Infectious disease Flashcards
When is the MMR vaccine given?
12 months
What are the clinical features of erythema infectiosum and management
- reticulate erythema of forearms
- slapped cheek appearance
- fever resolves at same time
- usually self-limiting, only need to manage if pregnant, immunosuppressed (chronic anemia) or sickle cell (aplastic anemia)
Clinical features of roseola infantum
- mainly infect 6months - 3 years
- high grade fevers with febrile convulsions
- rash appears AFTER fever settles
Triad of measles and clinical features
3 Cs- cough, Coryza, conjunctivitis
Koplik’s spots
Rash begins behind ears and goes down whole body
Infectious period: 4 days before and 4 days after rash
HFM disease characteristics and management
- flat pink patches
- painful vesicular lesions on hands, feet, mouth, tongue, butt, genitals
- may not want to eat
- 5-7 days of mild fever
- self-resolving, so give fluids and analgesia but do NOT pop vesicles
Rubella clinical presentation
- mild profuse maculopapular rash beginning on trunk > neck > LL
- Petechial hemorrhages (Forchheimer spots) on hard palate
- +/- arthralgia
Mild fever, sore throat, rhinitis
Infectious period is 7 days prior to rash and 7 days after rash appears
Mumps clinical features
- swollen parotid glands
- Trismus at jaw
- meningitis
- epididymo orchitis
Causes of recent onset localized cervical adenitis
Tonsillitis, viral URTI, Kawasaki, EBV, dental infection, bacterial lymphadenitis
Causes of persistent localized cervical adenitis
EBV, TB, cat scratch disease, atypical mycobacterium, leukemia, lymphoma, HIV, toxoplasmosis, SLE, CMV
Kawasaki disease diagnostic criteria
Fever persisting for 5 days or more + 4 of the following 5
- Conjunctival injection - bilateral, painless, non-edematous
- Erythematous polymorphous rash on trunk and extremities (maculopapular)
- Oral changes - strawberry tongue, pharyngeal injection, red and dry cracked lips
- Extremity changes - hyperemia and painful edema of palms and soles with desquamate at 2nd week
- Cervical lymphadenopathy, usually unilateral and tender
Tests for Kawasaki
Echo for coronary aneurysm, must do at 2 and 6 weeks
FBC, ESR/CRP, UEC, LFT, blood culture, ASOT, Covid-19 swab, urinalysis and culture
ECG
Managing Kawasaki
IVIG: 2g/kg single IV infusion over 10-12 hours
- should be given within first 10 days but if after that still active inflammation then can still give
Aspirin
- 3-5mg/kg PO daily for min. 6 weeks (depending on echo)
- avoid giving NSAIDS, traditional meds
- beware Reye’s
Steroids, conside in high-risk groups
- age < 12month, Asian
- ALT >100IU/L, albumin 30g/L or less, sodium 135 mmol/L or less, platelets 30 x 10^9 or less, CRP > 100ng/L, anemia
- cardiac/coronary artery involvement on echo at presentation
MUST delay MMR and varicella vaccines for at least 6-12 months
Other features of Kawasaki
Neuro; irritable, aseptic meningitis GI: abdominal pain, vomit, diarrhoea, gallbladder hydros Arthralgia/arthritis Dysuria Inflammation at recent BCG site
Ddx for Kawasaki
Group A strep, viral infections, EBV, CMV, adenovirus, HHV-6, JIA, sepsis, TSS, SJS, drug reaction, Malignancy
Meningitis features in child less than 3 (above 3 see GP section)
Fever, pallor, vomiting, lethargy, irritability, drowsiness, refusal to feed, indifferent to mother, neck stiffness, cold extremities, bulging fontanelle, non-blanching petechiae/outputs, opisthotonus, Brudzinski, Kernig
