06 METABOLIC MEDICINE 08 INFECTIOUS DISEASE 08.06 Viral infections 09 DERMATOLOGY 09.06 Dermatological infections
& ENDOCRINOLOGY • Chikungunya • Covid-19 • Tinea / dermatophyte infections
08.01 Bacterial infections • Cytomegalovirus • Epstein-Barr 09.01 Dermatological emergencies • Candida • Viral warts
06.01 Thyroid • Anthrax • Bacillus cereus • HFMD • HSV • Acute urticaria & angioedema • Molluscum contagiosum
• Hypothyroidism • Hyperthyroidism • Campylobacter • Botulism • Japanese encephalitis • HIV • Steven-Johnson's & TEN
• Thyroid cancers • Goitre • Cat scratch disease • Cholera • Eczema herpeticum 09.07 Dermatological infections
• Clostridiodes difficile • Diphtheria 08.07 Viral infections • Staph scalded skin syndrome • Varicella / chickenpox
06.02 Adrenals • Escherichia coli • Influenza • Measles • Necrotising fasciitis • Herpes zoster / shingles
• Cushing's disease • Enteric fever (typhoid/paratyphoid) • Mpox • Orf • Mumps • Pityriasis rosea
• Adrenal insufficiency • Norovirus • Parvovirus 09.02 Melanocytic lesions and mimickers • Hidradenitis suppurativa
• Hyperaldosteronism 08.02 Bacterial infections • Poliovirus • Melanoma & differentials
• Phaeochromocytoma • H. influenzae • Klebsiella • Seborrhoeic keratosis • Benign naevi 09.08 Miscellaneous
• Leptospirosis • Leprosy 08.09 Viral infections • Dermatofibroma • Pemphigus • Bullous pemphigoid
06.03 • Listeria • Lyme disease • Rabies • RSV • Rotavirus • Pyoderma gangrenosum • Insect bites • Skin lesions
• Acromegaly • Prolactinoma • Meliodosis & other Burholderia • Rubella • West Nile • Zika
10.07 Platelet disorders
• Hyperthyroidism & hypoparathyroidism • Mycoplasma pneumoniae • Viral haemorrhagic fevers, including 09.03 • Non-melanoma skin cancers
• Immune thrombocytopaenia
• Multiple endocrine neoplasia • Pseudomonas aeruginosa Dengue, Ebola, Yellow Fever - BCC & SCC
• Thrombocytopaenia
• Salmonella • Shigella • Acne vulgaris
• Haemophilia
06.04 Diabetes melitus 08.10 Genitourinary infections / STIs
• T1DM, T2DM 08.03 Bacterial infections • Chlamydia • Gonorrhoea 09.04 • Eczema • Psoriasis • von Willebrand disease
© quackquackmed.com
• Neutropaenia
• Drugs used in DM • Insulin • Q fever • Staph. aureus • Bacterial vaginosis • Rosacea
• DVLA rules for diabetes • Coagulase-negative staphylococci • Trichomonas vaginalis
10.08 Blood products
• Complications of DM & sick day rules • Strep. pneumoniae • Genital herpes • Genital warts 09.05 Dermatological infections
• Strep. pyogenes (incl scarlet fever) • Pubic lice • Donovanosis • Impetigo • Folliculitis • Packed red cells • Platelets
• CMV-ve and irradiated blood
06.05 • Strep agalactiae (GBS) • Syphilis • Chancroid • Cellulitis & erysipelas
• FFP & cryoprecipitate
• Diabetic ketoacidosis • Tetanus & other Clostridia • Ulcers in STIs • Head lice • Scabies
• Prothrombin complex
• Hyperosmotic hyperglycaemic state • Yersinia pestis
• Cell saver devices
• Hypoglycaemia 08.11 Helminth infections
10 HAEMATOLOGY & ONCOLOGY • Warfarin – Mx of high INR
• Diabetes insipidus 08.04 Bacterial & fungal infections Incl Hookworm, Cutaneous larva
• Blood product transfusion
- Water deprivation test • Rickettsiae • Actinomyces & Nocardia migrans, Strongyloides, Pinworm,
• Candida • Cryptococcosis Hydatid disease, Schistomiasis 10.01 Haematological cancers complications, including TACO, TRALI
06.06 • Acid-base balance • Aspergillus • Mucormycosis • ALL • CLL • Hairy cell leukaemia
