Infection Flashcards
what vaccines are given at 8 weeks?
- 6 in 1 vaccine(diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
- Meningococcal type B
- Rotavirus(oral vaccine)
what vaccines are given at 12 weeks?
- 6 in 1 vaccine(again)
- Pneumococcal(13 different serotypes)
- Rotavirus(again)
what vaccines are given at 16 weeks?
- 6 in 1 vaccine(again)
- Meningococcal type B(again)
what vaccines are given at 1 year?
- 2 in 1(haemophilus influenza type B and meningococcal type C)
- Pneumococcal(again)
- MMR vaccine(measles, mumps and rubella)
- Meningococcal type B(again)
what vaccines are given at 12-13 years?
- Human papillomavirus(HPV) vaccine (2 doses given 6 to 24 months apart) - ideally before sexually active
- against strain 6 &11 which causes genital warts
- 16 and 18 cervical cancer
wat vaccines are given at 14 years?
- 3 in 1(tetanus, diphtheria and polio)
- ***Meningococcal groups A,C,WandY
What are some risk factors for cadidiasis?
- Hot, humid weather
- Too much time between diaper changes
- Poor hygiene
- Taking medicines such as antibiotics or corticosteroids
- Health conditions that weaken the immune system, such as diabetes, cancer, or HIV
what are some key points in the history of a patient with candidasis?
- skin - rash, patches that ooze clear fluids, pimples, itching or burning
- vagina - white or yellow discharge, itching, redness in extrenal vagina, burning
- penis - redness, scaling, painful rash
- mouth - white patches on tongue, top of mouth, inside cheeks, pain
- fever and chills
what is the management of cadidasis?
- exclude risk factors - DM etc
- miconazole gel, nystatin
- oral hygiene advice, inhaler advice if steroid inhaler like rinse mouth after
- if not responding after 2w or recurrent paediatric referral!
what causes cellulitis in children?
- after trauma which causes opening in skin which leads to bacterial invasion
- group A strep - haemolytic
- strep pneumoniae
- staph aureus
- methicillin-resistant staph aureus
- Predisposing factors include skin abrasions, lacerations, burns, eczematous skin, chickenpox, etc
how does cellulitis present?
- swelling of skin
- tenderness
- warm skin
- pain
- bruising
- blisters
- fever and chills
- headache
- weakness
what are some red flag symptoms of cellulitis?
- very large area of erythema
- fever
- numbness, tingling in area
- skin black
- if swollen area around eye
- DM, immunocompromised
how do you manage cellulitis?
- rest
- oral or IV antibiotics - flucloxacillin
- cool, wet dressings
- surgical intervention and debridement if necrotising
what are the pathophysiology of conjunctivitis?
new born - chemical (2-4 days), gonococcal from vagina of infected mother
- childhood - large outbreaks in schools or day cares caused by bacteria, viruses like herpes or allergies
- bacteria - s.aureus, h.influenzae, s.pneumoniae, chlamydia
- virus - adenovirus, herpes
- allergies and chemicals like new born eye drops
how might conjunctivitis present?
itchy and irritated eyes
discharge - clear for viral, green and thick for bacterial
ear infection in some
swelling of eye lid
how is conjunctivitis managed?
- cleaning with saline or water is all that is required as it resolves spontaneously
- topical antibiotic eyes ointment eg: chloramphenicol or neomycin
- if gonococcal infection start treatment immediately as permanent loss of vision can occur
- 3rd generation cephalosporin IV and cleanse eye frequently
- chlamydia - oral erythromycin for 2w and treat mother and partner
what is the pathophysiology of epiglottitis?
- acute inflammatory swelling of epiglottis and surrounding tissues mostly caused by infection
- life threatening emergency as high risk of airway obstruction
- children higher risk as epiglottis more floppy, broad, long an dangled more into trachea
*H.influenza commonly causes, post vaccination streptococcus, candida and aspergillus in immunocompromised, HSV or parainfluenza etc virally
what are some worrying sign that may lead for you to suspect epiglottitis?
‼️ 4D - duration less than 12h, no cough
- dyspnoea
- dysphagia
- drooling
- dysphonia (hot potato voice)
what are some examination epiglottitis?
