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Sarah Paeds > Infection/Immunity > Flashcards

Infection/Immunity Flashcards

1
Q

What is the most common cause of meningitis?

A

Viral

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2
Q

What is the most common bacterial cause of meningitis in neonates?

A

GBS
E.coli
Listeria

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3
Q

What is the most common bacterial cause of meningitis in children and adolescents?

A

N.meningitides

S.pneumoniae

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4
Q

What process causes the damage in meningitis?

A

Inflammation leads to endothelial damage = cerebral oedema (raised ICP) = cortical infarction

most of the damage is caused by the host’s immune response

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5
Q

What might bulging fontanelle in a neonate suggest?

A

Raised ICP

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6
Q

What are the long term complications of meningitis?

A

Hearing loss
Subdural effusion
Abscesses
Infarction

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7
Q

What ix should be ordered in suspected meningitis?

A 
FBC 
BM
Gas
LP (PCR)
Rapid Ag test 
MCS (blood, stool, urine, throat)
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8
Q

What is the management for bacterial meningitis?

A

IV benpen until at hospital

Then 3rd gen cephalosporin (e.g. ceftriaxome/cefotaxime)

Dexamethasone

Supportive therapy

Prophylactic against MenC for other family members

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9
Q

What are the cardinal symptoms of encephalitis?

A

Altered behaviour
Reduced consciousness
Fever
Seizures

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10
Q

What is the most common causative agent for encephalitis?

A

HSV

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11
Q

What are the appropriate ix for suspected HSV?

A 
FBC 
LP
EEG - changes in temporal lobe 
CT/MRI - focal changes in temporal lobe 
(meningitis screen)
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12
Q

How is HSV diagnoses?

A

PCR from CSF

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13
Q

How is HSV encephalitis treated?

A

3/52 IV aciclovir

Supportive care

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14
Q

What is the commonest cause of UTI in a child?

A

Bowel flora migrates to UT

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15
Q

What is the commonest cause of UTI in a neonate?

A

Haematogenous spread

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16
Q

Which organisms commonly cause UTI? Which organisms are more common in boys?

A

E.coli,
Klebsiella,
Proteus (more common in boys because populates under prepuce)

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17
Q

What are the risk factors for UTIs?

A 
Incomplete emptying 
Infrequent voiding 
Vulvitis 
Constipation 
Neuropathic bladder 
Vesicoureteric reflux (familial)
Posterior urethric valves (in boys)
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18
Q

What is vesicoureteric reflux?

A

Reflux of urine back up ureters. Can be mild (a little way up) or moderate (tracking back to kidneys). Risk factor for UTIs

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19
Q

What may a pseudomonas caused UTI indicate?

A

Structural abnormalities - blockage

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20
Q

How should a suspected UTI be investigated?

A 
Urine dip (+MC&S)
FBC, U&E, CRP
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21
Q

When should UTIs be investigated further beyond bloods and urine?

A

If atypical organisms (non-E.coli) OR recurrent UTIS

–> for USS

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22
Q

What might be found on USS of a child with recurrent UTIs?

A

Strictures
Posterior urethral valve
Dilated ureter/calyces indicating vesicuourethral reflux

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23
Q

What is the treatment for <3mo baby with a UTI?

A

Hospital admission - IV cefotaxime

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24
Q

What is the treatment for a 6week - 2yrs child with a UTI?

A

Coamox

IV cef if unstable

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25
Q

What is the treatment for recurrent UTI?

A

Trimethoprim (3/7)

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26
Q

What is the conservative management/advice for a child with UTI?

A

Increased fluid intake

Second attempt at emptying to ensure complete void

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27
Q

What are the long term complications of UTIs?

A

Kidney scarring leading to HTN and CKD

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28
Q

What is the incubation period of chickenpox?

A

11-21 days

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29
Q

How long are children with chickenpox infective for?

A

4 days before lesions to until all lesions are scabbed over

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30
Q

What is the treatment for chickenpox?

A

Keep cool
Antiseptic cream for lesions
Trim nails

IV aciclovir if severe

VZIG if immunocompromised and exposed (no prior infection)

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31
Q

What is the evolution of chickenpox lesions?

A

Macules, papules, vesicles

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32
Q

How does lyme disease present?

