Infectious Disease Flashcards
Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus → machinery murmur)
Glaucoma
Other features:
- growth retardation
- hepatosplenomegaly
- purpuric skin lesions
- ‘salt and pepper’ chorioretinits
- microphthalmia
- cerebral palsy
Diagnosis? and Mx?
Congenital Rubella Infection
- serological diagnosis
- foetal damage depends on GA at age of onset of infection
- most presentation infection <8-10 wk GA
- 30% impaired hearing when infected at 13-16 wk GA
- beyond 18w GA, risk is minimal
Mx:
- No effective tx for rubella in pregnancy
- notify local health protection unit
- refer urgently to obstetrician for RA and counselling
- preventable with MMR
- admit if haemorrhage complications caused by thrombocytopaenia or encephalitis
- *Cerebral calcification**
- *Chorioretinitis**
- *Hydrocephalus**
Anaemia
Hepatosplenomegaly
Cerebral palsy
Diagnosis?
Acute infection (toxoplasma gondii, protozoa) form the consumption of undercooked meat or cat faeces
Amniocentesis after 20w to confirm vertical transmission
10% clinical manifestations:
- retinopathy (acute fundal chorioretiniits, can interfere with vision), cerebral calcification, hydrocephalus, long term neurodisabilities convulsions, spasticity
Mx symptomatic:
- Infected newborns tx with pyrimethamine, sulfadiazine + folinic acid for 1 year
- monitor LFTs + FBC every 4-6 weeks
Mx asymptomatic babies with positive serology:
- no definitive guidelines present as treatment is controversial
- discuss individual cases with infection and virology specialists
Ophthalmology and audiology assessment recommended
- *Growth retardation (LBW)**
- *Purpuric skin lesions**
Sensorineural deafness
microcephaly
seizures
Pneumonitis
Hepatosplenomegaly
Anaemia
Jaundice
Cerebral palsy
Diagnosis? Mx?
CMV (MOST COMMON CONGENITAL INFECTION) → childhood disability and deafness
When infant is treated:
- 90% are normal with normal development
- 5% have clinical features at birth – hepatosplenomegaly and petechiae with neurodevelopmental issues – sensorineural hearing loss
- 5% develop problems later in life – mainly sensorineural hearing loss
Infection in mother is usually asymptomatic or causes a mild non-specific illness
Amniocentesis 6w after maternal infection to confirm vertical transmission
Close surveillance for US abnormalities – intracranial and hepatic calcification
Meningitis in children: organisms (three age ranges)
Neonatal to 3 months
- Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes
- E. coli and other Gram -ve organisms
- Listeria monocytogenes
1 month to 6 years
- Neisseria meningitidis (meningococcus)
- Streptococcus pneumoniae (pneumococcus)
- Haemophilus influenzae
Greater than 6 years
- Neisseria meningitidis (meningococcus)
- Streptococcus pneumoniae (pneumococcus)
Immunisation schedule
All premature babies should still have immunisations at regular time (no adjustment required), however if <28 weeks at birth, should be given in hospital due to higher risk of apnoea. If a baby develops apnoea, bradycardia, or desaturation after the first immunisation, the second immunisation should also be given in hospital with similar monitoring.
Give some contraindications to vaccinations
Acute febrile illness
Egg allergy – influenza, yellow fever and tick-borne encephalitis (NB: MMR is usually safe but can be given in hospital if egg allergic)
Previous anaphylaxis to vaccine containing or constituent antigens/components
Immunocompromised depends on cause.
- Short term– delay vaccines.
- Care with live vaccines
Meningitis ACWY > Men C vaccine
What ix for meningitis in children and the contraindications to the ix
ix = Obs (mainly temperature, HR, RR), physical examination (fontanelle and rash)
LUMBAR PUNCTURE CONTRAINDICATIONS (from any signs of raised ICP)
- focal neurological signs
- papilloedema
- significant bulging of the fontanelle
- DIC
- Signs of cerebral herniation
- meningococcal septicaemia (blood cultures and PCR for meningococcus should be obtained)
Management of Bacterial meningitis
<3 months old:
- Antibiotics: IV ampicillin/amoxicillin + cefotaxime
>3 months old:
- IV ceftriaxone
Start empirical abx while writing for LP results
Supportive therapy:
- analgesia and antipyretics
- Oxygen: reservoir rebreathing mask, unless intubation required aka mechanical ventilation if respiratory impairment
- anticonvulsant therapy
- IV fluids: 0.9% NaCl + 5% dextrose to treat any shock e.g. with colloid
- vasopressors if hypotensive despite fluid resuscitation
Presenting in primary care
- single dose of IM/IV benzylpenicillin
- arrange emergency transfer to hospital via 999
- CHECK for penicillin allergy (moxifloxacin and vancomycin)
Recent foreign travel
- add vancomycin
Notify Health Protection Unit
When should you give dexamethasone in bacterial meningitis
Dexamethasone may be given if >3 months old and presents with these in CSF analysis: o FranklypurulentCSF
- CSF WBC>1000/μL
- Raised CSF WBC + protein concentration >1g/L
- Bacteria on Gram stain
- Note: steroids should not be used in meningococcal septicaemia
Discharge and follow up for bacterial meningitis
all children reviewed by paediatrician 4-6 weeks after discharge
offer formal audiological assessment
treating contacts: ciprofloxacin preferred over rifampicin (includes anyone who has had contact with the patients in the 7 days before onset)
Why is ceftriaxone contraindicated in babies <3 months
displaces bilirubin from albumin binding sites, resulting in higher levels of bilirubin that accumulate in the tissues.
