A 24-year-old woman who is 18 weeks pregnant presents to the Emergency Department. Earlier on in the morning she came into contact with a child who has chickenpox. She is unsure if she had the condition herself as a child.
What is the most appropriate action?
Correct Answer D: Chickenpox exposure in pregnancy - first step is to check antibodies.
If there is any doubt about the mother previously having chickenpox maternal blood should be checked for varicella antibodies.
Chickenpox exposure in pregnancy:
Chickenpox is caused by primary infection with varicella zoster virus. Shingles is reactivation of dormant virus in dorsal root ganglion. In pregnancy there is a risk to both the mother and also the fetus, a syndrome now termed fetal varicella syndrome.
Fetal varicella syndrome (FVS):
Management of chickenpox exposure:
A 19-year-old man presents with dysuria associated with a watery discharge from his urethral meatus. A urethral swab shows non-specific urethritis and urine is sent for Chlamydia/gonococcus.
What is the most appropriate antibiotic to use?
Correct Answer E: Chlamydia - treat with azithromycin or doxycycline.
Gonorrhoea would be demonstrated by the presence of Gram negative diplococci on the swab. As the swab showed non-specific urethritis a diagnosis of Chlamydia is most likely. The 2009 SIGN guidelines suggest azithromycin should be used first-line due to potentially poor compliance with a 7 day course of doxycycline.
Chlamydia: Chlamydia is the most prevalent sexually transmitted infection in the UK and is caused by Chlamydia trachomatis, an obligate intracellular pathogen. Approximately 1 in 10 young women in the UK have Chlamydia. The incubation period is around 7-21 days, although it should be remembered a large percentage of cases ar asymptomatic.
Features:
Potential complications:
Investigation:
Screening:
Management:
A 54-year-old female is admitted with a severe pneumonia following a holiday in Turkey. Bloods reveal both hyponatraemia and deranged liver function tests. A chest x-ray shows patchy alveolar infiltrates with consolidation in the right lower lobe.
Which one of the following investigations is most likely to confirm the probable diagnosis?
Correct Answer B: Legionella pneumophilia is best diagnosed by the urinary antigen test.
Legionella: Legionnaire's disease is caused by the intracellular bacterium Legionella pneumophilia. It is typically colonizes water tanks and hence questions may hint at air-conditioning systems or foreign holidays. Person-to-person transmission is not seen.
Diagnosis:
A 28-year-old man is admitted to the Emergency Department with dyspnoea and fever. Two days ago he developed an itchy, vesicular rash after coming into contact with a child who had chickenpox. On examination his temperature is 38.6ºC, respiratory rate 24 / min, pulse 120 / min and blood pressure 135/68 mmHg. Oxygen saturations are 95% on room air. Examination of chest reveals only occasional fine crackles bilaterally.
What is the most important intervention?
Correct Answer D: Varicella pneumonia is the most common and serious complication of chickenpox infection in adults. Auscultation of the chest is often unremarkable. Varicella zoster immunoglobulin is used for the prevention of varicella in at risk groups (e.g. Immunocompromised, pregnant women), rather than for treatment.
Chickenpox: Chickenpox is caused by primary infection with varicella zoster virus. Shingles is reactivation of dormant virus in dorsal root ganglion.
Chickenpox is highly infectious:
Clinical features (tend to be more severe in older children/adults):
Management is supportive:
A common complication is secondary bacterial infection of the lesions. Rare complications include:
*it was traditionally taught that patients were infective until all lesions had scabbed over
A 17-year-old female presents for review. Four days ago she presented to her doctor with a severe sore throat, lethargy and headache. Her doctor prescribed a course of amoxicillin to treat an upper respiratory tract infection. Two days ago she developed a widespread, pruritic maculopapular rash. Her original symptoms have also not improved.
What is the most likely diagnosis?
Correct Answer A: URTI symptoms + amoxicillin --> rash ?glandular fever.
A rash develops in around 99% of patients who take amoxicillin whilst they have infectious mononucleosis. Her treatment should be supportive as detailed below.
Infectious mononucleosis: Infectious mononucleosis (glandular fever) is caused by the Epstein-Barr virus (also known as human herpesvirus 4, HHV-4). It is most common in adolescents and young adults.
Management is supportive and includes:
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