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Infections and Immunity Flashcards

1
Q

What immunisations are given <1yr? (8)

A

8 weeks (2 months):

1) 6-in-1 vaccine
2) Pneumococcal (PCV) vaccine
3) Rotavirus vaccine
4) MenB

12 weeks (3 months):

5) 6-in-1 vaccine - 2nd dose
6) Rotavirus vaccine - 2nd dose

16 weeks (4 months):

7) 6-in-1 vaccine - 3rd dose
8) PCV - 2nd dose
9) MenB - 2nd dose

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2
Q

What immunisations are given aged 1-15yr? (10)

A

1 year:

1) Hib/MenC - 1st dose
2) MMR - 1st dose
3) PCV - 3rd dose
4) MenB - 3rd dose

2-10yrs:
5) Flu vaccine - every year

3yrs and 4 months:

6) MMR - 2nd dose
7) 4-in-1 pre-school booster

12-13yr:
8) HPV vaccine

14yr:

9) 3-in-1 teenage booster
10) MenACWY

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3
Q

What immunisations are given to adults? (3)

A

65yr:

1) Pneumococcal (PPV) vaccine
2) Flu vaccine (and every year after)

70yr:
3) Shingles vaccine

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4
Q

What immunisations are offered to pregnant women? (2)

A 
Flu vaccine - during flu season
Whooping cough (pertussis) vaccine - from 16 wks
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5
Q

What is in the 6-in-1 vaccine?

A

DHHPTW

1) Diptheria
2) Hep B
3) Hib - Haemophilus influenza type b
4) Polio
5) Tetanus
6) Whooping cough - pertussis

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6
Q

What is in the 4-in-1 pre-school booster?

A

DTPP

1) Diphtheria
2) Tetanus
3) Whooping cough - pertussis
4) Polio

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7
Q

What is in the 3-in-1 teenage booster?

A

DTP

1) Diphtheria
2) Tetanus
3) Polio

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8
Q

Which vaccines are live? (3)

A

1) Influenza
2) MMR
3) Rotavirus (oral)

+ BCG

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9
Q

When does meningitis mostly occur in children?

A

Mostly in first 5 years of life

75% of cases are <15yrs

Younger children are at greater risk of brain damage and are more difficult to diagnose

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10
Q

What proportion of meningitis cases are bacterial vs viral?

A

1/3rd bacterial

2/3rd viral

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11
Q

What is the pathophysiology of bacterial meningitis?

A

Colonisation of nasopharyngeal epithelium

Invasion of blood then meninges

Cerebral oedema caused by inflammation + leaky vessels

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12
Q

What is the pathophysiology of viral meningitis?

A

Infection of a mucus membrane followed by LN involvement

Primary viraemia = causes viral illness

Secondary viraemia = inolved organs such as liver

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13
Q

List some risk factors for meningitis (5)

A

1) Young age = most significant
2) Immune suppression
3) CSF shunt / dural defects
4) Spinal procedures eg spinal anaesthetics (Pseudomonas may be cause)
5) Crowding eg uni halls inc risk of meningococcal meningitides

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14
Q

What are some risk factors for neonatal meningitis? (6)

A

1) Low birth weight (<2500g)
2) Prematurity
3) Premature rupture of membranes
4) Traumatic delivery
5) Fetal hypoxia
6) Maternal peripartum infection

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15
Q

What are the most common bacterial causative organisms of meningitis in neonates? (3)

A

1) Group B strep
2) Listeria monocytogenes
3) E coli

+ other coliforms

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16
Q

What are the most common bacterial causative organisms of meningitis in infants / children? (4)

A

1) Haemophilus influenzae
2) Neisseria meningitidus
3) Streptococcus pneumoiae
4) Mycoplasma tuberculosis

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17
Q

What are the most common causative organisms of meningitis in adolescents / adults? (2)

A

1) Neisseria meningitidis

2) Streptococcus pneumoniae

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18
Q

What are the most common viral causative organisms of meningitis across all ages? (3)

A

1) Enterovirus
2) Adenovirus
3) Epstein-Barr

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19
Q

What symptoms may meningitis present with? (13)

A

Infant:

1) Fretfulness
2) High-pitched cry
3) Bulging fontanelle
4) Poor feeding
5) Respiratory distress

Child:

6) Headache
7) Photophobia
8) Neck stiffness

All ages:

9) Fever
10) Irritable
11) Vomitting
12) Drowsiness
13) Seizures

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20
Q

What are some signs of raised ICP? (6)

A

1) Papilloedema
2) Altered / LOC
3) Full fontanelle
4) Inc BP
5) Dec HR
6) Focal neuro signs

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21
Q

What is meningitis vs meningococcal septicaemia?

