Zika virus
Zika is a mosquito-borne infection caused by Zika virus, a member of the genus flavivirus and
family Flaviviridae. It was first isolated from a monkey in the Zika forest in Uganda in 1947.
Transmission is usually via the bite of an infected Aedes mosquito, although a small number of
cases of sexual transmission have been reported. There is increasing evidence of transmission via
the placenta from mother to fetus.
The majority of people infected with Zika virus have no symptoms. For those with symptoms,
Zika virus tends to cause a mild, short-lived (2 to 7 days) febrile disease. Signs and symptoms
suggestive of Zika virus infection may include a combination of the following:
fever
rash
arthralgia/arthritis
conjunctivitis
myalgia
headache
retro-orbital pain
pruritus
Serious complications in adults are not common, although the virus has been associated with
Guillain-Barre syndrome. Scientific consensus however has linked Zika with microcephaly and
other congenital abnormalities, which has led the World Health Organisation (WHO) to declare a
Public Health Emergency of International Concern (PHEIC).
Advice for travellers
There is currently no vaccine or drug to prevent Zika infection. Prevention revolves around
avoiding mosquito bites (Aedes mosquitoes usually bite during the day) by using mosquito
repellent and cover up clothing. Pregnant women are advised to avoid non-essential travel to Zika
prevalent areas until after pregnancy.
External Links
Public Health England
Zika virus guidance
,Question 1 of 212
A 34-year-old man with a past history of HIV infection presents to the Emergency Department with
watery diarrhoea. Cryptosporidium infection is confirmed on ZN staining. What is the most suitable
management?
Metronidazole
Sulfadiazine + pyrimethamine
Supportive therapy
Rifampicin + ethambutol + clarithromycin
Co-trimoxazole
,Question 1 of 212
A 34-year-old man with a past history of HIV infection presents to the Emergency Department with
watery diarrhoea. Cryptosporidium infection is confirmed on ZN staining. What is the most suitable
management?
Metronidazole
Sulfadiazine + pyrimethamine
Supportive therapy
Rifampicin + ethambutol + clarithromycin
Co-trimoxazole
Supportive therapy is the mainstay of treatment in Cryptosporidium diarrhoea
Discuss and give feedback
HIV: diarrhoea
, Question 2 of 212
A 70-year-old female presents to the Emergency Department (ED) with fever, tachycardia and
hypotension. She has no significant past medical history. On examination, there is a loud systolic
murmur in the mitral region which was not documented in an attendance to the ED the previous
month. She reports previous rash and lip swelling with penicillin. Which of the following empirical
antibiotic therapies is the most appropriate?
Intravenous ceftriaxone + gentamicin
Intravenous teicoplanin + streptomycin
Intravenous vancomycin + gentamicin
Intravenous teicoplanin + gentamicin + rifampicin
Intravenous vancomycin + meropenem
Zika is a mosquito-borne infection caused by Zika virus, a member of the genus flavivirus and
family Flaviviridae. It was first isolated from a monkey in the Zika forest in Uganda in 1947.
Transmission is usually via the bite of an infected Aedes mosquito, although a small number of
cases of sexual transmission have been reported. There is increasing evidence of transmission via
the placenta from mother to fetus.
The majority of people infected with Zika virus have no symptoms. For those with symptoms,
Zika virus tends to cause a mild, short-lived (2 to 7 days) febrile disease. Signs and symptoms
suggestive of Zika virus infection may include a combination of the following:
fever
rash
arthralgia/arthritis
conjunctivitis
myalgia
headache
retro-orbital pain
pruritus
Serious complications in adults are not common, although the virus has been associated with
Guillain-Barre syndrome. Scientific consensus however has linked Zika with microcephaly and
other congenital abnormalities, which has led the World Health Organisation (WHO) to declare a
Public Health Emergency of International Concern (PHEIC).
Advice for travellers
There is currently no vaccine or drug to prevent Zika infection. Prevention revolves around
avoiding mosquito bites (Aedes mosquitoes usually bite during the day) by using mosquito
repellent and cover up clothing. Pregnant women are advised to avoid non-essential travel to Zika
prevalent areas until after pregnancy.
External Links
Public Health England
Zika virus guidance
,Question 1 of 212
A 34-year-old man with a past history of HIV infection presents to the Emergency Department with
watery diarrhoea. Cryptosporidium infection is confirmed on ZN staining. What is the most suitable
management?
Metronidazole
Sulfadiazine + pyrimethamine
Supportive therapy
Rifampicin + ethambutol + clarithromycin
Co-trimoxazole
,Question 1 of 212
A 34-year-old man with a past history of HIV infection presents to the Emergency Department with
watery diarrhoea. Cryptosporidium infection is confirmed on ZN staining. What is the most suitable
management?
Metronidazole
Sulfadiazine + pyrimethamine
Supportive therapy
Rifampicin + ethambutol + clarithromycin
Co-trimoxazole
Supportive therapy is the mainstay of treatment in Cryptosporidium diarrhoea
Discuss and give feedback
HIV: diarrhoea
, Question 2 of 212
A 70-year-old female presents to the Emergency Department (ED) with fever, tachycardia and
hypotension. She has no significant past medical history. On examination, there is a loud systolic
murmur in the mitral region which was not documented in an attendance to the ED the previous
month. She reports previous rash and lip swelling with penicillin. Which of the following empirical
antibiotic therapies is the most appropriate?
Intravenous ceftriaxone + gentamicin
Intravenous teicoplanin + streptomycin
Intravenous vancomycin + gentamicin
Intravenous teicoplanin + gentamicin + rifampicin
Intravenous vancomycin + meropenem
