Infectious Diseases Flashcards
Examples of inactivated vaccines
Killed version of vaccine
Polio
Flu vaccine
HepA
Rabies
Subunit and conjugate vaccines
Contain parts of organism
Safer for immunocompromised patients
Examples:
Pneumococcus Meningococcus HepB Pertussis Haemophilus influenza TYB HPV Shingles
Live attenuated vaccines
Contain a weakened version of the pathogen
Still capable of causing infection
MMR BCG: TB Chickenpox: weakened varicella zoster Nasal influenza Rotavirus
Toxin vaccines
Contain toxin produced by vaccine
Diphtheria
Tetanus
Vaccines given at birth
BCG if risk factors
Vaccines given at 2 months/ 8 weeks
6in1
Oral rotavirus vaccine
MenB
Vaccines given at 12 weeks/ 3 months
6 in 1
Pneumococcal (PCV)
Rotavirus
Vacccines given at 4 months/ 16weeks
6in1
MenB
Vaccines given at 1 year
Hib/MenC (2in1)
Pneumococcal
MMR
MenB
Vaccines given at 2-8
Flu vaccine
Vaccine given at 3-4years
4in1 pre-school booster
MMR
Vaccines given at 12-13year
HPV vaccination
Vaccines given at 13-18years
3in1 teenage booster
MenACWY
6in1 vaccine
Diphtheria Tetanus Polio HepB Hib Pertussis
4in1 preschool booster
Diphtheria
Tetanus
Whooping cough
Polio
3in1 teenage booster
Tetanus
Diphtheria
Polio
HPV vaccine and strains
Protects against 6, 11, 16 and 18
Strains 6 and 11 cause genital warts
Strains 16 and 18 cause cervical cancer
Cytokines in paediatric sepsis
Interleukins and TNF
Immune system activation, NO released, vasodilation
Increased vessel permeability, oedema, increased diffusion distance, decreased oxygenation
Anaerobic respiration, lactic acidosis
Coagulation system activation, DIC, thrombocytopenia, haemorrhages
Septic shock
Sepsis has lead to cardiovascular dysfunction
Organ hypoperfusion, decreased BP
Rise in lactate, anaerobic resp
Circulatory collapse and hypoperfusion of organs
Management of septic shock
IV fluids to improve blood pressure and tissue perfusion
Escalate children to HDICU
Inotropes stimulate CVS and improve blood pressure and tissue perfusion
Signs of sepsis
Deranged physical observations Prolonged CRT Fever or hypothermia Deranged behaviour Poor feeding Inconsolable or high-pitched crying Weak cry Reduced consciousness Reduced body tone Skin colour changes (cyanosis, mottled pale, ashen)
Neonatal sepsis
Infection within 28 days of life
Causes of neonatal sepsis
Group B streptococcus,early-onset
E.coli
Late-onset: staphylococcal epidermidis, pseudomonas aeruginosa, klebsiella, enterobacter, fungal species
Risk factors for neonatal sepsis
Mother who has had a previous baby with GBS infection
Premature <37weeks
Low birth weight
Evidence of maternal chorioamnionitis
Neonatal sepsis presentation
Respiratory distress Tachycardia Apnoea Change in mental status/ lethargy Jaundice Seizures Poor/reduced feeding Abdominal distension Vomiting Temperature, pre term hypothermia, term febrile
Neonatal sepsis investigations
Blood culture FBC CRP Blood gases Urine microscopy, culture and sensitivity Lumbar puncture
Management of neonatal sepsis
IV benzylpenicillin with gentamicin CRP measured 18-24hours after presentation Oxygenation Fluid ad elctoyltres Vasporessor support Hypoglycaemia mx Metabolic acidosis mx
Sepsis risk assessment
Colour: cyanosis, mottled pale or ashen
Activity
Respiratory
Circulation and hydration
All infants <3months with a temperature of >38 need to be treated urgently for sepsis
Immediate management of sepsis
Give oxygen: if evidence of shock or saturations <94%
IV access
FBC, UE, CRP, clotting screen (INR), blood gas (lactate and acidosis)
Blood cultures
Urine dipstick
Antibiotics within 1 hr of presentation, continue for 5-7days
IV fluids: 20ml/kg IV if lactate >2mmol/L or if there is shock
When do you stop ax in sepsis
Low suspicion of bacterial infection
Patient is well
Blood cultures and 2 CRP results are negative at 48hours
Chickenpox features
Fever initially
Itchy rash starting on head/trunk before spreading
