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Pediatrics > Infectious and immunology > Flashcards

Infectious and immunology Flashcards

1
Q

Pathophys of bacterial meningitis

A
  • Damage caused by the host response to infection
  • Release of inflammatory mediators and activated leucocytes
  • Endothelial damage
  • -> Cerebral edema, raised ICP, decreased cerebral blood flow
  • Vasculopathy –> cerebral cortical infarction –> fibrin deposits block resorption of CSF –> hydrocephalus
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2
Q

Pathogens causing bacterial meningitis

A
  • Neonate - 3 months:
  • Group B streptococcus (Strep. Agalactiae)
  • E. coli
  • Listeria monocytogens
  • 1 month - 6 years
  • Neisseria meningitides
  • Strep. pneumoniae
  • H. influenza
  • > 6 years
  • N. meningitides
  • Strep. pneumonia
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3
Q

Clinical features of bacterial meningitis

A
  • Nonspecific signs in infants
  • Fever
  • Headache
  • Photophobia
  • Lethargy
  • Poor feeding/vomiting
  • Irritability
  • Hypotonia
  • Drowsiness
  • Loss of consciousness
  • Seizures
  • Late signs: bulging fontanelle, neck stiffness, arched back (opisthotonos)
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4
Q

Contraindications to lumbar puncture

A
  • Cardiorespiratory instability
  • Focal neurological signs
  • Increased ICP
  • Coagulopathy
  • Thrombocytopenia
  • Local infection at the site of LP
  • If it causes undue delay in starting antibiotics
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5
Q

Cerebral complications after bacterial meningitis

A
  • Hearing impairment
  • Local vasculitis
  • Local cerebral infarction
  • Subdural effusion
  • Hydrocephalus
  • Cerebral abscess
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6
Q

Viruses causing meningities

A

More than 2/3 of CNS infections are viral

  • Enteroviruses
  • EBV
  • Adenoviruses
  • Mumps
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7
Q

Encephalitis may be cause by

A
  • Direct invasion of the brain by neurotoxic virus (e.g. HSV)
  • Delayed brain swelling following a dysregulated neuroimmunological response to an Ag (post infectious encephalopathy)
  • Slow virus infection (e.g. HIV or subacute sclerosing panencephalitis from measles)
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8
Q

Clinical features of encephalitis

A
  • Fever
  • Altered consciousness
  • Often seizures
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9
Q

Most common cause of encephalitis

A 
Viruses:
- Enteroviruses
- Influenza viruses
- Herpesviruses (HSV, VZV, HHV-6)
Mycoplasma 
B. burgdorferi (Lyme)
Bartonella
Rickettsial infections
Arboviruses
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10
Q

Pathogens responsible of Toxic shock syndrome

A
  • S. aureus

- Group A streptococci

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11
Q

Clinical characteristics of Toxic shock syndrome

A
  1. Fever >39 C
  2. Hypotension
  3. Diffuse erythematous, macular rash
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12
Q

Organ dysfunction in Toxic shock syndrome

A

Toxin acts as superantigen

  • Mucositis - conjunctivae, orla mucosa, genital mucosa
  • GI dysfunction - diarrhea, vomiting
  • Renal impairment
  • Liver impairment
  • Clotting abnormalities and thrombocytopenia
  • CNS - altered consciousness
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13
Q

What happens after 1-2 weeks in Toxic shock syndrome?

A

Desquamation of the palms, soles, finger and toes

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14
Q

What is PVL?

A

Panton-Valentine leukocidin
= Toxin produced by 2% of S. aureus
Causing recurrent skin and soft tissue infections, can also cause necrotizing fasciitis and necrotizing hemorrhagic pneumonia

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15
Q

Pathogens causing necrotizing fasciitis/cellulitis

A
  • S. aureus

- Group A strep.

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16
Q

What are the characteristic feature of meningococcal meningitis?

A
  • Septicemia accompanied by a purpuric rash
  • May start anywhere on the body, spread
  • Lesions are nonblanching on palpation, irregular in size and outline, may have necrotic centre
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17
Q

Which type of N. meningitidis cause the majority of meningitis?

A

Group B meningococci

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18
Q

S. pneumonia may cause which diseases?

A
  • Pharyngitis
  • Otitis media
  • Conjunctivitis
  • Sinusitis
  • Invasive diseases: pneumonia, sepsis, meningitis
19
Q

Pathogen responsible for Impetigo

A
  • S. aureus

- Group A Strep.

