Herpes Simplex Virus and Hand, Foot and Mouth Disease: A Comparison

Herpes simplex virus (HSV) is a common viral infection that can cause cold sores on the face (type 1) or genital infections (type 2). Primary type 1 infection is usually mild or subclinical, but can cause herpetic gingivostomatitis, which is the most common clinical manifestation of the infection. After the initial infection, the virus remains latent in nerve cell ganglia and can be reactivated by various stimuli, resulting in a recurrence of symptoms and shedding of the virus.

In contrast, hand, foot and mouth disease is caused by the Coxsackie A virus and is usually a minor illness with mouth ulcers and vesicles on the hands and feet. While the mouth may be sore, it is not typically as severe as a herpes simplex infection.

Overall, understanding the differences between these two viral infections can help with proper diagnosis and treatment.

Understanding Hepatitis B: Surface Antigen and Antibodies

The hepatitis B virus is surrounded by a coating called the surface antigen (HBsAg). If this antigen is present, it indicates a hepatitis B infection, which can be either acute or chronic. The infected person can also infect others. It usually takes 4-12 weeks for HBsAg to appear after infection. When the surface antigens disappear and surface antibodies (anti-HBs) appear, the infection is considered cleared, which typically happens within 4 months of symptoms appearing. Anti-HBs indicates immunity from either an infection or immunization. Chronic hepatitis B is diagnosed when HBsAg is present for more than 6 months. Patients with chronic active hepatitis B have persistent liver inflammation and are at risk of cirrhosis and hepatocellular cancer. Patients with the inactive form usually remain asymptomatic and have less risk of complications but remain infectious. Understanding the role of surface antigen and antibodies is crucial in diagnosing and managing hepatitis B infections.

Treatment and Management of Travellers’ Diarrhoea

Travellers’ diarrhoea is commonly caused by E. coli and typically lasts for 72 hours. In healthy individuals, oral rehydration salts and paracetamol can effectively manage the symptoms. However, if the patient is unable to tolerate oral fluids and is significantly dehydrated, hospital admission may be necessary.

In severe cases of campylobacter or salmonella, where the patient is already weakened by chronic illness, ciprofloxacin may be prescribed. Meanwhile, metronidazole may be used as an option for giardiasis.

It is important to note that travellers’ diarrhoea can be prevented by practicing good hygiene, such as washing hands frequently and avoiding contaminated food and water sources.

Diagnosis and Treatment of Cavitating Tuberculosis

Cavitating tuberculosis is the likely diagnosis for a patient presenting with symptoms such as cough, fever, weight loss, and haemoptysis, along with a chest X-ray appearance. Although lung cancer could be a possible alternative diagnosis, the symptoms strongly suggest a tuberculous infection.

The recommended treatment for the initial phase of cavitating tuberculosis is a daily combination of isoniazid, rifampicin, pyrazinamide, and ethambutol. These drugs should be continued for two months. After the initial phase, treatment should continue for an additional four months with isoniazid and rifampicin. Combination preparations are available to make compliance easier for the patient. It is important to follow the prescribed treatment plan to ensure successful recovery from cavitating tuberculosis.

Understanding Bacillus cereus Infection

Bacillus cereus is a type of bacteria that can cause food poisoning. Its incubation period is between 6 to 24 hours, and symptoms usually appear within 1 to 2 days. The bacteria produce a toxin that can cause either severe diarrhea or profuse vomiting, depending on the type of toxin produced.

In Europe, Bacillus cereus infection is commonly associated with diarrhea. The bacteria are often found in reheated fried rice, which is a common cause of the infection. However, the infection is self-limiting, and appropriate oral rehydration advice is usually enough to manage the symptoms.

Overall, it is important to understand the symptoms and causes of Bacillus cereus infection to prevent its spread and manage its effects.

Pertussis Guidelines for Asymptomatic Contacts

Asymptomatic contacts of suspected or confirmed pertussis do not need exclusion from school or nursery, even if they are being treated with antibiotics. It is important to follow current guidelines and advise parents accordingly. Prophylactic antibiotics are only recommended for close contacts, which include household contacts and those sharing a room overnight with a case. Antibiotics are only recommended if there is a vulnerable contact and the onset of illness in the case is within 21 days.

If more cases of pertussis were to be diagnosed at the nursery, this would constitute an outbreak, and advice may then change at the discretion of the outbreak control team. Vulnerable contacts include newborn infants born to symptomatic mothers, infants under 1-year-old who have received less than three doses of DTaP/IPV/Hib, unimmunised or partially immunised infants or children up to ten years, women in the last month of pregnancy, adults who work in a healthcare, social care or childcare facility, immunocompromised individuals, and those with the presence of other chronic illnesses.