Macular, papular then vesicular
Systemic upset usually mild
Measles
Prodromal: irritable, conjunctivitis, fever
Koplik spots
Rash behind ears then to whole body
Discrete maculopapular rash, then blotchy and confluent
Mumps
Fever, malaise, muscular pain
Parotitis, unilateral then bilateral
Rubella
Pink maculopapular rash, initially on face before spreading to whole body
Usually fades by 3-5 days
Subocciptal and post auricular lymphadenopathy
Erythema infectiosum
Fifth disease Slapped cheek syndrome Parvovirus B19 Lethargy, fever, headache Slapped cheek rash spreading to proximal arms and extensor surfaces
Scarlet fever
Reaction to erythrogenic toxins produced by GroupA haemolytic streptococci
Fever, malaise, tonsilitis
Strawberry tongue
Circumoral pallor
Hand, foot and mouth disease
Coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in mouth and on the palms and soles of feet
Meningitis organisms
Neonatal to 3 months
Group B streptococcus: from mum
E,coli
Listeria monocytogenes
Meningitis organisms
1month-6years
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilius influenza
Meningitis organisms >6months
Neisseria meningitidis
Streptococcus pneumoniae
Presentation of meningitis
Fever Neck stiffness Vomiting Headache Photophobia Altered consciousness Seizures Hypotonia, poor feeding, lethargy, hypothermia, bulging fontanelle
Lumbar puncture indications in meningitis
<1 month and fever
1-3months with fever and unwell
<1 year with unexplained fever
Contraindications to lumbar puncture
RICP signs Focal neurological signs Significant bulging of fontanelle Papilloedema DIC Signs of cerebral herniation
Take blood cultures and PCR instead
Special tests for meningeal irritation
Kernigs test
Brudzinskis test
Kernigs test
For meningeal irritation Lie patient on back Flex hip and knee to 90 Straighten knee Spinal pain/resistant to movement
Brudzinski’s test
Lie patient on back
Use hands to lift their hand and neck off bed
Flex chin to their chest
Positive test: flex hip and knees
Management of meningitis
Lumbar puncture for CSF Blood culture Meningococcal PCR Fluids to treat shock Cerebral monitoring Notifiable disease, antibiotic prophylaxis of contacts, ciprofloxacin
Antibiotics in meningitis
<3 months: IV amoxicillin + IV cefotaxime
>3 months: IV ceftriaxone
Add vancomycin if risk of penicillin resistant pneumococcal infection
Steroids in meningitis
No corticosteroids if <3 months
Dexamethasone if lumbar puncture suggests bacterial meningitis, 4x daily for 4 days
Causes of viral meningitis
Herpes simplex virus
Enterovirus
Varicella zoster virus
Management of viral meningitis
Aciclovir
Meningitis CSF appearance
Cloudy in bacterial
Clear in viral
Meningitis CSF protein
0.2-0.4g/l: normal
>1.5g/L: bacterial
Mildly raised or normal: viral
Meningitis CSF glucose
Normal: 0.6-0.8
Viral: 0.6-0.8
Bacterial: <0.5
Meningitis CSF WCC
Normal <5
Bacterial >1000 and neutrophils
Viral >1000 and lymphocytes
Complications of meningits
Hearing loss
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
Cerebral palsy: limb weakness or spasticity
Causes of encephalitis
HSV-1 cold sores in children
HSV-2 genital warts in neonates (from birth)
Encephalitis presentation
Altered consciousness Altered cognition Unusual behaviour Acute onset of focal neurological symptoms Acute onset of focal seizures Fever
Diagnosis of encephalitis
Lumbar puncture CT scan MRI scan EEG recording Swabs: throat and vesicle HIV testing
Management of encephalitis
IV aciclovir: herpes simplex virus, varicella zoster virus
IV gancliclovir: cytomegalovirus
Repeat lumbar puncture
Complications of encephalitis
Lasting fatigue, prolonged recovery Change to personality or mood Changes to memory and cognition Learning disability Headaches Chronic pain Movement disorders Sensory disturbance Seizures Hormonal imbalance
Infectious mononucleosis
Glandular fever
EBD, human herpesvirus 4