• Hypercholesterolaemia • AML • CML • Myelofibrosis 10.09 Miscellaneous
• Histoplasmosis 08.12 Protozoan infections
• Malaria • Toxoplasmosis • Myelodysplastic syndrome • Hereditary angioedema
06.07 • Hyperkalaemia & hypokalaemia 08.05 Antibiogram • Cryptosporidiosis • Chagas disease • Polycythaemia vera • Hyposplenism • Splenomegaly
• Thymoma • Lymphadenopathy
• Hypercalcaemia & hypocalcaemia • Sleeping sickness • Leishmaniasis
10.02 Haematological cancers • Drugs – anticoagulants, antiplatelets,
• Hypomagnesaemia 08.06 Antibiotics – mechanisms of action • Giardiasis • Amoebiasis
and side effects • Non-Hodgkin's lymphoma tranexamic acid
06.08 • Hyponatraemia (DDx) • Notifiable diseases 08.13 Misc infections • Hodgkin's lymphoma
- SIADH • Multiple myeloma 10.10 Emergencies, organ transplants
• Sepsis • Animal & human bites
• Hypernatraemia • Cellulitis • Lemierre's syndrome • Neutropenic sepsis
• Spinal epidural abscess 10.03 Primary immunodeficiencies • Tumour lysis syndrome
• Neutrophilia / phagocytes • Graft versus host disease (GVHD)
• Hyposplenism • Diabetic foot infxn
07 RENAL MEDICINE & UROLOGY • Superior vena cava syndrome
• Vaccination schedule • T-cell disorders, incl DiGeorge's
• B & T-cell disorders, incl SCID • Organ transplant & rejection
07.01 • Acute kidney injury (AKI) 07.04 • Urinary tract stones • Acute intermittent porphyria
04.14 Misc infections
• Chronic kidney disease (CKD) • Benign prostatic hyperplasia 10.11
• Diarrhoea DDx • Gastroenteritis
- Renal replacement therapy • Erectile dysfunction 10.04 Anaemia • Common cancers • Tumour markers
• List of other infections found in book
• DDx chart + iron studies interpretation • Genetic conditions predisposing to
07.02 • Acute tubular necrosis 07.05 • Microcytic anaemia cancer
• Acute interstitial nephritis • Urological cancers: renal cell • Prescribing for palliative / end of life
• Diabetic nephropathy carcinoma, bladder Ca, prostate Ca care
10.05 Anaemia
• Lupus nephritis • Misc urology: circumcision, vasectomy, • Normocytic anaemia ÷ non-haemolytic
• ANCA glomerulonephritis priapism 10.12 Breast
and haemolytic anaemia
• Myeloma kidney • Breast Ca • Fibroadenoma
07.06 Testicular lumps 10.06 • Microcytic anaemia • Fibrocystic breast changes
07.03 Infections of the urinary tract • Inguinal hernia • Hydrocele • Fat necrosis • Lipoma
• Methaemoglobinaemia
• Infectious cystitis including UTI • Varicocele • Epididymal cyst • Phyllodes tumour • Galactocele
• Thrombophilia
• Pyelonephritis • Epididymitis • Epididymo-orchitis • Mammary duct ectasia
• Antiphospholipid syndrome
• Prostatitis • Balanoposthitis • Testicular torsion • Testicular tumour • Duct papilloma • Lump description
• Thrombocytosis
, * Low yield (but good to know)
Anthrax Woolsorter's disease Brucellosis Cholera Diphtheria Enteric fever
(typhoid / paratyphoid)
Gram +ve Bacillus anthracis Gram-ve Brucella melitensis, B. Gram -ve Vibrio cholerae Gram+ve Corynebacterium
From animals – usually infected abortus, B. suis. Rarely B. canis. Contaminated water, undercooked diphtheriae aerobic Gram-ve Salmonella enterica
carcasses (sheep) Zoonotic. Unpasteurised milk . seafood Respiratory droplets serotypes Typhi & Paratyphi A,B,C
Farmers, abattoirs Children 3-6mo; developing countries Faecal-oral route (contaminated food
S/smx: quite non-specific, incl undulant S/smx: Acute, severe watery diarrhoea
• Clinical disease due to oedema toxin, MOA: exotoxin inhibits protein synthesis and water). Travel hx.