It is important for GPs to understand and implement key national guidelines that influence healthcare provision for respiratory problems, as outlined in the RCGP Curriculum Statement 15.8. By following these guidelines, we can ensure the best possible care for our patients and prevent the spread of pertussis.

Fortunately, Helena falls within the 72-hour window period for commencing post-exposure prophylaxis (PEP) for HIV, and as such, she should start PEP without delay.

Post-Exposure Prophylaxis for Viral Infections

Post-exposure prophylaxis (PEP) is a preventive treatment given to individuals who have been exposed to a viral infection. The type of PEP given depends on the virus and the clinical situation. For hepatitis A, either human normal immunoglobulin or the hepatitis A vaccine may be used. For hepatitis B, the PEP given depends on whether the source is known to be positive for HBsAg or not. If the person exposed is a known responder to the HBV vaccine, then a booster dose should be given. If they are a non-responder, they need to have hepatitis B immune globulin and a booster vaccine. For hepatitis C, monthly PCR is recommended, and if seroconversion occurs, interferon +/- ribavirin may be given. For HIV, a combination of oral antiretrovirals should be given as soon as possible for four weeks. The risk of HIV transmission depends on the incident and the current viral load of the patient. For varicella zoster, VZIG is recommended for IgG negative pregnant women or immunosuppressed individuals. The risk of transmission for single needlestick injuries varies depending on the virus, with hepatitis B having a higher risk than hepatitis C and HIV.

Overall, PEP is an important preventive measure for individuals who have been exposed to viral infections. It is crucial to determine the appropriate PEP based on the virus and the clinical situation to ensure the best possible outcome.

If a pregnant patient has a penicillin allergy and is diagnosed with cellulitis, the recommended antibiotic is erythromycin as per the NICE antimicrobial guidance. Flucloxacillin and co-amoxiclav should not be prescribed in this case. It is important to note that doxycycline, a tetracycline antibiotic, is contraindicated in pregnancy and should not be prescribed.

Understanding Cellulitis: Symptoms, Diagnosis, and Treatment

Cellulitis is a common skin infection caused by Streptococcus pyogenes or Staphylococcus aureus. It is characterized by inflammation of the skin and subcutaneous tissues, usually on the shins, accompanied by erythema, pain, swelling, and sometimes fever. The diagnosis of cellulitis is based on clinical features, and no further investigations are required in primary care. However, bloods and blood cultures may be requested if the patient is admitted and septicaemia is suspected.

To guide the management of patients with cellulitis, NICE Clinical Knowledge Summaries recommend using the Eron classification. Patients with Eron Class III or Class IV cellulitis, severe or rapidly deteriorating cellulitis, very young or frail patients, immunocompromised patients, patients with significant lymphoedema, or facial or periorbital cellulitis (unless very mild) should be admitted for intravenous antibiotics. Patients with Eron Class II cellulitis may not require admission if the facilities and expertise are available in the community to give intravenous antibiotics and monitor the patient.

The first-line treatment for mild/moderate cellulitis is flucloxacillin, while clarithromycin, erythromycin (in pregnancy), or doxycycline is recommended for patients allergic to penicillin. Patients with severe cellulitis should be offered co-amoxiclav, cefuroxime, clindamycin, or ceftriaxone. Understanding the symptoms, diagnosis, and treatment of cellulitis is crucial for effective management and prevention of complications.

Diagnosing Hepatitis C: Understanding the Clinical Features and Testing Methods

Hepatitis C (HCV) is a viral infection that often goes undetected due to the lack of specific symptoms. Fatigue, a common symptom, is not enough to suspect hepatitis C unless other risk factors are present. Abnormal liver function tests may indicate HCV, but a positive serology test is needed to confirm the diagnosis. This test is usually positive three months after exposure, but may take up to nine months. HCV RNA testing is used to confirm ongoing infection, and negative results should be repeated after six months. Chronic infection is common in HCV, affecting about 80% of those infected.

Other viral infections, such as hepatitis B and Epstein-Barr virus (EBV), may also cause liver abnormalities. Jaundice is more common in hepatitis B, while EBV typically causes mild elevation of serum transaminases. Testing for IgM and IgG antibodies can help diagnose acute or past infections. Enzyme levels, such as alkaline phosphatase and gamma-glutamyl transpeptidase, may also be used to differentiate between viral infections.

It is probable that this young man is suffering from toxigenic food poisoning caused by Bacillus cereus, which is known to occur after consuming reheated rice. The spores of Bacillus cereus germinate in cooked rice and produce toxins if the cooked product is not adequately chilled. While S. aureus can also cause toxigenic food poisoning, the specific history of this case makes it less likely to be the underlying organism. Norwalk virus, on the other hand, can cause severe diarrhea and vomiting, but it is not associated with any particular food items. Bacterial food poisoning caused by Campylobacter and Shigella typically involves a longer history of bloody diarrhea.

