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Sachi Parikh scp21@ic.ac.uk Slides adapte d from Prathe eshan Sabeshan Infectious Diseases 2 MedEd Y3 Written Exam Lectures 2025SESSION CONTENT 1. Meningitis 2. Infective Endocarditis 3. Gastroenteritis 4. Hepatitis 5. MalariaSESSION STRUCTURE Aetiology History Presentation Investigations Management SBA 1 (question) A 23-year-old university student presents to the emergency department with a high-grade fever, severe headache, and stiff neck. He reports feeling very fatigued over the past few days and has been experiencing vomiting and confusion. On examination, he has nuchal rigidity and positive Kernig and Brudzinski sign. His observations are as follows: temperature of 39.5°C, heart rate of 120 beats per minute, and blood pressure of 110/70 mmHg. A lumbar puncture is performed, revealing cloudy cerebrospinal fluid (CSF) with an opening pressure of 300 mmH2O. CSF analysis shows elevated white blood cell count (3000/µL) with neutrophil predominance, elevated protein (150 mg/dL), and low glucose (25 mg/dL). What is the most likely diagnosis? a) Subarachnoid haemorrhage b) Encephalitis c) Migraine d) Bacterial meningitis e) Viral meningitis SBA 1 (answer) A 23-year-old university student presents to the emergency department with a high-grade fever, severe headache, and stiff neck. He reports feeling very fatigued over the past few days and has been experiencing vomiting and confusion. On examination, he has nuchal rigidity and positive Kernig and Brudzinski sign. His observations are as follows: temperature of 39.5°C, heart rate of 120 beats per minute, and blood pressure of 110/70 mmHg. A lumbar puncture is performed, revealing cloudy cerebrospinal fluid (CSF) with an opening pressure of 300 mmH2O. CSF analysis shows elevated white blood cell count (3000/µL) with neutrophil predominance, elevated protein (150 mg/dL), and low glucose (25 mg/dL). What is the most likely diagnosis? a) Subarachnoid haemorrhage b) Encephalitis c) Migraine d) Bacterial meningitis e) Viral meningitisMeningitis Definition: inflammation of the meninges, caused by viral or bacterial infection, and marked by intense headache and fever, sensitivity to light, and muscular rigidity. Risk Factors: Aetiology: Explaining Big Hot Neck Stiffness • Young (Infants) + Old (65+) ➔ • E.coli, Group B streptococcus ➔ infants Impaired immunity • Haemophilus influenzae ➔ kids • Sickle cell disease • Neisseria meningitides(Gram –ve diplococci) • Ventriculoperitoneal shunt ➔ young adults • Cochlear implants • Streptococcus pneumoniae (Gram +ve cocci) ➔ older adultsMeningitis • Signs/Symptoms: • Classic triad: Fever, Headache + Neck Stiffness • Focal neurological signs e.g., hemiparesis + hemianopia • Kernig’s sign: flexing the thighs at the hip, and the knees, at 90-degree angles, and assessing whether subsequent extension of the knee is painful • Brudzinski’s sign: forced flexion of the neck elicits a reflex flexion of the hips. • Non-blanching, petechial rash – meningococcal septicaemiaMeningitis • Bloods: Two sets of blood cultures • Imaging: CT scan looking for brain CSF Analysis herniation exclude raised intracranial pressure (not routine) • Lumbar puncture: Send CSF for MC&S and Gram staining to confirm diagnosis • Avoid/Delay LP if: • signs of severe sepsis or a rapidly evolving rash • severe respiratory/cardiac compromise • significant bleeding risk Neutrophils = Bacterial vs Lymphocytes = Viral/TB • Signs of raised ICPMeningitis • Pre-hospital setting: Admit/call an ambulance + give IM benzylpenicillin (pre- hospital setting i.e. GP) • In Hospital: ABC approach • Stable: • IV Cefotaxime/Ceftriaxone (3 generation cephalosporin) ➔ 3 months to 50 years • IV Cefotaxime/Ceftriaxone + Amoxicillin/Ampicillin ➔ >50yrs • IV Dexamethasone – if pneumococcal suspected but not in septic shock or immunocompromised • Severe Sepsis: IV antibiotics + IV fluid resuscitation • If consciousness affected, consider IV acyclovir to cover encephalitis • Close contact prophylaxis (if within 