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3a Child Health > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What is Kawasaki disease

A

a systemic medium-sized vessel vasculitis
(aka mucocutaneous, lymph node syndrome)

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2
Q

Describe the epidemiology of kawasaki disease

A
  • affects young children u5, peak incidence at 1yr
  • mc in Japanese children
  • mc in boys
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3
Q

Give 6 clinical features kawasaki disease

A
  • Persistent high fever for over 5 days
  • Non-purulent conjunctivitis
  • Red (strawb) tongue and cracked lips
  • Cervical lymphadenopathy
  • widespread maculopapular rash
  • Peeling of fingers and toes (later sign)
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4
Q

What is a major complication of kawasaki disease

A

coronary artery aneurysm

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5
Q

How is kawasaki disease investigated

A
  • Clinical diagnosis
  • ECHO - rule out aneurysms
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6
Q

How is kawasaki disease managed

A
  • IV immunoglobulins - reduce risk of CA anueyrsms
  • High dose aspirin
  • ECHO at 6 weeks
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7
Q

Why is aspirin given to children with kawasaki disease

A

reduce the risk of thrombosis

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8
Q

What is the major route of HIV infection in children

A

mother-child (vertical) transmission during pregnancy (intrauterine), at delivery (intrapartum), or through breastfeeding

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9
Q

How is HIV diagnosed in children over 18 months

A

HIV antibody screen: detects antibodies against the virus

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10
Q

How is HIV diagnosed in children less than 18 months

A

HIV DNA PCR

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11
Q

Why is the presence of antibodies against HIV in children under 18 months not diagnostic of the illness

A
  • Children <18 months who are born to
    infected mothers will have transplacental maternal HIV antibodies
  • at this age a positive antibody test confirms HIV exposure but not HIV infection.
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12
Q

Presentation of children with mild and moderate immunocompromise in HIV

A
  • Mild: may have lymphadenopathy or parotid enlargement
  • Moderate: recurrent bacterial infections, chronic diarrhoea and lymphocytic interstitial pneumonitis
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13
Q

Clinical features of severe AIDS in children

A
  • Pneumocystis jirovecii pneumonia
  • severe faltering growth
  • encephalopathy
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14
Q

How is HIV managed in children

A
  • Antiretroviral therapy should be started in all infants and some older children depending on clinical status/ HIV load and CD4 count
  • Don’t delay routine immunisations (except BCG)
  • MDT and Regular follow up: weight, development and clinical signs of disease
  • Prophylactic co-trimoxazole
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15
Q

Co-trimoxazole is given as a prophylaxis to some children with HIV.
a) what infection is this against
b) what circumstances is it prescribed (2)

A

a) pneumocystis jirovecii pneumonia
b) all infants who are HIV-infected and older children with low CD4 counts

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16
Q

Give 4 ways vertical transmission is reduced in HIV

A
  • Positive mothers should be on antiretroviral drugs to reduce viral load at time of delivery
  • Post exposure prophylaxis given to infant after birth (zidovudine)
  • avoid breastfeeding
  • C-sections in all women with > 400 copies / ml
  • IV zidovudine should be given during the caesarean if the viral load is unknown or there are > 10000 copies / ml
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17
Q

What testing is done in children to HIV positive parents and at what age is each test done (2)

A
  • HIV viral load at 3m - if -ve, child has not contracted HIV during birth and will not develop HIV unless they have further exposure
  • HIV Abx test at 24m - to assess whether they have contracted HIV since their 3 month viral load, for example through breast feeding
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18
Q

What causes scalded skin syndrome

A

caused by a type of staphylococcus aureus bacteria that produces epidermolytic toxins

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19
Q

Describe the clinical presentation of scalded skin syndrome

A
  • fever and malaise
  • red rash with wrinkled tissue
  • typically starts on face and flexural regions then spreads
  • after the rash, large fluid-filled blisters form
  • widespread erythema and tenderness
  • Nikolsky sign
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20
Q

Describe Nikolsky sign

A
  • The epidermis separates and creates an erosion when the skin is gently rubbed
  • Large areas of skin blister and peel away, leaving red, wet, and painful areas
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21
Q

How is scalded skin syndrome managed

A
  • IV anti-staph Ab e.g. flucloxacillin
  • Analgesia
  • monitor hydration and fluid balance
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22
Q

What causes toxic shock syndrome

A

Toxin-producing staph aureus and group A streptococci

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23
Q

Characteristics of toxic shock syndrome

A
  • Fever over 39
  • hypotension
  • diffuse erythematous, macular rash
  • desquamation of rash, especially of the palms and soles
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24
Q

