BACTERIAL ILLNESS IN CHILDREN Flashcards by Alex Kinsky

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

Skin - impetigo, boils

Wound infections - cellulitis

Bones - osteomyelitis

Joints - septic arthritis

Lungs - pneumonia

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

Staph aureus

Strep pyogenes

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Where on the body does impetigo usually manifest?

Face - around the mouth

Creases - eg axilla

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What are the risk factors for developing impetigo?

Anything that breaks the skin

Eczema

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What are the clinical features of impetigo?

Erythematous macules

Golden “honey coloured” crusted lesions

Desquamation

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

Topical fusidic acid

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

Topical retapamulin

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

Topical mupirocin

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What is the first line treatment for extensive impetigo?

Oral flucloxacillin

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

Oral erythromicin

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

Nasal carriage

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

Nasal cream containing chlorhexidine and neomycin

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What causes staphylococcal scalded skin syndrome?

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

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What are the clinical features of staphylococcal scalded skin syndrome?

Fever

Widespread raw erythematous desquamation

Blistering, scalded appearance

Dehydration

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How do we manage staphylococcal scalded skin syndrome?

Dermatological emergency

IV fluid resuscitation

IV flucloxacillin - If MRSA is suspected then use IV vancomycin

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

Pharyngitis / Tonsillitis

Cellulitis

Osteomyelitis

Septicaemia

Scarlet fever

Erysipelas

Toxic-shock like syndrome

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How long is the incubation period of scarlet fever?

2 - 4 days

What is the peak age of incidence of scarlet fever?

4 years old (2 - 6 years)

What are the clinical features of scarlet fever?

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

Desquamation happens later in disease.

Fever

Tonsillitis

Strawberry tongue

Where does the rash associated with scarlet fever usually appear?

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

How is a diagnosis of scarlet fever made?

Throat swab

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

Oral Penicillin V

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

Azithromycin

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

Scarlet fever is a notifiable disease

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

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

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

Indian subcontinent Sub-Saharan Africa

How are children usually infected by Mycobacterium tuberculosis?

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.

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

Chronic cough of more than 3 weeks - do not assume that this is asthma Night sweats Fatigue Weight loss or failure to thrive

What are the rarer features of active pulmonary TB?

Bronchial obstruction by enlarged hilar lymph nodes This might cause collapse and consolidation Pleural effusions Widespread lymphadenopathy

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

Under 4 year olds

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

Tuberculin test (Mantoux) Interferon-gamma release assay

How is the Mantoux TB test performed?

0.1 ml of 1:1,000 purified protein derivative (PPD) injected intradermally Result read 2-3 days later

How are the results of the Mantoux TB test read?

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.

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

Miliary TB Sarcoidosis HIV Lymphoma Very young age (e.g.

How is the interferon gamma release assay TB test performed?

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

When is the interferon gamma release assay TB performed?

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

How do we culture M. tuberculosis in children?

Early morning gastric washing - sensitivity of 64% Biopsy from lymph node

What are the radiographic features of TB in children?

Hilar lymphadenopathy - primary infection Calcification point Wedge of collapse - Consolidation Cavitations Millet sized granulomas

How do we treat TB in children?

Same as adults: Rifampicin - 6 months Isoniazid - 6 months Pyrazinamide - 2 months Ethambutol - 2 months

How does treatment for TB meningitis differ from pulmonary TB?

Treatment last for 12 months not 6