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Paediatrics > Infection & Immmunity - Allergy/HIV/Immunodeficiency/Other > Flashcards

Infection & Immmunity - Allergy/HIV/Immunodeficiency/Other Flashcards

1
Q

Why do allergic reactions occur?

A

when individuals make an abnormal immune response to harmless environmental stimuli (usually proteins)

developing immune system must be sensitised to an allergen before allergic immune response develops

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2
Q

How are allergic reactions classified?

A

IgE mediated

non-IgE mediated

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3
Q

What are the stages of an IgE mediated reaction?

A

Early phase - within minutes of exposure to allergen, caused be release of histamine and other mediates from mast cells (angioedema, urticarial etc)

Late phase - after 4-6 hours (nasal congestion, cough, bronchospasm)

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4
Q

How does a non-IgE mediated allergic reaction present?

A

delayed onset of symptoms and more varied clinical course

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5
Q

What are common allergens?

A

inhalant allergens - house-dust mite, plant pollens
ingestant allergens - nuts, seeds, legumes, cows milk
insect sting/bites, drugs etc

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6
Q

How do allergic reactions present?

A
  • Mouth breathing (poss due to obstructed nasal airway from rhinitis)
  • Allergic salute – habitual rubbing of nose
  • Pale + swollen inferior nasal turbinates
  • Hyperinflated chest or Harrison sulci from chronic undertreated asthma
  • Atopic eczema affecting limb flexures
  • Allergic conjunctivitis (may also be prominent creases + blue-grey discolouration below lower eyelids)
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7
Q

How are food allergies investigated?

A
  • Skin-prick tests
  • Measurement of specific IgE antibodies in blood
  • Endoscopy + intestinal biopsy if suspect non-IgE mediated
  • Exclusion of relevant food under dietician’s supervision, followed by double-blind placebo-controlled food challenge
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8
Q

How are allergies managed?

A

avoid food
antihistamines form mild attack
epipen for severe

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9
Q

What are some common allergens/allergic conditions?

A
  • Eczema + food allergy usually in infancy
  • Allergic rhinitis + conjunctivitis + asthma most often in preschool + primary school years
  • Rhinitis + conjunctivitis often precede
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10
Q

How is allergic rhinitis and conjunctivitis treated?

A
  • 2nd-gen non-sedating antihistamines (topical or systemic)
  • Topical corticosteroid nasal/eye preparations
  • Cromoglycate eye drops
  • Leukotriene receptor antagonists e.g. montelukast
  • Nasal decongestants (use for no more than 7-10 days)
  • Allergen immunotherapy – sublingual or subcut
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11
Q

How is urticarial rash treated?

A

2nd-gen non-sedating antihistamines (topical or systemic)

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12
Q

How do you report drug reactions?

A

•Drug challenge is the only way to conclusively confirm an allergy (contraindicated after severe reaction)

Report severe drug reactions with yellow card scheme

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13
Q

How are drug reactions immediately treated?

A
  • Assess: hospital/primary care/specialist advice
  • Stop use if reaction serious, avoid use in future
  • Consider alternative drug therapy
  • Consider altering dose or temporarily stopping drug treatment
  • Consider effects of drug interactions
  • Consider possibility of withdrawal effects if drug treatment stopped suddenly
  • Manage symptoms of reaction
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14
Q

How prevalent is HIV?

A

2 million children worldwide

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15
Q

What are the short term risks of HIV?

A

Opportunistic infections - TB, pneumocystis pneumonia, toxoplasmosis, VZV, CMV, candida
Thombocytopenia, anaemia, neutropenia

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16
Q

What are the long term risks of HIV?

A 
Compliance 
Failure to thrive 
Risk of transmission 
HIV encephalopathy 
Neuropathy and myelopathy
Cancers - Kaposi's Sarcoma, non-Hodgkins Lymphoma
17
Q

What are the clinical features of infectious mononucleosis?

