Acute Childhood infections Flashcards
Bronchiolitis
Common lower respiratory tract infection in babies under 1yr - caused by Respiratory syntactical virus
affects 1 in 3 children under 1yr and is generally self limiting
Symptoms of Bronchiolitis (5,3)
Usually like a cold but can develop into:
low grade Fever, cough, coryza, SOB, tachypnoea, poor feeding and dehydration, difficulty breathing/grunting/recession
Management of Bronchiolitis (2,2,2)
If severe give oxygen via nasal prongs or headbox
Tube feeds or IV fluids - consider suction and physiotherapy
Epiglottitis
An acute inflammation of the epiglottis causing obstruction of the airway
Generally caused by HIB in kids and crack cocaine in adults - causes fever, dysphagia, drooling, hoarseness and stridor
Quinsy
A peritonsilar abscess - a complication of tonsilitis presenting with unilateral throat & swallowing pain, may get ‘hot potato voice’ (muffled)
Treated with antibiotics and drainage - rupture can cause aspiration pneumonia
Tracheitis
An infection which is usually bacterial secondary to viral URTI with rapid onset barking cough and inspiratory stridor - if severe may require ICU and IV antibiotics
Diphtheria
A now rare bacterial throat infection causing a low fever, difficulty and pain on swallowing, a whitish pseudomembrane & breathing problems - can lead to myocarditis and peripheral neuropathy
Tb in children
Mainly in migrant groups - if they have a persistent cough/large mantoux reaction need to investigate - CXR and/or sputum culture - if confirmed treat and trace contacts
Meningitis
Presents with fever, behavioural change or confusion, peripheral shutdown and non-blanching purpuric rash- give stat IM penicillin - most commonly neisseria or strep pneumoniae. Lack specific meningitis signs under two yrs
Measles
Low grade fever prodrome (2-4days) then 39-41 with maculo-papular rash (kolpik spots - grey white spots in the mouth) 10-14days after infection. Can also have cough, conjunctivitis, mild generalised lymphoadenopathy - can lead to otitis media, pneumonia
Rubella
Moderate to low fever (38ish) with maculopapular rash after a short prodrome. will have tender lymphadenopathy - risk to pregnant women
Scarlet Fever
High fever on second day which normalises after 5-7days followed by red punctuate, flaking rash. May also have pharyngitis, strawberry tongue with circumoral pallor, risk of 2ary strep infection - treat with penicillin. Caused by an erythrgenic exotoxin from strep pyogenes (risk of Rheumatic fever)
Chickenpox
38-39 degree fever with rash (papular>vesicular>cloudy) 2wks after infection. Can develop into pneumonia, meningo-encephalitis, ITP
Will resolve by itself
Glandular Fever
occurs 30-50days after EBV infection - remittent fever can be related with maculopaular rash (Especially if given ampicillin or amoxicillin) –> can lead to lymphoadenopathy, splenomegaly, sore throat, nausea, fatigue. Anginose form may require intervention. Test for by Paul Bunnell test
Roseola Infantum
a Sudden persistent high fever due to infection by HHV-7, followed after 3-7days by a macular face rash. Can cause febrile seizures & bulging fontanelle
Parvovirus 19 infection
remittent mild fever with onset of fine macular rash after 6-12days over limbs which spares palms and soles
Malaria
Give a tertian or quartan fever with chills, rigors and risk of splenomegaly and anaemia. Can lead to cerebral malaria
Henoch-schonlein purpura
an IgA-mediated, autoimmune hypersensitivity vasculitis of childhood. Causes purpuric rash, arthritis, abdo pain, GI bleeding, orchitis & nephritis
Management of epiglottitis
A medical emergency requiring intubation - patient will be distressed, sitting forward in bed holding their head forward
Direct inspection should only be performed in controlled conditions due to the risk of airway spasm - call resus team and PICU,
Adr nebs, Ceftazidime and IV fluids
Croup
A post viral inflammation of the upper respiratory tract (steeple sign) which can cause barking cough, hoarseness and stridor, rarely requires admission
Imaging in Acute epiglottitis
The thumbprint sign on lateral x-ray indicates there is a swollen epiglottis while the halloween sign on CT indicates that the epiglottis is normal
Whooping Cough
Rare now - if not vaccinated then present with sore throat, low-grade fever, persistent cough and she is now scared of coughing - give amoxycillin or erythromycin (to prevent spread) contact tracing if confirmed?