fever, nausea, vomiting, night sweats, ("rice-water" with fishy odour)
lethal toxin, and capsule malaise, arthralgias, hepatospleno- • Dehydration can cause death in 6-12h S/smx: S/smx: • Fever: persistent high fever
• Cutaneous anthrax (95%) megaly and lymphadenopathy • Not normally a/w fever • Respiratory disease – fever, malaise (can be ≥39ºC); fever often persistent
- Pruritic papule vesicular lesion Key lies in travel Hx & exposure • Complications – hypoglycaemia, - Sore throat with 'diphtheric membrane' even with abx
surrounded by oedema painless hypotension, AKI, stroke (grey pseudomembrane on posterior • Other: abdo pain, constipation, head-
Ix: Serology. Blood and bone cultures.
black eschar (falls off in 1-2w) Ix: rapid antigen tests (eg dipstick stool pharyngeal wall) aches, hepatosplenomegaly, etc
DDx: TB, malaria, blood cancers.
• GI anthrax (<5%) due to ingestion of assays) – should not delay tx - Bulky cervical lymphadenopathy • Rose spots on trunk in 2-40%
contaminated meat. Mx: doxycycline & rifampicin "bull neck" + inspiratory stridor • Relative bradycardia (Faget's sign)
© quackquackmed.com
• Inhalational anthrax (rare); a/w handling doxy + streptomycin Mx: • Rapid Ax of dehydration, urgent • Cardiac – can develop heart block,
of wool, hides, bones or bioterrorism. • + Gentamicin if complicated disease fluid and electrolyte replacement Ix: blood & stool cultures. Rarely bone
heart failure
100% mortality without early abx. - Oral rehydration salts (ORS) – marrow cultures.
Comp: infective endocarditis, meningo- • Neurological – cranial nerve palsies,
• All can develop into fulminant infxns. encourage in all pts as able peripheral neuritis (motor deficits) Mx: depends on local resistance, etc.
encephalitis, osteomyelitis, orchitis, etc ◊ 0.5 tsp of salt + 6 tsp sugar in 1L of
Mx: Ciprofloxacin or doxycycline clean water
• Cutaneous – chronic non-healing ulcers • Up to 6% relapse in 2-3w, will require
• Further tx – expert advice with grey membranes additional course of abx
• Abx – macrolide or fluoroquinolone
Ix: bacterial throat swab, culture using Complications (3rd or 4th week): intesti-
Botulism Loeffler's media nal perforation/haemorrhage (3-15%).
Bacillus cereus Gram +ve anaerobic Clostridium Other organs can be affected. Untreated,
Mx: IM/IV penicillin, diphtheria antitoxin
botulinum (serotypes A-G) Clostridioides difficile C. diff mortality 10-15%.
