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infection Flashcards

1
Q

what organisms are likely in neonate- 3m meningitis

A

group B strep, E coli, listeria

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2
Q

what is added to cef antibiotics in neonatal meningitis

A

ampicillin

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3
Q

what organisms likely in 3m-6y meningitis

A

Neisseria meningitides, strep pneum, H influenza

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4
Q

what organisms likely in >6y

A

Neisseria meningitides, strep pneum

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5
Q

signs meningococcal infection

A

purpuric rash, non blanching. give IM benzlypenicillin straight away

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6
Q

contraindications to LP

A

cardiorespiratory instability, coagulopathy, signs incr ICP, local infection, thrombocytopenia, focal neuro signs

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7
Q

if CI to LP in meningitis what can be done

A

PCR, rapid antigen test

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8
Q

LP results bacterial

A

turbid, incr polymorphs, incr protein, low glucose

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9
Q

LP results viral

A

clear, incr lymphocytes, normal or incr protein, normal or low glucose

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10
Q

LP results TB

A

clear, turbid or viscous, incr lymphocytes, very high protein, very high glucose

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11
Q

treatment meningitis

A

cefotaxime or ceftriaxone. dexamethasone

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12
Q

complications meningitis

A

hearing loss, hydrocephalus, local vasculitis, local cerebral infarction, subdural effusion, cerebral abscess

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13
Q

what organisms can cause viral meningitis

A

enteroviruses, adeno, EBV, mumps.

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14
Q

what organisms may be more likely in the immunocompromised

A

mycoplasma and borelia (lyme)

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15
Q

commonest cause septicaemia in children

A

meningococcus

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16
Q

signs of septicaemia

A

fever, tachycardia, tachypnoea, purpuric rash, shock.

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17
Q

treatment septicaemia

A

antibiotics, fluids, circulatory support (inotropes), FFP and platelets for DIC

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18
Q

what can cause impetigo

A

staph/strep

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19
Q

signs impetigo

A

lesions on face, hands, neck. erythematous macules which can become vesicular and pustular, can rupture and leak. honey coloured cruster lesions

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20
Q

when can go to school with impetigo

A

when the lesions are dry

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21
Q

treatment impetigo

A

topical mupirocin, flucloxacillin, co amoxiclav

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22
Q

how to eradicate carriage impetigo

A

need to eradicate nasal carriage. nasal cream- mupirocin or neomycin

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23
Q

signs periorbital cellulitis

A

fever, erythema, tender, oedema eyelid. unilateral.

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24
Q

how can periorbital cellulitis occur

A

may follow local trauma. spread from paranasal sinus infection or dental abscess. treat promptly with IV antibiotics to prevent progression to orbital

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25
Q

signs orbital cellulitis

A

proptosis, painful eye movements, decr visual acuity. do CT

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26
Q

signs infectious mononucleosis

A

fever, malaise, tonsillopharyngitis, lymphadenopathy, petechiae on soft palate, spleno/hepatomegaly, maculopapular rash, jaundice

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27
Q

diagnosis infectious mononucleosis

A

monospot test. IgM and IgG to EBV antigens

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28
Q

what should you not give in EBV infection

A

amoxicillin or ampicillin as causes maculopapular rash in EBV

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29
Q

treatment EBV

A

symptomatic. corticosteroids if severe airway compromised. penicillin if group A grown

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30
Q

features measles

A

temp, maculopapular rash- starts behind the ears and involves the whole body, conjunctivitis, Kopliks spots, cough, coryza

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31
Q

what are pathognomonic in measles

A

Kopliks spots- white spots on buccal mucosa

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32
Q

complications measles

A

pneumonia, otitis media, febrile convulsions, encephalitis, subacute sclerosing panencephalitis, hepatitis, diarrhoea, appendicitis, croup

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33
Q

when does encephalitis come on in measles

A

8d after initial infection. initially- headache, lethargy, irritable. convulsions and coma.

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34
Q

long term complications encephalitis (measles)

A

hearing problems, hemiplegia, LD

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35
Q

when does subacute sclerosing panencephalitis occur

A

can occur 7-13y after infection. primary infection usually

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36
Q

signs subacute sclerosing panencephalitis

A

loss of neuro function- behaviour changes, myoclonus, choreoatheotosis, dystonia, leading to dementia and death

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37
Q

what can you give if patient is immunocompromised in measles and what to give patients in developing world

A

ribavirin (anti viral drug). vitamin A

38
Q

how is measles spread

A

droplets

39
Q

incubation measles

A

7-12 days, infective from prodrome until 5 days after rash starts

40
Q

infectivity rubella

A

5 days before to 5 days after start of rash.

41
Q

signs rubella

A

macular rash, suboccipital lymphadenopathy

42
Q

is the rubella vaccine a live virus

A

yes

43
Q

complications rubella

A

small joint arthritis, malformations in utero.

44
Q

what malformations in first four weeks if infected rubella in utero

A

eye anomaly

45
Q

malformation 4-8 weeks infection rubella in utero

A

cardiac abnormalities

46
Q

malformation 8-12 weeks rubella infection in utero

A

deafness

47
Q

spread of mumps

A

droplets, saliva

48
Q

immunity mumps

A

lifelong once infected

49
Q

infectivity mumps

A

7 days before and 9 days after parotid swelling

50
Q

signs mumps

A

prodromal malaise, incr temp, painful parotid swelling, bilateral in 70%.

