Infection and Immunity Flashcards
A febrile child:
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
Safety net for febrile children
Sxs of dehydration Seizure non-blaching rash >5d fever generally unwell Distress/concern that they cant look after child
Bacterial Meningitis Ix
LP Culture FBC, CRP, U+E, glucose Coag. CT head (before LP) Admit emergency sepsis siiix
bacterial meningitis Mx
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
indications for dex in bacterial meningitis
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
Discharge and follow up of bacterial meningitis
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
PACES counselling
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
Encephailitis in children Ix
FBC,
CT/MRI head
LP
Blood culture
Encephalitis in children Mx
Proven and suspected HSV encephalitis w/high dose IV aciclovir for 3 weeks
(untreated mortality rate >70%)
Toxic shock syndome
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
Necrotising fasciitis
Surgical emergency
debride all infected and devitalised tissue
IV fluids
Empirical IV Abx
Impetigo
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
medical Mx of impetigo
Localised: topical fusidic acid t/qds for 7d
Extensive: PO fluclox qds 7d(clari if allergic)
bullous infection: oral fluclox or clari
Cellulitis in children
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
Erysipelas
presents similarly but rash is very well demarcated
Penicillin V
Periorbital cellulitis
contrast CT of sinus and orbits
Prompt IV abx (ceftriaxone)
I+D if necessary
Staphylococcal scalded skin syndrome
IV fluclox
analgesia
hydration
HSV in children
paracetamol/ibuprofen
aciclovir considered
Chickenpox in children
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
Advise for chickenpox
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
Immunocompromised children and chickenpox
IV aciclovir
PO valaciclovir later on
VZIG used in t cell def. after contact (not absolute protection)
EBV in children
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
Seek help in EBV:
Stridor, resp difficulty dysphagia dehydration systemically unwell abdopain
CMV in children
self limiting
if necessary:
- IV ganciclovir, PO valgan
foscarnet ( all have serious SE)
HHV6 + 7
Roseola infantum will resolve over days/wk paracetamol/ibuprofen hydration risk of febrile seizure
Parvovirus B19
paracetamol/ibuprofen
Measles in children
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
Measles safety net
SOB
uncontrolled fever
convulsions/altered consciousness
Mumpsin children
Notify HPT Ix: salivary IgM, amylase Self limiting Rest and fluids paracetamol/ibuprofen stay away from school 5d after developing parotitis
Mumps safety net
meningitis
epididymo-orchitis
immunisation status of close contacts
Rubella in children
Call HPT IgM serology, viral PCR Dx oral fluid sample self limitng rest and fluids admit if haemorrhagic Cx or encephalitis
Kawasaki Disease
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
Tuberculosis in children
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)
Requirements for AFB smear
3 specimens, at least 8hrs apart
includes one early morning specimen
Medical Mx of tuberculosis
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
Latent TB Rx
Isoniazid 6m
Rifampicin and isoniazid 3m
HIV in children
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
Reducing vertical transmission of HIV
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
Hereditary Immunodeficiency Antimicrobial proph.
T cell and neutrophil: co-trimox. for PCP, itraconazole for other infections
B cell:azithromycin
Hereditary Immunodeficiency antibiotic Rx
Prompt
longer courses
low IV threshold
Hereditary Immunodeficiency screening for end organ Dx
CT in Ig deficiency for bronchiectasis
Hereditary Immunodeficiency immunoglobulin replacement therapy
for antibody def.
BMT in Hereditary Immunodeficiency
SCID, chronic granulomatous Dx
MMR CI and SE
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