- dehydration
- high grade fever
- stridor - late sign
*tripod position - lean forwards, outstretched arms, neck extended and tongue out as attempt to position inflamed structures away from airway
what are complications of epiglottitis?
mediastinitis, retropharyngeal abscess, pneumonia, meningitis, sepsis
what are the initial investigations for epiglottitis?
SECURE AIRWAY
*keep env calm, not supine
- lateral neck XR - thumb print sign, thickened aryepiglottic folds, increased opacity of larynx and vocal cords
- good for ruling out but don’t waste time
what are some management options for epiglottitis?
1.secure airway - call anaesthetist, ENT, avoid distress
a. may require tracheostomy
2. oxygen- parent can hold mask near child
3. nebulised adrenaline - bridging therapy while waiting for definitive airway management by reducing oedema
4. IV steroids - benefit not proven
5. IVI - resuscitation and maintenance, NBM until airway improved
6. secure airway in theatre
What is the new vaccination programme for influenza?
- A new NHS influenza vaccination programme for children was announced in 2013. There are three key things to remember about the children’s vaccine:
- it is givenintranasally
- the first dose is given at2-3 years, thenannuallyafter that
- it is alive vaccine
what are some red flag signs of influenza?
- Signs andsymptoms that require hospital admission
- Presence of alower respiratory tract infection (hypoxaemia, dyspnoea, lung infiltrate)
- Central nervous system involvement
- Significant exacerbation of an underlying medical condition
how would you differentiate between common cold and the flu?
Flu tends to have an abrupt onset, whereas a common cold has a more gradual onset.
Fever is a typical feature of the flu but is rare with a common cold.
Finally, people with the flu are “wiped out” with muscle aches and lethargy, whereas people with a cold can usually continue many activities.
how is influenza managed?
*clinical diagnosis
- paracetamol or ibuprofen for fever and pains
- maintain hydration and feeds
- rest, steam inhalation, nasal drops to help congestion
- gargling with salt water
- oral oseltamivir or inhaled zanamivir - if at risk
- must be taken within 48h of first symptoms to be effective
how does a HSV infection present?
- 2-20 days after contact
- painful, itchy, burning or tingling skin
- blisters which become sores
- sores crust and heal over 1-2w
- flu-like symptoms - swollen glands, headache, body aches, fever
*may remain dormant and come back with stress, too tired, irritated skin, menstruation
what is the pathophysiology of herpes simplex infection?
- HSV is a very contagious virus
- HSV-1 causes sores around lips or inside mouth called cold sores
- HSV-2 causes sores in genitals
- spreads via direct contact with infected persons mucous membranes, saliva, oozing fluid from sore
what are some red flag signs for HSV sores?
complications of encephalitis in children!! can cause death in neonates!
- non healing
- signs of pus, redness etc
- sores near eyes
- immuno-compromised
how is an HSV infection managed?
- antivirals
- acetaminophen, paracetamol, ibuprofen for pain
- infected areas kept dry
- wash hands often
what is the pathophysiology of malaria?
- most commonly imported tropical disease to the UK, more commonly seen in children as susceptible UK born children accompany overseas born parents to visit endemic areas
- commonly plasmodium falciparum P.falciparumand these infections usually present in first few months after exposure
how might a malaria patient present?
- suspect malaria in a patient with fever and recent travel to a malaria‐endemic area
- non-specific symptoms in uncomplicated - fever, lethargy, malaise, N+V+D, abdominal pain
- severe : respiratory disease, hypoglycaemia
- severe cerebral malaria : reduced GCS, seizures, altered respiration
what are some complications of malaria?
- cerebral malaria
- acute renal failure
- ARDS
- hypoglycaemia
- DIC
how is malaria investigated?
- antigen tests
- thick and thin blood films
*If initial tests are negative arrange to repeat after 12, 24 and 48hrs if child remains unwell and no clear focus of infection evident
- blood gas including glucose
- FBC - thrombocytopenia highly suggestive
- LFT, U&Es, blood glucose, clotting profile
- G6PD screen
how is malaria managed?
notify public health
admit all patients
4h observations and blood glucose monitoring
repeat thick films
*oral artemether with lumefantrine
*severe - IV artesunate
*supportive care
what is the pathophysiology of measles?
