Infectious Disease Flashcards
What is Kawasaki Disease
A febrile vasculitic syndrome causing coronary aneurysm
How does Kawasaki present
3 phases:
Acute Febrile: 1-2 weeks
Fever for 5 days or more + 4 of following:
- Bilateral non-exudative conjunctivitis
- Cervical lymphadenopathy
- Pharyngeal Injection, dry fissured lips and strawberry tongue
- polymorphous rash
- change in extremities e.g arthralgia, palmer erythema or later swelling of hands/feet
Subacute: lasts until remission of fever (weeks 4-6)
- Development of coronary artery aneurysms
and risk of MI/sudden death
- desquamation of digits, thrombocytosis, irritability and conjunctival injection
Convalescent: (weeks 6-12)
- Resolution of clinical signs
- normalisation of inflammatory markers
What would be found on Ix of Kawasaki Disease
ESR & CRP raised Bilirubin raised Platelets raised Echocardiogram MRA accurately defines aneurysms
What is the Rx for Kawasaki Disease
IV Ig (immunoglobulin) - decreases new coronary aneurysms
if unresponsive - IVIG + prednisolone
Aspirin
What should do if someone has measles
Report to you local health protect team as it is notifiable disease
How does measles present in the prodome and when is it infective from
Infective from prodome: Fever with CCCK:
- Cough
- Coryza
- Conjunctivitis
- Koplik Spots on palate
When does the rash develop in measles
What are the complications of measles
A maculopapular rash 5d starting e.g behind ears and spreading down body
Complications:
Acute: Most common: Otitis Media Croup and Tracheitis Pneumonia - most common cause of death!!! Encephalitis - older patients
Chronic:
Subacute sclerosing parencephalitis - progressive change in behaviour, myoclonus, dystonia, dementia, coma, death
What is the Rx of measles
Isolate in hospital
- Paracetamol/ antipyretics for fever
- Adequate nutrition and fluids
- Vit A
- Treat secondary bacterial infection with Abx
What is Chicken Pox caused by
Varicella - Zoster Virus
What are the signs of chicken pox
Fever followed by rash 2 days later:
- Macules - Papules - Vesicles with red surrounding - Ulcers - Crusting
Starts on face, scalp or trunk and is more concentrated to torso than the extremities
What are complications of chicken pox
when is chicken pox dangerous
Spots blackish - purpura fulminans
Bluish - necrotising fasciitis - ITU!!!!!
Immunosuppression, CF, Severe eczema and neonates
What is the treatment of chicken pox
- Keeping cool may reduce number of lesions
- Calamine lotion soothes
- Daily antiseptic for spots
- Flucloxicillin if bacterial superinfection
- Antivaricella-zoster immunoglobulin + aciclovir in immunocomprimised/suppressed
When is Rubella infective and how does it present
Infective 5 days before to 5 days after rash
- Macular rash
- Suborbital Lympadenopathy
How is rubella prevented and what complications can it cause
MMR vaccine
Small joint arthritis
Malformations in utero e.g eye anomaly, cardiac abnormalities, deafness
How does mumps caused by and how does it present
Paramyoxovirus
Presents with:
prodromal malaise, fever, and painful parotid swelling
What causes hand, foot and mouth disease
Coxsackies
How does hand, foot and mouth present
- child mildly unwell with fever
- Sore throat
- Vesicles develop in mouth, hands and feet
- May also be ulcers in the mouth
(May also have Abdo pain and nausea)
What is scalded skin syndrome
A small number of Staph Aureus produces a toxin which is toxic to the skin
presents with skin blistering and peeling
Presents in the usual places:
