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Year 4 PAEDS > Infections and Immunity 2 > Flashcards

Infections and Immunity 2 Flashcards

1
Q

What is conjunctivitis?

A

Inflammation the conjunctiva (thin membrane which covers the sclera of the eyes and the inside of the eyelids)

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2
Q

What are some causes of bacterial conjunctivitis?

A 
Staph aureus
Strep pneumoniae
H influenzae
Morazella catarrhalis
Pseudomonas aeruginosa
Gonococcal
Chlamydial
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3
Q

What does neonatal conjunctivitis within the first 48hrs, with purulent discharge and swelling of the eyelids suggest?

A

Gonococcal conjunctivitis

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4
Q

How is gonococcal conjunctivitis managed?

A

IV cephalosporin

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5
Q

How is chlamydial conjunctivitis in a newborn diagnosed and treated?

A

Specific monoclonal antibody test performed on conjunctival secretions

PO erythromycin / topical tetracycline

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6
Q

What are some causes of viral conjunctivitis?

A

Adenovirus (most common)

HSV
HZV
Molluscum contagiosum

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7
Q

How is allergic conjunctivitis managed?

A

Topical mast cell stabilisers

Antihistamines

Topical steroids (specialist)

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8
Q

How does viral conjunctivitis present?

A

Red eye, usually generalised, often bilateral

Irritation, grittiness and discomfort typical (not significant pain)

Clear, watery discharge with mucoid component

NO PHOTOPHOBIA
NO CHANGE IN VISUAL ACUITY

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9
Q

What does marked pain, photophobia and possibly decreased visual acuity suggest?

A

Uveitis

These symptoms suggest deeper inflammatory conditions of eye

Esp in those with ‘conjunctivitis’ not responding to conventional treatment and those with previous episodes

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10
Q

How do scleritis and episcleritis present?

A

Unilateral with localised injection and aching (episcleritis) or intense boring pain (scleritis)

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11
Q

What is the management of bacterial conjunctivas?

A

Chloramphenicol or fusidic acid drops

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12
Q

What is the management of viral conjunctivitis?

A

Symptomatic

Self-limiting

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13
Q

What is the discharge like in conjunctivitis that is:

1) Viral
2) Bacterial
3) Allergic

A

1) Viral - watery / sticky
2) Bacterial - thick yellow / green
3) Allergic - watery / clear / no discharge

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14
Q

What are some advantages of breastfeeding for:

a) Baby
b) Mother

A

Advantages to baby
• Antibodies - especially from rich colostrum in first few days
• Attachment with mum
• As baby grows, the composition of the milk changes to suit the baby
• Reduces risk of allergies, infections, eczema
• Reduce risk of obesity, CVD, diabetes, certain cancers
• In short term, reduces risk of neurodevelopmental problems

Advantages to mother
• Faster uterine involution (oxytocin stimulates uterine contractions) - reduces risk of PPH
• Earlier return to pre-pregnancy weight - burns 500kcal/day
• Lactational amenorrhoea providing natural contraception - 98% effective if fully breastfeeding for up to 6 months post-partum
• Improved bonding with infant
• Reduced risk of ovarian, breast, endometrial cancer and cardiovascular disease and osteoporosis
• Reduced costs and reduced time - more convenient

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15
Q

What is colostrum?

A

Colostrum (thick, yellow fluid) = the first milk produced during late pregnancy until 3-4 days post-partum, which is rich in proteins and immunoglobulins that play important part in gut maturation and immunity for infant

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16
Q

What are some CI to breastfeeding?

A
  • Galactosemia in infant - autosomal recessive defects in enzymes that metabolise galactose
  • HIV infection
  • Cocaine use
  • Active TB or varicella infection - but can give expressed breast milk instead
  • Herpes simplex breast lesions (but if no lesions, encourage breastfeeding)
  • Drugs - tetracyclines (teeth staining), chemotherapy, cytotoxics, lithium, methotrexate, amiodarone
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17
Q

What is the time frame of the weaning process?

