Click to edit Master title style

• Click to edit Master text styles

• Second level
• Third level
MICROBIOLOGY PART- 1
• Fourth level
• Fifth level
DR HAMZA RIZWAN
FCPS (EMERGENCY MEDICINE)
MRCEM-PRIMARY

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Click to edit Master title style
• Click to edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
INFECTIONS

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Click toEpiglottitis
Acute edit Master title style
• Click Agents
Infective to edit Master text styles
• • Haemophilus
• Second level
influenzae type b
Clinical Features
• Third level
• High fever • Fourth level
• Fifth level
• Stridor
• Painful throat causing child to drool saliva and be reluctant to talk, eat or drink
Complications
• Bacteraemia
• Airway obstruction
Diagnosis
• Clinical
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 Click to edit Master title style
Treatment
• Senior support
• Airway management
• •Antibiotic
Click totherapy
edit Master text styles
• Second
• Cefotaxime (or level
ceftriaxone) first line
• Third level
• Chloramphenicol if history of immediate hypersensitivity to penicillin
• Fourth level
• Fifth level

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Click toOTITIS
ACUTE edit Master
MEDIAtitle style
Acute otitis media is an inflammation in the middle ear associated with effusion and accompanied
by an ear infection.
• Click to edit Master text styles
Infective Agents
• Second level
Viral (> 50% of cases)- Respiratory syncytial virus (RSV), Rhinovirus
• Third level
Bacterial • Fourth level
• Haemophilus influenzae
• Fifth level
• Streptococcus pneumoniae
• Moraxella catarrhalis
• Clinical Features
• Pain in affected ear - pulling, tugging or rubbing of ear
• Fever
• Irritability, crying, poor feeding

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Click to edit Master title style
• Click to edit
Complications Master text styles
• Rupture
• Second
of tympanic
level membrane with pus discharge
• Hearing• loss
Third level
• Fourthmeningitis,
• Rarely mastoiditis, level intracranial abscess, sinus thrombosis, facial nerve paralysis
• Fifth level
Diagnosis
• Clinical or microscopy, culture and sensitivity of specimen

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 Click to edit Master title style
Treatment
• Antibacterial therapy should be offered to children with acute otitis media who are systemically
very unwell, have signs and symptoms of a more serious illness, or those who are at high-risk of
•serious
Click complications
to edit Master due to text stylescomorbidities. Antibacterial therapy should also be
pre-existing
considered if otorrhoea (discharge following perforation of the eardrum) is present, or in children
• Second
under level
2 years of age with bilateral otitis
• Third are
When antibiotics levelindicated:
• Fourth level
• Amoxicillin first line (suggested
• Fifth level duration of treatment 5 days)
• Consider co-amoxiclav if worsening symptoms despite 2 - 3 days of treatment
• If penicillin allergic, clarithromycin or erythromycin

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 Click toTONSILLITIS
ACUTE edit Master title style
• Tonsillitis is inflammation due to infection of the tonsils. It is a very common condition, most frequent in
children aged 5 - 10 years and young adults between 15 - 25 years.
• Click
Clinical to
Features edit Master text styles
• Patients
• may complain
Second of pain in the throat, pain on swallowing, pain referred to the ears, headache and a high
level
temperature. Nausea, vomiting, and abdominal pain are common in children. On examination, the throat is red,
the tonsils •areThird level
swollen and may be coated or have white flecks of pus on them (exudative). Patients are usually
pyrexial and may • have swollen
Fourth level and tender anterior cervical glands.
Causes • Fifth level
• The most common bacterial cause of tonsillitis is group A beta-haemolytic streptococcus (GABHS), also called
Streptococcus pyogenes (15 - 30% of sore throats in children and 10% in adults).
Common viral causes of a sore throat include:
• Rhinovirus, coronavirus, parainfluenza virus: the common cold (25% of sore throats)
• Influenza types A and B: influenza
• Adenovirus: pharyngoconjunctival fever (4% of sore throats)
• Epstein-Barr virus: infectious mononucleosis (< 1% of sore throats)

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 Click to
Investigations
edit Master
• Investigations are not performed routinely.
title style
Management
• •Pain
Click
and to edit
fever Master
should text
be treated styles
with paracetamol or an NSAID such as ibuprofen. In most patients,
no or
• delayed
Secondantibiotic
level prescribing is recommended. Sore throat due to a viral or bacterial cause is
a self-limiting condition. Symptoms resolve within 3 days in 40% of people, and within 1 week in
• Thirdirrespective
85% of people, level of whether or not the sore throat is due to a streptococcal infection
• Fourth level
• Fifth level

