron
45
What is Malaria?
A disease caused by Plasmodium protozoa which is spread by the female Anopheles mosquito
46
4 species that cause Malaria in man
Plasmodium falciparum : severe malaria Plasmodium vivax : most common cause of benign malaria Plasmodium ovale Plasmodium malariae : associated with nephrotic syndrome
47
Protective factors of Malaria
- Sickle cell trait - G6PD deficiency - HLA-B53 - absence of Duffy antigens
48
H&E of Malaria
Fever : cyclical in benign malaria - Every 48hrs in vivax/ovale - Every 72hrs in malariae - Sore throat, runny nose, widespread rash - Hx of recent travel - Rigors - Headache - Splenomegaly - N+V - Diarrhoea
49
Investigations for Malaria
Severe malaria: - schizonts on blood film - Parasitaema > 2% - Acidosis - Severe anaemia - Hypoglycaemia
50
Complications of Malaria Plasmodium falciparum
- cerebral malaria : seizures, coma - acute renal failure : black water fever, 2nd to intravascular haemolysis, mechanism unknown - ARDS - hypoglycaemia - DIC
51
Management of Uncomplicated falciparum Malaria
- Artemisinin-based combination therapy (ACT)
52
Management of Severe falciparum Malaria
- Parenteral treatment if parasite count >2% - IV artesunate - Exchange transfusion if parasite count >10%
53
Management of Non-falciparum Malaria
- Artemisinin-based combination therapy (ACT) OR chloroquine Avoid ACT in pregnant women Give primaquine after chloroquine in vivax and ovale to prevent relapse
54
Aetiology of Infectious Mononucleosis
- Glandular fever - Caused by EBV - ‘Kissing Disease’ - Transmission through saliva and sexual contact - MC in 15-24yo
55
H&E of Infectious Mononucleosis
Primary infection: - Fever, sore throat/pharyngitis, lymphadenopathy Complications : - Hepatosplenomegaly = splenic rupture - Lymphoma - Hodgkin’s, Burkitt’s
56
Investigations for Infectious Mononucleosis
FBC + Blood films - Lymphocytosis, atypical lymphocytes (large, irregular nuclei + clumped chromatin) Monospot - +ve heterophile antibodies (IgM) - Cross reaction with sheep/horse RBC = agglutination LFTs - Raised transaminases Direct viral detection - EBV DNA and EBV-specific ABs
57
Management of Infectious Mononucleosis
- Analgesia, anti-pyretics - Corticosteroids if upper airway obstruction - IV IG if thrombocytopenia - Aspirin is CONTRAINDICATED - ABx can cause rash
58
What is Mesenteric Adenitis?
- Pain caused by inflamed mesenteric lymph nodes - Mainly caused by viral infections - ‘Abdominal migraine’ - Similar symptoms to appendicitis - Affects mainly children and young adults
59
H&E of Mesenteric Adenitis
- Pain, typically RLQ - Hx of gastroenteritis
60
Investigations of Mesenteric Adenitis
- Raised CRP - USS - enlarged mesenteric lymph nodes
61
Management of Mesenteric Adenitis
- Self-limiting - Simple analgesia
62
What is COVID-19?
A potentially severe acute respiratory infection caused by novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
63
H&E of COVID-19
- Fever - Cough - Dyspnoea - Altered sense of smell/taste
64
Investigations for COVID-19
RT-PCR test Rapid antigen test
65
Management of COVID-19
- Isolation - Symptom management In those hospitalised with hypoxia requiring O2, Dexamethasone and Remdesivir (nucleotide analogue) should be administered providing no contraindications
66
What is E.coli?
Gram-negative, rod-shaped bacterium Becomes pathogenic by acquiring virulence factors or genetic mutations Infection occurs through ingestion, usually contaminated food or water
67
H&E of Infectious Diarrhoea
- Diarrhoea - Hx of travel, contact with contaminated food, or infected person - Abdo pain or discomfort - Volume depletion
68
Investigations of Infectious Diarrhoea
- Stool cultures - FBC : E.coli associated with haemolytic uraemic syndrome - anaemia and thrombocytopenia - Renal function
69
Management of E.coli
- Rehydration and supportive measures - Bismuth subsalicylate - Consider ciprofloxacin for moderate to severe corners
70
What is HSV and its transmission and RF?