Gram +ve rod Bacillus cereus • Notifiable disease
contaminated food (tinned food,
Food, soil, water Gram +ve rod anaerobic, spore- • Prevention: toxoid vaccine
honey ), IVDU
forming, toxin-producing Escherichia coli
Food poisoning syndromes MOA: botulinum toxin is a neurotoxin
Healthcare facilities – spread by
• Emetic form: onset 1-5h (nausea, which irreversibly blocks the release of
faecal-oral route, ingestion of spores facultative anaerobic, lactose-
vomiting, cramps) ± diarrhoea. Due ACh – affects bulbar muscles and the
• R: abx exposure (esp clindamycin, fermenting, Gram-ve rod
to heat-stable exotoxin cereulide. autonomic nervous system normal gut commensal
cephalosporins), PPI use
◊ Classically a/w reheated rice S/smx: MOA: clinical disease dependent on
• Diarrhoeal syndrome: onset 8-16h • Nausea, vomiting, diplopia, b/l ptosis surface antigens (eg O-antigen), toxins
S/smx:
(cramps, profuse diarrhoea). • Then descending motor loss with • Diarrhoea – classically very smelly (if S/smx:
• Smx resolve within 24h for both. flaccid paralysis (floppy). Difficulty you know you know)
Can cause disseminated infxns in • UTIs – E.coli is the commonest cause
speaking and swallowing. • Abdominal pain
immunocompromise. Mx: • Review medicines used • GI – diarrhoeal disease
• Pt retains consciousness & sensation. • If severe, toxic megacolon may develop • Accurate stool charting - Enterotoxigenic E.coli (ETEC) causes
Mx of food poisoning: supportive tx Mx: botulism antitox, supportive care • First episode traveller's diarrhoea
Others: β-lactamase + vancomycin • Antitoxin is only useful if given early, Dx/Ix: Stool sample, testing for antigen - PO vancomycin x10d - Enterohaemorrhagic E.coli (EHEC)
once toxin binds to AChR it cannot or toxin; test only if pt has diarrhoea - PO fidaxomicin causes haemorrhagic colitis
be reversed - Not useful as test for cure; pt can - 3rd-line: PO vanco ± IV metronidazole - E. coli O157:H7 is a strain of Shiga
remain positive • Recurrent episode toxin-producing E.coli found in conta-
Campylobacter
• Others: bloods (FBC, CRP, U&Es, etc) - Within 12w of smx resolution: PO minated ground beef, a/w haemolytic
Gram-ve rod Campylobacter jejuni Cat scratch disease fidaxomicin uraemic syndrome in young children
Public Health England severity scale
faecal-oral route – incubate 1-6d Gram -ve Bartonella henselae • Mild: normal WCC - After 12w: PO vanco or fidaxomicin Mx:
Cat (vector: cat flea) • Moderate: WCC (10-15 x10⁹) • Life-threatening infxn • UTIs: nitrofurantoin, trimethoprim
S/smx: prodromal headache and malaise - typically 3-5 loose stools per day - PO vancomycin and IV metronidazole • Diarrhoeal illnesses – supportive care.
• Diarrhoea – bloody :( S/smx: • Papule/pustule at site 3-10d • Severe: WCC (>15 x10⁹)
• Abdo pain mimicking appendicitis - Specialist advice: surgery Abx not routinely indicated.
