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Toni's Paeds > Infection + immunity > Flashcards

Infection + immunity Flashcards

1
Q

What type of infection is a febrile 2 month old infant likely to have?

A

bacterial
passive immunity to viral infection from mothers
septic screen
IV abx

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2
Q

What are risk factors for infection?

A

unwell contacts
travel to regions with endemic contagious disease
contact with animals

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3
Q

What are Red Flags signs of infection?

A 
38
3-6 months, T >39
pale, mottled, blue skin
reduced consciousness, neck stiffness, bulging fontanelle, status epilepticus, focal neuro signs, seizures
significant resp distress
bile stained vomit
severe dehydration/shock
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4
Q

What comprises a septic screen?

A

blood culture, FBC, CRP, ESR, albumin, urine dip, M,C + S
consider:
CXR, LP, meningo/pneumococcal PCR, viral PCR
rapid antigen screen

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5
Q

What can cause encephalitis?

A

direct neurotoxic virus invasion of the cerebrum e.g. HSV
disordered neuro-immuno response to viral antigen e.g. post infectious encephalopathy
slow virus infection e.g. HIV or SSPE after measles

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6
Q

What are the consequences of HSV encephalitis?

A

severe neuro sequelae
focal changes seen on EEg and CT/MRI, oft temporal lobes
IV aciclovir given to all children with encephalitis
proven cases treated for 3 wks

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7
Q

How does Toxic Shock Syndrome present?

A

fever > 39
hypotension
diffuse erythematous macular rash

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8
Q

What causes TSS?

A

toxin producing Staph aureas and GpA strep
infection at any site
toxin acts as superantigen

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9
Q

What is the treatment for TSS?

A

ABC: resucitate/stabilise
3rd gen cephalosporin: ceftriaxone + clindamycin
acts on bacterial ribosome to switch off toxin production
PICU
surgical debridement
IVIg to neutralise circulating toxin
1-2 wks after onset: desquamation of hands and feet

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10
Q

What is PVL-producing staph aureas?

A

recurrent skin/soft tissue infection
necrotising fasciitis
necrotising haemorrhagic pneumonia
PVL toxin -> procoagulant state venous thrombosis

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11
Q

What is necrotising fascitis / cellulitis?

A 
severe subcutaneous infection which travels along tissue planes 
large poorly perfused necrotic areas of tissue
severe pain
systemic illness
staph aureas / Gp A strep
\+- syndergistic anaerobe
IV abx + aggressive surgical debridement
IVIg
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12
Q

meningococcal meningitis

A

lowest risk of long term neuro sequelae
septicaemia + purpuric rash
non -blanching, irregular, necrotic centre
when extensive = purpura fulminans

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13
Q

pneumococcal meningits

A

high morbidity and mortality
seen in young infants
poor immune response to encapsulated organisms
hyposplenic children req daily prophylactic penicillin

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14
Q

What infections can haemophilus cause?

A 
otitis media
pneumonia
epiglottitis
cellulitis
osteomyelitis
septic arthritis
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15
Q

How do superantigens work?

A

usually antigens stimulate ony a small subset of T cells with a specific receptor
superantigens bind to receptors that many T cells share
->massive T cell proliferation and cytokine release

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16
Q

What is impetigo?

A

localised, highly contgious staph or strep skin infection
more common with pre existing skin disease
lesions usually on face, neck and hands
confluent honey crusted lesions
spreads readily via autoinnoculation of infected exudate

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17
Q

How do you treat impetigo?

A

topical abx e.g. mupirocin if mild
narrow spec abx e.g. flucloxacilling if severe
better adherence with co-amoxiclav
erradicate nasal carriage with nasal cream containingmupirocin or chlorhexidine + neomycin

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18
Q

What is a boil?

A

staph aureas infection of a hair follicle/sweat gland
systemic abx/occasionally surgery
persistent boils usually due to nasal carriage/family resevoir
rarely indication of immune deficiency

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19
Q

what is periorbital cellulitis?

A

fever, with erythema, tenderness and oedema of the eyelid
unilateral
if unimmunised - H influenzae b!
due to local trauma or spread from paranasal sinus/dental abscess

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20
Q

How would you manage periorbital cellulitis?

A

prompt IV abx

to prevent posterior spread and orbital cellulitis

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21
Q

What are the signs of orbital cellulitis?

A 
proptosis
painful, limited occular movement
reduced visual accuity
complications inc
abscess, meningitis, cavernous sinus thrombosis
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22
Q

How would you manage orbital cellulitis?

