How should bloods be taken when dealing with a patient with possible bacterial endocarditis?
- 3 sets of blood cultures (with the first and last 1 hour apart)
- taken from peripheral veins
- 10mls of blood in each bottle
- taken before antibiotics
- meticulous sterile technique
What is the most contaminants in a blood culture?
Coagulase-negative staphylococci
When a patient has CDI what precautions are put in place?
- standard infection precautions
- isolation of the patient
- hand hygeine with soap and water
What facts should you establish in a sexual history?
- date of last sex
- gender of their sexual partners
- type of sex
- did he/the partner use a condom
- has he ever has a sexual health check-up
What tests are taken at a sexual health test?
- Blood test for HIV and syphilis
- NAAT (nucleic acid amplification test) for gonorrhoea and chlamydia (swabs taken from relevant sites)
- Test for Hep B should be tested for in blood if MSM
What are the benefits of regular sexual health checks for men having sex with men?
- Allows discussion of preventative measures: condom use, safe sex, HIV symptom awareness, drugs and alcohol
- People often misjudge personal risk
- Psychological support: recreational drug use, ‘coming out’, relationship issues. Can signpost to other services
What type of infection is HSV?
Chronic recurrent STI
How is gonorrheoa treated?
IM ceftriaxone and oral azithromycin
What can be done to minimise the development of drug resistant strains of gonorrhoea?
- Rapid accurate diagnosis
- Avoid blind therapy with inappropriate drugs
- Partner notification
- Epidemiological monitoring of resistance data
What advice can you give to help a man reaquiring a gonnorhoea infection?
- reinforce safer sex with condom
- not having sex with recent sexual partners until they are tested and treated
- test of cure at 2 weeks post treatment
What is a rash involving the palms in sexual health patient indicative of? How long can this condition take to appear?
Syphilis
Primary = up to 90 days
Secondary = up to 6 months
A woman comes to the doctors reporting acute onset diarrheoa. What should you ask her when taking a history?
- Food history
- Ill contacts
- Travel history
- PMH
- Occupational history
- Risk factors for CDI (i.e >65, recent hospitalisation, recent course of antibiotics) (having 2/3 of these factors should make you consider CDI)
What are some non-infectious causes of diarrhoea?
- IBD (UC, Crohn’s)
- Diveticular disease
- Chronic pancreatitis
- HIV
- Ischaemic bowel
What are the most common causes of gastroenteritis?
- Campylobacter
- Salmonella
- E. coli 0157
- Norovirus
- Rotavirus’
- Giardiasis
- Enterohaemorrhagic E. Coli
Which viruses cause a vesicular rash?
- HSV -1/2
- Varicellar zoster virus (chicken pox)
- Enteroviruses (Hand Foot and Mouth Disease)
What can variecella zoster virus be reactivated to? Who is at risk of this?
- Reactivation to herpes zoster (shingles)
- Pregnant women, neonates, immunocompromised
How do you diagnose a vesicular rash?
Chickenpox can be diagnosed clinically
HSV1/2, varicella zoster virus and enterovirus can be diagnosed in the lab using PCR on a vesicle swab
How is varicellar zoster transmitted?
- Respiratory transmission
2. Contact with vesicle fluid
How do we provide evidence of VZV immunity in immunocompromised individuals?
VZV IgG testing
What would an immunocompromised individual with VZV be at risk of?
- Bacterial infection of the skin and soft tissues
- Disseminated varicella
- haemorrhagic varicella
- VZV encephalitis
- VZV pneumonitis
What prophylaxis can an immunocompromised individual be given for VZV?
If this prophylaxis is unsuccessful what therapy is availble?
VZ Immunoglobulin prepared from pooled plasma of non-UK donors (due to risk of vCJD)
Aciclovir
