Childhood Infections

Question 1

History in infants

Answer 1

• Feeding/vomiting
• Crying
• Sleeping
• Smiling
• Localising symptoms
• Unwell contacts

Question 2

History in children

Answer 2

• Feeding
• Activity levels
• Drowsiness
• Localising symptoms (cough, coryza, vomiting, diarrhoea, rash, dysuria, headache, sore ears/throat)
• Causation (nursery contacts etc)

Question 3

Examination

Answer 3

• Temperature
• ABCDE
• Well or unwell?
• Act now of observe?
• Localising (rash, coryza, RR, precussion of chest, auscultation of chest, hydration state, ENT, meningism)

Question 4

Investigations

Answer 4

• FBC
• Inflammatory markers
• Specimins (resp secretions, blood cultures, TS for bacteriology, CSF, stool cultures, urine specimin)
• Imaging (CXR)

Question 5

LRTIs

Answer 5

• Neonates - group B strep, E coli, resp viruses
• Young infants - resp viruses, enteroviruses, chlamydia
• Infants and young clildren - strep pneumonia, resp viruses
• Older children - mycoplasma pneuminia, strep pneumonia, resp viruses

Question 6

Other clinical syndromes

Answer 6

• Croup - parainfluenza, influenza, rhino
• Epoglotitis - haemophulis type B
• Bronchiolitis - RSV
• Tracheitis - staphylococcus aureus
• Otiotis media - viral, strep pneumonia, haemophilus type B, moraxella catarhalis
• Tonsilitis - viral, group A strep
• Dysentery - salmonella, campylobacter, shigella, VTEC
• UTI - E coli, proteus, klebsiella, enterococcus

Question 7

Meningitis

Answer 7

• Neonate - group B strep, E coli, haemophilus type B (Hib), meningococcus, strep pneumonia, listeria
• 1-3 months - meningococcus, sterp pneumonia, Hib, listeria
• 3 months - 5 years meningococcus, sterp pneumonia, Hib (rare)
• >6 years - meningococcus, sterp pneumonia

Question 8

Gastroenteritis

Answer 8

• 1-35 months - rotavirus, adenovirus, salmonella, campylobacter
• 35-59 months - viral, salmonella, campylobacter, cryptosporidium, shigella

Question 9

Management

Answer 9

• ABCDE
• Fluid, O2 and supportive therapy
• Anti-pyretics

Question 10

Measles

Answer 10

• Incubation period 7-14 days
• Infective 1-2 days before symptoms to 4 days post appearance of rash
• Prodrome (3-5 days) of fever, coryza, cough, conjunctivitis and Koplok’s spots, after which maculopapular rash starts behind ears, migrates to face and trunk then to limbs. Associated with cervical lymphadenopathy and high fever.
• Complications include otitis media, lymphadenitis, interstitial pneumonitis, secondary bacterial bronchopneumonia, myocarditis (rare), and post-infectious demyelinating encephalomyelitis. SSPE is rare.
• Treatment is supportive
• Prevention with MMR vaccine

Question 11

VZV (chicken pox)

Answer 11

• Incubation period 14-21 days
• Infective 2 days before and 5 days after rash
• Fever, malaise, headache and abdominal pain for 48hrs. Followed by development of itchy crops of erythematous macules that evolve into papules, then vesicles containing serous fluid. Usually start on trunk and spread to limbs. Different stages of lesions present simultaneously.
• Complications include secondary bacterial infection (Group A Streptococcus, S. aureus), pneumonia, encephalitis, progressive disseminated varicella, cerebellar ataxia, thrombocytopenia, purpura fulminans, post-infectious encephalitis.
• Treatment supportive, acyclovir in high risk.
• Vaccinate in high risk or immunocompromised

Question 12

Mumps

Answer 12

• Incubation 14-21 days
• Infective 1-2 days before and 9 days after parotid swelling
• Prodrome of fever, anorexia, headache, followed by painful uni/bilateral salivary +/- submandibular gland swelling
• Complications include meningoencephalitis, deafness, orchitis, epididymitis, pancreatitis, nephritis, myocarditis, arthritis, thyroiditis
• Treatment supportive
• Prevent with MMR vaccination

Question 13

Erythema infectiosum/slapped cheek/Fifth’s disease

Answer 13

• Incubation 4-14 days
• Not infective once rash appears
• Prodrome of low-grade fever, general malaise, followed after a few days by maculopapular spots on cheeks, which coalesce to give‘slapped cheek’ appearance. Fine rash extends to trunk& limbs. Fades with central clearing giving a lacy appearance. Lasts 2 – 30 days. May have associated arthralgia, arthritis.
• Complications include aplastic crisis in chronic haemolytic disease e.g. sickle cell disease, thalassaemia, and immunocompromised
• Treatment supportive

Question 14

Rubella

Answer 14

• Incubation 14-21 days
• Infective 1-2 days before and 7 days after rash appear
• Prodrome of coryza,tender cervical lymphadenopathy followed by development of a fine maculopapular rash, starts on the face from where it fades as it spreads down the trunk. Arthralgia, palatal petechiae.
• Treatment supportive
• Prevent with MMR vaccination

Question 15

Roseola infantum/Sixth disease

Answer 15

• Incubation 7-14 days
• Infective until fever subsides
• Sudden onset high fever with only mild coryza, absence of other physical findings. On day 3-4 fever resolves and a maculopapular rash appears on trunk and limbs, lasts for 1-2 days.
• Complications include febrile convulsions in the 6 – 18 month old age group, usually happen on the first day of illness, encephalitis.
• Treatment supportive

Question 16

Pertussis

Answer 16

• Incubation 7-14 days
• Infective whilst coughing
• Catarrhal phase; low-grade fever, coryza, conjunctivitis for 1-2 weeks, followed by paroxysmal phase; paroxysms of severe cough with or without whoop, post-tussive vomiting, may develop associated cyanosis and apnoea. Paroxysmal phase may last for 2-8 weeks, and is followed by the convalescent stage; during which cough subsides over weeks to months.
• Complications include apnoea, secondary bacterial pneumonia and weight loss secondary to feeding difficulties and post-tussive vomiting.
• Diagnosis via perinasal swab for PCR testing and culture
• Treatment is supportive - low threshold for admision in neonate
• Preventative vaccination