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Um So today's lecture is on infectious diseases. Uh My name is Si and my email is on the slide. If you have any questions after this session, feel free to email me. Um And the session uses slides originally made by pre a few years ago. Um So we're gonna cover these five conditions. Um meningitis, infective, endocarditis, gastroenteritis, hepatitis, and malaria. And it will follow a similar structure to the previous sessions. Um We'll be running through some high infection um cases using case based single best answer questions and then going through the relevant content after. Um So to start off with SBA one, I'll give you around 30 40 seconds to read it yourself and feel free to put in an answer into the chat. Um If you think of one. Yeah, great. So we have an answer in the chat. Um It's correct. The answer is deep. Um So as you correctly identified, this is a case of classic bacterial meningitis. The student has a fever, headache, neck, uh stiff neck and signs of meningeal irritation such as a positive Koenig's and BRS bruzin signs. Um So the lumbar puncture itself shows elevated neutrophils, high protein and low glucose, which will go through why they all indicate Lumb bacterial meningitis. Um So, as you correctly identified, the answer is d um so what is meningitis? Meningitis is inflammation of the meninges. And this is usually due back to bacterial or viral infection. And high risk groups include infants, elderly people, um immunocompromised. Um and also include people who have sickle cell disease, um who may have shunts or cochlear implants and a good way of trying to remember the causes. So, the bacterial causes uh of meningitis is the pneumonic explaining big hot neck stiffness. Um So, E for E Coli B for group B, streptococcus, both of which are seen in infants most commonly. The next the H is for hemophilia influenza which is commonly seen in um Children or kids. Um The N is for Neisseria meningitidis um which is a gram negative dip occi, which might be important to know if um your med school likes to put in patho patho pathology in the question stamps. And the S is for streptococcus pneumoniae which is a gram positive cocci. Um And you see this is in older adults. So, signs and symptoms, you'll see the classic triad of fever, headache and neck stiffness. Um and other important signs include chronic signs. So this is when you flex the thigh at the hip and the knees at a 90 degree angle, probably better understand by the diagram on the right hip. Um And then you assess whether there is pain when there's extension of the knee. Whereas Brudzinski sign, you probably see better on the diagram. On the right hand side is when there's forced flexion of the neck um of the patient. And then that elicits a reflex hip flexion. So the hips go up essentially. Um and that's the positive prudens sign and both of these are specific for meningitis. Um You might also see focal neurological signs. So, hemiparesis or hemianopia um and a non blanching rash in a patient may suggest meningo meningococcal re septicemia, which can occur alongside meningitis. Um So this is when the Neisseria meningitis, meningitis, bacteria enters the bloodstream and spreads throughout the body. Um So this can cause symptoms such as cold hands or feet, um limb pain and also like the classic purple rash. Um and it can lead to um organ failure and death a lot faster than meningitis alone. Um But it can often occur alongside meningitis. So it's something to be aware of. Um but unlike meningitis, it primarily affects the circulatory system rather than the brain and the spinal cord lining. Um So, in terms of investigations, you wanna be doing two sets of blood cultures and a head ct if there are signs of raised intracranial pressure, lumbar pressure, lumbar puncture is diagnostic, sorry. Um And you can see that there's a table on the right, which shows like how the analysis of CSF can differ between bacterial viral and T TB caused meningitis um to simplify the table further. If essentially, if white cells are present in the CSF um and are neutrophils, it's more likely to be bacterial meningitis. But if they are lymphocytes in origin, then the infection is most likely caused due to a virus or to TB. Um But I would recommend having a look at the slides in the catch up content later for sure. Um You also wanna avoid or delay during a lumbar puncture. If the patient has severe signs of sepsis or a rapidly evolving rash, if they have severe respiratory cardiac compromise, um significant bleeding or signs of a raised eye, um intracranial pressure. Um So, always look out in the question stamp for any of those signs in terms of treatment. Um Firstly, if there is a non blanching rash or any suspicion of meningococcal septicemia, this is a medical emergency. Um If you're suspecting either meningococcal septicemia or meningitis. Um The first thing you wanna do is admit um the patient or call an ambulance. Um And if you're in an appropriate um prehospital setting, such such as the GP, you wanna give the patient im benzylpenicillin. Um Next, once the patient is in hospital, you follow the ABC approach, airways breathing circulation to stabilize them first, then once they're stabilized, if um they're an adult um or a child, if they're a patient from three, who are aged three months to 50 years, um you wanna give them IV cefotaxime or cefTRIAXone, um which is a third generation cephalosporin. However, if they're over 50 years old, they might be at increased risk of the meningitis being caused by listeria. So you wanna add IV ampicillin or amoxicillin just to cover um a possible case of Listeria. Um You may also wanna consider giving IV dexamethasone. Um And that's if pneumococcal um uh meningitis is suspected but the patient must not be in shock or immunocompromised. In which case, you do not give them IV dexamethasone. If someone is in severe septic uh shock or severely immunocompromised, um you escalate and you give IV antibiotics and you give IV fluid resuscitation. Um if their consciousness is affected, um you may also want to consider IV acyclovir just to cover the possibility of them having encephalitis. Now, we've talked about what you do to treat the patients um who may have meningitis, but it's also um important to consider any close contacts. So for any co close contacts and that tends to be defined as anyone that they were exposed to within around a week. Um before the onset of meningitis, you wanna give prophylactic antibiotics to these people. Um And this tends to be rifAMPin or ciprofloxacin and this essentially reduces the transmission risk. Ok? Um Moving on to SBA two. So this is just consolidating the information. Um I mentioned earlier, I'll give you around 30 seconds um to have a go at this. Ok, great. Um Some of you already got it and the correct answer is c so as we just discussed earlier, um So this is an out of hospital setting um with a patient who has suspected meningitis. So the first thing you wanna do is give them im Benzyl penicillin and amoxicillin, so well done guys. Um This is just a summary slide. Um So in the catch up content, feel free to have a look at it later. Um Moving on to SS BA three and I'll give you 30 seconds or so. Ok. Um So you guys got it. So it's a um so this is a pretty, it's a bit of a harder question, but it's a classic case of infective endocarditis in an IV drug user. Um.