Childhood infections
Features of erythema infectiosum and causative organism
‘Fifth disease/slapped-cheek syndrome’
Slapped cheek rash spreading to proximal arms and extensor surfaces
Parvovirus B19
lethargy, fever, headache
Hand, foot, mouth disease
causative organism
features
Coxsackie A16 virus
Mild systemic upset: sore throat, fever
vesicles in mouth and on the palms and soles of the feet
Hand, foot, mouth disease mx
Symptomatic treatment only (hydration and analgesia)
Keep blisters clean and apply non-adherent dressings to erosions
Reassurance there is no link to disease in cattle
Do not necessarily need exclusion from school
Will subside within days
Erythema infectiosum mx
Paracetamol (10-15mg/kg every 4-6hrs) or ibuprofen (5-10mg/kg every 4-6hrs) for symptomatic relief
Encourage adequate fluid intake and rest
Secondary arthritis may be treated with ibuprofen (4-10mg/kg every 6-8hrs)
If infection persists >3wks:
- Give IVIG for 5d
- May need a RBC transfusion for anaemia
NICE traffic light
Threadworms (Enterobius vermicularis/pinworms)
Infestation occurs after swallowing eggs that are present in the environment.
Threadworm infestation is asymptomatic in around 90% of cases, possible features include:
- perianal itching, particularly at night
- girls may have vulval symptoms
Diagnosis may be made by the applying Sellotape to the perianal areaand sending it to the laboratory for microscopy to see the eggs. However, most patients are treated empirically and this approach is supported in the CKS guidelines.
Management = hygiene measures + single dose mebendazole for all the family
- CKS recommend a combination of anthelmintic with hygiene measures for all members of the household
- mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists
What is the criteria for Kawasaki disease?
Kawasaki disease (type fo vasculitis) is a rare condition mainly seen in children under 5-years-old. It is classified by a fever which is present for 5 days (fever characteristically resistant to antipyretics) or more along with 4 of the following features:
- Bright red, dry cracked lips
- Bilateral conjunctivitis
- Red palms of the hands and soles of the feet which later peel, peeling of skin on fingers and toes
- Cervical lymphadenopathy
- Red rash over trunk
Other features:
- strawberry tongue
*
How do we manage Kawasaki disease?
IVIG infusion (single dose, can repeat after 36 hours)
High-dose aspirin (reduce thrombosis risk) 24-72 hours after fever then low-dose aspirin for 8 weeks
- 2nd line = corticosteroids and infliximab
- 3rd = cyclosporin, anakinra or plasma exchange
RA for myocardial ischaemia and coronary artery aneurysm:
- low risk = no further medications after 8 wks aspirin
- moderate risk = low dose aspirin until aneurysm regression, ECG and ECHO follow up annually
- High risk = low dose aspirin long term, with ECG and ECHO 2x a year. Need long term warfarin (iNR target 2-3), may need clopidogrel
Give 2 complications of Kawasakis
Coronary artery aneurysm
Myocardial ischaemia
What is roseola infantum? features and consequences
Roseola infantum (also known as exanthem subitum, occasionally sixth disease) is a common disease of infancy caused by the human herpes virus 6 (HHV6). It has an incubation period of 5-15 days and typically affects children aged 6 months to 2 years.
Features
- high fever: lasting a few days, followed later by a
- maculopapular rash = STARTS TRUNK/CHEST with minimal limb spread
- Nagayama spots: papular enanthem on the uvula and soft palate
- febrile convulsions occur in around 10-15%
- diarrhoea and cough are also commonly seen
Other possible consequences of HHV6 infection
- aseptic meningitis
- hepatitis
roseola infantum mx
Mx of Parvovirus B19 (erythema infectiosum)
mother
child
What investigations to do in infants younger than 3 months with fever?
FIRSTLY → NEED HOSPITAL ADMISSION
Set of obs (bar blood pressure)
- Full blood count
- Blood culture
- C-reactive protein
- Urine testing for urinary tract infection
- Chest radiograph only if respiratory signs are present
- Stool culture, if diarrhoea is present
summary of congenital infections
Rubella = rest and fluids
Toxoplasmosis = spiramycyn
CMV = vaganciclovir
Ix and Management of CMV in the newborn
urine/salivary PCR for CMB
- definitive test = done in first 2 weeks of life
barrier nursing
- CMV shed in urine and body secretions
anti-virals for 6 months if:
- CNS infection
- acutely unwell
Oral vaganciclovir preferred, if concerns with absorption, then give ganciclovir
Meningitis CSF findings
Ix for fever without focus
Quick guide to rashes:
Papular = hand, foot and mouth
Macular (chest) = measles (or rubella)
Maculo-papular = any normal blanching viral rash, probably okay
Vesicular = HSV/VZV
Petechial/purpuric = meningococcal sepsis/DIC, ITP, HSP, ?Leukaemia
