infection and immunity Flashcards

1
Q

How to safety net febrile child

A
come back if:
seizures
unwell > 5 days
rashes
child looks generally unwell
concerned you can't look after child
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2
Q

What organisms cause meningitis

A
<3 months
group b strep
e. coli
listeria
3 months - 6 years
n. meningitides
strep pneumonia
h. influenza
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3
Q

what are the contraindications for LP

A

neuro signs of inc. ICP
cardio resp fragility
thrombocytopenia
coagulopathy

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4
Q

Mx meningitis

A
  1. benzylpenicillin ASAP
  2. 3rd gen cephalosporin (+ supportive - anticonvulsants, saline)
  3. Dexamethasone if: v. turbid csf, CSF WCC >1000, bacteria on gram stain
    don’t use steroids in meningococcal speticaemia

give ciprofolxacin prophylaxis to all household after meningococcal meningitis or h.influenza

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5
Q

Causes of atypical meningitis

A

Lyme’s disease
TB
mycoplasma
fungal

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6
Q

Mx encephalitis

A
treat all w/ IV aciclovir until cause is determined
supportive care in ICU
HSV1+2 - IV aciclovir
VZV- aciclovir/ganciclovir
CMV - ganciclovir +foscarnet
EBV - aciclovir
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7
Q

What causes toxic shock syndrome

A

toxin producing staph a

group a streptococci

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8
Q

how does toxic shock syndrome present

A

fever
hypotension
widespread erythematous macular rash
NB- some staph a have PVL which causes necrotising fasciitis

after 2 weeks get desquamation of palms + soles

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9
Q

Mx of toxic shock syndrome

A

ICU
surgically debride infected areas
start BSA before cultures come back

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10
Q

What does impetigo look like

A

honey crusted lesions on nose and mouth

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11
Q

Mx impetifo

A

advice about hand washing

topical or oral abx

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12
Q

mx

A

admission
IV abx (flucloxacillin)
emollient

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13
Q

How does HSV present in most children

A

gingivostomatitis

secondary presentations (from reactivation):
cold sores
eczema herpeticum (can get overlying bacterial infection)
herpetic whitlow on skin by nails
eye problems

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14
Q

Which children get disseminated HSV

A

neonates
immunocompromised
get encephalitis and aseptic meningitis

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15
Q

Mx HSV

A

symptomatic

if severe: aciclovir and IV fluids

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16
Q

complications of VZV

A

Secondary bacterial infections - staph aureus, group a strep causing necrotising fasciitis + TSS
Encephalitis - prognosis quite good. Typically get VZV cerebllitis so present ataxic
Purpura fulminans - VZV viral Ab attack skin (also get increased risk of clot)

17
Q

Mx VZV

A

Advice:
most contagious 1-2 days before rash
stops being contagious when everything crusted over

avoid contact w/:
pregnant women
immunocompromised
<4 weeks old

Mild disease:
oral paracetamol and emollients to stop itching (keep nails short)

moderate disease:
oral aciclovir
oral paracetamol, emollient
admit if serious complications

severe:
IV aciclovir
+ others

immunocompromised:
human VZVIg IV

18
Q

Symptoms of EBV

A
fever
tonsiliitis/pharyngitis
lymphadenopathy
splenomegaly
maculopapular rash
19
Q

Dx of EBV

A

atypical lymphocytes on
Monospot test (heterophile Ab positive)
seroconversion with 3 antibodies

20
Q

Mx of EBV

A

paracetamol/ibuprofen
lasts 2-4 weeks
don’t need to stay home but avoid contact sports

come back if stridor, difficulty breathing, abdo pain

NB - ampicillin and amoxicillin cause maculopapular rash

21
Q

How does CMV present

A

Mononucleosis like syndrome
pharyngitis
atypical lymphocytes
BUT heterophile Ab negative (unlike EBV)

22
Q

what causes roseola infantum and how does it presetn

A

HHV6 + 7
High fever
macular rash (comes on as fever starts to wane)

23
Q

what does parvovirus B19 cause

A

slapped cheek syndrome (erythema infectiosum)

24
Q

natural hx of parvovirus b19

A

fever + myalgia
red cheeks after a week
lace-like purpuric rash on trunk + limbs after a week

can get aplastic crisis if underlying anaemias/thalassemia
avoid pregnant woman (get hydrops)

25
Mx parvovirus
Avoid pregnant women | pain killers and hydration
26
What can enteroviruses cause
Hand foot and mouth disease (painful vesicles) herpangina (vesicles on soft palate and uvula) myocarditis (rare) enteroviral neonatal sepsis (intrapartum infection)
27
Features of measles
Rash koplik's spots on buccal mucosa coryzal symptoms rarely encephalitis and long term neuro damage
28
mx measles
NOTIFIABLE DISEASE hydration and rest vitamin a given if hospitalised or <2
29
how does measles present
parotitis + fever | if abdo pain and plasma amylase high then think pancreatic involvement
30
Mx measles
notifiable disease stay away from school for 5 days after development of parotitis warn about mumps orchitis
31
mx rubella
notifiable disease low grade fever maculopapular rash on face which lasts 3-5 days lymphadenopathy
32
features of kawaski
``` Crash and Burn conjunctivitis rash adenopathy (cervical) strawberry tongue hands - erythema and swelling ``` burn - fever systemic vasuclitis - can cause coronary aneurysm
33
mx kawasaki
IVIg high dose aspirin for 8 weeks (to reduce risk of thrombosis) (can give steroids as second line) carry out risk assessment for MI at 8 weeks low risk - no fruther treatment high risk - low dose aspirin til aneurysm regress
34
Diagnosis of TB in children
can't do sputum in chidlren <8 so do gastric washing | tuberculin test - induration >5mm = latent TB
35
Mx TB
notifiable disease if unwell and active TB admit, if well refer to clinic Rifampicin, isoniazid, ethambutol, pyrazinamide 4 months pyrazinamide and ethambutol 2 months pyridoxine (B6) given to prevent neuropathy from isoniazid latent TB -iosniazid 6 months, rifampicin + isoniazid 3 months
36
Dx of HIV
>18 months they have Ab that they've produced themselves so identifying this = dx of HIV <18 months still have maternal Ig so it only proves exposure Do HIV RNA PCR in these people
37
What does lyme disease look like
``` erythema migrans (target rash) at site of infection (painless) fever and myalgia ```
38
mx for immundeficiency
antimicrobial prophylaxis t cell + neutrophil defects - cotrimoxazole for PCP, itraconazole for fungal stuff B cell defects - azithromycin for recurrent bacterial infections