A 77-year-old female presents with a non-healing ulcer on her right foot. Blood cultures grow MRSA.
Which antibiotic would you consider in addition to vancomycin?
Correct Answer E: Methicillin-resistant Staphylococcus aureus (MRSA) was one of the first organisms which highlighted the dangers of hospital-acquired infections.
MRSA:
Who should be screened for MRSA?
How should a patient be screened for MRSA?
Suppression of MRSA from a carrier once identified:
The following antibiotics are commonly used in the treatment of MRSA infections:
Some strains may be sensitive to the antibiotics listed below but they should not generally be used alone because resistance may develop:
Relatively new antibiotics such as linezolid, quinupristin/dalfopristin combinations and tigecycline have activity against MRSA but should be reserved for resistant cases.
Which one of the following vaccines uses an extract of the organism or virus?
Correct Answer E:
Vaccinations: It is important to be aware of vaccines which are of the live-attenuated type as these may pose a risk to immunocompromised patients. The main types of vaccine are as follows:
Live attenuated:
Inactivated preparations:
Extracts of the organism/virus (sometimes termed fragment)**:
Notes:
*Whole cell typhoid vaccine is no longer used in the UK.
**May also be produced using recombinant DNA technology.
A woman who is 14 weeks pregnant presents as she came into contact with a child who has chickenpox around 4 days ago. She is unsure if she had the condition herself as a child. Blood tests show the following:
What is the most appropriate management?
Correct Answer A: Chickenpox exposure when pregnant - if not immune give VZIG.
The negative IgG indicates no previous exposure to chickenpox.
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:
Which of the following infections usually has the longest incubation period?
Correct Answer C:
Incubation periods: Questions may either ask directly about incubation periods or they may be used to provide a clue in a differential diagnosis.
Less than 1 week:
1 - 2 weeks:
2 - 3 weeks:
Longer than 3 weeks:
A 14-year-old boy presents with pyrexia, myalgia and lethargy. Clinical examination reveals a temperature of 38.8ºC. He is haemodynamically stable and his chest is clear. Given the current pandemic a presumptive diagnosis of H1N1 influenza is made and oseltamivir is prescribed.
What is the most likely side-effect he will experience?
Correct Answer D: Gastrointestinal symptoms are the most common side-effects of oseltamivir (Tamiflu).
H1N1 influenza pandemic:
The 2009 H1N1 influenza (swine flu) outbreak was first observed in Mexico in early 2009. In June 2009, the WHO declared the outbreak to be a pandemic.
H1N1: The H1N1 virus is a sub-type of the influenza A virus and the most common cause of flu in humans. The 2009 pandemic was caused by a new strain of the H1N1 virus. The following groups are particularly at risk:
Features:
The majority of symptoms are typical of those seen in a flu-like illness:
A minority of patients may go on to develop an acute respiratory distress syndrome which may require ventilator support.
Treatment:
There are two main treatments currently available:
Oseltamivir (Tamiflu):
Zanamivir (Relenza):
*Intravenous preparations are available for patients who are acutely unwell.
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