Infectious

Question 1

What is this an image of?

Answer 1

Scarlet fever

Question 2

What microorganism causes Scarlet fever?

Answer 2

Group A B-haemolytic streptococci - usually Streptococcus pyogenes

Question 3

What are the features of scarlet fever?

Answer 3

fever: typically lasts 24 to 48 hours

malaise, headache, nausea/vomiting

sore throat

‘strawberry’ tongue

rash

fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles

children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures

it is often described as having a rough ‘sandpaper’ texture

desquamination occurs later in the course of the illness, particularly around the fingers and toes

2-6 yrs old

Question 4

How do we manage Scarlet Fever?

Answer 4

Management

oral penicillin V for 10 days

patients who have a penicillin allergy should be given azithromycin

children can return to school 24 hours after commencing antibiotics

Notify PHE

Question 5

What are the complications of Scarlet Fever?

Answer 5

• otitis media: the most common complication
• rheumatic fever: typically occurs 20 days after infection
• acute glomerulonephritis: typically occurs 10 days after infection
• invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness

Question 6

How can we differentiate Kawasaki’s syndrome and Scarlet Fever?

Answer 6

Kawasaki typically presents in children 5 years old or younger and with a higher temperature of around 39 degrees C.

Question 7

What is the school exclusion advice for some common infectious diseases in children?

Answer 7

AdviceCondition(s)

No exclusion:

Conjunctivitis
Fifth disease (slapped cheek)
Roseola
Infectious mononucleosis
Head lice
Threadworms
Hand, foot and mouth

24 hours after commencing antibiotics: Scarlet fever

2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics ): Whooping cough

4 days from onset of rash: Measles

5 days from onset of rash: Rubella

All lesions crusted over: Chickenpox*

5 days from onset of swollen glands: Mumps

Until symptoms have settled for 48 hours: Diarrhoea & vomiting

Until lesions are crusted and healed, or 48 hours
after commencing antibiotic treatment: Impetigo

Until treated: Scabies

Until recovered: Influenza

Question 9

What are the signs and sx of whooping cough?

Answer 9

Incubation period: 5-10 days

Catarrhal phase: Coryzal prodrome, Low grade fever

Paroxysmal phase: clusters of rapid coughs - worse at night and after feeding (>=14 days), long inspiratory effort with a whoop, central cyanosis, vomiting (post-tussive emesis) and exhaustion, apnoea spells, subconjuctival haemorrhages, anoxia - syncope and seizures, lymphocytosis

Convalescent phase: Gradual recovery 2-3 weeks/months

Question 10

What pathogen causes whooping cough?

Answer 10

Gram negative Bordatella Pertussis

Question 11

What are Ix for whooping cough?

Answer 11

Bedside: Obs

Bloods: FBC - WBC check for lymphocytosis, CRP

Swab: Nasal swab MCS for Bordetella Pertussis, PCR and serology testing?

Question 12

What is the management for whooping cough?

Answer 12

• Admit if under 6 months
• Notify public health England
• Check guidelines and local policy
• Give oral macrolide Abx if cough started within 21 days of presentation - clarithromycin, azithromycin, erythromycin
• Offer household contacts Abx prophylaxis
• Exclude from school for 48 hrs after commencing Abx or 21 days after onset of sx if no Abx

Question 13

What are the complications of whooping cough

Answer 13

Subconjunctival haemorrhage

Pneumonia (recurrent chest infections)

Bronchiectasis

Seizure

Question 14

What vaccines would a woman be offered during the pregnancy?

Answer 14

Influenza - any time during the pregnancy

Pertussis - 16-32 weeks pregnant

Question 15

How would a congenital cytomegalovirus (CMV) infection present?

Answer 15

Microcephaly

Low birth weight

Hepatosplenomegaly

Petechial rash

Seizures

Jaundice

Anaemia

Later: hearing loss, learning disability, vision impairment, cerebral palsy

Question 16

In a child with limp/hip pain and fever, with a past cold what do you need to rule out?

Answer 16

Septic arthritis

According to the Kocher criteria, there is a 3% chance that a child with an acutely irritable hip and fever >38.5ºC has septic arthritis, warranting urgent assessment with the possibility of synovial aspiration.

Question 17

What are the rules on school exclusion for non-bullous impetigo?

Answer 17

A child with impetigo should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

Question 18

What pathogens typically cause early onset sepsis and late onset sepsis respectively in the neonate?

a) Neisseria meningitidis
b) Streptococcus agalacticae
c) Staphylococcus epidermis
d) Staphylococcus aureus

Answer 18

Late-onset sepsis normally occurs due to hospital acquired pathogens such as Staphylococcus epidermidis and Staphylococcus aureus.

The most likely pathogen causing early onset sepsis is Group B Strep (Streptococcus agalacticae) which is a common commensal of the female genital tract.

Question 20

What are the RF for Group B Streptococcus infection in the neonate?

Answer 20

prematurity

prolonged rupture of the membranes

previous sibling GBS infection

maternal pyrexia e.g. secondary to chorioamnionitis

Question 21

What are the Ix for Measles?

Answer 21

1st: measles specific IgM and IgG serology (ELISA) is most sensitive 3-14 days after onset of the rash
2nd: measles RNA detection by PCR best for swabs taken 1-3 days after rash onset

Question 22

What is the Mx for measles?

Answer 22

Supportive care which will normally include an antipyrexial

Vitamin A in all children under 2

Ribavarin may reduce the duration of symptoms but its use is not routinely recommended

Question 24

What are the features of kawasaki disease?

Answer 24

Conjunctivitis

Rash

Edema/Erythema of hands and feet

Adenopathy (cervical, commonly unilateral)

Mucosal involvement (strawberry tongue, oral fissures etc)

5 day < Hx of fever

Question 25

What is the treatment for Kawasaki disease?

Answer 25

Aspirin

Intravenouos immunoglobulin (gamma globulin)