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 Click to edit Master title style
The NICE guidelines suggests that indications for immediate antibiotics include:
• Features of marked systemic upset secondary to the acute sore throat
• Unilateral peritonsillitis
• •AClick
historyto edit Master
of rheumatic text
fever or styles
valvular heart disease
• Secondrisk
• An increased level
of severe infection or developing complications (such as a child with diabetes
mellitus•orThird
immunodeficiency)
level
• Fourth level
• Fifth level

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• Acute tonsillitis with three or four Centor criteria present (i.e. likely bacterial infection)
Click to edit Master title style
• The likelihood of the presence of bacterial infection is based on the Centor Criteria:
• History of fever
•• Tonsillar
Click to edit
exudate Master text styles
• No •cough
Second level
Tender •anterior cervical lymphadenopathy
Third level
• Patients with
• one or level
Fourth none of these criteria are unlikely to have GABHS. Consideration of antibiotic
prescription should be limited
• Fifth level to patients with three or four criteria.
• If antibiotics are to be used, first line is a 10 day course of phenoxymethy|penicillin. Ambxicillin or
ampicillin should be avoided if there is a possibility of glandular fever. If penicillin-allergic, a 5 day
course of clarithromycin is recommended.

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 Click to edit Master title style
Complications of streptococcal pharyngotonsillitis include:
Local extension
• Otitis media
• Acute sinusitis
• Click to edit Master text styles
• Peritonsillar abscess (quinsy)
• Second
• Peritonsillar level
cellulitis
• Third abscess
• Parapharyngeal level
• Fourth
• Retropharyngeal level
abscess
• Fifth level
• Mastoiditis
• Streptococcal pneumonia
Systemic
• Metastatic infection (e.g. brain abscess, endocarditis, meningitis, osteomyelitis or liver abscess)
• Streptococcal toxic shock syndrome
• Scarlet fever
• Rheumatic fever
• Post-streptococcal glomerulonephritis

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Click to edit Master title style
CELLULITIS
Infective Agents
• Staphylococcus aureus (including MRSA)
•• Click to edit
Streptococcus Master text styles
pyogenes
• Secondaeruginosa
• Pseudomonas level
• Gram-negative
• Thirdcoliforms
level (immobile patients)
Risk Factors • Fourth level
• Pre-existing skin conditions e.g. eczema
• Fifth level
• Skin wound e.g. burn, insect bite, cannula insertion site
• Peripheral vascular disease
• Diabetes mellitus
Treatment
• Erysipelas- Phenoxymethy|penicillin or benzylpenicillin
• If severe infection, replace phenoxymethy|penicillin or benzylpenicillin with high-dose flucloxacillin
• Suggested duration of treatment at least 7 days
• If penicillin-allergic, clindamycin or clarithromycin (or azithromycin or erythromycin)

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Click to edit Master title style
• ClickDisease
Clinical to edit Master text styles
• Cellulitis
• Second level
• Erythematous
• Third (indistinct
level margins), swollen, painful lesion that spreads, typically occurring on the
limbs. • Fourth level
Erysipelas • Fifth level
• Appears similar to cellulitis but the border is distinct and is typically on the face, shin or foot
Diagnosis
• Clinical diagnosis
• Swab lesions for M, C & S
• Blood cultures

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 Click to edit Master
Cellulitis- High-dose flucloxacillin
title style
• If streptococcal infection confirmed, replace flucloxacillin with phenoxymethylpenicillin or
benzylpenicillin
• •If Gram-negative
Click to editbacteria
Master text styles
or anaerobes suspected, use broad-spectrum antibacterials
• If penicillin-allergic,
• Second level clindamycin or clarithromycin (or azithromycin or erythromycin) or vancomycin
(or teicoplanin) |
• Third level
Animal/human•bite (forlevel
Fourth both prophylaxis and treatment of infected bite wound)
Cleanse wound thoroughly.
• Fifth level
• For tetanus-prone wound, give human tetanus immunoglobulin (with a tetanus-containing vaccine
if necessary, according to immunisation history and risk of infection).
• Consider rabies prophylaxis for bites from animals in endemic countries.
• Assess risk of blood-borne viruses (including HIV, hepatitis B and C) and give appropriate prophylaxis
to prevent viral spread.
• First line: Co-amoxiclav
• If penicillin-allergic, doxycycline + metronidazole

