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Child Health > Infection/Immunology > Flashcards

Infection/Immunology Flashcards

1
Q

What proportion of cases of meningitis are viral?

What is the incidence of meningococcaemia?

A

2/3rds

Incidence meningococcaemia 0.7-1.4 in 100,000

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2
Q

How is meningococcus transmitted?

A

Large % have nasal/resp tract carriage

Transmitted via aerosol / nasopharyngeal secretion

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3
Q

What are the main virulence factors of meningococcus?

A

Polysaccharide capsule
Lipo-oligosachharide endotoxin (mediates invasion)
Immunoglobulin A1 protease (help org survive intracell)

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4
Q

At what ages are the Men C vaccine given?

A

3m, 4m + 1yr

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5
Q

Describe the physiology behind meningococcus effect on meninges/brain

A

Inflamm mediators + leucocytes → endothelial damage

→ Cerebral oedema
→ Raised ICP
→ Reduced cerebral blood flow

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6
Q

What are the main causative organisms of meningitis in:
Neonates (3)
1m-6yrs (3)
6yrs+ (2)

A

Neonates: GrpB Strep, E.Coli, Listeria

1m-6yrs: N.Meningitidis, S.pneumoniae, H.influenzae

6yrs+: N.Meningitidis, S.Pneumoniae

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7
Q

List some possible symptoms of bacterial meningitis in neonates (8)

A

NB more non-specific

Hyperthermia
Vomiting
Seizures
Bulging fontanelle

Irritability
Altered sleeping/eating
High pitched cry
Quiet child at rest but cries when moved/comforted

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8
Q

List some possible symptoms of meningitis in 3m-2yrs (5)

+ in >2-3yrs

A

NB more bact-associated

Vomiting
Fever

Irritability
Lethargy
Change in behaviour

In >2-3y/o: above + meningism (headache, stiff neck, photophobia)

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9
Q

What % of meningococcal meningitis get the rash?

Describe the rash (site + form)

A

Common: 50-80%

Axilla/flank/wrists/ankles
Non-blanching petechial rash (due to vasculitis)
Irregular in size
Necrotic centre

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10
Q

What other conditions to meningitis may exhibit neck stiffness? (2)

A

Tonsillitis

Cervical lymphadenopathy

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11
Q

What viruses may cause meningitis? (4)

A

Enteroviruses
Adenoviruses
Mumps
Epstein-Barr

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12
Q

What signs may be seen O/E in meningitis? (4)

A

Petechial rash (meningococcal)
Opisthotonus (arched back: raised ICP)
+ve Brudzinski (neck flexion supine → knee/hip flexion)
+ve Kernig (hip flex /knee extension supine → back pain)

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13
Q

What are the 4 element features of septicaemia?

A

Capillary leak: severe hypovol

Coagulopathy: bleed tendency + thrombosis in microvasc

Metabolic derangement: acidosis + hypokal/cal/mag/phos

Myocardial failure: direct damage from inflamm meds (func impaired even after circ vol/metab abns restored)

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14
Q

What signs may be seen on cardiac examination with septicaemia? (3)

A

Raised CVP
Hepatomegaly
Gallop rhythm

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15
Q

What are the features of meningococcal septicaemia? (10)

A

Fever
Vomiting
Headache
Rash (erythematous → petech/purpuric)

Hypotension
Tachycardia/pnoea
Cool extremities
Initially normal consciousness level

Myalgia
Abdo pain

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16
Q

What is the difference b/wn meningococcal septicaemia + meningococcal meningitis?

A

Septicaemia: pts present with shock
Meningitis: pts mainly present with raised ICP

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17
Q

List some DDx for meningococcal septicaemia (6)

A 
Sepsis
Febrile convulsions
Measles/mumps
ITP
HSP
Reye's syndrome (rapid encephalopathy from aspirin)
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18
Q

What is the immediate management of any child with a fever + purpuric rash?

A

Immediate IM benzylpenicillin + urgent transfer to hospital

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19
Q

What is the commonest pathogenic cause of sepsis in children?

