Infection Flashcards
1
Q
What is TORCH?
A
Congenital and neonatal infections:
- Toxoplasmosis
- Other (syphilis, parvovirus, VZV, HIV, HBV)
- Rubella
- CMV
- HSV
2
Q
What is the management of toxoplasmosis?
A
- Pyrimethamine
- Sulfadiazine
- Calcium folinate
- +Consider prednisolone
3
Q
What is the management of Syphilis?
A
IM benzathine penicillin
4
Q
What is the management of parvovirus?
A
Intrauterine = blood transfusion if foetal hydrops
Infant = self-limiting
5
Q
What is the management of VZV?
A
Mild:
- Supportive care (e.g. hydration, paracetamol, skin emollients, antihistamines)
Moderate:
- Oral acyclovir
- +Supportive care
Severe:
- IV acyclovir
- +Supportive care
6
Q
What is the management of HBV?
A
- Complete course of HBV vaccination (for all infants of mothers who are HBsAg +ve)
- Blood test at 12m for HBV infection
- Mother = tenofovir disoproxil OR lamivudine (no risk of transference through breastfeeding)
7
Q
What is the management of Rubella?
A
- Refer to foetal medicine unit and notify HPU
- Rest, adequate fluids, analgesia
- Infant = cardiac scans, hearing tests
8
Q
What is the management of CMV?
A
IV ganciclovir or oral valganciclovir
9
Q
What is the management of HSV?
A
Acyclovir
if neonate exposed on delivery
10
Q
What is the management of GBS?
A
Baby:
- Benzylpenicillin or ampicillin PLUS gentamicin
- Supportive therapy
Mother (during labour):
- IV benzylpenicillin
11
Q
What is the cause and consequence of listeria monocytogenes?
A
- Mother has mild influenza-like illness and passes to child in placenta
- Can cause spontaneous abortion, PTL, neonatal sepsis
- Mortality = 30%
12
Q
What are the S/S of listeria monocytogenes?
A
- Meconium stained liquor (MSL) in preterm infant
- Widespread rash
Can cause:
- Sepsis
- Pneumonia
- Meningitis
13
Q
What is the management of listeria monocytogenes?
A
- IV ampicillin
- +Gentamicin (if severe infection)
14
Q
What is Kawasaki Disease?
A
Systemic vasculitis disease
characteristically affecting young children (<5yrs)
15
Q
Who does Kawasaki Disease affect?
A
- Children 6m-4yrs (peak 1yr)
- Japanese, Black-Caribbean ethnicity
16
Q
What are the S/S of Kawasaki Disease?
A
(CRASH + Burn)
- C = conjunctivitis (bilateral)
- R = rash (polymorphous, begins hands/feet)
- A = adenopathy (cervical lymphadenopathy)
- S = strawberry tongue
- H = hands + feet swollen / red (and desquamate/peel)
- Burn = fever >5d (not responsive to antipyretics)
17
Q
What are the investigations for Kawasaki Disease?
A
Clinical diagnosis
- FBC (inc. platelets), CRP, ESR
- Echo
18
Q
What is the management of Kawasaki Disease?
A
>ADMISSION
1st line: (if within 10d / ongoing inflammation)
- IVIG
- Plus high-dose aspirin
- Consider corticosteroids
2nd line:
- Infliximab, ciclosporin, plasmapheresis
If > 10 days / no ongoing inflammation:
- Low-dose aspirin
19
Q
What is the main complication of Kawasaki Disease?
A
Coronary aneurysms
Early dx key to stop coronary artery aneurysms forming > ECHO
20
Q
What causes malaria?
A
Protozoa Plasmodium, spread by female Anopheles mosquito
21
Q
What are the types of malaria?
A
- Falciparum (most fatal)
- Ovale
- Malariae
- Vivax
22
Q
What are the S/S of malaria?
A
- Onset 7-10d after inoculation (<1yr)
- Fever (cyclical / continuous with spikes)
- D&V
- Flu-like sx > shaking, chills, night sweats, headache, myalgia
- Jaundice
- Anaemia
- Thrombocytopaenia
- Particularly susceptible to cerebral malaria, severe anaemia
23
Q
What are the investigations for malaria?
