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CP > Clinical infections: Childhood and pregnancy > Flashcards

Clinical infections: Childhood and pregnancy Flashcards

1
Q

how can infection be transmitted from mother to baby during pregnancy? (TORCH)

A 
Toxoplasmosis
Others (syphilis, HIV. Coxsackie virus, Hepatitis B, Varicella-zoster)
Rubella
Cytomegalovirus disease
Herpes simplex disease
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2
Q

Which viruses are acquired by respiratory droplet/secretions in pregnant women?

A

Cytomegalovirus CMV
Parvovirus B19
Varicella Zoster virus VZV

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3
Q

which virus is acquired by ingestion of oocysts in pregnant women?

A

Toxoplasmosis

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4
Q

which virus is acquired by nasopharyngeal secretions in pregnant women?

A

rubella

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5
Q

which virus is acquired by mosquito bites in pregnant women?

A

Zika virus

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6
Q

what problems can zika virus infection cause to the foetus and how do we diagnose this in pregnant women?

A

zika virus can cause microcephaly and other severe fetal brain defects in foetus’

as Zika virus may asymptomatic in the pregnant women, travel history is key to diagnosing this infection

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7
Q

how is HIV and HBV be passed to the foetus from the pregnant women?

A

in utero and postnatal via breast milk

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8
Q

what is Chorioamnionitis?

A

refers to inflammation of umbilical cord, amniotic membranes/fluid, placenta, a major cause of perinatal morbidity and mortality

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9
Q

what are the risk factors of intra-amniotic infections?

A
  • most common after prolonged rupture of membranes
  • amniocentesis
  • cordocentesis
  • cervical cerclage
  • multiple vaginal examinations
  • bacterial vaginosis
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10
Q

what is the pathogenies of intra-amniotic infections?

A

bacteria present in the vagina cause infection by ascending through the cervix

haematogenous infection is rare.

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11
Q

what are the causative organisms of intra-amniotic infections?

A

Group B streptococcus
Escherichia coli
Genital Mycoplasma

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12
Q

what is the management of intra-amniotic infections?

A

intrapartum antimicrobials and delivery of the foetus

antimicrobials should be administered at the time of diagnosis

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13
Q

what are the risk factors of puerperal endometritis?

A

caesarean section,
prolonged labour,
prolonged rupture of membranes, multiple vaginal examinations

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14
Q

what is puerperal endometritis?

A

uterine infection (lining of the womb) during puerperium

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15
Q

what are the clinical features of the puerperal endometritis?

A 
fever
uterine tenderness
purulent, foul-smelling lochia
increased white cell count
general malaise, abdominal pain
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16
Q

what are the causative organisms of puerperal endometritis?

A

frequently mice
escherichia coli
beta-haemolytic streptococci (group b)
anaerobes

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17
Q

what are the three common childhood infections?

A

Respiratory tract infections
UTI
Meningitis

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18
Q

what is the death rate in babies early onset sepsis EOS?

A

1 in 4 babies who develop it, even when given antibiotics

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19
Q

what are the main upper respiratory tract infections in children?

A

common cold
acute tonsillitis
acute otitis media

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20
Q

what are the clinical features of otitis media?

A
  • unusual irritability
  • difficulty sleeping
  • tugging or pulling at one or both ears
  • fever
  • fluid draining from the ear
  • loss of balance
  • unresponsiveness to quiet
    sounds or other signs of hearing difficulty
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21
Q

what is the prevalence/incidence of lower respiratory tract infections in children?

A

30-40 cases per 1000 children per year in the UK. respiratory viruses remain the leading cause in children under 5 years

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22
Q

what is Bronchiolitis?

A

inflammation of the bronchioles/small airways in children younger than 2 years, usually 3-6 months of life

23
Q

what are the causative organisms of bronchiolitis?

A
  • respiratory syncytial virus RSV
  • Metapneumovirus
  • adenovirus
  • para-influenza virus
  • influenza
  • rhinovirus
24
Q

what are the three stages of pertussis?

A
  1. Catarrhal phase
  2. Paroxysmal Phase
  3. Convalescent phase
25
Q

what occurs during the catarrhal phase of pertussis?

A

cold like symptoms (coryza, conjunctival infection, occasionally a slight cough)
lasts 7-10 days

26
Q

what occurs during the paroxysmal phase?

A

long duration 2-6 weeks; no fever

  • a series of rapid, forced expirations, followed by gasping inhalation, the typical whooping cough
  • post-tussive vomiting common
  • very young infants may present with apnea or cyanosis in the absence of cough
27
Q

what is pertussis caused by?