after inoculation - acute creatinine (>1.5x baseline) • Other meds: bezlotoxumab, faecal
Mx: • Self-limiting; supportive tx • Non-specific s/smx: regional lymphade- - temp >38.5ºC
microbiota transplant (consider if ≥2
• Tx if immunocompromised or severe nopathy, fever. Can cause headache, - evidence of severe colitis (abdominal
or radiological signs) previous episodes)
clarithromycin ciprofloxacin sore throat and rash less commonly. • Prevention: isolation in side room until
• Life-threatening: hypotension
• Complications in immunocompromised no more episodes of diarrhoea for
Comp: a/w Guillian Barre syndrome - Partial or complete ileus
classically, reactive arthritis, septicaemia, Mx: doxycycline, azithromycin - Toxic megacolon ≥48h + PPE + hand wash with soap
endocarditis • Lymphadenopathy settles in 2-4mo - CT evidence of severe disease (alcohol rub not useful)
even without treatment
08.01 Infectious disease – Bacterial infections last updated 17/09/2025
& ENDOCRINOLOGY • Chikungunya • Covid-19 • Tinea / dermatophyte infections
08.01 Bacterial infections • Cytomegalovirus • Epstein-Barr 09.01 Dermatological emergencies • Candida • Viral warts
06.01 Thyroid • Anthrax • Bacillus cereus • HFMD • HSV • Acute urticaria & angioedema • Molluscum contagiosum
• Hypothyroidism • Hyperthyroidism • Campylobacter • Botulism • Japanese encephalitis • HIV • Steven-Johnson's & TEN
• Thyroid cancers • Goitre • Cat scratch disease • Cholera • Eczema herpeticum 09.07 Dermatological infections
• Clostridiodes difficile • Diphtheria 08.07 Viral infections • Staph scalded skin syndrome • Varicella / chickenpox
06.02 Adrenals • Escherichia coli • Influenza • Measles • Necrotising fasciitis • Herpes zoster / shingles
• Cushing's disease • Enteric fever (typhoid/paratyphoid) • Mpox • Orf • Mumps • Pityriasis rosea
• Adrenal insufficiency • Norovirus • Parvovirus 09.02 Melanocytic lesions and mimickers • Hidradenitis suppurativa
• Hyperaldosteronism 08.02 Bacterial infections • Poliovirus • Melanoma & differentials
• Phaeochromocytoma • H. influenzae • Klebsiella • Seborrhoeic keratosis • Benign naevi 09.08 Miscellaneous
• Leptospirosis • Leprosy 08.09 Viral infections • Dermatofibroma • Pemphigus • Bullous pemphigoid
06.03 • Listeria • Lyme disease • Rabies • RSV • Rotavirus • Pyoderma gangrenosum • Insect bites • Skin lesions
• Acromegaly • Prolactinoma • Meliodosis & other Burholderia • Rubella • West Nile • Zika
10.07 Platelet disorders
• Hyperthyroidism & hypoparathyroidism • Mycoplasma pneumoniae • Viral haemorrhagic fevers, including 09.03 • Non-melanoma skin cancers
• Immune thrombocytopaenia
• Multiple endocrine neoplasia • Pseudomonas aeruginosa Dengue, Ebola, Yellow Fever - BCC & SCC
• Thrombocytopaenia
• Salmonella • Shigella • Acne vulgaris
• Haemophilia
06.04 Diabetes melitus 08.10 Genitourinary infections / STIs
• T1DM, T2DM 08.03 Bacterial infections • Chlamydia • Gonorrhoea 09.04 • Eczema • Psoriasis • von Willebrand disease
© quackquackmed.com
• Neutropaenia
• Drugs used in DM • Insulin • Q fever • Staph. aureus • Bacterial vaginosis • Rosacea
• DVLA rules for diabetes • Coagulase-negative staphylococci • Trichomonas vaginalis
10.08 Blood products
• Complications of DM & sick day rules • Strep. pneumoniae • Genital herpes • Genital warts 09.05 Dermatological infections
• Strep. pyogenes (incl scarlet fever) • Pubic lice • Donovanosis • Impetigo • Folliculitis • Packed red cells • Platelets
• CMV-ve and irradiated blood
06.05 • Strep agalactiae (GBS) • Syphilis • Chancroid • Cellulitis & erysipelas
• FFP & cryoprecipitate
• Diabetic ketoacidosis • Tetanus & other Clostridia • Ulcers in STIs • Head lice • Scabies
• Prothrombin complex
• Hyperosmotic hyperglycaemic state • Yersinia pestis
• Cell saver devices
• Hypoglycaemia 08.11 Helminth infections
10 HAEMATOLOGY & ONCOLOGY • Warfarin – Mx of high INR
