Infection and Immunity Flashcards
How is fever identified <4 weeks?
electronic thermometer in axilla
How is fever identified 4 weeks to 5 years
electronic / chemical dot thermometer in axilla
OR infrared tympanic thermometer
What is a fever in a child considered to be?
Body temp >37.5 degrees
What are risk factors for infection?
ill close contacts lack of immunisation recent travel abroad contact with animal s immunodeficiency
What are red flag features for a feverish child?
fever >38 if <3m, >39 if 3-6 months colour (pale, mottled, cyanosed) reduced consciousness neck stiffness bulging fontanelle status epilepticus focal Neuro signs seizures respiratory distress bile-stained vomit RASH
How do you manage a febrile child?
If not seriously ill: discharge home with paracetamol/ibuprofen
Safety net parents + keep child away from school
If seriously ill: admit to paeds assessment unit, A&E, children ward
What is most of the damage in meningitis caused by=
by the host response to infection (i.e. release of inflammatory mediators, recruitment of inflammatory cells, endothelial damage) which causes cerebral oedema, raised ICP, reduced blood flow
what are causatrive organisms for meningitis in neonate -3months old
GBS
E coli
Listeria monocytogenes
What are causative organisms in children 1m-6 yrs
NSH:
Neisseria meningitides
Strep pneumonia
Haemophilius influenzar
What are causative organisms for BACTERIAL meningitis in children> 6 years
Neisseria meningitides
Strep pneumonia
what investigations are appropriate for meningitis
Bloods - CRP, WCC, blood culture, coag
Rapid antigen test for meningitis organism
LP
How do you manage bacterial meningitis ‘ at GP
IM benzylpenicillin single dose at GP
What are complications of bacterial meningitis
hearing impairment vasculitis > CN palsies Cerebral infarction Subdural effusion Hydrocephalus
What must you give to household contacts of meningococcal meningitis
ciprofloxacin (or rifampicin)
to eradicate nasopharyngeal carriage
What is the most dangerous cause of viral encephalitis?
HSV
How do you treat HSV encephalitis?
high dose IV acyclovir
What causes toxic shock syndrome?
Toxin from S aureus
Group A strep
What is presentation of TSS?
fever >39 degrees
hypotension
diffuse erythematous macular rash
What does the toxin do in TSS
it acts as a SUPERANTIGEN causes organ dysfunction - mucositis - GI dysfunction - renal impairment - liver impairment - clotting abnormality
what antibiotics fro you give for TSS=
Ceftriaxone
clindamycin
IVIG
What toxin causes necrotising fascitis
Staph a
Group A strep
What is management for necrotising fasciitis
surgical emergency
debride all infected tissue
IV fluids
empirical IV antibiotica
what are sx of meningococcal septicaemia?
purpuric rash
non-blanching, irregular in size and colour, necrotic centre
What is the most common cause of meningococcal septicaemia
group B meningococci
What is eczema herpeticum?
widespread vesicular rash resulting in secondary bacvgertial infection > septicaemia
What are herpetic whitlow
painful herpetic pustules on fingers, at site of broken ski
What is Kawasaki disease
a systemic vasculitis
what is the epidemiology of Kawasaki disease
more common in japanese children
6 m to 4 yrs
young infants are more severely affected
What are cardinal fts of Kawasaki
CRASH and burn
Conjunctivitis Rash Adenopathy Strawberry tongue Hand swelling / erythema / desquamation on hands and feet
Burn - fever difficult to control
WHAT ARE blood markers like in Kawasaki disease
high inflamm markers
platelets rise in 2nd week
what occurs to coronary arteries in Kawasaki disease
Croronary arteries can be affected
- aneurysm
- myocardial ischaemia, sudden death
What is management of Kawasaki disease
IVIG
High dose aspirin
corticosteroids, infliximab, plasma exchange
“AEIO”
What are clinical fts of TB like in children
Very non speicfic - prolonged fever - malaise - anorexia .- WL - lymph node swelling
What are ix for TB in children
Gastric washings on 3 consec mornings (as children swallow sputum TB clture PCR tuberulin skin test interferon gamma release assay
How do you manage TB in children
RIPE
Rifampicin + isoniazid 6 months
pyrazinamide + ethambutol first 2 months
How do you treat bacterial meningitis in hospital if <3m
IV amoxicillin + cefotaxime
How do you treat bacterial meningitis in hospital if >3m
IV ceftriaxone
How long do you give IV ceftriaxone based on the causative organism?