Rash after amoxicillin
Features of infectious mononucleosis
Sore throat
Lymphadenopathy: anterior and posterior triangles
Pyrexia
Fatigue Tonsillar enlargement, snoring Splenomegaly: splenic ruptures Malaise, anorexia, headache Palatal petechiae Hepatitis, transient rise in ALT Lymphocytosis Haemolytic anaemia
Symptoms resolve after 2-4sweek
Diagnosis of infectious mononucleosis
Heterophil antibody test: Monospot (horses) or Paul-Bunnell test (sheep)
In 2nd week
Viral capsid antigen for EBV antibodies
Monospot test infectious mononucleosis
Introduces patients blood to RBC from horses
Heterophile antibodies will give a positive result
Management and prognosis infectious mononucleosis
Acute illness lasts 2-3weeks, fatigue for several months once infection is disabled
Avoid alcohol
Rest during early stages
Avoid playing contact sports for 8 weeks after having glandular fever to reduce risk of splenic rupture
Complications of infectious mononucleosis
Splenic rupture Glomerulonephritis Haemolytic anaemia Thrombocytopenia Chronic fatigue Gillian-Barre syndrome Encephalitis
Associated with Burkitts lymphoma
Mumps
RNA paramyxovirus Respiratory droplets Incubation 14-21days Self-limiting, lasts 1 week Supportive management
Presentation of mumps
Fever Malaise, muscular pain Parotitis: unilateral then bilateral, with associated pain Lethargy Dry mouth Reduced appetite Headache
Complications of mumps
Abdominal pain: pancreatitis
Testicular pain and swelling: orchitis
Confusion, neck stiffness and headache (meningitis or encephalitis)
Sensorineural hearing loss: unilateral and transient
Management of mumps
PCR test on saliva swab to diagnose
Test saliva for antibodies
Supportive management
Notifiable disease
Epiglottitis
Inflammation and swelling of epiglottitis
Caused by infection
Haemophilus influenza TYB
Streptococcus pneumoniae
Pathophysiology of epiglottitis
Haemophilus influenza and streptococcus pneumoniae infection
Can also be due to non-infectious cases: trauma, thermal/chemical damage
Inflammation starts on lingual surface
Spreads to aryepiglottic folds, arytenoids, supraglottic larynx
Vocal cords swelling restricted by epithelium, increased pressure in small area, airway obstruction
Epiglottitis in children airway obstruction more likely
Epiglottis is more floppy, broader, longer and angled more obliquely to trachea
Larger tones and anteriorly-angled vocal cords mean children find it more difficult to move air past partial obstruction
Risk factors for epiglottitis
Not receiving HiB vaccine
Male gender
Immunosuppression
4Ds of epiglottitis
Dyspnea
Dysphagia
Drooling
Dysphonia
Clinical features epiglottitis
Sore throat and stridor Drooling Tripod position High fever Difficulty or painful swallowing Muffled voice Scared and quiet child Septic and unwell appearance
Symptom duration<12hours
No cough typically
DD epiglottitis
Croup Inhaled foreign body Retropharyngeal abscess Tonsilitis Peritonsillar abscess Diphtheria
Investigations epiglottitis
Secure airways Intubation equipment ready Throaty swabs Blood tests: FBC, cultures, CRP Lateral neck XRAY: thumb print signs, thickened aryepiglottic folds, increased opacity of larynx and vocal cord
Management of epiglottitis
Secure airway: Escalate to anaesthetist and ENT registrar
Oxygen
Nebulised adrenaline to reduce oedema
IV antibiotics: 3rd generation cephalosporin (cefotaxime, ceftriaxone), oral co-amoxicillin once well
IV steroids (dexamethasone)
IV infusion
Complications of epiglottitis
Mediastinitis: if spreads to retropharyngeal space Deep neck space infection Pneumonia Meningitis Sepsis/ Bacteraemia
Glandular fever epidemiology
Age 1-6
Age 18-22
Tonsilitis
Inflammation of palatine tonsils Viral infection Concentration of lymphoid tissue within oropharynx Tonsillopharyngitis Adenotonsilitis
Causes of bacterial tonsilitis
Group A streptococcus (pyogenes)
Penicillin V (phenoxymethylpenicillin)