Gastroenteritis can occur either at home or while traveling abroad, which is known as travelers’ diarrhea. This type of diarrhea is characterized by at least three loose to watery stools in 24 hours, along with abdominal cramps, fever, nausea, vomiting, or blood in the stool. The most common cause of traveler’s’ diarrhea is Escherichia coli. Another type of illness is acute food poisoning, which is caused by the ingestion of a toxin and results in sudden onset of nausea, vomiting, and diarrhea. Staphylococcus aureus, Bacillus cereus, and Clostridium perfringens are the typical causes of acute food poisoning.

Different infections have stereotypical histories and presentations. Escherichia coli is common among travelers and causes watery stools, abdominal cramps, and nausea. Giardiasis results in prolonged, non-bloody diarrhea. Cholera causes profuse, watery diarrhea and severe dehydration resulting in weight loss, but it is not common among travelers. Shigella causes bloody diarrhea, vomiting, and abdominal pain. Staphylococcus aureus causes severe vomiting with a short incubation period. Campylobacter usually starts with a flu-like prodrome and is followed by crampy abdominal pains, fever, and diarrhea, which may be bloody and may mimic appendicitis. Bacillus cereus has two types of illness: vomiting within six hours, typically due to rice, and diarrheal illness occurring after six hours. Amoebiasis has a gradual onset of bloody diarrhea, abdominal pain, and tenderness that may last for several weeks.

The incubation period for different infections varies. Staphylococcus aureus and Bacillus cereus have an incubation period of 1-6 hours, while Salmonella and Escherichia coli have an incubation period of 12-48 hours. Shigella and Campylobacter have an incubation period of 48-72 hours, while Giardiasis and Amoebiasis have an incubation period of more than seven days. The vomiting subtype of Bacillus cereus has an incubation period of 6-14 hours, while the diarrheal illness has an incubation period of more than six hours.

In England and Wales, clinicians are required by law to report cases of scarlet fever as it is a notifiable disease. They do not need to wait for laboratory confirmation before notifying their local health protection team. Public Health England advises that the necessary forms should be filled out immediately upon suspicion of a notifiable disease and submitted within 72 hours. In case of an emergency, verbal notification should be made within 24 hours.

Notifiable Diseases in the UK

In the UK, certain diseases are considered notifiable, meaning that the Local Health Protection Team must be notified if a case is suspected or confirmed. These diseases are then reported to the Health Protection Agency on a weekly basis. Notifiable diseases include acute encephalitis, acute infectious hepatitis, acute meningitis, acute poliomyelitis, anthrax, botulism, brucellosis, cholera, COVID-19, diphtheria, enteric fever, food poisoning, haemolytic uraemic syndrome, infectious bloody diarrhoea, invasive group A streptococcal disease, Legionnaires Disease, leprosy, malaria, measles, meningococcal septicaemia, mumps, plague, rabies, rubella, severe acute respiratory syndrome, scarlet fever, smallpox, tetanus, tuberculosis, typhus, viral haemorrhagic fever, whooping cough, and yellow fever.

It is important to note that HIV is not a notifiable disease in the UK. Additionally, in April 2010, dysentery, ophthalmia neonatorum, leptospirosis, and relapsing fever were removed from the list of notifiable diseases.

Understanding MRSA: Causes, Transmission, and Treatment

MRSA, or Methicillin-resistant Staphylococcus aureus, is a type of bacteria that can be acquired in both hospital and community settings. While it is carried by many people without causing harm, it can also cause serious infections. MRSA can be spread through direct contact or airborne infection. When treatment is necessary, a combination of doxycycline, fusidic acid, or trimethoprim with rifampicin is typically effective. However, it is important to note that fusidic acid and rifampicin should not be used alone due to the risk of resistance developing. Understanding the causes, transmission, and treatment of MRSA is crucial in preventing its spread and managing infections.

Childhood Diarrhoea: Causes and Treatment

Childhood diarrhoea is commonly caused by viruses, with rotavirus being the most prevalent. Other viruses such as norovirus, echoviruses, and enteroviruses can also cause diarrhoea. Rotavirus causes outbreaks of diarrhoea and vomiting during the winter and spring, affecting mainly children under 1 year old. Adults usually have some immunity to the virus, but the elderly can be susceptible. Rotavirus vaccine is now included in childhood vaccination programmes. Ciprofloxacin is not recommended for children and is ineffective against viruses. Loperamide can reduce the duration of diarrhoea, but its adverse effects are unclear and it should not be prescribed. According to NICE guidance, children should avoid school or nursery for at least 48 hours after their symptoms have settled and avoid public swimming pools for 2 weeks. Childhood diarrhoea can be effectively managed with appropriate treatment and prevention measures.