Neisseria 7 days
Strep p 14 days
Haemophilius influenza 10 days
What other drug can you give if CSF in meningitis is very concerning ?
Add IV dexamethasone
When must you NEVER give IV dexa in meningitis
If meninogococcal septicaemia
What is the most common form of primary HSV in children
Gingivostomatitis
How does gingivostomatitis present
vesicular lesions on lips, gums, tongue, palate
Progresses to extensive painful ulceration and bleeding
with high fever
What are the causative organisms for hand foot and mouth disease
viral (cocksackie A16, enterovirus 71)
Who is hand foot and mouth disease common in
children under age of 5
what are symptoms of hand foot and mouth disease
low grade fever, malaise
sore throat, N&V, anorexia, irritability
RASH - moth sores (yellow ulcer with red halo on buccal mucosa)
- erythematous macule (flat, discoloured) that progress to grey vesicles ON HAND, FOOT
How do you manage hand foot and mouth disease
analgesia (self limiting)
no need to exclude from school
Explain spread of chicken pox
HIGHLY infectious
spreads via respiratory route
can be caought from someone with shingles
Explain when the infectious period is in chicken pox
-4 to 5 days around rash
What are symptoms of chicken pox
200 lesions start on head and trunk
progressing to peripheries
lesions appear as crops of papule, vesicles, with surrounding erythema
itching and scratching
results in permanent depigmented scar
How do you manage chicken pox
Supportive
- calamine lotion
- school exclusion until 5 days from rash onset
What are major complications of chicken pox
Secondary bacterial infections (staph/Group A strep) > TSS/necrotising fascitis
Encephalitis (good prognosis)
Purpura fulminant
What symptoms is chicken pox encephalitis associated with
VZV associated cerebellitis
What is purpora fulminans
disseminated haemorrhage chicken pox
causes loss of large areas of skin by necrosis
What viruses cause roseola infantum
HHV6, HHV7
What are symptoms of roseola infantum?
high fever, malaise, generalised macular rash
What does human parvovirus B19 cause in derm children (give all names for it=)
Erythema infectious
Fifth disease
Slapped cheek syndrome
How is P B19 transmitted
via respiratory secretions / vertical transmission / infected blood products
What is the presentation of erythema infectiosum
fever, malaise, headache, myalgia > red cheeks, peri oral pallor (SLAPPED CHEEK)> progresses to lace like rash on trunk, limbs
What is the pathological organism causing measles
Morbillivirus (pox)
How is measles transmitted
(via resiratory tract - droplet spread)
What are the symptoms of measles
fever, cough, coryza maculopapular rash (from head to body), may desquamate in second week Koplik spots (white spots on mouth)
How do you manage measles
Notify HPT
Conservative management
Stay away from school for 4 days after rash develops
How do mumps spread
Through respiratory droplepts
What are symptoms of mumps
incubation period 2 weeks
fever, malaise, parotitis
PAROTITIS - unilateral, then becomes bilateral
Also have earache and pain when eating / drinking
How do you manage mumps
Notify HPU
Self limiting
How do you diagnose mumps
oral swab
What are appropriate investigations for suspected Kawasaki
FBC, U&E, LFT, CRP, ESR
urine MC&S
Troponin
Echo, ECG
What are blood results of Kawasakiu
RAISED ALT, platelets, WCC, albumin
What are negative effects of Kawasaki on vascular system
Aneurysm > rupture, pericardial effusion
Thrombosis > MI > sudden death!!!!