A 
Eythema migricans 
Fever 
Malaise 
Mylagia 
Lymphadenopathy

(can be neuro and cardio involvement)

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33
Q

What is the treatment for >12 years with lyme disease?

A

Doxy

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34
Q

What is the treatment for <12 years with lyme disease?

A

Amoxicillin

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35
Q

What is the treatment for lyme disease with neuro/cardiac involvement?

A

IV ceftriaxone

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36
Q

What is Kawasaki’s disease?

A

Immune hyperreactivity causing systemic vasculitis

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37
Q

How does Kawasaki’s disease present?

A 
Very irritable 
Prolonged fever >5 days (difficult to control)
Non-purulent conjunctivitis 
Red mucous membranes 
Peeling hands and feet 
Lymphadenopathy 
(Inflammation at BCG site)
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38
Q

What are the long term complications of Kawasaki’s disease?

A

Coronary artery aneurysms

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39
Q

What are the investigations for Kawasaki’s disease?

A

FBC (raised WCC, ESR, CRP)

Echo (after 6/52 to check for cardiac aneurysms)

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40
Q

What is the treatment for Kawasaki’s disease?

A 
IVIG 
Steroids 
Ciclosporin 
Infliximab
Aspirin (lower risk thrombosis)
Long term warfarin if severe coronary involvement
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41
Q

In which populations is Kawasaki’s disease most common?

A

Japanese

Afro-Caribbean

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42
Q

Which gene is Kawasaki’s disease associated with?

A

ITPKC

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43
Q

What are the four species of malaria?

A

Falciparum
Ovale
Vivax
Malariae

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44
Q

What are the most significant complications of malaria, particularly in children?

A

Anaemia

Cerebral oedema

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45
Q

What are the investigations for suspected malaria?

A

FBC
Urinalysis + MC&S
Thick and thin blood film

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46
Q

When do the symptoms of malaria become apparent?

A

7-10 days after innoculation

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47
Q

How does malaria present?

A 
Swinging fevers (48-72 hours) - although not always 
Malaise 
Myalgia 
Headaches 
N&amp;V&amp;D 
Jaundice
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48
Q

What is the treatment for malaria?

A

PREVENTION
Falciparum - quinine
Others - chloroquine

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49
Q

How is typhoid transmitted?

A

FO

Salmonella typhi, paratyphi

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50
Q

How does typhoid present?

A 
Worsening fever 
Frontal headaches, cough, abdo pain, 
Splenomegaly 
Bradycardia 
ROSE COLOURED SPOTS on trunk
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51
Q

How is typhoid diagnosed?

A

Blood cultures

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52
Q

What is the treatment for typhoid?

A

Cotrimoxazole

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53
Q

How is dengue transmitted?

A

Aedes anopheles mosquito

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54
Q

What are the severe symptoms of dengue?

A

Leukopenia
Thrombocytopenia
Haemorrhage

–> severe capillary leak syndrome

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55
Q

How does dengue fever present?

A

Fine, erythematous rash, headaches, myalgia

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56
Q

How is dengue diagnosed?

A

Viral antigen serology

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57
Q

How is dengue treated?

A

Fluid resus

Monitoring

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58
Q

How is acute otitis media diagnosed?

A

Assessment of the tympanic membranes

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59
Q

What is the major complicationsof recurrent acute otitis media?

A

Otitis media with effusion (glue ear) = speech and learning difficulties from (conductive) hearing loss

Otitis media can also track and cause a cerebral abscess

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60
Q

What is the most common age group suffering from acute otitis media?

A

6-12 months

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61
Q

Why are babies and infants most at risk of acute otitis media?

A

Short, horizontal, poorly functioning eustachian tubes

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62
Q

What is acute otitis media often associated with?

A

Viral URTI - bacterial infection grows in viral fluid in ear

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63
Q

What is the most common cause of conductive hearing loss in children?

A

Otitis media with effusion (glue ear)

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64
Q

Why are neonates less likely to suffer from viral infection (and more likely bacterial)?

A

Passive immunity from mother

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65
Q

What is the CENTOR criteria for bacterial tonsillitis?

A 
Cough absent 
Exudate 
Nodes 
Temperature 
Young OR old
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66
Q

What is the commonest causative organism of tonsillitis?

