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• <1 neutrophils + fever → neutropenic sepsis
• clozapine can cause drug induced neutropenia
• Strep pneumoniae (50%) & haem influenzae (20%) - chest infection (SOB, productive sputum, temperature, crackles)
• Treat Strep pneumoniae with amoxicillin
• holiday hotel/ shower → legionella (atypical)
• farmer → coxiella burnetti (Q fever)
• birds → chlamydia psittaci
• Indicator of UTI - nitrates
• e coli (gram negative) causes UTIs
• treat UTIs with trimethoprim/nitrofurantoin (3 days female, 7 days male) but avoid trim in 1 trimester (folate antagonist) and nitro in 3rd trimester (haemolytic anaemia in newborns)
• Staph aureus → cellulitis (group A & C strep) + joint infections
• neisseria gonorrhoea (gram negative diplococci) → joint infections in young sexually active
• treat skin and soft tissue infection with IV flucloxacillin (clarithromycin if penicillin allergy)
• treat joint infection with IV flucloxacillin (clarithro/clindamycin if penicillin allergy)
• Bacillus cereus (gram positive rods) → watery diarrhoea, leftover fried rice at room temperature, resolves within 24 hours
• campylobacter (undercooked poultry) only grows at 42 degrees
• ECO157 and shiga toxin → haemolytic uraemic syndrome (HUS)
• most common bacterial meningitis in children and adults → neisseria meningitidis + strep pneumoniae
• neonates → Group B strep
• treat bacterial meningitis in the community with IM/IV benzylpenicillin
• treat bacterial meningitis in the hospital with broad spectrum cephalosporin (ceftriaxione >3 months and cefotaxime + amox <3 months)
• viral meningitis (hsv, entero, vzv) treatment → supportive + acyclovir
• bacterial tonsillitis → strep pyogenes (group A strep) → treat with pheneoxymethylpenicillin (pen V) for 10 days
• otitis media + sinusitis → strep pneumoniae
• clear, normal glucose, low protein, low wcc → viral meningitis
• turbid, low glucose, high protein, high wcc → bacterial meningitis
• Ziehl Neelsen stain → mycobacterium tuberculosis (acid fast bacilli)
• +ve mantoux test → vaccinated, latent, active tb. +ve interferon gamma release assay (igra) → latent
• risk of reactivation of latent tb → isoniazid and rifampicin (3 months) or isoniazid (6 months)
• acute tb → RIPE 6622 (rifampicin, isoniazid, pyrazinamide, ethambutol)
• HIV → CD4 <200 → high risk opportunistic infection
• undetectable HIV viral load → transmission unlikely, breastfeeding and vaginal birth considered
• Malaria → plasmodium falciparum with incubation 1-4 weeks post infection
• Procalcitonin → +ve bacteria & -ve viral
• COVID → -ve procalcitonin (viral) and low lymphocytes on FBC. if admitted + needs oxygen, test for covid immunoglobulins, prescribe steroid for 7-10 days (dexamethasone), antiviral (remdesivir) and monoclonal antibody (casirivimab/imdevimab)