Infection Flashcards
UTI presentation
Across all ages
- Abdominal/ suprapubic tenderness/ pain
- Fever
- Foul smelling/ cloudy urine
- Haematuria
- Vomiting
<3 months
- lethargy
- Failure to thrive
- Irritability
- Jaundice
Preverbal > 3months
- Lethargy
- Irritability
- Poor feeding
-
Risk factors for UTI
Urinary tract abnormalities
- Vesico-ureteric reflux
Incomplete bladder empyting
First line investigations for UTI
Urinanalysis
- Dipstick= positive nitrites, leucocytes
- Microscopy and sensitivity= bacteria >10^5
Atypical UTI in paeds (7)
Symptoms
- Very unwell
- Poor urine flow
Signs
- Abdominal/ bladder mass
Investigation/ treatment findings
- Septicaemia
- Failure to respond to antibiotics within 48 hours
- Non- E.coli infection
- Raised creatinine
Acute management of pyelonephritis
Severe
- IV fluids and antibiotics
- Analgesia
Causative organisms of UTI
- E.coli
- Klebsiella
- Proteus–> forms stones
- Pseudomonas–> may indicate structural abnormality
- Enterococcus faecalis
Antimicrobial UTI management
- > 3months upper UTI, lower UTI
- < 3 months
- Trimethoprim (monotherapy for lower)
- IV for upper
< 3months
- Co-amoxiclav
Ultrasound indications in UTI
Acute ultrasound
- <6 months= Atypical and recurrent infection
- >6 months= atypical UTI
6-week ultrasound
- < 6 months, responds to antibiotics in 48 hours
DMSA scan indications
Nuclear renal scan that assesses scarring in kidneys.
Indications= 4-6 weeks post-UTI
- < 6 months- < 3 years= recurrent and atypical infections
- > 3 years= recurrent infection
Indications for Micturating cystourethrogram (MCUG)
Looks for VUR
- < 6 months= recurrent and atypical UTI
> 6 months - <3 years= consider if
- Non-E.coli
- Family Hx of VUR
- Poor urine flow
- US showing dilation
Fifth disease
- Official name
- Cause
Erythema infectiosum
- Caused by Parvovirus B16
Presentation of erythema infectiosum
Prodromal
- low grade fever
- Runny nose
Rash
- Maculopapular on the body
- Erythematous cheeks (slapped cheek)
How long does slapped cheek syndrome last for?
Typically resolves in 1 week
Complications of erythema infectiosum
Anaemia
- In children with chronic haemolytic disease
Hydrops fatalis in a fetus
- virus can cross placenta
Measles
- Presentation
Prodromal
- Fever
- 3 Cs: coryza, conjunctivitis, cough
Rash
- Koplik spots
- Maculopapular rash started on the head, travelling caudally
Measles
- Diagnosis
IgM specific antibodies
PCR
Measles
- Complications
Pneumonia
Encephalitis
Diarrhoea
Later complication
- Subacute sclerosing panencephalitis (SSPE)
Rubella
- Cause
Rubella virus
- Also known as ‘German measles’
Rubella
- Presentation
Fever
Lymphadenopathy: sub-occipital, posterior auricular
Forcheimer spots
Rash
- Maculopapular
- Behind ears- trunk- extremities
Forchheimer spots
Petechiae on the soft palette associated with Rubella
Congenital rubella syndrome
Caused by vertical transmission of rubella
Triad
- hearing loss
- Cataracts
- Heart defects
Rosella
- Cause
Also known as exanthem subitum
Caused by HHV-6 and HHV-7
Presentation of roseolla
Flu-like symptoms
High fever
- May trigger febrile seizures
Maculopapular rash
- Starts on the trunk
- Spreads to face and extremities
Chickenpox
- Cause
- Incubation period
Varicella- Zoster
Incubation period
- 10-21 days
Chickenpox
- Presentation
Prodromal
- Flu like illness
Vesicular rash
- Starts on trunk and spreads to extremities
- Very itchy
Chickenpox complications
Encephalitis
Cerebellatis
Congenital varicella syndrome
- In first and second trimester
Congenital varicella syndrome features
Limb atrophy
Skin fibrosis/ contracture
Ocular defects
Neurological defects
The most common cause of viral tonsilitis is _____
Rhinovirus
Most common cause of bacterial tonsilitis is ______