A

Group A beta haemolytic strep

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67
Q

What percentage of tonsillitis is bacterial?

A

1/3

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68
Q

When should abx be prescribed in tonsillitis?

69
Q

Name a viral cause of tonsillitis?

70
Q

How should tonsillitis be managed?

A

Penicillin/erythromycin (if bacterial)
Hospital admission if unable to E+D
Analgesia for pain/fever

71
Q

How is tonsillitis diagnosed?

A

Clinically

+/- throat swab, rapid Ag test

72
Q

When is a tonsillectomy considered?

A

Recurrent bacterial tonsillitis
Peritonsillar abscess
Obstructive sleep apnoea

73
Q

What are the features of epiglottitis?

A

Rapid onset fever >38.5
Drooling (unable to swallow secretions)
Quiet stridor
Sore throat

(Cherry red epiglottis)

74
Q

How is epiglottitis managed?

A

DO NOT MOVE CHILD!!!!
Secure airway
Anaesthetist/ENT involvement

Blood cultures
IV ceftriaxone

Some children may respond to adrenaline/corticosteroids

Once extubated - PO coamox

75
Q

What is the commonest causative organism in epiglottitis?

76
Q

Acute otitis media mx

A

Admit if:

  • Severe systemic infx
  • Complications - masoiditis, meningitis
  • <3 mos with T > 38

Paracetamol/ibuprofen for pain

Delayed abx prescription - only to be used if symptoms persist for more than 3 days.

Abx: amoxicillin 5-7 days

77
Q

What is the usual course of otitis media?

A

3 days (but can last up to 1 week)

78
Q

How is amoxicillin prescribed in acute otitis media?

A

Can be delayed (e.g. use if symptoms persist by or worsen before 3 days)

79
Q

Do abx for otitis media have any effect on hearing loss?

80
Q

Important considerations in children presenting with fever

A

Immunizations?
Ill contacts
Travel abroad
Community illnesses

81
Q

Why do neonates rarely suffer from viral infections?

A

Passive immunity from mother

82
Q

Septic screen

A

Blood culture
FBC (incl WCC differential)
Urine
CRP

+CXR
+LP
+Rapid antigen test

83
Q

Abx in neonates

A

Cefotaxime

84
Q

Abx for Listeria

A

Ampicillin

85
Q

What should be considered if there is no obvious focus of infection?

A

Severe bacterial infection

Or viral prodrome

86
Q

Two commonest causative agents toxic shock syndrome

A

Toxin producing S.aureus

Group A strep

87
Q

Signs/symptoms TSS

A

High fever >39
Hypotension
Diffuse erythematous, macular rash - peeling skin

Mucositis - eyes, oral, genital. 
GI - vomiting/diarrhoea 
Renal
Liver 
Clotting 
CNS - altered consciousness
88
Q

Mx of TSS

A

ICU

  • IVI
  • Abx (clinda, vanc)
  • Vasopressor support

Surgical debridement of affected areas

89
Q

Complications of TSS

90
Q

Which toxin does S.aureus produce?

A

PVL Panton Valentine Leukocidin

– SUPERANTIGEN

91
Q

Causative agent in impetigo

92
Q

Risk factors for impetigo

A

Pre-existing skin lesions, e.g. eczema

93
Q

Impetigo Ix

94
Q

Impetigo Mx

A

Topical/PO flucloxacillin
Fusidic acid

HYGIENE +++ lots of hand washing to avoid autoinnoculation/spread to others

Do not go to nursey/school until the lesions are dry

95
Q

Periorbital cellulitis causes

A

Spread from sinusitis or dental abscess.

Local trauma to skin

96
Q

Periorbital cellulitis mx

A

Prompt IV abx (e.g. ceftriaxone)

Incision, drainage, culture may be necessary

97
Q

Complications of periorbital cellulitis

A

Spread into orbit (order CT to check spread)

98
Q

Toxin in staphylococcal scalded skin syndrome

A

Staphylococcus

99
Q

Pathophysiology of SSSS

A

Separation of the epidermal skin through granular layers

100
Q

SSSS features

A

Fever
Malaise
Purulent, crusting localised infection around eyes, nose and mouth with subsequent widespread erythema and tenderness of skin

Skin separates on gentle pressure

101
Q

SSSS mx

A

Hospital admission
IV abx (fluclox)
Analgesia

Monitor hydration (similar to burns)

