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Paediatrics > Infections and Immunity Core Conditions > Flashcards

Infections and Immunity Core Conditions Flashcards

1
Q

What vaccinations does a child receive at 8 weeks?

A
  1. 6 in 1 (1st) (Dip, Tet, Polio, Pertussis, Hib, Hep B)
  2. Meningococcal type B
  3. Rotavirus (1st) (Oral vaccine)
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2
Q

What vaccinations does a child receive at 12 weeks?

A
  1. 6 in 1 (2nd) (Dip, Tet, Polio, Pertussis, Hib, Hep B)
  2. Pneumococccal
  3. Rotavirus (2nd) (Oral)
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3
Q

What vaccinations does a child receive at 16 weeks?

A
  1. 6 in 1 (3rd) (Dip, Tet, Polio, Pertussis, Hib, Hep B)
  2. Meningococcal type B (2nd)
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4
Q

What vaccinations does a child receive at 1 year?

A
  1. 2 in 1 (Hib and Men C)
  2. Pneumococcal (2nd)
  3. MMR (Measles, mumps and Rubella) (1st)
  4. MenB (3rd)
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5
Q

What vaccinations does a child receive at 3 years and 4 months?

A
  1. 4 in 1 (Dip, Tet, Pertussis, Polio)
  2. MMR (2nd)
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6
Q

What vaccinations does a child receive at 14 years?

A
  1. 3 in 1 (Tet, Dip and Polio)
  2. Men ACWY
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7
Q

What are Inactivated vaccines?

A

When a killed version of the pathogen is given. They cannot cause infections and are safe for immunocompromised.
Inactived vaccines:
-Polio
-Flu vaccine
-Hep A
-Rabies

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8
Q

What are subunit/conjugated vaccines?

A

When only parts of the organism are used to stimulate an immune response. Cannot cause infection and are safe for immunocompromised patients.
-Penumococcus
-Meningococcus
-Hep B
-Pertussis
-HiB
-HPV
-Shingles

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9
Q

What are live attenuated vaccines?

A

Contain weakened versions of the pathogen. Still capable of causing infection particularly in immunocompromised patients.
-MMR
-BCG
-Chickenpox
-Nasal Flu
-Rotavirus

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10
Q

What are toxin vaccines?

A

Contain a toxin that is normally produced by a pathogen. Cause immunity to the toxin and not the pathogen itself.
-Diphtheria
-Tetanus

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11
Q

What is meningitis?

A

Inflammation of the meninges covering the brain. Can be confirmed by the presence of WBC in the CSF.

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12
Q

What are the common causative organisms of bacterial meningitis is children <3 months old?

A

-Group B Streptococcus (usually contracted during birth from the GBS bacteria that live in the mother’s vagina. More common in low birth weight babies and following prolonged rupture of the membranes)
-Escherichia Coli and other coliforms
-Listeria monocytogenes

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13
Q

What are the common causative organisms of bacterial meningitis in children >3 months old?

A

-Neisseria meningitides (meningococcus)
-Steptococcus pneumoniae (pneumococcus)
-Haemophilus influenzae (in children 1 month - 6 years)

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14
Q

What are the features of meningitis in children?

A

-Neck stiffness (brudzinski’s and Kernig’s sign)
-Fever
-Headache
-Lethargy
-Photophobia
-Poor feeding/ vomiting
-Irritability
-Hypotonia
-Drowsiness
-Loss of consciousness
-Seizures
-Bulging fontanelle
-Purpuric rash (meningococcal disease)
-Signs of shock
-Focal neurological signs

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15
Q

What is Brudzinski’s sign?

A

Flexion of the neck with the child supine causes flexion of the knees and hips

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16
Q

What is Kernig’s sign?

A

When the child is lying supine and with the hips and knees flexed, there is back pain on extension of the knee. Creates stretch of the meninges.

17
Q

What investigations are needed in suspected meningitis?

A

-FBC, Coagulation screen, CRP, U&Es, LFTs.
-Blood glucose and blood gas (for acidosis)
-Blood, throat swab, urine and stool cultures
-Viral PCR
-Lumbar puncture (unless contrandicated)

18
Q

What are the contraindications to lumbar puncture?

A

-Cardiorespiratory instability
-Focal neurological signs
-Signs of raised ICP (coma, high BP, low heart rate, papilloedema, bulging fontanelle)
-Coagulopathy
-Thrombocytopenia
-Local infection at the site of LP
-Meningococcal septicaemia

19
Q

Where is a lumbar puncture performed?

A

Into the L3-4 intervertebral space (spinal cord ends at L1-2)

20
Q

What are the CSF changes in bacterial meningitis?

A

Turbid appearance, raised protein, raised WCC (polymorphs, neutrophils), low glucose.C

21
Q

What are the CSF changes in bacterial meningitis?

A

Clear appearance, mildly raised or normal protein, normal glucose, high WCC (lymphocytes)

22
Q

What antibiotics are given to treat bacterial meningitis in children <3 months?

A

IV amoxicillin (or ampicillin) + IV cefotaxime

23
Q

What antibiotics are given to treat bacterial meningitis in children >3 months?

A

IV ceftriaxone (or cefotaxime)

24
Q

How is bacterial meningitis managed?

A
  1. Antibiotics
  2. Steroids (dexamethasone in children >3 months)
  3. Fluids - to treat shock
  4. Cerebral monitoring
  5. Public health notification and antibiotics prophylaxis of contacts (Ciprofloxacin)
25
Q

When are why are steroids given in bacterial meningitis?

A

Given to reduce the frequency and severity of hearing loss and neurological damage. Dexamethasone is given 4x daily for 4 days to children over 3 months if the LP is suggestive of bacterial meningitis

26
Q

What are the complications of meningitis?

A

-Hearing loss
-Seizures and epilepsy
-Cognitive impairment and learning disability
-Memory loss
-Cerebral palsy, with focal neurological deficits such as limb weakness or spasticity
-Focal neurological deficit
-Sepsis, intracerebral abscess
-Brain herniation, hydrocephalus

27
Q

What are the causes of viral meningitis?

A

-HSV
-Enterovirus
-Varicella zoster virus
-EBV
-Mumps (now rare due to MMR vaccine)

28
Q

How does presentation and management of viral meningitis differ from bacterial?

A

Much more common however much milder disease than bacterial. Often only requires supportive treatment and will make a full recovery. Can treat with Aciclovir. Treat with abx if any query over if bacterial.

29
Q

How should children seen in primary care with suspected meningitis and a non-blanching rash be treated?

A

Urgent stat injection (IM or IV) of benzylpenicillin

Paediatrics (2 decks)

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