Group A beta-haemolytic strep
- S. pyogenes
Complications of tonsilitis
Quincy
- Peritonsillar abscess
Scarlet fever
Fever PAIN criteria
- Features
One point for each: Higher
F- Fever (previous 24 hours)
P- Purulence
A- Attends rapidly (within 3 days)
I- Inflammed tonsils
N- No cough/ coryza
Centor criteria
- Features
Used in ADULT patients Tonsillar exudat
A score of 0-1 in FeverPAIN shows _____ likelihood of bacterial infection
13-18%
A score of 2-3 in FeverPAIN shows _____ likelihood of bacterial infection
34-40%
A score of 4-5 in FeverPAIN shows _____ likelihood of bacterial infection
62-65%
Centor criteria
- Features
Tonsillar exudate
Tender anterior cervical lymphadenopathy
Fever
Absence of cough
A score of 3-4 on Centor criteria is a ____ likelihood of bacterial tonsilitis
32-56%
First line antibiotic of bacterial tonsilitis
Penicillin V
Pen allergy
- Clarithromycin/ erythromycin
ENT referral tonsilitis is indicated for
______ in 1 year
______ per year in 2 years
or
______ per year in 3 years
- 7
- 5
- 3
______ is indicated first line for mild-moderate fungal tonsilitis
Nystatin
__________ is indicated for widespread fungal tonsilitis
Fluconazole
Follow up features tonsillitis
No improvement with 3-4 days of antibiotics
Pain +/- fever not improving in 3 days
Breathing/ swallowing difficulty
Unilateral neck/ tonsillar swelling
Presentation of quinsy
Tender cervical lymphadenopathy
Referred ear pain
Trismus
- Unable to open mouth
Hot potato voice
Management of Quinsy
ENT referral for incision and drainage
- Under GA
Broad-spectrum antibiotic
- Co-amoxiclav/ local guidelines
Dexamethasone
- Reduce swelling.
Complications of acute otitis media [6]
Perforated tympanic membrane
Mastoiditis
Meningitis
Sinus thrombosis
CN7 paralysis
Intracranial abscess
Bacterial causes of acute otitis media [3]
Haemophilus influenzae
S.pnuemoniae
Moraxella catarrhalis
ENT referral indications for AOM
<3 months with fever >38
3-6 months with fever >39
Indications for immediate antibiotic prescription in AOM
Systemically unwell
Bilateral AOM and <2 years
Otorrhoea
Immunocompromised,
Typical course of AOM is _____
3-7 days
Indication for delayed antibiotic prescription in AOM
No improvement/ worsening of symptoms in 3 days.
First line antibiotic treatment in AOM
Amoxicillin
- 5-7 days
Second line antibiotic treatment in AOM
Co-amoxiclav 5-7 days
Glue ear
- Initial management
Hearing loss- referral to audiometry
Watchful waiting for 3 months
Management of persistent glue ear (> 3months)
Refferal to ENT
- Especially if hearing/ development is affected
The most common surgical option for otitis media with effusion is ______
Myringotomy with Grommets
Follow up for grommets
Follow up until the grommets have been forced out and the eardrum has healed.
The most common complication of grommets is ______
Otorrhoea
Complications of grommets [6]
Infection
Tympanosclerosis
Perforation of the tympanic membrane.
Fibrosis.
Cholesteatoma.
Bleeding.
The 6 in 1 vaccine includes:
DiTaP
- Diptheria
- Tetanus
- Pertussis
IPV
- Polio
Hepatitis B
Hib (H. influenza b)
Diagnosis of parvovirus
Serology
Most common causes of meningitis is neonates are…
Group B streptococcus
Listeria
E. coli
Pneumococcus
Staph. aures
Most common causes of meningitis is children >1 month
N. Meningitides (most common)
Pneumonoccocus
HiB
Meningococcal Gp C vaccine is routinely given is given at ages ______ and ______ as part of tje 12 months of the ______ vaccine
12 months and 14 years
- Part of the MenACWY vaccine
_______ is the most common meningococcal strain that causes meningitis
Meningococcal group B
Dose of iv aciclovir for HSV encephalitis in children
500mg/ M2 for up to 21 days
Formula for body surface area (m2)
M3= (square root) weight x height (cm) / 3600