Streptococcus pneumoniae
Also:
H. influenza
Morazella catarrhalis
Staphylococcus aureus
Causes of viral tonsilitis
Adenovirus
EBV
Group A strep (strep. Pyogenes)
Risk factors for tonsilitis
Smoking
Second hand smoke
Waldeyer’s tonsillar ring
Ring of lymphoid tissue in pharynx Adenoids Tubular Lingual Palatine Infected and enlarged in tonsilitis
Tonsilitis history
Symptoms last 5-7 days, if linger could be glandular fever Odynophagia Fever Reduced oral intake Halitosis New onset snoring Shortness of breath
Tonsilitis examination
Red inflamed tonsils
White exudate spots on tonsils
Cervical lymphadenopathy
Examine eats to visualise tympanic membranes
Centor criteria
Estimate probability that tonsilitis is due to bacterial infection
>3 Fever >38 Tonsillar exudates Absence of cough Tender anterior cervical lymph nodes (lymphadenopathy)
FeverPAIN criteria
Probability of bacterial tonsilitis
>4 Fever: during previous 24hours Purulence (pus on tonsils) Attended within 3 days of the onset of symptoms Inflamed tonsils (severely inflamed) No cough or Coryza
Streptococcal score card
Specific to Group A streptococci
Tonsilitis
5-15years Season Fever Cervical lymphadenopathy Pharyngeal erythema, oedema or exudate No viral URTI symptoms
DD tonsilitis
Quinsy or peritonsillar abscess Pharyngitis Glandular fever Tonsillar malignancy Epiglottitis
Investigations tonsilitis
Throat swabs limited value
FBC
LFT, glandular fever
U&E: dehydration/AKI
Initial management of tonsilitis
Check for respiratory compromise Rehydrate Analgesia Steroids Antibiotics: benzylpenicillin IV, oral penicillin V if able to swallow 7-10days
Complications of tonsilitis
Chronic tonsilitis Peritonsillar abscess, quinsy Otitis media Scarlet fever Rheumatic fever Post-streptococcal glomerulonephritis Post-streptococcal reactive arthritis
Post-streptococcal glomerulonephritis
Hypertension
Haematuria
Oedema
Rheumatic fever post-streptococcal
Prolonged fever
Anaemia
Arthritis
Pancarditis
Peritonsillar abscess
Quinsy
Collection of pus in peritonsillar space that surrounds palatine tonsils
Deep neck space abscess
Complications of tonsilitis
Pathophysiology peritonsillar abscess
Tonsil between anterior tonsillar pillar (glossopalatine muscle) and posterior tonsillar pillar (pharyngopalatine muscles)
Pus collects in space between tonsillar capsule and superior pharyngeal muscles
Causative organisms peritonsillar abscess
30-39years: Group A Streptococcus (Strep pyogenes)
15-24years: fusobacterium necrophorum
Risk factors peritonsillar abscess
Recurrent tonsilitis
Partially treated tonsilitis
Smokers
Peritonsillar abscess presentation
Sore throat Painful swallowing/ drooling Trismus: muscle spasms preventing jaw opening to full extent Hot potato voice: pharyngeal swelling Halitosis Fever Neck pain Referred ear pain Swollen tender lymph nodes Fatigue and irritability: dehydration
Peritonsillar abscess examination
Unilateral tonsillar inflammation
Deviation of uvula away from affected side
Restricted opening of jaw
Fullness/ fluctuant swelling superior to the tonsil/ in posterior soft palpate pushing the tonsil infero-medially
Peritonsillar abscess examination
Unilateral tonsillar inflammation
Deviation of uvula away from affected side
Restricted opening of jaw
Fullness/fluctuant swelling superior to tonsil/ in posterior soft palate pushing the tonsil inferomedially
DD peritonsillar abscess
Tonsilitis
Peritonsillar cellulitis
Parapharyngeal/ retropharyngeal abscess
Epiglottitis
Investigations for peritonsillar abscess
FBC, elevated neutrophil
U&E
CRP
Glandular fever
CT to see if infection is spread into parapharyngeal or retropharyngeal space
Management peritonsillar abscess
Aspiration or incision and drainage Antibiotics: co-amoxicillin or benzylpenicillin and metronidazole. IV rehydration Steroid therapy: dexamethasone Needle aspiration
Tonsillectomy indications
7 or more in 1 year
