Infectious Disease and Travel Medicine Flashcards
As per Nice, how should temperature be measured in a child?
Axilla in under 4 weeks age
4 weeks to 5 years - axilla (electronic or chemical dot), or infrared tympanic
NOT routinely with oral or rectal thermometers
As per NICE, how should fevers/perception of fever reported by a parent be considered?
It should be taken seriously and considered valid
What should be assessed first on assessment of a child with a fever?
Are there any life threatening signs present?
What life threatening signs may be present on initial assessment of a child with a fever?
Think ABC:
Airway collapse/compromise
Impaired breathing
Circulatory collapse
Decreased level of consciousness
What system can be used to predict the risk of serious illness in children?
Traffic light system
What are the signs in children looked for in the skin to help risk stratify for traffic light system for fevers?
Pale, mottled, ashen, blue skin, lips of tongue would be red
Pallor detected by parent/carer but perhaps less convincing objectively to clinician may be amber
What are the social signs in children looked for to help risk stratify for traffic light system for fevers?
No response to social cues, not smiling could be red or amber depending on the situation
What are the signs in children looked for in the chest/respiratory system to help risk stratify for traffic light system for fevers?
RED:
Weak/high pitched cry
Grunting
Recessions
Resp rate greater than 60
AMBER:
Nasal flaring
Other than social cues, skin appearance, and respiratory symptoms, what other signs in children do we look for to help risk stratify for traffic light system for fevers?
RED:
Not waking or if roused does not stay awake
Appearing unwell
Reduced skin turgor
Bulging fontanelle
AMBER:
Dry mucous membranes
Rigours
Reduced urine output
Poor feeding in infants
Under what age is a temperature of 38C or more considered a high risk sign on its own?
Under 3 months
What should be assessed for in a child who has had a fever for 5 days or more?
Kawasaki disease
In whom should meningococcal disease be considered?
Anyone with fever, non blanching rash, neck stiffness, signs of severe illness
In whom should bacterial meningitis be considered?
Any child with fever, and any of neck stiffness, bulging fontanelle,decreased LoC, or convulsive status epilepticus
How might herpes simplex encephalitis present?
Child with fever, focal neurology, focal seizures, and/or decreased level of consciousness
What other symptoms/signs may present in a child with pneumonia?
Tachypnoea
Crackles in chest
Nasal flaring
Recessions
Cyanosis
Oxygen sats 95% or less on air
How might a UTI present in a child?
Dysuria
Frequency of urination
New bed wetting
Malodorous urine
Dark/cloudy urine
Frank haematuria
Abdo/loin pain
A child is brought in by their mother with acute onset swelling to right knee, with new inability to weightbear through it due to pain, and fevers.
What is the most concerning diagnosis?
Septic arthritis or osteomyelitis
A child is brought in with a non specific fever lasting over 1 week. What other features should you check for in the mouth and what are they looking to rule out?
Kawasaki disease
Bilateral conjunctival injection without exudate
Strawberry tongue or erythema/cracking of lips
A child with a week long history or non specific fever and new strawberry tongue is brought in. What cutaneous features should you look for in this condition?
Kawasaki disease
Oedema and erythema to hands and feet
Polymorphous rash
Cervical lymphadenopathy
What is the risk associated with Kawasaki disease?
Coronary artery disease
When taking an infection history, what category should not be missed?
Travel history
A mother calls in about their child who has had a fever, appears mottled, and is difficult to rouse, although appears to be breathing well and has normal responses when spoken to.
How quickly should they be assessed as per NICE face to face?
Within 2 hours for any child with red features who does not have any immediately life threatening signs
Do antipyretics prevent febrile convulsions?
No
When should antipyretics be used in children?
To reduce a fever in a child who is distressed by the fever - d not give with sole aim to reduce temperature
What general advice can be given to parents to manage a feverish child at home?
Encourage fluids and hydration
How to detect dehydration
How to identify non-blanching rash
Check on child in night
Avoid nursery/school while unwell ad inform
If a UTI is suspected in a baby under 3 months, what should happen?