A

0-6 months - breast or formula milk only

6 months - Introduce solid foods such as pureed and finger feeds

7-9 months - give more soft feeds before milk feeds. Encourage finger feeding. Give fruit juices in a cup

9-12 months - mash food with a fork. 3 meals / day, at least one with family

1 year and over - undiluted cow’s milk in a cup

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18
Q

What is the difference between food allergy and food intolerance?

A

Food allergy = immunologically mediated reaction to food allerges

  • Acute, rapid onset usually IgE
  • Delayed and non-acute usually non-IgE

Food intolerance = vague term requiring specific explanation

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19
Q

What investigations are done for food allergy?

A

Food diary
Psysician-supervised oral food challenged
Skin-prick testing
Food-specific serum IgE testing

Concordance between results of skin prick testing and serum IgE levels is not always good and thus both need to be carried out

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20
Q

How are serum-allergen specific IgE measured?

A

Enzyme-linked immunosorbent assay (ELISA) and fluorescent enzyme immunoassay (FEIA) tests

Only available for a some foods and v expensive

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21
Q

What are some classic foods involved in allergy?

A 
Milk
Eggs
Fish and seafood
Peanuts
Sesame
Tree nuts
Soy beans
Wheat
Kiwi fruit
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22
Q

What are some examples of non-IgE mediated food allergy?

A

1) Food protein induced enterocolitis
2) Eosinophilic oesophagitis and gastroenteritis
3) Coeliac disease (not strictly an allergy)

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23
Q

How does food protein induced enterocolitis present?

A

Projectile committing, diarrhoea and FTT in first few months of life

Cows milk and soy protein formulas are usually responsible

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24
Q

How does eosinophilic oesophagitis and gastroenteritis present?

A

Nausea, abdo pain, reflux and FTT

No response to antacids

Eosinophilia may be found on FBC or at GI biopsy

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25
Q

What is the management of food allergy and intolerance?

A

Food avoidance (inc breastfeeding mothers)

Dietician referral

Drug therapy:
Antihisatmine for mild symtoms
Oral sodium cromoglicate
Corticosteroids

Medical emergency identification bracelet
EpiPen (IM) in severe respiratory symptoms or anaphylaxis

Injection immunotherapy (desensitisation) successfully sued for pollen and insect venom allergies (but risky for food)

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26
Q

What is the prognosis of food allergy?

A

Most children grow out of allergies

1/3rd adults and children lose their clinical reactivity to food allergens after 1-2 years of food elimination diets

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27
Q

Which foods is sensitivity rarely lost?

A

Peanuts
Seafood
Fish and tree nuts

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28
Q

What are some examples of GI enzyme deficiency leading to food intolerances? (2)

A

1) Lactose intolerance

2) Congenital sucrose-isomaltase deficiency

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29
Q

What are some common food additives and chemicals in food that can cause pharmacological food intolerance reactions?

A

1) Artificial food colours / preservatives
2) Glutamates including monosodium glutamate
3) Salicylates
4) Caffeine

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30
Q

What causes infectious mononucleosis?

A

aka glandular fever

Epstein-barr virus (90%)

Rarely CMV

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31
Q

How does infectious mononucleosis present?

A

Prodrome of flu-like illness for 3 days

1) Low-grade fever
2) Malaise
3) Pharyngitis
4) Cervical lymphadenopahty

Occasionally:

5) Hepatotosplenomegally
6) Jaundice

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32
Q

What investigations are done for infectious mononucleosis?

A

Triad:

1) FBC - WCC shows lymphocytosis (lymphocytes account for 80-90% WBC)
2) Blood films - more than 10% lymphocytes atypical
3) Serology - positive agglutination test (monospot test) for EBV (or CMV)

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33
Q

How long do symptoms last of infectious mononucleosis?