A

Caused by B.pertussis

28
Q

how is pertussis transmitted?

A

Person-to-Person transmission through aerosolised respiratory droplets

29
Q

what is the clinical presentation of meningitis in children?

A
  • Fever
  • irritability
  • lethargy
  • poor feeding
  • high pitched cry,
  • bulging AF
  • Convulsions
  • opisthotonus
30
Q

what is the commonest bacteria in viral meningitis?

A

Enteroviruses occurring 50% of children < 3month

31
Q

how do you treat viral meningitis?

A

symptomatic treatment

32
Q

what is the mortality of meningococcemia?

A

5-10% (90% if DIC)

33
Q

what is the morbidity of meningococcemia?

A

10% (deafness, neurological problems, amputations)

34
Q

what age is the peak incidence for meningococcemia?

A

4 years old

35
Q

what is the clinical features of meningococcemia?

A

Fever, non-specific malaise, lethargy, vomiting, meningism, resp distress, irritability, seizures

36
Q

which bacteria cause impetigo?

A

staphylococcus aureus or strep pyogènes

37
Q

what is the classic feature of impetigo?

A

classically ruptured vesicles with honey-coloured crusting these may be bullous

38
Q

what are the clinical features of scarlet fever?

A
  • fever, headache, sore throat, unwell
  • flushed face with circumoral pallor
  • rash that may extend to the whole body
  • rough ‘sandpaper’ skin
  • school age children
  • white strawberry tongue
39
Q

Give 6 notifiable diseases which must be reported to public health England?

A

1) Acute meningitis
2) Acute poliomyelitis
3) Measles
4) Mumps
5) Rubella
6) Small pox

40
Q

What is the difference in productions of IgM and IgG in response to infection?

A

IgM is produced in acute infection - will rise in acute infection
IgG provides long term immunity - will be raised following infection and last for longer

41
Q

Which kind of Ab is found in breast milk?

A

IgA

42
Q

Name 7 possible causes of a rash in a child?

A

1) Parovirus
2) Measles
3) Chickenpox
4) Rubella
5) Non-polio enterovirus infection
6) Epstein Barr Virus (with ampicillin)
7) Bacterial causes such as staphylococcus aureus, N. meningitidis

43
Q

What is the route of transmission of infections from mother to baby during pregnancy?

A

haematogenous

44
Q

Give 6 pathogens which can be transmitted from mother to baby during pregnancy?

A

1) Cytomegalovirus (CMV)
2) Parovirus B19
3) Toxoplasmosis
4) Syphilis
5) Varicella zoster virus (VZV)
6) Zika virus

45
Q

Give 6 infections which can be transmitted from mother to baby during delivery?

A

1) Group B streptococcus
2) Herpes simplex virus (HSV)
3) Gonorrhoea
4) Chlamydia
5) Human immunodeficiency virus
6) Hepatitis B virus

46
Q

Other than foetal toxicity for what 2 other reasons may doses of antimicrobials have to be changed during pregnancy?

A

1) Handling of drugs differs during pregnancy - eg. increase in GFR results in increased renal excretion of many antimicrobials
2) Serum levels of antimicrobials are generally lower during pregnancy

47
Q

Why is the potential of harm to the foetus/neonate a consideration in the prescribing of any anti microbial during pregnancy? 2

A

1) All anti microbials cross the placenta to some extent

2) Virtually all antimicrobials appear in breast milk of given in therapeutic amounts to breast feeding women

48
Q

Which 2 antimicrobials are considered safe in pregnancy?

A

1) Penicillins

2) Cephalosporins

49
Q

Which 4 antimicrobials are considered unsafe in pregnancy?

A

1) Chloramphenicol
2) Tetracycline
3) Fluoroquinolones (eg. ciprofloxacin)
4) Trimethoprim - sulphamethoxazole

50
Q

Name 2 viruses which are tetratogenic?

A

1) Rubella virus

2) Zika virus

51
Q

What is bacteriuria?

A

prescence of bacteria in the urine.

52
Q

Why is screening for bacteriuria indicated in pregnancy?

A

Because continuing bacteriuria is associated with premature delivery and increased perinatal mortality

53
Q

What is the treatment for UTI in pregnancy? 2

A

1) 7 days relatively non-toxic antibiotic eg. amoxicillin or cephalexin
2) Repeat urine culture post treatment to confirm culture

54
Q

Can trimethoprim be used in pregnancy?

A

Avoid in the first trimester but can be given in second and third in conjunction with folate

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