- highly contagious viral infection spread by aerosol breath, cough or sneeze
- infects respiratory tract and spreads through body
- RNA paramyxovirus
- infective until 4 days after rash starts
what are some clinical features of measles?
- high fever (may spike to more than 104°)
- cough,
- runny nose (coryza), and
- red, watery eyes
- 2-3 days after - koplik spots in mouth
- 3-5 days after rash begins
what are the examination findings of measles?
- prodromal - conjunctivitis
- Koplik spots
- rash - starts from behind ear and spreads to whole body
- made up of small red-brown, flat or slightly raised spots that may join together into larger blotchy patches
what are some complications of measles?
encephalitis
otitis media
pneumonia
febrile convulsions
resp - croup, tracheitis
neuro - febrile seizures
other - diarrhoea, hepatitis
how is measles diagnosed?
- IgM antibodies
- nose and throat swab
how is measles managed?
- mainly supportive
- paracetamol and ibuprofen for fever or pains
- admission in immunosuppressed
- stay off school until 4 days after rash
- stay away from unvaccinated or pregnant
- if child not vaccinated and came in contact offer MMR within 72h
- stay hydrated
- notify public health!!
what is the pathophysiology of meningitis?
- inflammation of the meninges which line the brain and spinal cord, most likely caused by bacteria or viruses
- neisseria meningitidis - gram negative
what are the key clinical features of meningitis?
- fever
- neck stiffness
- headache
- photophobia
- altered consciousness
- seizures
- neonates - hypotonia, poor feeding, lethargy, hypothermia
what are some examination findings for meningitis?
altered consciousness
non-blanching rash
kernig’s test
brudzinski
differentiate between kernig’s and brudzinski.
- Kernig’s test - lie flat, flex one hip and knee to 90 and slowly straighten knee while hip flexed at 90
- Brudzinski - flat on back, use hands to lift head and neck off bed and flex chin to chest and observe if involuntary flex in hips and knees
what are the complications of meningitis?
- hearing loss
- seizures and epilepsy
- cognitive impairment and learning disability
- memory loss
- cerebral palsy with focal neurological deficits like limb weakness or spasticity
what are some investigations done for meningitis?
sepsis screen
LP - if under 1m with fever, 1-3m fever and unwell
viral PCR
what are some contraindications for an LP?
- focal neurological signs
- papilloedema
- significant bulging of the fontanelle
- disseminated intravascular coagulation
- signs of cerebral herniation
- *blood cultures and PCR for meningococcus should be obtained.
how is meningitis managed?
- notify public health
- community - IM benzylpenicillin
- under 3m cefotaxime plus amoxicillin
- dexamethasone over 3m
- fluids
- post-exposure prophylaxis - single dose of ciprofloxacin
- acyclovir for HSV or VZV
what is the pathophysiology of mumps?
viral infection which is self limiting within 1 week, droplet spread
RNA paramyxovirus, winter, spring
what are some key clinical features of mumps?
initial flu prodromal. which occurs before parotid swelling
fever, muscle aches, lethargy, reduced appetite
parotitis
- parotid swelling which can be unilateral or bilateral (with associated pain)
- tenderness to touch
what are some complications of mumps?
- pancreatitis - abdominal pain
- orchitis - testicular pain
- meningitis or encephalitis - confusion, neck stiffness and headache
- sensorineural hearing loss
what are the initial investigations of mumps?
- PCR testing on saliva swab
- antibodies to mumps virus testing via blood or saliva
how is mumps managed?
- notifiable disease so notify public health if suspected or confirmed
- supportive management as self limiting
- rest
- fluids
- analgesia
- manage complication as needed
what is the pathophysiology of tonsillitis?
- inflammation of palatine tonsils, which is a part of Waldeyer’s ring
- commonly viral infection, hence do not require Abx
- bacterial - group A strep pyogenes or strep pneumoniae
- may accompany otitis media, rhino-sinusitis
- children of 5-10 or those 15-20
what is the clinical presentation of tonsilitis?