A
- 3 thick and thin blood films (detects parasites inside erythrocytes)
- Malaria rapid diagnostic tests (RDTs) (detection of parasite antigen or enzymes)
- Bloods: FBC, Clotting profile, U&Es, LFTs, BM, ABG
- Urinalysis
24
Q
What is the management of malaria?
A
General:
- Bite-prevention (repellent and nets)
- Prophylaxis - mefloquine
- Arrange immediate admission (medical emergency)
- Notify PHE
Non-falciparum:
- 1st line = Chloroquine + primaquine / ACT
Falciparum:
- Severe / complicated = IV artesunate (doe minimum 24hrs, then switch to ACT)
- Uncomplicated = Artemisinin-based combination therapies (ACT)
- +Supportive care (careful fluid management, renal support, airway protection, control of seizures, transfusion of blood products)
- +/-ICU
25
What causes Typhoid Fever?
Salmonella typhi or paratyphoid
26
How is typhoid fever transmitted?
Faeco-oral transmission
27
What are the complications of typhoid fever?
- GI perforation
- Myocarditis
- Hepatitis
- Nephritis
28
Where have people with typhoid fever commonly travelled to?
Pakistan, India, Bangladesh
29
What are the S/S of typhoid fever?
- Persistent high temperature that gradually increases each day
- Relative bradycardia
- Abdominal pain and distension
- **Constipation**
- Headache
- Anorexia (WL+++)
- Rose-spots on trunk
30
What are the investigations for typhoid fever?
- Blood culture (diagnostic)
- FBC, LFTs
- Stool culture, urine culture
31
What is the management for typhoid fever?
- 1st line = IV ceftriaxone + supportive care (antipyretics, fluids)
- 2nd line (if resistant) = PO azithromycin
32
What causes Dengue fever?
Caused by dengue arbovirus transmitted by Aedes Aegyptii mosquito
33
Where is dengue fever usually imported from?
SE Asia or South Africa
34
What are the S/S of dengue fever?
**Primary infection:**
- Headache (retro-orbital)
- Fine erythematous sunburn-like rash
- High fever and myalgia
**Other:**
- Hepatomegaly, abdominal distension
**Severe:**
- Low WCC, low platelets, haemorrhage
**Dengue haemorrhagic fever (secondary infection):**
- Previously infected child > subsequent infection (different strain) > severe capillary leak, hypotension, haemorrhagic manifestations > fluid resus usually helps a lot
- Due to partially effected host immune response augmenting the severity of the infection
35
What are the investigations for dengue fever?
- PCR viral antigen
- Serology (positive IgM and IgG)
- FBC, LFTs, serum albumin (low)
36
What is the management of dengue fever?
- Supportive (fluids and monitoring)
- ITU (if increased deterioration / severe disease)
37
What causes mumps?
Mumps orthorubulavirus
38
How is mumps transmitted?
Respiratory secretions
39
What is the timeline of mumps?
- Long incubation period (15-24d)
- Infectious 5d before and 5d after the parotid swelling (should pass totally in 1-2wks)
>Can still get infected if they had vaccine but likely to be reduced sx
40
What are the S/S of mumps?
- Asx (30%)
- Headache, fever
- Parotid swelling
- Other > pancreatitis, neuritis, arthritis, mastitis, nephritis, thyroiditis, pericarditis
41
What are the investigations for mumps?
- Salivary mumps IgM
42
What is the management of mumps?
**General:**
- Notify HPU
- Isolate for 5d from time of parotid swelling
**Advise and educate:**
- Self-limiting condition
- Supportive care (rest, analgesia, fluids)
**Safety net for complications:**
- Mumps orchitis > infertility (very rare)
- Viral meningitis > encephalitis (very rare)
- Deafness (unilateral and transient)
43
What causes measles?
Paramyxovirus
44
How is measles transmitted?
**Respiratory secretions**
One of the most highly communicable diseases (>15m in direct contact is enough to transmit)
45
What is the timeline of measles?