• Diabetes insipidus 08.04 Bacterial & fungal infections Incl Hookworm, Cutaneous larva
• Blood product transfusion
- Water deprivation test • Rickettsiae • Actinomyces & Nocardia migrans, Strongyloides, Pinworm,
• Candida • Cryptococcosis Hydatid disease, Schistomiasis 10.01 Haematological cancers complications, including TACO, TRALI
06.06 • Acid-base balance • Aspergillus • Mucormycosis • ALL • CLL • Hairy cell leukaemia
• Hypercholesterolaemia • AML • CML • Myelofibrosis 10.09 Miscellaneous
• Histoplasmosis 08.12 Protozoan infections
• Malaria • Toxoplasmosis • Myelodysplastic syndrome • Hereditary angioedema
06.07 • Hyperkalaemia & hypokalaemia 08.05 Antibiogram • Cryptosporidiosis • Chagas disease • Polycythaemia vera • Hyposplenism • Splenomegaly
• Thymoma • Lymphadenopathy
• Hypercalcaemia & hypocalcaemia • Sleeping sickness • Leishmaniasis
10.02 Haematological cancers • Drugs – anticoagulants, antiplatelets,
• Hypomagnesaemia 08.06 Antibiotics – mechanisms of action • Giardiasis • Amoebiasis
and side effects • Non-Hodgkin's lymphoma tranexamic acid
06.08 • Hyponatraemia (DDx) • Notifiable diseases 08.13 Misc infections • Hodgkin's lymphoma
- SIADH • Multiple myeloma 10.10 Emergencies, organ transplants
• Sepsis • Animal & human bites
• Hypernatraemia • Cellulitis • Lemierre's syndrome • Neutropenic sepsis
• Spinal epidural abscess 10.03 Primary immunodeficiencies • Tumour lysis syndrome
• Neutrophilia / phagocytes • Graft versus host disease (GVHD)
• Hyposplenism • Diabetic foot infxn
07 RENAL MEDICINE & UROLOGY • Superior vena cava syndrome
• Vaccination schedule • T-cell disorders, incl DiGeorge's
• B & T-cell disorders, incl SCID • Organ transplant & rejection
07.01 • Acute kidney injury (AKI) 07.04 • Urinary tract stones • Acute intermittent porphyria
04.14 Misc infections
• Chronic kidney disease (CKD) • Benign prostatic hyperplasia 10.11
• Diarrhoea DDx • Gastroenteritis
- Renal replacement therapy • Erectile dysfunction 10.04 Anaemia • Common cancers • Tumour markers
• List of other infections found in book
• DDx chart + iron studies interpretation • Genetic conditions predisposing to
07.02 • Acute tubular necrosis 07.05 • Microcytic anaemia cancer
• Acute interstitial nephritis • Urological cancers: renal cell • Prescribing for palliative / end of life
• Diabetic nephropathy carcinoma, bladder Ca, prostate Ca care
10.05 Anaemia
• Lupus nephritis • Misc urology: circumcision, vasectomy, • Normocytic anaemia ÷ non-haemolytic
• ANCA glomerulonephritis priapism 10.12 Breast
and haemolytic anaemia
• Myeloma kidney • Breast Ca • Fibroadenoma
07.06 Testicular lumps 10.06 • Microcytic anaemia • Fibrocystic breast changes
07.03 Infections of the urinary tract • Inguinal hernia • Hydrocele • Fat necrosis • Lipoma
• Methaemoglobinaemia
• Infectious cystitis including UTI • Varicocele • Epididymal cyst • Phyllodes tumour • Galactocele
• Thrombophilia
• Pyelonephritis • Epididymitis • Epididymo-orchitis • Mammary duct ectasia
• Antiphospholipid syndrome
• Prostatitis • Balanoposthitis • Testicular torsion • Testicular tumour • Duct papilloma • Lump description
• Thrombocytosis
, * Low yield (but good to know)
Anthrax Woolsorter's disease Brucellosis Cholera Diphtheria Enteric fever
(typhoid / paratyphoid)
Gram +ve Bacillus anthracis Gram-ve Brucella melitensis, B. Gram -ve Vibrio cholerae Gram+ve Corynebacterium
From animals – usually infected abortus, B. suis. Rarely B. canis. Contaminated water, undercooked diphtheriae aerobic Gram-ve Salmonella enterica
carcasses (sheep) Zoonotic. Unpasteurised milk . seafood Respiratory droplets serotypes Typhi & Paratyphi A,B,C
Farmers, abattoirs Children 3-6mo; developing countries Faecal-oral route (contaminated food
S/smx: quite non-specific, incl undulant S/smx: Acute, severe watery diarrhoea
• Clinical disease due to oedema toxin, MOA: exotoxin inhibits protein synthesis and water). Travel hx.