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Click to editENCEPHALITIS
INFECTIVE Master title style
• Encephalitis is inflammation within the substance of the central nervous system.
• Click to
Infective edit Master
Agents text styles
• Herpes
• Second
simplex virus (most common cause)
level
Temporal lobe is most frequently affected
• Third level
• Varicella zoster virus
• Fourth level
• Fifth level
• Cytomegalovirus
Clinical Disease
• Fever
• Headache
• Neck stiffness
• Impaired consciousness, Focal neurological signs
• Seizures

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Click to edit Master title style
• Click to
Diagnosis edit Master text styles
• Lumbar
• Second
puncture
level
• encephalitis
• Thirdleads
level to a lymphocytosis with normal CSF/plasma glucose ratio
• Blood FBC,• biochemistry,
Fourth level film, serology and cultures
• Fifth level
• CT/MRI head may demonstrate focal lesions
• EEG
Treatment
• • Treatment of herpes simplex encephalitis is with intravenous aciclovir

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Click to editENDOCARDITIS
INFECTIVE Master title style
Infective Agents
Bacteria
• Click to edit Master text styles
• Staphylococcus aureus (intravenous drug use, indwelling vascular catheters, prosthetic or native
• Second level
valves)
• Third level
• Coagulase-negative Staphylococcus spp. (Neonates, prosthetic heart valves)
• Fourth level
• Alpha-haemolytic streptococci
• Fifth level (dental conditions or procedures)
• Streptococcus agalactiae
• Enterococcus spp. (gastric surgery or pathology)
HACEK organisms:
• Haemophilus spp., Actinobacillus actinomycetemcomitans, Cardiobacterium hominis
• Eikenella corrodens
• Kingella kingae

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Click to edit Master title style
• ClickDisease
Clinical to edit Master text styles
• Systemic
• Secondfeatures:
levelfever and night sweats, malaise, weight loss, Haematuria,
Arthralgia, Symptoms of heart failure
• Third level
• Fourth level
• Fifth level

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Fungi
Click to edit Master title style
• Candida spp.
• Aspergillus spp.
• Click to spp.
• Histoplasma edit Master text styles
• Second level
Pathogenesis
• There are• two
Third level
main risk factors for infective endocarditis:
• Fourth level
Bacteraemia
• Fifth level
• IVDU
• dental treatment or poor hygiene
• infections e.g. skin, UTI, respiratory
• cardiac surgery e.g. pacemaker insertion
• venous procedures e.g. cannula or central venous line insertion

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Abnormal cardiac epithelium
Click to edit Master title style
• Heart valve disease
• Rheumatic heart disease
• Click to
• Prosthetic edit
heart Master text
valves styles
• Structural
• Second
defects e.g. VSD, PDA, calcified aortic stenosis, hypertrophic cardiomyopathy
level
• Previous episode
• Third level
of infective endocarditis
• Fourth level
• Structurally weakened and damaged endocardium is susceptible to colonisation with an infective
• Fifth
organism, especially level
if a thrombus has already been deposited. This process of infection and
deposition of thrombus continues, forming the characteristic vegetation lesion. As the disease
progresses, the valve is destroyed and regurgitation or obstruction develops. Thrombi from the
vegetation can embolise to distant sites. In addition, infective organisms can enter the circulation
and form immune complexes.

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 Click
Signs:
to edit Master title style
• Clubbing, New/changed murmur, Splenomegaly, Osler's nodes (painful, red, raised lesions on pulps
of fingers), Janeway lesions (red painless macules on palm)
• •Splinter
Clickhaemorrhages
to edit Master
(small,text styles
straight lesions under the nails)
• Roth's
• Second
spots (redlevel
lesions with central pale zone seen on fundoscopy)
• Petechiae• on skinlevel
Third
Complications • Fourth level
• Fifth level
Right-hand side ( Associated with IVDU)
• Pulmonary embolism
• Lung abscess

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 Click to edit Master title style
Left-hand side
• Renal failure (immune complex deposition or decreased renal blood flow)
• Stroke (thrombotic embolism or cerebral haemorrhage)
• Click to edit Master text styles
• Distal gangrene (embolism or vasculitis)
• Second level
• Gastrointestinal/splenic
• Third level embolism
Diagnosis • Fourth level
• Fifth level haematuria
• Urine dipstick - microscopic
• Blood tests (FBC, U&Es, CRP/ESR) - anaemia, neutrophil leucocytosis, raised inflammatory markers
• Blood cultures (three separate sets)
• Echocardiography (transesophageal or transthoracic) - vegetations or valve dysfunction
• Chest x-ray - signs of heart failure
Antibacterial prophylaxis and chlorhexidine mouthwash are not recommended for the prevention of endocarditis in patients
undergoing dental procedures.