A

Meningitis = inflammation of the leptomeninges that surround the brain and spinal cord

  • Various causative organisms
  • May have neck stiffness / photophobia
  • Unlikely to have a rash

Meningococcal septicaemia = systemic infection

  • CAUSED BY NEISSERIA MENINGITIDIS
  • Rapidly spreading purpuric rash
  • May or may not also have meningitis
  • Often fatal
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22
Q

List 3 signs of meningism

A

1) Nuchal rigidity - unable to flex neck
2) Kernig’s sign - unable to extend knee when thigh flexed to 90 degrees
3) Brudunski’s sign - involuntary lifting of leg when lying supine and head is raised

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23
Q

List some ddx of meningitis

A

Drugs / toxicity
Migraine
Encephalitis
SAH

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24
Q

What investigations are done in meningitis? (6)

A

Do not delay abx by more than 30 mins

1) LP - unless suspected raised ICP
2) CT head
3) Bloods - FBC, U&Es, CRIP, glucose, blood cultures, gases
4) Urine for MCC
5) Nasal / throat swabs
6) CXR - lung abscess

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25
What would the LP results be in bacterial vs viral meningitis?
Viral: - Clear / hazy appearance - Lymphocytes + - Protein + - Glucose = Normal Bacterial: - Cloudy / purprulent - Neutrophils ++ - Protein ++ - Glucose = Low
26
List some contraindications to LP (7)
1) Raised ICP = stabilise first 2) Shock = stabilise first 3) After convulsions = stabilise first 4) Respiratory insufficiency = stabilise frist 5) Abnormal clotting 6) Infection at LP site 7) Extensive purpura
27
What is a pyrexia? What is a red flag? What is an amber flag?
Temp of 38 degrees celsius or more <3 months, fever of more than 38 = red flag 3-6 months, fever of over 39 = amber flag
28
What is the treatment of suspected meningococcal meningitis in the community?
If in doubt - treat as bacterial IM benzylpenicillin single dose ``` <10yr = 1g 1-9yr = 600mg <1yr = 300mg ```
29
What is the treatment of suspected bacterial meningitis in hospital?
<3 months = IV cefotaxime >3 months = IV ceftriaxone Symptomatic treatment - antipyretics, analgesics, IV fluids (viral meningitis is treated only symptomatically) Dexamethasone
30
What is the prognosis of bacterial and viral meningitis?
Bacterial: 5-10% die, 10% experience brain damage - Pneumococcal has the highest morbidity/mortality Viral: complete recovery usually - Except HSV (morbidity/mortality 50%)
31
What are some complications of meningitis?
Immediate: - Septic shock - Seizures - DIC - Cerebral oedema - Hydrocephalus (blockage of ventricular outlet) Delayed: - Hearing loss (follow up includes hearing test) - Focal paralysis - Seizures - Cerebral palsy (if <2yr)
32
List preventative measures for meningitis
Prophylactic abx in labour if known Group B strep colonisation - Or neonatal abx if not completely treated in labour Vaccinations: - Childhood vaccination against Him, Menc/B, strep pneumonia - Quadrivalent (meningococcus groups A,C,W,Y) for teenagers Chemoprohpylaxis for those living in same house / spending more than 5 hours a day with child - Ciprofloxacin or rifampicin
33
What is meningococcal septicaemia?
Acute infection of the bloodstream and subsequent vasculitis with bacteria Neisseria meningitides
34
What type of bacteria is Neisseria meningitides?
Gram -ve diplococci
35
What groups are there of Neisseria meningitides?
A, B, C, W, Y
36
What is the epidemiology of meningococcal septicaemia?
Most cases <5yr Second peak in a adolescence
37
What are the early signs of meningococcal septicaemia? (6)
1) Fever 2) Mottling 3) Leg pain 4) Cold peripheries 5) Breathing difficulties 6) Non-blanching rash >12hrs
38
What are some early complications of meningococcal septicaemia? (4)
1) DIC 2) AKI 3) Adrenal haemorrhage 4) Circulatory collapse