fever, nausea, vomiting, night sweats, ("rice-water" with fishy odour)
lethal toxin, and capsule malaise, arthralgias, hepatospleno- • Dehydration can cause death in 6-12h S/smx: S/smx: • Fever: persistent high fever
• Cutaneous anthrax (95%) megaly and lymphadenopathy • Not normally a/w fever • Respiratory disease – fever, malaise (can be ≥39ºC); fever often persistent
- Pruritic papule vesicular lesion Key lies in travel Hx & exposure • Complications – hypoglycaemia, - Sore throat with 'diphtheric membrane' even with abx
surrounded by oedema painless hypotension, AKI, stroke (grey pseudomembrane on posterior • Other: abdo pain, constipation, head-
Ix: Serology. Blood and bone cultures.
black eschar (falls off in 1-2w) Ix: rapid antigen tests (eg dipstick stool pharyngeal wall) aches, hepatosplenomegaly, etc
DDx: TB, malaria, blood cancers.
• GI anthrax (<5%) due to ingestion of assays) – should not delay tx - Bulky cervical lymphadenopathy • Rose spots on trunk in 2-40%
contaminated meat. Mx: doxycycline & rifampicin "bull neck" + inspiratory stridor • Relative bradycardia (Faget's sign)
© quackquackmed.com
• Inhalational anthrax (rare); a/w handling doxy + streptomycin Mx: • Rapid Ax of dehydration, urgent • Cardiac – can develop heart block,
of wool, hides, bones or bioterrorism. • + Gentamicin if complicated disease fluid and electrolyte replacement Ix: blood & stool cultures. Rarely bone
heart failure
100% mortality without early abx. - Oral rehydration salts (ORS) – marrow cultures.
Comp: infective endocarditis, meningo- • Neurological – cranial nerve palsies,
• All can develop into fulminant infxns. encourage in all pts as able peripheral neuritis (motor deficits) Mx: depends on local resistance, etc.
encephalitis, osteomyelitis, orchitis, etc ◊ 0.5 tsp of salt + 6 tsp sugar in 1L of
Mx: Ciprofloxacin or doxycycline clean water
• Cutaneous – chronic non-healing ulcers • Up to 6% relapse in 2-3w, will require
• Further tx – expert advice with grey membranes additional course of abx
• Abx – macrolide or fluoroquinolone
Ix: bacterial throat swab, culture using Complications (3rd or 4th week): intesti-
Botulism Loeffler's media nal perforation/haemorrhage (3-15%).
Bacillus cereus Gram +ve anaerobic Clostridium Other organs can be affected. Untreated,
Mx: IM/IV penicillin, diphtheria antitoxin
botulinum (serotypes A-G) Clostridioides difficile C. diff mortality 10-15%.