In most cases, Campylobacter infection resolves on its own without the need for treatment. This is the case for the patient in this scenario, as their symptoms have completely disappeared. However, if the symptoms are severe or persist for more than a week, the first-line treatment is clarithromycin. Ciprofloxacin is an alternative treatment option but not the first choice. Vancomycin is not used to treat Campylobacter infection as it is used for C. difficile infections. There is no need to repeat the stool sample as the patient is clinically well and their diarrhea has resolved.

Campylobacter is a type of bacteria that is responsible for causing the majority of cases of infectious intestinal disease in the UK. It is a Gram-negative bacillus that is spread through the faecal-oral route and has an incubation period of 1-6 days. Symptoms of Campylobacter infection include a prodrome of headache and malaise, as well as diarrhoea that is often bloody and abdominal pain that may mimic appendicitis.

In most cases, Campylobacter infection is self-limiting and doesn’t require treatment. However, the British National Formulary (BNF) recommends treatment with antibiotics if the symptoms are severe or if the patient is immunocompromised. Clinical Knowledge summaries also suggest antibiotics if the symptoms are severe, such as high fever, bloody diarrhoea, or more than eight stools per day, or if the symptoms have lasted for more than one week. The first-line antibiotic for Campylobacter infection is clarithromycin, although ciprofloxacin is an alternative. However, the BNF notes that strains with decreased sensitivity to ciprofloxacin are frequently isolated.

Complications of Campylobacter infection can include Guillain-Barre syndrome, reactive arthritis, septicaemia, endocarditis, and arthritis.

Transmission and Treatment of Hepatitis C

Hepatitis C virus is not as easily transmitted through a needlestick as hepatitis B virus, with a risk of transmission estimated at only 3%. Currently, there is no post-exposure vaccine available and neither immunoglobulin nor any antiviral agent has been proven effective in preventing transmission. Studies have shown that high anti-HCV titre immunoglobulin did not prevent transmission. Healthcare workers exposed to a source known to be positive for anti-HCV or HCV RNA should have their serum tested for HCV RNA at 6 and 12 weeks and for anti-HCV at 12 and 24 weeks.

In the treatment of hepatitis C infection, peg-interferon α and ribavirin are commonly used. These treatments have been found to be particularly effective in people infected with virus of genotypes 2 and 3.

Assessment of a Child with Feverish Illness

According to the guideline ‘Feverish Illness in Children’ (NICE CG 47. May 2007), a child with feverish illness can be assessed using a traffic light system to determine the risk of serious illness. In this case, the child would be placed in the low-risk category, indicating that he most likely has a viral infection.

Symptomatic treatment, along with safety-netting and review, is all that is required. However, it is recommended to send a urine sample for culture if possible. This assessment helps healthcare professionals to provide appropriate care and management for children with feverish illness.

Understanding HIV Seroconversion

HIV seroconversion is a process that occurs in individuals who have been recently infected with the virus. It is characterized by symptoms that resemble those of glandular fever, such as sore throat, lymphadenopathy, malaise, myalgia, arthralgia, diarrhea, maculopapular rash, and mouth ulcers. In some rare cases, it can also lead to meningoencephalitis. The severity of the symptoms is associated with the long-term prognosis of the patient, with more severe symptoms indicating a poorer prognosis.

Diagnosing HIV seroconversion can be challenging, as antibodies to the virus may not be present in the early stages of infection. However, HIV PCR and p24 antigen tests can confirm the diagnosis. Understanding the process of HIV seroconversion is crucial for early detection and treatment of the virus, as well as for preventing its spread to others. By recognizing the symptoms and seeking medical attention promptly, individuals can receive the care they need to manage the virus and improve their long-term outcomes.

According to the GMC, doctors should refrain from treating themselves or individuals with whom they have a close personal relationship. It is recommended that doctors register with a GP outside of their family. Therefore, the most appropriate course of action would be to suggest that the colleague consults with their own GP. Discussing their medical history could create confusion regarding the doctor-patient relationship. Urging them to visit A&E is not advisable as it is not an emergency or an accident. It is worth noting that this type of request is not uncommon among colleagues, and reporting it to the GMC may be considered excessive.

