!!!!!!! THERE PROBABLY ARE SOME MISTAKES IN THIS !!!!!!!
PLEASE E-MAIL CORRECTIONS
TO: s.bridgett@qub.ac.uk
| Symptoms | Differential Diagnosis | Specimens | Treatment | Notes |
| RTI - PNEUMONIA
Pyrexia, sputum, difficult breathing, unwell, aches & pains, lung X-ray patches
|
Haemophilicus, Group A strep pyrogens, St pneumonia,
Staph aurens, Chlamydia pneumonia, Mycoplasma pneumonia, TB,
Influenza A or B Adenovirus, EBV Aspirgilus Fungal ball in old TB lesion |
Throat swabs - dry & viral transport
Blood - culture, clotted acute & convalecent Urine - early morning (for TB/Legionella) |
Penicillin (erythromycin if allergic) or Cefotoxine.
Multidrug theraphy (Rifamipicin + Isonvazide) upto 6 months for TB |
CFT, monoclonal antibodies
ZN & LJ slope for TB
|
| RTI - Q-FEVER
Short of breath, tirdness |
Coxiella burnetti | Phase II -> acute
Phase I & II -> chronic From cattle, sheep. |
||
| SKIN - SCABIES
Itchy skin rash, excoriation, erythema |
Scabies, Impetigo | Needle biopsy of skin | Malathion power.
House & family too. |
Scabies is very infective |
| SKIN - RINGWORM
Local skin & neck lesions |
Ringworm Contact dermatitis, Psoriasis, Eczema, Microsorum canis | Skin scrappings | Grisefulvin + Topical cream | Woods light(UV)
LPB (Lacto-phenol blue) Treat source (cat) |
| NAILS
Nain, skin & hair infection |
Trichopyton mentagrophytes var granular | Oral griseofulvin upto 6 months | Microscopy, LPB.
From walking barefoot on contaminated floors, sweaty shoes. |
|
| SKIN - CARBUNCLE
Skin lesion round hair follicle |
Staph aurens (could be MRSA) | Blood culture
Skin swab |
Surgical drainage,
Vancomycin + analagesia |
|
| SKIN RASH ON BABY
Baby, Rash, Joint pain
|
Scarlet fever (Group A strep)
HSV 6, Enterovirus, Parvovirus B19 |
Throat swab - Dry
Blood clotted acute for B19, Rubella IgM Faeces - for enterovirus |
B19->low fetal RBC -> anaemia heatt problems -> 12% stillbirth | |
| SKIN BURNS INFECTION
Extensive necrosis, high mortality rate |
Pseudomonas aeruginosa (blue/green pigment on nutrient agar) Staphy aurens, Group A strep, enterococci Candidia & Aspergillies species | Gentamicin + Ticarcillin
May need skin graft |
||
| CNS - BACTERIAL (PURULENT) MENINGITIS
Children, adolencents, sore throat, headache, drowsiness, fever, irritibility, stiff neck, haemorrhagic kin rash |
Neisseria (meningococcal) meningitis (Gram- diplocci)
Seen inside pus cells (as intracellular bacteria)
|
CSF (biochem, gram, culture bacteria/viral PCR)
Blood - culture, clotted acute & convalesent, EDTA Throat swab - dry & viral transport Skin scraping from rash |
Penicillin (Ampicillin if allergic)
Prophalysis for contacts: Rifampicin & Vaccine |
Emergency - treat immediately.