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Click to edit Master title style
• Click to edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

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Click to edit Master title style
MENINGITIS
• Click
Viral to edit
causes Master text styles
• Enteroviruses
• Second level
(Coxsackievirus, poliovirus and Enterovirus)
• Varicella
• Third
zoster virus
level
• Fourth
• Herpes simplex level
virus
• Fifth level
• Mumps virus
Bacterial causes vary by age:

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Click to edit Master title style
Clinical Disease
• Headache
• Photophobia
•• Fever
Click to edit Master text styles
• Neck stiffness level
• Second
• Poor feeding/irritability
• Third level
• Altered consciousness or confusion
• Fourth level
• Kernig's sign (extension
• Fifth level
of flexed knee causes pain and resistance to movement)
• Brudzinski's sign (passive neck flexion causes bilateral hip and knee flexion)
• Bulging fontanelle
Diagnosis
• Lumbar puncture for CSF analysis, Gram-stain, microscopy and culture
• Blood for culture, rapid antigen detection and glucose determination
• CT head to exclude encephalitis

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Click to edit Master title style
VIP
• Click to edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

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Click to edit Master title style
• Click to edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

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Click to edit Master title style
MYOCARDITIS
• Click Agents
Infective to edit Master text styles
Viral• Second level
• Coxsackievirus (most common cause), Parvovirus B19, Herpesviridae, Echovirus,
• Third level
Adenovirus,• Rubella
Fourth level
Bacterial • Fifth level
• Mycoplasma pneumoniae, Staphylococcus aureus
• Corynebacterium diphtheriae (toxin-mediated)
Immune-mediated
• Group A streptococcal infection (rheumatic fever)

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Click to edit Master title style
Clinical Disease
• Flu-like symptoms associated with fatigue, exertional dyspnoea, palpitations and precordial pain
• Tachycardia, dysrhythmia or cardiac failure may be present
• Click to edit Master text styles
• ECG may show T-wave inversion, prolongation of the PR or QRS interval, extrasystoles or heart
• Second level
block
• Third
• Chest x-ray maylevel
show cardiomegaly
• Fourth level
• Cardiac enzymes may be elevated
• Fifth level
Diagnosis
• Viruses may be detected in fecal, nasopharyngeal and throat specimens in nucleic acid
amplification tests (NAATs).
Treatment
• Treatment is supportive.

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Click to edit Master title style
OSTEOMYELITIS
• Click Agents
Infective to edit Master text styles
• Staphylococcus
• Second level
aureus (most common)
• Streptococcus pyogenes
• Third level
• Fourth
• Haemophilus level
influenzae
• Fifth level
• Escherichia colI
• Salmonella spp. (in sickle cell disease)
• Mycoplasma tuberculosis
Pathogenesis
• Haematogenous spread - distant infection causes bacteraemia and subsequent osteomyelitis
• Adjacent joint infection - septic arthritis can spread from the joint to the bone
• Direct infection - trauma, surgery or a deep ulcer can infect adjacent bone
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Click to edit Master title style
• ClickDisease
Clinical to edit Master text styles
• Systemic
• Second
features:
levelfever, malaise
• Localised pain level
• Third over bone
• Fourth and
• Erythema, swelling levelpus drainage through sinuses
• Fifth level
• Pathological fractures
Diagnosis
• X-ray - changes only visible after 7 - 10 days, bone destruction and joint effusions
• MRI - bone destruction, effusions and joint damage
• Swab pus for M, C & S
• Blood cultures

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 Click
Treatment
to edit
• Immobilise bone
Master title style
• Antibiotic therapy
• •Flucloxacillin
Click to edit Master
first line text ifstyles
(clindamycin penicillin allergic)
• Second
• Vancomycin (orlevel
teicoplanin) if MRSA suspected
• Consider• adding
Third level
fusidic acid or rifampicin for initial 2 weeks
• Fourth level
• Suggested duration of treatment 6 weeks for acute infection
• Fifth level
• Surgical therapy
• Drainage and excision of the sequestrum

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 Click toINFLAMATORY
PELVIC edit Master title
DISEASE
style
Infectious Agents
• •Neisseria
Click to gonorrhoeae
edit Master text styles
• Chlamydia trachomatis
• Second level
• Mixed anaerobic infection
• Third level
Clinical Disease• Fourth level
• Fifth level
Symptoms
• Fever
• Pelvic or lower abdominal pain
• Deep dyspareunia
• Abnormal vaginal bleeding (intermenstrual or postcoital)
• Abnormal vaginal or cervical discharge
• Right upper quadrant pain due to perihepatitis (Fitz-Hugh-Curtis syndrome)