20
Q

Clinical features of Impetigo

A
  • More common i children with preexisting skin disease, e.g. atopic dermatitis
  • Skin infection on the face, neck, and hands
  • Begin as erythematous macules that may become vesicular/pustular og bullous
  • Honey-colored crusted lesions (rupture of vesicles)
21
Q

What is Nikolsky sign?

A

When areas of epidermis separate on gentle pressure, leaving denuded areas of skin, which subsequently dry and heal, generally without scarring.
- In staphylococcal scalded skin syndrome

22
Q

Most common presentation of herpes simplex virus infection

A
  • Gingivostomatitis
  • Usually occurs from 10 months - 3 years of age
  • Vesicular lesions on lips, gums, and anterior surfaces of the tongue and hard palate
23
Q

Which disease does HHV-6 and 7 cause?

A

Roseola infantum = exanthema subitum

24
Q

Clinical features of Roseaola

A

High fever - then - rash

  • Fever with malaise
  • Generalized macular rash (appears as the fever wanes)
  • Rash first appear on trunk, then extend to extremities and face
25
Q

Pathogen causing fifth disease/Erythema infectiosum

A

Human parvovirus B19

26
Q

Clinical features of Erythema infectiosum

A
  • Fever
  • Malaise
  • Headache
  • Myalgia
  • “Slapped-cheek” - characteristic rash on face appearing a week later, progressing to a maculopapular, “lace”-like rash on the trunk and limbs
27
Q

What is the most serious consequence of HPV-B19?

A

Aplastic crisis

  • occurs in children with chronic hemolytic anemia and in immunocompromised children
  • in fetus (fetal hydrops)
28
Q

Clinical features of Measles

A

Fever and Rash at the same time
- Maculopapular rash starts from face, spreads downwards
4 Cs:
- Koplik spots - spots on buccal mucosa = pathognomonic
- Conjunctivitis
- Coryza
- Cough

29
Q

Complications of Measles

A
  • Encephalitis

- Subacute sclerosing panencephalitis (SSPE)

30
Q

Clinical features of Mumps

A
  • Fever and malaise
  • Parotitis - earache or pain on eating or drinking
  • Abdominal pain (pancreatic involvement)
31
Q

Complications of mumps

A
  • Meningitis and encephalitis

- Orchitis

32
Q

Clinical features of Rubella

A

Rash and fever at same time

  • Prodrome: mild or no fever
  • Maculopapular rash, first on face, spreads to rest of body
  • Lymphadenopathy - esp. the suboccipital and post auricular nodes
33
Q

What is Kawasaki disease?

A

Systemic vasculitis

34
Q

Clinical features of Kawasaki disease

A
  • Fever +
    4/5:
  • Conjunctivitis
  • Mucous membrane changes (cracked lips, strawberry tongue)
  • Cervical lymphadenopathy
  • Rash
  • Extremities - red and edematous palms and soles, peeling of fingers and toes
35
Q

Main complication of Kawasaki disease

A
  • Cardiovascular - coronary arteries are affected in 1/3 - aneurysm - scarring - MI
36
Q

Treatment of TB

A
  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
    Treatment for 6 months
    Last 4 months - only Rifampicin and Isoniazid
37
Q

Child with travel history, fever and loose stools with blood or mucus, diff. Dx?

A
  • Shigella
  • Salmonella
  • Campylobacter
  • Entamoeba histolytica
38
Q

Clinical presentation of T-cell defects

A
  • Severe and/or unusual viral and fungal infections
  • Faltering growth in first months of life
  • Severe bronchiolitis
  • Severe diarrhea
  • Oral thrush
  • PCP
  • Disseminated or severe CMV infection
39
Q

Triad of Wiskott-Aldrich syndrome

A
  1. Immunodeficiency
  2. Thrombocytopenia
  3. Eczema
40
Q

Clinical presentation of B-cell defects

A
  • In first 2 years (after infancy because acquired maternal ab) severe bacterial infections
  • Ear, sinus, pulmonary and skin infections
  • Recurrent diarrhea
  • Faltering growth
41
Q

Most common primary immune defect

A

Selective IgA deficiency

42
Q

Clinical features of neutrophil defects

A
  • Recurrent bacterial infections
  • Abscesses
  • Poor wound healing
  • Perianal disease
  • Periodontal infections
  • Invasive fungal infections (aspergillosis)
  • Diarrhea
  • Faltering growth
  • Granulomas from chronic inflammation
43
Q

Clinical features of complement defects

A
  • Recurrent bacterial infections
  • SLE-like illness
  • Recurrent meningococcal, pneumococcal and Haemophilus influenza infections

Pediatrics (9 decks)

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