infectious disease Flashcards
what is diphtheria
acute URTI which can also affect the skin
caused by Corynebacterium diphtheriae
risk factors for diphtheria
poor hygiene
poor living conditions
lack of immunisation
route of transmission for diphtheria
via resp route or contact with exudate from skin lesions
clinical presentation of diphtheria
nasal discharge that is initially watery but become purulent and blood-stained
enlarged cervical lymph nodes
difficulty swallowing
thick grey-white coating that can cover the back of the throat, nose and tongue
differential diagnosis of diphtheria
oral thrush
tonsillitis
guillain barre syndrome
management of diphtheria
abx
contacts should be given erythromycin or penicillin (abx prophylaxis)
complications of diphtheria
paralysis
difficulty swallowing and nasal speech
cardiac complications
what is whooping cough
highly contagious resp infection caused by bordetella pertussis
what are the 3 phases of whooping cough
catarrhal phase
paroxysmal phase
convalescent phase
what is the catarrhal phase
lasts 1-2 weeks and presents similarly to common lrti
what is the paroxysmal phase
last about 1 week
characterised by bouts of paroxysmal coughing
what is the convalescent phase
lasts 2-3weeks
gradual improvement in cough frequency and severity
clinical presentation of whooping cough
coryzal symptoms
fever
cough- severe coughing starts ~1 week after
post-tussive vomiting
investigations for whooping cough
nasal/ throat swab
blood cultures
pcr
management for whooping cough
hospital if 6months or younger
abx
what abx to give in whooping cough
macrolide
under 1month - clarithromycin
over 1yrs - azithromycin or clarithromycin
what can result in after vigorous coughing in whooping cough
epistaxis
subconjunctival haemorrhages
complications of whooping cough
pneumonia
convulsions
bronchiectasis
when is abx most effective in whooping cough
most effective when given during catarrhal phase
within first 21 days
what is polio
infection caused by the poliovirus
complications of polio
meningitis
paralysis
route of transmission of polio
faeco-oral
resp
highly contagious
clinical presentation of polio
most are asymptomatic or flu-like illness
non-paralytic polio - flu-like symptoms and meningitis
paralytic polio- flu-like symptoms and then variable severity
clinical features of paralytic polio
myalgia, muscle spasms and meningism
asymmetrical, flaccid motor paralysis, predom. lower-limb
bulbar form of paralysis - resp failure, bulbar symptoms e.g. dysphagia and dysphonia
management of polio
notification and contacts
bed rest
analgesia
physio
no treatment
how is the polio vaccine given
combined- tetanus/ diphtheria/ inactivated polio vaccine (Td/IPV)
clinical presentation of TB
most kids are asymptomatic
fever
weight loss
cough - doesnt get better after 3 weeks
night sweats
investigations for tb
chest xray
mantoux
interferon -gamma release assays (if mantoux testing is not available or impractical)
management for active tb
RIPE for 2 months
rifampicin
isoniazid (with pyridoxine)
pyrazinamide
ethambutol
then isoniazid (pyridoxine) and rifampicin for 4 months (10 months if CNS involvement)
why is pyridoxine given with isoniazid
to prevent peripheral neuropathy
(given after puberty in children as this complication doesnt occur in young children)
why is mantoux test contraindicated if bcg vaccination has been given
gives false positive as individual has already been exposed tuberculin protein from bcg vaccination
management for latent tb
isoniazid (with pyridoxine) and rifampicin for 3 months
who is bcg vaccine offered to
infants (0-12months) parent or grandparent who was born in a tb prone country
infants (0-12 months) living in areas of the UK where incidence of tb is high
previously unvaccinated children (1-5yrs) with a parent or grandparent who was born in a country with high incidence of tb
previously unvaccinated, tuberculin-negative children (6-16yrs) with a parent or grandparent who was born in a country with high incidence of tb
main route of HIV infection in children
mother to child transmission
occurs during pregnancy, at delivery, through breastfeeding
symptoms of HIV
mouth ulcers
various degree of immunosuppression (e.g. recurrent bacterial infections)
chronic diarrhoea
weight loss
lymphadenopathy
parotitis
fever
management for child born to HIV positive mother
regular HIV DNA PCR tests until 18months
start on ART
what determines whether treatment is given and what is the treatment
ART (antiretroviral therapy)
based in clinical status, HIV viral load and CD4 count
management for encephalitis
IV aciclovir - suspected, encephalitis, HSV, VZV
IV ganciclovir- CMV
supportive treatment
which strains of HSV mainly affect children
children >3months - HSV-1 ; localised to temporal and frontal lobes
neonates - HSV-2; brain involvement is usually generalised
which virus would you expect to be the cause of encephalitis in someone with immunodeficiency
CMV
clinical presentation for encephalitis
fever
altered consciousness
seizures
unusual behaviour
investigations for encephalitis
lp - send csf fro viral pcr (ct if lp contraindicated)
MRI after lp
hiv testing
contraindications for lp
infected skin over puncture site
increased ICP
trauma /mass to lumbar vertebra
what is toxic shock syndrome
severe systemic reaction to staphylococcal exotoxins
which is characterised by fever >39deg, hypotension, diffuse erythematous, macular rash
what is the toxin causing toxic shock syndrome
tsst-1 superantigen toxin
clinical presentation of toxic shock syndrome
fever
low bp
blanching erythematous rash
late sign - peeling hands and feet (1-2 weeks after onset)
organ involvement in toxic shock syndrome
myositis
gi - vomting
renal dysfunction - increased creatinine
altered consciousness
thrombocytopaenia
management for toxic shock syndrome
intensive care support
areas of infection should be removed
abx - cephalosporins (e.g. ceftriaxone) and clindamycin
transmission of coxsackie’s disease
faeco-oral
what is hand foot and mouth disease
painful vesicular lesions on the hands, feet and mouth and tongue
caused by coxsackie a virus
how does hand foot and mouth disease usually typically first present
typical URTI - tiredness, sore throat, dry cough and raised temp
1-2 days after mouth ulcers appear followed by blistering red spots across the body
management for hand foot and mouth disease
supportive - adequate fluid intake, analgesia
highly contagious so avoid sharing towels, bedding etc
what is nappy rash
contact dermatitis in the nappy area
what is nappy rash caused by
friction between skin and nappy
contact with urine and faeces
when is nappy rash common
9-12 months
what can occur as a result of nappy rash
candida infection
presentation of nappy rash with candida infection
erythematous rash involving flexure regions
satellite lesions
well demarcated scaly border
circular pattern to the rash spreading outwards
management of nappy rash
avoid irritants
emollients
use highly absorbent nappies
change nappy and clean skin asap after wetting or soiling
management for nappy rash with candida infection
anti fungal cream - clotrimazole, miconazole
abx- fluclox