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Paediatrics > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What is Kawasaki disease and who does it affect?

A

Systemic vasculitic disease which affects children aged 6mo - 4y, peaking at 1yo. Particularly Japanese and black/AC ethnicity
unknown aetiology, may have inflammation of BCG scar

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2
Q

How would a child with Kawasaki present?

A

remember CRASH + Burn:

  • Conjunctivitis
  • Rash (polymorphous, beginning on hands and feet)
  • Adenopathy (cervical, usually unilateral)
  • Strawberry tongue
  • Hands and feet are red, swollen and peel/desquamate
  • Burn - fever OVER 5 days and unresponsive to anti-pyretics
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3
Q

How would you manage (Ix+Mx) a child with potential Kawasaki disease? What is a complication of Kawasaki’s?

A

Ix:

  • clinical diagnosis (no test)
  • bloods (FBC, CRP, ESR)
  • ECHO! (due to increased risk of coronary artery aneurysms)

Mx:

  • Admission
  • High dose aspirin to reduce thrombosis risk + IVIG (within 10 days)
  • other agents include CS, infliximab/ciclosporin and plasmapheresis for persistent inflammation and fever

note: children with coronary artery aneurysms may require long-term warfarin and close follow up

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4
Q

What causes a mumps infection? What is the incubation and infective period?

A

Mumps paramyxovirus [viral]

  • transmitted via respiratory secretions
  • long incubation period (15-24 days)
  • infective 5 days before and 5 days after parotid swelling (should pass totally after 1-2 weeks)
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5
Q

How may a child with mumps present?

A

Sx:

  • 30% cases asymptomatic
  • headache, fever
  • PAROTID swelling!!
  • other complications include pancreatitis, neuritis, pericarditis etc
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6
Q

How would you investigate and manage a child with mumps? What are some complications to be wary of?

A

Ix:

  • Oral fluid IgM sample
  • Bloods - inc amylase levels which will be raised

Mx:

  • notify HPU and isolate for 5 days from time of parotid swelling
  • supportive Tx (fluids, analgesia, rest) and advice to parents
  • safety net for complications - deafness (usually transient, unilateral), viral meningitis/encephalitis (rare) and orchitis (infertility - rare)
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7
Q

How is measles transmitted + its incubation? When is the infective period?

A

Paramyxovirus, spread through respiratory droplets

  • one of the most communicable diseases (>15 mins is enough contact)
  • incubation = 7-18 days, infective period = 4 days before and 4 days after rash
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8
Q

How may a child with measles present?

A

Sx:

  • prodromal symptoms = high fever, coryza/conjunctivitis, irritability, febrile seizures
  • maculopapular rash (from face/neck to hands and feet)
  • Koplik spots (white spots in mouth)
  • cough
  • NO LYMPHADENOPATHY
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9
Q

How would you Ix + Mx a patient with measles? What are complications to be wary of?

A

Ix:

  • ELISA IgM and IgG bloods
  • Oral fluid test of measles IgM and IgG
  • PCR of blood or saliva (2nd line)

Mx:

  • Notify HPU and isolate for 4 days following rash development
  • Rest and supportive treatment, good fluid intake
  • Immunise close contacts and encourage vaccination after acute episode
  • Vitamin A orally
  • Safety net complications:
  • -> Seek help if getting worse, DiB
  • -> Otitis media (most common)
  • -> Pneumonia (most common cause of death)
  • -> Encephalitis (headaches, lethargy, irritability–>seizures), –>SSPE (7y later - measles dormant in CNS causing dementia and death)
  • -> Keratoconjunctivitis
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10
Q

What is rubella infection caused by? What is the infective period?

A

Rubella, AKA German measles, is caused by a togavirus infection via respiratory droplets (coughing and sneezing) - similar to measles

  • incubation = 6-21 days
  • infective 1 week before to 5 days after rash onset
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11
Q

How may a child present with rubella?

A

Sx:

  • Prodrome = mild fever/asymptomatic
  • PINK maculopapular rash (face –> whole body) and fades in 3-5 days
  • 20% get Forchheimer spots (red spots on soft palate)
  • lymphadenopathy (suboccipital, postauricular)
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12
Q

How would you investigate and manage a child with rubella? What is a complication of rubella?

A

Ix:

  • Oral fluid test for rubella serology (IgM and IgG)
  • (2nd line) reverse transcriptase PCR
  • FBC

Mx:

  • Notify HPU and isolate for 4/5 days after rash onset
  • supportive tx
  • safety net (haemorrhage complications due to thrombocytopenia)
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13
Q

What is slapped cheek/fifth disease and which cells do they infect? How is it transmitted and how long are pt’s infective?

A

Parvovirus B19 infection - respiratory droplet transmission + vertical transmission

  • infects RBC precursors in the bone marrow
  • infective 10 days before to 1 day after rash onset
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14
Q

How may a child with PB19 present? What about i) in utero ii) in SCD and immunodeficient children?

A

Sx:
1st - asymptomatic OR coryzal illness for 2-3 days

then latent for 7-10 days

2nd - erythema infectiosum which starts with red slapped cheek rash on face (+fever, malaise, headache, myalgia)
—> progresses 1w later to maculopapular ‘LACE’-like rash on trunk and limbs

  • Can cause aplastic crises in children with SCD or immunodeficiency
  • fetal disease via maternal transmission can cause fetal hydrops, death due to severe anaemia
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15
Q

How would you manage (Ix+Mx) a child with PB19?

A

Ix:

  • Clinical Dx
  • Oral fluid test for B19 serology (IgG, IgM)
  • RT-PCR (2nd line)

Mx:

  • Supportive Tx (will clear in ~3 weeks)
  • no need to stay off school as after rash onset they are not really infectious
  • safety net (anaemia, lethargy, pregnancy)
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16
Q

What is chicken pox caused by and what is its infective period? How is it transmitted?

