Infectious disease Flashcards
What are inactivated vaccines
Killed versions of pathogens
Safe for immunocompromised patients
Polio, flu, hep A, rabies
What are subunit and conjugate vaccines
Contain part of organism
Safe for immunocompromised patients
Pneumococcus, meningitis, hep B, whooping cough, haemophilus influenza B, HPV, shingles
What are live attenuated vaccines
Weakened version of pathogen
Can cause infection
MMR, BCG, chickenpox, nasal influenza, rotavirus
What are toxin vaccines
Cause immunity to toxins, not pathogen itself
Diphtheria, tetanus
What vaccines are included in the vaccine schedule
8 weeks: 6 in 1 (diphtheria, tetanus, pertussis, polio, haemophilus influenza B, hep B), meningococcal B, rotavirus (oral)
12 weeks: 6 in 1 (again), pneumococcal, rotavirus (again)
16 weeks: 6 in 1 (again), meningococcal B (again)
1 year: 2 in 1 (haemophilus influenza B, meningococcal C), pneumococcal (again), MMR, meningococcal B (again)
Yearly from 2-8: influenza (nasal)
3 year 4 months: 4 in 1 (diphtheria, tetanus, pertussis, polio), MMR (again)
12-13 years: HPV
14 years: 3 in 1 (tetanus, diphtheria, polio), meningococcal ACWY
What strains does the HPV vaccine protect against
6 and 11: genital warts
16 and 18: cervical cancer
What are the signs of paediatric sepsis
Deranged physical observations
Prolonged capillary refill time
Fever or hypothermia
Deranged behaviour
Poor feeding
Inconsolable or high pitched crying
Weak cry
Reduced consciousness
Reduced body tone
Cyanosed, mottled, pale, ashen skin
What are the 4 categories that make up the traffic light system for paediatric sepsis
Colour
Activity
Respiration
Circulation and hydration
How should babies under 3 months with a temperature be managed
Urgently treat for sepsis until proven otherwise
What is the immediate management for paediatric sepsis
Call for senior help early
Oxygen
IV access
Bloods (normal, clotting, blood gas)
Urine dip
Antibiotics (within 1 hour)
IV fluids (20ml/kg bolus, repeat as needed)
What are the further management steps for paediatric sepsis
Chest X-ray
Abdominal and pelvic ultrasound
Lumbar puncture
Meningococcal PCR
Serum cortisol
Continue antibiotics for 5-7 days
What are the common causes of meningitis in children and neonates
Children: neisseria meningitidis, streptococcus pneumoniae
Neonates: group B strep
How might a patient with meningitis present
Fever
Neck stiffness
Vomiting
Headache
Photophobia
Altered consciousness
Seizures
Non-blanching rash
Neonates and babies: hypothermia, poor feeding, lethargy, hypotonia, bulging fontanelles
What are the investigations for meningitis
Lumbar puncture if: < 1 month with fever, 1-3 months with fever and unwell, < 1 year with fever and other features of serious infection
Kernig’s test
Brudzinski’s test
What is the management for meningitis in the community
Urgent stat IV/IM benzylpenicillin
Urgent transfer to hospital
What is the management for meningitis in hospital
Blood cultures
Lumbar puncture
Steroids (dexamethasone)
Notifiable disease
What is involved in post-exposure prophylaxis for meningitis
Close contacts for past 7 days
Single dose antibiotic (ciprofoxacin)
Within 24 hours of diagnosis
What is viral meningitis
Caused by herpes simplex or enterovirus varicella zoster
Usually milder than bacterial meningitis
Often only need supportive care
Give aciclovir
What would a lumbar puncture show in bacterial meningitis
Cloudy
High protein
Low glucose
High neutrophils (WCC)
Bacteria in culture
What would a lumbar puncture show in viral meningitis
Clear
Slightly raised or normal protein
Normal glucose
High lymphocytes (WCC)
Negative culture
What are the complications of meningitis
Hearing loss
Seizures and epilepsy
Cognitive impairment
Learning disability
Memory loss
Cerebral palsy
What is encephalitis
Inflammation of the brain
Usually viral: herpes simplex, varicella zoster, cytomegalovirus, Epstein-Barr
How might a patient with encephalitis present
Altered consciousness
Altered cognition
Unusual behaviour
Acute onset focal neurological symptoms
Acute onset focal seizures
Fever
What are the investigations for encephalitis
Lumbar puncture
CT head
MRI brain
EEG
Swab of area (look for causative organism)
HIV test
What is the management for encephalitis
IV antivirals: aciclovir for herpes simplex/varicella zoster, ganciclovir for cytomegalovirus
Repeat lumbar puncture (ensure successful treatment before stopping antivirals)
Follow up support and rehabilitation
What are the complications of encephalitis
Lasting fatigue
Prolonged recovery
Changes in personality
Changes in memory and cognition
Learning disability
Headaches
Chronic pain
Movement disorders
Sensory disturbance
Seizures
Hormonal imbalance
What is infectious mononucleosis
Infection with Epstein-Barr virus
Aka mono, glandular fever
Transmitted through infected saliva
How might a patient with infectious mononucleosis present
Fever
Sore throat
Fatigue
Lymphadenopathy
Tonsillar enlargement
Splenomegaly
What are the investigations for infectious mononucleosis
Specific antibody tests (IgG, IgM)
Heterophile antibodies: not specific to EBV, take 6 weeks to be produced, aka monospot test
What is the management for infectious mononucleosis
Usually self limiting
Acute illness lasts 2-3 weeks
Advise to avoid alcohol and contact sports
What are the complications of infectious mononucleosis
Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue
Lymphoma
What is mumps
A viral infection
Droplet spread
14-25 day incubation
Usually self limiting
Lasts around 1 week
A notifiable disease
How might a patient with mumps present
Initial flu-like symptoms
Parotid swelling (painful)
Fever
Muscle aches
Lethargy
Reduced appetite
Headaches
Dry mouth
Symptoms of complications (abdominal pain for pancreatitis, testicular pain for orchitis)
What are the investigations for mumps
Saliva swab for PCR and antibody testing
What is the management for mumps
Supportive care (rest, fluids, simple analgesia)
What are the complications of mumps
Pancreatitis
Orchitis
Meningitis
Sensorineural hearing loss
What is HIV
RNA retrovirus
Destroys CD4+ T helper cells
Initial seroconversion flu-like illness
Asymptomatic phase
Symptoms due to being immunocompromised
How is HIV transmitted
Unprotected anal, vaginal, or oral sex
Vertical transmission
Exposure to bodily fluids
What are the investigations for babies of HIV positive parents
HIV viral load test at 3 months
HIV antibody test at 24 months
What is the management for HIV
Antiretroviral therapy
Normal childhood vaccines
Prophylactic co-trimoxazole
Treat opportunistic infections
What is hepatitis B
DNA virus
Transmitted through contact with bodily fluids
Most neonates fully recover in 2 months (some have chronic infection)
Which children should be screened for hep B
Have hep B positive mother (screen at 12 months)
Migrants from endemic areas
Close hep B contact
What is the management for hep B
Babies of hep B positive mothers: hep B vaccine and hep B immunoglobulin infusion at birth
Safe to breastfeed as long as baby is vaccinated
What is the management for hep C
Test babies of positive mothers at 18 months
Able to breastfeed (stop if nipples crack)
Usually resolves spontaneously
Regular monitoring (liver function, hep C viral load)
Children over 3: pegylated interferon, ribavirin
Treatment delayed until adulthood if possible