Management of Meningitis
ABC, Blood cultures, oxygen, volume support, – lumbar puncture will not change management at this stage - consider others in house and contact communicable disease team
Difference between meningitis in babies and children
Infants have bulging fontanelle but minimal meningism while older children have more severe meningism and more localised symptom (headache) - infants will have a rapid systemic progression
Mucocutaneous lymph node syndrome
Kawasaki disease - an idiopathic, self limiting systemic vasculitis which effects asian children under 5yrs. Rapid onset persistent high fever for 1-3wks - erythema multiforme, maculopapular and strawberry tongue –> can cause aortic artery anyursms
Complications of rubella in pregnant women
50-80% infection of the fetus if infected in 1st trimester, 20-60% in 2nd trimester –> infection leads to abortion or congenital rubella syndrome (CRS)
Congenital rubella syndrome (CRS)
At birth - IUGR, microcephaly, micro-ophthalmia, cataracts, thrombocytopenia, CHD, linear bone lesions, retinitis, Convulsion
Later - 20% die in infancy, 90% sensorineural hearing loss, 40-60% CHD, 30-50% developmental delay, thyroid dysfunction, DM, Infantile autism
Varicella Neonatorum
can be very severe - maternal rash from 7days prenatal to 2 days post partum indicates infant at high risk — treat with aciclovir
Congential varicella syndrome
2% if mother infected in 1st trimester - cicatricial scarring of limbs, cortical atrophy, hypoplasia of limbs, digital defects, retinitis, cataracts
Management of Mucocutaneous lymph node syndrome
Fever rapidly responds to aspirin or IV immunoglobin
HIV in children
600> children with HIV in uk - 2/3 are in london - MTCT stopped with ART
1/5 present in 1st yr with PCP with severe complications while rest have median survival of 9yrs
Hand, foot and mouth disease
A self limiting condition caused by intestinal viruses (coxsackie A16). V. contagious and typically occurs in outbreaks at nurseries. Presents with sore throat, fever, oral ulcers followed by vesicles on the palms and soles. Treat with hydration, analgesia and keep from school if feeling unwell.
Congenital Toxoplasmosis
Cerebral calcification
Chorioretinitis (salt and pepper)
Hydrocephalus
More rarely: anaemia, hepatosplenomegaly and cerebral palsy
Congential Cytomegalovirus
Growth retardation and purpuric skin lesions.
More rarely: sensorineural deafness, encephalitis/seizures, pneumonitis, hepatosplenomegaly, anaemia, jaundice, cerebral palsy
Tetanus infection
Will occur in children who havent been vaccinated and with an injury with rust/earth contamination 4-21 days ago. Principle symptoms are jaw stiffness (lockjaw or trismus) spreading to the body causing neck extension and back arching (opisthotonos). Can also have high fever, sweating, tachycardia and hypertension.
Cat scratch disease
Caused by Gram negative rods (Bartonella Henselae). will present with fever, regional lymphadenopathy, headache and malaise. There will be a history of a cat scratch.
Fever of 38.4 in 2month old?
Any fever >38 in a child under 3months is a ‘red flag’ and warranting urgent referral to hospital/paediatrician
Management of Meningitis in a child under 3months
Give IV amoxicillin in addition to cefotaxime to cover for listeria.
Measurement of BP in febrile children?
No necessary - HR, temp, RR, stats should all be measured but not BP
Malarial Prophylaxis in children
Can’t use DEET until they are over 2months old and cant use doxycycline until they are over 12yrs old.