A

Self-limiting but can last months

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34
Q

What is contraindicated in infectious mononucleosis?

A

Amoxicillin as will cause a maculopapular rash in EBV infection

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35
Q

Does the monospot test have high or low sensitivity?

A

Low sensitivitiy

False positives in lymphoma and hepatitis

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36
Q

What else may be found when investigating infectious mononucleosis?

A

Raised LFTs
Mild thromobocytopenia
Raised IgM and IgG early in disease

37
Q

What is the management of infectious mononucleosis?

A

Supportive

Pt with splenomegaly should avoid contact sports for 1 months and avoid alcohol

38
Q

What are some complications of infectious mononucleosis?

A

GI / abdo:

  • Hepatitis
  • Splenomegaly
  • Splenic rupture

CNS:

  • Aseptic meningitis
  • Encephalitis
  • Guillan-Barre syndrome

Post-viral tiredness

Also:

  • Lymphoma
  • Orchitis
  • Myocarditis
  • Pneumonia
39
Q

What is the pathophysiology of infectious mononucleosis?

A

Virus infects B lymphocytes in pharyngeal lymphoid tissue then spreads to the rest of the lymphoid system

40
Q

What is the incubation period of infectious mononucleosis?

A

4-8 weeks

41
Q

What is EBV also associated with?

A

Burkitt’s lymphoma
B-cell lymphoma
MS

42
Q

What is Kawasaki disease?

A

Idiopathic self-limiting systemic vasculitis

43
Q

What age group does Kawasaki disease most commonly affect?

A

6 months - 5 years

M>F

44
Q

Children of which origin are most commonly affected by Kawasaki disease?

A

Asian esp Japanese and Chinese

45
Q

Kawasaki disease is the most common cause of what in the developing world?

A

Acquired childhood heart disease

It has taken over from rheumatic fever

46
Q

What are the characteristic features of Kawasaki disease? (6)

A

CRASH and burn

Conjunctivitis - bilateral and dry
Rash - widespread non-vesicular
Adenopathy - cervical LN >1.5cm
Strawberry tongue - inflammation of mucous membranes of mouth, lips, tongue
Hand - erythema, swelling and desquamation

Burn = prolonged fever of 39 degrees or more (5 or more days)

(or echocardiographic evidence of coronary artery aneurysms)

May not all be present at the same time

47
Q

What are some other features of Kawasaki disease? (7)

A

1) Lethargy
2) Urethritis and sterile pyuria
3) d&v
4) Abdo pain
5) Myalgia
6) Arthralgia
7) Arthritis

48
Q

Describe the type of rash and its course in Kawasaki disease

A

Polymorphic exanthema

Comes on within 3-5 days of onset of fever

49
Q

What investigations are performed for Kawasaki?

A

No diagnostic test for condition - diagnosis made clinically

FBC - leukocytosis, neutrophilia, raised ESR and CRP (in acute phase)

Platelets elevated and marked thrombocytopenia in 2-3rd weeks

LFTS - elevated transaminases and bilirubin

Urinalysis - sterile pyuria

Abdo US - gallbladder distension

ECG - conduction abnormalities

50
Q

How is Kawasaki managed?

A

Hospital admission

Aspirin

  • One of the few cases in which aspirin is indicated in a child due danger of Reye’s syndrome
  • 30-50mg/kg/day divided QDS
  • For at least 6 weeks
  • Reduces risk of thrombus

IV immunoglobulin

  • 2g/kg as a single infusion over 12 hours
  • Give in first 10 days (or much less effective)
51
Q

What is the follow up management of Kawasaki disease?

A

Children who receive IvIg should have live vaccines (eg MMR) delayed for 3-11 months

Follow up echocardioloogy to determine if there have been any coronary artery complications

52
Q

List some ddx of Kawasaki disease

A 
Bacterial = strep / staph infection
Viral = adenovirus / enterovirus / measles infection
Others = drug reaction / SJS
53
Q

What are some complications of Kawasaki disease? What is the mortality?

