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Paediatrics > Infection and Immunity > Flashcards

Infection and Immunity Flashcards

1
Q

Red flags in infection

A

Fever >38’c (<3 months) >39’c (3-6 Months)
Pale, mottled, cyanosis
Reduced consciousness: does not wake or remain awake when roused
Bulging fontanelles
Neck stiffness
Status epilepticus
Focal neurology
Severe dehydration/shock: reduced skin turgor, tachycardia, < cap refill, dry mucous membranes, poor feeding
Bile stained vomit
Significant respiratory distress: grunting, tachypnoea (RR>60), moderate or severe chest indrawing
No response to social cues
Weak, high-pitched or continuous cry

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2
Q

Mx sepsis

A

Ceftriaxone, IV fluids

Correction of clotting in DIC: FFP, cryoprecipitate, platelet transfusion

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3
Q

Causative organisms sepsis

A

Associated with staph aureus or staph pneumonia in children

In neonates group B stress or E.coli

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4
Q

Features bacterial meningitis

A

Usually follows bacteraemia
Release of inflammatory mediators and activated leukocytes cause cerebral odea, and fibrin deposits block resorption of CSF

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5
Q

Causative organisms bacterial meningitis

A

Neonates: GBS, E.coli, Listeria
1month-3 months: Neisseria meningitidis, strep pneumonia, H. influenza
>6 years: N. meningitidis, step pneumonia

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6
Q

Mx bacterial meningitis

A

Administer antibiotics and supportive therapy: third gen cephalosporin
Prophylaxis rifampin or ciprofloxacin given to eradicate nasal carriage in household contacts and vaccination against Men C

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7
Q

Causative organism viral meningitis

A

Usually enterovirus, EBV, adenovirus and mumps

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8
Q

Atypical organisms meningitis

A

Mycoplasma, borrelia bordefei, TB, fungal infection

Usually in immunodefiency

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9
Q

Features encephalitis

A

nflammation of the brain substance
Most commonly enterovirus, respiratory virus and herpes virus
High dose acyclovir given to all in case of HSV encephalitis
HSV encephalitis:
-Rare cause
-Detected by PCR
-CT/MRI shows focal lesions due to the destructive nature of virus
-High mortality with severe neurological sequelae

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10
Q

Mx toxic shock syndrome

A

Usually requires ICU to managed shock
Areas of infection need surgical debridement
Third cephalosporin antibiotics to switch of bacterial toxin production
IVIg can be used to neutralise circulation toxin

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11
Q

Features toxic shock syndreom

A

Toxin producing bacteria: staph aureus, group A strep
Characterised by: fever over 39’c, hypotension, diffuse erythema, macular rash
Multiple organ dysfunction
Desquamation of palms and soles can occur 1-2 weeks following onset of illness

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12
Q

Features necrotising faciitis

A

Severe cutaneous infection involving skin place to fascia/muscle
Typically staph aureus or group A strep
Severe pain and systemic illness
Usually requires ICU
IV antibiotics are not sufficient alone
Surgical intervention and debridement of necrotic tissue

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13
Q

Features Kawasaki

A

Systemic vasculitis: requires immediate treatment
Affects children aged 6 months- 4yars with peak onset at year 1
More common in Japanese and Balck carribean origin
Typically high fever over 5 days resistant to antipyretics
Conjunctival injection, bright red/cracked lips, strawberry tongue, cervical lymphadenopathy, red palms on hands and soles of feet
Clinical diagnosis, no specific testing

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14
Q

Mx Kawasakis

A

High dose aspirin: reduces thrombosis, given until the fever subsides and inflammatory markers return to normal
Lower dose given for 6 weeks after normal echo
IVIg given within first 10 days
Echocardiogram: screening for coronary artery aneurysm (giant aneurysm requires warfarin)

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15
Q

Presentations of staph

A 
Impetigo
Boils
Periorbital cellulitis
Orbital cellulitis
Staphylococcal scalded skin syndrome
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16
Q

Presentations of H. influenzae

A

otitis media, pneumonia, epiglottitis, cellulitis, osteomyelitis, septic arthritis

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17
Q

Presentations of pneumococcus

A

pharyngitis, otitis media, conjunctivitis, sinusitis

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18
Q

Features herpes virus infection

A

gastroenteritis, cold sores, eczema herpeticum, herpetic whitlows (edematous white pustules, typically on finger), eye disease, dissemination