102
Q

Hallmark of herpesviruses

A

After primary infection, virus becomes latent. Remains dormant in host.
Reactivation may occur after certain stimuli

103
Q

Commonest form of HSV in children

A

Gingivostomatitis

104
Q

Age of presentation gingivostomatitis

A

10 months to 3 years

105
Q

Features gingivostomatitis

A

Vesicular lesions on lips, gums, anterior surfaces of tongue and hard palate

Becomes ulcerated and bleeds

High fever, miserable child

106
Q

What route of administration of aciclovir should be used in chicenpox severe enough to warrant it?

107
Q

Which cells does the EBV virus attack?

A

B lymphocytes,

Epithelial cells of the pharynx (hence sore throat)

108
Q

Investigations for suspected EBV

A

Blood film - large atypical monocytes
Monospot test (heterophile antibodies)
Electrophoresis - IgM and IgG from seroconversion

109
Q

Presentation of EBV

A

Malaise
Fever
Tonsilitis
Lymphadenopathy

Petechiae on soft palate
Hepatosplenomegaly
Maculopapular rash

110
Q

Which abx should be avoided in pts with EBV?

A

Amox/Ampicillin - florid maculopapular rash

111
Q

EBV mx

A

Supportive (paracetamol, fluids, bed rest)

PO pred and admission if upper airway obstruction

IVIG if active bleeding

112
Q

What should pts with EBV be recommended to avoid for 8 weeks after?

A

Contact sports

113
Q

How long should patients with EBV avoid contact sports for?

114
Q

In which groups of patients is CMV particularly important?

A

Immunocompromised (incl. transplant recipients)

The foetus

115
Q

Treatment for CMV

A

IV ganclicovir

PO valganciclovir

116
Q

Complications of CMV

A 
Retinitis,
Oesophagitis,
BM failure, 
Colitis,
Pneumonitis
117
Q

Presentation of CMV

A

Tends to be subclinical or mild

  • Fever
  • Malaise
118
Q

Presentation of HHV6

A
  • Fever
  • Malaise
  • Generalised macular rash (Roseola infantum (exanthem))

– common cause of febrile convulsions

119
Q

Mx of HHV6/7

A

Most resolve spontaneously over days/week

Paracetamol/ibuprofen
Fluids

120
Q

Three ways parvovirus B19 is transmitted?

A

Respiratory
Vertical
Contaminated blood products

121
Q

Presentation of parvovirus B19

A

Erythema infectiosum - SLAPPED CHEEK

Fever
Malaise
Headache
Arthralgia

122
Q

Complications of parvovirus B19

A

Aplastic crisis.

Particular in children with high turnover of RBCs e.g. haemolysis (SCD, thalassaemia, G6PD) OR maliganancy (cannot fight infection)

123
Q

Effect of parvovirus b19 on fetus

A

Hydrops fetalis

124
Q

What type of virus causes hand, foot and mouth disease

A

Coxsackie A16

125
Q

Presentation of measles

A

Fever
Malaise
Cough, coryza

Maculopapular rash starting on head/behind ears and spreading over body

Koplik’s spots

126
Q

Complications of measles

A

Encephalitis
Subacute sclerosis panencephalitis (7 years later)
Respiratory

127
Q

Which vitamin deficiency is associated with a worser course of measles ?

A

Vitamin A

PO Vitamin A if admitted

128
Q

Treatment for measles

A

Notify Health Protection Unit

  • Isolation
  • Rest and fluids
  • Paracetamol/ibuprofen
  • Vitamin A PO (if admitted)
129
Q

Where does the mumps virus replicate?

A

Epithelial cells of the respiratory tract

Then into parotid glands

130
Q

What time of year is mumps most common?

131
Q

Presentation of mumps

A

Fever
Malaise
Parotitis (initially unilaterial then bilateral)

132
Q

Incubation period of mumps

A

15-24 days

133
Q

Most infective period of mumps

A

Within 7 days of parotitis

134
Q

What might children with mumps complain of?

A

Ear ache (parotid swelling)

135
Q

Which enzyme may be raised in mumps?

136
Q

What might abdominal pain in mumps indicate?