- fever, sore throat, painful swallowing
- non specific - fever, poor oral intake, headache, vomiting, abdominal pain
*-throat examination shows red, inflamed and enlarged tonsils with or without exudates
- otoscopy - TM
- palpate for cervical lymphadenopathy
what are some complications of tonsillitis?
- admission if immunocompromised, systemically unwell, dehydrated, stridor, respiratory distress, peritonsillar abscess, cellulitis
- trapped pus abscess in region of tonsils - trismus, change in voice ‘hot potato voice’, uvula deviation away from affected side due to unilateral swelling
- complications - chronic tonsillitis, quinsy, otitis media, scarlet fever, rheumatic fever, PSGN, reactive arthritis
what are the centor criteria for tonsilitis?
- A score of3 or more gives a 40 – 60 % probability ofbacterial tonsillitis, and it is appropriate to offer antibiotics. A point is given if each of the following features are present:
- Fever over 38ºC
- Tonsillar exudates
- Absenceof cough
-Tenderanterior cervical lymph nodes (lymphadenopathy)
what are the fever pain criteria for tonsillitis?
- Feverduring previous 24hours
- P–Purulence (pus on tonsils)
- A–Attended within 3days of the onset of symptoms
- I–Inflamed tonsils (severely inflamed)
- N–No cough or coryza
what are some management options of tonsillitis?
- viral: analgesia for fever and pain
- abx: phenoxymethylpenicillin for 10 days, clarythromycin
- delayed prescription
- admission if immunocompromised, systemically unwell
- tonsillectomy
When would you consider a tonsillectomy?
7 episodes in 1 year, 5 per year for 2 or 2 episodes of quinsy
what is the pathophysiology of otitis media?
inflammation of middle ear between TM and inner ear where cochlea, vestibular apparatus and nerves found, caused by virus or bacteria strep. pneumoniae
what are the clinical features of otitis media?
- earache, young children tugging ear
- reduced hearing
- fever, cough, sore throat, coryzal symptoms
- restlessness
- balance issues and vertigo
- discharge if perforation
- *non specific in young children - poor feeding, vomiting, lethargy, fever, generally unwell
what are some complications of otitis media?
- can complicate to TM perforation, facial nerve involvement, mastoiditis or even intracranial complications
- HL, recurrent infection, abscess
how would you manage otitis media?
- specialist and consider admission in infants younger than 3m, temp 38c 3-6m old with temp. over 39c
- most resolve without antibiotics in 3 days and upto a week
- safety net, education, advise on when to seek attention
- simple analgesia for pain and fever
- prescribing Abx - immediate, delayed or none
- consider prescribing when child has significant systemic illness, immunocompromised, less than 2 years with BL or with otorrhoea
- amoxicillin for 5 days, erythromycin otherwise
what is viral gastroenteritis?
- temporary disorder due to an enteric infection characterised by sudden onset diarrhoea with or without vomiting
- diarrhoea 5-7 days, stop within 2w and vomiting 1-2 days up to 3 days
- commonly viral - rotavirus, norovirus and adenovirus
what are some features of recognised dehydration risk in young children with viral gastroenteritis?
- younger children under 6m
- passed >5 diarrhoea stools in last 24h
- vomited >2 in last 24h
- children who stopped breast feeding during illness
what are some complications viral gastroenteritis?
- haemolytic uraemic syndrome - rare but serious as can cause acute renal failure, haemolytic anaemia
- toxic megacolon - rotavirus complication
- acquired or secondary lactose intolerance - lining of intestine being destroyed, improved with lining healing
when would you consider an alternative diagnosis for a child presumed to have viral gastroenteritis?
- temp over 38c or 39c if over 3m
- breathlessness or tachypnoea
- altered GCS
- meningism
- blood in stool
- bilious vomit
- severe and localised abdominal pain
- abdominal distension or guarding
what are some investigations that can be carried out for viral gasteoenteritis?
- stool sample send if sepsis suspected, blood in stool, child immunocompromised
- bloods not routine but measure sodium, potassium, creatinine, urea, glucose if IVF ongoing, or hypernatraemia signs seen (jittery, increased muscle tone, convulsions, drowsiness or coma)
- measure acid-base balance and chloride concentration if shock suspected
what are some management of viral gastroenteritis?