- infections of cuts/grazes
- boils/abcesses
- impetigo
- nappy rash
- conjunctivitis
What is Diphtheria caused by
The toxin of Corynebacterium Diphtheriae
How does Diphtheria present
tonsillitis + Pseudomembrane - A thick/grey white coating over back of throat
High Fever
Shock from myocarditis, cardiac conducting system involvement
Dysphagia
Muffled voice
Airway obstruction
what is a concern with Diphtheria
Toxin induced myocarditis (do frequent ECG)
What is the Diagnosis and Rx of Diphtheria
Swab culture of material below pseudomembrane
Rx: Diphtheria Antitoxin and Erythromycin
What causes Whooping Cough
Bordetella Pertussis
How does whooping cough present
Infants: Apnoea Bouts of coughing with vomiting worse at night and after feeding Whoops caused on inspiration Co-infection with RSV e.g bronchiolitis
What is the diagnosis and Rx of Whooping Cough
PCR via nasal swab
Macroglide - Clarithromycin
What is a complication of whooping cough
Prolonged illness can lead to bronchiectasis and death
What is TB cause by
Mycobacterium Tuberculosis
What is the pathogenesis of TB
Can be latent - asymptomatic, uninfectous
or active - symptomatic, mortality high
Resists killing by Macrophages
Therefore Bacilli and Macrophages form a Granuloma in the lung
What is the risk factors for TB
HIV +ve Overseas contact IVUD Homeless Crowded living
What are the features of TB
Pulmonary: Cough, Chest pain, Dyspnoea, Haemoptysis, Pleural Effusion
Systemic: Weight loss, Anorexia, Low grade fever, Night Sweats, Failure to thrive, Malaise
What is Extrapulmonary TB
haematogenous dissemination
- Lymph nodes - swelling
- Millary TB
- Bone - pain, swelling of joints, Potts
- Abdominal TB - ascites, malabsorption
- Genito-Urinary TB
- CNS TB - meningitis
How is TB diagnosed
- Tuberculin Test - skin test
- Interferon Gamma release testing - blood test
- Culture + Zielhl - Neesen Stain of sputa
- CXR: consolidation, cavitation, (small white dots means millary spread)
How is TB treated
4 drugs for 6 months in active disease:
- Rifampicin
- Isoniazid
- Pyrazinamide - first 2 months only
- Ethambutol - first 2 months only
In latent disease 2 drugs for 3 months
What is the TB treatment SE
Rifampicin - Hepatitis
Isoniazid - Neuropathy
Ethamabutol - Optic Neuritis
(Monitor LFTs and U&Es)
Remember - Drug Resistance major problem therefore compliance is vital
What is meningitis and how does it present
Inflammation of the Meninges
Infants subtle: Crying, Irritability, Lethargy, Difficulty feeding, Fever, Seizures, Bulging Fontanelle
Septic Signs: Fever/raised T, cold hands/feet, limb/joint pain, abnormal skin colour, abnormal behaviour, non blanching purpuric rash, DIC, Raised HR, Low BP
Meningeal Signs: Less common in young children!!!
- Headache
- Neck Stiffness
- Photophobia
- Nausea/Vomiting
- Kernigs Sign - resistance to extending knee when hip flexed
What are the main causes of meningitis
Neonates: Step B Pneumococcus
Older: nisseria Meningitidis
How is meningitis managed pre hospital
Suspected bacterial meningitis without non blanching rash
- Urgent transfer to secondary care without giving parenteral Abx
Suspected meningococcal disease (meningitis with rash or meningococcal septicaemia)
- Give IV/IM benzylpenicillin
How is meningitis managed in secondary care
- Examination for signs of meningitis or septicaemia
- Give IV Cefotaxime immediately/without delay if any hint of meningococcal disease (meningitis with rash or meningococcal septicaemia) sending bloods and CSF must not delay this!!!!!