Incubation = 7-18d
Infective period = 4d before and 4d after rash
46
What are the S/S of measles?
- Prodrome = high fever, irritability, conjunctivitis, coryza, febrile convulsions
- Maculopapular rash (face/neck > hands/feet)
- Koplik spots (small white spots surrounded by red ring in mouth)
- Cough
47
What are the investigations for measles?
- **Measles specific IgG and IgM serology** (ELISA)
- 2nd line = PCR of blood or saliva
48
What is the management for measles?
**General:**
- Notify HPU
- Advise it's self-limiting but likely to cause unpleasant symptoms e.g. rash, fever, cough, conjunctivitis
- Immunise close contacts and encourage vaccination after acute episode
- Isolate for 4d after development of rash
**Supportive tx**
- Fluids, antipyretics, rest
- Children isolated in hospital
- Vitamin A supplements if severe
**Safety net for complications**
- Seek urgent medical advice if they develop complications such as: SOB, uncontrolled fever, convulsions / altered consciousness
49
What are the complications of measles?
- **Otitis media** (most common)
- Encephalitis (after 102wks) > headache, lethargy, irritability, seizures, coma
- Sub-acute sclerosing panencephalitis (SSPE) (after 7yrs) > measles dormant in CNS, dementia, death
- Pneumonia
- Keratoconjunctivitis
50
What causes Rubella?
‘German Measles’ caused by Togavirus
51
How is Rubella transmitted?
Spread through coughing and sneezing
52
What is the timeline of rubella?
- Incubation period = 6-21d
- Infective period = 1wk before to 5d after rash onset
- Illness period = 7-10d
53
What are the S/S of rubella?
- Prodrome = mild fever / asx
- Pink maculopapular rash (face > whole body), fades in 3-5d
- 20% > Forchheimer spots (red spots on soft palate)
- Lymphadenopathy (suboccipital, postauricular)
- >No Koplik spots or conjunctivitis
54
What are the investigations for rubella?
- Rubella serology (IgG and IgM) from oral fluid test
- RT-PCR (2nd line)
55
What is the management for rubella?
- Notify HPU
- Isolate for 4d after development of rash
- Advise that it is a self-limiting disease
- Supportive (fluids, analgesia, rest)
- Safety net the complications (haemorrhagic complications due to thrombocytopenia)
56
What does Parvovirus B19 cause?
“Fifth's disease / erythema infectiosum / Slapped Cheek”
57
How is parvovirus B19 transmitted?
- Respiratory secretions
- Vertical transmission
58
When is a patient with Parvovirus B19 infectious?
10d before to 1d after rash develops
59
What is parvovirus B19 in pregnancy associated with?
Hydrops fetalis
60
What are the RFs for parvovirus B19?
- HIV
- Sickle cell
61
What are the S/S of parvovirus B19?
**1st:**
- Asx, or
- Coryzal illness for 2-3d > latent for 7-10d
**2nd:**
- Erythema infectiosum (most common)
- Red ‘slapped cheek’ rash on face (viraemic phase of fever, malaise, headache, myalgia)
- Progresses 1w later to maculopapular (lace) like rash in trunk and limbs
**Aplastic crisis:**
- Occurs in children with chronic haemolytic anaemia (sickle cell) or immunodeficient
**Foetal disease:**
- Maternal transmission
- Leads to foetal hydrops, death due to severe anaemia
62
What are the investigations for parvovirus B19?
- B19 serology (IgM and IgG)
- RT-PCR (2nd line)
63
What is the management for parvovirus B19?
- Supportive (fluids, analgesia, rest) > will clear in 3wks
- Secondary arthritis may be treated with ibuprofen
- No need to stay off school or avoid pregnant women (not infectious once rash develops)
- Safety net complications (anaemia, lethargy, pregnancy)
64
What causes chickenpox?
Varicella zoster virus (HHv-3)
>Reactivation of dormant virus after chickenpox leads to herpes zoster (shingles)
65
What is the timeline of chickenpox?
- Incubation period = 10-21d
- Infectious period = 48hrs before rash to last crusted over lesion (5-7d after rash appears)
66
What are the S/S of chickenpox?