- not clinically dehydrated: continue breastfeeding, encourage fluid intake and not fizzy
- dehydrated - IVF, oral therapy, NGT
- post-hydration: full strength milk straight away etc
what is pre-septal cellulitis?
inflammatory disease of orbit limited to the tissues anterior to the orbital septum
*
what is orbital cellulitis?
inflammatory disease of the superficial and deep structures of the orbit
*cannot open eye, lid erythema, swollen conjunctiva, impaired visual acuity, painful eye movement, proptosis, asymmetrical pupils, fever
what are the key points in the history?
- peri-orbital
- lid swelling and redness
- orbital
- General malaise, pain, blurred vision, double vision, loss of colour vision, sinus headache
how does pre-septal vs orbital cellulitis present?
pre-septal: can open eye to examine, lid erythema, white conjunctiva, normal visual acuity, normal painless movements of eye, no proptosis, equal pupil reaction, systemic wellness
orbital: cannot open eye, lid erythema, swollen conjunctiva, impaired visual acuity, painful eye movement, proptosis, asymmetrical pupils, fever
what are some red flags regarding orbital cellulitis?
- cannot open eye, lid erythema, swollen conjunctiva, impaired visual acuity, painful eye movement, proptosis, asymmetrical pupils, fever
- SIGHT THREAT!!
how would you manage pre-septal cellulitis?
- If under 3 months old - admit under medics and refer to ophthalmology and ENT
- If over 3 months old – If systemically well, sensible parents and mild features may be discharged on PO antibiotics (co-amoxiclav) 7-10 days?
- Give clear instructions to return immediately if condition worsens
how is orbital cellulitis managed?
- admission!! IV access
- ENT and ophthal referral and review
- IV ceftriaxone 10-14 days
- +/- IV metronidazole if sinuses involved
- 4h obs
- surgery maybe required incase of abscess needing draining
what is toxic shock syndrome?
- exotoxin-mediated acute severe condition
- children susceptible due to immature immunity, colonisation of wound or burn with toxic producing strains of staph A and group A strep causes, MRSA
- exotoxins in bloodstream act as superantigens causing T cell activation and massive release of cytokines causing massive
- rapid progression to septic
shock and multi-organ failure
what is TSS associated with usually?
- TSS is usually associated with burns or wounds (including surgical), skin infections
- e.g. in association with varicella infection or bites, or any other recent infection, tampon use
- in UK commonly - small surface area burn in a child (3). It is typically
associated with children aged 1-4 years, two days after a small burn
what are some key features of TSS?
- high fever - 38.9c <
- vomiting or diarrhoea
- muscle pain
- confusion
- lethargy
- diffuse macular erythroderma
- hypotension
- pyrexia
- reduced consciousness
how would you investigate TSS?
- CLINICAL
- BP
- U&E - CK levels, creatinine high
- blood cultures
- FBC - platelets low, CRP may be raised
- coagulation
- blood gas - lactate
- blood glucose
- group and save
how is TSS managed?
- A-E
- high flow oxygen
- fluid resuscitation - 10ml/kg bolus and reassess
- IV antibiotics - IV flucloxacillin, IV clindamycin if TSS suspected
- analgesia
- clean infected wound
- administer platelets if needed
- BP medication if low
- MDT review
what are some reg flags regarding URTI?
- have a fever lasting more than five days
- are having difficulty breathing
- wheezing and difficulty breathing
- less energy and irritable
- are not managing to drink enough fluid
- are less than three months old and have a fever above 38 degrees Celsius
what management options do you give for someone with a URTI?
- paracetamol or ibuprofen for high fever, upset, pain
- ensure hydration - sugar-free ice lollies
- throat lozenges for older children
- babies saline nose drops to ease blockage
what is viral exanthema?
- eruptive skin rash that is often related to a viral infection
- The most common childhood viral exanthems include chickenpox (varicella), fifth disease, measles (rubeola), roseola, and rubella (German measles), covid, hand, foot and mouth
how is viral exanthema managed?
- clinical
- cultures
- swabs maybe
- lotions to reduce itchiness
- NSAIDs
- self limiting
TB
finish
Rubella
finish
primary immune deficiency syndrome
finish