Send urine sample for urgent MC&S
Refer to paediatric specialist care
When should a urine sample be sent for UTI?
Prior to commencing antibiotics, as soon as possible
What results on urine dip in symptomatic children would warrant treatment with antibiotics, and what else should be done?
Either leukocytes or nitrites or both positive
Send for MC&S
A child with a non-specific fever is assessed in clinic. The urine dip is positive for leukocytes but not nitrites.
What should be done here?
Send urine for culture but do not treat as UTI yet as leukocytes could be present from another source of infection which should be checked for, and the child has no specific clinical features of UTI
What congenital features increase risk of UTI in children?
Antenatally diagnosed renal disease
Spinal lesions
What physical issues can increase risk of UTIs in children?
Constipation
Abdominal mass
Spinal lesion
Poor growth
High BP
Which children with UTIs should be referred for imaging?
Those with atypical UTIs or recurrent UTIs
You are referring a child with recurrent UTIs to specialist care for investigation. What element of clinical assessment will be useful for diagnosis of renal parenchymal defects?
Proteinuria
Blood pressure
What is bronchiolitis?
A respiratory illness caught in the first 2 years of life
When is bronchiolitis most commonly caught?
Between 3 and 6 months of age, although can be up to age 2
A 5 month old is brought in by dad, who is concerned due to new fevers for 2 days with runny nose, persistent cough, and sounding wheezy.
What is the likely diagnosis?
Bronchiolitis
A child aged 3 comes in with fevers for 2 days with runny nose, persistent cough, and sounding wheezy.
What are the top differentials, and what is less likely?
Viral induced wheeze
Pneumonia
Bronchiolitis less likely due to age
Why do insect bites/stings cause a reaction?
Insects inject substances such as anticoagulants and vasodilators, as well as antigenic components pare often present
If bites seen are suspected to be due to bed bugs, what should you advise the patient regarding eradication?
They should contact pest control as these are difficult to eradicate
If bites seen are suspected to be due to fleas, what should you advise the patient regarding eradication?
Advise these are usually due to pets (cats/dogs) being infested, so pets should be examined and treated
A patient presents with flea bites from their dog, who is being treated.
The bites are very itchy and keeping the patient awake at night. What can you advise?
-The itching will improve with time
-Try not to scratch as this may introduce infection
-Not a lot of evidence for medical management of itching in this case but oral antihistamines may help short term
What is scabies?
An intensely itchy skin infestation caused by human parasite Sarcoptes scabiei, a mite that burrows in the stratum corneum
How long is the life-cycle of scabies mite?
4-6 weeks
A patient attends with signs of scabies. Who else may need to be informed given mode of transmission?
Any sexual partners
Anyone who shares clothing or bedding (or in extreme cases soft furnishings) with the patient
Casual contact is unlikely to lead to transmission
What are the risk factors for catching scabies?
-Poverty and social deprivation
-Crowded living conditions and institutionalisation
-Winter months
What are the potential complications of scabies?
Generally good prognosis, but can cause:
-secondary bacterial infection
-secondary eczematization
-nodular scabies
What is nodular scabies?
Pruritic nodules of the axillae, groin, and male genitalia which can persist for weeks or months following treatment due to a prolonged immune response to mite antigens.
A patient presents with an intense generalised itch, worse at night, with erythematous papules across hands (including in between fingers), extensor aspects of limbs, and a few other areas.
Which area of the body may be spared in this condition?
Scabies
The back is usually spared, and the head except in children.
How can a diagnosis of scabies be confirmed?
Skin scrapings and/or ink test if suitable expertise is available
How should scabies be managed in an immune-compromised person?
Usually needs hospitalisation as generally causes crusted scabies (more severe and widespread)
How should scabies be managed?
Permethrin 5% cream of the patient and household members/sexual partners
Decontaminate bedding/clothing/towels at 60 degrees at least then hot drying, or sealing in a plastic bag for 72 hours
Which of the following are notifiable diseases?
a. acute encephalitis
b. rubella
c. tuberculosis
All of them
Which of the following are notifiable diseases?
a. Malaria
b. Diphtheria
c. Candidiasis
a and b