Infection and immunity Flashcards
Give some examples of causative organisms for bacterial meningitis
< 1 month = Group B strep
> 1 month:
- Neisseria meningitis
- Streptococcus pneumoniae
What are the symptoms and signs of meningitis in infants and children?
Symptoms:
- Infants = very non specific, e.g. irritability, lethargy, poor feeding
- Older children who are able to talk may be able to also describe the classical symptoms of headache, neck stiffness and photophobia
Signs:
- Fever
- Non-blanching purpuric rash
- Positive Kernig’s sign (with the child lying supine and the hips and knees flexed, extension of the knee elicits back pain)
Describe the investigation of suspected meningitis
Septic screen:
- FBC
- CRP
- Blood cultures
- Urine culture
- LP (contraindicated in meningococcal septicaemia)
Describe the management of suspected meningitis in infants and children (and their contacts)
Which other medication is given in the treatment of bacterial meningitis to children over 3 months?
- Community/GP: IM benzylpenicillin
- Hospital: IV broad spectrum antibiotics*
- Household contacts: ciprofloxacin
- Choice of antibiotics depends on age:
- < 3 months old = cefotaxime + amoxicillin (listeria cover)
- > 3 months old = ceftriaxone
Dexamethasone
What is the organism that causes chickenpox?
Varicella zoster virus (VZV)
What are the clinical features of chickenpox?
- Fever
- Itchy, vesicular rash which covers the whole body
Describe the management of chickenpox for the patient and contacts
Do children need to be excluded from school?
- Patient = supportive treatment
- Contacts (who are non-immune PLUS immunocompromised or pregnant) = VZIG 7-14 days post exposure
- Yes, until all lesions have crusted over
What are the potential complications of chickenpox?
- Encephalitis
- Secondary bacterial infection
- Disseminated disease in immunocompromised
Describe the clinical features of measles
- Fever
- 3 C’s (and 1 K): coryza, cough, conjunctivitis, Koplik spots (white spots on buccal mucosa)
- Erythematous widespread rash
Describe the management of measles
Do children need to be excluded form school?
Supportive
Yes, until 4 days after onset of rash
Describe the clinical features of mumps
- Fever
- Parotitis
Describe the management of mumps
Do children need to be excluded form school?
Supportive
Yes, until 5 days after onset of swollen glands
What are the potential complications of mumps?
- Encephalitis
- Hearing loss (usually transient and unilateral)
- Orchitis
Which organism causes hand, foot and mouth disease?
Coxsackie virus (a type of enterovirus)
What are the clinical features of hand, foot and mouth disease?
- Fever
- Painful vesicular lesions on the hands, feet and mouth (and often also on the buttocks)
Describe the management of hand, foot and mouth disease
Do children need to be excluded form school?
Supportive
No
Describe the NHS vaccination programme for…
- Babies aged under 1 year
- Children aged 1-15 years
Babies under 1 year: 8 weeks: 6MR - 6-in-1 (diphtheria, tetanus, polio, pertussis, hep B, Hib) - MenB - Rotavirus
12 weeks: 6PR
- 6-in-1
- Pneumococcal vaccine
- Rotavirus
16 weeks: 6M
- 6-in-1
- MenB
Children aged 1-15 years: 1 year: PMHM - Pneumococcal - MenB - Hib/Men C - MMR
2-10 years:
- Flu vaccine (every year)
3 years 4 months:
- MMR
- 4-in-1 pre-school booster (diphtheria, tetanus, polio, pertussis)
12-13 years:
- HPV vaccine for girls AND boys
14 years:
- 3-in-1 teenage booster (diphtheria, tetanus, polio)
- MenACWY
Describe the aetiology of scarlet fever
Scarlet fever is a bacterial infection caused by Streptococcus pyogenes (group A streptococcus)
What are the clinical features of scarlet fever?
- Fever
- 3 S’s: Sore throat (strep pharyngitis), Strawberry tongue, Sandpaper rash
- Rash: erythematous, widespread
Describe the management of scarlet fever
Do children need to be excluded from school?
Are there any complications of scarlet fever?
Management:
- 10 day course of penicillin
Yes, until 24 hours after commencing antibiotics
Complications:
- Rheumatic fever
‘Slapped cheek syndrome’ is also known as…?
- Fifth disease
Describe the aetiology of slapped cheek syndrome
Parvovirus B19
Describe the clinical features of slapped cheek syndrome
Are there any complications of slapped cheek syndrome?
Clinical features:
- Fever
- Coryza
- Rash: erythematous; on the cheeks
Complications:
- Aplastic crisis (reticulocytopenia) in children with chronic haemolytic anaemia (e.g. sickle cell anaemia, thalassaemia)
Describe the management of slapped cheek syndrome
Do children need to be excluded from school?
Supportive
No
If you suspect a case of measles, mumps or rubella - aside from management of the patient, what further action is required?
Notification (PHE)
Describe the aetiology of roseola infantum
Human Herpesvirus 6 (HH6) = most common cause (also known as ‘sixth disease’)
What are the clinical features of roseola infantum?
- Fever (typically lasting 3 days), FOLLOWED by erythematous rash (develops as child is getting better)
Describe the management of roseola infantum
Do children need to be excluded form school?
Supportive
No
What is shingles?
Reactivation of VZV
What are the clinical features of shingles?
- Erythematous rash
- Dermatomal distribution (does not cross the midline)
Describe the management of shingles for the patient and contacts
- Patient = oral aciclovir
- Contacts (who are non-immune PLUS immunocompromised or pregnant) = varicella zoster immunoglobulin (VZIG)
Which mnemonic can you use to remember the components of the NICE febrile child traffic light guidelines?
AARCH (+other):
- Appearance
- Activity
- Respiratory
- Circulation and Hydration
+ other (fever)
Describe the AMBER criteria of the NICE febrile child traffic light guidelines
Appearance:
- Pallor (reported by parent/carer)
Activity:
- Not responding normally to social cues
- Wakes only with prolonged stimulation
- No smile
Respiratory: - Nasal flaring - Tachypnoea: >50 breaths/min (6-12 months) >40 breaths/min (>12 months) - Oxygen sats <95%
Circulation + Hydration: - Tachycardia: >160 bpm (<12 months) >150 bpm (12-24 months) >140 bpm (2-5 years) - CRT >3 seconds - Dry mucous membranes - Reduced oral intake/urine output
Other:
- 3-6 months with fever >39 degrees
- Fever 5 days+
Describe the RED criteria of the NICE febrile child traffic light guidelines
Appearance:
- Pallor/cyanosis
Activity:
- No response to social cues
- Does not wake when roused
- Weak/high-pitched/continuous cry
Respiratory:
- Grunting
- Moderate/severe chest indrawing
- Tachypnoea (>60 breaths/min)
- Oxygen sats <92%
Circulation + Hydration:
- Reduced skin turgor
Other:
- <3 months with fever >38 degrees
Which class of drugs is used to treat whooping cough? Give examples.
When must this drug be given?
Do children need to be excluded form school if they have whooping cough?
Macrolide antibiotics, e.g. azithromycin/clarithromycin
Up to 21 days from onset of symptoms
Yes, until 2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics)