39
What are some late complications of meningococcal septicaemia? (5)
1) Deafness 2) Scarring 3) Renal failure 4) Limb amputations 5) Mortality
40
What are purpura?
Non-blanching spots caused by bleeding under the skin Spots <3mm are called petechiae Spots >10mm are called ecchymoses
41
What are purpura a sign of?
= non-specific sign However in febrile / unwell child they can indicate serious bacterial infection esp meningococcal disease
42
List some causes of purpura
VITAMIN CDE ``` Vascular Infective / Inflammatory Trauma Autoimmune Metabolic Iatrogenic Neoplastic Congenital / Coagulopathy Developmental / Digestive Endocrine / Environment ```
43
What is a vascular condition causing purpura?
Henoch-Schonlein purpura
44
What is the distribution of purpura in Henoch-Schonlein purpura? What is the platelet count?
Pupura distributed across extensor surfaces, buttocks and ankles Normal platelet count
45
What is an infective / inflammatory cause of purpura?
Meningococcal disease
46
What is the distribution of purpura in meningococcal disease?
Diffuse macular rash - appear before your eyes Give immediate IM Benzylpenicillin !!!!
47
What coagulopathies can cause purpura?
Thrombocytopenia Also DIC and scurvy (vit C deficiency causes weak capillary walls)
48
What is the course of purpura in thrombocytopenia?
Petichial rash followed by a purpuric rash Usually acute onset in the weeks following a URTI
49
What is Henoch-Schonlein purpura?
IgA-mediated, autoimmune hypersensitivity vasculitis of childhood Main features: purpura, arthritis, abode pain, GI bleeding and nephritis
50
# Define: 1) Sepsis 2) Septicaemia 3) Septic shock
Sepsis = systemic inflammatory response Septicaemia = blood borne infection which causes sepsis Septic shock = severe sepsis causing hypotension and compromised tissue perfusion
51
Describe the process of septic shock
Bacterial toxins cause systemic inflammatory response: 1) Vasodilation 2) Increased microvascular permeability 3) Tissue hypoxia 4) Myocardial depression 5) DIC
52
How may early signs of compensated shock present?
``` Tachycardia Cool peripheries Tachypnoea Decreased UO Inc cap refill time O2 sats <95% Confusion / LOC Hypotension (later) ``` NB high fever can also cause tachycardia and peripheral vasoconstriction which may present similarly to early compensated shock If septicaemia is meningococcal = look for signs of meningitis and non-blanching petechial/purpuric rash as an early sign (not always present) - in 30% rash is blanching and maculopapular
53
What investigations should be performed for septic shock?
Septic screen = CRAP blood Cultures - blood, urine, stool, CSF (if no raised ICP), indwelling catheters Radiography - CXR, AXR ABG - metabolic acidosis Pee (urinalysis) Bloods - FCB (raised WCC), U&Es, LFTs, CRP, ESR, glucose, calcium, phosphate, clotting
54
List some common possible sauces of septic shock (4), their causative organisms and appropriate abx
1) Indwelling catheter - s. aureus (trust guidelines) 2) Intra-abdo - gut anaerobes (metronidazole, gentamicin) 3) Immunosuppressed - pseudomonas (ceftazidime, gentamicin) 4) Cellulitis - group A strep (penicillin)
55
What prophylaxis is given for septic shock?
Close contacts (and affected child on discharge) are given 2-day course of rifampicin NB makes urine pink
56
How us neisseria meningitides divided?
Into 13 serogroups These include A, B, C, W and Y which account for 90% of invasive disease and we are vaccinated against
57
Which vaccine commonly gives a fever in the days following its administration?
MMR Parents often bring children to A&E but advise them this is a self-limiting reaction
58
List some ddx for a child presenting with a fever and a rash (7)
1) Measles 2) Rubella 3) Roseola 4) Scarlett fever 5) Fifth disease 6) Hand food and mouth disease 7) Chicken pox 8) Meningococcaemia
59