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Click
Signs
to edit Master
• Lower abdominal or pelvic tenderness
title style
• Adnexal, cervical motion or uterine tenderness
•• Abnormal
Click to cervical
edit Master
or vaginaltext styles
discharge
• Second level
Complications
• Third level
• Tubal infertility
• Fourth level
• Ectopic pregnancy
• Fifth level
• Chronic pelvic pain

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 Click
Diagnosis
to edit
• Clinical diagnosis
Master title style
• Endocervical and high vaginal swabs should be taken for nucleic acid amplification tests (NAATs)
• Click to
Treatment edit Master text styles
• Second
• Contact tracinglevel
recommended
• Third
• First Line: level + metronidazole + single-dose of i/m ceftriaxone or ofioxacin +
Doxycycline
metronidazole • Fourth level
• Fifth level
• Suggested duration of treatment 14 days (except i/m ceftriaxone)
• In severely ill patients initial treatment with doxycycline + i/v ceftriaxone + i/v metronidazole, then
switch to oral treatment with doxycycline + metronidazole to complete 14 days' treatment

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Click to edit Master title style
PNEUMONIA
• Click Agents
Infective to edit Master text styles
• Second
Community acquired
levelpneumonia
• Streptococcus pneumoniae (most common)
• Third level
• Fourth
• Haemophilus level
influenzae
• Fifth level
• Staphylococcus aureus

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 Click to edit Master title style
Hospital acquired pneumonia (develops at least 24 hours after hospital admission)
• Gram-negative bacilli e.g. Escherichia coli and Klebsiella pneumoniae
• Pseudomonas aeruginosa
• Click to edit Master text styles
• Staphylococcus aureus
• Second level
• Atypical pneumonia
• Third level
• Mycoplasma•pneumoniae
Fourth level
• Legionella pneumophila
• Fifth level
• Chlamydophila pneumoniae
• Chlamydophila psittaci

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 Click to edit Master title style
Clinical Features
Symptoms
• Systemic features: fever, myalgia, arthralgia, rigors, headache
• Click to edit Master text styles
• Cough (+/- productive)
• Second level
• Dyspnoea
• Third level
• Pleuritic chest• pain
Fourth level
• Fifth level

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Click to edit Master title style
Signs
• Dull percussion note over infected area
• Reduced chest expansion on affected side
• Click to edit Master text styles
• Bronchial breathing
• Second level
• Crackles
• Third level
• Increased tactile fremitus
• Fourth level and vocal resonance
• Tachypnoea and•tachycardia
Fifth level

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Specific Pneumonias
Click to edit Master title style
Mycoplasma pneumoniae
• More common in younger patients (school age and young adults)
• Outbreaks occur approximately every 4 years in the UK
• Click to edit Master text styles
• Flu-like illness followed by dry cough associated with extrapulmonary complications such as erythema multiforme
• Secondhaemolytic
and SJS, autoimmune level anaemia, pericarditis and myocarditis, meningoencephalitis
• Third level
Legionella pneumophila
• Fourth
• Outbreaks among patients level at institutions with contaminated water tanks
staying
• Fifth level
• Flu-like illness before developing a dry cough and shortness of breath, associated with renal failure, gastrointestinal
upset, confusion and hyponatraemia
Chlamydia psittaci (psittacosis)
• Linked with exposure to infected birds
• Flu-like illness, dry cough, high temperature, photophobia and neck stiffness
Klebsiella pneumoniae
• Associated with older patients, diabetes mellitus and alcoholism

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 Click to edit Master title style
Diagnosis
• Chest x-ray - consolidation +/- pleural effusion
• Sputum for M, C & S
• •Urinary
Click to edit Master
antigens text styles
for L. pneumophila and M. pneumoniae
• Second
• Blood cultureslevel
• Third level
• Bloods (FBC, U&Es, LFTs, CRP)
• Fourth level
• Serology for atypical
• Fifthorganisms
level

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Click to edit Master title style
Assessment of CAP
In adults, severity is assessed by clinical judgement guided by mortality risk score
(CURB65):
•• Confusion
Click to edit Mastermental
(abbreviated text test,
styles
AMT score ≤ 8)
• Second
• Urea level
(> 7 mmol/L)|
• Third level
• Respiratory rate (≥ 30/min)|
• Fourth level
• Blood pressure• (< systolic or ≤ 60 diastolic)
90level
Fifth
• 65 (age ≥ 65 years) |