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19
Q

Features chicken pox

A

Common skin condition of childhood with characteristic rash and prodrome including fever, headache, malaise, abdominal pain
Self resolving in most children

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20
Q

Prophylaxis indications chicken pox

A

IV acyclovir and IVIg in immunocompromised and pregnancy with exposure to children

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21
Q

Features EBV

A

Tropism for B lymphocytes and epithelial cells of the oropharynx
Oral transmission
Fatigue prominent feature
Fever, malaise, tonsillitis, pharyngitis, lymphadenopathy, petechiae, splenomegaly, hepatomegaly, maculopapular rash, jaundice
Long course typically 1-3m

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22
Q

Mx EBV

A

Symptomatic treatment
Corticosteroids given where airway is compromised
Group A strep commonly concurrent- penicillin
Avoid amoxicillin and ampicillin which can cause a florid maculopapular rash

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23
Q

Ix EBV

A

Blood film shows atypical lymphocytes and numerous large T cells
Monospot test positive (Poor sensitivity)
Seroconversion with antibodies

24
Q

Features CMV

A

subclinical in most immunocompetent hosts

25
Q

Mx CMV

A

IV ganciclovir and valganciclovir

Used as prophylaxis in immunocompromised .e.g. transplant

26
Q

Features HPV B19

A

Causes slapped cheek syndrome
Commonly occurs in outbreaks typically in the summer
Effects erythroblastosis red cell precursors in bone marrow
Multiple clinical syndromes: erythema infectiosum; aplastic crisis;fetal disease

27
Q

Features mumps

A

Replicated in epithelial cells: access to parotid via widespread dissemination
Fever, malaise, parotitis often unilateral and becomes bilateral
Can cause orchitis especially in post pubertal males: unilateral hence infertility is uncommon
Transient hearing loss associated
Pancreatic involvement causes abdo pain

28
Q

Features tuberculosis

A

Latent disease is asymptomatic: more likely to progress to active disease in children
Local inflammatory responses typically limits progression of infection
Lymphatic spread occurs in failure of immune response in children, causing systemic symptoms of fever, anorexia, weight loss, cough

29
Q

Ix Tuberculosis

A

Sputum sample difficult to acquire in children <8years of age
Gastric washing can be used to collected swallow septum in children
Culture shows acid fast bacilli and PCR
Mantoux test positive for previous infection and vaccination
Induration of 5mm is positive of active TB regardless of previous vaccination
ChestXray shows hilar lymphadenopathy, collapse and consolidation/pleural effusion

30
Q

Mx tuberculosis

A

Quadruple therapy: rifampicin, isoniazid, pyrimidine, ethambutol for 2 months then decreasing to rifampicin and isoniazid for 4 months
Pyridoxine is given weekly in adolescents to prevent peripheral neuropathy associated with isoniazid
BCG vaccination for high risk individuals only
Dexamethasone given in meningitis
Latent TB in children can be treated prophylactically to decrease reactivation in later life

31
Q

Features rheumatic fever

A

Rare in developed world
Response to group A beta haemolytic strep
Affects children aged 5-15
Prevention by use of antibiotics for 10 days in initial strep infection
Latent period of 2-6 weeks
Main manifestations:
-Endocarditis
-Myocarditis and heart failure
-Pericarditis (friction rub, effusion, tarde)
-Sydenham Chorea
-Migratory arthritis: ankles, knees and wrists
-Erythema Marginatum: rash on trunk and limbs
-Subcutaneous nodules: extensor surfaces
Heart disease is often long term damage from scarring and fibrosis of valvular tissue- associated with mitral stenosis developing in adult life

32
Q

Ix Rheumatic fever

A

GAS titre including culture or antigen- raised in acute phase
Prolonged PR interval on ECG

33
Q

Mx Rheumatic fever

A

Bed rest and anti-inflammatories
High dose aspirin effective in suppression of inflammatory responses
Corticosteroids for non-resolving fever and inflammation
Heart failure controlled by diuretics and ACE inhibitors
Recurrence prevented by daily oral penicillin or monthly injection of benzylpenicillin (erythromycin in penicillin allergy)
Prophylaxis given for 10 years post infection or until age 21