A

Pancreatic involvement

137
Q

Mx mumps

A

Notify Health Protection Unit

  • Isolation (don’t go back to school until 5 days after parotitis)
  • Rest and fluids
  • Paracetamol/ibuprofen
138
Q

Complications of mumps

A

Orchitis (uncommon in pre-pubertal boys)

Meningitis/encephalitis

139
Q

Presentation of rubella

A

Maculopapular rash starting at head and working its way over body

Low grade fever

Suboccipital/postauricular lymphadenopathy

140
Q

How is rubella diagnosis confirmed?

A

Serologically

141
Q

Treatment for rubella (child)

A

Notify HPU

Rest, fluids

142
Q

Effect of rubella on fetus

A

Cataracts

Cardiac (PDA)Deafness

143
Q

When is the fetus most at risk of rubella?

A

First 8 weeks of pregnancy maternal infection

144
Q

Commonest age Kawasaki’s

A

6mos - 4 years

145
Q

Who should not receive the BCG vaccination?

A

Immunosuppressed

146
Q

How is TB spread?

A

Resp into lymphatic system

147
Q

Where do children usually get TB from?

A

Infected adult in the household

148
Q

Clinical features of TB

A

Fevers
Anorexia/weight loss
Cough
CXR features (e.g. bilateral hilar lymphadenopathy, apical consolidation)

149
Q

Complications of TB

A

Miliary TB
TB meningitis
Coinfection with HIV

150
Q

How is TB diagnosed?

A

Ideally sputum sample, but this can be difficult to obtain. Three consecutive morning gastric washings. Cultured for AFB.

Mantoux test

Interferon gamma release assays

CXR changes

Clinical features

151
Q

How do interferon gamma release assays work?

A

Assess the respnse of T cells to specific antigen

152
Q

What constitutes a positive mantoux test?

A

> 10mm if no previoius BCG

>15 mm if previous BCG

153
Q

Which patients may show a false negative for a mantoux/IGRA test?

A

HIV - immunocompromise so do not mount immune response

154
Q

Management of active TB

A

Notify HPU

RI for 6 months
PE for first 2 months

(+pyridoxine vB6 for isoniazid)

Contract tracing

155
Q

How is latent TB managed?

A

3 months of rifampicin and isoniazid

156
Q

Commonest route of transmission HIV

A

Mother to child transmission

  • Intrauterine
  • Intrapartum
  • Postpartum (breastfeeding)
157
Q

Which group of HIV positive patients should start ART asap? Why?

A

Infants - they have an increased risk of disease progression

158
Q

How is HIV diagnosed (in <18mos and >18 mos)?

A

> 18 mos HIV IgG Abs

<18 mos HIV DNA PCR
(infant will retain transplacental IgG Abs if infected mother, so not a good test) - 2x negative tests after first 3 months of treatment rules out HIV

159
Q

What is the treatment for babies born to HIV+ mothers?

A

Zidovudine for 6 weeks

160
Q

Clinical features of HIV in paeds

A

Mild - recurrent fevers, lymphadenopathy, parotitis, thrombocytopenia, hepatosplenomegaly

Moderate - Recurrent bacterial infx, candidiasis, chronic diarrhoea, lymphocytic pneumonia

AIDs - PCP, malignancy, severe FTT

161
Q

What is the management of HIV in children?

A 
HAART 
Counselling incl family therapy 
Nutrition 
Weight and development monitoring 
Vaccinations (no live vaccines)
Prophylaxis for opportunistic infx
162
Q

What types of vaccines must not be given to HIV patients?

A

Live (e.g. BCG)

163
Q

What factor increases the likelihood of vertical transmission of HIV?

A

Viral load in the mother (and CD4 count)

164
Q

How is the risk of vertical transmission of HIV reduced?

A

Maternal/AN/PN ART - reduce viral load in mother to ideally undetectable before pregnancy/birth
Avoiding breast feeding
Avoiding PROM/instrumental delivery
Ideally a CS

165
Q

What is the incubation period of lyme disease?

166
Q

Eczema, thrombocytopenia, recurrent infections

A

Wiskott-Aldrich syndrome (WASP gene)

167
Q

When is SCID likely to have been fatal by if undiagnosed?

168
Q

Biochemistry SCID

A

Low T, B, Ig

Sarah Paeds (20 decks)

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