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Paediatrics > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

Give examples of an inactivated vaccine

A
  • polio
  • influenza
  • hep A
  • rabies
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2
Q

Give examples of a subunit and conjugate vaccine

A
  • pneumococcus
  • meningococcus
  • haemophilus influenza type B
  • hepatitis B
  • pertussis
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3
Q

Give examples of live attenuated vaccines

A
  • MMR
  • BCG
  • rotavirus
  • nasal influenza
  • chicken pox
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4
Q

Why is it important to give the HPV vaccine early?

A

Before become sexually active - to prevent them contracting and spreading HPV once they do.

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5
Q

What HPV strains does Gardasil protect against?

A

6,11,16 and 18

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6
Q

Which HPV strains cause genital warts?

A

6 and 11

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7
Q

Which HPV strains cause cervical cancer?

A

16 and 18

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8
Q

Who is offered the TB vaccine?

A
  • babies at high risk
  • e.g. with relatives from countries with a high prevalance
  • live in urban areas with high rate of TB
  • people in close contact with others with TB
  • healthcare workers
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9
Q

What is meningitis?

A

Inflammation of the meninges (the lining of the brain and spinal cord). Normally due to viral or bacterial infection

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10
Q

What is meningococcal septicaemia?

A

Meningococcus bacterial infection in the blood stream causing the ‘non blancing rash’.

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11
Q

What is the pathophysiology behind the non blanching rash in meningococcal septicaemia?

A

DIC - disseminated intravascular coagulopathy and subcutaneous haemorrhages due to sepsis.

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12
Q

What bacteria causes meningococcal septicaemia?

A

Neisseria meningitis

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13
Q

What gram stain is neisseria meningitis?

A

Gram negative diplococcus

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14
Q

What bacteria commonly cause meningitis?

A
  • neisseria meningitidis
  • streptococcus pneumoniae

In neonates
- group B streptococcus

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15
Q

How does meningitis present?

A
  • fever
  • stiff neck
  • photophobia
  • vomiting
  • headache
  • altered conciousness
  • seizures
  • non blanching rash in meningococcal septicaemia.
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16
Q

How may meningitis present in neonates?

A
  • fever or hypothermia
  • vomiting
    altered consciousness
  • hypotonia
  • poor feeding
  • buldging fontanelle
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17
Q

What investigations are done for suspected meningitis?

A
  • CT scan if decreased consciousness / brain pathology suspected
  • lumbar puncture
  • blood culture
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18
Q

What tests can be performed to look for meningeal irritation?

A
  • Kernig’s test
  • Brudzinski’s test
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19
Q

How is Kernig’s test performed?

A
  • lying the patient on back
  • flex one hip and knee to 90degrees
  • slowly straighten knee whilst keeping hip flexed
  • in meningitis = spinal pain or resistance to movement
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20
Q

How is Brudzinski’s test performed?

A
  • lying patient on back
  • lift their head and neck gently to flex their chin to chest
  • positive if causes involuntary flexion of the hips and knees
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21
Q

How is bacterial meningitis managed initially in the community?

A

If suspected meningitis AND non-blanching rash - give IM (or IV) dose of benzylpenicillin
- transfer immediately to hospital

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22
Q

How is bacterial meningitis managed (>3months old)?

A
  • ideally do blood cultures and lumbar puncture before starting abx.
  • above 3 months give ceftriaxone. Initally also give aciclovir to cover viruses. can also add vancomycin.
    -steroids - dexamethasone - 4x daily for 4 days - to reduce frequency and severity of hearing loss and neurological damage
  • notify public health
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23
Q

How is bacterial meningitis managed (<3months old)?

A
  • ideally do blood cultures and lumbar puncture before starting abx.
  • give cefotaxamine plus amoxicillin ( cover listeria) Can also add vancomycin.
  • steroids - dexamethasone - 4x daily for 4 days - to reduce frequency and severity of hearing loss and neurological damage
  • notify public health
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24
Q

What post exposure prophylaxis can be given for bacterial meningitis?

A

Single dose of ciprofloxacin

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25
Q

What organisms commonly cause viral meningitis?

A
  • herpes simplex virus
  • enterovirus
  • varicella zoster virus
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26
Q

What is given to treat viral meningitis?