Understanding Vaginal Discharge: Causes and Symptoms

Vaginal discharge is a common occurrence in women, but it can sometimes indicate an underlying health issue. The most common causes of vaginal discharge are physiological, bacterial vaginosis, and candidal infections. Bacterial vaginosis is caused by the anaerobe Gardnerella vaginalis, which disrupts the normal vaginal flora. It causes a thin, profuse, and fishy-smelling discharge without itch or soreness. Candidiasis results in a thick, white, non-offensive discharge, which is associated with vulval itch and soreness. It may cause mild dyspareunia and external dysuria.

Sexually transmitted infections such as Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis can also cause purulent vaginal discharge. These infections may be asymptomatic, making it difficult to differentiate between them without laboratory testing. T. vaginalis is a protozoan parasite that causes an offensive yellow vaginal discharge, which is often profuse and frothy. It is associated with vulval itch and soreness, dysuria, abdominal pain, and superficial dyspareunia. A pelvic examination may reveal red blotches on the vaginal wall or cervix, and the labia may be swollen.

It is important to understand the causes and symptoms of vaginal discharge to identify any potential health issues and seek appropriate treatment. Regular gynecological check-ups and practicing safe sex can help prevent and manage vaginal discharge.

The use of macrolides, such as erythromycin and clarithromycin, has been associated with QT interval prolongation. Other antimicrobials like fluoroquinolones (e.g. ciprofloxacin) and oral antifungals (e.g. fluconazole, ketoconazole) have also been implicated. Additionally, certain medications used for arrhythmias (e.g. amiodarone), psychiatric disorders (e.g. haloperidol), and depression (e.g. citalopram) can cause QT prolongation. However, doxycycline, propranolol, levothyroxine, and ibuprofen are not known to have this effect.

Macrolides are a class of antibiotics that include erythromycin, clarithromycin, and azithromycin. They work by blocking translocation during bacterial protein synthesis, ultimately inhibiting bacterial growth. While they are generally considered bacteriostatic, their effectiveness can vary depending on the dose and type of organism being treated. Resistance to macrolides can occur through post-transcriptional methylation of the 23S bacterial ribosomal RNA.

However, macrolides can also have adverse effects. They may cause prolongation of the QT interval and gastrointestinal side-effects, such as nausea. Cholestatic jaundice is a potential risk, but using erythromycin stearate may reduce this risk. Additionally, macrolides are known to inhibit the cytochrome P450 isoenzyme CYP3A4, which metabolizes statins. Therefore, it is important to stop taking statins while on a course of macrolides to avoid the risk of myopathy and rhabdomyolysis. Azithromycin is also associated with hearing loss and tinnitus.

Overall, while macrolides can be effective antibiotics, they do come with potential risks and side-effects. It is important to weigh the benefits and risks before starting a course of treatment with these antibiotics.

The standard diagnostic and screening test for HIV now includes a combination of HIV p24 antigen and HIV antibody testing. Therefore, the correct option is to offer the patient testing for HIV p24 antigen and HIV antibody. Monitoring for those with confirmed HIV infection involves measuring CD4 lymphocyte cell count and viral load, which is not applicable in this case as the patient doesn’t have a confirmed diagnosis. A full blood count may show features suggesting HIV, but it is not a diagnostic test for HIV. NICE recommends offering an HIV test in primary care to those who request testing, have risk factors for HIV, have another sexually transmitted infection, have an AIDS-defining condition, an indicator condition, or clinical features of HIV infection. Therefore, offering the patient testing for a full blood count or stating that testing is not required as he is asymptomatic are incorrect options.

HIV seroconversion is a process where the body develops antibodies against the virus. This process is symptomatic in 60-80% of patients and usually presents as a glandular fever type illness. The severity of symptoms is associated with a poorer long-term prognosis. The symptoms typically occur 3-12 weeks after infection and include a sore throat, lymphadenopathy, malaise, myalgia, arthralgia, diarrhea, maculopapular rash, mouth ulcers, and rarely meningoencephalitis.

Diagnosing HIV involves testing for HIV antibodies, which may not be present in early infection. However, most people develop antibodies to HIV at 4-6 weeks, and 99% do so by 3 months. The diagnosis usually involves both a screening ELISA test and a confirmatory Western Blot Assay. Additionally, a p24 antigen test can be used to detect a viral core protein that appears early in the blood as the viral RNA levels rise. Combination tests that test for both HIV p24 antigen and HIV antibody are now standard for the diagnosis and screening of HIV. If the combined test is positive, it should be repeated to confirm the diagnosis. Some centers may also test the viral load (HIV RNA levels) if HIV is suspected at the same time. Testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure, and after an initial negative result, a repeat test should be offered at 12 weeks.

