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Paediatrics > Infection And Immunity > Flashcards

Infection And Immunity Flashcards

1
Q

Causes and presentation of fever in less than 3 months

A

Often have bacterial infection because viral is rare due to passive immunity from mothers
Usually present with non-specific clinical features and fever
Need urgent investigation with septic screen and IV antibiotics

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2
Q

Severe fever in less than 3 months

A

If less than 3 months then 38 is severe

If 3-6 months then >39

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3
Q

Other signs of severe illness in febrile infant

A 
Pale, blue and mottled
Reduced consciousness, bulging fontanelle, neck stiffness, status epilepticus, focal neurological signs or seizures (meningitis) 
Significant Resp distress 
Bile stained vomiting
Severe dehydration or shock
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4
Q

Which antibiotics are given to seriously unwell febrile infants

A

3rd generation cephalosporin eg. Cefotaxime or ceftriaxone if >3 months
If 1-3 months then cefotaxime and ampicillin

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5
Q

What should be given to febrile child if herpes simplex encephalitis suspected

A

Aciclovir

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6
Q

Where does most of the damage come from in bacterial meningitis? X3

A

From host immune response rather than organism itself
Release of inflammatory mediators and activated leukocytes, together with endothelial damage lead to cerebral oedema, raised ICP and decreased cerebral blood flow
Inflammatory response below the meninges causes vasculopathy - cortical infarction
Fibrin deposits block resorption of CSF leading to hydrocephalus

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7
Q

Common organisms causing meningitis in neonate-3months x3

A

Group b strep
E Coli
Listeria monocytogenes

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8
Q

Common meningitis organisms 1 month- 6 years x3

A

Neisseria meningitidis
Strep pneumoniae
Haemophilus influenzae

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9
Q

Common meningitis organisms >6 years x2

A

Neisseria meningitidis

Strep pneumoniae

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10
Q

Investigations for meningitis

A 
Lumbar puncture for CSF 
FBC 
Coag screen and crp 
Blood, urine, throat swab, stool culture 
Blood and csf PCR
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11
Q

What is brudzinski sign

A

Sign of meningitis

Flexion of neck when supine causes knee and hip flexion

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12
Q

What is Kernig sign

A

When supine with hips and knees flexed, back pain on extension of knee
Sign of meningitis

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13
Q

Meningitis antibiotics

A

3rd generation cephalosporin eg. Cefotaxime or ceftriaxone

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14
Q

What can be given with antibiotics in the management of meningitis beyond neonatal period and why

A

Dexamethasone to reduce long term complications such as deafness

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15
Q

Cerebral complications of meningitis x 6

A

Hearing loss from inflammatory damage to cochlear hair cells
Local vasculitis causing cranial nerve damage or focal lesions
Local cerebral infarctions
Subdural effusion (esp. With haemophilius influenzae and pneumococcal)
Hydrocephalus
Cerebral abscess - suspect if clinical condition deteriorates and signs of SOL and fluctuating temperature

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16
Q

Most common presentation of encephalitis x3

A

Fever, altered consciousness and seizures

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17
Q

Most frequent causes of encephalitis in UK x3

A

Enteroviruses, resp viruses and herpesvirus

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18
Q

What should all children with encephalitis be treated with and why?

A

Aciclovir because although rare - herpes encephalitis can have devastating long term consequences
Therefore all started with high dose until herpes eliminated

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19
Q

Investigations for encephalitis

A

Same for meningitis

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20
Q

How long do you treat proven or highly suspicious herpes encephalitis for?

A

3 weeks IV aciclovir

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21
Q

What causes toxic shock syndrome

A

Toxin producing staph aureus and group a strep

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22
Q

Characteristics of toxic shock syndrome x3

A

Fever >39
Hypotension
Diffuse erythematous macular rash

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23
Q

What happens in toxic shock syndrome

A

Toxin producing bacteria released from an infection at any site including small lesions
Toxin acts as super antigen and causes organ dysfunction

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24
Q

Effects of toxic shock syndrome x6

A

Mucositis (conjunctivae, oral and genital mucosa)
GIT dysfunction (d and v)
Renal impairment
Liver impairment
Clotting abnormalities and thrombocytopenia
CNS disturbances

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25
Q

Management of toxic shock syndrome

A

Surgical debridement and antibiotics (3rd generation cephalosporin) also clindamycin - switches off toxin production by acting on bacterial ribosome
ICU to manage the shock

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26
Q

What happens 1-2 weeks after onset of toxic shock syndrome

A

Desquamation of palms, soles, fingers and toes

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27
Q

Complication of toxic shock syndrome causing severe problems

A

PVL (Panton-Valentine leukocidin) producing staph aureus causes recurrent skin and tissue infections
Can also cause necrotising fasciitis and a necrotising haemorrhagic pneumoniae following influenza type illness

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28
Q

What is necrotising fasciitis and management?

