Infections Flashcards

1
Q

WHAT IS KAWASAKI

A

A SYSTEMIC VASCULITIS

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2
Q

WHO IS COMMONLY AFFECTED BY KAWASAKI

A

CHILDREN AGED 4M-6Y

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3
Q

WHAT IS THE PRESENTATION OF KAWASAKI

A

WEEK ONE

  • FEVER LASTING 5 DAYS
  • CONJUNCTIVITIS
  • STRAWBERRY TONGUE AND CRACKED LIPS
  • CERVIACLE LYMPHADENOPATHY
  • POLYMORPHUS RASH

WEEK 2-4

  • RED OEDEMATUS PALMS AND SOLES THAN THEN CAUSES PEELING OF SKIN ON DIGITS

WEEK 3-8

  • CARDIOVASULAR SIGNS
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4
Q

HOW DO YOU DIAGNOSE KAWASAKI

A

FEVER LASTING 5 DAYS PLUS 4 OTHER SYMPTOMS

BLOODS:

RAISED ESR, CRP, PLATELETS

ECHO AT WEEKS 6+8 TO ASSESS CARDIAC INVOLVEMENT

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5
Q

WHAT IS THE CARDIOVASCULAR RISK ASSOCIATED WITH KAWASAKI

A

CORONARY ANEURISM

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6
Q

HOW DO YOU TREAT KAWASAKI

A

IvIg x10D

ASPRIN

CLOPIDROGEL (ANTIPLATELET)

INFLIXIMAB IF THERES PERSISTENT FEVER

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7
Q

WHAT WOULD THE CARDIAC SIGNS OF KAWASAKI BE

A

GALLOP RYTHUMN

MYOCARDITIS

PERICARDITIS

CORONARY AND PERIFERAL ANEURISMS

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8
Q

HOW DO YOU MANAGE A GIANT CELL ANURISM

A

WARFRIN AND FOLLOW UP

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9
Q

WHAT CELLS DOES HIV AFFECT

A

MACROPHAGES

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10
Q

DESRIBE HOW MOTHER CHILD HIV TRANSMISSION OCCURS

A

AT BIRTH

BREAST FEEDING

EN UTERO

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11
Q

HOW DO YOU DIAGNOSE HIV IN A CHILD

A

DNA PCR IN A CHILD OVER 18M

BEFORE 18 MONTHS THEN YOU CAN ONLY ASSESS FOR NEGATIVE DIAGNOSIS

  • COMPLETION OF ANTENATAL ANTIVIRALS
  • X2 NEGATIVE PCR
  • X1 PCR AFTER 18 MONTHS
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12
Q