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Click to edit Master title style
Treatment of CAP
• Use clinical judgement in conjunction with the CURB65 score to guide the management of
community-acquired pneumonia, as follows:
• •consider
Click tohome-based caretext
edit Master for patients
styleswith a CURB65 score of 0 or 1
• consider hospital-based care for patients with a CURB65 score of 2 or more
• Second level
• consider intensive
• Third level care assessment for patients with a CURB65 score of 3 or more
• Fourth level
• Fifth level

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Click to edit Master title style
• Click to edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

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Click toARTHRITIS
SEPTIC edit Master title style
• Click Agents
Infective to edit Master text styles
• Staphylococcus
• Second level
aureus (most common)
• Streptococcus pyogenes
• Third level
• Fourth
• Haemophilus level
influenzae
• Fifth level
• Neisseria gonorrhoeae
• Pseudomonas aeruginosa
• Enterobacteriaceae
• Salmonella (In children with Sickle Cell disease)

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 Click to
Risk factors:
• Elderly
edit Master title style
• Diabetes mellitus
• •IVClick to edit
drug user Master text styles
• Second
• Recent level
joint surgery
• Third level
• Immunocompromised
• Fourth level
• Endocarditis or recent bacteraemia
• Fifth level
• Prosthetic or damaged joints (knee most commonly affected)
Clinical Disease
• Acute onset of painful, swollen, hot, erythematous joint with reduced range of movement
secondary to pain +/- systemic features

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 Click to edit Master title style
Pathogenesis
• Haematogenous spread - distant infection causes bacteraemia and subsequent septic arthritis
• Direct infection - trauma, surgery or a deep ulcer can infect an adjacent joint
• Click to edit Master text styles
• Second level
Diagnosis
• Third level
• Joint aspiration for Gram stain, M, C & S
• Fourth level
• Cloudy or purulent jointlevel
• Fifth fluid, raised WCC (usually > 50.000), neutrophilia, low glucose and Gram-
stain may suggest infection that can be confirmed by culture or NAAT
• Blood cultures
• X-ray may show periarticular soft-tissue swelling

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 Click
Treatment
to edit Master title
• Immobilise joint and start physiotherapy early
style
Antibiotic therapy
• •Flucloxacillin
Click to edit Master
first line text
(suggested stylesof treatment 4 - 6 weeks, longer if infection complicated).
duration
• Second
• If penicillin level
allergic, clindamycin
• Third level
• If MRSA suspected, vancomycin or teicoplanin
• Fourth level
• If gonococcal arthritis or Gram-negative infection suspected, cefotaxime or ceftriaxone
• Fifth level
Surgical therapy
• Aspiration and irrigation of joint to reduce inflammatory damage

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Click to edit
URINARY TRACT
Master
INFECTION
title style
• Click to edit
Urinary-tract infection is moretext
Master common in women than in men: when it occurs in men there is
styles
frequently an underlying abnormality of the renal tract.
• Second level
• Recurrent episodes of infection are an indication for radiological investigation especially in
• in
children Third level
whom untreated pyelonephritis may lead to permanent kidney damage.
• Fourth level
Infective Agents • Fifth level
• Escherichia coli (most common), Staphylococcus saprophyticus (especially in sexually active young
women) , Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa (particularly in long
term catheters)

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Risk Factors
Click to edit Master title style
• Poor hygiene
• Sexual activity in females
• •Outflow
Click to edit Master
obstruction e.g. BPHtext styles
or prostate cancer, vaginal prolapse in elderly women, renal calculi,
urethral strictures, bladder tumours
• Second level
• Neurogenic bladder
• Third level
• Immunocompromised
• Fourth level
e.g. chemotherapy, diabetes mellitus
• Pregnancy • Fifth level

• Urethral catheters
• Dehydration

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Click to edit Master title style
Clinical Disease
Lower UTI
• urinary frequency or urgency
•• dysuria
Click to edit Master text styles
• Second
• suprapubic level
discomfort
• Third level
Acute pyelonephritis
• Fourth level
• fever, rigors • Fifth level
• loin pain
• renal angle tenderness
• signs of septicaemia

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Click to edit Master title style
Acute prostatitis
• fever, rigors
• Urinary voiding symptoms or acute urinary retention
• Click to edit Master text styles
• Perineal or suprapubic pain (penile pain, low back pain, pain on ejaculation, and pain during bowel
• Secondcan
movements level
also occur) |
• Tender •prostate
Third level
on examination
• Fourth level
Diagnosis • Fifth level
• Dipstick test for leucocyte esterase, nitrites and blood
• If both dipstick tests are negative, a UTI is unlikely.
• If the leucocyte esterase test alone is positive, a UTI is moderately likely.
• If the nitrite test is positive, with or without a positive leucocyte esterase test, a UTI is highly likely.