5 per year for 2 years
3 per year for 3 years
Recurrent tonsillar abscesses (2 episodes)
Enlarged tonsils causing difficult breathing, swallowing or snoring
Complications of tonsillectomy
Pain, sore throat Damage to teeth Infection Post-tonsillectomy bleeding Risks of general anaesthetic
Post-tonsillectomy bleeding management
Call ENT registrar
IV access, send bloods including FBC, clotting screen, group and save, crossmatch
Keep child calm and give adequate analgesia
Sit child up and encourage to spit out blood rather than swallowing
IV fluids for maintenance and resuscitation as required
Hydrogen peroxide gargle
Adrenalin soaked swab applied topically
Otitis media
Middle ear infection
Bacteria enter through Eustachian tube
Viral URTI
Short,straight wide Eustachian tube in children
Bacteria in otitis media
Streptococcus pneumoniae most common
Also: Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus RSV Rhinovirus
Risk factors for acute otitis media
Age Gender Passive smoking Bottle feeding Craniofacial abnormalities
Recurrent AOM seen more commonly with use of pacifiers
Fed supine, first episode occurred <6months
More common in winter season
Clinical features of otitis media
Ear pain, reduced hearing
Pain, malaise, fever, coryzal symptoms lasting a few days
Feeling generally unwell
Tug at ears or cradle ear that hurts
Vestibular system: balance issues, vertigo, discharge when tympanic membrane perforated
Fever, vomiting, irritability, lethargy, poor feeding
Examination otitis media
Otoscope:
Tympanic membrane erythematous and bulging
Tear and discharge
Conductive hearing loss
Cervical lymphadenopathy
Test and document function of facial nerve
Intracranial complications
DD acute otitis media
Chronic suppurative otitis media
Otitis media with effusion
Otitis externa
Management of otitis media
Assessment and admission in infants <3 months or with a temperature of >38
Or 3-6 months with a temperature >39
Symptoms resolve in <3 days
Grommets
Indications for antibiotics in otitis media
Amoxicillin 5 days Systemically unwell children not requiring admission Known risk factors for complications Unwell for >4days Discharge with ear <2s with bilateral infections
Complications of otitis media
Otitis media with effusion Mastoiditis Perforated eardrum Hearing loss Recurrent infection Abscess
Mastoiditis from otitis media
Boggy, erythematous swelling behind ear Pushes pinna forward IV AX CT head if no improvement High risk of intracranial spread and meningitis
Otitis media with effusion
Eustachian tube dysfunction
Build up of fluid in middle ear
Loss of hearing
Risk factors glue ear
Bottle fed Paternal smoking Atopy Genetic disorders: mucociliary disorders(CF, primary ciliary dyskinesia) Craniofacial disorders (Downs syndrome)
Glue ear presentation
Reduction of hearing in that ear
Sensation of pressure, popping or crackling noises
Vertigo
Otoscopy: Dull tympanic membrane No light reflex Bubble seen behind TM Visible fluid level
Investigations glue ear
Pure tone audiometry
Tympanometry
Conductive hearing loss and reduced membrane compliance
Management of glue ear
Resolve within 3 months
No resolution after 3 months:
Non-surgical: hearing aid insertion
Surgical: myringotomy and grommet insertion
Persistent disease:
Adenoidectomy
Peri-orbital cellulitis epidemiology
0-15years
More common in males
Bi-modal seasonal variation late winter/early spring
Sinus related infections
Peri-orbital cellulitis pathophysiology
Pre-septal cellulitis
Post-septal cellulitis
Paranasal sinuses: ethmoidal sinuses most common cause, frontal sinuses, sphenoidal sinuses, maxillary sinuses
Why does peri-orbital cellulitis occur more in children
Neonates haven’t yet formed their frontal sinuses
Thinner and dehiscent bone surface of lamina papyracea
Increased diploic venous supply in comparison with adulthood
Incomplete immunologic development in age group