- Carry out appropriate Ix
- Protect Airways, Give high flow O2, set up IVI
- Children 3 months or older - IV Ceftriaxone
- Children younger than 3 months - IV cefotaxime + Amoxicillin
Dexamethasone - can be given to prevent deafness (complication of meningitis)
If Viral Meningitis e.g Herpes Simplex give Acyclovir
What Ix should be performed in suspected Meningitis
FBC CRP Coagulation Screening Blood Culture PCR - for N. Meningitidis Lumbar Puncture - only do if not contraindicated e.g signs of Raised ICP, shock, DIC, purpura, brain herniation near Blood glucose and gas
How too you distinguish bacterial and viral meningitis
Appearance - Viral usually clear, Bacterial turbid
Predominant cell - Viral mononuclear, Bacterial polymorph
Glucose - low in bacterial, normal in viral
Protein - raised in bacterial, normal in viral
What can be given as prophylaxis to prevent meningitis
Ciprofloxacin
What are the causes of meningitis
Over 3 months:
- Meningococcus/Neisseria Meninigitiis
- Streptococcus Pneumoniae
- Haemophillus Influenzas (in unvaccinated)
Under 3 months:
- Group B haemolytic Streptococci!!! - via mothers vagina
- E-coli, meningococcus, pneumococcus
Viruses: Enterovirus, HSV
How does Encephalitis present
Flu like prodome Change in consciousness Odd behaviour Vomting Fits Temp Increase Menignism
What are the causes of Encephalitis
HSV Mumps Varicella Zoster Rabies TB Malaria Enetroviruses
How Is Encephalitis managed
CSP Blood Cultures MC&S Test stools Urine
If Herpes Simplex give Acyclovir
What is slapped cheek syndrome
Caused by Parovirus B19
presents with: High Fever Headache Runny nose & sore throat Bright red rash on both cheeks Maculopapular rash with pruritus on torso, arms and legs
What is impetigo
Skin infection caused by Staph Aureus
Presents with:
Blisters that quickly burst and form a golden crust which can be itchy and painful
Rx: Topical Abx e.g Fusidic Acid
More widespread? - oral Abx - Flucloxicillin
What is candida
A fungal Infection
Can cause:
Nappy Rash
How do children often develop HIV
Through Vertical transmission from mother to baby during childbirth - may need C-section
OR
through breastfeeding - ALL HIV +ve women should bottle-feed
How may an undiagnosed HIV +ve Child present
Failure to thrive Lympadenopathy Hepatospleomegaly Presisitant diarrhoea Parotid enlargement Shingles Recurrent slow to clear infection TB Low platelets Clubbing
What are the risks of HIV in children
Immunocomprimised
How is HIV managed in children
Full course of vaccination
HAART treatment
What is poliomyelitis
A viral infection that can result in temporary or permanent paralysis due to its potential invasion of the grey matter of the spinal cord
Spread by faeco-oral spread
How does polio present
Most are asymptomatic (90%)
Poliomyelitis without CNS involvement (flu symptoms) :
- high temp
- sore throat
- headache
- abdo pain
- aching muscles
- feeling sick
Poliomyelitis with CNS involvement:
- Fever, neck stiffness, headache, vomiting
- Paralysis, respiratory failure
What are the long term complications of polio
Muscle weakness and pain
What will be found on Ix
PCR amplification of poliovirus RNA from CSF
What is the Rx of Polio
Pain relief
mechanical ventilation
close monitoring of BP and RR
Immunisation - for prevention
What is scarlet fever
Caused by Group A bets haemolytic step
How does scarlet fever present
Acute tonsillitis
- Fever
- Tonsillopharyngitis - sore throat, white coating of tongue, pharyngeal erythema and strawberry tongue
Scarlet colour maculopapular rash with sandpaper like texture with Pastia’s lines
Desquamation phase - desquamation of skin in flakes
How is it diagnosed and treated
Diagnosis: Throat swab
Abx: Oral penicillin
What is toxic shock syndrome caused by
Staphlyococcus or Streptococcus bacteria which can release harmful toxins Causes: - High Temp - Flu like symptoms - Nausea/Vomitng - Diarrhoea - Wide spread rash - dizziness, fainting and difficulty breathing
What vaccinations are given at 8 weeks old
The 6 in 1 Diphtheria Tetanus Pertussis (DTaP) Polio (IPV) Haemophilus Influenza Type B (HiB) Hepatitis B (HepB)
Pneumococcal
Meningococcal Group B (MenB)
Rotavirus Gastroenteritis
What vaccinations are given at twelve weeks old
Diphtheria, Tetanus & Pertussis (DTaP)
Polio (IPV)
HiB
Hepatitis B
Rotavirus
What vaccinations are given at 16 weeks old
Diphtheria, Tetanus & Pertussis (DTaP)
Pneumococcal
MenB
What vaccinations are given at 1 year
HiB and MenC
Pneumococcal
MMR
MenB
What vaccinations are given at 3 years and 4 months
Diphtheria, Tetanus & Pertussis
Polio (IPV)
MMR
