Infectious Disease Flashcards
What is Kawasaki Disease?
Self-limiting systemic medium sized vasculitis particularly affecting coronary arteries (inflammation of blood vessels)
What are the symptoms of Kawasaki Disease?
Cojunctivitis, erythema, oedema, irritability, mucositis, strawberry tongue, fever, cervical lymphadenopathy
What investigation needs to be done in Kawasaki Disease?
ECHO - coronary artery aneurysms, valvular disease, pericarditis
Why is aspirin normally contraindicated in children?
Due to the risk of Reye’s Syndrome - rare encephalopathy associated with liver failure
What is the treatment for Kawasaki Disease?
Oral aspirin, IV Ig
When is the MMR vaccine given?
1 year, 3 years 4 months
Describe measles and its spread
It is a highly contagious respiratory viral infection caused by morbillivirus spread by droplet spread
What is the presentation of measles?
Koplik spots, erythematous, maculopapular rash, cough, coryza, diarrhoea, fever
What is an antiviral that can be used in measles for those immunocompromised?
Ribavirin
What causes chicken pox?
Varicella Zoster Virus
Describe the rash of chicken pox
Begins as small erythematous macules on scalp, face, trunk and proximal limbs
Develops into papules, vesicles and pustules in itchy crops
Crusting usually after 5 days
Why should NSAIDs be avoided in chicken pox?
Increase the risk of necrotising soft tissue infections
What can high risk groups be given for chicken pox?
Aciclovir and IV IgG
What can be a long-term effect of chicken pox?
VZV remains dormant in the sensory nerve ganglia of the dorsal root and can reactivate as herpes zoster (Shingles) years later
What is rubella?
German measles caused by maternal infection with rubella virus in the first 20 weeks of pregnancy
Who is a rubella rash itchy in?
Adults only
What causes scalded skin syndrome?
Staph aureus - produces epidermolytic toxins which break down proteins holding skin cells together
What is the presentation of scalded skin syndrome?
Generalised erythema progressing to bullae (fluid filled blisters) which burst, fever, irritability, lethargy and dehydration
What is Nikolsky sign?
In SSS - gentle rubbing of the skin causes it to peel away
What is polio?
Highly infectious disease caused by virus transmitted via faecal-oral route and can invade the nervous system and cause paralysis
What is the presentation of polio?
Fever, fatigue, headache, vomiting, neck stiffness, limb pain
When is the polio vaccine given?
8, 12, 16 weeks, 3 years 4 months, 14 years
What is TB?
Infectious disease caused by mycobacteritum tuberculosis (small rod-shaped bacillus) spread by droplet infection
How do you test for TB?
Acid fast so stained using Zehil-Neelsen stain turning red
What is the initial presentation of TB (4-8 weeks)?
Febrile illness, fever, night sweats, SOB, malaise, chest pain
What is the presentation of TB at 6-9 months?
Progressive healing of primary complex, effusion, cavitation, coin lesion on CXR, miliary spread
What is the diagnosis for TB?
Sputum sample x 3
Mantoux skin test
CXR - gohn focus and bilateral hilar lymphadenopathy
What is the treatment for TB?
RIPE = Rifampicin, Isonazid, Pyrazinamide and Ethambutol
What is given with treatment for TB after puberty?
Pyridoxine (B6) because isonazid depletes B6 causing peripheral neuropathy
How long are RIPE drugs given for TB?
R and I for 6 months and P and E for 2 months
What are the side effects of RIPE drugs?
R - red body fluids
I - peripheral neuropathy
P - hepatitis and gout
E - optic neuritis
What vaccine can be used for TB?
BCG - recommended at birth for high risk groups such as Asian or African origin
What is HIV?
RNA retrovirus which destroys CD4 T-helper cells and leads to AIDS when levels are below 200 cells/ mm3
What is given to babies if mothers HIV copies are above 10,000?
IV Zidovudine
What are some later clinical features of HIV in children?
Cough, hypoxaemia, delayed development, cerebral palsy, splenomegaly, failure to thrive, chronic diarrhoea, recurrent infections
Name 2 AIDS defining illnesses in children
PCP and Candida oesophagitis
When is a c-section used for HIV mothers?
Copies over 50
What is meningitis?
Inflammation of the meninges
What are the viral causes of meningitis?
Viral is most common overall
VZV, HSV and mumps
What is a bacterial cause of meningitis in newborns?
Group B strep and listeria monocytogenes
What is the most common cause of bacterial meningitis?
Strep pneumoniae
What is the presentation of meningitis in children?
Fever, vomiting, headache, neck stiffness, photophobia, altered consciousness, seizures
What are the symptoms of meningitis in babies?
Very non-specific such as hypotonia, poor feeding, lethargy, hypothermia and bulging fontanelle
What is a sign of meningococcal septicaemia?
Non-blanching purpuric rash
What is kernigs sign?
