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Paediatrics > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

Cervical lymphadenopathy definition

A

Enlargement of cervical lymph nodes

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2
Q

Causes cervical lymphadenopathy

A

ALL
Napkin dermatitis
Acute bacterial adenitis nodes >10mm, warm and fluctuant. Usually Staph aureus/ group A strep
Kawasaki disease (unilat, >15mm, painful nodes + other ass features)
Atopic eczema (nodes >2wks, usually bilat)
Measles
JIA
Chickenpox
HIV
Mononucleosis/ Epstein Barr Virus infection (generalised lymphadenopathy, hepatosplenomegaly)
Mycobacterium avium (usually unilat, child

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3
Q

Mx acute adenitis

A

Incision and drainage (but NOT if ?TB)
Oral abx for 10 days (fluclox)
IV abx if neonates/ unwell/ failed oral rx

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4
Q

EBV illnesses

A

Most infections sub-clinical
Infectious mononucleosis
Burkett lymphoma
Lymphoproliferative disease in immunocomp hosts

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5
Q

EBV transmission

A

Usually oral contact

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6
Q

EBV syndrome

A

Older kids (and sometimes young):

  • fever
  • malaise
  • tonsillopharyngitis (often severe, limiting oral fluid + food ingestion. Sometimes can compromise breathing)
  • lymphadenopathy, esp cervical nodes
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7
Q

Other sx EBV infection

A 
petechiae soft palate
splenomegaly
hepatomegaly
maculopapular rash
jaundice
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8
Q

Dx EBV

A

Dx supported by:
atypical lymphocytes (numerous large T cells on blood film)
positive Monspot test (but this often -ve in young children with the disease)
seroconversion with production of IgM and IgG to EBV
Sx can persist for 1-3 months but ultimately resolve

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9
Q

Tx EBV

A

Tx symptomatic
When airway severely comp, can consider steroids
In 5%, group A strep grown from tonsils - can be tx with penicillin (AVOID ampicillin/ amoxicillin in children w ?EBV - can cause florid maculopapular rash)

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10
Q

CMV transmission

A

Usually transmitted via saliva, genital secretions, breast milk
More rarely: blood products, organ transplants, transplacentally

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11
Q

CBV infection syndromes

A

Mild/ subclinical infection in normal hosts
(Developed countries: ~1/2 adults show ev of past infection)
Mononucleosis syndrome; gen less pronounced pharyngitis and lymphadenopathy vs EBV

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12
Q

RFs CMV infection

A

Immunocompromised people:
- retinitis, pneumonitis, BM failure, enceph, hepatitis, colitis, oesophagitis
MUST watch out for CMV activation post-organ transplant: PCR of bloods
Foetus (congenital infection)

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13
Q

CMV Ix

A

Atypical lymphocytes on blood film BUT

heterophile antibody negative

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14
Q

CMV Tx

A

Ganciclovir or foscarnet BUT both have serious SEs

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15
Q

Epidemiology pneumonia

A

Peak incidence in infants + elderly
Relatively high in childhood however
Viruses most common cause in younger children, bacteria commoner in older children

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16
Q

Pathogens causing pneumonia in newborn

A

Organisms from mothers genital tract, esp group B strep

also TB

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17
Q

Pathogens causing pneumonia in infants + young children

A

Resp viruses, esp RSV, most common
Bacteria: strep pneumoniae, H. influenzae
(also TB)

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18
Q

Pathogens causing pneumonia in children >5

A

Mycoplasma pneumonia
Strep pneumoniae
Chlamydia pneumoniae
(also TB)

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19
Q

Clin features pneumonia

A

Fever + breathing difficulty = main sx (usually preceded by URTI)
Other sx: lethargy, cough, poor feeding
Localised chest/ back/ abdo pain suggests pleural irritation + bacterial infection

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20
Q

O/E pneumonia

A

Tachypnoea
Nasal flaring
Chest indrawing
End-inspiratory coarse crackles
BEST CLIN FEATURE = INCREASED RESP RATE (can miss pneumonia if RR not measured)
(Consolidation w dullness to percussion, decreased breath sounds and bronchial breathing often absent in young kids)
O2 sats may be low = IX FOR ADMISSION