1 week before onset) : rifampicin/ ciprofloxacin SBA 2 (question) A 72-year-old woman presents to the general practice complaining of neck stiffness and headache for the past two days. She has a past medical history of a migraine, but states that the headache feels different to a usual migraine attack. Her examination reveals a non-blanching rash on her body, and she has positive Kernig and Brudzinski’s sign. What is the most appropriate next step in the management of this woman? a) IV benzylpenicillin + call an ambulance b) IV ceftriaxone c) IM benzylpenicillin + call an ambulance d) IM ceftriaxone e) IV ceftriaxone and amoxicillin SBA 2 (answer) A 72-year-old woman presents to the general practice complaining of neck stiffness and headache for the past two days. She has a past medical history of a migraine, but states that the headache feels different to a usual migraine attack. Her examination reveals a non-blanching rash on her body, and she has positive Kernig and Brudzinski’s sign. What is the most appropriate next step in the management of this woman? a) IV benzylpenicillin + call an ambulance b) IV ceftriaxone c) IM benzylpenicillin + call an ambulance d) IM ceftriaxone e) IV ceftriaxone and amoxicillinMeningitis: Summary slide Aetiology: Examination: Investigations: Explaining Big ✶ Petechial rash ➔ ✶ Bloods: two sets of Hot Neck meningococcal blood cultures septicaemia ✶ Lumbar puncture: for Stiffness ✶ Focal CSF analysis Young (infants) neurological sign ✶ Avoid LP: severe and Old (65+) – ✶ Kernig’s sign sepsis, raised ICP, main risk factor ✶ Brudzinski’s sign developing rash History: Management: Complications: ✶ First line ✶ Sensorineural ClassicTriad: ✶ Non-blanching/Meningococcal: Admit/Call hearing loss Ambulance + IV/IM benzylpenicillin Fever, ✶ Stable: ✶ Seizures Headache + ✶ IV Cefotaxime/Ceftriaxone ➔ 3 months to 50 ✶ Waterhouse- years Friedrichsen Neck Stiffness ✶ IV Cefotaxime/Ceftriaxone + Amoxicillin/Ampicillin ➔ >50yrs Syndrome: adrenal ✶ IV dexamethasone – suspected pneumococcal haemorrhage 2ry to meningitis SBA 3 (question) A 40-year-old woman presents to the emergency department complaining of shortness of breath on the background of IV drug use. Cardiovascular examination reveals multiple petechial lesions on his palms and soles and on auscultation of the chest, a pansystolic murmur at the left sternal border is heard. An echocardiogram is done in order to get a better understanding of her presentation which shows the presence of vegetation on the valvular leaflet. What is the most likely cause of the murmur heard? a) Tricuspid regurgitation b) Mitral stenosis c) Aortic regurgitation d) Aortic stenosis e) Mitral regurgitation SBA 3 (answer) A 40-year-old woman presents to the emergency department complaining of shortness of breath on the background of IV drug use. Cardiovascular examination reveals multiple petechial lesions on his palms and soles and on auscultation of the chest, there is a pansystolic murmur heard loudest on inspiration. An echocardiogram is done in order to get a better understanding of her presentation which shows the presence of vegetation on the valvular leaflet. What is the most likely cause of the murmur heard? a) Tricuspid regurgitation Exam Tip (RILE): b) Mitral stenosis • Right-sided murmurs (Tricuspid/Pulmonary): c) Aortic regurgitation Loudest on INSPIRATION d) Aortic stenosis • Left-sided murmurs (Mitral/Aortic): Loudest e) Mitral regurgitation on EXPIRATIONInfective Endocarditis Definition: inflammation of the Aetiology endocardium as well as the valves that Staphylococci: separate each of the four chambers within • Staph aureus: most the heart common • Staph epidermis: <2 Risk Factors: hours of recent surgery • Valvular/heart disease • IV drug use Streptococci: • Valve replacement/prosthetic valves • Strep viridans: poor dentition/after dental • Long standing catheter procedure • Dental Work/Poor dentition • Strep bovis: colorectal • Immunodeficiency cancerInfective Endocarditis Signs/Symptoms: FROM JANE • Fever