An 18-year-old man is bitten by a frantic dog whilst taking a gap year in Ecuador. He is worried about rabies and phones for advice. He was not immunized against prior to traveling to Ecuador.
What is the most appropriate advice after thorough cleansing of the wound?
Correct Answer A: Rabies - following possible exposure give immunglobulin + vaccination.
Rabies:
Features:
There is now considered to be 'no risk' of developing rabies following an animal bite in the UK and the majority of developed countries. Following an animal bite in at risk countries:
A 12-year-old boy who had a splenectomy following a road traffic accident is reviewed in clinic. He had his full immunization course as a child and was given a repeat pneumococcal vaccination 5 days following surgery.
What is the most appropriate ongoing management?
Correct Answer E: Debate still exists regarding how long a patient should take penicillin prophylaxis for. The majority of doctors advocate lifelong penicillin. Consensus guidelines agree however that In this case prophylaxis should be continued until the patient is at least 16 years old, so of the available options E is the correct answer.
Splenectomy: Following a splenectomy patients are particularly at risk from pneumococcus, Haemophilus, meningococcus and Capnocytophaga canimorsus* infections.
Vaccination:
Antibiotic prophylaxis:
*Usually from dog bites.
A 27-year-old woman develops fever and lymph node swelling after being scratched by her cat.
Which one of the organisms is responsible for cat scratch disease?
Correct Answer C: Cat scratch disease - caused by Bartonella henselae.
Cat scratch disease: Cat scratch disease is generally caused by the Gram negative rod Bartonella henselae.
A 40-year-old man is admitted to the intensive care unit following a severe episode of acute pancreatitis. On the third day of his admission he becomes pyrexial. A septic screen is ordered including cultures taken from both peripheral blood and the internal jugular line. There is no signs of infection on the chest x-ray or urine sample. The microbiology laboratory phone to report signs of bacterial infection in the sample from the central line.
What is the most likely organism to be isolated?
Correct Answer C: Most common organism found in central line infections - Staphylococcus epidermidis.
Staphylococci:
Staphylococci are a common type of bacteria which are often found normal commensal organisms but may also cause invasive disease. Some basic facts include:
The two main types of Staphylococci you need to know about are Staphylococcus aureus and Staphylococcus epidermidis.
A 19-year-old man from a traveling community presents to the Emergency Department with breathing difficulties.
On examination he has a temperature of 38.2ºC and stridor. A diagnosis of acute epiglottitis is suspected.
Which one of the following organisms is most likely to be responsible?
Correct Answer D: Patients from traveling communities may not always receive a full course of immunization. Acute epiglottitis is of course much more common in young children.
Acute epiglottitis:
Acute epiglottitis is rare but serious infection caused by Haemophilus influenzae type B. Prompt recognition and treatment is essential as airway obstruction may develop. Epiglottitis generally occurs in children between the ages of 2 and 6 years. The incidence of epiglottitis has decreased since the introduction of the Hib vaccine.
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