27 - Infectious Diseases 2 Flashcards
How does malaria present in children?
ALWAYS CHECK TRAVEL HISTORY
- Drowsiness
- Irritability
- Poor feeding
- Fever
- Splenomegaly
- Jaundiced
- Seizures
- Chills, fever, sweating cycling every 2-3 days
What organism causes malaria and when do children present?
- Plasmodium Falciparum (75%)
- Plasmodium Vivax
Most present within the first month, if not up to 6 months
What are some signs of severe malaria?
What investigations are done to diagnose malaria in children?
- Thick and thin films: if initial test negative but suspected, film needs to be repeated up to 3 times (12, 24 and 48 hours)
- Rapid antigen tests
- Bloods:
- FBC
- Blood glucose rapid test and laboratory sample blood gas
- U+Es, LFTs, CRP, Clotting screen
- Blood cultures
- G6PD if primaquine is required
What investigations are done to diagnose malaria in children?
- Thick and thin films: if initial test negative but suspected, film needs to be repeated up to 3 times (12, 24 and 48 hours)
- Rapid antigen tests
- Bloods:
- FBC
- Blood glucose rapid test and laboratory sample blood gas
- U+Es, LFTs, CRP, Clotting screen
- Blood cultures
- G6PD if primaquine is required
How are all children with malaria regardless of cause and severity managed?
- Inform public health
- Admit to hospital for 24h for
How is complicated malaria in children managed?
- Admit to HDU/PICU
- IV artesunate for 24 hours
- Then a full course of oral Artemether- lumefantrine when can tolerate
- Hourly observations including neuro in first 12 hours as risk of rapid deterioration
How is uncomplicated falciparum malaria treated in children?
Can be outpatient
First line: Artemether-lumifantrine or DHA-PPQ (Dihydroartemisinin-piperaquine).
- Quinine with doxycycline or Atovaquone-proguanil can also be used
How is uncomplicated non-falciparum malaria treated?
Chloroquine or Primaquine
Always check G6PD
How is a pregnant woman with malaria treated?
If neonate infected will present like neonatal sepsis
C, E, B
Always be thinking TB and malignancy
What are contraindications to vaccination?
- Previous anaphylaxis to a vaccine or vaccine component (
- Primary or acquired immunodeficiency
- Immunosuppressive therapy. e.g. chemotherapy or radiotherapy, high-dose steroids).
Temporary deferral:
- Acutely unwell e.g. with fever >38.5°C. Postpone immunisation until well.
- Immunoglobulin therapy
A and C
C is DiGeorge syndrome so immunosuppressed
Which vaccines in the routine immunisation schedule are live?
- MMR
- Rotavirus
- Nasal flu
What are the different types of adverse events following immunisation? (AEFI)
- Programme-related e.g. wrong dose, vaccine inappropriately prepared, vaccine stored incorrectly.
- Vaccine-induced Reactions in individuals to a particular vaccine
- Coincidental. Not a true AEFI but only linked because of the timing of the occurrence
- Unknown
What are some reasons for under vaccination?
- Vaccine hesitancy/refusal
- Children in large families
- Children with lone or single parents
- Looked after children
- Children in mobile families
- Migrant/asylum seeking children
- Children with disabling or chronic conditions
- Children in ethnic minority groups
What is toxic shock syndrome and what is it caused by?
Acute, multi-system inflammatory response to an exotoxin-mediated bacterial infection
Life-threatening with rapid progression to septic shock
Common pathogens: Staphylococcus aureus and Group A Streptococcus (GAS; S pyogenes)
What are some risk factors for toxic shock syndrome in children?
Always consider in burns!!!!!
Usually small surface area burn presenting 2 days after burn
What is the centre for disease control and prevention diagnostic criteria for TSS?
Fever, Hypotension, Rash
PLUS
3 or more organ systems involved
Why are children more susceptible to severe toxic shock syndrome?
- Immature immune systems that cannot produce antitoxin antibodies
- Infants under 1 are protected by passive immunity at birth and in breast milk
- Small burns worse as less aggressively treated
When should you suspect toxic shock syndrome?
An unwell child with a burn or other risk factors is TSS until proven otherwise
Similar presentation to sepsis, multi system involvement
What are some non-specific signs of TSS?
- High fever ≥38.9
- Tachycardia
- Tachypnoea
- Capillary refill >3 seconds
How is toxic shock syndrome managed acutely?
Same as sepsis!!!
- High flow oxygen
- Obtain IV/IO Access
- Obtain bloods
- Empirical sepsis antibiotics plus IV clindamycin
- Consier fluid resuscitation: fluid bolus: 10-20ml/kg saline over 5-10 mins, beware fluid overload (crepitations, gallop rhythm, hepatomegaly) Consider catheterisation
- Observe minimum every 15-30 minutes
- Analgesia
- Gentle clean and dressing of wound, take wound swabs for MC+S
- Refer to Paediatrics, (Plastic Surgery if burns/skin loss), PICU, Microbiology
What are empirical antibiotics for TSS once microbiology results are back?
If not improving give Fresh Frozen Plasma and IVIG
What is the most common cause of neonatal encephalitis?
Herpes Simplex Virus
Can present up to 4 weeks after delivery, give IV aciclovir if mother infected with vulval herpes
That is why shouldn’t kiss newborns
What do investigations show with herpes simplex encephalitis?
Temporal changes on CT
How does Herpes Simplex tend to present in children?
- Gums
- Lips
- Eyes
- Genitals
What is chicken pox caused by and how does it present?
Varicella Zoster Virus
- Prodrome: Fever is often the first symptom, fatigue and malaise
- Vesicular rash: starting papular on trunk or face and spreading outwards
- Lesions scab over
What is the management of chicken pox in children?
- Encourage fluids and give paracetamol
- Trim nails
- Calamine lotion
- School exclusion until crusted over
- Immunocompromised patients and Newborns need varicella zoster immunoglobulin (VZIG). If chickenpox develops then give IV aciclovir
What are some rare complications of chicken pox?
- Bacterial superinfection: AVOID NSAIDs
- Pneumonia
- Encephalitis (cerebellar involvement may be seen)
- Disseminated haemorrhagic chickenpox
- Arthritis, nephritis and pancreatitis
What are the five types of nappy rash?
- Irritant/Ammonia dermatitis
- Candida
- Seborrhoeic dermatitis
- Psoriasis
- Atopic eczema
How does candidate nappy rash occur?
Erythematous rash which involve the flexures and has characteristic satellite lesions
- Rash extending into skin folds
- Larger red macules
- Well demarcated scaly border
- Circular pattern to the rash spreading outwards, similar to ringworm
- Satellite lesions
- May have oral thrush, check tongue