Mild periorbital cellulitis-> sight-threatening orbital abscess
Causes of peri-orbital cellulitis
Sinuses infection spread Dacrocystitis Dental infecton Endophthalmitis Trauma Foreign bodies Insect bites Skin infections (impetigo) Eyelid lesions (chalazia, hordeola) Eyelid and oral procedures
Haemophilus influenza TYB
Clinical features of pre-septal cellulitis
Eyelid oedema Erythema of upper eyelid Abscence of orbital signs Normal vision Absence of proptosis Full ocular motility without pain on movement
Impedance to drainage through ethmoid vessels:
Erythema may spread to upper cheek and brow area
Hx of acute sinusitis or URTI
Hyperaemia of nasal mucosa
Occasional purulent discharge from ipsilateral osteomeatal complex and sphenoethmoidal recess
Clinical features of orbital cellulitis
Proptosis Opthalmoplegia Decreased visual acuity Loss of red colour vision- first sign of optic neuropathy Chemosis Painful diplopia
Chandler classification
TY1: pre-septal cellulitis TY2: post septal, orbital cellulitis TY3: sub periosteal abscess TY4: intra-orbital abscess TY5: cavernous sinus thrombosis
TY1: pre-septal cellulitis
Cellulitis confined to eyelid
Anterior to superior orbital septum: inflammation does not spread beyond orbital septum
TY2: post-septal, orbital cellulitis
Inflammation extends into orbital tissue
No abscess formation
Cellulitis involving the orbit-a disuse infiltration of orbital tissues with inflammatory cells
Eyelids may be swollen and there may be conjunctival chemosis with variable degree of proptosis and visual loss
TY3: subperiosteal abscess
Abscess forms deep to periosteum of the orbit
Purulent material collects periorbitally and in the bony walls of the orbit
Pronounced eyelid oedema, conjunctival chemosis, and tenderness along the affected orbital rim with variable degree of motility, proptosis and visual acuity changes
TY4: intra-orbital abscess
Collection of pus inside or outside muscle cone
Progressive and untreated orbital cellulitis
Proptosis, conjunctival chemosis, decreased ocular motility, and visual loss may be severe
TY4: cavernous sinus thrombosis
Bilateral marked eye oedema
Involvement of CN3, 5, 6
Associated generalised sepsis, nausea, vomiting and signs of altered mentation
Orbital apex syndrome: proptosis, eyelid oedema, optic neuritis, opthalmoplegia, neuralgia of opthalmic division of CN5
Caused by sinus disease aroun optic foramen and superior orbital fissure
Examination peri-orbital cellulitis
Investigations
Vitals
Dentition
Anterior rhinoscopy: appearance of the nasal mucosa in general and middle meatus area
Discharge should be swapped and sent for culture
Opthalmic assessment
Neurological examination
Inflammatory markers to check response to treatment
CT: extension of disease into orbit
DD peri-orbital cellulitis
Vesicles of herpes zoster opthalmicus Erythematous irritation of contact dermatitis Hordeolum or stye Chalazion Dacrocystitis Blepharitis Raised, dry plaques of atopic dermatitis
Management of pre-septal cellulitis
Outpatient
Broad spectrum oral ax
Management of orbital cellulitis
Hospital admission IV ax Nasal decongestants Steroid nasal drops Nasal douching IV fluids Analgesia Optic nerve monitoring
Intracranial complications: urgent drainage
Optic complication of peri-orbital cellulitis
Loss of vision: from papilloedema or neuritis, mechanical pressure, compression of arteries, necrosis of optic nerve
Asymmetrical eyelid opening
Impaired ocular motility
Eyelid inflammation
Neurological complications of peri-orbital cellulitis
Encephalomeningitis
Cavernous sinus thrombosis
Sepsis
Intracranial abscess formation: fever, altered mental status
Staphylococcal toxic shock syndrome
Severe systemic reaction to staphylococcal exotoxins
TSST-1 superantigen txin
Staphylococcal toxic shock syndrome
Centres for disease control and prevention diagnosirtc criteria