WHY CANT YOU REALLY DIAGNOSE A CHILD WITH HIV BEFORE 18M

A

MATERNAL ANTIBODIES STILL ARE PRESENT

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13
Q

IF UNTREATED WHEN DOES CHILD HIV TURN TO AIDS

A

VARYING FROM 1Y +

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14
Q

WHAT ARE MILD PRESENTATIONS OF HIV

A

LYMPHADENOPATHY

PAROTITIS

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15
Q

WHAT ARE MODERATE PRESENTATIONS OF HIV

A

RECURRENT BACTERIAL INFECTIONS

CANDIDIASIS

CHRONIC DIARRHOEA

LYMPHOCYTIC INTERSTITIAL PNEUMONITIS

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16
Q

WHAT ARE SEVERE PRESENTATIONS OF HIV

A

OPPORTUNISTIC INFECTIONS

SEVERE FAILURE TO THRIVE

ENCEPHALOPATHY

MALIGNANY

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17
Q

WHAT IS THE TREATEMENT FOR HIV AIDS IF CD4 IS 200-350

A

2 NEUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS

1 NON NEUCLOSIDE REVERSE TRANSCRIPTASE INHIBITORS

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18
Q

WHAT IS THE TREAMENT FOR HIV AIDS OF CD4 >350

A

2 NEUCLOSIDE REVERSE TRANSCRIPTASE INHIBITORS

1 PROTEASE INHIBITORS

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19
Q

WHAT IS ALWAYS GIVEN TO HIV PATIENTS

A

PCP (CO-TRIMOXAZOLE) IF OVER AGE OF 4

ALL VACCIENES BUT NOT BCG

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20
Q

WHAT ARE GENERAL SIGNS OF A HIV CHILD ON PRESENTATION

A

PERSISTENT LYMPHADENOPATHY

HEPATOSPLENOMEGALY

RECURRANT FEVER

THROMBOCYTOPENIA

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21
Q

HOW DO YOU REDUCE THE RISK OF VERTICAL TRANSMISSION IN HIV

A

ANTIRETROVIRAL DRUGS IN PREGNANCY // BEFORE

NOT BREAST FEEDING

AVOIDING PROLONGED ROM

NO INSTRUMENTAL DELIVARIES

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22
Q

WHAT IS ENCEPHALITIS

A

INFLAMMATION OF THE BRAIN

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23
Q

WHAT ARE CAUSES OF ENCEPHALITIS

A

MAINLY VIRAL

  • HSV
  • ENTEROVIRUS (MOST COMMON)
  • POST INFECTIOS TO CHICKEN POX AND MEASLES
  • HIV
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24
Q