- Pyrexia, headache, abdominal pain, malaise
- Crops of vesicles appear over 3-5d
- Head, neck, trunk (less on limbs) > itchy
- Papule > vesicle > crust > several stages at once
67
What is the management of chickenpox?
**Supportive:**
- Fluids, analgesia (no ibuprofen), rest
- Advice > nail short, loose clothing, adequate fluid,
- Isolate from > immunocompromised, pregnant women, neonates, keep off school
**Admit if serious complications:**
- Secondary bacterial superinfection > sudden high fever, toxic shock, necrotising fasciitis
- Encephalitis
- Purpura fulminans > purpuric skin rash
- Dehydration (severe)
- Immunocompetent = oral acyclovir (if <24hrs of rash)
- Immunocompromised = IV acyclovir > oral acyclovir
**Prophylactic prevention:**
- Human VZV IVIG
68
What causes hand, foot, and mouth disease?
Most commonly due to **Coxsackie A16 virus**
Severe = enterovirus 71
Atypical = Coxsackie A6
69
What are the S/S of hand, foot, and mouth disease?
- Painful, itchy, vesicular lesions (hand, foot, mouth, tongue, buttocks)
- Mild systemic features > fever, sore throat, spots in mouth > develop into ulcers
70
What is the management of hand, foot, and mouth disease?
- Supportive > fluids, analgesia, rest (will clear in 7-10d)
- Safety net > dehydration, if doesn’t clear up in 2wks, pregnancy
- Don’t need to be kept off school but HPA recommend they do until better
71
What causes Roseola Infantum?
**HHV6**
(Sixth disease / exanthum subitem)
72
When are children infected with Roseola Infantum?
- Most children infected by 2yrs (6m-2yrs)
- Highly infectious during whole period of disease
- >Infected VERY young compared to other infections
73
What are the S/S of roseola infantum?
**Fever followed later by rash**
- High fever and malaise (3-4d) > generalised macular (small pink spots) rash appears as fever wanes
- Rash starts on neck/body and spread to arms, lasts 1-2d, non-itchy, blanching
- Many have febrile illness and never develop a rash, commonly misdiagnosed as measles/rubella
- Febrile convulsions in 10-15%
- Sore throat, lymphadenopathy, coryzal sx, D&V
- Nagayama spots (spots on the uvula and soft palate)
>Lack of Koplik spots (white spots on buccal mucosa)
74
What are the investigations of roseola infantum?
- HHV6/7 serology (IgG and IgM)
- Measles & rubella serology (similar presentation)
75
What is the management of roseola infantum?
- Supportive > fluids, rest, analgesia > will clear in ~1w
- No need to stay off school
- Safety net the complications > high fever, febrile convulsions
76
What are the investigations for HIV in children?
- >18m = antibody detection (ELISA)
- <18m (still have transplacental anti-HIV IgG from mother) = PCR of virus
- >Measured at birth, on discharge, 6wks, 12wks, 18m
77
What is the management of HIV in children?
**Reducing Vertical Transmission:**
- C-section will be recommended
- Cord clamped as soon as possible and baby bathed immediately after birth
- Zidovudine monotherapy for 2-4wks (low/med risk) or PEP combination (high risk)
- Women not to breastfeed
- Give all immunisations including BCG (unless mod-high risk of transmission)
**PCR HIV virons at 6 and 12w (at least 2 and 8w after stopping prophylaxis)**
- Baby will have passive IgG from mother up until at least 6m
**Decision to start is based on a combination of clinical status, HIV viral load and CD4 count**
IMPORTANT: infants should start ART shortly after diagnosis because they are at higher risk of disease progression
- PCP prophylaxis with co-trimoxazole is given to infants who are HIV-infected, and for older patients with low CD4 counts
**Other aspects of management:**
- Immunisation (except BCG)
- MDT approach
- Regular follow-up with particular attention to weight and developmental progress
78
What is the management if an immunocompromised patient comes into contact with chicken pox?
Immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG).
If chickenpox develops then IV aciclovir should be considered