A 
fever 
malaise 
tonsillopharyngitis 
lymphadenopathy 
petechiae on soft palate
hepatospenomegaly 
maculopapular rash 
jaundice
18
Q

What are the complications for infectious mononucleosis?

A

symptoms persist for 1-3 months but ultimately resolve (self limiting)

complications: 
hepatitis 
jaundice 
mild thrombocytopenia
haemolytic anaemia 
upper airway obstruction to tonsil hypertrophy 
splenic rupture 
chronic fatigue syndrome 
neuro complications
19
Q

What are the treatment options for infectious mononucleosis?

A

compromised airway - corticosteroids

group A streptococcus in tonsils - penicillin

20
Q

What is Kawasaki disease?

A 
systemic vasculitis 
fever of 38+ for more than 5 days and 4+ of the following: 
- conjunctival infection in both eyes 
- change in mouth/throat 
- changes to skin on arms or legs 
- rash 
- swollen LN of neck
21
Q

What are the 3 phases of Kawasaki disease?

A

1.Acute (weeks 1-2)
•Sudden symptoms + severe

2.Sub-acute (weeks 3-4)
•Symptoms severe but last longer
•Fever subsides but persistent irritability + considerable pain
•Complications likely

3.Convalescent (weeks 4-6)
•Recovery + all signs of illness should disappear
•May still lack energy
•Some complications

22
Q

What are the investigation results for Kawasaki disease?

A

CRP, ESR, WCC = raised
Platelet count - rises in the 2nd week
Echo - to check for aneurysms

23
Q

What is the treatment for Kawasaki disease?

A
  • IV immunoglobulin (within first 10 days, reduce risk of coronary artery aneurysms)
  • Aspirin – reduce risk of thrombosis (high dose until fever subsides + low dose until echo at 6 weeks)
  • Antiplatelet aggregation agents if platelet count v high
  • Long term warfarin + close follow up if giant coronary artery aneurysms
  • If persistent inflammation + fever, treat with infliximab, steroids or ciclosporin
24
Q

What are the long term complications of Kawasaki disease?

A

aneurysms of coronary arteries

subsequent narrowing from vessels from scar formation can result in myocardial ischaemia and sudden death

25
Q

What are the causes of immunodeficiency in children?

A

Deliberate immunosuppression - BM transplant, organ transplant, crohn’s disease

Non-deliberate immunosuppression - malnutrition, ageing, cancers

26
Q

What are the causes immunodeficiency in children?

A 
Primary = intrinsic defects in immune system
T cell defects 
B cell defects 
Neutrophil defects 
Leucocyte function defects 
Complement defects

Secondary - another disease or treatment e.g. HIV

27
Q

How can infection be prevented in immunocompromised children?

A
  • Antimicrobial prophylaxis
  • Antibiotic treatment – prompt treatment of infections, generally longer courses with lower threshold for IV
  • Screen for end organ disease
  • Immunoglobulin replacement therapy (for children with antibody deficiency)
  • Bone marrow transplantation (for SCID + chronic granulomatous disease
  • Gene therapy (certain forms of SCID but risk of leukaemia)
28
Q

What are the clinical features of Typhoid fever?

A
  • Worsening fever
  • Headaches
  • Cough
  • Abdo pain
  • Anorexia
  • Malaise
  • Myalgia
  • GI symptoms later
  • Poss splenomegaly, bradycardia + rose-coloured spots on trunk
29
Q

What is the treatment of typhoid fever?

A

3rd gen cephalosporin or azithromycin

30
Q

What are the clinical features of malaria?

A 
fever 
dairrhoea
vomiting 
flu-like symptoms 
jaundice 
anaemia 
thrombocytopenia 
rare cerebreal malaria

onset is 7-10 days after inoculation but iinfections can present many months later

31
Q

How is malaria treated?

A

Quinine

Travellers should use prophylaxis

Paediatrics (14 decks)

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