with sweats/rigors • Roth spots on fundoscopy – small flame shaped haemorrhage with white spot in the middle • New regurgitation murmur • Frequency: Mitral > aortic > tricuspid > pulmonary • Tricuspid ➔ associated with IV drug use • Finger clubbing (remember for cardio OSCE) • Splenomegaly due to splenic artery occlusion • Hands: • Splinter Haemorrhages • Osler nodes: painful, red-purple, slightly raised, tender lumps, often with a pale centre; Osler ➔ Ouch • Janeway lesions: non-tender, often haemorrhagic and occur mostly on the palms and soles on the thenar and hypothenar eminencesInfective Endocarditis Investigations: • Routine Bloods: FBC ➔ high neutrophils, normocytic anaemia; Raised ESR + CRP • ECG: lengthened PR interval ➔ aortic abscess • 3 blood cultures: 1 hr apart, WITHIN 24 HOURS • Urgent transthoracic echocardiogram (Transoesophageal: if prosthetic valve): • Looking for valvular abscess/vegetation • Modified Duke’s Criteria: BE TIMER • Definitive: TWO MAJOR or ONE MAJOR + THREE MINOR or FIVE MINOR • Possible: ONE MAJOR + MINOR or THREE MINORInfective Endocarditis Management: • Antibiotics: • Refer to cardiology + infectious Situation Suggested Antibiotics diseases/microbiologist for treatment Initialblind therapy Native: Amoxicillin • Empirical antibiotics then targeted Prosthetic: Vancomycin + antibiotics aftersensitivity rifampicin + low-dose • DON’T LEARN SPECIFIC ANTIBIOTICS ➔ table on the right forinterest gentamicin • Surgery: Staphylococci Native: Flucloxacillin • Severe valvularincompetence Prosthetic: Flucloxacillin + rifampicin + low-dose • Aortic abscess ➔ lengthened PR interval gentamicin • Recurrent emboli after antibiotic therapy Streptococci Native: Benzylpenicillin • Poor prognosis if: Prosthetic: Benzylpenicillin + • Staphylococcus aureus infection low-dose gentamicin • Prosthetic valve • Low complement levels SBA 4 (question) A 42-year-old man presents to the general practice complaining of chest pain and shortness of breath for the past two weeks. He has a past medical history of mitral valve prolapse and states that recently he underwent a tooth extraction. Cardiovascularexamination reveals multiple splinter haemorrhages and on auscultation of his chest, he has a mitral regurgitation murmur. His observations are as follows: temperature 38.5°C, heart rate 96 beats per minute, blood pressure 125/82mmHg, respiratory rate 16 breaths per minute and a GCS of 15. Based on the likely diagnosis, what is the most likely causative organism? a) Staphylococcus aureus b) Pseudomonas aeruginosa c) Streptococcus viridans d) Candida albicans e) Streptococcus bovis SBA 4 (answer) A 42-year-old man presents to the general practice complaining of chest pain and shortness of breath for the past two weeks. He has a past medical history of mitral valve prolapse and states that recently he underwent a tooth extraction. Cardiovascularexamination reveals multiple splinter haemorrhagesand on auscultation ofhis chest, he has a mitral regurgitation murmur. His observations are as follows: temperature 38.5°C, heart rate 96 beats per minute, blood pressure 125/82mmHg, respiratory rate 16 breaths per minute and a GCS of 15. Based on the likely diagnosis, what is the most likely causative organism? a) Staphylococcus aureus ➔ most common b) Pseudomonas aeruginosa c) Streptococcus viridans d) Candida albicans e) Streptococcus bovis ➔ colorectal cancerInfective Endocarditis: Summary slide Aetiology: Management: Staph aureus – most common Risk Factors: ✶ First line – Refer to cardiologist/infectious cause • Valvular/heart disease diseases ➔ empirical then targeted Strepviridans– poor • IV druguse dentition/dental procedure • Valve Staph epidermis- <2 months of replacement/prosthetic ✶ Surgery: Severe valvular incompetence,Aortic surgery • Long standing catheter abscess Recurrent emboli after antibiotic therapy Strepbovis – colorectal cancer • DentalWork/Poor dentition Examination: FROM JANE Investigations: BETIMER Complications: ✶ Stroke ✶ PE ✶ Congestive HF SBA 5 (question) A 