If a patient’s tetanus vaccination history is uncertain, they should receive a booster vaccine and immunoglobulin, unless the wound is minor and less than six hours old. In the case of Sarah, who has a tetanus-prone wound contaminated with soil, she requires treatment with human tetanus immunoglobulin. According to NICE guidelines, if a person’s immunisation status is unknown or uncertain, an immediate dose of vaccine should be given, followed by a full five-dose course if necessary to ensure future immunity. Therefore, the correct course of action is to administer both a booster vaccine and tetanus immunoglobulin. Waiting to confirm the tetanus immunisation history is not recommended, as tetanus prophylaxis needs to be given urgently. Advising that no tetanus prophylaxis is required is also incorrect, especially in the case of a tetanus-prone wound, which requires both a booster vaccine and tetanus immunoglobulin.

Tetanus Vaccination and Management of Wounds

The tetanus vaccine is a purified toxin that is given as part of a combined vaccine. In the UK, it is given as part of the routine immunisation schedule at 2, 3, and 4 months, 3-5 years, and 13-18 years, providing a total of 5 doses. This is considered to provide long-term protection against tetanus.

When managing wounds, the first step is to classify them as clean, tetanus-prone, or high-risk tetanus-prone. Clean wounds are less than 6 hours old and non-penetrating with negligible tissue damage. Tetanus-prone wounds include puncture-type injuries acquired in a contaminated environment, wounds containing foreign bodies, and compound fractures. High-risk tetanus-prone wounds include wounds or burns with systemic sepsis, certain animal bites and scratches, heavy contamination with material likely to contain tetanus spores, wounds or burns that show extensive devitalised tissue, and wounds or burns that require surgical intervention.

If the patient has had a full course of tetanus vaccines with the last dose less than 10 years ago, no vaccine or tetanus immunoglobulin is required regardless of the wound severity. If the patient has had a full course of tetanus vaccines with the last dose more than 10 years ago, a reinforcing dose of vaccine is required for tetanus-prone wounds, and a reinforcing dose of vaccine plus tetanus immunoglobulin is required for high-risk wounds. If the vaccination history is incomplete or unknown, a reinforcing dose of vaccine is required regardless of the wound severity, and a reinforcing dose of vaccine plus tetanus immunoglobulin is required for tetanus-prone and high-risk wounds.

The BCG vaccine is a form of immunization that provides limited protection against tuberculosis (TB). In the UK, it is typically given to high-risk infants and was previously administered to children at the age of 13 years until 2005. The Greenbook recommends that the vaccine be given to infants living in areas with an annual incidence of TB of 40/100,000 or greater, as well as infants with a parent or grandparent born in a country with a similar incidence rate. Other groups that should receive the vaccine include previously unvaccinated contacts of respiratory TB cases, healthcare workers, prison staff, and those who work with homeless people.

The vaccine contains live attenuated Mycobacterium bovis and also offers limited protection against leprosy. Before receiving the BCG vaccine, individuals must undergo a tuberculin skin test, with the exception of children under six years old who have had no contact with tuberculosis. The vaccine is administered intradermally to the lateral aspect of the left upper arm and can be given at the same time as other live vaccines, with a four-week interval if not administered simultaneously.

There are several contraindications for the BCG vaccine, including previous vaccination, a history of tuberculosis, HIV, pregnancy, and a positive tuberculin test. It is not recommended for individuals over the age of 35, as there is no evidence that it is effective for this age group.

Reactive arthritis doesn’t usually have an acute onset and can develop up to four weeks after the initial infection. It may have a relapsing-remitting course over several months.

The correct treatment for this patient’s severe polyarthritis would be oral prednisolone, a systemic corticosteroid. The dosing should be based on the severity of the arthritis, with tapering to the lowest effective dose. Typical starting doses are 20-40 mg/day.

TNF inhibitor therapy would not be appropriate in this case. However, it may be effective and safe for patients with reactive arthritis who are unresponsive to NSAID or non-biologic DMARD therapy.

Celecoxib is not the correct choice for this patient. Since regular ibuprofen did not provide relief for a week, the next step would be oral corticosteroids. Although patients may require high doses of NSAIDs with a long half-life, such as Naproxen 500mg BD, systemic corticosteroids are more appropriate for this patient with multiple joints involved and systemic illness.

Intra-articular injections are useful for large joint effusions, but in this case, systemic corticosteroids are more appropriate due to the patient’s multiple joint involvement and systemic illness.

Understanding Reactive Arthritis: Symptoms and Features

Reactive arthritis is a type of seronegative spondyloarthropathy that is associated with HLA-B27. It was previously known as Reiter’s syndrome, which was characterized by a triad of urethritis, conjunctivitis, and arthritis following a dysenteric illness during World War II. However, later studies revealed that patients could develop symptoms after a sexually transmitted infection, now referred to as sexually acquired reactive arthritis (SARA).

