Infections: HIV; HBV & C; Flashcards
How do you determine mode of delivery to prevent transmission during birth? [3]
Normal vaginal delivery is recommended for women with a viral load < 50 copies / ml
Caesarean sections are considered in patients with > 50 copies copies / ml and in all women with > 400 copies / ml
What tx do you give during a c-section if viral load is unknown / > 10000 copies? [1]
IV zidovudine should be given during the caesarean if the viral load is unknown or there are > 10000 copies / ml
Prophylaxis treatment may be given to the baby depending on the mothers HIV viral load
What are these treatments and viral loads? [2]
How long should each treatment last for? [2]
- Low risk babies, where mums viral load is < 50 copies per ml, should be given zidovudine for 4 weeks
- High risk babies, where mums viral load is > 50 copies / ml, should be given zidovudine, lamivudine and nevirapine for 4 weeks
What advice should you give around breastfeeding for people living with HIV who are mothers? [1]
HIV can be transmitted during breastfeeding, even if the mother’s viral load is undetectable. Breastfeeding is never recommended for mothers with HIV, however if the mum is adamant and the viral load is undetectable, sometimes it is attempted with close monitoring by the HIV team.
When do you test for HIV in children? [4]
- Babies to HIV positive parents
- When immunodeficiency is suspected, for example where there are unusual, severe or frequent infections
- Young people who are sexually active can be offered testing if there are concerns
- Risk factors such as needle stick injuries, sexual abuse or IV drug use
Babies to HIV positive parents are tested twice for HIV.
When and with which tests? [2]
HIV viral load test at 3 months.
- If this is negative, the child has not contracted HIV during birth and will not develop HIV unless they have further exposure.
HIV antibody test at 24 months.
- This is to assess whether they have contracted HIV since their 3 month viral load, for example through breast feeding. If the 3 month test is negative and they are not breastfed, this should be negative.
NB: Note that the antibody test can be positive in infants who do not have HIV for up to 18 months of age. This is due to maternal antibodies that have crossed the placenta during pregnancy.
Hep B can be passed from mother to child during pregnancy and delivery. This is known as vertical transmission.
Describe the disease course of Hep B in children [2]
Most children fully recover from the infection within 2 months.
However a portion go on to become chronic hepatitis B carriers. In these patients the virus DNA has integrated into their own DNA and they continue to produce the viral proteins. The risk of developing chronic hepatitis B after exposure is:
* 90% for neonates
* 30% for children under 5
* Under 10% for adolescents
Describe the clinical impact of being a chronic Hep B carrier [2]
Most children with chronic hepatitis B are asymptomatic, with normal growth and development and normal liver function tests.
- Less than 5% will develop liver cirrhosis and less than 0.05% will develop hepatocellular carcinoma before adulthood. These risks increase once they enter adulthood.
viral markers.
How do you reduce the risk of baby contracting Hep B at birth if mother is HBV +ve? [2]
Describe the follow up care given throughout life because of their +ve mother? [3]
within 24 hours neonates with hepatitis B positive mothers should be given both:
* Hepatitis B vaccine
* Hepatitis B immunoglobulin infusion
Infants are given an additional hepatitis B vaccine at 1 and 12 months of age
They will also receive the hepatitis B vaccine as part of the normal 6 in 1 vaccine given to all infants aged 8, 12 and 16 weeks.
They are tested for the HBsAg at 1 year to see if they have contracted hepatitis B.
What is the advice regarding breastfeeding and Hep B? [1]
The hepatitis B virus can be found in the breast milk of mothers with hepatitis B. Babies of these mothers have already been exposed to the virus during pregnancy and birth. They should also receive the hepatitis B vaccine and hepatitis B immunoglobulin infusion. Therefore, the general advice is that it is safe for hepatitis B positive mother to breastfeed provided their babies are properly vaccinated.
A mother has HCV.
How do you manage their newborn child? [4]
Babies to hepatitis C positive mothers are tested at 18 months of age using the hepatitis C antibody test. Breastfeeding has not been found to spread hepatitis C, so mothers are free to breastfeed their babies. If nipples become cracked or bleed breastfeeding should temporarily stop whilst they heal.
Medical treatment may be considered in children over 3 years. Treatment in childhood involves:
- pegylated interferon and ribavirin, which are less effective and well tolerated compared with the adult treatments.
- Treatment is typically delayed until adulthood unless the child is significantly affected, because children are usually asymptomatic and newly available treatment for adults is highly effective.
A patient (6 year old girl), presents with a sore throat and difficulty swallowing.
How do you determine if this is a bacterial or viral cause? [+]
Use FeverPAIN:
- Fever
- Abscence of cough
- Purulent tonsils
- Tonsillar exudates
- < 3 days of symptoms
Higher scores suggest more severe symptoms and likely bacterial (streptococcal) cause / GAS
How do you interpret FeverPAIN or Centro score to manage sore throat?
FeverPAIN: 0-1 or Centor score: 0-2
- Low liklihood of bacterial infection: don’t give abx
FeverPAIN: 2-3
- Consider no abx or a back-up prescription
FeverPAIN 4-5 or Centor 3-4:
- Consider immediate abx or a back up prescription
NB: only used for adults
The CENTOR score is used for bacterial cause of infection. What criteria is used for this score? [4]
CENTor
C an’t Cough
E xudates on tonsils
N odes tender
T emperature
Which treatment would you give for high FeverPAIN score in children? [1]
Penicillin V (also called phenoxymethylpenicillin) for a 10-day course is typically first-line. It has a relatively narrow spectrum of activity and is effective against Streptococcus pyogenes.
Dx? [1]
Describe the dx [1]
Red, inflammed and bulging - acute otitis media
- Pus builds up behind tympanic membrane - pathogens have moved from nasopharynx and causes infection
- If tympanic membrane bursts - get pus
Describe the managment plan for otitis media in children [+]
Give advise that normally last 3 days - 1 week
If discharge after eardrum burst / perforated ear drum OR children < 2 with both ears involved
- can give immediate abx, or give back up / none
If child is systemically v unwell or has symptoms and signs of more serious illness:
- can give immediate abx prescription
