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Phase 3a - Paediatrics > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What is kawasaki disease?

A

A mucocutaneous lymph node syndrome. It’s a medium sized vessel vasculitis - causes swelling of blood vessels throughout body.

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2
Q

Sx of Kawasaki disease?

Hint - mnemonic CREAM

A

High grade fevers for >5days + 4/5 of following features:
* Conjunctivitis (bilateral)
* Rash (any non-bullous rash)
* Edema/Erythema of hands + feet
* Adenopathy (cervical, unilateral + non-tender)
* Mucosal involvement (strawberry tongue, oral fissures etc)

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3
Q

Main complication of Kawasaki disease?

A

Coronary artery aneurysm

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4
Q

Ix for Kawasaki disease?

A

ECHO - risk of coronary aneurysm
Bloods - CRP + ESR

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5
Q

Tx of Kawasaki?

A
  • Intravenous immunoglobulin (IVIg) - reduce coronary aneurysm risk
  • High-dose aspirin - reduce thrombosis risk
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6
Q

Kawasaki disease is one of the few scenarios where aspirin is used in children. Why is aspirin usually avoided?

A

Due to the risk of Reye’s syndrome.

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7
Q

What virus is chickenpox caused by?

A

varicella zoster virus (VZV)

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8
Q

Sx of chickenpox?

A
  • Widespread, erythematous, raised, vesicular (fluid filled), blistering lesions - usually starts on trunk/face and spreads outwards affecting whole body (highly contagious - stops being contagious when all lesions have crusted over)
  • Fever
  • Itch
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9
Q

Mx of chickenpox?

A

Usually self-limiting

If immunocompromised - aciclovir

Itching - calamine lotion and chlorphenamine (antihistamine)

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10
Q

What is rubella (aka German measles)? What causes it and how is it transmitted?

A

Contagious viral illness caused by rubella togavirus.
Transmitted through resp droplets.

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11
Q

Rubella sx?

A
  • Fever
  • Coryza
  • Arthralgia
  • A rash that typically begins on the face and moves down to the trunk
  • Lymphadenopathy
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12
Q

Ix for rubella?

A

Serological testing - rubella-specific IgM or rubella specific IgG in acute samples.

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13
Q

Mx of rubella?

A

Supportive - antipyretics and analgesics + isolation

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14
Q

What is diphtheria and what organism causes it?

A

A disease caused by a bacterium that affects upper resp tract.

Organism - Gram positive bacterium Corynebacterium diphtheriae

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15
Q

Sx of diphtheria?

A
  • Sore throat with a ‘diphtheric membrane’ - grey, pseudomembrane on the posterior pharyngeal wall
  • Bulky cervical lymphadenopathy
  • Neuritis e.g. cranial nerves
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16
Q

Ix of diphtheria?

A

Throat swab culture

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17
Q

Tx of diphtheria?

A

IM penicillin
Diphtheria antitoxin

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18
Q

What is scalded skin syndrome?

A

A rare, severe, superificial blistering skin disorder which is characterised by detachment of epidermis.

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19
Q

What bacteria triggers scalded skin syndrome?

A

Staph. aureus

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20
Q

Sx of scalded skin syndrome?

A
  • Red rash w/wrinkled tissue consistency
  • Large fluid-filled blisters following rash
  • Rupture of blisters leading to epidermis peeling off easily - leaves skin with a burned-like appearance.
  • Gentle skin rubbing causes exfoliation of outermost layer (Nikolsky sx +ve)
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21
Q

Ix for scalded skin syndrome?

A
  • Skin swabs
  • Skin biopsy
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22
Q

Tx of scalded skin syndrome?

A

IV abx:
* 1st line - Flucloxacillin
* Ceftriaxone, clarithromycin - if penicillin allergy
* If MRSA infx - vancomycin

Analgesia - pain relief

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23
Q

Complications of scalded skin syndrome?

