Infectious disease Flashcards
What is Kawasaki disease?
Systemic medium-sized vessel vasculitis
What is the demographic of patients who present with Kawasaki disease?
<5 years old, Asian (Japanese, Korea), typically boys
Key signs of Kawasaki disease?
Fever lasting >5 days with a rash, strawberry tongue, lymphadenopathy, conjunctivitis
+cracked lips and skin peeling on palms and soles
Kawasaki disease is characterized by three stages. What are the stages and what occurs within each stage?
Acute phase - 1-2wks, most unwell with Sx
Subacute phase - 2-4wks; Sx settle, coronary aneurysm risk high
Convalescent stage - 2-4wks; Sx settle and aneurysms regress
Key signs of Kawasaki disease?
Fever lasting >5 days with a rash (widespread maculopapular rash), strawberry tongue, lymphadenopathy, conjunctivitis
+cracked lips and skin peeling on palms and soles
What is seen on FBC and LFT with Kawasaki disease?
FBC: anemia, leukocytosis, thrombocytosis
LFT: hypoalbuminemia, raised liver enzymes
What is seen on urinalysis and echocardiogram in Kawasaki disease?
WBC without infection, echocardiogram (coronary artery pathology)
What are the x2 key managements of kawasaki disease?
- High dose aspirin - reduce risk of thrombosis
- IV immunoglobulins to reduce risk of coronary artery aneurysm
If a child is suffering a persistent high fever >39C for several days and is irritable, what should you consider?
Kawasaki disease
Why is aspirin typically avoided in children?
Risk of Reye’s syndrome, however it is used to treat Kawasaki disease
What does PIMS-Ts stand for?
Paediatric inflammatory multisystem syndrome
What is PIMS-Ts characterized by?
Adolescent a few weeks after catching novel coronavirus suffers systemic swelling as the immune system fights off infection.
What are the symptoms of PIMS-Ts (pretty general)?
Unexplained irritability, swollen glands in the hands and the neck.
Red, cracked lips, stomach pains and cramps, red eyes, weakness (muscles and pain), headache.
What medication can be given to a patient to treat PIMS-Ts?
Inotropic agents to treat cardiac instability
IV Ig, corticosteroids, aspirin dalteparin
PPI (Px as corticosteroids and aspirin can irritate the stomach)
Biologics - anakinra, tocilizumab
Long-term implications of PIMS-Ts?
Brain fog
Thin hair/hair loss
Sleeping difficulty
Rash/skin peel
Changes to hearing
Peripheral neuropathy
Heart/kidney/breathing long-term damage.
What is encephalitis?
Brain inflammation due to infective or non-infective (autoimmune causes)
Give some infective causes of encephalitis?
HSV, HSV-2, ZSZ, CMV, EBV (associated w/ infectious mononucleosis, enterovirus, adenovirus, influenza virus). Polio, mumps, measles, rubella.
Treatment for encephalitis caused by HSV and/VZV?
IV Acyclovir
Treatment for encephalitis caused by CMV?
IV Ganciclovir
A child presents with a fever. Previously they had been alert and playing with their toys, but now they seem confused and are drifting in-and-out of consciousness. They don’t seem to recognize their favourite toy. Additionally, they have suffered some seizures. What is the most likely diagnosis?
Encephalitis
Either viral in origin or autoimmune.
Patient may also be suffering from focal neuro Sx (including Movement changes, including paralysis, weakness, loss of muscle control, increased muscle tone, loss of muscle tone, or movements a person cannot control (involuntary movements, such as tremor))
What tests would be carried out to diagnose a patient with encephalitis?
Lumbar puncture (1st)
CT, MRI, EEG, swabs, HIV testing
What would be the indication for a lumbar puncture of a patient with suspected encephalitis?
GCS<9, active seizures, post-ictal, hemodynamically unstable.
Symptoms of infectious mononucleosis (IM - glandular fever)?
Sore throat, fever, fatigue (can last several months)
Lymphadenopathy
Tonsillar enlargement
Splenomegaly - splenic rupture if trauma
Hepatomegaly
Photophobia (can suffer headaches)
What antibiotic should not be used in the treatment of mono and what will develop if it is used?
