Infectious Diseases

Reference: Davidson 23rd , Page : 1239

Reference: Davidson 23rd; P-762

Strict anaerobes
Bacteroides spp.
Clostridioides difficile Clostridium spp.
Fusobacterium spp.

Reference: Davidson 23rd; P-581

Explanation: Initial flushing faint macular rash in first 1–2 days. Maculopapular, scarlet morbilliform blanching rash from days 3–5 on trunk, spreading centrifugally and sparing palms and soles; onset often with fever defervescence. May desquamate on resolution or give rise to petechiae on extensor surfaces

In tuberculoid leprosy, ulnar and common peroneal nerves are typically affected.

Drugs causes gout are: Thiazide and loop diuretics, Low-dose aspirin, Ciclosporin & Pyrazinamide

P. falciparum, P. knowlesi and P. malariae have no persistent exoerythrocytic phase but recrudescence of fever may result from multiplication of parasites in red cells that have not been eliminated by treatment and immune processes

Chancroid usually starts as a small papule that rapidly becomes pustular and eventually ulcerates. The ulcer enlarges, develops ragged undermined borders, and is surrounded by a rim of erythema. Unlike syphilis, lesions are tender and the border of the ulcer is not indurated

Reference: Davidson 23rd; P-581

Mild falciparum malaria
Preferred therapy
• Co-artemether (CoArtem or Riamet); contains artemether and lumefantrine (4 tablets orally at 0, 8, 24, 36, 48 and 60 hrs)
Alternative therapy
• Quinine (600 mg of quinine salt 3 times daily orally for 5-7 days), together with or followed by doxycycline (200 mg once daily orally for 7 days)
Use clindamycin not doxycycline if the patient is a pregnant woman or young child
or
• Atovaquone-proguanil (Malarone, 4 tablets orally once daily for 3 days)
Pregnancy
• Co-artemether but avoid in early pregnancy
• If not using co-artemether, use quinine plus clindamycin (450 mg 3 times daily orally for 7 days)
Other regimens
• Artesunate (200 mg orally daily for 3 days) and mefloquine (1 g orally on day 2 and 500 mg orally on day 3)

Breast implant infection
Staphylococcus aureus
Coagulase-negative staphylococci
Peritoneal dialysis-related peritoniti
Staphylococcus aureus
Coagulase-negative staphylococci Coliforms
Pseudomonas spp.

Leprosy, also known as Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae. The disease affects the skin, the peripheral nerves, mucosal surfaces of the upper respiratory tract and the eyes.

Complications
 Laryngeal obstruction or paralysis
 Myocarditis  Peripheral neuropathy

Reference: Davidson 23rd, Box-13.12

Passive transfer of maternal antibodies: can mediate autoimmune disease in the fetus and newborn, including SLE, Graves' disease, and myasthenia gravis.

Persistent mild jaundice indicates Gilbert’s syndrome.
Jaundice with high fever and urinary complain indicates leptospirosis.
Recurrent jaundice with neurological abnormality—Wilson’s disease.

Explanation: Leptospirainterrogans persist indefinitely in the convoluted tubules of the kidney.

Investigations
1 to 5 days of fever : CBC, NS1 antigen, SGOT and SGPT (Not mandatory but helpful)
• After day7: IgM and IgG Antibodies (Day 5-7 window period)
• Follow up testing may be done on 1st afebrile day, but should be done daily when DHF is suspected
Haematocrit:
-A regular haematocrit is more important for management than the thrombocytopenia
-In severe dengue especially with shock hourly haematocrit is crucial for management

Foul smelling dark colored sputum: lung abscess
Rusty sputum: pneumococcal pneumonia.
Productive cough with frothy sputum occurs in pulmonary edema.
Barking cough: acute epiglottitis.

 The "steeple sign" refers to the narrowing of the subglottic trachea, resembling a church steeple, and is characteristic of croup (laryngotracheobronchitis). Davidson explains that croup is a viral respiratory illness, most often caused by parainfluenza viruses, and commonly affects young children. Harrison adds that the steeple sign is an important radiographic finding, though clinical diagnosis is usually sufficient.

Reference: Davidson 23rd; P-612

Davidson 23rd; P-1121

Vaginal discharge from endocervicitis is the most common presenting symptom of gonorrhea and is usually described as thin, purulent, and mildly odorous. Many patients have minimal or no symptoms from gonococcal cervicitis. Dysuria or a scant urethral discharge may be due to urethritis accompanying cervicitis.

Explanation: Neisseria gonorrhoeae is the most common organism causing urethritis

Explanation: please see question 45

Explanation: Syphilis is caused by infection, through abrasions in the skin or mucous membranes, with the spirochaete Treponema pallidum.

P. vivax and P. ovale may persist in liver cells as  dormant form hypnozoites capable of developing  into merozoites months or years later
Thus the first attack of clinical malaria may occur  long after the patient has left the endemic area, and  the disease may relapse after treatment with drugs  that only kill the erythrocytic stage of the parasite
P. falciparum, P. knowlesi and P. malariae have no  persistent exoerythrocytic phase but recrudescence  of fever may result from multiplication of parasites  in red cells that have not been eliminated by  treatment and immune processes

Mode of Transmission-Sexually from partner, Neonate  exposed to infected secretions in birth canal

The clinical features here are of fever in a patient at high risk of neutropenia. This is an oncological emergency. Patients are at risk of neutropenia at any point during their systemic anti-cancer therapy treatment cycle, with the highest risk typically 10–14 days after a treatment. In patients with potential neutropenic sepsis high-dose broad spectrum intravenous antibiotics should be commenced, ideally within 1 hour of admission, without awaiting test results. In this  should not delay the first dose of antibiotic therapy. Test results may later inform changes to antimicrobial therapy and its duration.

Dengue virus, which has 4 distinct  serotypes, i.e. DENV-1, DENV-2, DENV-3,  DENV-4 is transmitted by Aedes aegypti  and Aedes albopictus to human

  Signs
ØCoated tongue
ØRelative bradycardia
ØSplenomegaly ( Just Palpable)
ØCaecal gurgling

Reference: Davidson 23rd; P-612
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Indications of Colloid in Dengue
• Patients with massive plasma leakage
• Patients with shock with rising Hct.
• Those not responding to the maximum volume of crystalloid
• Those with pulse pressure < 10 mm Hg, who need urgent restore BP

Explanation: the most serious cause of viral encephalitis is herpes simplex which probably reaches the brain via the olfactory nerves. Varicella zoster is also an important cause.

Diethylcarbamazine (DEC)—6 mg/kg in three divided doses for 2 weeks

Explanation: ‘Koplik’s spots’ seen on buccal mucosa in the early stages of clinical measles, is pathognomonic for measles