A

Meningococcus

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20
Q

What Ix should be done if suspect meningococcal septicaemia? (11)

A 
FBC
Coag screen
U+Es
LFTs
Blood gases
Blood glucose
LP
Cultures: urine/blood/throat/stool
Rapid antigen test (for meningitis orgs)
CXR (if suspect TB)
Consider CT/MRI + EEG
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21
Q

Describe the management of meningococcal septicaemia (6)

A

Empirical broad spec Abx (depends on likely pathogen - usually 3rd gen cephalo like ceftriaxone/cefotaxime)

CVP
Catheterisation
Mechanical ventilation
Iotropic support (for myocardial contractility)
FFP + Platelets → correct any DIC (widespread microvasc thrombosis)

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22
Q

As well as Abx, what other drug must be given in meningococcal septicaemia for neonates?

A

Abx + Dexamethasone (reduce risk of long-term complications e.g. deafness)

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23
Q

What prophylaxis is given for household contacts of meningococcemia?

A

Rifampicin (eradicate nasopharyngeal carriage)

Men C vaccine

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24
Q

What is the mortality rate of meningococcaemia?

What is the incidence of serious complications?

A

15-20% neonates
5% risk in childen older than this

10-15% will have focal neuro sequelae

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25
Q

What are the possible complications on the nervous system of meningococcaemia? (9)

A

Hearing loss
Visual field defects

Facial palsy
Local vasculitis → CN palsy/ other focal lesion
Hemiparesis

Hydrocephalus
Subdural effusion (pneumococcal + HiB)

Epilepsy (local cerebral infarct → multi/focal seizures)

Cerebral abscess

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26
Q

What are the other (not CNS) complications of meningococcaemia (6)

A

Bacterial endocarditis
Pericarditis

DIC
Thrombocytopenia

Septic arthritis
Gangrene

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27
Q

What may be the underlying cause in pts with recurrent meningococcaemia?

A

Underlying immune deficits

30% recurrent meningococcaemia have complement defc

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28
Q

What are the poss causative organisms for neonatal early onset sepsis (4) + neonatal late onset sepsis (7)

A

Early (from birth canal):
GrpB Strep / E.Coli / Listeria / H.Influenzae

Late (from environment):
Staph epidermidis
Staph aureus
E.Coli / Enterococci / Klebsiella / Pseudomonas 
Candida
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29
Q

What are the 2 main ‘at risk’ groups for septicaemia + common associated pathogens?

A

Immunodeficient: pneumococcus

Chronic resp illness: pseudomonas

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30
Q

Describe the physiology behind Shock

A

= Inadequate substrate/oxygen delivery
→ anaerobic → lactic acid accum

→ Cannot maintain homeostasis → disrupt ion pumps

→ intracellular Na influx / K efflux
→ Cells swell / memb breakdown / cell death
→ Multiorgan failure

31
Q

What are the 3 main features in which you should assume shock?

A

Prolonged CRT
Tachycardia
Cool extremities

32
Q

What are some early (compensated) features of shock (8)

A 
Tachycardia
Tachypnoea
CRT > 2s
Core-peripheral temp gap >4 degrees
Pale/cold/mottled skin

Sunken eyes/fontanelle
Reduced skin turgor
Reduced urine output

33
Q

What is the physiological mechanisms behind early/compensated shock

A

BP maintained by increased HR/RR

Blood diversion from non-essentials e.g. skin

34
Q

What are some late (decompensated) features of shock (6)

A

Acidotic breathing (Kussmaul)
Bradycardia
Blue peripheries
Hypotensive

Confusion/reduced consciousness
Anuria

35
Q

What empirical Abx for sepsis are given in neonates?

+ in older infants / older children?

A

Neonates: ampicillin + gentamicin/3rd gen cephalo
Older: 3rd gen cephalo

36
Q

Outline the management of shock (9)

A

BLS
Abx
High-flow O2

Volume replacement (20ml/kg)
Intubation/ventilation
(if still shocked after 2x VR - even if still alert)

Correction of acidosis
Correction of elec abns
Correct coagulopathy → FFP
Correct anaemia → blood

37
Q

How is management of fluid resuscitation different depending on whether responsive to initial volume replacement

A

Responsive: monitor/reassess for further shock/pulm oedema
Unresponsive: further VR (may have 2x bolus) + poss ionotropic support + poss adrenaline

38
Q

Describe Type 1 Hypersensitivity reaction: initial + subsequent

A

Initial: allergen → antigen-presenting cell → Thelper
→ B cells (with IgE-bound)

Thelper cells produce cytokines → B cells prolif
→ plasma cells (IgE producing)

IgE → mast cells (now sensitised)

Subsequent: allergen → mast cell IgE
→ Inflamm mediator release
(preformed e.g. histamine + arachidonic acid derived)

→ Vasodilation / SM contraction
→ Small vessel permeability
→ Mucus secretion

39
Q

What Ix may be done into allergies? (4)

A

Detailed clinical Hx
Hypersensitivity marker bloods
Patch testing (cutaneous allergens)
Stimulus introduced in controlled conditions

40
Q

What other condition is assoc w. eczema in young infants?