WHAT IS THE PRESENTATION OF ENCEPHALITIS

A

FEAVER

HEADACHE

DECREASED CONCIOUSNESS

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25
HOW DO YOU DIAGNOSE ENCEPHALITIS
BLOOD CULTURES SWABS (SKIN AND THROAT) LP IMAGING
26
WHAT IS THE COMMON ISSUE FACED WHEN DIAGNOSING ENCEPHALITIS
ORGANSIM CAN ONLY BE FOUND IN 50% OF CASES
27
WHAT IS THE MANAGEMENT OF ENCEPHALITIS
TREAT AS MENINGITIS/HSV ENCEPHALITIS UNTIL PROVEN OTHERWISE THEN SUPPORTIVE UNLESS HSV ENCEPHALITIS THEN USE ACYCLOVIR +- PHENYTOIN (ANTICONVUSLANT)
28
WHAT IS MENINGITIS
INFLAMMATION OF THE MENINGES USUALLY DUE TO BACTERIA: PRECEEDED BY BACTEREMIA CAUSING A SEVERE IMMUNE RESPONSE
29
WHAT PATHOGENS USUALLY CAUSE MENINGITIS AT 0-3M
GBS E COLI LISTERIA
30
WHAT PATHOGENS USUALLY CAUSE MENINGITIS AFETR 3M
NISSERIA MENINGITIDES STREP. PNEUMONIA H. INFUENZA MININGOCOCCUS (V BAD)
31
WHAT IS THE PRESENTATION OF MENINGITIS IN AN ONLDER CHILD
FEVER PHOTOPHOBIA HYPOTONIA DROWSINESS NECK STIFFNESS SHOCK SEIZURES PURPURIC NON BLANCHING RASH
32
HOW DO YOU INVESTIGATE MENINGITIS
BLOOD CULTURES BLOOD GLUCOSE GASSES COAG SCREEN + LACTATE MSU THROAT SWAB LP PCR
33
YOU DO AN LP IN A ?MENINGITIS CHILD THE CSF IS: * TURBID * POLYMORPHS * HIGH PROTEIN * V. LOW GLUCOSE WHAT IS THE PATHOGEN TYPE
BACTERIAL
34
YOU DO AN LP IN A ?MENINGITIS CHILD THE CSF IS: * CLEAR * LYMPHOCTURES * NORMAL PROTEIN * LOW GLUCOSE WHAT IS THE PATHOGEN TYPE
VIRAL
35
YOU DO AN LP IN A ?MENINGITIS CHILD THE CSF IS: NORMAL (BUT CAN BE TURBID) * LYMPHOCYTES * VERY HIGH PROTEIN * VERY LOW GLUCOSE WHAT IS THE PATHOGEN TYPE
TB
36
WHAT IS THE MANAGEMENT OF MENINGITIS
SUPPORTIVE ABX DEXAMETHOSONE BUT NOT IN INFANTS
37
WHAT ARE THE ABX TO TREAT MENINGITIS
CEFPTAXIME FOR 21DAYS
38
WHAT IS THE TREATEMENT FOR CHILDREN UNDER 3M WITH MENINGITIS
CEFOTAMINE + AMOXICILLIN FOR 14D
39
WHEN IS PROFYLAXIS GIVEN TO CLOSE CONTACTS AND WHAT IS THE ABX USED
WHEN THE MENINGITIS IS CAUSED BY NISSERIA MENINGITIDIS OR H INFLUENA RIFAMPACIN
40
WHAT ARE THE COMPLICATIONS OF MENINGITIS
DEATH CEREBRAL INFARCTION SUBDURAL EFFUSION - H INFLUENZA HYDROCEPHALUS CEREBRAL ABCESS LOCAL VASCULITIS HEARNING LOSS
41
WHAT ARE VIRAL CAUSESOF MENINGITIS
ENTEROVIRUS EBV ADENOVIRUS MUMPS
42
WHAT IS HSV
A COMMON VIRAL INFECTION THAT GOES THROUGH PERIODS OF LATENCY AND LONG TERM PERSISTANCE
43
WHAT ARE THE TYPES OF HSV
HSV 1 - LIP AND SKIN LESIONS HSV 2 - GENITAL LESIONS
44
WHAT IS THE PRESENTATION OF HSV
PAINFUL VISICULAR LESIONS ON GUMS AND LIPS * GINGIVOSTOMATITIS AT MUCOCUTANEOUS JUNCTIONS HIGH FEVER AND IRRITABLE CHILD BLEPHERITIS AND CONJUNCTIVITIS ENCEPHALITIS/ESEPTIC MENINGITIS ECZEMA HERPETICUM HERPETIC WHITLOWS
45
WHAT COMPLICATIONS OF HSV THAT CAN MANIFEST DURING A PRIMARY/ACUTE ATTACK
ECZEMA HERPATICUM LEADING TO SERIOUS SECONDARY INFECTIONS CONREAL SCARRING FROM BLEPHERITIS AND CONJUNCTIVITIS
46
WHAT IS THE TREATEMENT FOR HSV