A

Coronary artery aneurysms (20-30%)
Coronary thrombosis
MI
Dysrhythmias

4% mortality

54
Q

What causes measles?

A

Paramyxovirus

Leading cause of vaccine-preventable childhood mortality in the world

55
Q

Is measles contagious?

A

One of the most contagious infectious diseases

NB is a notifiable disease

56
Q

How is measles transmitted?

A

Airborne via respiratory droplets

These can spread to surfaces and the virus can remain transmissible for up to 2 hours

57
Q

What is the incubation period of measles?

A

10-12 days

Infectivity lasts from 4 days before until 4 days after the rash appears

58
Q

How does measles present?

A

Rash + 3 x C’s (cough, coryza and conjunctivitis)

1) Rash for at least 3 days

2) Fever for at least 1 day plus at least one of:
- Cough
- Coryza
- Conjunctivitis

3) Prodrome: 2-4 days with fever, cough, runny nose, mild conjunctivitis and diarrhoea
4) Koplik spots
5) Rash = morbilliform

+/- high fever and nonproductive cough
+/- swelling around the eyes and photophobia

Child ill and irritable (miserable disease) unlike other infectious diseases

59
Q

What are Koplik spots?

A

Pathognomonic

On buccal mucosa

Small, red spots each with a bluish-white speck (like a grain of rice) in centre

Present in 60-70% during prodrome and for up to 2-3 days after rash disappears

60
Q

Where does the rash first appear in measles?

A

Morbilliform = measles-like

Maculopapular rash

First on forehead and behind ears, then spreads to neck and spreads, involving trunk and finally limbs, over 3-4 days

Fades after 3-4 days

Leaves behind brown-discolouration (+/- fine desquamation)

61
Q

How is measles confirmed?

A

Laboratory diagnosis:

  • Salaviary swab or serum sample for measles-specific IgM within 6 weeks of onset
  • RNA detection in salivary swabs
62
Q

How is measles managed?

A

Uncomplicated measles is usually self-limiting and treatment is symptomatic - paracetamol, ibuprofen, fluids

Stay at home to limit spread

Monitor carefully for complications

63
Q

What are some respiratory complications of measles?

A

Respiratory:

  • Bronchopneumonia
  • Giant cell pneumonitis
64
Q

What are some neurological complications of measles?

A

Neurological = 3 different encephalitic diseases:
- Acute demyelinating encephalitis

  • Subacute sclerosing panencephalitis (SSPA) occurs 4-10yrs after attack and characterised by slow progressive neurological degeneration
  • Measles inclusion body encephalitis
65
Q

What are some GI complications of measles?

A

GI:

  • Diarrhoea
  • Hepatitis
  • Hypocalcaemia
66
Q

What are some obstetric complications of measles?

A

Potentially fatal pneumonitis

Greater risk of miscarriage, prematurity an low birth weight (but not congenital malformation)

67
Q

What are some other complications of measles?

A

Vitamin A deficiency and blindness
- Those with boardlerline vitA should be given a high dose vit A

Immunodeficiency

Acute OM

68
Q

How is measles prevented?

A

MMR vaccine at 12 months

69
Q

What is periorbital cellulitis?

A

Aka preseptal cellulitis

Infection of eyelid and surrounding skin anterior to the orbital septum

Alarming

70
Q

What are the usual causes of periorbital cellulitis?

A

Staph aureus
H influenza type B
Staph epidermidis
Anaeorbes

71
Q

What may periorbital cellulitis occur secondary to in older children?

A

Paranasal or dental abscesses

URTI and sinusitis

72
Q

How does periorbital cellulitis present?