A
  • Scarring
  • Dehydration and electrolyte imbalance
  • Hypothermia
  • Secondary infections eg sepsis, cellulitis, pneumonia
  • Renal failure
24
Q

What is whooping cough (aka pertussis) and what bacteria is it caused by?

A

Whooping cough is an upper resp . tract infx.

Caused by Bordetella pertussis (a gram negative bacteria)

25
Q

Sx of whooping cough?

A

Starts as:
* Mild coryzal sx
* Low grade fever
* Mild dry cough

Then evolves into:
* Severe coughing fits
* Loud inspiratory whoop when coughing ends
* Vomit

26
Q

Ix of whooping cough?

A
  • Nasopharyngeal or nasal swab with PCR testing or bacterial culture
  • Anti-pertussis toxin immunoglobulin G
27
Q

Mx of whooping cough (pertussis)?

A

Macrolides - azithromycin, erythromycin and clarithromycin
Macrolide alternative - co-trimoxazole

Give prophylactic abx to close contacts of infected pts.

28
Q

What is polio and how is it spread?

A

Highly infectious viral disease transmitted by person to person mainly through faecal-oral route.

There is no cure for polio.

29
Q

Sx of polio?

A

Initially, fever, fatigue, headache, vomiting and pain in limbs.

If not recovered in 2-10 days, virus can cause paralysis (usually of legs) often permanently.

30
Q

What is TB and what is it caused by? How is it spread?

A

Infectious disease caused by Mycobacterium tuberculosis (rod-shaped bacteria).

Spread by inhaling saliva droplets from infected people.

31
Q

What staining is required to identify TB causing bacteria and why?

A

Zeihl-Neelsen stain (turns bacteria bright red against a blue background) - This is bec M. tuberculosis has a waxy coating that makes gram staining ineffective. They are resistant to the acids used in the staining procedure, making them acid-fast bacilli.

32
Q

RF for TB?

A
  • HIV
  • Immunosuppression
  • Close contacts of infected patients
  • High risk country - i.e. Pakistan, Somalia, Romania
  • Homelessness
  • Children and elderly pts
33
Q

Sx of TB?

A
  • Cough
  • Haemoptysis (coughing up blood)
  • Lethargy
  • Fever or night sweats
  • Weight loss
  • Lymphadenopathy
  • Erythema nodosum (tender, red nodules on the shins caused by inflammation of the subcutaneous fat)
  • Spinal pain in spinal tuberculosis
34
Q

Ix for TB?

A

To test for immune response caused by previous infx, latent TB or active TB:
* Mantoux test
* Interferon‑gamma release assay (IGRA)

If active TB:
* CXR - patchy consolidation, pleural effusions and hilar lymphadenopathy.
* Cultures
* Nucleic acid amplification tests (NAAT)

35
Q

Tx of TB?

A

If latent, either:
* Isoniazid and rifampicin for 3 months OR
* Isoniazid for 6 months

If active (RIPE mnemonic):
* R – Rifampicin for 6 months
* I – Isoniazid for 6 months
* P – Pyrazinamide for 2 months
* E – Ethambutol for 2 months

36
Q

What is the main SE of isoniazid and what drug should also be prescribed alonside to help prevent this SE?

A

SE - peripheral neuropathy
Drug - pyridoxine or vitamin B6

isoniazide (“I’m-so-numb-azid”)

37
Q

Main SE of Rifampicin?

A

red/orange discolouration of secretions, such as urine and tears + reduces effects of drugs such as COCP

rifampicin (“red-I’m-pissin’”)

38
Q

Main SE of pyrazinamide?

A

Hyperuricaemia (high uric acid levels), resulting in gout and kidney stones.

39
Q

Main SE of ethambutol?

A

Colour blindness and reduced visual acuity.

ethambutol (“eye-thambutol”)

40
Q

What causes slapped cheek syndrome?

aka fifth disease

A

Parovirus B19

41
Q

Sx of slapped cheek syndrome?

