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Paeds > Infection and Immunity > Flashcards

Infection and Immunity Flashcards

1
Q

A febrile child:

A

Assess risk
paracetamol or ibuprofen if >38C + distres/unwell
- NOT simultaneously try one then the other
Advice:
- dehydration Sx and fluids advice
- Check regularly
- keep away from other children if it persists

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2
Q

Safety net for febrile children

A 
Sxs of dehydration
Seizure
non-blaching rash
>5d fever
generally unwell
Distress/concern that they cant look after child
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3
Q

Bacterial Meningitis Ix

A 
LP
Culture
FBC, CRP, U+E, glucose
Coag.
CT head (before LP)
Admit emergency sepsis siiix
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4
Q

bacterial meningitis Mx

A 
Single dose IM/IV benzylpenicillin (second line moxifloxacin/vancomycin)
IV ceftriaxone:
- H. influenzae 10d
- S. pneumoniae 14d
- N. meningitidis 7d
?Dexamethasone
?IV saline
Notify health protection unit
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5
Q

indications for dex in bacterial meningitis

A 
frankly purulent CSF
CSF WCC >1000/ul
Rasied CSF WCC + protein conc. >1g/L
Bacteria on gram stain
1+ months and H. influenzae
NOT in meningococcal
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6
Q

Discharge and follow up of bacterial meningitis

A

r/v 4-6w
Cx: hearing loss, ortho., skin, neurodevelopmental
purpura fulminans: acute often fatal thrombotic dx (bruising, skin necrosis, DIC - may need FFP, debridement or amputation)
Formal audiological assessment
Consider testing for complement def. if >1 episode of meningococcus or abnormal serotype dx
treating contacts: cipro>rifampicin, includes everyone who has had close contact w/patient in 7d before

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7
Q

PACES counselling

A 
Infection in tissue surrounding brain
Serious, but we have ABx
Requires admission
Can be long term Cx: hearing loss, will offter audiological assessment
FU 4-6wks
cipro proph. for close contacts
support: meningitis now
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8
Q

Encephailitis in children Ix

A

FBC,
CT/MRI head
LP
Blood culture

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9
Q

Encephalitis in children Mx

A

Proven and suspected HSV encephalitis w/high dose IV aciclovir for 3 weeks
(untreated mortality rate >70%)

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10
Q

Toxic shock syndome

A 
Ix: FBC, culture, coag
Intensive care
debridement
Abx:
- clinamycin (acts on ribosome to prevent toxin production)
- vanc/mero
IVIG may neutralise toxin
1-2 wks after onset you will see desquamation of palms soles fingers toes
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11
Q

Necrotising fasciitis

A

Surgical emergency
debride all infected and devitalised tissue
IV fluids
Empirical IV Abx

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12
Q

Impetigo

A 
Clinical dx
Leaflets from BAD
usually heals no scarring
hygiene important (wash area, hands after touching, no sharing towels)
avoid school until lesions are dry and scabbed 
FU if no improvement in 7d:
- r/v dx
- check compliance
- take swab
- consider PO abx
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13
Q

medical Mx of impetigo

A

Localised: topical fusidic acid t/qds for 7d
Extensive: PO fluclox qds 7d(clari if allergic)
bullous infection: oral fluclox or clari

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14
Q

Cellulitis in children

A

Ix: mark area, FBC, culture/molecular diagnosis
Mx: high dose fluclox (clari 2L)
48hr r/v
If occurring on top of VZV: fluclox + amox (cipro+clari 2L)
NO need for regular swabs/bloods if mild
Paracetamol/ibuprofen
seek help if worsens/doesnt improve in 48hr

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15
Q

Erysipelas

A

presents similarly but rash is very well demarcated

Penicillin V

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16
Q

Periorbital cellulitis

A

contrast CT of sinus and orbits
Prompt IV abx (ceftriaxone)
I+D if necessary

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17
Q

Staphylococcal scalded skin syndrome

A

IV fluclox
analgesia
hydration

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18
Q

HSV in children

A

paracetamol/ibuprofen

aciclovir considered

19
Q

Chickenpox in children

A

Admit if any serious Cx (pneumonia, encephalitis, dehydration)
Consider PO aciclovir 800mg 5d in adolescents if presenting within 24hrs of rash onset or if severe

20
Q

Advise for chickenpox

A

fluid intake
dress appropriately in smooth cotton
short nails
most infectious 1-2d before rash appears, lasts until all lesions crusted
when infectious AVOID: IC, pregnant, <4w infants
AWAY from school until lesions crusted
Seek help:
- bacterial superinfection (high grade fever, redness, tenderness on lesions)
- dehyration (red. urine output, lethargy, cool peripheries

