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Paediatrics > BACTERIAL ILLNESS IN CHILDREN > Flashcards

BACTERIAL ILLNESS IN CHILDREN Flashcards

1
Q

What are the sites most commonly affected by staphylococcus aureus in children?

A

Skin - impetigo, boils

Wound infections - cellulitis

Bones - osteomyelitis

Joints - septic arthritis

Lungs - pneumonia

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2
Q

What are the two bacteria that are normally responsible for impetigo?

A

Staph aureus

Strep pyogenes

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3
Q

Where on the body does impetigo usually manifest?

A

Face - around the mouth

Creases - eg axilla

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4
Q

What are the risk factors for developing impetigo?

A

Anything that breaks the skin

Eczema

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5
Q

What are the clinical features of impetigo?

A

Erythematous macules

Golden “honey coloured” crusted lesions

Desquamation

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6
Q

What is the first line treatment for limited, localised impetigo in children?

A

Topical fusidic acid

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7
Q

What is the second line treatment for limited, localised impetigo in children?

A

Topical retapamulin

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8
Q

What is the treatment for limited, localised impetigo caused by MRSA?

A

Topical mupirocin

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9
Q

What is the first line treatment for extensive impetigo?

A

Oral flucloxacillin

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10
Q

What is the treatment for extensive impetigo in a child who is allergic to penicillin?

A

Oral erythromicin

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11
Q

What is an important source of reinfection that should be cleared in children with impetigo?

A

Nasal carriage

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12
Q

How is nasal carriage of staph aureus cleared in children who have had impetigo to avoid re-infection?

A

Nasal cream containing chlorhexidine and neomycin

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13
Q

What causes staphylococcal scalded skin syndrome?

A

Epidermolytic exotoxins A and B, which are released by S. aureus and cause detachment within the epidermal layer

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14
Q

What are the clinical features of staphylococcal scalded skin syndrome?

A

Fever

Widespread raw erythematous desquamation

Blistering, scalded appearance

Dehydration

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15
Q

How do we manage staphylococcal scalded skin syndrome?

A

Dermatological emergency

IV fluid resuscitation

IV flucloxacillin - If MRSA is suspected then use IV vancomycin

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16
Q

What are the infections that group A streptococcus (strep pyogenes) most commonly cause?

A

Pharyngitis / Tonsillitis

Cellulitis

Osteomyelitis

Septicaemia

Scarlet fever

Erysipelas

Toxic-shock like syndrome

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17
Q

How long is the incubation period of scarlet fever?

A

2 - 4 days

18
Q

What is the peak age of incidence of scarlet fever?

A

4 years old (2 - 6 years)

19
Q

What are the clinical features of scarlet fever?

A

Rash - fine punctate erythema (‘pinhead’), larger areas feel like sandpaper.

Desquamation happens later in disease.

Fever

Tonsillitis

Strawberry tongue

20
Q

Where does the rash associated with scarlet fever usually appear?

A

Appears first on the torso and spares the face although children often have a flushed appearance with perioral pallor.

21
Q

How is a diagnosis of scarlet fever made?

A

Throat swab

22
Q

What antibiotics should be prescribed for someone presenting with the signs and symptoms of scarlet fever?

A

Oral Penicillin V

23
Q

What antibiotics should be prescribed for someone with a penicillin allergy who presents with the signs and symptoms of scarlet fever?

A

Azithromycin

24
Q

Other than antibiotics what other important step must the clinician take in the management of a patient with scarlet fever?

A

Scarlet fever is a notifiable disease

25
Q

What are the complications of scarlet fever and how long after infection does each occur?

A

Otitis media: the most common complication, with or straight after infection

Rheumatic fever: typically occurs 20 days after infection

Acute glomerulonephritis: typically occurs 10 days after infection

26
Q

Families from which endemic areas are most at risk of TB?

A

Indian subcontinent

Sub-Saharan Africa

27
Q

How are children usually infected by Mycobacterium tuberculosis?

A

Inhalation of droplet nuclei from an adult

Children with the disease (even if active) are almost never infectious, therefore notification to public health is essential in contact tracing.

28
Q

What are the classic features of active pulmonary TB in a child?

A

Chronic cough of more than 3 weeks - do not assume that this is asthma

Night sweats

Fatigue

Weight loss or failure to thrive

29
Q

What are the rarer features of active pulmonary TB?

A

Bronchial obstruction by enlarged hilar lymph nodes

This might cause collapse and consolidation

Pleural effusions

Widespread lymphadenopathy

30
Q

What age group are at a particularly high risk of disseminated disease eg TB meningitis?

A

Under 4 year olds

31
Q

What are the main two tests used to assess exposure to TB?

A

Tuberculin test (Mantoux)

Interferon-gamma release assay

32
Q

How is the Mantoux TB test performed?

A

0.1 ml of 1:1,000 purified protein derivative (PPD) injected intradermally

Result read 2-3 days later

33
Q

How are the results of the Mantoux TB test read?

A

Size of lesion that develops:

Less than 6 mm - negative - may be given BCG vaccine

Between 6 - 15 mm - positive - but not confirmation. Cannot give BCG as may suggest previous exposure

More than 15 mm - strongly positive - highly suggestive of TB infection.

34
Q

What could cause a false negative reading of the Mantoux TB test?

A

Miliary TB

Sarcoidosis

HIV

Lymphoma

Very young age (e.g.

35
Q

How is the interferon gamma release assay TB test performed?

A

White cells from a blood sample are exposed to tuberculous antigens. If infection is present the white cells will secrete interferon-gamma.

36
Q

When is the interferon gamma release assay TB performed?

A

For those in whom the Mantoux test gave an ambiguous reading or in those who have already had the BCG vaccine.

37
Q

How do we culture M. tuberculosis in children?

A

Early morning gastric washing - sensitivity of 64%

Biopsy from lymph node

38
Q

What are the radiographic features of TB in children?

A

Hilar lymphadenopathy - primary infection

Calcification point

Wedge of collapse - Consolidation

Cavitations

Millet sized granulomas

39
Q

How do we treat TB in children?

A

Same as adults:

Rifampicin - 6 months

Isoniazid - 6 months

Pyrazinamide - 2 months

Ethambutol - 2 months

40
Q

How does treatment for TB meningitis differ from pulmonary TB?

A

Treatment last for 12 months not 6

Paediatrics (40 decks)

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