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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
Q

What is HSV?

A

Viral infection initially of mucous membranes or skin causing intense local mucosal damage
HSV1: lip
HSV2: genital
mostly asymptomatic

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26
Q

What is aciclovir

A

viral DNA polymerase inhibitor used to treat severe HSV infection

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27
Q

Gingivostomatitis

A

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

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28
Q

What is a herpetic whitlow?

A

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

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29
Q

What is eczema herpeticum?

A

serious
widespread vesicular lesions develop on eczematous skin
can be complicated by secondary bacterial infection and result in septicaemia

30
Q

Can HSV afeect the eyes?

A

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
Q

How are neonates affected by HSV?

A

infection can be focal or widely disseminated.
skin and eyes usually affected
encephalitis can occur
morbidity and mortality are high

32
Q

What are the complications of VZV?

A

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
Q

What is EBV

A

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
Q

How might children with infectious mononucleosis syndrome present?

A

fever
malaise
tonsillopharyngitis
lymphadenopathy

(petechiae on soft palate, splenomegaly, hepatomegaly, mac-pap rash, jaundice)

35
Q

How do you diagnose infectious mononucleosis syndrome?

A

blood film: atypical lymphocytes - numerous large T cells
+ve monospot test
Igm + IgG to EV antigens

36
Q

What is infectious mononucleosis syndrome?

A

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
Q

Why should you not give ampicillin or amoxicillin in cases of suspected EBV?

A

it will cause a florid maculopapular rash

38
Q

What is CMV?

A

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
Q

What precautions are taken to avoid CMV transmission in those undergoing transplantation?

A

CMV -ve blood
anti-CMV prophylaxis
don’t transplant CMV +ve organs

40
Q

What effects can CMV have in the immunocompromised ?

A 
retinitis
pneumontis
bone marrow failure
encephalitis
hepatitis
colitis
oesophagitis
41
Q

How is CMV treated?

A

ganciclovir

foscarnet

42
Q

What is exanthem subitum?

A 
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
Q

What illnesses can parvovirus B 19 cause?

A

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
Q

What clinical syndromes are caused by enteroviruses?

A

mostly cause asymptomatic/self-limiting illnes with rash (purpuric)

hand, foot and mouth disease
herpangina
aseptic meningitis
pleurodynia
myocarditis/pericarditis
45
Q

What is Guillaine-Barré syndrome?

A 
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
Q

What is haemolytic uraemic syndrome and how does it present?

A 
Hx of gastroenteritis infection (e.coli)
Oliguria
Oedema
Petechiae
Pallor (jaundice) 
AKI + fluid overload = severe htn, HF, convulsions
47
Q

How to treat malaria

A

Evidenc of ruptured spleen -

48
Q

Salmonella typhi

A

Rose spots !!!

49
Q

SCID

A

Low B cells
Low Ig
Low T cells

50
Q

Hyper IgM

A

CD40 ligand defect
Recurrent infections
Normal B cells
Normal T cells

51
Q

Bruton’s agammaglobulinaemia

A

Normal T cells
Low B cells
Low Ig
Predisposition to Resp and CNS infections

52
Q

Thymic absence/ hypoplasia

A

No T cells
Normal B cells
Normal Ig
Risk from encapsulated organisms: strep pneumoniae, haemophilus influenzae

53
Q

Complement deficiency: c3

A

Recurrent pyogenic infection

54
Q

Complement deficiency: c1, c2, c4

A

Autoimmune issues

55
Q

Complement deficiency: c5-9

A

N.meningitidis

56
Q

Infection risk in the immunocompromised (HIV, steroids, chemo)

A 
TB
Pneumocystis jiroveci (PCP)
57
Q

Opportunistic infection prevented by prophylactic septrin post transplant

A

Pneumocystis jiroveci

58
Q

Pos transplant infection risks

A

CMV
VZV
Fungal:

59
Q

Drugs used for immunosuppression post transplant

A

Tacrolimus
Ciclosporin
Mycophenolate mofetil

60
Q

Fifth disease
Aka slapped cheek
Aka erythema infectiosum
Aka parvovirus

A

Slapped cheek appearance -> macpap rash on limb
Malaise + fever
Complications incl: arthralgia + aplastic anaemia
Do FBC to rule out aplastic crisis

61
Q

VZV

Aka chicken pox

A

14-21 day incubation
Rash on trunk + scalp: vesicles + pustules
Fever
Complications incl: encephalitis(ataxia), pneumonitis, conjunctival lesions
More dangerous with concurrent eczema

62
Q

Measles

A

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
Q

Scarlet fever

Gp A beta-haemolytic strep

A

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
Q

Roseola infantum

Aka exanthema subitum

A

HHV 6+7
High fever malaise
Generalised macular rash
Ddx on finding evidence of virus in serum

65
Q

Kawasaki

A

Childhood vasculitis, most

66
Q

Managing giardiasis

A

Oral metronidazole

67
Q

Mumps

A

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
Q

Diphtheria

A 
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
Q

Quinsy

Aka peritonsillar abscess

A

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
Q

Tetanus

A 
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
Q

Poliomyelitis

A

RNA poliovirus
Ant horn cells of lower motor neurones
Flu like illness, muscle pain, flaccid paralysis, areflexi

72
Q

Pertussis

Aka whooping cough

A

Bordetella pertussis
Coryza, dry cough, becomes paroxysmal
No treatment
Complications incl pneumonia + bronchiectasis

Toni's Paeds (16 decks)

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