21
Q

Immunocompromised children and chickenpox

A

IV aciclovir
PO valaciclovir later on
VZIG used in t cell def. after contact (not absolute protection)

22
Q

EBV in children

A 
Paracetamol/ibuprofen
2-3wks 
Dont have to avoids school
limit spread
avoid contact sport for 8wks
corticosteroids rarely for airway compromise
AVOID: amoxicillin and ampiciilin
23
Q

Seek help in EBV:

A 
Stridor, resp difficulty
dysphagia
dehydration
systemically unwell
abdopain
24
Q

CMV in children

A

self limiting
if necessary:
- IV ganciclovir, PO valgan
foscarnet ( all have serious SE)

25
Q

HHV6 + 7

A 
Roseola infantum
will resolve over days/wk
paracetamol/ibuprofen
hydration
risk of febrile seizure
26
Q

Parvovirus B19

A

paracetamol/ibuprofen

27
Q

Measles in children

A 
Notify HPT
usually self-limiting but can cause: rash, fever, conjunctivitis, cough, convulsion
Ix: serology (IgM/G), consider PCR
Rest and drink plenty
ibuprofen/paracetamol
Stay away from school at least 4d after developing rash
safety net
encourage vaccinations once episode over
Isolate children
Ribavirin if IC
28
Q

Measles safety net

A

SOB
uncontrolled fever
convulsions/altered consciousness

29
Q

Mumpsin children

A 
Notify HPT
Ix: salivary IgM, amylase
Self limiting
Rest and fluids
paracetamol/ibuprofen
stay away from school 5d after developing parotitis
30
Q

Mumps safety net

A

meningitis
epididymo-orchitis
immunisation status of close contacts

31
Q

Rubella in children

A 
Call HPT
IgM serology, viral PCR
Dx oral fluid sample
self limitng
rest and fluids
admit if haemorrhagic Cx or encephalitis
32
Q

Kawasaki Disease

A 
Ix: FBC, ESR/CRP, Echo
IVIG
High dose aspirin
(consider steroids, infliximab)
Children w/large coronoary artery aneurysm may need long term warfarin and FU
CV risk assessment necessary
33
Q

Tuberculosis in children

A

notify HPT
Ix: CXR, sputum AFB smear, sputum culture (takes >4w)
NAAT: result in 8hr, use if smear +ve to confirm M. tuberculosis, FBC
Admit if active TB and unwell
if well send to specialist TB service (includes key worker)
Contact tracing
TB alert (website)

34
Q

Requirements for AFB smear

A

3 specimens, at least 8hrs apart

includes one early morning specimen

35
Q

Medical Mx of tuberculosis

A

Rifampicin and isoniazid 6m
Pyrazinamide and ethambutol for first 2m
In adolescent: pyroxidine given weekly (peripheral neuropathy)
If TB meningitis: dexamethasone
NB. asymptomatic children who are mantoux/IGRA +ve (latent) should be Rx to reduce reactivation
Risk assessment for drug-resistance

36
Q

Latent TB Rx

A

Isoniazid 6m

Rifampicin and isoniazid 3m

37
Q

HIV in children

A

Decision to start Rx based on clinical status, VL and CD4
Start on ART early with infants bc higher risk of progression
PCP prophylaxis w/co-trim. for infants who are HIV infected and for older pts w/low CD4
Immunisations (except BCG)
MDT
Regular FU w/weight + development

38
Q

Reducing vertical transmission of HIV

A 
VL >50 c-section
babies born to HIV+ mothers zidovudine for 6weeks
Avoidance of bf 
perinatal transmission <1% bc:
- ART in pregnancy
- PEP for baby
- avoidance of bf
- active mx to prevent prolonged labour
- c-section early if VL>50
39
Q

Hereditary Immunodeficiency Antimicrobial proph.

A

T cell and neutrophil: co-trimox. for PCP, itraconazole for other infections
B cell:azithromycin

40
Q

Hereditary Immunodeficiency antibiotic Rx

A

Prompt
longer courses
low IV threshold

41
Q

Hereditary Immunodeficiency screening for end organ Dx

A

CT in Ig deficiency for bronchiectasis

42
Q

Hereditary Immunodeficiency immunoglobulin replacement therapy

A

for antibody def.

43
Q

BMT in Hereditary Immunodeficiency

A

SCID, chronic granulomatous Dx

44
Q

MMR CI and SE

A

CI:
severe IS
Allergy to neomycin
another live vaccine by injection in last 4 weeks
IG therapy in the last 3m
Adverse effects:
Malaise, fever, rash can occur after 5-10d lasts 2-3d

Paeds (23 decks)

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