1
Q
Histoplasmosis
A
- Fungus: mold in cold, yeast in heat
- Yeast found inside macrophages
- Starling and bat feces
- Associated with cave entrances
- Common in Mississipi and Ohio river valley
- Causes pneumonia
- Caseating necrotic granuloma
- Erythema nodosum
2
Q
Brucella
A
- Caused by a gram-negative coccobacillus
- From unpasteurized milk, goats cheese and contact with infected animals
- Resides in macrophages
- proliferates inside lymph nodes causing lymphadenopathy
- Acutely undulating fevers, rigors, sweating, lethargy, headache, joint pain, palpable spleen
- Granulomas can develop from attempts to clear the infection
- Serum agglutination tests
- Management with doxycycline+ rifampicin, Doxycyclin+streptomycin, gentamycin
3
Q
Salmonella Typhii
A
- Gram negative bacillus
- Acid labille- more at risk if taking PPI or pernicious anaemia
- Infection of macrophages at peyers patches in terminal ileum, can perforate and bleed into ileum
- Fever >3 days AND GI Sx
- Abdo pain, diarrhoea (pea soup)/constipation
- Ix blood and stool cultures
- Treat with ceftriaxone
- Chronic carriers harbour it in gall bladder
4
Q
Enteric Fever syndrome
A
- consumption of infected food or water
- Salmonella enterica or paratyphi
- endemic to south east asia and pacific
- abdo pain, fever, chills, brady cardia
- pulse temperature disscociation
- Rose spots (salmon coloured macules on trunk and abdomen)
5
Q
Salmonella Enteridis
A
- Chickens are natural reservoir
- inflammatory diarrhoea
6
Q
Klebsiella pneumonia
A
- Gram negative bacillus
- Most common cause of liver abcess
- Infection is usually hospital acquired
- Immunoscopromised
- Lobar pneumonia: uncommon but causes red current sputum
7
Q
Infective Endocarditis
A
- Abnormal valves, following endocardial damage (MI, pacemaker,IVDU etc.)
- Embolic phenomena
- 3 blood cultures over 2 hours
- Image for vegetations
- Emperical Benzyl penecillin
- Alpha hemolytic strep (mutans, mitor, sanguinis)
- S.bovis: suspect colon cancer
8
Q
Syphilis Symptoms
A
- Treponema pallidum
- Can’t be cultured
- Initial ulcerative lesion: chancre which heals
- Infects lymph nodes and deseminates
- Secondary syphillis has systemic symptoms: fever, rash, headache, malaise, anorexia, diffuse lymphadnopathy, sore throat, myalgia, alopecia
- Late secondary: Aortitis leading to regurg, gummate with nodular lesions
- CNS syphili: lightning like leg pain and paraesthesia (tabes dorsalis), argyll robertson pupil
- Treat wiyh IM benzathin penecillin, ceftriaxone, azithromycin
9
Q
Syphilis investigations
A
Serology
EIA, TPPA, RPR
Apart frm RPR tests are + for life
RPR is the dilution at which bacteria is detected, this should drop with treatment.
10
Q
Herpes Simplex
A
Vesicles rupture and ulcer multiple painful lesions HSV1 is facial with or without genital- can cause encephalitis (requires high dose acyclovir) HSV2 is genital- can cause meningitis Swab and PCR Acyclovir for primary infection
11
Q
Cystitis
A
- Bladder infection
- No fevers
- No systemic symptoms
- No bacteraemia
- Frequency, urgency, dysuria
- Nitrofurantoin
- E coli
12
Q
Pyelonephritis
A
- Kidney infection
- fever, back pain
- systemic upset
- bacteramia
- E.coli (pseudomonas)
- send for urinanalysis and culture
- Gentamycin (IV), trimethprim (PO)
13
Q
Leptospirosis
A
- Jaundice
- Abrupt fever, rigors, myalgias, headache
- conjunctival suffusion (red and swollen conjunctiva)
- haemoptysis
- Alveolar haemmorhage
- Rate urine- entry vis cuts and abrasions
- May cause renal impairement (ATN), uveitis, ARS, myocarditis, rhabdomyolysis
- Tropics and water sports are risk factors
- Polymorphic leukocytosis, may have thrombocytopenia.
- Blood and urine cultures
- Treat with Doxycicline or IV penicllin
14
Q
Infectious mononucleousis
A
- Caused by EBV
- Commonly amongst young adults
- lymphadenopathy
- Fever, pharyngeal inflammations and exudate
- May have splenomegaly
- palate peticheia
- perioccular oedema
- hepatitis
- Atypical lymphocytes
- positive monospot indicating heterophils
- Supportive management- no amoxy (causes reaction), can give a short course of prednisone for throat oedema
- Avoid contact sport (risk of spleen rupture)
15
Q
Cytomegalovirus
A
- Older age group vs EBV (25-35 yo)
- Transmission via body fluids
- Hepatomegaly, splenomegaly more likley
- Pharyngitis,lymphadenopathy tonsillitis less likely
- Negative monospot
- Fewer atytpical lymphocytes
- Derranged LFTs
- CMV specific IGM
- Supportive treatment, avoid amoxycillin
16
Q
Congenital CMV
A
- IUGR
- Microcephaly
- hypotonic
- poor feeding
- seizures
- Jaundice
- purpura
17
Q
Toxoplasmosis gondii
A
- From cat feces, soil
- form tissue cysts in hosts
- Causes subclinical disease
- Painless cervical lymphadenopathy
- May have malaise, fever, fatigue, muscle pain, sore throat, headache
- Self limiting
- treatment of severe disease and in immunocompromised: pyrimethamine, sulfadiazine
18
Q
Congential toxoplasmosis
A
- retinochoroiditis
- microcephaly
- hydrocephalus
19
Q
Lyme Disease
A
- caused by borrelia
- Transmitted by ticks
- Initial infection causes erythema migrans (rash)
- may have fever, headache, lymphadenopathy
- Subsequent infection: deseminated disease: malaise, arthalgia, lymphcytic meningitis, cranial nerve palsies and peripheral neuropathy
- Late disease: arthritis, polyneuritis, encephalopathy, doughy pathy skin atrophy
- Treat erythema migrans with doxcycline or amoxicilklin
- neuro- tret with iv beta lactam abx like ceftriaxone, cefotaxime, benzyllpenicillin, cephalosporin
20
Q
Q fever
A
- Coxiella burnetii
- Intracellular
- spore forming
- From animals
- inhalation of spores from hay
- Causes atypical pneumonias- fever and headache
- Endocarditis: cultures are negative
- Hepatitis: granulomas, resembles acute hepatitis, PUO
- Neurological: severe headache, monocellular cell response, increase protein normal glucose
- Complement fixation test
- Treat with tetracycline
- Prolongued treatment of endocarditis with doxycycline and rifampicin
21
Q
Hand foot and mouth
A
- Common among children
- Coxsackie virus
- other enteroviruses
- vesicular eruptions on hands, feet and oral mucosa (maybe buttocks and genitals)
- Sore throat, mouth pain, refuse to eat
- fever
- Symptomatic treatment: oral hygeine, soft diet
22
Q
Whooping cough
A
Bordetella pertussis
Droplet transmission
URTI symptoms
Catarrhal stage: sneezing, tearing (coryza), anorexia, night cough
Paroxysmal stage: increased severity and frequency of cough. paroxysmal or sposmodic cough, mucus, vomiting
Convalescent stage
Diagnosed by nasopharyngeal culture, PCR, serology
Treat with macrolides (erythromycin or azithromycin), supportive care, isolate for 5 days
Progress Test
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