Flex the hip, extend the knee and positive if there is a hamstring spasm
What is brudzinskis sign?
Passively flex neck and if there is hip/ knee flexion = positive
What is the diagnosis of meningitis?
LP at L4 within an hour
CT head
Blood cultures
Throat swab
Blood glucose
What does LP show for viral meningitis?
Lymphocytes
Normal protein
Normal glucose
What does LP show for bacterial meningitis?
Neutrophil polymorphs
Low glucose
High protein
What is the treatment for meningitis?
IM Ben pen in community if septicaemia
Under 3 months - Amoxicillin and Cefotaxime
After 3 months - Ceftriaxone
Steroids - Dexamethasone
Viral - Aciclovir
What can be used for post exposure prophylaxis in meningitis?
Ciprofloxacin or Rifampicin - single dose within 24 hours for those with close contact within 7 days
List some complications of meningitis
Hearing loss, epilepsy, seizures, cerebral palsy, memory loss, vasculitis, cognitive impairment
When is meningitis vaccination given?
MenB - 8, 16 weeks and 1 year
6-in-1 given at 8, 12 and 16 weeks (Hib)
Pneumococcal - 12 weeks, 1 year
Hib/ Men C given at 1 year
MMR
MenACWY - 14 years
What is encephalitis?
Inflammation of brain parenchyma
What is the most common cause of encephalitis?
HSV-1 from cold sores
Name some non-infective causes of encephalitis
TB, malaria, vaccination, previous infection, autoimmune disease
What is the presentation of encephalitis?
Altered consciousness and cognition, unusual behaviour, acute onset of focal neurological symptoms, focal seizures, fever
What is the LP for encephalitis?
Elevated lymphocytes
Normal glucose
Raised protein
Give some contraindications for a lumbar puncture
Focal neurology
Infection at LP site
Increased intracranial pressure
Active seizures
GCS below 9
What is the treatment for encephalitis?
Aciclovir for HSV and VZV
Ganciclovir for CMV
What can be given for high ICP?
Dexamethasone
Give some other causes of encephalitis
VZV, CMV, ebstein-barr
What is parvovirus?
Slapped cheek syndrome - parvovirus b19 induces immune complex formations that deposit in joints and the skin
What is the presentation of Parvovirus?
Low grade fever, headache, macules on face which spreads to limbs but spares palms and soles
What is impetigo?
Staph or strep skin infection
What is the characteristic of a staph skin infection?
Golden crust
Describe non-bullous impetigo
Typically around nose or mouth, forms a golden crust
Topical fusidic acid can be used for treatment
Describe bullous impetigo
Always caused by staph aureus
Causes fluid filled vesicles which can form a golden crust
Systemic symptoms are more common
Treatment with flucloxacillin
Give some complications of Impetigo
Cellulitis, sepsis, scarring, post strep glomerulonephritis, scarlet fever
What is Candida?
A yeast infection causing no harm found on skin, vaginal area and digestive system but it can sometimes overgrow and cause a rash and itching
What are the causes of Candida becoming problematic?
Damaged skin, warm, humid, weak immune system, antibiotics, too long between nappy changes
What are the symptoms of Candida?
Rash, patches that ooze clear fluid, pimples, itching or burning, white or yellow vaginal discharge, white patches on tongue, swelling, pain, pus
What is the treatment for Candida?
Fungal creams - Clotrimazole
Thrush- medicated mouthwash or lozenges
Oral anti-fungals - Fluconazole
What is toxic shock syndrome?
Acute multi-system inflammatory response to exotoxin mediated bacterial infection which can progress to septic shock
What are the risk factors for toxic shock syndrome?
Small surface area burn, children 1-4 years 2 days after a small burn
What are the causes of toxic shock syndrome?
Staph aureus and strep pyogenes
What is the presentation of toxic shock syndrome?
Fever over 39, macular rash, diarrhoea, headache, muscle aches, vomiting, confusion, weakness, fatigue
What is the treatment for toxic shock syndrome?
Add IV Clindamycin to: -
Staph aureus - IV Fluclox
MRSA - IV Vancomycin
Strep - IV ben pen
What is scarlet fever?
Group A strep infection usually tonsilitis
Caused by an exotoxin produced by strep pyogenes
What is the presentation of scarlet fever?
red-pink, blotchy macular rash with sandpaper skin starting on trunk and spreading outwards
Red cheeks
Fever
Lethargy
Sore throat
Strawberry tongue
What is the treatment for scarlet fever?
Penicillin V for 10 days
What is Coxsackie Disease?
Hand, foot and mouth caused by Coxsackie A virus
What is the presentation of Coxsackie A virus?
URT symptoms - dry mouth, sore throat, fatigue, fever
Small mouth ulcers
Blistering red spots
How do you treat threadworm?
Oral Mebendazole
What is the tetrad of HSP?
Rash, abdominal pain, arthralgia and glomerulonephritis