Fever: temperature >38.9 Hypotension: systolic blood pressure <90 Diffuse erythematous rash Desquamation of rash, especially of the palms and soles Involvement of >3 organ systems
Presentation of staphylocccal toxic shock syndrome
GI: D/V Mucous membrane erythema Renal failure Hepatitis Thrombocytopenia CNS involvement
Management of staphylococcal toxic shock syndrome
Removal of infection focus, tampon
IV fluids
IV ax
Candidiasis
Balanitis
Oral thrush
Vaginal discharge: cottage cheese discharge, vulvitis, itch
Onychomycosis
Black hairy tongue
Candida dermatitis (napkin rash), satellite lesions, involves flexure
Features of bacterial conjunctivitis
Purulent discharge
Eyes stuck together in morning
Features of viral conjunctivitis
Serous discharge
Recent URTI
Preauricular lymph nodes
Management of infective conjunctivitis
Self-limiting in 1-2sweeks
Topical Ax therapy, chloramphenicol drops
Topical fusidic acid for pregnant women
Kawasaki disease
Mucocutaneous lymph node syndrome Medium sized vasculitis <5s affected More common in boys and Asian children Complication: coronary artery aneurysm
Features of Kawasaki disease
High-grade fever >5 days Conjunctival injection Bright red, cracked lips Strawberry tongue Cervical lymphadenopathy Red palms of hand and soles of feet, desquamation Fever resistant to antipyretic Widespread erythematous maculopapular rash
Investigations Kawasaki disease
FBC: anaemia, leukocytosis, thrombocytosis
LFT: hypoalbuminaemia, elevated liver enzymes
Inflammatory markers raised
Urinalysis: raised WCC without infection
ECHO: coronary artery pathology
Disease course Kawasaki disease
Acute phase: fever, rash, lymphadenopathy 1-2weeks
Subacute phrase: desquamation and arthralgia, risk of coronary artery aneurysms forming, 2-4weeks
Convalescent stage: settle, 2-4weeks
Management of Kawasaki disease
High dose aspirin to reduce thrombosis risk
IVIG to reduce risk of coronary artery aneurysm
Follow up with ECHO
Congenital rubella syndrome
8-10 weeks risk of damage to fetus is high
Caused by togavirus
If contracted during pregnancy
Incubation 14-21days
Features of congenital rubella syndrome
Sensorineural deafness Congenital cataracts Congenital heart disease Growth retardation Hepatosplenomegaly Purpurin skin lesions Salt and pepper chorioretinitis Micropthalmia Cerebral palsy
Diagnosis of congenital rubella syndrome
Health protection unit
IgM antibodies raised n women recently exposed to virus
Management of congenital rubella syndrome
Discuss with local health protection unit
Offer non-immune mom MMR vaccine post-natally
Rubella features
Milder erythematous macular rash
Starts on face and spreads to body
Rash lasts 3 days
Associated with mild fever, joint pain, sore throat
Lymphadenopathy behind ear and at back of neck
Management of rubella
Supportive
Notifiable disease
Stay off school 5 days after rash first appearance
Children should avoid pregnant women
Complications of rubella
Thrombocytopenia Encephalitis Arthritis Myocarditis Congenital rubella syndrome: deafness, blindness, congenital heart disease
Measles
RNA paramyxovirus
Spread by droplets
Infective from prodromal until 4 days after rash starts
Incubation 10-14datys
Features of measles
Prodrome: irritable, conjunctivitis, fever
Koplik spots
Rash behind ears then to whole body, discrete maculopapular rash becoming blotchy and confluent
Diarrhoea in 10% of patients
Investigations for measles
IGM antibodies few days after rash appears
Management of measles
Mainly supportive, self resolves after 7-10 days of symptoms
Admission may be considered in immunosuppressed or pregnant patients
Notifiable disease-> inform public health
Complications of measles
Pneumonia Otitis media Encephalitis Subacute sclerosing pan encephalitis, may present 5-10years following illness Febrile convulsions Keratoconjunctivitis, corneal ulceration Diarrhoea Increased incidence of appendicitis Myocarditis Dehydration Meningitis Vision loss Death
