Infection Flashcards

Question

Management of slapped cheek syndrome?

Answer 1

Self limiting, better in 3wks. Paracetamol/ ibruprofen. See GP: pregnant (miscarriage), sickle cell (aplastic crisis, supress erythroporesis for a wk) thalassaemia (severe anaemia), weakned immune system. No school exclusion

Answer 2

asymptomatic pancytopenia in immunosuppressed patients aplastic crises e.g. in sickle-cell disease parvovirus B19 suppresses erythropoiesis for about a week so aplastic anaemia is rare unless there is a chronic haemolytic anaemia hydrops fetalis parvovirus B19 in pregnant women can cross the placenta in pregnant women this causes severe anaemia due to viral suppression of fetal erythropoiesis → heart failure secondary to severe anaemia → the accumulation of fluid in fetal serous cavities (e.g. ascites, pleural and pericardial effusions) treated with intrauterine blood transfusions

Answer 3

a reaction to erythrogenic toxins produced by Group A haemolytic streptococci (usually Streptococcus pyogenes). It is more common in children aged 2 - 6 years with the peak incidence being at 4 years. spread via the respiratory route by inhaling or ingesting respiratory droplets or by direct contact with nose and throat discharges, (especially during sneezing and coughing).

Answer 4

Incubation period of 2-4 days fever: typically lasts 24 to 48 hours malaise, headache, nausea/vomiting sore throat - can appear 1-2 days after tonsillitis 'strawberry' tongue rash: > fine punctate erythema ('pinhead') which generally appears first on the torso and spares the palms and soles > children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures > it is often described as having a rough 'sandpaper' texture > desquamination occurs later in the course of the illness, particularly around the fingers and toes

Answer 5

a throat swab is normally taken but antibiotic treatment should be commenced immediately, rather than waiting for the results

Answer 6

oral penicillin V for 10 days patients who have a penicillin allergy should be given azithromycin children can return to school 24 hours after commencing antibiotics scarlet fever is a notifiable disease

Answer 7

otitis media: the most common complication rheumatic fever: typically occurs 20 days after infection acute glomerulonephritis: typically occurs 10 days after infection invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness

Answer 8

Hand, foot, mouth Caused by intestinal virus of picornaviruses (coxsackie A16 + enterovirus 71). Very contagious typically occurs in outbreaks at nursery

Answer 9

mild systemic upset: sore throat, fever oral ulcers followed later by vesicles on the palms and soles of the feet

Answer 10

symptomatic treatment only: general advice about hydration and analgesia reassurance no link to disease in cattle children do not need to be excluded from school the HPA recommends that children who are unwell should be kept off school until they feel better they also advise that you contact them if you suspect that there may be a large outbreak.

Answer 11

caused by primary infection with varicella zoster virus. Shingles is a reactivation of the dormant virus in dorsal root ganglion Highly infectious spread via the respiratory route can be caught from someone with shingles infectivity = 4 days before rash, until 5 days after the rash first appeared* incubation period = 10-21 days

Answer 12

fever initially itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular then crust and fall off systemic upset is usually mild more sever in older children/adults

Answer 13

supportive keep cool, trim nails calamine lotion school exclusion: NICE Clinical Knowledge Summaries state the following: Advise that the most infectious period is 1–2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash). immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG). If chickenpox develops then IV aciclovir should be considered

Answer 14

secondary bacterial infection of the lesions -NSAIDs may ^ risk, single infected area/small area of cellulitis, invasive group A streptococcal soft tissue infections may occur > necrotising fasciitis pneumonia encephalitis (cerebellar involvement may be seen) disseminated haemorrhagic chickenpox arthritis, nephritis and pancreatitis may very rarely be seen

Answer 15

a serious bacterial or viral infection in the blood affects babies within the first 28 days of life. Neonatal sepsis is categorised into early-onset (EOS, within 72 hours of birth) and late-onset (LOS, between 7-28 days of life) sepsis account for 10% of all neonatal mortality Male:female incidence 1:1 Incidence of neonatal sepsis: 1-5 per 1000 live births Term neonates: 1-2 per 1000 live births Late pre-term infants: 5 per 1000 live births Birth weight <2.5kg: 0.5 per 1000 live births Black race is an independent risk factor for group B streptococcus-related sepsis

Answer 16

The overall most common causes of neonatal sepsis are group B streptococcus (GBS) and Escherichia coli, accounting for approximately two thirds of neonatal sepsis cases Early-onset sepsis in the UK is primarily caused by GBS infection (75%) Infective causes in early-onset sepsis are usually due to transmission of pathogens from the mother to the neonate during delivery Late-onset sepsis usually occurs via the transmission of pathogens from the environment post-delivery, this is normally from contacts such as the parents or healthcare workers Infective causes are more commonly coagulase-negative staphylococcal species such as Staphylococcus epidermidis, Gram-negative bacteria such as Pseudomonas aeruginosa, Klebsiella and Enterobacter, and fungal species ``` Other less common causes include: Staphylococcus aureus Enterococcus Listeria monocytogenes Viruses including herpes simplex and enterovirus ```

Answer 17

Mother who has had a previous baby with GBS infection, who has current GBS colonisation from prenatal screening, current bacteruria, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy Premature (<37 weeks): approximately 85% of neonatal sepsis cases are in premature neonates Low birth weight (<2.5kg): approximately 80% are low birth weight Evidence of maternal chorioamnionitis

Answer 18

Respiratory distress (85%) = Grunting, Nasal flaring, Use of accessory respiratory muscles, Tachypnoea Tachycardia: common, but non-specific Apnoea (40%) Apparent change in mental status/lethargy Jaundice (35%) Seizures (35%): if cause of sepsis is meningitis Poor/reduced feeding (30%) Abdominal distention (20%) Vomiting (25%) Temperature: not usually a reliable sign as the temperature can vary from being raised, lowered or normal Term infants are more likely to be febrile Pre-term infants are more likely to be hypothermic The clinical presentation can vary from very subtle signs of illness to clear septic shock Frequently, the symptoms will be related to the source of infection (e.g. pneumonia + respiratory symptoms, meningitis + neurological symptoms)

Answer 19

Blood culture FBC - abnormal neutrophil count CRP - help to guide management Blood gases - metabolic acidosis is particularly concerning for neonatal sepsis, particularly a base deficit of ≥10 mmol/L Urine MC&S - more useful in LOS, show signs of infection (^ leukocytes, positive culture, haematuria, proteinuria) if urosepsis Lumbar puncture - if suspecting meningitis as source of infection

Answer 20

intravenous benzylpenicillin with gentamicin as a first-line regimen for suspected or confirmed neonatal sepsis - unless local bacterial resistance patterns disagree CRP measured to monitor progress antibiotics can be ceased at 48 hours in neonates who have CRP of <10 mg/L and a negative blood culture at presentation and at 48 hours Normally, in neonates with culture-proven sepsis, duration will be approximately 10 days O2, fluid and elctrolytes severely ill neonates may need volume and/or vasopressor support prevention/management of hypoglycaemia prevention/management of metabolic acidosis