A

Infection often involving all tissue planes down to fascia and muscle
Need surgical debridement to treat

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29
Q

What causes meningoccoal infection and meningitis

A

Neisseria meningitidis

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30
Q

Risks associated with meningoccocal infection

A

Can kill within hours but out of the 3 main causes of bacterial meningitis it has the lowest risk of long-term neurological sequelae

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31
Q

Characteristic of meningococcal infection

A

Non blanching rash, irregular lesions with necrotic centre - may or may not be meningitis present

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32
Q

Treatment of meningococcal infection (rash)

A

Immediate IV antibiotics eg. Penicillin

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33
Q

Vaccinations against meningoccoal infection?

A

Against group a and c meningococcus but none against group b which causes majority of isolates in UK

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34
Q

What causes impetigo?

A

Staph aureus (both) or strep pyogenes (only non-bullous)

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35
Q

What is impetigo?

A

Highly contagious, localised skin infection - most common in infants and young children
Rapid spread via autoinoculation

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36
Q

When is impetigo more common?

A

In pre existing skin disease eg. Eczema

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37
Q

Features of impetigo

A

Non-bullous - Lesions usually on face, neck and hands
Begin as erythematous macules that become vesicular/pustular and then rupture with exudation of fluid and get honey coloured crusted lesions
Usually asymptomatic - might be a bit itchy
Or bullous - Blisters that then burst to form crusts - less commonly affects the face (more neck folds, nappy area and axilla) painful and systemic symptoms more common

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38
Q

Treatment of impetigo

A

Non-bullous - fusidic acid TDS/QDS 7 days or oral fluclox if widespread (clarithro or erythro if pen allergic) for 7 days

Bullous - oral always needed - as above

MRSA then mupirocin

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39
Q

What are boils and what caused by?

A

Infected sweat glands or hair follicles by staph a

Treatment with systemic antibiotics and occasionally surgery

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40
Q

What causes peri orbital cellulitis?

A

Staph a or strep

Also haem influenzae type b - which may also be accompanied by other infection sites eg. meningitis

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41
Q

Presentation of peri orbital cellulitis

A

Fever with erythema, tenderness and oedema of eyelid

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42
Q

Management of periorbital cellulitis

A

Treatment with IV antibiotics to present posterior spread of infection to orbital cellulitis
CT scan to see if spread posterior
Maybe LP to exclude meningitis

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43
Q

Signs of orbital cellulitis

A

Proptosis, painful or limited eye movements and reduced visual acuity

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44
Q

What is scalded skin syndrome?

A

Staph a toxin causing separation of epidermal skin layers

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45
Q

Who gets scalded skin syndrome?

A

Infants and young children

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46
Q

Signs of scalded skin syndrome

A

Fever, malaise and may have purulent, crusting, localised infection around eyes, nose, mouth - subsequent widespread erythema and tenderness of skin
Epidermis separates on gentle pressure (Nikolsky sign) leaving denuded areas of skin which subsequently dry and heal without scar

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47
Q

Management of scaled skin syndrome x3

A

IV anti-Staph antibiotic
Analgesia
Monitor fluid balance

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48
Q

How accurate is axillary temp?

A

Generally underestimates by 0.5 degrees

49
Q

How do herpes simplex viruses typically enter the body?

A

Through mucosal membranes or skin - site of primary infection typically has intense local mucosal damage

50
Q

Where does herpes simplex 1 typically affect?

A

Lip and skin lesions

51
Q

Where does herpes simplex 2 typically affect

A

Genital lesions

But both HSV can cause oral and genital lesions

52
Q

Treatment of HSV

A

Aciclovir

53
Q

Most common primary HSV infection in children

A

Gingivostomatitis

54
Q

When does herpes gingivostomatitis typically occur?

A

10 months to 3 years

55
Q

Presentation of herpes gingivostomatitis

A

Vesicular lesions on lips, gums, tongue and hard palate
Very painful and ulceration leads to bleeding
High fever and child unhappy
Decreased eating and drinking can lead to dehydration and poor nutrition

56
Q

Management of herpes gingivostomatitis

A

Aciclovir

IV fluids and nutrition

57
Q

Skin manifestation of HSV x2

A 
Eczema herpeticum (serious condition, widespread vesicular lesions which develop on eczematous skin - can be complicated by secondary bacterial infection which may result in septicaemia) 
Herpetic whitlow (painful, erythematous, oedematous white pustules on site of broken skin on fingers - spread is from autoinnoculation or parents kissing children's fingers or from HSV 2 in sexually active teens)
58
Q

Eye disease of HSV x4

A

May cause blephritis or conjunctivitis
Can extend to cornea producing dendritic ulceration
Can lead to corneal scarring and loss of vision

