Infections Flashcards
Main causative organisms of bacterial meningitis for each age category?
Neonates - Group B strep, E.coli, listeria
1 month - 6 years - HiB, Neisseria
Adolescents - Neisseria, strep pneumoniae
Uni age - Neisseria, Men A/C/W/Y
What are Kernig’s and Brudzinski’s signs?
Kernig = K for Knee, pain on extension of knee with hips flexed
Brudzinski’s = Hips and knees flex when neck flexed
Purpura in a febrile child?
Always assume meningococcal sepsis until proven otherwise
Administer IM Ben Pen and refer to hospital immediately for assessment
Contraindications to lumbar puncture?
Cardiorespiratory instability
Raised ICP - focal neurology, coma, papilloedema
Coagulopathy
local site of infection
CSF results in LP for bacterial meningitis
Cloudy/turbid appearance
Protein high (>1g/L)
Glucose low
Cells - neutrophils
LP CSF results for viral meningitis?
Clear appearance
Protein normal/raised
Glucose normal
Cells - lymphocytes
Management of bacterial meningitis?
IM Ben Pen in Primary care
IV Cefotaxime + Ceftriaxone
+ IV Dexamethasone to reduce ICP and neurological sequelae
Criteria for needing prophylaxis in bacterial meningitis
Family members + close contacts (>4hrs in the same room)
Rifampicin
Most important viral meningitis?
Herpes Simplex Virus - associated with hearing loss
Treated with Aciclovir
Difference between sepsis and septicaemia
Sepsis = infection + SIRS - systemic inflammatory response syndrome
Septicaemia = specifically an infection of the bloodstream, often co-existing with meningitis (60%)
Causative organisms and Mx of septicaemia?
Neonates - Group B strep
Others - Strep pneumoniae
Same Mx as meningitis:
IV Cefotaxime + Ceftriaxone
IM Ben Pen in primary care
Clinical course of Chicken Pox (VZV)
Fever, malaise for up to 4 days
rash: popular –> vesicular –> pustule –> crust
Very itchy, covers head neck and trunk
Management of chickenpox
Minimise itching - antihistamines and emollients
Avoid contact with pregnant women/neonates/immunocompromised
School exclusion until lesions crusted over
Management of conjunctivitis?
Clean eyes with saline/water
Topical Neomycin
if more concerning consider bacterial gonococcal/chlamydia infection (3rd gen Ceph)
Investigations for suspected food allergy?
Skin prick test –> -ve test unlikely to be IgE mediated, more likely food intolerance
RAAST test - measures circulating levels of IgE
Which food allergies persist and which resolve?
Cow’s milk and egg - typically resolves over time
Nuts and seafood - usually persists into adulthood
Clinical features of Infectious mononucleosis (IM)/EBV / glandular fever
low grade fever, prolonged malaise
sore throat and tonsillar enlargement
fatigue potentially persisting for several months
EBV associated with Burkitt’s lymphoma
Investigations of IM
Monospot test
heterophile antibodies specific to EBV
Clinical course of Kawasaki disease
Fever >5 days - typically >39 degrees
Conjunctivitis
Widespread polymorphous rash
Red cracked lips, dry inflamed (strawberry) tongue
Unilateral cervical lymphadenopathy
Swelling and desquamation of hands and feet
Acute phase 1-2 weeks, sub-acute 2-8 weeks
Management of Kawasaki Disease
Admit for support + monitoring of cardiac complications
Echocardiogram at diagnosis, in 2nd week and 2 months after diagnosis
IV immunoglobulin to cause defervescence
High dose Aspirin initially, then low dose for 8 weeks
Investigations in Kawasaki disease
FBC - show marked rise in platelets in 2nd/3rd week - up to 1000 x 10^9
Serum ESR and CRP ^^
Cause and clinical course of Measles
Paramyxovirus infection
2 week incubation
Cough + conjunctivitis, coryza
Koplik’s spots - white dots on Buccal mucosa (pathognomonic)
Morbilliform rash - red macular lesions 2-10mm
Investigations in Measles infection
Measles specific immunoglobulin M (IgM)
Management for measles
Viral, self limiting infection - supportive - antipyretics
Consider vitamin A supplementation