What conditions assoc w. allergic rhino-conjunctivitis? (4)

A

Link b/wn eczema + food allergy (esp egg)

Eczema, sinusitis, adenoidal hypertrophy, asthma

41
Q

Define effects of mild/moderate/severe insect sting hypersensitivity

A

Mild → local swelling
Moderate → generalised urticaria
Severe → systemic symps with wheeze/shock

42
Q

What types/drugs are commoner for allergic reaction? (6)

A 
Antibiotics (penicillins/cephalosporins)
Anaesthetics (lidocaine)
Analgesics (aspirin, NSAIDs)
Dextran (anticoag)
Opiates
Radiocontrast media
43
Q

What are the short-term risks in HIV infection (2)

What are the long-term risks (6)

A

Opportunistic infections
Pancytopenia (thrombi/anaemia/neutropenia)

Non-compliance
Transmission
Failure to thrive
Cancers (Kaposi's sarcoma, Non-Hodgkins)
Neuropathy/myelopathy
HIV encephalopathy
44
Q

What is EBV infection characterised by? (4)

A

1-2wks H/o malaise/fatigue (persisting fatigue)
Pharyngitis
Generalised lymphadenopathy
Hepatosplenomegaly

45
Q

List the possible symptoms that may be seen in EBV/Glandular fever (6)

A 
Fever (>90%)
Sore throat
Headache
Nausea
Myalgia
Abdo pain
46
Q

List some possible complications of EBV infection (10)

Harry Tries Justifying His Stupid ‘Necessities’ + Unrealistic Costly Recreational Plans

A 
Hepatitis (90%)
Thrombocytopenia (mild) (50%)
Jaundice (5%)
Haemolytic anaemia
Splenic rupture (req splenectomy)
Neuro complications (coma/meningitis/enceph/CN palsy)
Upper airway obstrn
Chronic fatigue syndrome
Reye syndrome
Peri/myocarditis
47
Q

What is Kawasaki disease

What age group does it affect?

A

Rare type vasculitis of medium-sized blood vessels

Affects <5yrs

48
Q

How may Kawasaki disease present?

What are the Dx criteria? (6)

A

Severe fever unresponsive to meds + viral-like symps

Temp ≥38 for >5d plus at least 2 of:
Rash
Cervical lymphadenopathy
Conjunctivitis (bilateral)
Oral/throat changes (cracked lips/strawberry tongue)
Arm/leg skin changes (swelling/red/peeling)

49
Q

How long spent in acute/sub-acute/convalescent phase of Kawasaki disease?

A

Acute (Weeks 1-2)
Sub-acute (Weeks 3-4) (less severe symps)
Convalascent (weeks 4-6) (lethargy persists)

50
Q

List the symptoms that may be seen in the sub-acute phase of Kawasaki disease (8)

A 
Lethargy
Headache
Joint pain
Peeling skin
Abdo pain
Jaundice
D+V
Pyuria
51
Q

In what phase of Kawasaki disease are complications most likely to happen?
What is the main concerning complication involved with mortality?
What is the mortality rate of Kawasaki disease?

A

Sub-acute phase:
Coronary aneurysms likely to develop (in 1/3rd pts)
→ MI / Sudden death
Mortality 1-2%

52
Q

What Ix can be done into Kawasaki disease? (4)

How is it Dx?