A

Aciclovir.

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27
Q

Describe normal lumbar puncture results

A
  • clear
  • low protein
  • 0.6-0.8 glucose
  • low WCC (<5)
  • negative culture
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28
Q

Describe bacterial lumbar puncture results

A
  • cloudy
  • high protein (released by the bacteria)
  • low glucose (used up by bacteria)
  • high WCC and neutrophils
  • bacteria on culture
29
Q

Describe viral lumbar puncture results

A
  • clear
  • mildly raised or normal protein
  • normal glucose
  • high WCC and lymphocytes
  • negative culture
  • positive viral PCR
30
Q

What are some of the complications of meningitis?

A
  • hearing loss
  • seizures and epilepsy
  • cognitive impairment and learning disability
  • memory loss
  • cerebral palsy
31
Q

What is encephalitis?

A

Inflammation of the brain - this can be infective or autoimmune

32
Q

What are the most common causes of encephalitis?

A

Viruses
- herpes simplex virus
- varicella zoster virus
- epstein-barr virus
+ many others

33
Q

How does encephalitis present?

A
  • altered consciousness
  • altered cognition
  • unusual behaviour (delerium)
  • acute onset of focal neurological symptoms
  • acute onset of seizures
  • fever
34
Q

How is encephalitis diagnosed?

A
  • lumbar puncture - with viral PCR
  • CT scan ( before lumbar puncture if indicated)
  • MRI scan
  • EEG can be helpful in mild symptoms
  • HIV testing is recommended
35
Q

How is encephalitis managed?

A

IV antivirals - aciclovir for HSV and VZV.
Ganciclovir for cytomegalovirus.
Repeat lumbar puncture may be done to ensure success.

36
Q

What are some of the complications of encephalitis?

A
  • lasting fatigue + prolonged recovery
  • change in personality or mood
  • changes to memory and cognition
  • learning disability
  • headaches
  • chronic pain
  • movement disorders
  • seizures / epilepsy
37
Q

What virus causes glandular fever?

A

Epstein Barr virus

38
Q

How is glandular fever spread?

A

Through saliva - kissing, sharing cups, toothbruses etc.

39
Q

What are the features of glandular fever?

A
  • fever
  • sore throat
  • fatigue
  • lymphadenopathy
  • enlarged tonsils
  • splenomegaly (rare = rupture)

Mainly in teenagers / young adults

40
Q

What can happen if antibiotics are given for glandular fever?

A

Itchy maculopapular rash in response to amoxicillin or cephalosporins.

41
Q

Do i need to know about tests and heterophile antibody testing for glandular fever>????

A

???

42
Q

How is glandular fever managed?

A
  • supportive management
  • avoid spreading
  • avoid alcohol (as impacts livers processing of alcohol)
  • avoid contact sports (risk of splenic rupture)
43
Q

What are some of the complications of glandular fever?

A
  • chronic fatigue
  • splenic rupture
  • glomerulonephritis
  • haemolytic anaemia
  • thrombocytopenia.

Can also be associated with certain cancers –> Burkitt’s lymphoma

44
Q

What is mumps?

A

A viral infection spread by respiratory droplets.

45
Q

Why is mumps rare?

A

As vaccination offers around 80% immunity

46
Q

What is the incubation period for mumps?

A

14-25 days

47
Q

How does mumps present?

A

Initial flu like symptoms - known as the prodrome
- fever, muscle aches, headache, lethargy, reduced appetite
Then
- parotid gland swelling with associated pain (can be uni or bilateral)

Can also have symptoms of complications.

48
Q

What are some of the complications of mumps?

A
  • pancreatitis
  • meningitis / encephalitis
  • orchitis
  • sensorineural hearing loss
49
Q

How is mumps managed?

A
  • supportive management - rest, fluids, analgesia
  • notify public health
50
Q

How is mumps diagnosis confirmed?

A
  • PCR test of a saliva swab
  • blood test for antibodies to the virus
51
Q

What is HIV?

A

Infection with human immunodeficiency virus.

52
Q

Describe the progression / pathophysiology behind HIV?