A

Often systemically unwell with:

  • Acute onset of swelling, redness, warmth and tenderness of eyelid
  • Eyelid oedema in the absence or orbital signs such as gaze restriction or proptosis
  • Fever, malaise, irritability
  • Ptosis
73
Q

What features increase suspicion of orbital cellulitis?

A 
Decreased visual acuity
Proptosis
External ophthalmoplegia
Temp >37.5
Leuckocytosis
74
Q

How is periorbital cellulitis investigated?

A

Clinical diagnosis

FBC may show leukocytosis

CT of sinuses and orbit +/- brain

MRI can help confirm cavernous sinus thrombosis

75
Q

How is periorbital cellulitis managed?

A

Emergency referral to hospital - all children with suspected preseptal cellulitis should be considered to have orbital cellulitis until proven otherwise

ie repeated exams normal, good response to abx, normal CT

PO co-amoxliclav
- should show improvement within 24-48hrs

Possible IV ceftriaxone until response seen

76
Q

What are some complications of periorbital cellulitis?

A

Progression of infection to orbital cellulitis

Lagophthalmos (inability to completely close eyelids)
Lid abcess
Cicatricial ectropion
Lid necrosis

77
Q

What can orbital cellulitis lead to?

A

Untreated periorbital cellulitis may develop into orbital cellulitis with:

  • Evolving ocular proptosis
  • Limited ocular movement
  • Decreased visual acuity

Rarely:

  • Intracranial abscess formation
  • Meningitis
  • Cavernous sinus thrombosis
78
Q

What is prophylactic management of peri-orbital cellulitis?

A

Prophylactic abx eg chloramphenicol for surgical and accidental trauma to eyelid
- QDS to clean wound for one week

Hib vaccine

79
Q

What features do HIV infected infants usually present with?

A

Immunodeficiency:

  • FTT
  • Diarrhoea
  • Candidiasis
  • Hepatosplenomegaly
  • Severe bacterial infections
80
Q

What severe bacterial infections may affect HIV infected infants? (6)

A

1) Pneumonia
2) Septicaemia
3) Persistent pulmonary infiltrates
4) Pneumocystis jiroveci pneumonia (PCP)
5) TB
6) Systemic candida

81
Q

How is HIV diagnosed in children?

A

Detection of HIV antibody = very specific and sensitive

However, passive maternal transplacental IgG obscures diagnosis in young infants as antibody may still be measurable up to 18 months in uninfected clinically well infants

Thus in children <2yrs, detection of HIV antigen is required to confirm diagnosis

82
Q

How is HIV managed in children?

A

Antiviral drugs
Prophylactic abx
Viral vaccines

Where necessary, immune serum globulin

83
Q

What is the prognosis of babies born to HIV-positive mothers?

A

20-30% become HIV positive themselves

84
Q

How is vertical HIV transmission prevented?

A

Administration of combination antiretroviral therapy including zidovudine to HIV-infected pregnant women

Delivery by CS

At birth infant should receive zidovudine for 4 weeks

Avoid breastfeeding

85
Q

List 3 AIDS defining conditions in a HIV +ve child

A

1) Lymphocytic interstitial pneumonitis
2) PCP
3) Candida oesphagitis

86
Q

What is rubella? When is it concerning?

A

aka German measles

Mild illness and rash may not even be noticed

Concerning if it is contracted in first trimester

87
Q

How may a fetus be affected if the mother contracts rubella in the first trimester of pregnancy?

A 
Fetal death
Congenital heart disease
Mental retardation
Deafness
Cataracts
88
Q

How does rubella present? What is the incubation period?

A

Rash appears in tiny macule on face and trunk and works its way down the body, lasts 2-3 days

  • Suboccipital LN
    (+/- generalised lymphadenopathy)

Generally well

+/- fever

Incubation period is 14-21 days

89
Q

What are some complications of rubella?

A

Thrombocytopenia
Encephalitis
Arthritis (rare)

Devastating effects on fetus

Year 4 PAEDS (23 decks)

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