A
  • Mild fever
  • Bright rose-red rash on cheeks - may spread to rest of body

Child begins to feel better as rash appears.

42
Q

Tx of slapped cheek syndrome?

A

No specific tx required. Not infectious once rash emerges.

43
Q

What is toxic shock syndrome and what is it caused by?

A

A severe, life-threatening cdtn. Primarily caused by Streptococcus (usually group A), Staphylococcus aureus and MRSA.

44
Q

RF for toxic shock syndrome?

A
  • Staphylococcal cellulitis
  • Wounds (especially burns)
  • Alcoholism and intravenous drug use
  • HIV
  • Tampon use or gynaecological infections
45
Q

Sx of toxic shock syndrome?

A
  1. Starts off: non-specific flu-like sx, N+V, diarrhoea
  2. Rapid progression: High fever, widespread macular rash covering >90% body surface
  3. Multiorgan involvement: shock and cardiac depression
46
Q

Ix for toxic shock syndrome?

A
  • Sepsis 6 - blood cultures and lactate (within 1 hr)
  • Throat swabs or wound swabs
  • Bloods

Sepsis 6 (give 3 take 3):
1. Give O2
2. Take Blood culture
3. Give IV abx
4. Give IV fluids
5. Measure lactate
6. Monitor urine output

47
Q

Toxic shock syndrome mx?

A
  • A-E approach
  • Abx: Generally clindamycin + a cephalosporin/meropenem/vancomycin for broad spectrum coverage.
  • Corticosteroids
48
Q

What is scarlet fever and what is it caused by? How is it spread?

A

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci (usually Streptococcus pyogenes).

Spread via resp route or by direct contact with nose/throat discharges.

49
Q

Sx of scarlet fever?

A
  • Fever: typically lasts 24 to 48 hours
  • Malaise, headache, N+V
  • Sore throat
  • ‘Strawberry’ tongue
  • Rash - fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles. Rough ‘sandpaper’ texture.
50
Q

Mx of scarlet fever?

A
  • Phenoxymethylpenicillin (Pen V) QDS for 10 days
  • If penicillin allergy give azithromycin
51
Q

What causes hand, foot and mouth disease?

A

coxsackie A16 and enterovirus 71

52
Q

Sx of hand, foot and mouth disease?

A
  • Mild systemic upset: sore throat, fever
  • Loss of appetite
  • Oral ulcers
  • Followed later by vesicles on the palms and soles of the feet - pink macules to oval blisters
53
Q

How is HIV transmitted?

A
  • Unprotected anal, vaginal or oral sexual activity.
  • Mother to child at any stage of pregnancy, birth or breastfeeding - vertical transmission.
  • Mucous membrane, blood or open wound exposure to infected blood or bodily fluids - e.g. needles, blood splashed in eye
54
Q

How to prevent transmission of HIV during birth?

A

Determine** mode of delivery** based on mother viral load:
* Normal vaginal delivery - viral load < 50 copies
* C-section - > 50 copies copies + give** IV zidovudine** during c-section if viral load unknown or there are > 10000 copies

Prophylaxis treatment may be given to baby:
* Low risk babies, mother < 50 copies viral load - give zidovudine for 4 wks
* High risk babies, mother > 50 copies viral load - give zidovudine, lamivudine and nevirapine for 4 wks

55
Q

Testing for HIV?

A
  • HIV antibody screen
  • HIV viral load
56
Q

Babies to HIV positive parents are tested twice for HIV. When are they done?

A
  • HIV viral load test at 3 months
  • HIV antibody test at 24 months
57
Q

Tx of HIV?

A
  • Antiretroviral therapy (ART) - suppress HIV infx
  • Prophylactic co-trimoxazole (Septrin) - if child has low CD4 counts to protect against PCP
  • Normal childhood vaxx

Phase 3a - Paediatrics (14 decks)

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