Cloudy CSF as v.high cell count, high protein, low glucose Infects meningies around brain/spine Neisseria = fast onset (1-3 day incubation) |
| Very young, elderly & after trauma | Strep pneumococcal meningitis (Gram+ coccus) | As above | ||
| Children < 5yrs | Haemophilus (H. Influenza type B) meningitis (Gram- coccobacillis) | As above | Cefotaxime (Ampicillin/Chlormphenol) | Needs V & X factors to grow, satalites Staph aurens. |
| CNS - VIRAL (ASEPTIC) MENINGITIS
Commonest meningitis, milder headache, fever, illness, less stiff neck, photophobia |
Enterovirus (Echo, Coxsackie, Polio) HSV I & II | As above, plus:
Feaces - viral culture. |
Symptomic management | Clear CSF - raised cells, normal protein & glucose
Need RT-PCR as RNA viruses |
| CNS - ENCEPHALITIS
Cerebral dysfunction, abnormal behaviour, seizures (eg. temporal lobe = smells), altered consciousness, nausea, vomiting, fever, space occupying lesion. |
Enterovirus, VZV, measles, lyme disease. | As above | Acyclovir for HSV & VZV | Infects brain itself.
Faecal-oral spread, esp summer/autumn. Viruses in monkey cell culture (normally cobble-stone) are cytopathic = round up cells, with gaps between. Measles fuse cells -> giant cells. |
| CNS - DIPHTHERIA
High fever, confused, difficult breathing, sore throat |
C. Diphtheria | Throat swap Blood -clotted for monocyte & EBV assey | Anti-toxin + Penicillin (or erythromycin) | From developing world or Russia
False membrane between mouth & pharynx. Neural toxin. |
| CNS - BRAIN ABCESS
Pyrexia, headaches, vomiting, nausea, previous ear tumor |
Bacterial (mixed - Staph aurens, Step mill),
Fungal, Tumor |
Surgical drainage & broad spectrum antibiotic | Walled off so not tumor.
Spread from direct(trauma), local(ear) or distant(lungs) |
|
| GIT - GASTRO-ENTERITIS
Vomiting, diahorrea |
Salmonella, Shigella, Toxic E.coli.
Viral enteritis: Roto, Adeno, Norwalk, Astro viruses |
Blood culture
Faeces - O&P, bacteria & viral culture, EM |
||
| GIT - FOOD POISONING
|
As above plus:
Yersina, Campylobacter |
As above | Supportive care, rehydration, Abtibiotics if bacteraemia. | If reaction within 2hrs, food contains toxin already. May ferment lactose, & split urea. |
| GIT - DYSENTRY-AMOEBA
Bloody mucoid diahorrea, abdomin pain, cramps |
Above plus:
Amoeba (Trophozites) |
As above | Metronidazole | From India Trophozoites ingest red cells & invade
organs.
Enteric precausions. |
| GIT - DYSENTRY-PARASITE
As above |
Parasites: Gardia, Cryptosporia C. difficile | As above | Metronidazole or Vancomycin
|
If virus, tissue culture cells round up. Kills elderly Enteric precausions??? |
| GASTRIC/DUODENAL ULCER
Abdominal pain, nausea, anti-acids relieve |
H. pylori
|
Ulcer biopsy | Triple theraphy(Bismuth subsalulate, Metronidizole, Amoxycillin) +H2 blocker | Radio-labelled Urea -> CO2 in breath.
ELISA |
| HEPATITIS
Jaundice, abnormal liver function IV drug use |
HCV (often with HDV) HBV | Liver biopsy | Interferon & Rabavin Barrier contaception. | Low viral load best. |
| REACTIVE ARTHRITIS
Joint pain, stiffness after GIT infection or fever |
GIT: Yersina, Campylobacter, Salmonella, Shigella.
Septic arthritis: Staphylococcus, Gonococcus, Lyme disease Viral arthritis: HBV, Rubella, Parvovirus B19 |
Blood - culture, clotted acute & convalecent | Anaglesia for pain
If Yersina septacaemia (50% mortality) give gentamicin. |
Reactive arthritis is associated with HLA-B27 antigen |
| PERINATAL
Small septic baby |
Listeria monocytes? | Blood culture, clotted acute & convalescent | Penicillin/Ampicillin + Gentamicin. | Gtanulamosa in internal organs -> stillborn risk.