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21
Q

Pneumonia Ix

A

CXR (But cant differentiate btwn viral + bacterial, except classic lobar pneumonia = Staph aureus)
Bloods (^ ESR, CRP)
Younger kids: nasopharyngeal aspirate can differentiate btwn bacterial + viral causes

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22
Q

Indications for admission pneumonia

A

O2 sats

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23
Q

General principles mx pneumonia

A

Gen supportive care: O2 if hypoxia, analgesics if pain
IV fluids if needed
Physiotherapy no role

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24
Q

Abx pneumonia

A

Newborns: IV broad spectrum
Older infants: oral amoxicillin
Reserve broad-spectrum abx, e.g. co-amox for complicated/ unresponsive patients)
Children >5: amoxicillin or oral macrolide, e.g. erythromycin

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25
Q

Mx parapneumonic effusions

A

Most resolve w abx

Small proportion develop empyema that requires drainage (Chest drain or surgical decortication)

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26
Q

Prognosis pneumonia

A

Children w simple consolidation on CXR + who recover clinically generally don’t need follow up
F/U CXR after 4-6 wks if ev lobar collapse, atelectasis or empyema
Virtually all kids make full recovery

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27
Q

Definition stomatitis

A

Inflammation of the mucous membranes of the mouth

28
Q

Causes stomatitis

A

Many causes
Infancy: Candida infection
After infancy: 1st infection with Cocksackie A viruses or HSV-1
Stevens-Johnson syndrome

29
Q

Features Stevens-Johnson syndrome

A

Severe mouth ulceration with conjunctivitis, erythema multiforme, severe systemic illness

30
Q

Mx Candida stomatitis

A

Deal with RFs (immunodef, poor hygeine, chronic illness, malnutrition)
Treat w topical antifungal (nystatin)

31
Q

Mx viral stomatitis

A

Mostly symptomatic

If severe HSV-1, may need IV fluids and acyclovir

32
Q

Chickenpox incubation period

A

14-21 days

Spread by respiratory route, then via blood and lymphatics

33
Q

Chickenpox period of infectivity

A

2 days before rash to

5 days after rash appears (i.e. when all the lesions crust)

34
Q

Presentation

A

Fever
Itchy, vesicular rash which appears in crops (i.e. appears in clusters of lesions in different areas) over 3-5 days
Crops mainly on head, neck and trunk: sparse on limbs

35
Q

Chickenpox virus

A

Varicella Zoster Virus

36
Q

Mx chickepox

A

Symptomatic
Aciclovir if immunocomp or adolescent (likely to develop more severe disease)
If immunocomp and in contact with or maternal chickenpox around delivery or VZVIg

37
Q

Complications chickenpox

A

2y bacterial infection
Encephalitis
Purpura fulminans

38
Q

Causes macular/papular/maculopapular rash

A

Rubella (macular only)
Measles
Human Herpes Virus 6/7 (Roseola infantum)
Enterovirus

39
Q

Causes purpuric/ petechial rash

A

Meningococcal sepiticaemia
Henoch Schonlein purpura
Enterovirus
Thrombocytopaenia

40
Q

Causes vesicular rash

A

Herpes simplex
Chickenpox
Hand, foot and mouth disease
Shingles

41
Q

Causes pustular/ bullous rash

A

Impetigo

Scalded skin syndrome

42
Q

Causes desquamation

A

Post-scarlet fever

Kawasaki’s disease

43
Q

Presentation measles

A 
Fever
Rash
Cough
Coryza
Conjunctivitis
Koplik's spots
44
Q

Measles rash

A

Maculopapular, spreads down from behind ears to whole body. Discrete -> blotchy/ confluent. May desquamate in 2nd week

45
Q

Diagnosis measles

A

History of fever (2-3 days)
One of cough/ coryza/ conjunctivitis/ Koplik’s spots
Lab = IgM antibody or isolation of viral RNA