List some ddx for a child presenting with an acute fever (9)
1) URTI 2) Tonsillitis 3) OM 4) Nonspecific viral infection 5) Pneumonia 6) Meningitis 7) UTI 8) Septic arthritis 9) Non-infectious causes
60
List some ddx for a febrile child with a swelling in the neck (5)
1) Cervical adenitis 2) Infectious mononucleosis 3) Mumps 4) Thyroiditis (often no fever) 5) Mastoiditis
61
List some ddx of a child with pyrexia of unknown origin (6)
1) Infective endocarditis 2) Osteomyelitis 3) Collagen vascular disease 4) IBD 5) Neoplastic disease 6) Factitious fever
62
What is causes a factitious fever?
Eg taking a temperature after a hot drink, deliberate manipulation of the thermometer
63
List some ddx of a febrile child with recurrent infections (2)
1) HIV / AIDS | 2) Hyposplenism / splenectomy
64
What virus causes chickenpox?
Varicella-Zoster virus
65
What does reactivation of VZV lead to?
Shingles
66
What is the incubation period of chicken pox?
14-17 days
67
What is the usual duration of the rash in chickenpox?
6-10 days
68
What is the recommended isolation period for chicken pox?
Until all the lesions are crusted over (usually 5-6 days)
69
Describe the type of rash and distribution in chickenpox
Vesicular rash Occurs in crops on face and trunk Pass through stages of papule, vesicle, pustule and crust
70
What is the first feature of chickenpox? How long does this last?
Fever for up to 4 days
71
How else does chickenpox present?
``` Headache Malaise Abdo Pain Itchy rash Shallow ulcers of the mucous membranes Coryzal ```
72
What may occur when immunocompromised get chickenpox?
Pneumonia Large and bleeding vesicles DIC
73
What investigations are done for chickenpox?
Diagnosis clinical Can confirm with scrapings and performing immunohistochemical staining or PCR Complications require further investigations eg CXR and neurological features eg LP
74
What is the management of chickenpox in an otherwise healthy individual?
Rest and fluids Symptomatic - analgesia and antipyretics Help pruritus with antihistamines Keep nails short Avoid contact with pregnancy women, neonates, immunocompromised
75
Why are NSAIDs not advised. for chickenpox?
Possible association with necrotising soft tissue infections
76
What populations require antiviral treatment for chickenpox?
IV aciclovir: - Immunocompromised - Systemic disease - Pt on high dose steroids - New lesions appearing after 8 days PO aciclovir: - >12yr
77
What are some complications of chickenpox?
1) Secondary infection of skin lesions (eg if Group A strep can produce necrotising fasciitis and toxic shock syndrome) 2) Viral pneumonia 3) Encephalitis 4) CNS complications eg benign cerebellar ataxia
78
Why is chickenpox late in pregnancy concerning?
It can cause premature delivery If rash appears within a week of delivery or 2 days after, there is a risk of neonatal chickenpox
79
Why is neonatal chickenpox concerning?
There is transplacental transmission of virus but not antibody, and there is no time for IgG to develop and the baby is at 30% risk of death from severe pneumonia or fulminant hepatitis NB IgG can cross the placenta (initial IgM cannot) - so if at least a week passes between rash and delivery is fine as IgG will have developed
80
Why is chickenpox within first 2 weeks of pregnancy concerning?
Risk of congenital varicella syndrome - IUGR - Microcephaly - Cortical atrophy - Limb hypoplasia
81
What is the treatment of neonatal chickenpox?
Immunoglobulin and aciclovir
82
How is chickenpox transmitted?
Respiratory droplets or direct contact with vesicular fluid
83
How does encephalitis following chickenpox usually present?
Ataxia one week after rash Good prognosis
84
When should parents be advised they can reenter their children to school with chickenpox?
6 days after the last spots appear

extra 1 (e) (19 decks)

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