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 Click
Treatment
to edit Master title style
• Treatment should not be delayed while waiting for results. The antibacterial chosen should reflect
current local bacterial sensitivity to antibacterials.
• Clicktreatment
Empirical to edit Master text
for lower UTI styles
• Second or
• Trimethoprim nitrofurantoin first line
level
• Third
• Amoxicillin level
or oral cephalosporin alternatively
• Fourth7level
• Suggested duration days (a 3-day course is usually adequate for uncomplicated UTI in women)
• Fifth level
Treatment for acute pyelonephritis
• Oral cefalexin, ciprofloxacin or co-amoxiclav for patients who can be managed at home
• Intravenous cephalosporin or quinolone if unwell, gentamicin can also be used
• Suggested duration 10 - 14 days
Treatment for prostatitis
• Ciprofloxacin or ofloxacin (suggested duration 14 days)

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Click to edit Master
BORDETELLA PERTUSSIS
title style
• Click to edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

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 Click
Transmission
to edit Master title style
• Bordetella pertussis causes whooping cough, and is spread via the respiratory droplet route.
Pathogenesis
• •B.Click to express
pertussis edit Master text
fibriae that aid styles
their adhesion to the ciliated epithelium of the upper
• Second
respiratory tract, and produce a number of exotoxins, causing the characteristic thickened
level
bronchial secretions, paralysis of cilia and lymphocytosis.
• Third level
Clinical Disease• Fourth level
• The incubation period
• Fifthislevel
about 7 - 10 days (range 5 - 21 days) and whooping cough is considered to
be infectious for 3 weeks after the initial onset of symptoms.
• A 1 - 2 week cold-like prodromal illness (catarrhal phase) occurs before the paroxysmal phase
which is characterised by repeated paroxysmal, prolonged severe coughing fits. Typically,
paroxysms consist of a short expiratory burst followed by an inspiratory gasp, causing the 'whoop'
sound.

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Click to edit Master title style
Complications
• Secondary bacterial bronchopneumonia, Secondary bacterial otitis media,
Seizures, Encephalopathy, Unilateral hearing loss, Complications due to violent prolonged coughing
• • Pneumothorax,
Click to editabdominal
Masterherniatextformation,
styles rectal prolapse, rib fracture, herniation of lumbar
intervertebral discs, urinary incontinence, subconjunctival haemorrhage, facial/truncal petechiae,
• Second level
post-coughing vomiting leading to dehydration/malnutrition
• Third level
Clinical Diagnosis
• Fourth level
Whooping cough should
• Fifthbe suspected if a person has an acute cough that has lasted for 14 days or
level
more without another apparent cause, and has one or more of the following features:
• Paroxysmal cough.
• Inspiratory whoop.
• Post-tussive vomiting.
• Undiagnosed apnoeic attacks in young infants.

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 Click to edit Master title style
Clinical suspicion should be raised if the person is not fully immunized, or has been in contact with a
person who is confirmed or suspected of having whooping cough.
Laboratory Diagnosis
• •Whooping
Click tocough
editisMaster text
a notifiable styles
disease.
• If the
• cough
Secondis of 2 weeks' duration or less, culture of a nasopharyngeal aspirate or
level
nasopharyngeal/pernasal swabs is recommended for people of all ages. However, a negative result
• Third level
does not exclude pertussis.
• Fourth level
• Real-time PCR testing oflevel
• Fifth nasopharyngeal or throat swabs can also be used to confirm infection in
people of all ages with symptoms of less than three weeks' duration.
• If the cough is of more than 2 weeks' duration, anti-pertussis toxin immunoglobulin G (IgG)
serology may be employed in people aged over 17 years.
• Anti-pertussis toxin IgG detection in oral fluid can be used in children aged 5 to 16 years.