A

Varizella Zoster virus (VZV/HHV-3) - reactivation of dormant infection can lead to herpes zoster (Shingles)

  • direct contact/inhalation/respiratory transmission
  • incubation - 10-21 days
  • infective - 48h before rash to until the last lesion is crusted over (~5-7 days post-onset of rash)
17
Q

How would a child with VZV present?

A

Sx:

  • fever, headache, abdominal pain and malaise
  • crops of ITCHY vesicles appear over 3-5 days (head, neck and trunk&raquo_space;»> than limbs)
  • papule –> vesicle –> crust
18
Q

How would you manage (Ix+Mx) a child with VZV? What are some complications/reasons for admission?

A

Ix:
- Clinical Dx

Mx:

  • Supportive (fluids, rest, analgesia but NO ibuprofen –> can cause nec.fasc. and complications)
  • Advice (infective until last lesion crusted, trim nails, keep cool, calamine lotion)
  • Isolate from school and also immunocompromised, pregnant women and neonates (<28d old)

Special cases:

  • Admission if serious complications such as:
  • -> Bacterial superinfection (sudden HIGH fever –> toxic shock, necrotising fasciitis)
  • -> Encephalitis (ataxic with cerebellar signs)
  • -> Purpura fulminans (large necrosis of skin due to cross-activation of antiviral abs)
  • -> Severe dehydration

Medical:

  • -> Immunocompetent adolescents/adults - oral acyclovir 800mg 5/day for 7 days if within 24h of rash onset
  • -> Immunocompromised children (IV > oral acyclovir); prophylaxis IVIg also available
19
Q

What is hand, foot and mouth disease and how may it present? Who is often affected?

A

Most commonly due to Cocksackie A16 virus (severe may be enterovirus 71 and atypical may be Cocksackie A6)
Common in children <10, very contagious

Sx:

  • Mild systemic features (fever, sore throat, spots in mouth that develop –> ulcers)
  • Painful, itchy, vesicular lesions on hands, feet, mouth and buttocks
20
Q

How would you manage a child with hand, foot and mouth disease?

A

Clinical Dx

Mx:

  • Supportive (rest, fluids, analgesia)
  • Advice - will clear in 7-10 days (HPA don’t say you NEED to be kept from school but recommended to stay away until feel better)
  • Safety net: dehydration, if it doesn’t clear within 2 weeks, pregnancy
21
Q

What is Roseola Infantum?

A

AKA Sixth disease; caused by HHV6

  • most children infected by age 2 (6mo-2y) - younger than other infections
  • highly infectious + infective during whole period of disease
22
Q

How would a child with roseola infantum present?

A

Sx:

  • HIGH fever (>40) and malaise (3-4d) –> generalised macular rash of small pink spots which are non-itchy and blanching (neck/body –> arms) - appears as fever wanes
  • many have fever + no rash and so can often be confused with measles/rubella
  • febrile convulsions in 10-15%
  • coryza symptoms, sore throat, lymphadenopathy, D&V
  • Nagayama spots (on uvula and soft palate)
23
Q

How would you manage (Ix+Mx) a child with roseola?

A

Ix:
- HHV6/7 serology (IgG,IgM). and also for measles/rubella

Mx:

  • supportive (will clear in 1w)
  • no need to stay off school
  • safety net - high fever can lead to febrile convulsions,
24
Q

What happens in children born to a HIV+ mother?

A

<18mo - PCR of virus measured at birth, discharge, 6w, 12w and 18mo (still have maternal transplacental anti-HIV IgG)
>18mo - antibody detection (ELISA)

Management:

  • Cord clamped ASAP and baby bathed immediately after birth
  • Zidovudine mono therapy for 2-4w (low/medium risk) or PEP combination (2 NRTIs + INI - high risk)
  • Mothers NOT to breastfeed
  • All immunisations given including BCG [unless moderate/high risk of transmission]
  • Infant testing for HIV at 6 and 12 weeks (at least 2 and 8 weeks after stopping prophylaxis)
25
Q

How would congenital rubella syndrome present?

A 
Eyes - congenital cataracts, other eye issues
Ears - sensorineural deafness
Brain - CNS defects
Cardiac - PDA, heart defects
Jaundice, hepatosplenomegaly etc

Timing of infection affects outcome i.e. T1 = high risk CRS (90%, 20% miscarry); T3 = low risk

26
Q

When and how would T-cell immunodeficiency present? What are some causes?

A 
Di George
Wiskott-Aldrich syndrome
Duncan disease
SCID
HIV
Ataxia telangiectesia

Presents <1yo with severe viral or fungal infections

27
Q

When and how would B-cell immunodeficiency present? What are some causes?

A

Brutons (XLHG)
HyperIgM syndrome
Common variable ID
Selective IgA def

Presents >6m but <2yo with severe bacterial infections

28
Q

How would neutrophil immunodeficiency present? What are some causes?

A

CGD

Presents with recurrent bacterial infections or invasive fungal infections

29
Q

How would NK immunodeficiency present? What are some causes?

A

Recurrent viral infections

  • Classical NK deficiency
  • Function NK deficiency
30
Q

How would leukocyte function defect immunodeficiency present? What are some causes?

A

LAD

Sx = delayed separation of umbilical cord and chronic skin ulcers

31
Q

How would complement immunodeficiency present? What are some causes?

A

Recurrent bacterial infections, especially encapsulate bacteria (NHS)

  • Early complement deficiency (C1,2+4)
  • Late complement deficiency (C5-9)

Paediatrics (14 decks)

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