51
Q

complications mumps

A

usually none. orchitis (+- infertility), arthritis, meningitis, pancreatitis, deafness

52
Q

features hand foot and mouth disease

A

mildly unwell child, vesicles on palms soles and mouth, may cause discomfort until they heal without crusting

53
Q

cause hand foot and mouth

A

coxsackie virus a16 or enterovirus 71

54
Q

signs erythrovirus (parvovirus 19)

A

mild acute infection wth malar erythema (slapped cheek) and rash mainly on the limbs ( glove and socks syndrome)

55
Q

complications erythrovirus

A

aplastic crisis. fetal death in pregnancy- hydrops fetalis.

56
Q

what is roseola infantum

A

mild self limiting. incr temp, maculopapular rash, ulcers.

57
Q

what causes roseola infantum

A

herpes virus 6

58
Q

what is Kawasaki disease

A

systemic vasculitis. 6m-4y

59
Q

features Kawasaki disease

A

prolonged fever >5 days. conjunctiva, mucous membranes, cervical lymphadenopathy, rash, extremities (red, peeling)

60
Q

treatment Kawasaki disease

A

IvIg. aspirin- 6 weeks. persistent inflammation- infliximab, steroids

61
Q

what can be affected in 1/3 Kawasaki patients

A

coronary arteries- aneurysms (give warfarin),MI

62
Q

what is chicken pox

A

primary varicella zoster infection. spread by resp droplets

63
Q

features chicken pox

A

vesicular rash- papules vesicles and pustules. starts on head and trunk then spreads to peripheries. temperature.

64
Q

complications chicken pox

A

bacterial superinfection, staph, strep, toxic shock syndrome, nec fasciitis, encephalitis, meningitis, pneumonitis, DIC, purpura fulminans

65
Q

treatment chicken pox

A

in immunocompromised- IV acyclovir. then switch to oral valaciclovir. varicella zoster IG to immunocompromised

66
Q

can chicken pox be caught from someone with shingles

A

yes

67
Q

treatment bacterial superinfection in chickenpox

A

flucloxacillin

68
Q

what is shingles

A

herpes zoster. reactivation of latent varicella zoster

69
Q

features shingles

A

vesicular eruption in dermatomal distribution. unlikely to get neuralgic pain in childhood. common in the thoracic region. if recurrent- immunocompromised

70
Q

treatment shingles

A

oral analgesia. acyclovir in immuno.

71
Q

what can be given as prophylaxis in pregnancy

A

varicella zoster globulin

72
Q

what happens if pregnant lady gets infected with varicella zoster

A

aciclovir

73
Q

what does HSV1 cause

A

lip and skin

74
Q

what does HSV2 cause

A

genital lesions

75
Q

what is the most common presentation of herpes simplex in children

A

gingivostomatitis

76
Q

features gingivostomatitis

A

vesicles on lips, gum, tongue, palate can ulcerate and bleed. 10m-3y. fever and miserable child

77
Q

what is a herpetic whitlow

A

painful white pustules on site of broken skin. fingers and thumbs

78
Q

eye complications herpes simplex

A

blepharitis, conjunctivitis, cornea- scarring, loss vision

79
Q

investigations in osteomyelitis

A

MRI shows infection with pus and debris, radionuclide bone scan

80
Q

when is the mother at risk of passing on HIV

A

during pregnancy, during delivery, breastfeeding

81
Q

when is HIV vertical transmission more likely

A

high viral load or symptomatic

82
Q

diagnosing vertically acquired HIV

A

HIV DNA PCR- to be clear need 2 negative in first 3m of life 2 weeks after postnatal antiretrovirals

83
Q

how long do children have placentally transferred IgG antibodies HIV

A

18 months so don’t use standard tests

84
Q

when should you consider HIV in children

A

PUO, lymphadenopathy, hepatosplenomegaly, persistent diarrhoea, parotid enlargement, shingles decr platelets, failure to thrive, clubbing, CMV

85
Q

decreasing vertical transmission HIV

A

antiretrovirals to mother, avoid breastfeeding, pre labour C section, avoid prolonged rupture of membranes

86
Q

treatment vertically transmitted HIV

A

highly active antiretroviral therapy PENTA regimen- start at once if AIDs defining conditions or CD4

87
Q

features diphtheria

A

nasal discharge, bull neck, sore throat, airway obstruction, cardiac and neuro toxins

88
Q

opportunistic infections in HIV

A

aspergillus, candida, Cryptococcus, cryptosporidium, pneumocystitis, HH8 (Kaposi sarcoma), pseudomonas, CMV encephalitis, TB encephalitis, lymphoma, toxoplasmosis

89
Q

what does cryptosporidium cause (HIV)

A

chronic diarrhoea

90
Q

what does Cryptococcus cause (HIV)

A

meningo encephalitis

91
Q

treatment PCP

A

co trimoxazole

92
Q

what is Kaposi sarcoma

A

cause HHV-8. 4 types. skin not always involved. can get purple macules papules nodules and plaques affecting limbs, face +- periorbital purpura/raccoon eyes

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