59
Q

Clinical features of chicken pox x5

A

Vascular rash with 200-500 lesions that start on torso and progress to peripheries - papules then vesicules, then pustules and then crusts
Crops appear at different times for up to one week
Itchy

60
Q

Complications of chickenpox x3

A

Secondary bacterial infection with staph or group a strep (impetigo) - can lead to further complications such as toxic shock or necrotising fasciitis
Encephalitis - good prognosis (unlike HSV) ataxic and cerebellum presentation
Purpura fulminans - consequence of vasculitis in skin and SC tissues, best known in relation to meningoccoal disease but can rarely occur after VZV infection

61
Q

What can occur in immunocompromised patient with VZV

A

Primary infection can result in severe progressive disseminated disease - mortality of up to 20%
Vesicular eruptions persist and can become haemorrhagic

62
Q

Treatment of chickenpox

A

Aciclovir has no proven benefit - unless immunocompromised
If organ dissemination has not occurred then vaciclovir can be used
Vaciclovir can be used in older children and adults who have worse illness

63
Q

Prevention of chickenpox

A

Human varicella zoster immunoglobulin for immunocompromised patients following contact with chickenpox

64
Q

Shingles in children?

A

Is uncommon

Occurs most commonly in thoracic regions and in children who had primary infection in first year of life

65
Q

Shingles in immunocompromised infant

A

Can get recurrent or multi dermal shingles

Reactivated infection can also disseminate to cause severe disease

66
Q

Features of EBV infection

A

Fever, malaise, tonsillopharyngitis, lymphadenopathy

Less commonly - Petechiae on soft palate, HSMG, maculopapualar rash, jaundice

67
Q

Treatment of EBV

A

Symptomatic

If group a strep is grown on Tonsils (5%) can be treated with penicillin

68
Q

How is CMV transmitted

A

Saliva, genital secretions or breast milk

Also more rarely blood products, organ transplant and transplacentally

69
Q

What does CMV infection cause in normal hosts

A

Mild or sub clinical infection

May cause glandular fever type syndrome

70
Q

What can CMV infection cause in immunocompromised host

A

Retinitis, pneumonitis, bone marrow failure, encephalitis, hepatitis, colitis and oesophagitis

71
Q

When is CMV an important pathogen - eg. When high risk?

A

Following organ transplantation

72
Q

How can CMV disease be treated - problem?

A

Ganciclovir or foscamet can be used but both have serious side effects

73
Q

What does parvovirus B19 cause?

A

Erythema infectiosum or slapped cheek syndrome

74
Q

When do parvovirus B19 infections typically occur

A

Outbreaks most common in spring but can happen at any time

75
Q

What does parvovirus b19 infect

A

Erythroblastoid red cell precursors in bone marrow

76
Q

What are the four clinical syndromes that parvovirus B19 can cause?

A

Asymptomatic infection - common about 5-10% of preschool children
Erythema infectiosum
Aplastic crisis
Fetal disease

77
Q

Features of erythema infectiosum

A

Most common illness from parvovirus b19 infection
Viraemic phase of fever, malaise, headache and myalgia
Week later slapped cheek rash on face
Progressing to maculopapular rash on trunk and limbs

78
Q

What is aplastic crisis

A

In children with haemolytic anaemias and parvovirus b19

79
Q

Fetal disease with parvovirus b19

A

Maternal transmission may lead to fetal hydrops and death due to severe anaemia
But majority of infected fetuses will recover

80
Q

When do enteroviruses commonly occur?

A

Autumn and summer

81
Q

What different infections can enteroviruses cause?

A

Hand foot and mouth disease
Herpangina (vesicular and ulcerated lesions on soft palate and uvula)
Pleurodynia (acute illness with fever, pleuritic chest pain and muscle tenderness)
Myocarditis and pericarditis

82
Q

Features of measles

A

Prodromal phase fever, cough, runny nose, conjunctivitis, marked malaise
Then development of Kopliks spots (pathognomic - White spots on red buccal mucosa) and rash

83
Q

Pathognomonic sign if measles

A

Kopliks spots

84
Q

Features of rash in measles

A

Starts behind the ears and spreads downwards onto face and then rest of body
Discrete maculopapular to begin with and then becomes blotchy and confluent

85
Q

Serious complications of measles x3

A

Pneumonia
Encephalitis 1-2weeks after illness onset
Subacute sclerosing panencephalitis - 7 years after measles, loss of neurological function progresses to dementia and death

86
Q

Treatment of measles

A

Symptomatic
Isolate infected children in hospital
If immunocompromised - ribavirin

87
Q

Features of mumps x4

A

Fever, malaise and parotitis
In up to 30% it is sub clinical
Parotitis typically 1 day after general signs

88
Q

Parotitis in mumps?

