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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
Sx of whooping cough?
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
Ix of whooping cough?
* Nasopharyngeal or nasal swab with PCR testing or bacterial culture * Anti-pertussis toxin immunoglobulin G
27
Mx of whooping cough (pertussis)?
Macrolides - azithromycin, erythromycin and clarithromycin Macrolide alternative - co-trimoxazole Give prophylactic abx to close contacts of infected pts.
28
What is polio and how is it spread?
Highly infectious viral disease transmitted by person to person mainly through faecal-oral route. There is no cure for polio.
29
Sx of polio?
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
What is TB and what is it caused by? How is it spread?
Infectious disease caused by Mycobacterium tuberculosis (rod-shaped bacteria). Spread by inhaling saliva droplets from infected people.
31
What staining is required to identify TB causing bacteria and why?
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
RF for TB?
* HIV * Immunosuppression * Close contacts of infected patients * High risk country - i.e. Pakistan, Somalia, Romania * Homelessness * Children and elderly pts
33
Sx of TB?
* 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
Ix for TB?
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
Tx of TB?
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
What is the main SE of isoniazid and what drug should also be prescribed alonside to help prevent this SE?
SE - peripheral neuropathy Drug - pyridoxine or vitamin B6 ## Footnote isoniazide (“I’m-so-numb-azid”)
37
Main SE of Rifampicin?
red/orange discolouration of secretions, such as urine and tears + reduces effects of drugs such as COCP ## Footnote rifampicin (“red-I’m-pissin’”)
38
Main SE of pyrazinamide?
Hyperuricaemia (high uric acid levels), resulting in gout and kidney stones.
39
Main SE of ethambutol?
Colour blindness and reduced visual acuity. ## Footnote ethambutol (“eye-thambutol”)
40
What causes slapped cheek syndrome? | aka fifth disease
Parovirus B19
41
Sx of slapped cheek syndrome?
* Mild fever * Bright rose-red rash on cheeks - may spread to rest of body Child begins to feel better as rash appears.
42
Tx of slapped cheek syndrome?
No specific tx required. Not infectious once rash emerges.
43
What is toxic shock syndrome and what is it caused by?
A severe, life-threatening cdtn. Primarily caused by Streptococcus (usually group A), Staphylococcus aureus and MRSA.
44
RF for toxic shock syndrome?
* Staphylococcal cellulitis * Wounds (especially burns) * Alcoholism and intravenous drug use * HIV * Tampon use or gynaecological infections
45
Sx of toxic shock syndrome?
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
Ix for toxic shock syndrome?
* Sepsis 6 - blood cultures and lactate (within 1 hr) * Throat swabs or wound swabs * Bloods ## Footnote 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
Toxic shock syndrome mx?
* A-E approach * Abx: Generally clindamycin + a cephalosporin/meropenem/vancomycin for broad spectrum coverage. * Corticosteroids
48
What is scarlet fever and what is it caused by? How is it spread?
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
Sx of scarlet fever?
* 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
Mx of scarlet fever?
* Phenoxymethylpenicillin (Pen V) QDS for 10 days * If penicillin allergy give azithromycin
51
What causes hand, foot and mouth disease?
coxsackie A16 and enterovirus 71
52
Sx of hand, foot and mouth disease?
* 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
How is HIV transmitted?
* 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
How to prevent transmission of HIV during birth?
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
Testing for HIV?
* HIV antibody screen * HIV viral load
56
Babies to HIV positive parents are tested twice for HIV. When are they done?
* HIV viral load test at 3 months * HIV antibody test at 24 months
57
Tx of HIV?
* 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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