A

CRP/ESR (raised)
WCC (raised)
Platelets (raised - in 2nd wk)
ECHO (for aneurysm)

Clinical Dx

53
Q

Describe the management of Kawasaki disease (4)

A

Prompt IVIG (+ infliximab/steroids/ciclosporin if persistent)

Aspirin: high dose until fever/inflamm markers normal + low-dose until normal ECHO

Antiplatelets (if platelets high)

Long term warfarin (if large aneurysm)

54
Q

List some possible non-deliberate causes of immunosuppression (5)

A

Malnutrition
Ageing
Certain cancers (leukaemia/lymphoma/multi-myeloma)
AIDS
Drug side effect (treating other condition)

55
Q

List/catagorise the different causes of immunodeficiency (1+7)

A

Primary (uncommon): inherited / autosomal recessive

Secondary:
Intercurrent viral/bacterial
HIV
Malignancy
Malnutrition
Immunosuppressants
Splenectomy
Nephrotic syndrome
56
Q

What is immunodeficiency characterised by?

A

SPUR infections:

Serious / Persistent / Unusual / Recurrent

57
Q

List some diff T cell defect conditions (6)

A 
Severe Combined Immunodefc (SCID) (inheritable)
HIV (progressive defc)
DiGeorge syndrome (absent thymus)
Duncan syndrome (abnormal EBV response)
Wiskott-Aldrich (triad w. thrombocytopenia/eczema)
Ataxia Telangiectasia (DNA repair defect)
58
Q

List some diff B cell defect conditions (4)

A

Selective IgA defc (commonest)

X-linked agammglobulinaemia
(abnorm tyrosine kinase - for B cell maturation)

Common Variable Immunodefc (CVID) - B cell defc
(high risk autoimmune + malignancy)

Hyper IgM syndrome
(B cells make IgM but cannot switch it →IgG/A)

59
Q

How do T cell defects present? (5)

A 
In 1st 3m 
Severe/unusual viral/fungals
Failure to thrive
Severe bronch/diarrhoea/oral thrush
PCP
60
Q

How do B cell defects present? (4)

A

In 1st 2yrs (beyond infancy due to passive immunity)
Failure to thrive
Severe bacterial infections (ear/sinus/skin/pulm)
Complications of recur rents (bronchiectasis/hearing loss)

61
Q

How do neutrophil defects present (5)

A 
Recurrent bacterial infections
Abscesses
Poor wound healing
Invasive fungals e.g. aspergilliosis
Granulomas (from chronic inflamm)
62
Q

Give an example of neutrophil defect

A

Chronic granulomatous disease

X-linked recessive phagocytosis defect

63
Q

How do leucocyte function defects present? (4)

A

Delayed umbilical cord separation
Delayed wound healing
Chronic skin ulcers
Deep seating infections

64
Q

Give an example of leucocyte function defect

A

Leucocyte Adhesion Defect (LAD)

Inability for neutrophils to migrate to inf/inflamm site

65
Q

How do complement defects present? (2)

A

Recurrent bacterial + meningococcal infections

SLE-like illness

66
Q

Give 3 examples of complement defect conditions

A

Early complement component defc
Terminal complement component defc
Mannose-binding lectin (MBL) defc

67
Q

What are the 5 options for prevention/treating infections in immunodefc? (PIGS in Bs)

A

Antimicrobial prophylaxis:
T-cell/neutrophil → co-trimox (PCP) / antifungals
B-cell → Abx (azithromycin)

Ig replacement
Gene therapy (certain types SCID)
Screen for end-organ disease
Bone marrow transplant

68
Q

What pathogens may cause typhoid fever? (2)

What is the route of transmission

A

Salmonella thyphi
Parathyphi infection

Via contaminated food/water

69
Q

What are the clinical features of typhoid fever? (10)

A 
Worsening fever
Malaise/myalgia
Headache
Cough
Bradycardia

Abdo pain
GI symps (2nd wk)
Anorexia
Splenomegaly

Rose spots**

70
Q

What are the poss complications of typhoid fever? (4)

A

GI perforation
Myocarditis
Nephritis
Hepatitis

71
Q

What age children are affected worse by malaria?

What % of child deaths?

A

6m-5yrs

Where endemic = 10% all child deaths

72
Q

What are the clinical features of malaria

A 
Fever
Thrombocytopenia
Anaemia
Jaundice
D+V
Flu-like symptoms
73
Q

What happens in cerebral malaria?

What are the main features (2)

A 
Rapid encephalopathy (occurs in 20-50% pts)
from parasites adhering to cerebral microvasc (→ ischaemia/blockage)

Raised ICP
Seizures

Child Health (14 decks)

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