A

HIV is an RNA retrovirus. Enters and destroys CD4 T helper cells.
- initial flu like illness within first few weeks of infection
- then asymptomatic until it progresses enough to cause immunocomprimisation. This can then lead to AIDS.

53
Q

How is HIV transmission prevented during birth?

A

Mode of delivery depends on mothers viral load
- If viral load <50copies/ml can have a normal vaginal delivery
- if >50 consider C section
- Give IV zidovudine during C section if the viral load is unknown or >10000.

Prophylaxis treatment may be given to the baby
- low risk = viral load <50 = given zidovudine for 4 weeks
- high risk = viral load > 50 = given zidovudine, lamivudine and nevirapine for 4 weeks (just remember 3 different antiretroviral meds)

54
Q

Can a mother with HIV breastfeed?

A

It is never recommended to breast feed with HIV, even if the viral load is undetectable.

55
Q

How is a child tested for HIV?

A
  • HIV antibody screen - however can give positives in babies of HIV mums (<18mnths) as they cross the placenta. It can also take up to 3 months for antibodies to develop after exposure to the virus.
  • HIV viral load - tests directly for viruses in the blood. Never falsely positive.
56
Q

When would a child be tested for HIV?

A
  • babies to HIV positive parents
  • if immunodeficiency is suspected - getting unusual, severe or frequent infections
  • young people who are sexually active can be offered testing if concerned.
  • young people with risk factors - e.g. IV drug use, sexual abuse
57
Q

When is testing for HIV done for children to HIV positive parents?

A
  • HIV viral load - at 3 months old.
  • HIV antibody test - at 24 months.
58
Q

What is the treatment for HIV in children?

A
  • specialist care - follow ups, psychosocial support etc.
  • Antiretroviral therapy (ART)
  • normal vaccinations (unless severely immunosuppressed)
  • prophylactic co-trimoxazole if low CD4 count to protect against PCP infection (pneumocystis jirovecii pneumonia)
  • treatment of any infections
59
Q

What type of virus is Hepatitis B?

A

DNA virus.

60
Q

How is hepatitis B transmitted?

A

direct contact with blood or bodily fluids
- vertical transmission during pregnancy and delivery
- sharing household products such as toothbrushes
- unprotected sex
- sharing needles

61
Q

How does hepatitis B affect children?

A

Most fully recover within 2 months however some go on to become chronic hep B carriers.
The risk of chronic hep B after exposure is
- 90% for neonates
- 30% for under 5s
- under 10% for adolescents
This is mainly asymptomatic, however there is an increased risk of liver cirrhosis and hepatocellular carcinoma.

62
Q

Which children are tested for hepatitis B?

A
  • children of hepatitis B positive mothers (screen at 12 months or later)
  • migrants from endemic areas
  • close contacts of patients with active hep B
63
Q

What are the 5 serological viral markers used for Hep B and what do they indicate?

A
  • HBsAg - surface antigen - active infection
  • HBeAg - E antigen - marker of viral replication and implies high infectivity
  • HBcAb - core antibodies - active (IgG) or current (IgM - low = chronic, high = acute)
  • HBsAb - surface antibody - indicates vaccination or past or current infection
  • HBV DNA - a direct count of the viral load
64
Q

Is it safe for a Hep B+ mother to breastfeed?

A

If the baby is properly vaccinated - hep B vaccine and immunoglobulin infusion, then it is safe to breastfeed.

65
Q

How are children with chronic hep B managed?

A

Most are asymptomatic and don’t require treatment.
Regular specialist monitoring of
- serum ALT
- HbEAg
- HBV DNA
- physical examination
- liver ultrasound

If evidence of cirrhosis or hepatitis, will be treated appropriately.

66
Q

What type of virus is Hep C?

A

RNA virus

67
Q

Is it safe for Hep C+ mothers to breastfeed?

A

Yes. If nipples become cracked or bleed, temporarily stop whilst they heal.

68
Q

How is Hep C managed in children?

A

Test babies of infected mothers at 18 months.
- children often clear the virus themselves
- medical treatment can be considered in children over 3 - pegylated interferon and ribavirin (less effected and less well tolerated than adult treatments)
- if chronic infection which isn’t causing any issues - treatment is typically delayed until adulthood as the available treatments are more effective

Paediatrics (14 decks)

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