30-year-old male presents to the emergency department complaining of severe diarrhoea, abdominal cramps, and nausea. He reports that he had eaten a meal of undercooked chicken at a restaurant the previous night. On physical examination, he is dehydrated, and his abdomen is tender on palpation. Stool studies reveal leukocytes and occult blood. What is the most likely causative organism of this patient's gastroenteritis? A) Vibrio cholerae B) Escherichia coli C) Shigella dysenteriae D) Norovirus E) Salmonella enterica SBA 5 (answer) A 30-year-old male presents to the emergency department complaining of severe diarrhoea, abdominal cramps, and nausea. He reports that he had eaten a meal of undercooked chicken at a restaurant the previous night. On physical examination, he is dehydrated, and his abdomen is tender on palpation. Stool studies revealleukocytes and occult blood. What is the most likely causative organism of this patient's gastroenteritis? A) Vibrio cholerae B) Escherichia coli C) Shigella dysenteriae D) Norovirus E) Salmonella enterica ➔ undercooked chickenGastroenteritis Definition: Inflammation of the Signs/Symptoms: gastrointestinal tract caused by pathogens • Sudden-onset diarrhoea (>3 movements/day) Risk Factors: • Blood/mucus in the stool • Ingestion of contaminated food/water • Faecal urgency • Poor personal hygiene • Nausea/ Vomiting • Travel • Abdominal pain or cramps • Headache Main presentation types: • Myalgia • Travellers’ diarrhoea: three loose/watery • Bloating stools in 24 hours +/- abdominal cramps, • Weight loss fever, blood in stool (Enterotoxigenic • Dry mucous membranes/reduced skin E.coli ➔ most common) turgor ➔ DEHYDRATION • Food Poisoning: sudden onset nausea, • Malabsorption vomiting and diarrhoea after foodGastroenteritis Viral Causes: Bacterial Causes: BLOODY ➔ CHESS • Presentation: Asymptomatic OR watery, non-bloody diarrhoea • Norovirus (most common) - all ages • Rotavirus - Primarily in young children <5 years • Enteric Adenovirus - Young children. Long periods of diarrhoea. (>12 days) • Cytomegalovirus - Immunosuppressed; Colitis with ulcerationGastroenteritisGastroenteritis Investigations: Management: • Routine Bloods: Raised CRP , elevated • No systemic signs: Bed rest, fluids and leucocytes electrolyte replacement with oral • Renal function and electrolytes: rehydration solution (glucose + salt) Impaired renal function ➔ • Systemic signs/Dehydration/High Haemolytic uraemic syndrome Fever/Symptoms > 2 weeks: Admit and • Stool MC+S (GOLD STANDARD): give oral fluids + Antibiotics if infective • Bacterial pathogens organism identified ➔ Antibiotic • Ova cysts therapy is contraindicated for • Parasites enterohemorrhagic E. coli. It may increase the risk of or worsen HUS. SBA 6 (question) A 32-year-old woman presents to the general practice complaining of abdominal pain, watery diarrhoea, and persistent vomiting for the past 24 hours. She reports feeling weak and dehydrated and reports a low-grade fever. She denies any recent travel or exposure to sick contacts. Upon examination, she appears lethargic andabdominal examination reveals diffuse tenderness, hyperactive bowel sounds, and no guarding or rebound tenderness. Her stool is positive for faecal leukocytes. What is the most appropriate management for this woman? A) IV fluids + IV antibiotics B) Bed rest and oral rehydration solution C) Bed rest, oral rehydration and antibiotics D) Call an ambulance and admit to hospital E) Refer to a gastroenterologist for further investigation SBA 6 (answer) A 32-year-old woman presents to the general practice complaining of abdominal pain, watery diarrhoea, and persistent vomiting for the past 24 hours. She reports feeling weak and dehydrated and reports a low-grade fever. She denies any recent travel or exposure to sick contacts. Upon examination, she appears lethargic and abdominal examination reveals diffuse tenderness, hyperactive bowel sounds, and no guarding or rebound tenderness. Her stool is positive for faecal leukocytes. What is the most appropriate