Amoxicillin - itchy rash
What changes in antibodies can be observed in glandular fever?
What do they indicate?
IgM - initially raised and will indicate acute infection
IgG - persists after and indicates immunity
WBCs: leukocytosis also
Treatment for mono?
Supportive: acute is 2-3 weeks.
Avoid alcohol - spleen. Avoid contact sport - splenic rupture.
What are (key is 1) complications of mono in children?
Burkitt’s lymphoma
Hodgkin’s lymphoma, splenic rupture, haemolytic anemia, thrombocytopenia, chronic fatigue.
What is mumps?
Self-limiting viral infection spread by respiratory droplets
How long is the intubation period for mumps?
14-25 days, 1 week symptoms
What is the clinical presentation of a patient with mumps?
Prodrome: fever, muscle aches, lethargy, reduced appetite, headache, dry mouth
Parotid gland swelling (uni or bi, pain)
Complications of mumps (x3)?
Pancreatitis, orchitis, meningitis/encephalitis
Dx for mumps?
PCR testing; blood, saliva for viral antibody
What is mumps management?
Notifiable disease, supportive (analgesia, rest, fluids)
What is the measles virus?
Single stranded, spherical RNA virus spread through respiratory droplets.
What is observed on the ELISA test for measles diagnosis?
Measles-specific IgM/IgG serology (IgM suggests acute infection)
What are potential complications for a measles infection picked up during pregnancy?
Miscarriage
Stillbirth
Premature birth
Low birthweight
A child presents with a fever and has been coughing recently. Their parents report they have been suffering diarrhoea and have noticed some small red spots in their child’s mouth. They have another child who had had a large rash the previous week, and had been being treated for a similar condition.
A) What is a potential diagnosis for the child?
B) What is the name of the spots and the rash
A) Measles
B) Koplik’s spots. Erythematous, maculopapular rash.
What is the potential measles management?
Supportive, vitamin A, notifiable, MMR vaccine (post exposure prophylaxis if >6 months and within 72 hours of exposure).
What virus causes rubella?
Togavirus
Should a women suffer rubella during pregnancy what will the baby suffer from?
Cataracts, deafness, heart abnormalities, brain damage
Clinical features of rubella?
Red-pin rash with small spots Swollen glands around head and neck
Coryzal
Fever
Joint pain
Rubella, how long does it last?
Self-limiting (7-10 days)
How can a HIV +ve mother be prevented from giving birth to a HIV +ve baby? (thinking prevention during birth)
IV zidovudine given during the C-section (if viral load unknown or >10000 copies/ml)
What viral load is suitable for a NVD and what viral load is suitable for a C-Section?
NVD = <50 copies/ml
C-Section = >50 copies/ml patient, all women >400 copies/ml
What should be given to babies at low risk of HIV from mother? (+time period)
Zidovudine
4 wks
What should be given to babies at high risk of HIV from mother? (+time period)
Zigovudine, lamivudine, nevirapine
4 wks.
What are indications of HIV testing in babies?
HIV +ve parents
Immunodeficiency suspected: unusual, severe, frequent infections
Young people: sexually active with concerns
Think RF: need stick injury, sexual abuse, IVDU
How to test for HIV infection?
- HIV viral load at 3 months (-ve: no HIV)
- HIV antibody test at 24 months (risk due to vertical during breastfeeding)
What is given to a HIV patient to maintain normal CD4 and undetectable viral load?
ART (Antiretroviral therapy)
Also be aware of opportunistic infections
What is given to children with low CD4 counts and to protect against what?
Septrin (prophylactic co-trimoxazole)
PCP - pneumocystis jiroveci pneumonia
What is in the 6-in-1 vaccine?
Polio
Diphtheria
Tetanus
HiB
Whooping Cough
Hepatitis B (virus) vaccine
Polio vaccine is given at how many time points and when?
5 vaccines
8, 12, 16 weeks, 3 years and 4 months, 14 years
Polio symptoms?
Fever, extreme fatigue, headache, vomiting, stiff neck, muscle pain lasting 10 days
Rare: paralysis, permanent disability, dysphagia
What is the treatment for polio?
