Infection

Question 1

Generate a management plan for varicella zoster

Answer 1

Management is supportive:

• keep cool, trim nails
• calamine lotion
• school exclusion: the 2016 Public Health England guidelines reverted to the traditional advice to exclude children until all vesicles have crusted over, rather than 5 days post onset of rash, which had been advocated over recent years
• immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG). If chickenpox develops then IV aciclovir should be considered

(Passmedicine)

Question 2

Identify the possible complications of chickenpox

Answer 2

A common complication is secondary bacterial infection of the lesions.

Rare complications include:

• pneumonia
• encephalitis (cerebellar involvement may be seen)
• disseminated haemorrhagic chickenpox
• arthritis, nephritis and pancreatitis may very rarely be seen

(passmedicine)

Question 3

What are the indications for antibiotic use in a pt with a sore throat?

Answer 3

NICE indications for antibiotics

• features of marked systemic upset secondary to the acute sore throat
• unilateral peritonsillitis
• a history of rheumatic fever
• an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
• patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present

(passmedicine, NICE)

Question 4

Generate a management plan for cellulitis

Answer 4

• Medical
  
  • Depends on severity
    
    • Class I: oral antibiotics
    • Class II: IV antibiotics (in community if suitable facilities)
    • Class III + IV: IV antibiotics + admit
  • Antibiotic choice
    
    • Mild/moderate:
      
      • 1st: flucloxacillin (or clarithromycin if allergic)
      • 2nd: clindomycin
    • Severe: benzylpenicillin + clarithromycin
  • Also admit if:
    
    • rapidly deteriorating cellulitis
    • <1y old or frail
    • immunocompromise
    • significant lymphoedema
    • facial cellulitis or periorbital cellulitis

(passmedicine, NICE)

Question 5

Outline the severity classification for cellulitis

Answer 5

Eron Classification:

• Class I: no systemic upset, no uncontrolled comorbidities
• Class II: systemic upset OR comorbidity which may delay resolution
• Class III: significant systemic upset (confusion, tachycardia, tachypnoea, hypotension) OR comorbidity whick may impair response to tx OR vascular compromise (limb-threatening)
• Class IV: sepsis or necrotizing fasciitis

(passmedicine, NICE)

Question 6

What is the definition of neutropenic sepsis?

Answer 6

Neutrophil count < 0.5 * 109 in a patient who is having anticancer treatment and 1+ of:

• a temperature higher than 38ºC or
• other signs or symptoms consistent with clinically significant sepsis

(passmedicine)

Question 7

Generate a management plan for neutropenic sepsis

Answer 7

• Medical
  
  • Empirical antibiotics
    
    • 1st: tazocin
    • 2nd (if no response in 48h): meropenem +/- vancomycin
  • If no response in 4-6 days: HRCT for ?fungal infection
    
    • If +ve: start antifungals
  • G-CSF may have a role in some pts

(passmedicine, NICE)