TOPICAL ACYCLOVIS IV ACYCLOVIR IN ENCEPHALIIS OR IN IMMUNOCOMPRIMESED
47
WHAT IS SCOLDED SKIN SYNDROME
A SKIN INFECTION BY STAPHYLOCOCCUS OR GROUP A STREP
48
WHAT IS THE PATHOPHYSIOLOGY OF SCALDED SKIN SYNDROME
BACTERIA RELEASESUPERTOXINS WHICH CAUSE THE SEPARATION OF EPITHELIAL SKIN THROUGH TO THE GRANSULAR LAYER
49
WHAT IS THE PRESENTATION OF SCALDED SKIN SYNDROME
FEVER REDNESS PEELING SKIN LESIONS RAW SKIN
50
WHAT IS THE TREATEMENT OF SCALDED SKIN SYNDROME
IV ABX ANALGESIA FLUID BALANCE
51
WHAT ABX WOULD YOU USE FOR SCALDED SKIN SYNDROME
FLUCLOXACILLLIN CEFALEXIN CLINAMYCIN
52
WHAT IS THE PRESENTATION OF PRIMARY TB
90% ASYMPTOMATIC IF HOST CANNOT CONTAIN THE TB * FEVER * ANOREXIA * WEIGHT LOSS * COUGH * CHEST X RAY * LYMPHADENOPATHY * SOB * GHON PRIMARY COMPLEX
53
WHAT IS THE PRESENTATION OF POST PRIMRY TB
COUGH FEVER NIGHT SWEATS WEIGHT LOSS CHEST PAIN MENINGITIS Sx BONE AND JOINT PAIN POTTS DISEASE
54
WHAT WOULD TUBERCULUS PLEURITIS CAUSE AS A CARDINAL Sx
CHEST PAIN
55
WHAT WOULD TUBERCULUS CNS INVOLVEMENT CAUSE AS A CARDINAL Sx
MENINGITIS Sx
56
WHAT WOULD MILLARY TUBERCULUS CAUSE AS A CARDINAL Sx
BONE AND JOINT PAIN
57
HOW WOULD YOU DIAGNOSE ACTIVE TB
SPUTUM SAMPLE GASTRIC WASHING W THREE DAYS NG TUBE URINALYSIS IF SUGGESTIVE: LYMPH NODE EXTUSION CSF C XRAY
58
HOW WOULD YOU DIAGNOSE EXPOSURE TO TB
MANTOUX TEST IGRA
59
WHAT IS THE MANTOUX TEST
A PUREFIED PROTEIN DERIVATIVE TEST TO CHECK SENSITIVITY OF THE IMMUNE SYSTEM TO TB
60
A CHILD HAS HAD THEIR BCG VACCIENE AND THEIR MANTOUX COMES BACK WITH A SWELL OF \>15MM IS THIS RESULT POSITIVE OR NEGATIVE FOR TB
POSITIVE
61
A CHILD HASNT HAD THEIR BCG VACCIENE AND THEIR MANTOUX COMES BACK WITH A SWELL OF \>10MM IS THIS RESULT POSITIVE OR NEGATIVE FOR TB
POSITIVE
62
WHAT IS IGRA
INTERFERON GAMMA RELEASE ASSEYIS A BLOOD TEST ASSESSING T CELL STIMULATION TO ANTIGENS
63
WHAT HAPPENS TO MANTOUX AND IGRA IF PATIENT IS HIV POSITIVE AND HAS HAD TB
BOTH ARE NEGATIVE
64
HOW DO YOU TREAT TB
RIFAMPACIN - 6M ISONIAZID-6M PYRAZINAMIDE-2M ETHAMBUTOL - 2M
65
WHAT ARE THE SIDE EFFECTS OF THE TB DRUGS
RIFAMPACIN - RED/ORANGE URINE ISONIAZID-PERIFERAL NEURITIS PYRAZINAMIDE-DECREASED VISUAL ACUITY ETHAMBUTOL - INCREASED URIC ACID CAUSING GOUT
66
WHEN WOULD YOU GIVE PYRIDOXINE WITH ISONIAZID
POST PUBERTY TO DECREASE CHANCES OF PERIFERAL NEURITIS
67
WHAT IS POLIO
A SERIOUS VIRAL INFECTION
68
WHAT IS THE PRESENTATION OF POLIO
ASYMTOMATIC MAINLY CAN HAVE * HIGH FEVER * SORE THROAT * HEADACHE * ABDO PAIN * N+V * PARALYSIS- CAN BE TEMOPRARY OR PERMANENT BUT CAN ALSO BE LIFE THREATNING
69
WHAT IS THE MANAGEMENT FOR POLIO
SUPPORTIVE CARE =/- VENTILATION PHYSIO IF AFFECTED BY PARALYSIS
70
WHAT CAN BE LONG TERM PROBLEMS OF POLIO
DEGREES OF PARALYSIS MUSCLE WEAKNESS MUSCLE ATROPHY TIGHT JOINTS DEFORMITIED IE TWISTED FEET POST POLIO SYNDROME
71
WHAT IS POST POLIO SYNDROME