A

May be unilateral initially but usually progresses to be bilateral
Children may complain of earache on eating and drinking

89
Q

Test in mumps

A

Plasma amylase may be elevated in association with abdominal pain - pancreatitis

90
Q

Consequences of mumps infection

A

Usually mild and self limiting infection
Sometimes unilateral transient hearing loss
Viral meningitis in 10% and encephalitis in 1 in 5000
Epididymo-orchiditis rarely and unilaterally

91
Q

Importance of rubella

A

Congenital infection can cause severe damage to fetus but usually mild in childhood

92
Q

What age typically is affected by Kawasaki disease?

A

Age 6 months to 4 years

93
Q

What sort of disease is Kawasaki disease?

A

Systemic vasculitis

94
Q

Features of Kawasaki disease

A 
Prolonged fever >5 days
Adenopathy
Conjunctivitis
Inflammation of BCG site 
High inflammatory markers
Red, oedeamotous palms and soles of feet - can peel 
Rash scarlitiform 
Lips or buccal mucosa red and inflamed
95
Q

Serious complications of Kawasaki disease

A

Coronary artery aneurysm - therefore aspirin at high dose during infection and then maintenance dose for 6 weeks until echo shows no aneurysm
May need long term warfarin if serious

96
Q

Treatment of Kawasaki

A

IV immunoglobulin

Persistent inflammation or fever may require infliximab, steroids or ciclosporin

97
Q

What does mantoux pick up

A

Current tb (infection or disease) or past BCG

98
Q

Features of TB x5

A

Prolonged fever, malaise, anorexia, weight loss or focal signs of infection

99
Q

Treatment of TB

A

Triple or quadruple therapy with rifampicin, isoniazid, pyrazinamide, ethambutol - recommened until sensitivity found
Then reduce to rifampicin and isoniazid after 2 months
Usually for 6 months if uncomplicated
Give pyridoxine weekly to prevent peripheral neuropathy of isoniazid

100
Q

HIV signs in children with mild immunosuppression

A

Lymphadenopathy or parotitis

101
Q

Moderate HIV immunosuppression

A

Recurrent bacterial infections, candidiasis, chronic diarrhoea, lymphocytic interstitial pneumonitis

102
Q

Severe immunosuppression with full blown aids

A

Opportunistic infections such as PCP, severe failure to thrive or encephalopathy and malignancy
Rare in children

103
Q

Type of rash in rheumatic fever

A

Erythema marginatum, pink rings on the torso

104
Q

Main criteria of rheumatic fever x5

A 
Erythema marginatum
Sydenham's chorea
Polyarthritis
Carditis (endo-, myo- or peri-)
Subcutaneous nodules
105
Q

Features of hand foot and mouth disease

A

Initial prodrome lasting 1-2 days
Followed by oral ulceration
Soon followed by macules and papules on the hand and feet - more commonly on margins than on soles/palms

106
Q

Management of hand foot and mouth

A

Self-limiting therefore just monitor and keep up hydration

107
Q

Cause of hand foot and mouth

A

Coxsackie virus (A16 most commonly)

108
Q

What causes scarlet fever

A

Strep pyogenes (group A strep)

109
Q

When does scarlet fever usually occur (age and season)

A

age 4 average
Autumn and winter
highly contageous therefore occurs in outbreaks

110
Q

Features of scarlet fever

A

Initial sore throat, high fever and general malaise
Followed 12-48hr by rash that starts on abdomen and then spreads
Also lymphadenopathy
Strawberry tongue
Flushed face and circumoral pallor

111
Q

Features of scarlet fever rash

A

Red, extensive, punctate like sand paper

Rash especially florid in skin folds

112
Q

Complications of scarlet fever

A

Rheumatic fever

Streptococcal glomerulonephritis

113
Q

Management of scarlet fever

A

Antibiotics - Phenoxymethylpenicillin (penicillin V) or azithromycin if pen allergic

114
Q

Features of tetanus infection

A

Suspect if tonic muscle stiffness and spasm (including lock jaw) develops several days after skin wound or burn

115
Q

Management of tetanus infection

A

Treat with antitoxin, wound debridement and general support

116
Q

Features of diptheria infection

A 
Fatal infection spread by droplet or touching infected material - close contact etc 
Grey/white film over back of throat
High temp
Breathing difficulties 
Sore throat
117
Q

Where else can diptheria infect

A

Myocardium, adrenals and nervous system

118
Q

Features of roseola infantum

A

Exanthem subitum, also known as 6th disease - caused by herpes virus 6
typically affects children 6m-2y
Very high fever for a few days (febrile convulsions common)
then maculopapular rash
diarrhoea and cough common

Paediatrics (16 decks)

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