management for this woman? A) IV fluids + IV antibiotics B) Bed rest and oral rehydration solution ➔ no signs of systemic upset/severe disease C) Bed rest, oral rehydration and antibiotics D) Call an ambulance and admit to hospital E) Refer to a gastroenterologist for further investigationGastroenteritis: Summary slide Aetiology: Signs/Symptoms: Investigations: Definition: Inflammationof the • Routine Bloods: Raised CRP, elevated gastrointestinal tract caused by • Travellers’ diarrhoea: three leucocytes pathogens loose/watery stools in 24 hours +/- • Renal functionandelectrolytes: abdominal cramps, fever, blood in stool Impaired renal function ➔ Haemolytic Risk Factors: (Enterotoxigenic E.coli ➔ most uraemicsyndrome • Ingestion of contaminated common) • Stool MC+S (GOLDSTANDARD): food/water • Bacterial pathogens • Poor personal hygiene • Food Poisoning: sudden onset nausea, • Travel vomiting and diarrhoea after food • Ova cysts • Parasites History: CHESS Management: • No systemic signs: Bed rest, fluids and electrolyte replacement with oral rehydration solution (glucose + salt) • Systemic signs/Dehydration/High Fever/Symptoms > 2 weeks: Admit and give oral fluids + Antibiotics if infective organism identified SBA 7 (question) A 45-year-old man presents to the GP with a three-week history of fatigue, nausea, and abdominal discomfort. His symptomshave been gradually worsening, and he reports increasing tiredness. He has a history of IV drug use and unprotected sex, but no recent travel or known sick contacts. On examination, he appearstired with slightly yellowsclerae. Blood tests show mildly elevated ALT and AST. What is the most likely diagnosis? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D E) Hepatitis E SBA 7 (question) A 45-year-old man presents to the GP with a three-week history of fatigue. His symptoms have been gradually worsening, and he reportsincreasing tiredness. He has a history of IV drug use and unprotected sex, but no recent travel or known sick contacts. On examination, he appears tired with slightly yellowsclerae. Blood testsshow mildly elevated ALT and AST. What is the most likely diagnosis? A) Hepatitis A ➔ hepatomegaly+ Hep A is usually contaminated food B) Hepatitis B ➔ more acute onset, high fever, marked jaundice C) Hepatitis C D) Hepatitis D➔ only occurs as a co-infection with Hep B E) Hepatitis E ➔ no travel HxHepatitis Hepatitis A Hepatitis B Hepatitis C Incubation: 2-4 weeks Incubation: 6-20 weeks Incubation: 6-9 weeks Transmission: Faecal-Oral Transmission: Infected Blood/Body Transmission: Blood-Blood route i.e., contaminated food Fluids i.e., Contaminated needles, route i.e., IVdrug users (Hepatitis A+E ➔ Faecal) mother to baby (vertical transmission) Features: Asymptomatic Features: Features: Fever + Jaundice + Elevated primarily; can present with • flu-like prodrome ALT/AST transient rise in ALT/AST, • abdominal pain: typically, Management: acute ➔ supportive; fatigue and arthralgia right upper quadrant chronic ➔ Pegylated interferon-alpha; Management: acute ➔ • tender hepatomegaly vaccination (part of routine supportive; chronic ➔ DAA • jaundice immunization for children born in the (directly acting antivirals) e.g., • deranged liver function UK) Sofosbuvir/Daclatasvir +/- tests Complications: ribavirin Management: Self-limiting Chronic Hepatitis B (“Ground-Glass Complications: Chronic disease ➔ SUPPORTIVE Hepatocytes), liver failure Hepatitis C, Hepatocellular THERAPY; avoid alcohol CarcinomaHepatitis TOP SEROLOGY TIPS: • HbSAg: • 1-6months= ACUTE • >6 months = CHRONIC • Anti HBs = immunity • Anti-HBc = previous/current infection Therefore: • Vaccinated: ONLY anti-HBs +ve • Previous hep B, not a carrier: anti-HBc and anti HBs +ve • Previous hep B + carrier: anti-HBc + HBsAg +Ve SBA 8 (question) A 43-year-old homelessman presents to the emergency department complaining of “yellow skin” and fever for roughly one week and are accompanied by muscle and joint pains, along with mild abdominal discomfort. He has been an intravenousdruguser