Gram +ve rod Bacillus cereus • Notifiable disease
contaminated food (tinned food,
Food, soil, water Gram +ve rod anaerobic, spore- • Prevention: toxoid vaccine
honey ), IVDU
forming, toxin-producing Escherichia coli
Food poisoning syndromes MOA: botulinum toxin is a neurotoxin
Healthcare facilities – spread by
• Emetic form: onset 1-5h (nausea, which irreversibly blocks the release of
faecal-oral route, ingestion of spores facultative anaerobic, lactose-
vomiting, cramps) ± diarrhoea. Due ACh – affects bulbar muscles and the
• R: abx exposure (esp clindamycin, fermenting, Gram-ve rod
to heat-stable exotoxin cereulide. autonomic nervous system normal gut commensal
cephalosporins), PPI use
◊ Classically a/w reheated rice S/smx: MOA: clinical disease dependent on
• Diarrhoeal syndrome: onset 8-16h • Nausea, vomiting, diplopia, b/l ptosis surface antigens (eg O-antigen), toxins
S/smx:
(cramps, profuse diarrhoea). • Then descending motor loss with • Diarrhoea – classically very smelly (if S/smx:
• Smx resolve within 24h for both. flaccid paralysis (floppy). Difficulty you know you know)
Can cause disseminated infxns in • UTIs – E.coli is the commonest cause
speaking and swallowing. • Abdominal pain
immunocompromise. Mx: • Review medicines used • GI – diarrhoeal disease
• Pt retains consciousness & sensation. • If severe, toxic megacolon may develop • Accurate stool charting - Enterotoxigenic E.coli (ETEC) causes
Mx of food poisoning: supportive tx Mx: botulism antitox, supportive care • First episode traveller's diarrhoea
Others: β-lactamase + vancomycin • Antitoxin is only useful if given early, Dx/Ix: Stool sample, testing for antigen - PO vancomycin x10d - Enterohaemorrhagic E.coli (EHEC)
once toxin binds to AChR it cannot or toxin; test only if pt has diarrhoea - PO fidaxomicin causes haemorrhagic colitis
be reversed - Not useful as test for cure; pt can - 3rd-line: PO vanco ± IV metronidazole - E. coli O157:H7 is a strain of Shiga
remain positive • Recurrent episode toxin-producing E.coli found in conta-
Campylobacter
• Others: bloods (FBC, CRP, U&Es, etc) - Within 12w of smx resolution: PO minated ground beef, a/w haemolytic
Gram-ve rod Campylobacter jejuni Cat scratch disease fidaxomicin uraemic syndrome in young children
Public Health England severity scale
faecal-oral route – incubate 1-6d Gram -ve Bartonella henselae • Mild: normal WCC - After 12w: PO vanco or fidaxomicin Mx:
Cat (vector: cat flea) • Moderate: WCC (10-15 x10⁹) • Life-threatening infxn • UTIs: nitrofurantoin, trimethoprim
S/smx: prodromal headache and malaise - typically 3-5 loose stools per day - PO vancomycin and IV metronidazole • Diarrhoeal illnesses – supportive care.
• Diarrhoea – bloody :( S/smx: • Papule/pustule at site 3-10d • Severe: WCC (>15 x10⁹)
• Abdo pain mimicking appendicitis - Specialist advice: surgery Abx not routinely indicated.
after inoculation - acute creatinine (>1.5x baseline) • Other meds: bezlotoxumab, faecal
Mx: • Self-limiting; supportive tx • Non-specific s/smx: regional lymphade- - temp >38.5ºC
microbiota transplant (consider if ≥2
• Tx if immunocompromised or severe nopathy, fever. Can cause headache, - evidence of severe colitis (abdominal
or radiological signs) previous episodes)
clarithromycin ciprofloxacin sore throat and rash less commonly. • Prevention: isolation in side room until
• Life-threatening: hypotension
• Complications in immunocompromised no more episodes of diarrhoea for
Comp: a/w Guillian Barre syndrome - Partial or complete ileus
classically, reactive arthritis, septicaemia, Mx: doxycycline, azithromycin - Toxic megacolon ≥48h + PPE + hand wash with soap
endocarditis • Lymphadenopathy settles in 2-4mo - CT evidence of severe disease (alcohol rub not useful)
even without treatment
08.01 Infectious disease – Bacterial infections last updated 17/09/2025
