Infections/Fever Flashcards
What is the virus causing hand, foot and mouth disease?
Coxsakie A16
What are the clinical features of hand, foot and mouth disease
- mild systemic upset: sore throat, fever
- oral ulcers
- vesicles on palms and soles of feet
Management of Hand, food and mouth disease
Symptomatic: analgesia and hydration
Reassure no link to disease in cattle
What are the exclusion rules for hand foot and mouth disease
None - keep off in unwell
Contact HPA if large outbreak
Contraindications to Lumbar Puncture
focal neurological signs papilloedema significant bulging of the fontanelle disseminated intravascular coagulation signs of cerebral herniation meningococcal septicaemia
Investigations for meningococcal septicaemia
Blood cultures
PCR for meningococcus
Meningitis antibiotics in children <3 months
IV amoxicillin + IV cefotaxime
aciclovir if worried about viral infection
Meningitis antibiotics
IV cefotaxime
What is Brudzinski sign
Lay on back, pull neck forward towards chest
If legs bend up/causes distress - positive
What is Kernigs sign
Lay down, extend hip and knee 90 degress passivly extend out if pain - positive
What subtle symptoms should you look for in infants
irritability
Abnormal/high pitch cry
lethargy
difficulty feeding
What is the managment of meningitis in paeds
- call senior help
- protect airway, high flow O2
- IV/IO access
- Bloods
- Anti-pyretics
- LP & Urine cultures
- Start Abx
Which bloods should be done if suspecting meningitis
lcatate
cultures
PCR for meningococcus
What antibiotics do you given in children >3month with meningitis
- ceftriaxone
erythromycin if pen allergy
What antibiotics do you given in children <3month with meningitis
- Ceftriaxone + amoxicillan (ampicillan)
- covers listeria
When and why do you give steroids with bacterial meningitis
- give dexamethsone in confrimed/suspected if >3 monthd
- With or W/I 4hrs of first ABX dose
- decreases hearing loss
What pathogen causes hearing loss in meningitis
pneumococcal
What are the RF for bacterial meningitis
Low family income 3-8 month and adolescents asplenia day care/crowded places basal skull fracture maternal infection/pyrexia at delivery
What would you see on LP in bacterial/pyogenic meningitis
- turbid/cloudy appearance
- hig neutrophils
- low lymphocytes
- Protein >1
- glucose CSF:blood: low
High opening pressure
What would you see on LP in viral meningitis
- Clear appearance
- <100 neutrophils
- high lymphocytes
- Protein 0.4-1
- Glucose CSF:blood normal
- normal/high opening pressure
What would you see on LP in TB meningitis
- opaque appearance
- neutrophils <100
- high lympocytes
- Very high protein
- Glucose CSF:blood low
- high opening pressure
What are the common meningitis pathogens in neonates 0-3 months
Group B streptococcus
E. Coli
Listerial monocytogenes
What are the common meningitis pathogens in infants 3mo-5yrs
Nisseria meningitide
Streptococcus pneumoniae
Haemophillus influenza B
What are the common meningitis pathogens in children >5yrs
Niserria meningitide
Streptococcus pneumoniae
What is group B streptocccus
gram positive coccus chains
What is E.coli
Gram negative rod
What is listeria monocytogenes
gram positive rod
What is Nisseria meningitide
gram negative cocci
What is streptococcus pneumoniae
Gram positive cocci
What is haemophilus influenzae B
Gram negative diplococci