LATE ONSET (15+YRS AFTER POLIO) CNS SYMPTOMS * DECREASED MUSCULAR FUNCTION * ACUTE WEAKNESS * PAIN * FATIGUE
72
WHAT IS THE VACCIENE SCHEDULE FOR POLIO
THE 6-IN-1 AT: * 8W * 12W * 16W THE 4-IN-1 AT * 3 1/2 Y TEENAGE BOOSTER * AT 14Y
73
WHAT PATHOGEN CAUSES WHOOPING COUGH
BORDATELLA PERTUSIS
74
HOW DOES WHOOPING COUGH PRESENT IN OLDER CHILDREN
WEEK 1 * CORYZAL SYMPTOMS * PROXYMAL SPASMODIC COUGH * VOMITING * TURNING BLUE DURING COUGH * COUGH WORSE AT NIGHT WEEK 7 - END OF COUGH
75
WHAT IS THE PRESENTATION OF WHOOPING COUGH IN INFANTS
APNAOE WHOOP IN COUGH SUNJUNCTIVAL HAEMORROIDS
76
WHAT ARE COMPLICATIONS OF WHOOPING COUGH
PNEUMONIA CONVULSIONS BRONCHIECTASIS
77
WHAT INVESTIGATIONS ARE REQUIRED FOR WHOOPING COUGH
PERI NASAL SWABS AND CULTURES BLOODS: V RAISED LYMPHOCYTES
78
WHAT IS THE MANAGEMENT OF WHOOPING COUGH
INFANTS AND YOUNG CHILDREN ISOLATED ERYTHOMYCIN (ONLY WITHIN THE FIRST THREE WEEKS) GIVE ERYTHROMYCIN PROFYLAXIS TO CLOSE CONTACTS
79
DESCRIBE THE VACCIENE SCHEDULE FOR WHOOPING COUGH
PREGNANCY VACCIENE AT 2, 3, 4 MONTHS AND AGAIN AT 3.5Y AS THE 4-IN-1
80
WHAT IS THE PATHOGEN THAT CAUSES DIPTHERIA
CORYNEA-BACTERIUM DIPTHERIAE
81
WHAT IS THE PRESENTATION OF DIPTHERIA
HIGH FEVER CYANOSIS BRASSY BARKING COUGH (DIPTHERIC CROUP) BULL NECK LYMPHADENOPATHY GREY PSEUDOMEMBRANES FOUL SMELLING BLOODY NASAL DISCHARGE
82
WHAT COMPLICATIONS CAN ARISE DUE TO DIPTHERIA
ARRYTHMIAS SKIN LESIONS\MOCARDITIS NERVE PALSEYS
83
WHAT ARE THE INVESTIGATIONS FOR DIPTHERIA
THROAT SWAB + CULTURES OR CLINICALLY: URTI + GREY PSUDOMEMBRANES
84
HOW WOULD YOU TREAT DIPTHERIA
METRONIDAZOLE ERYTHROMYCIN FOR 14 DAYS DIPTHERIA ANTITOXIN
85
WHAT IS QUINAVAXEM
THE VACCIENE FOR DIPTHERIA
86
WHAT IS THE VACCIENE SCHEDULE FOR DIPTHERIA
6 10 14 WEEKS
87
WHAT IS RUBELLA
A RARE VIRAL DISEASE WHICH IS ACQUIRED CONGENITALLY CAN HAVE VERY SERIOUS COMPLICATIONS
88
WHAT IS THE PRESENTATION OF RUBELLAIF ACQUIRED IN CHILDHOOD
MILD FEVER MACHULOPAPULAR RASH - NON ITCHY LYMPHADENOPATHY - SUBOCCIPITAL AND POST AURICULAR
89
WHAT ARE THE CHARACTERISTIC FEATURES OF A RUBELLA RASH
STARTED AT FACE/BEHIND EARS SPREADS CENTRIFUGALLY AROUND THE BODY FADES AFTER 3-5 DAYS
90
WHEN ARE COMPLICATIONS MORE LIKELY TO HAPPEN WITH RUBELLA
IF ACQUIRED BY ADULT OR EN UTERO
91
WHAT ARE COMPLICATIONS (NOT EN UTERO) OF RUBELLA
ARTHERITIS ENCEPHALITIS THROMBOCYTOPENIA MYOCARDITIS
92
WHEN IS IT NECESSARY TO TEST SERIGICALLY FOR RUBELLA
IN PREGNANCY
93
WHAT ARE COMMON COMPLICATIONS OF CONGENITALLY ACQUIRED RUBLELLA
ACQUIRED UNDER 8W DEAFNESS CHD CATARACTS ACQUIRED AT 13-16W IMPAIED HEARING AFTTER 18 W MINIMAL DAMAGE
94
WHAT ARE LESS COMMON COMPLICATIONS OF CONGENITAL RUBELLA
PDA RETINOPATHY INTREACEREBRAL CALCIFICATION IUGR NEUROLOGICAL DISABILITY
95
WHAT IS CHORIORETINITIS
A COMPLICATION OF CONGENITALLY ACQUIRED RUBELLA WHICH DEVELOPS IN ADULHOOD
96
WHAT IS THE MANAGEMENT OF CONGENITALLY ACQUIRED RUBELLA
PYRIMETHAMINE SULFADIAZINE FOR 1 YEAR
97