Double-stranded linear DNA virus HSV 1 and 2 Transmitted through sex, mucosal/skin breaks and vertical transmission RF are immunosuppression, medications and HIV/AIDS
71
Types of HSV and what they affect
HSV 1 affects mouth HSV 2 affects genitals Travels along sensory neurons to dorsal root ganglion = get reactivated by stressors = replication and anterograde movement
72
H&E of HSV
Herpes labialis = lips Genital herpes Disseminated (severe)
73
Investigations for HSV
Smear test
74
Management of HSV
Guanosine analogue - acyclovir, valaciclovir, famciclovir Oral acyclovir and chlorhexidine mouthwash for herpes labialis Oral acyclovir for genital herpes IV for disseminated herpes If pregnant, give prophylaxis and caesarean section if < 28 weeks Risk of transmission to baby is low
75
What is HIV and its transmission?
Single-stranded, positive sense, enveloped RNA retrovirus HIV-1 MC Transmission through sex, IVDU, vertical transmission, needle stick, blood transfusion
76
How does HIV work?
HIV docks to CD4 receptor with GP120 = binds to CXCR4 and CCR5 co-receptors = fusion with cell membrane
77
H&E of HIV
Acute phase : - Fever, myalgia, sore throat Chronic/ latent phase : - Asymptomatic - Oral/ vaginal candidiasis - Herpes zoster - TB - Oral hairy leukolakia (EBV) - white patches on tongue AIDS : - FLAWS + diarrhoea, lymphadenopathy - AIDS-defining illness - Neuropsychiatric disease
78
Investigations for HIV
Antibody-antigen test - Positive IgG, IgM (takes 15-45 days) - Presence of HIV p24 antigen RNA/DNA test - presence of HIV genome CD4 lymphocyte cell count and viral load are measured as part of monitoring for those with confirmed HIV infection
79
Management of HIV
Antiretroviral therapy - regardless of CD4 and viral load 3 different drugs across 2 classes - NRTIs : tenofovir, abacavir - NNRTIs : efavirenz, nevirapine - Integrase inhibitors : Raltegravir - Protease inhibitors : Fosamprenavir, atazanavir - CCR5 inhibitor : maraviroc - Fusion inhibitor : enfuvirtide
80
H&E of C.diff
Diarrhoea Abdo pain If severe : toxic megacolon may develop
81
Public Health England severity scale for C.diff
Mild : normal WCC Moderate : - inc. WCC (<15) - typically 3-5 loose stool/day Severe : - inc. WCC (>15) - acutely inc. creatinine (> 50% above baseline) - temp > 38.5 - evidence of severe colitis Life-threatening : - Hypotension - Parital or complete ileus - Toxic megacolon - CT evidence of severe disease
82
Investigations for C.diff
- Raised WCC - Raised calprotectin - Stool culture detecting CDT - C.diff antigen positivity only show exposure rather than current infection
83
Management of C.diff
Stop Abx First episode : - First line - oral vancomycin for 10 days - Second line - oral fidaxomicin - Third line - oral vancomycin +/- IV metronidazole Recurrent : - within 12 weeks - oral fidaxomicin - after 12 weeks - oral vancomycin OR oral fidaxomicin Life threatening : - Oral vancomycin AND IV metronidazole - Specialist advice - surgery considered Otter therapies : - Faecal microbiota transplant (2 or more episodes)
84
RF for TB
- Having lived in asia, latin america, eastern europe, africa for years - exposure to an infectious TB case - Immunocompromised individuals - Silicosis - Apical fibrosis
85
H&E of TB
- Coughing - Haemoptysis - Fever - Weight loss - Erythema nodosum
86
Screening for TB
Mantoux test Interferon-gamma blood test if Mantoux test positive or equivocal, or could be falsely negative Causes of false negative : miliary TB, sarcoidosis, HIV, lymphoma and <6m age
87
Diagnosis of Active TB
CXR : upper lobe CAVITATION in reactivated TB and bilateral hilar lymphadenopathy Sputum smear : Ziehl-Neelson stain for acid fast bacilli, 3 specimens needed Sputum culture : (GOLD) can assess drug sensitivities, can take 1-3 weeks Nucleic acid amplification Test : allows rapid diagnosis, more sensitive than smear, less than culture
88
Management of TB
Active : Initial phase (2m) - RIPE : rifampicin, isoniazid, pyrazinamide, ethambutol Continuation phase (next 4m) - Rifampicin + Isoniazid (+ pyridoxine) Latent : - 3 months of Isoniazid (+ pyridoxine) + rifampicin OR - 6 months of Isoniazid (+ pyridoxine) Meningeal TB : - Treat for 12 months + steroids
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