34
Q

Topical infections examples

A 
Malaria
Typhoid
Dengue
Chiniingiya 
Zika virus
Viral haemorrhagic fever
35
Q

Examples T cell defects

A 
Severe combined immunodeficiency
Wiskott Aldrich syndrome
DiGeorge
Duncan disease
Ataxia telangiectasia
36
Q

Features T cell defect immunodeficiency

A

Severe and unusual viral and fungal infection and faltering growth in the first few months
Abnormal FBC and lymphocyte subsets

37
Q

Mx T cell immunodeficiency

A

Cotrimoxazole to prevent PCP and itraconazole/fluconazole to prevent fungal infection

38
Q

Features wiskott aldrich syndrome

A

Triad of immunodeficiency, thrombocytopenia and eczema

X linked

39
Q

Features Duncan disease

A

poor response to EBV

Susceptible to lymphoma

40
Q

Features ataxia telangiectasia

A

Defect in DNA repair
Increased risk of lymphoma
Cerebellar ataxia
Developmental Delay

41
Q

Dx HIV

A

Diagnosis is by antibody detection in children over 18 months
Before 18 months, maternal IgG is present: HIV PCR is diagnostic test
2 negative tests within first 3 months confirms lack of HIV

42
Q

Mx HIV

A

All children followed up with ART following diagnosis
Prophylaxis for PCP given in low CD4 count
Reduction in vertical transmission during pregnancy by good regimen HAART and no breastfeeding, good labour management including possible C section

43
Q

Childhood presentation HIV

A

Mild: lymphadenopathy or parotid enlargement
Moderate: recurrent bacterial infections, candidiasis, chronic diarrhoea, lymphocytic interstitial pneumonitis
Severe: opportunistic infections, severe growth faltering, encephalopathy, malignancy

44
Q

Features B cell immunodeficiency

A

In first 2 years severe bacterial infections, especially hearts, sinus, pulmonary, and skin infections.
Recurrent diarrhoea and faltering growth
Immunoglobulin levels and subclasses

45
Q

Mx B cell deficiency

A

Antibiotic prophylaxis .e.g. Azithromycin to prevent recurrent bacterial infections

46
Q

Examples B cell defects

A

X-linked ammaglobulinaemia
Common variable immune deficiency
Hyper IgM syndrome
Selective IgA deficiency

47
Q

Features leukocyte function defects

A

Delayed separation of the umbilical cord, delayed wound healing, chronic skin ulcers, deep-seated infections
Leukocyte adhesion deficiency: Deficiency of neutrophil surface adhesion molecules causes inability of neutrophils to migrate to sites of infection and inflammation

48
Q

Features Complement Defects

A

Recurrent bacterial infections
SLE like illness
Recurrent meningococcal, pneumococcal and H.influenzae infection
E.g. Early complement component deficiency, terminal complement component deficiency, mannose-binding lectin deficiency

49
Q

Ix complement defects

A

Tests of classical and alternative complement pathways, mannose binding lectin levels and assay for individual complement proteins.

50
Q

dDx infectious rashes

A 
Chicken pox
Measles
Rubella
Erythema Infectiosum
Scarlet fever
Hand, foot, and mouth
51
Q

Features chicken pox rash

A

Initially a fever
Itchy rash, starting on head/trunk before spreading.
Initially macular then popular than vesicular
Systemic illness usually mild

52
Q

Features Measles

A

Irritable, conjunctivitis, fever prodrome
Koplick spots: white spot on buccal mucosa
Rash starting behind ears spreading to whole body
Discrete maculopapular rash become blotchy and confluet

53
Q

Features Rubella

A

Pink maculopapular initially on face before spreading to whole body
Usually afdes by day 3-5
Lymphadenopathy affecting suboccipital and postauricular

54
Q

Features Erythema Infectiosum

A

Slapped cheek syndrome
Associated with parvovirus B19
Lethargy, fever, headache, , cheek rash spreading to arms and extensor surfaces

55
Q

Feasture Scarlet fever

A

Group A haemolytic streptococci
Fever, malaise, tonsillitis, strawberry tongue
Rash is fine punctate sandpaper rash sparing around the mouth (circumoral pallor)

56
Q

Features hand foot and mouth

A

Coxsackie A16 virus
Mild systemic upset of sore throat and fever
Vesicles in the mouth and on palms and soles of feet

Paediatrics (22 decks)

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