A

CT scan: assess posterior spread

LP: exclude menigitis

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23
Q

What is scalded skin syndrome?

A

exfoliative staphylococcal toxin
fever, malaise, purulent crusting around face, widespread erythema and tenderness of skin
Nikolsky sign: areas of skin separate on gentle pressure
= denuded areas of skin

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24
Q

How would you manage SSS?

A

IV anti-staph abx
analgesia
monitoring fluid balance

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25
What is HSV?
Viral infection initially of mucous membranes or skin causing intense local mucosal damage HSV1: lip HSV2: genital mostly asymptomatic
26
What is aciclovir
viral DNA polymerase inhibitor used to treat severe HSV infection
27
Gingivostomatitis
10 months - 3 years vesicular lesions on lips, gums, tongue, hard palate -> extensive painful ulceration with bleeding high fever 2 wk duration symptom management - dehydration a concern
28
What is a herpetic whitlow?
HSV painful, erythematous, oedematous, white pustules on the site of broken skin on the fingers spread by autoinoculation from gingivostomatitis or from lips of infected parents
29
What is eczema herpeticum?
serious widespread vesicular lesions develop on eczematous skin can be complicated by secondary bacterial infection and result in septicaemia
30
Can HSV afeect the eyes?
Yes it can cause blepharitis or conjunctivitis may extend to involve the cornea can cause scarring and loss of vision if herpetic lesions are near the eye opthalmic investigation of the cornea by slit lamp is req
31
How are neonates affected by HSV?
infection can be focal or widely disseminated. skin and eyes usually affected encephalitis can occur morbidity and mortality are high
32
What are the complications of VZV?
Secondary staph/GpA strep Infection, may -> TSS/nec fasc consider where onset of new fever or persistent high T after first few days Encephalitis generalised, e\arly days of illness, gd prognosis mostly VZV assoc cerebellitis usually occurs 1 wk after onset of rash child is ataxic with cerebellar signs Purpura Fulminans: production of antiviral antibodies may cross react and inactivated protein S -> dysreg of fibrinolysis and incr clotting Disseminated Disease: may occur in immunocompromise vesicular erruptions persist and become haemorrhagic 20% mortality
33
What is EBV
virus transmitted by oral contact majority = subclinical can -> infectious mononucleosis syndrome involved in pathogenesis of: Burkitts lymphoma lymphoproliferative disease in the immunocompromised and naopharyngeal carcinoma
34
How might children with infectious mononucleosis syndrome present?
fever malaise tonsillopharyngitis lymphadenopathy (petechiae on soft palate, splenomegaly, hepatomegaly, mac-pap rash, jaundice)
35
How do you diagnose infectious mononucleosis syndrome?
blood film: atypical lymphocytes - numerous large T cells +ve monospot test Igm + IgG to EV antigens
36
What is infectious mononucleosis syndrome?
immune response to EBV can last up to 3 months treatment is symptomatic e.g. corticosteroids may be req in case of airway compromise
37
Why should you not give ampicillin or amoxicillin in cases of suspected EBV?
it will cause a florid maculopapular rash
38
What is CMV?
virus transmitted in bodily fluids usually mild/subclinical infection most infected by 2 yrs an issue in the immunocompromised and the fetus Fetal: deafness, IUGR, hydrocephalus, thrombocytopenia
39
What precautions are taken to avoid CMV transmission in those undergoing transplantation?
CMV -ve blood anti-CMV prophylaxis don't transplant CMV +ve organs
40
What effects can CMV have in the immunocompromised ?
``` retinitis pneumontis bone marrow failure encephalitis hepatitis colitis oesophagitis ```
41
How is CMV treated?
ganciclovir | foscarnet
42
What is exanthem subitum?
``` 2yrs aka roseola infantum high fever + malaise for a few days generalised macular rash rare -req serological confirmation HHV6 or 7 commonly causes febrile convulsions ```
43
What illnesses can parvovirus B 19 cause?
Asymptomatic infection Erythema Infectiosum: aka slapped cheek/fifth disease transmission: resp secretions/vertical/blood fever, malaise, headache, myalgia, facial rash Aplastic crisis: in children with chronic haemolytic anaemias causing incr RBC turnover or immunosuppressed Fetal disease: vertical transmission -> fetal hydrops + death
