Infections in Childhood Flashcards
What are the features of mumps?
Prodromal malaise
Fever
Parotitis - may start unilateral and become bilateral
Which viral infection of childhood is associated with arthritis as a complication?
Rubella
What is ‘German Measles’?
Rubella
How does rubella present if it is acquired in childhood?
Prodromal illness - low grade fever
Rash which starts on face and spreads over body
Lymphadenopathy - posterior auricular and occipital nodes
What is the incubation period of rubella?
2-3 weeks
For which childhood viral infection are Koplik’s spots pathognomonic?
Measles - although these are sometimes hard to see
What is a very rare, late (from 7 years after initial infection) complication of measles, and how does it present?
Subacute sclerosing pan encephalitis - Presents with loss of neurological function which progresses over many years, leading to dementia and death
What is the incubation period of measles? How long is a child infectious for?
5-14 days (average about 10 days)…Infectious until about Day 5 of the rash
Give some clinical features of measles
Prodromal illness Coryza, cough Conjunctivitis Koplik's spots Maculopapular rash late in the illness (starts from the ears and spreads downwards, covering entire body) Encephalitis - rare
What are Koplik’s spots and when are they seen?
White spot on buccal mucosa which are pathognomonic of measles infection although they can be difficult to see on the mucosa
What is the treatment for measles?
Symptomatic
Isolate infected children if in hospital
Prevention with vaccination
Which age-group are most commonly affected by measles?
Age 5-10
Which virus causes glandular fever?
Epstein-Barr virus (EBV)
By what name(s) is erythema infectiosum also known?
‘Fifth’ disease
Slapped cheek disease
Which virus causes erythema infectiosum?
Parvovirus B19
What are the features of erythema infectiosum?
Fever, lethargy
Malar rash ('slapped cheek' appearance), spreading to limbsWhat are the complications of erythema infectiosum?
Aplastic crisis - the virus suppresses bone marrow
Complications in pregnancy - Hydrops fetalis and fetal death
Describe the progression of the rash in chickenpox
Macules, then papules, then vesicles, then pustules, then crusts
What are the 2 common features of chickenpox?
Fever
Rash which follows a particular progression
True / False: Vaccination against VZV is given to everyone in the UK
False - There is a vaccination available but it is not routinely given in the UK
Which virus causes hand, foot and mouth disease?
Coxackie A16 virus
What are the features of hand, foot and mouth disease
The child is mildly unwell, perhaps with fever
Vesicles appear on palms, soles and in mouth
There may be associated sore throat
Treatment is symptomatic
Which organism causes 95% of UTIs in children
E. coli
How might a child / infant with a UTI present?
Non-specific illness!! Fever Irritability Poor feeding Vomiting
What are the guidelines for when to investigate of UTI in infants / children?
Single, uncomplicated UTI in infant/child over 6 months = No investigation required
Investigate if:
- Any UTI in infant under 6 months old
- 2 or more UTIs in infant/children over 6 months old
What should always be considered in an infant / child with an unexplained fever?
UTI - Often presents with non-specific symptoms
What is the investigation(s) of choice for UTI in infants and children?
Ultrasound scan within 6/52: Typical UTI in infant / child under 6 months old, recurrent UTI in children over 6 months old
DMSA: All infants and children under 3 yrs old if atypical or recurrent UTIs
MCUG: Infants under 6 months with atypical / recurrent UTI
Acute ultrasound scan: All infants and children if atypical UTI
What is an MCUG?
Micturating cystogram - Aims to detect vesicoureteric reflux in under 6/12 olds
What is a DMSA?
A radio-isotope scan which clearly visualises the renal anatomy and looks for any scarring which may have been caused by recurrent UTIs
Give some examples of enteroviruses
Coxackie virus A and B
Poliovirus
Echovirus
What are the features of polio?
Over 90% are asymptomatic
Mild symptoms such as fever, headache, malaise
May cause aseptic meningitis
‘Paralysis polio’ is caused when the virus destroys the anterior horn cells of spinal cord
What are the 2 manifestations of enteroviruses to be aware of in paediatrics?
Hand, foot and mouth disease (Coxackie virus)
Polio (poliovirus)
What is the presentation of infectious mononucleosis?
Fever Malaise Tonsillopharyngitis Cervical lymphadenopathy Petechiae on soft palate Florid, maculopapular rash may develop if amoxicillin is given Hepatosplenomegaly
What is the treatment for infectious mononucleosis?
Symptomatic treatment
What are the consequences to the baby of listeria infection in pregnancy?
Miscarriage Stillbirth Prematurity Sepsis Conjunctivitis Petechial rash Leucopenia Meningitis
What are the neonatal symptoms of antenatal toxoplasmosis infection?
Neurological symptoms: Hydrocephalus, encephalitis, epilepsy Hepatosplenomegaly Thrombocytopenia Jaundice Mental retardation
How does rubella affect the baby if acquired antenatally?
Sensorineural deafness Congenital cataracts Cardiac lesions Jaundice Hepatosplenomegaly Purpura Cerebral malsy Microcephaly Mental retardation Microphthlmia Retinitis
What is the cause of roseola infantum?
Herpesvirus 6
List some features of roseola infantum
High fever for 2-5 days Maculopapular rash develops suddenly as the fever is subsiding Febrile convulsion Diarrhoea Cough
List some complications of mumps
Orchiditis
Pancreatitis
Meningitis
Oophoritis
How is measles diagnosed?
Detection of virus nucleic acid in throat swab or urine
Detection of measles IgM
How should an immunocompromised patient who comes into contact with measles (and who is not themselves immune) be managed?
Check immune status
Give measles immunoglobulin if not immune
True / False: Measles vaccination is given to immunocompromised patients who come into contact with a patient with measles and who are not immune themselves
False - The measles vaccine is part of the live MMR vaccine and so cannot be given to immunocompromised patients
Give 3 infections in childhood which cause vesicular rashes
HSV
VZV (Chickenpox)
Hand, foot and mouth disease (enterovirus)
A rash which appears after a fever has subsided is typical of which childhood infection?
Roseola infantum