Regurgitation
What causes Lyme disease
Borrelia burgdorferi
HARD TICKS
What are clinical features of lime disease
Erythema migrant - erythematous macule that enlarges to form a painless red expanding lesion
Fever, headache, malaise
Myalgia, arthlagia
Lymphadenopathy
What are late features of Lyme disease
Neuro (encephalitis, neuropathy)
Cardiac (myocarditis)
Joint (arthritis - 50% of patients)
How do you diagnose Lyme disease
Clinical
ELISA if without erythema migricans > immunoblot
How do you manage Lyme disease
Doxycycline
What vaccine can you give at birth
BCG if AT RIsk
What are key times for vaccines
2m
3m
4m
12m
3y 4m
13yo
18yo
What vaccine do you give at 2 m
6 in 1
Rotavirus
Men B
What vaccine do you give at 3 m
6 in 1
Rotavirus
Pneumococcus (PCV)
What vaccine do you give at 4m
6 in 1
Men B
What vaccine do you give at 12 m
Hib, Men C
MMR
Booster: pneumococcus, men B
What vaccine do you give at 3 y 4m
Booster: DTPP
MMR 2nd dose
What vaccine do you give at 13years
HPV
Booster: DTP
What vaccine do you give at 18years
Men ACWY
To freshers and all 17/18 yo
What is the 6 in 1
DTPPHH
Diphteria Tetanus Pertussis Polio Hep B Hib
When do you give 6 in 1 vaccines
2m
3m
4m
When do you give 6 in 1 boosters
3 years 4 months DTPP (diphtheria, tetanus, Polio, Pertusssis)
13 years: DTP (diphtheria, tetanus, pertussis9
When do you give MMR
1 year
3y 4 m
what should you add to treatment plan for meningitis in child who has travelled recently
vancomycin
when should you add dexamethasone to meningitis tx
if >3m AND CSF analysis shows following:
- purulent CSF
- WBC >1000
- raised CSF WBC and protein conc >1g/L
- bacteria on gram stain
what should you organise as discharge and follow up in child who has meningitis
review by paediatrician 4-6 weeks post discharge
formal audiological assessment
what should YOU NOT FORGET to do as holistic tx when a child has meningitis
treat contacts (anyone who had close contact with ptient over past 7 days) with CIPROFLOXACIN
what are key components of traffic light system
CARCO Colour Activity Resp Circulation and Hydration Other
what colour places child in RED traffic light system
pale, mottled, ashen, blue
what activity level places child in RED traffic light system
no response to socia
what resp places child in RED traffic light
grunting
tachypnoea RR >60
moderate/severe chest intrawing
what hydration status places child in RED traffic light
reduced skin turgor
what other features place child in RED traffic light
age <3m &temp >38 non-blanching rash bulging fontanelle neck stiffness status epilepticus focal neuro signs focal seizures
what colour places child in YELLOW traffiuc light
pallor reported by parent
what activity level places child in AMBER. traffic light
not responding normally to social cues
no smile
wakes only on prolonged stimulation
decreased activity
what resp features place child in AMBER traffic light
nasal flaring
tachpynoea (RR>50 if 6-12m, RR>40 if >12m(
ox sat <95
chest crackles
what circ/hydration place child in amber traffic light
tachycardia (>160 if <12m, >150 if 12-24m, >140 if 2-5yo) CRT >3 dry mucous membranes poor feeding redu ed urine output
what other features place child in amber traffic light
3-6m, temp >39 fever for >5 days rigors limb swellinng non weight bearing limbv
how should you manage child in red traffic light
refer urgently to paeds specialisy FBC, CRP, blood culture urine dip + MC&S CXR, LP, serum electrolytes, blood gas Consider starting empirical antibiotics
how do you manage roseola infantum (HSV6/7)
partacetamol or ibuprofen for pain relief
should self resolve
how do you treat baby with HIV + motgher
ZIDOVUDINE for 6 weeks
How do you manage non-bullous neonatal impetigo (non-MRSA vs MRSA)
nonMRSA: erythromycin 7 days || MRSA: vancomycin 7 days
HYGENE: 2x daily wash with soap and water
How do you manage impetigo in infants/children
fusidic acid (topical) oral fluclox / clindamycin
how do you prevent impetigo recurrence
intranasal mupirocin
HOW DO YOU MANAGE staphylococcal scalded skin syndrome
hospital admission
IV fluclox
analgesia
emollient for pruritus and tendnerness
how do you manage suspected typhoid
ceftriaxone +/-azithromycin
how do you manage known typhoid
ciprofloxacin days 7
what are complications of measles
Neuro: encephalitis, subacute sclerosing panencephalitis
Resp: pneumonia, otitis media
Other: myocarditis, diarrhoea
What are complications of mumps
- hearing loss
- meningitis, encephalitis
- orchitis
What are complications of rubella
arthritis, encephalitis, thrombocytopoenia, myocarditis