None: supportive
What causes diphtheria?
Corynebacterium diphtheriae
What is the antibiotics treatment for diphtheria?
Penicillin, erythromycin, antitoxin
What are the clinical symptoms of diphtheria?
Sore throat, greyish pseudo-membrane on tonsils/pharynx/nasal cavity, low fever
Complications of diphtheria?
CN lesions, palate, hypopharynx paralysis, AV block, 16% death
What bacteria causes tetanus?
Clostridium tetani
What bacteria causes tetanus?
Clostridium tetani
What antibiotics treat tetanus?
Antitoxin, penicillin
A child presents with lockjaw causing drooling as well as widespread spasms. What is the most likely diagnosis and how long is the incubation period placing other children at risk?
Tetanus
3-14 days
A 10 month old child who’s parents are anti-vac presents with a cough, SOB, ear pain, sore throat, fever and have been described as being very irritable over the last 24 hours. What is the most likely diagnosis?
HiB
Treatment for HiB?
IV 3rd generation cephalosporin, supportive care.
What causes whooping cough?
Bordetella pertussis
What is the disease progression for whooping cough and Sx associated?
6-14 days: incubation period
1-2 wks: catarrhal (URT Sx)
2 wks: whoop stridor convalescent
What are the antibiotic treatment options for whooping cough?
Azithromycin
Erythromycin
Clarithromycin
What is slapped cheek syndrome?
Self-limiting viral infection caused by parvovirus-B18
A 5 year old has been suffering a fever for the past 48 hours. They have had a running nose and been complaining about feeling sick. They have now developed a red rash on their cheeks. Their parents say it has also recently become visible on their toes. What is the most likely diagnosis and treatment?
Slapped cheek syndrome
Supportive - is self-limiting
What causes Coxsackie disease (hand, foot and mouth disease)?
Coxsackievirus A16 and enterovirus A71.
What is Coxsackie disease characterized by?
Oral vesicles in mouth - rupture to form ulcers
Macular, maculopapular or vesicular exanthema on hands, feet, bum, legs, arms
What is the treatment for systemic impetigo?
Flucloxacillin, clarithromycin
What is the topical treatment for impetigo?
Fusidic acid, mupirocin
A 14-year-old presents with erythematous macules on their face, neck and hands. They are known to pick at their cuts. What is a potential diagnosis?
Impetigo
What commonly causes chickenpox?
VZV and can be re-activated causing shingles in later life
A 4YO presents with red macules that turned to papules that turned to pustules and finally crusted over. There were a number of other children it their class suffered from Sx that also included a fever, itching and headache. What is the potential diagnosis?
Chickenpox
Also could have anorexia, URTI
Which high risk groups should be considered if a chickenpox outbreak?
Pregnant, IC, neonates, elderly (also make sure to notify the health authorities)
What causes scarlet fever?
Group A strep pyogenes
Clinical presentation of a child with scarlet fever?
Pink-red rash (1-2 days starting on trunk and spreading to ears and neck), strawberry tongue
Headache, high temperature
Flushed cheeks, swollen tongue
Treatment for scarlett fever?
Amoxicillin (10 day course), penicillin
Complications of scarlet fever?
Pneumonia, ear infection, sinusitis
What causes staphylococcal scalded skin syndrome and in which child high risk group?
Staphylococcal toxin typically in <3YO.
What is the first line management for staphylococcal scalded skin syndrome?
Flucloxacillin and admit the patient to hospital
Clinical presentation of staphylococcal scalded skin syndrome? What is the sign?
Blistering then desquamation of flexural areas, bum, hands, feet. Positive Nikolsky’s sign
What medication can be given to treat candida n children?
Antifungal: fluconazole, miconazole, nystatin
Hydrocortisone
Clinical features of candida in children?
Oral thrush and rash, itching around nappy
RF for candida in young child?
Immunocompromised
Low birthweight
Autoimmune conditions
Poor hygiene
Lassa fever what causes it?
Viral hemorrhagic fever caused by Lassa virus spread in urine and faeces of infected Mastomys rats
Treatment for Lassa fever?
Supportive, rehydration therapy
Where is Lassa fever endemic?
West Africa