This condition is defined as an arthritis that develops after an infection where the organism cannot be recovered from the joint. The symptoms typically develop within four weeks of the initial infection and last for around 4-6 months. Approximately 25% of patients experience recurrent episodes, while 10% develop chronic disease.

The arthritis associated with reactive arthritis is usually an asymmetrical oligoarthritis of the lower limbs, and patients may also experience dactylitis. Other symptoms include urethritis, conjunctivitis (seen in 10-30% of patients), and anterior uveitis. Skin symptoms may also occur, such as circinate balanitis (painless vesicles on the coronal margin of the prepuce) and keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles).

To remember the symptoms associated with reactive arthritis, the phrase can’t see, pee, or climb a tree is often used. It is important to note that the term Reiter’s syndrome is no longer used due to the fact that the eponym was named after a member of the Nazi party. Understanding the symptoms and features of reactive arthritis can aid in prompt diagnosis and treatment.

The Importance of Understanding Immunisation Schedules

Immunisation schedules are crucial to understand, especially with recent changes to UK guidance in January 2020. One significant change relates to the timing of pneumococcal immunisation. Additionally, hepatitis B vaccination is routinely available as part of the NHS vaccination schedule. It is offered to all babies at 8, 12, and 16 weeks of age, as well as those at increased risk of hepatitis B or its complications.

It is essential to memorise the latest schedule, as it may feature in your exam. We have included a reference to a summary guide below for your convenience. Understanding immunisation schedules is crucial for healthcare professionals to ensure that patients receive the appropriate vaccinations at the correct time.

Managing Conjunctivitis in Children: Antibiotics Not Always Necessary

As of April 2010, ophthalmia neonatorum is no longer a notifiable disease. A randomized controlled trial published in the Lancet in 2005 compared placebo with chloramphenicol drops in children with conjunctivitis and concluded that prescribing antibiotic drops for conjunctivitis in children should be stopped. Instead, children should be advised to keep the eye clean and return for review if no better after one week. The Health Professionals Alliance’s guidance on infection control in schools and other childcare settings doesn’t recommend any time away for children with conjunctivitis. Simple bacterial conjunctivitis usually lasts 10-14 days and is self-limiting. A review if no better at one week to exclude corneal involvement or other complications is recommended. Adenoviral conjunctivitis is highly contagious and often rapidly becomes bilateral.

Treatment and Prevention of Pertussis

Pertussis, commonly known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. Treatment with antibiotics can reduce the infectivity of the disease, but it doesn’t shorten the duration of the illness. Macrolide antibiotics are the preferred treatment for pertussis.

Immunization is the most effective way to prevent pertussis. However, the vaccine provides only 95% protection and relies on a degree of herd immunity. Infants less than 6 months old and any unwell child should be admitted to the hospital for treatment.

If left untreated, pertussis can lead to complications such as bronchiectasis and pneumonia. Therefore, it is important to seek medical attention if you suspect you or your child has pertussis. Early diagnosis and treatment can help prevent the spread of the disease and reduce the risk of complications.

Co-amoxiclav is the appropriate treatment for human bites, similar to animal bites. In case the patient is allergic to penicillin, doxycycline and metronidazole can be used. However, since there is no mention of any allergies, we assume that the patient has none. Waiting for the swab results is not the correct approach. Antibiotic prophylaxis is recommended for various conditions, including hand/foot/facial injuries, deep puncture wounds, wounds requiring surgical debridement, wounds involving joints/tendons/ligaments, suspected fractures, and patients who are immunosuppressed, diabetic, cirrhotic, asplenic, or elderly. Antibiotic treatment is necessary for infected bites, which is the case here as the bite appears red, swollen, and is on the hand. Cellulitis, on the other hand, is treated with flucloxacillin.

Animal bites are a common occurrence in everyday practice, with dogs and cats being the most frequent culprits. These bites are usually caused by multiple types of bacteria, with Pasteurella multocida being the most commonly isolated organism. To manage these bites, it is important to cleanse the wound thoroughly. Puncture wounds should not be sutured unless there is a risk of cosmesis. The current recommendation is to use co-amoxiclav, but if the patient is allergic to penicillin, doxycycline and metronidazole are recommended.

On the other hand, human bites can cause infections from a variety of bacteria, including both aerobic and anaerobic types. Common organisms include Streptococci spp., Staphylococcus aureus, Eikenella, Fusobacterium, and Prevotella. To manage these bites, co-amoxiclav is also recommended. It is important to consider the risk of viral infections such as HIV and hepatitis C when dealing with human bites.