98
WHAT IS THE PATHOGEN THAT CAUSES CHICKEN POX
VARICELLA ZOSTER
99
DESCRIBE THE PRESENTATION OF VARICELLA ZOSTER
FEVER - 4 D RASH FROM A FEW - 500 LESIONS STARTING AT THE TRUNK AND MOVING TO THE PERIFERIES
100
DESCRIBE THE COURSE OF THE VARICELLA ZOSTER RASH
PAPULES PAPULES + VESICLES VESICLES + PUSTULES CRUSTS
101
IF THE LESIONS OF VARICELLA ZOSTER ARE LASTING MORE THAN 10 D WHAT CAN THIS MEAN
DEFECTIVE CELLULAR IMMUNITY
102
WHAT COMPLICATIONS CAN OCCUR WITH VARICELLA ZOSTER
SECONDARY BACTERIAL INFECTIONS ENCEPHALITIS PURPURA FULMINANS
103
AN IMMUNOCOMPRIMISED PATIENT WITH CHICKEN POX (VZ) HASNT BEEN TREATED, WHAT ARE THEY AT RISK OF
VESICLE RUPTURE CAUSING HAEMORRAGE AND DEATH
104
WHAT ARE THE SIGNS OF ENCEPHALITIS
ATAXIA OTHER CEREBELLAR SIGNS
105
IN VARICELLA OSTER ENCEPHALITIS WHAT IS THE RECOVERY PERIOD
SOLF RESOLVES WITHIN 1 MONTH
106
WHAT IS PURPURA FULMINANS
A RARE COMPLICATION OF CHICKEN POX CAUSING VASCULITIS IN SKIN AND SUB CUTANEOUS TISSUE LEADING TO NECROSIS
107
HOW DO YOU TREAT VARICELLA ZOSTER
SUPPORTIVE UNLESS: IMMUOCOMPRISED (IV ACYCLOVIR OR IvIg in t cell immunity- HIV) TEENAGERS+ADULTS (PO ACYCLOVIR)
108
WHAT IS SHINGLES
LATENT VARICELLA ZOSTER
109
WHAT IS THE PRESENTATION OF SHINGLES
VESICULAR ERUPTION IN DEROTOMAL DISTRIBUTION NEUROPATHIC PAIN
110
WHAT IS MEASLES
AN UNCOMMON VIRAL DISEASE, LESS SEVERE IN YOUNG AGE
111
A CHILD PRESENTS WITH A HISTORY OF * HUGH FEVER PEAKING AT DAY 5 * DISCRETE MACULOPAPULAR RASH STARTING BEHIND EARS AND MOING DOWN THE BODY * WHICH BEGAN DESQUAMATING AT THE SECOND WEEK * COUGH, CORYZA, CONJUNCTIVITIS * KOPLIK SPOTS WHAT IS THE DIAGNOSIS
MEASLES
112
WHAT ARE KOPLICK SPORTS
WHITE SPOTS ON BUCCAL MUCOSA AGAINST A BRIGHT RED BACKGROUND
113
WHAT ARE COMPLICATIONS OF MEASLES
ENCEPHALITIS SUBACUTE SCLEROSING PANCEPHALITIS
114
WHAT IS THE PRESENTATION OF MEASLES ENCEPHALITIS AND POSSIBLE COMPLICATIONS
LETHARGY HEADACHES IRRITABILITY SEIZURES COMA CAN LEAD TO LEARNING DISABILITIES AND DEAFNESS
115
WHAT IS SUBACUTE SCLEROSING PANCEPHALITIS
MANIFESTS 7Y AFTER INFECTION COMMIN IN THOSE WHO GOT MEASLES BEFORE AGEOF 2 CAUSED BY VIRUS VARIENT REMAINING IN CNS DEMENTIA LEADING TO DEATH
116
WHAT ARE TREATEMENTS FOR MEASLES
ISOLATION SUPPORTIVE SYMPTOMATIC Tx IN IMMUNOCOMPRIMISED: VIRAL ANTIBODIES AND ANTIVIRAL RIBARININ
117
WHAT IS IMPETIGO
LOCALISED AND HIGHLY INFECTION SKIN INFECTION CAUSED BY STAPHYLOCOCCUS
118
WHAT IS THE PRESENTATION OF IMPETIGO
ERYTHEMATOUS MACULES TURNING TO VESICLES AND POSTULES THESE RUPTURE TURNING INTO HONEY COLOURED CRUSTED LESIONS
119
WHAT ARE TREATEMENTS FOR IMPETIGO
TOPICAL MUPIROCIN PO FLUCLOXACILLIN/CO-AMOXICLAV KEEP OUT OF SCHOOL UNTILLESIONS DRY
120
WHAT ARE BOILS
INFECTIONS OF HAIR FOLLICLES / SWEAT GLANDS DUE TO STAPH. A
121
WHAT IS THE TREATEMENT FOR BOILS
FLUCLOXACILLIN
122
WHAT DO PERSISTENT BOILS SUGGEST
PATIENT OR CLOSE CONTACTS ARE NASAL CARRIERS