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Management
Click to edit Master title style
 Arrange admission if the person:
 Is 6 months of age or younger and acutely unwell.
 Has significant breathing difficulties (for example apnoea episodes, severe paroxysms, or cyanosis).
• Has
 Click to edit
a significant Master(for
complication text styles
example seizures or pneumonia).
 Note:
• Second
inform thelevel
hospital of the need for appropriate isolation before the person is admitted.
 If admission is not needed, prescribe an antibiotic if the onset of cough is within the previous 21 days.
• Third level
 A macrolide antibiotic is recommended first-line
• Fourth level
 Prescribe clarithromycin for infants less than 1 month of age.
• Fifth level
 Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
 Prescribe erythromycin for pregnant women.
 Advise rest, adequate fluid intake, and the use of paracetamol or ibuprofen for symptomatic relief.
 Advise that children and healthcare workers who have suspected or confirmed whooping cough should stay
off nursery, school, or work until 48 hours of appropriate antibiotic treatment has been completed, or 21
days after onset of symptoms if not treated.
 People who work in other settings should avoid contact with infants under one year of age who are
unvaccinated or partially vaccinated until 48 hours of appropriate antibiotic treatment has been completed,
or 21 days after onset of symptoms if not treated.

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Click to edit Master
Campylobacter Jejunititle style
• Click to edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

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• Campylobacter spp. are a common cause of acute infective gastroenteritis, particularly in children,
Click to edit Master title style
with Campylobacter jejuni responsible for 90% of Campylobacter gastroenteritis.
Transmission
• Campylobacter spp. are found in human and animal gastrointestinal tracts. Infection typically
• follows
Click ingestion
to edit ofMaster text meat
contaminated styles
(most frequently undercooked poultry), unpasteurised
milk• or
Second level water, following which the microorganism invades and colonises the mucosa
contaminated
of the small intestine.
• Third level
Clinical Disease• Fourth level
• Fifth level
Clinical features typically include:
• Fever
• Flu-like illness
• Abdominal pain/cramps (children may be misdiagnosed with acute appendicitis or
intussusception)
• Profuse and occasionally bloody diarrhoea
• Nausea and vomiting

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 Click
Diagnosis
to edit Master title
• Diagnosis is made from culture of a stool specimen.
style
Treatment
• •Diarrhoea
Click toisedit
usuallyMaster text
self-limiting andstyles
treatment supportive but antibiotics may be indicated in
severe infectionlevel
• Second or in immunocompromised patients; first line is clarithromycin (or azithromycin or
erythromycin), ciprofloxacin is an alternative.
• Third level
Complications • Fourth level
• Immune-mediated
• Fifth
complications
level include (typically occurring 1 - 2 weeks after onset):
• Reactive arthritis (usually of the ankles, knees and wrists)
• Reiter's syndrome (triad of reactive arthritis, conjunctivitis and urethritis)
• Guillain-Barre syndrome (an autoimmune ascending peripheral neuropathy)

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Click to edit Master title style
CANDIDA
Transmission
•• Candida
Click spp.
to are normally
edit Master widely
text distributed
styles in the environment. They form part of the normal
commensal flora of the skin, gastrointestinal tractand female genital tract and infection is usually
• Second Infections
endogenous. level can occur when normal bacterial flora is disrupted e.g. following
treatment withlevel
• Third broad-spectrum antibiotics, in pregnancy, in diabetes mellitus or when immunity
is altered. Most infections
• Fourth level are caused by Candida albicans.
Clinical Disease • Fifth level
Skin
• Cutaneous candidiasis
• Candidal paronychia
• Nappy rash

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Click to edit Master title style
• Click
Oral to edit Master text styles
• Oral
• Second
candidiasis (commonly associated with inhaled corticosteroids)
level
Genitourinary tract
• Third level
• candidiasis
• Vulvovaginal Fourth level (thrush) |
• Fifth level
• UTI (colonises catheters) |

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Click to edit Master title style
Gastrointestinal
• Candidal oesophagitis (can be severe in immunocompromised patients)
• Clickinfection
Systemic to edit Master text styles
• Common
• Second
in neutropenic
level patients, or patients in intensive care (e.g. line associated infection).
Diagnosis• Third level
• Diagnosis is •byFourth level (Gram-positive spores and pseudohyphae), culture or NAAT of
microscopy
specimens of skin,• Fifth
nailslevel
or oral or vaginal swabs. Given its widespread distribution in normal flora,
the significance of each isolate is determined in relation to the overall clinical picture.
Treatment
• Vulvovaginal or cutaneous candidiasis - topical clotrimazole or oral fluconazole
• Oral candidiasis - nystatin mouthwash or oral fluconazole
• Invasive candidiasis - systemic fluconazole, echinocandin e.g. caspofungin or amphotericin

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Click to edit Master title style
• Click to edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

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