Toxic shock syndrome causes organ dysfunction. Give 5 examples of this

A
  • Mucositis - oral and genital mucosa
  • GI dysfunction - vomiting/ diarrhoea
  • Liver impairment
  • renal impairment
  • Clotting abnormalities and thrombocytopenia
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25
How is toxic shock syndrome managed
* IV fluids * areas of infection should be surgically debrided (removed) * IV antibiotics - flucloxacillin + clindamycin * IVIg to neutralise circulating toxins
26
What is measles
Highly infectious disease caused by measles virus
27
Features of measles
* Prodrome: fever, conjunctivitis, irritability * koplik spots - typically develop before the rash, white spots on the buccal mucosa * discrete maculopapular rash becoming blotchy & confluent * rash begins behind the ears and spreads to the whole body
28
How is measles diagnosed
* ELISA (blood test) - measles-specific IgM and IgG serology * clinical
29
How is measles managed
* supportive treatment * avoid school 5 days after initial rash * Notify public health * vitamin A supplements
30
How is measles prevented in the UK
Immunisation - 2 doses of MMR vaccine
31
Give 3 complications of measles
* otitis media - mc * febrile convulsions * encephalitis * subacute sclerosing panencephalitis (rare, years after infection) * pneumonia
32
How long after measles infection does subacute sclerosing panencephalitis typically manifest
7 years
33
What causes subacute sclerosing panencephalitis
variant of the measles virus which persists in the CNS
34
What is chickenpox
* common virus spread by respiratory droplets * Highly infectious during viral shedding
35
What virus causes chickenpox
varicella zoster
36
Describe the presentation of chickenpox
* Fever initially * itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular * itching may lead to permanent scars/ secondary infection
37
How is chickenpox managed
* keep cool, trim nails * calamine lotion * Immunocompromised kids - aciclovir * avoid school until lesions are dry and have crusted over
38
Give 4 complications of chickenpox
* secondary bacterial infection of the lesions * generalised encephalitis * pneumonitis * disseminated haemorrhagic chickenpox
39
What severe complication can occur in a small number of chickenpox patients with bacterial infections?
Invasive group A streptococcal soft tissue infections, potentially leading to necrotizing fasciitis.
40
What causes scarlet fever
group A, beta haemolytic streptococcus - strep.pyogenes
41
Scarlet fever is most common between what ages
2 - 8 years old
42
Describe the presentation of scarlet fever
* Fever : typically lasts 24 to 48 hours * headache, N+V, malaise * sore throat * sandpaper like maculopapular rash initially on trunk then spreads (spares area around mouth) * flushed cheeks * strawberry tongue * cervical lymphadenopathy
43
How is scarlet fever managed
* 10 days course of phenoxymethylpenicillin (penicillin V) * penicillin allergy: clarithromycin (10d), azithromycin (5d) * pregnancy - erythromycin 10d * notify public health * can return to school 24h after starting antibiotics
44
When are outbreaks of rubella more common
winter and spring
45
What is the incubation period of rubella
14-21 days
46
When are individuals with rubella infectious
individuals are infectious from 7 days before symptoms appear to 4 days after the onset of the rash
47
features of rubella
* prodrome, e.g. low-grade fever * rash: maculopapular, initially on the face before spreading to the whole body, usually fades by the 3-5 day
48
Give 3 complications of rubella
* arthritis * encephalitis * myocarditis
49
What causes diphtheria
Corynebacterium diphtheriae (gram positive bacillus)
50
How may diphtheria present
* neuritis * heart block * sore throat with a grey, pseudomembrane on the posterior pharyngeal wall * bulky cervical lymphadenopathy
51
What causes slapped cheek syndrome
parvovirus B19 (aka erythema infectiosum)
52
Describe the presentation of slapped cheek syndrome
* may be asymptomatic * fever, headache and myalgia * characteristic rose-red rash on face which may spread to the trunks and limbs * aplastic crisis in children with haemolytic anaemia
53
What is impetigo
superficial bacterial skin infection usually caused by either Staphylcoccus aureus or Streptococcus pyogenes
54
Describe the features of non-bullous impetigo
* usually occurs around the nose or mouth * exudate from lesions dries to form a golden crust * no systemic symptoms, will not be unwell
55
Describe the features of bullous impetigo
* always caused by s. aureus * fluid filled vesicles form and then burst leaving golden crust * fever and malaise
56
How is impetigo managed
* Localised, non-bullous: hydrogen peroxide 1% cream or fusidic acid * widespread, non-bullous: 5 days topical fusidic acid or mupirocin * widespread or bullous: 5 days flucloxacillin or clarithromycin (if penicillin allergy) * children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
57
Give 3 complications of impetigo
* cellulitis * Staphylococcal scalded skin syndrome * scarring
58
What commonly causes hand, foot and mouth disease
coxsackie A16 and enterovirus 71
59
Describe the presentation of hand, foot and mouth disease
* mild systemic upset: sore throat, fever * oral ulcers * followed later by vesicles on the palms and soles of the feet
60
How is hand, foot and mouth disease managed
* symptomatic treatment only: general advice about hydration and analgesia * children do not need to be excluded from school * highly contagious: advice about measures to avoid transmission

3a Child Health (19 decks)

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