46
Q

Management measles

A

If symptomatic, isolate patient if admitted
If immunocomp, consider ribavirin. Give vit A in developing countries
Immunisation, usually via MMR

47
Q

Complications measles

A

MEASLES COMP
myocarditis, encephalitis, appendicitis, subacute sclerosing encephalitis, laryngitis, early death, shits (diarrhoea), corneal ulcer, otitis media, mesenteric lymphadenitis, pneumonia (+ related: bronchiolotis, bronchitis, croup)

48
Q

Prognosis measles

A

Good prognosis, serious complications v rare.

Rare in developed countries (vaccine)

49
Q

Rubella presentation

A

Generally mild disease in childhood

  • Low grade fever or none at all
  • Rash
  • Prominent lymphadenopathy (esp suboccipital + postauricular nodes)
50
Q

Rubella rash

A

Maculopapular, appears initially on fever, spreads centrifugally to whole body. Not itchy, fades in 3-5 days

51
Q

Congenital rubella syndrome

A

Rubber ducky, I’m so blue
Rubber: Rubella
Ducky: patent Ductus arteriosus, pulmonary artery stenosis
I’m: Eyes (cataracts, retinopathy, micropthalmia, glaucoma)
Blue: “Blueberry Muffin” rash (extramedullary haematopoesis in skin + purpura)

52
Q

Mx rubella

A

Symptomatic

Immunisation (MMR)

53
Q

Complications rubella

A 
Rare in childhood. TEAM
Thrombocytopaenia
Enceph
Arthritis
Myocarditis
54
Q

Prognosis rubella

A

Mild, self-limiting, often asymptomatic in children

Poor prognosis in congenital rubella syndrome

55
Q

Cause scarlet fever

A

Exotoxin release by Strep pyogenes

56
Q

Presentation scarlet fever

A

Sore throat
Fever
Bright red (“strawberry”) tongue
Characteristic rash

57
Q

Scarlet fever rash

A 
Fine, red, rough, blanches
12-48 hrs post-fever
Starts on chest, armpits, behind ears
Worse on skin folds
Fades 3-4 days after onset
58
Q

Scarlet fever dx

A 
Dx= CLIN
Marked leucocytosis with neutrophilia
High ESR, CRP
Raised antistreptolysin O titre 
Strep in throat culture
59
Q

Mx scarlet fever

A

Penicillin

if allergic, clindamycin/ erythromycin

60
Q

Complications scarlet fever

A

Septic: sepsis, ear and sinus infection, strep pneumonia, empyema, meningitis (SEPEM)
Immunological: acute glomerulonephiritis, rheumatic fever, erythema nodosum (ARE)

61
Q

Prognosis SF

A

Rash can last 2-3 weeks, excellent prognosis w abx

62
Q

Kawasaki Disease clin features

A

FEEL my conjunctivitis
F: fever, for 5 days, often high
E: Edema of hands and feet, clasically child refuses to walk
E: erythematous rash, classically maculopapular + desquamation of fingers and toes but polymorphic!!
L: lymphadenopathy, often unilar cervical
My: mucositis = dry, cracked lips, red throat + oral mucosa, strawberry tongue
Conjunctivitis: Non-purulent, limbic sparing (part of sclera around iris remains white)

63
Q

Dx Kawasaki disease

A

Fever >5 days AND 4/5 of:

  • conjunctivitis
  • red mucous membranes
  • cervical lymphadenopathy
  • rash (polymorphic)
  • extremities: red + oedematous palms, desquamation of fingers and toes
64
Q

Mx Kawasaki’s

A

Prompt IVIg within 1st ten days

Aspirin reduces risk thrombosis

65
Q

Complications Kawasaki

A

Affects coronary arteries in 1/3

Can cause coronary artery aneurysm followed by scarring and stenosis, MI and sudden death (1-2% mortality)

66
Q

Kawasaki prognosis

A

Good with prompt tx, if untreated 2% die of coronary complications

Paediatrics (7 decks)

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