From uncooked or stored meat Crosses placenta Aesailin slop - black around growth as above, |
| Small baby, ...
|
Group B strep septacaemia Gram +, Beta-haemolysis, Basotracin resistant (so not group A strep) | Blood culture
CSF Ear swab Gastric aspirate |
From birth canal, Risk factors: early maternal membrane rupture, long/difficult labour | |
| STD
Pain on micturation & discharge, pelvic inflammatory disease, infertility, ectopic pregnancy |
Gonococcal Neisseria gonorrhoea (Gram- diplocci) | Urine - early morning, MSSU Urethral swab - charcoal | Metronidazole (not 1st trimester) | Check for HIV/HBV |
| Foul smelling discharge, viginal pain | Trichomonas (motile) | Secretions - wet & fungal swab | Azithromycin or Cipofoxain | |
| No smell | Candida | Geamisa for blue inclusion bodies of Chlamydia. | ||
| Painful vascular lesions on penis | HSV I (more common than II) Syphillis Chancroid | Skin swab - PCR, culture | Acyclovir/ Famciclovir topical/oral. | HSV = "fried egg" on EM Immunoantibody
Not necessarily outside relationship. Can be transmitted even when no lesions. |
| CARDIOVASCULAR
Rhumatic heart disease, pan-systolic mumur (ECHO & ECG), pyrexia, night sweats. |
Strep sanguis group A | Etest MIC, OPID disk | ||
| UTI - OBSTETRIC
Frequent urine with pain, or no symptoms |
Staphylococcus, E. coli, Enterococcus, Proteus sp. | Blood - culture
Urine - early morning, MSSU |
Antibiotic 7 days | Pus cells & epithelial cells in urine
Bacteria spread from gut Bacteruritis Dipstick for nitrates |
| Neonate, retinal lesions
|
Toxoplasmosis, CMV | Blood - ELISA for IgG & IgM | Live toxoplasmiosis take up methyl-blue | |
| IMMUNOCOMPROMISED - AIDS
AIDS patient, pyrexia, headache, drowsiness, neck stiffness, dysphagia, white lesions in mouth |
Meningitis: Cryptoccus neoformans, M. tuberculosis, Listeria
monocytes, Candidia, Toxoplasmosa gondi, HSV.
Fungal growth: Candya-albacans-osaphigitis (only in AIDS patients) (This is subacute, so not Strep pyrogens) |
Blood culture, EDTA
CSF (biochem, culture) Mucus membrane scrapping |
Osapagus marrowing seen on Barum swallow
Germ-tube under microscope |
|
| IMMUNOSUPPRESSED - RENAL TRANSPLANT
Low WCC, pyrexia, abnormal liver function. Was CMV seronegative before op. |
Acute CMV, pneumonia, septacaemia, rejection. | Blood - culture, clotted, EDTA (PCR to detect CMV)
Urine - MSSU Sputum Liver biopsy |
Reduce immunosuppression (but may lose kidney), Ganscylovere (antiviral) & passive immune theraphy (anti-CMV serum) | Owl's eye appearance in liver of CMV patient
CMV antibody in blood CMV from donor kidney |
| CHEMOTHERAPHY
Chemotheraphy for Leukaemia -> v.low WCC, Central venous catheter (CVC), lung patches on X-ray, pyrexia. |
Multi-resistant Staphyloccus septacaemia
Multi-resistant Clebesli pneumonia |
Blood - culture, clotted - acute & convalescent
Urine - MSSU Sputum Bronscopy material Central line culture |
Peperacillin/Tazobactum or Imipenum (but risk of superinfection
of gut with fungi) until fever resolves 48hrs, or moderate WCC
Bone marrow granulocyte colony stimulating factors (GCSF) |
Clebesli = opportunistis chest pathogen, thick casule
resists phagocytosis & large plasmids code for extended Beta-lactamase
enzyme->
resists most antibiotics |