for 2 yearsand drinks15unitsof alcoholper week. On examination, he appears clinically jaundiced and reveals mild hepatomegaly. Blood test show markedly elevated liver transaminases and tests for hepatitis B serology results are obtained as follows: HBsAg positive Anti-HBs negative IgM anti-HBc positive What is the most likely diagnosis? A) Hepatitis C infection B) Previous hepatitis B vaccination C) Chronic hepatitis B infection D) Acute hepatitis Binfection E) Alcoholic liver disease SBA 8 (answer) A 43-year-old homelessman presents to the emergency department complaining of “yellow skin” and fever for roughly one week,which are accompanied by muscle and joint pains, alongwith mild abdominal discomfort. He has been an intravenous drug user for 2yearsand drinks 15 units of alcohol perweek. On examination, he appears clinically jaundiced and reveals mild hepatomegaly. Blood test show markedly elevated liver transaminases and tests for hepatitis B serology results are obtained as follows: HBsAg positive Anti-HBs negative IgM anti-HBpositive What is the most likely diagnosis? A) Hepatitis C infection B) Previous hepatitis B vaccination C) Chronic hepatitis B infection D) Acute hepatitis B infection ➔ HBsAgpositive, anti-HBs negative, IgM anti-HBc positive - acute infection E) Alcoholic liver disease SBA 9 (question) A 28-year-old woman presents to the general practice with a history of fever and dark urine for the past five days. She reports having chills, headache, and body aches. She has a history of traveling to West Africa three weeks ago. On physical examination, her temperature is 39.2°C, and her spleen is palpable on abdominal examination What is the most likely organism causing this woman’s presentation? A) Plasmodium ovale B) Plasmodium vivax C) Plasmodium falciparum D) Plasmodium knowlesi E) Plasmodium malariae SBA 9 (answer) A 28-year-old woman presents to the general practice with a history of fever and dark urine for the past five days. She reports having chills, headache, and body aches. She has a history of traveling to West Africa three weeks ago. On physical examination, her temperature is 39.2°C, and her spleen is palpable on abdominal examination What is the most likely organism causing this woman’s presentation? A) Plasmodium ovale B) Plasmodium vivax C) Plasmodium falciparum ➔ dark urine ➔ blackwater fever (SEVEREMALARIA) D) Plasmodium knowlesi E) Plasmodium malariaeMalaria Definition: Infection of the RBCs by plasmodium Aetiology: parasites; spread by female Anopheles mosquito • 80%: plasmodium falciparum ➔ severe malaria Epidemiology: Endemic in tropics • 20%: plasmodium vivax (most common), plasmodium ovale + plasmodium malariae ➔ “benign malaria” Protective Factors: • Sickle cell anaemia • G6PD Deficiency • HLA-B53 (common in western Africa)Malaria General signs/symptoms: Malaria Life Cycle (DON’T LEARN) • Fever, headache, splenomegaly • Myalgia/Arthralgia Falciparum malaria signs/symptoms: • Temperature > 39 °C • Severe anaemia ➔ intravascular haemolysis can lead to dark urine (blackwater fever) • Schizonts on blood film Non-falciparum malaria signs/symptoms: • Plasmodium vivax/ovale: cyclical fever every 2 days • Plasmodium malariae: cyclical fever every 3 days and associated with nephrotic syndromeMalaria Gold Standard Investigation: Giemsa-stained thick and thin blood smears • Thick – detects parasites present ((higher sensitivity) – can be negative in pregnancy • Thin – identifies species (higher specificity) Management: • Uncomplicated: Chloroquine/Artemisinin combination therapy (ACT) (Avoid ACT in pregnancy) • Complicated/Severe: IV artesunate (can cause haemolysis so monitor with blood tests)Malaria: Summary slide Aetiology: Investigations: Definition: Infection of the RBCs by Gold Standard Investigation: plasmodium parasites; spread by female Giemsa-stained thick and thin Anopheles mosquito blood smears Aetiology: • Thick – detects parasites • 80%: plasmodium falciparum ➔ severe malaria present ((higher sensitivity) – can be negative in pregnancy • 20%: plasmodiumvivax (most common), plasmodium • Thin – identifies species ovale + plasmodiummalariae ➔ “benign malaria (higher specificity Signs/Symptoms Management: Complications: General signs/symptoms: Fever, headache, splenomegaly, myalgia, arthralgia • Uncomplicated: Chloroquine/Artemisinin Falciparum malaria signs/symptoms: combination therapy (ACT) • Temperature > 39 °C ✶ Coma • Severeanaemia ➔ blackwater fever (AvoidACT in pregnancy) ✶ Cerebral Malaria • Complicated/Severe: IV Non-falciparum malaria signs/symptoms: artesunate (can cause ✶ Renal Failure • Plasmodium vivax/ovale: cyclical fever every2 days haemolysis so monitor with • Plasmodium malariae: cyclical fever every3 days blood tests)COVID-19: Summary slide Aetiology: Investigations: Differentials: A potentially severe acute • RT -PCR: +ve for SARS-CoV2 by the novel coronaviruseumonia viral DNA severe acute respiratory coronavirus 2 (SARS-CoV-2). • Pulse oximetry: Low O 2 Influenza saturation if moderate/severe SARS-CoV-2 attaches to • Routine Bloods: ACE2 receptor on target host cells.ACE2 is highly • CXR/Chest CT: Ground expressed in upper and lower Cold glass opacity + consolidation myocardial, renal epithelial, enterocytes and endothelial cells of multiple organs.agement: Complications: History: ✶ ARDS ✶ Mild/Moderate COVID-19: Bed rest, paracetamol, • Dyspnoea ibuprofen, maintain hydration, monitor2O saturation • Fever ✶ Severe COVID-19: Hospital admission. Oxygen ✶ Thrombosis (due to • Cough therapy,VTE prophylaxis, dexamethasone, remdesivir, hypercoagulable state) • Headache IL-6 inhibitor e.g., tocilizumab or Janus kinase (JAK)✶ Post COVID-19 • Altered smell inhibitor e.g., baricitinib, consider ICU admission for and taste ventilation/ECMO syndrome (long COVID) • GI disturbancesSurgical Site Infection: Summary slide Aetiology: Risk Factors: • Surgical site infections (SSI) may occur • Shaving the wound using a razor (disposable clipper following a breach in tissue surfaces and allow preferred) normal commensals and other pathogens to • Using a non-iodine impregnated incise drape if one is initiate infection. deemed to be necessary • SSI comprise up to 20% of all healthcare- associated infections and at least 5% of • Tissue hypoxia patients undergoing surgery will develop an • Delayed administration of prophylactic antibiotics in SSI as a result. tourniquet surgery Management/Prevention: Pre-operatively: Intraoperatively: • Don't remove body hair routinely • If hair needs removal, use electrical clippers with a single-usePrepare the skin with alcoholic chlorhexidine head (razors increase infection risk) (Lowest incidence of SSI) • Antibiotic prophylaxis if: • Cover surgical site with dressing • Supplementary oxygen does not reduce • placement of prosthesis or valve • clean-contaminated surgery the risk of wound infection • contaminated surgery • Wound edge protectors do not appear to • Aim to give single-dose IV antibiotic on anaesthesia confer benefit • If a tourniquet used ➔ prophylactic antibiotics earlierBrainAbscess: Summary slide Aetiology: Examination: Investigations: Brain abscess is a suppurative collection of• Positive Kernig microbes withina gliotic or Brudzinski capsule occurring within the brainparenchyma. sign • Increased head Risk Factors: circumference • Sinusitis • Otitis Media (infants) • Meningitis • Papilloedema History: Management: Complications: • Headache: often dull, • First line – surgery persistent • Fever: may be absent • a craniotomy is performed, and the abscess cavity and usually not the debrided swinging pyrexia seen • the abscess may reform because the head is ✶ Seizures withabscesses at other ✶ Hydrocephalus sites closed following abscess drainage. ✶ Hyponatraemia • focal neurology e.g., • IV antibiotics: IV 3rd-generation cephalosporin + oculomotor nerve palsy metronidazole ✶ Ventriculitis or abducens nerve palsy secondary to raised • intracranial pressure management: e.g., ICP. dexamethasoneTHANK YOU FOR COMING! 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