44
What clinical syndromes are caused by enteroviruses?
mostly cause asymptomatic/self-limiting illnes with rash (purpuric) ``` hand, foot and mouth disease herpangina aseptic meningitis pleurodynia myocarditis/pericarditis ```
45
What is Guillaine-Barré syndrome?
``` Acute post infectious polyneuropathy 2-3 wks after URTI or campylobacter Ascending symmetrical weakness Autonomic dysfunction (urinary retention, will req cath) Depression of respiration (measure vital cap + peak flow, may req vent) Arreflexia CSF protein raised Max weakness 2-4 wks after onset Supportive treatment ```
46
What is haemolytic uraemic syndrome and how does it present?
``` Hx of gastroenteritis infection (e.coli) Oliguria Oedema Petechiae Pallor (jaundice) AKI + fluid overload = severe htn, HF, convulsions ```
47
How to treat malaria
Evidenc of ruptured spleen -
48
Salmonella typhi
Rose spots !!!
49
SCID
Low B cells Low Ig Low T cells
50
Hyper IgM
CD40 ligand defect Recurrent infections Normal B cells Normal T cells
51
Bruton's agammaglobulinaemia
Normal T cells Low B cells Low Ig Predisposition to Resp and CNS infections
52
Thymic absence/ hypoplasia
No T cells Normal B cells Normal Ig Risk from encapsulated organisms: strep pneumoniae, haemophilus influenzae
53
Complement deficiency: c3
Recurrent pyogenic infection
54
Complement deficiency: c1, c2, c4
Autoimmune issues
55
Complement deficiency: c5-9
N.meningitidis
56
Infection risk in the immunocompromised (HIV, steroids, chemo)
``` TB Pneumocystis jiroveci (PCP) ```
57
Opportunistic infection prevented by prophylactic septrin post transplant
Pneumocystis jiroveci
58
Pos transplant infection risks
CMV VZV Fungal:
59
Drugs used for immunosuppression post transplant
Tacrolimus Ciclosporin Mycophenolate mofetil
60
Fifth disease Aka slapped cheek Aka erythema infectiosum Aka parvovirus
Slapped cheek appearance -> macpap rash on limb Malaise + fever Complications incl: arthralgia + aplastic anaemia Do FBC to rule out aplastic crisis
61
VZV | Aka chicken pox
14-21 day incubation Rash on trunk + scalp: vesicles + pustules Fever Complications incl: encephalitis(ataxia), pneumonitis, conjunctival lesions More dangerous with concurrent eczema
62
Measles
1-12 day incubation Lethargy, fever, cough, coryza, conjunctivitis 4 days later Macular rash starts on face -> trunk Koplik's spots in mouth Complications incl: pneumonia, otitis media, encephalitis
63
Scarlet fever | Gp A beta-haemolytic strep
Tonsillitis 7 day incubation Erythematous rash, mostly on trunk Strawberry tongue + desquamation Complications incl: otitis media, rheumatic fever, acute nephritis Diagnosis: raised ASOT titres, gp A strep on throat swab
64
Roseola infantum | Aka exanthema subitum
HHV 6+7 High fever malaise Generalised macular rash Ddx on finding evidence of virus in serum
65
Kawasaki
Childhood vasculitis, most
66
Managing giardiasis
Oral metronidazole
67
Mumps
Paramyxovirus Droplet spread in pre adolescents Parotitis and constitutional sx Complications: orchitis, meningitis, pancreatitis Management: bed rest, scrotal support, analgesia Orchitis -> testicular atrophy in 50%, bilat = infertility
68
Diphtheria
``` Flu like illness + neck swelling Sore throat with grey slough covering mucosa of pharynx and tonsils Corynebacterium diptheriae G+ve anaerobe + demonstration of toxin req for Dx Toxin can cause sever hypotension ```
69
Quinsy | Aka peritonsillar abscess
Unwell Severe dysphagia, earache, trismus(lockjaw) Unilat bulge of soft palate with deviation of uvula to opposite side Inflamed tonsils + halitosis Rupture of the abscess can result in aspiration pneumonia
70
Tetanus
``` G+ve Anaerobe clostridium tetani Neurotoxin= tetanospasmin Acts on motor cells of CNS Signs: trismus (lockjaw), risus sardonicus (grinning face), opisthotonus (arched body + hyperextended neck), autonomic dysfunction (tachycardia, arrhythmia, low bp, sweating) Anti-tetanospasmin Ig ```
71
Poliomyelitis
RNA poliovirus Ant horn cells of lower motor neurones Flu like illness, muscle pain, flaccid paralysis, areflexi
72
Pertussis | Aka whooping cough
Bordetella pertussis Coryza, dry cough, becomes paroxysmal No treatment Complications incl pneumonia + bronchiectasis

Toni's Paeds (16 decks)

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