A returning traveler experiencing retro-orbital headache, fever, facial flushing, rash, and thrombocytopenia is likely suffering from dengue fever. This disease is commonly found in South America and Southeast Asia and is characterized by sudden onset fever and joint pain, as well as low platelet counts and bleeding in severe cases. Chagas disease, which is also found in this region, typically presents with mild symptoms and elevated eosinophil levels. Viral hepatitis and malaria are less probable causes of a petechial rash.

Understanding Dengue Fever

Dengue fever is a viral infection that can lead to viral haemorrhagic fever, which includes diseases like yellow fever, Lassa fever, and Ebola. The dengue virus is an RNA virus that belongs to the Flavivirus genus and is transmitted by the Aedes aegypti mosquito. The incubation period for dengue fever is seven days.

Patients with dengue fever can be classified into three categories: those without warning signs, those with warning signs, and those with severe dengue (dengue haemorrhagic fever). Symptoms of dengue fever include fever, headache (often retro-orbital), myalgia, bone pain, arthralgia (also known as ‘break-bone fever’), pleuritic pain, facial flushing, maculopapular rash, and haemorrhagic manifestations such as a positive tourniquet test, petechiae, purpura/ecchymosis, and epistaxis. Warning signs include abdominal pain, hepatomegaly, persistent vomiting, and clinical fluid accumulation (ascites, pleural effusion). Severe dengue (dengue haemorrhagic fever) is a form of disseminated intravascular coagulation (DIC) that results in thrombocytopenia and spontaneous bleeding. Around 20-30% of these patients go on to develop dengue shock syndrome (DSS).

Typically, blood tests are used to diagnose dengue fever, which may show leukopenia, thrombocytopenia, and raised aminotransferases. Diagnostic tests such as serology, nucleic acid amplification tests for viral RNA, and NS1 antigen tests may also be used. Treatment for dengue fever is entirely symptomatic, including fluid resuscitation and blood transfusions. Currently, there are no antivirals available for the treatment of dengue fever.

If a patient who previously had gastroenteritis and maintains a normal diet continues to experience changes in their bowel habits, the most probable diagnosis is acquired lactose intolerance.

The most likely explanation for this scenario is secondary lactose intolerance, which occurs when the lining of the gut is damaged and temporarily unable to produce sufficient lactase. This damage can be caused by any condition that irritates and harms the gut, such as gastroenteritis. This type of lactose intolerance is usually temporary, and avoiding dairy products for a few weeks or months allows the gut to heal. Over time, the gut’s ability to produce lactase will recover, and the patient will be able to consume dairy products again.

While other possibilities exist, inflammatory bowel disease and coeliac disease are less likely than lactose intolerance and are not typically associated with confirmed gastroenteritis.

Haemolytic uraemic syndrome is a rare complication of gastroenteritis, particularly with certain strains of E.coli, but it typically presents with haematuria and decreased urine output.

The final option is unlikely since it appears that the infection has improved.

Gastroenteritis can occur either at home or while traveling abroad, which is known as travelers’ diarrhea. This type of diarrhea is characterized by at least three loose to watery stools in 24 hours, along with abdominal cramps, fever, nausea, vomiting, or blood in the stool. The most common cause of traveler’s’ diarrhea is Escherichia coli. Another type of illness is acute food poisoning, which is caused by the ingestion of a toxin and results in sudden onset of nausea, vomiting, and diarrhea. Staphylococcus aureus, Bacillus cereus, and Clostridium perfringens are the typical causes of acute food poisoning.

Different infections have stereotypical histories and presentations. Escherichia coli is common among travelers and causes watery stools, abdominal cramps, and nausea. Giardiasis results in prolonged, non-bloody diarrhea. Cholera causes profuse, watery diarrhea and severe dehydration resulting in weight loss, but it is not common among travelers. Shigella causes bloody diarrhea, vomiting, and abdominal pain. Staphylococcus aureus causes severe vomiting with a short incubation period. Campylobacter usually starts with a flu-like prodrome and is followed by crampy abdominal pains, fever, and diarrhea, which may be bloody and may mimic appendicitis. Bacillus cereus has two types of illness: vomiting within six hours, typically due to rice, and diarrheal illness occurring after six hours. Amoebiasis has a gradual onset of bloody diarrhea, abdominal pain, and tenderness that may last for several weeks.

The incubation period for different infections varies. Staphylococcus aureus and Bacillus cereus have an incubation period of 1-6 hours, while Salmonella and Escherichia coli have an incubation period of 12-48 hours. Shigella and Campylobacter have an incubation period of 48-72 hours, while Giardiasis and Amoebiasis have an incubation period of more than seven days. The vomiting subtype of Bacillus cereus has an incubation period of 6-14 hours, while the diarrheal illness has an incubation period of more than six hours.