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Yr4: Child Health > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

There are 4 different types/mechanisms of action vaccines; state and describe each

A
  • Inactivated: a killed version of the pathogen
  • Subunit and conjugate: contain part of the organism needed to stimulate an immune response
  • Toxin: contain a toxin that is usually produced by pathogen; cause immunity to the toxin and not the pathogen itself
  • Live attenuated: contained weakened version of the pathogen
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2
Q

State some examples of each of the following types of vaccine:

  • Inactivated
  • Subunit & conjugate
  • Toxin
  • Live attenuated
A
  • Inactivated: polio, influenza injection, hepatitis A, rabies
  • Subunit & conjugate: pneumococcus, meningococcus, HPV, shingles, HiB, pertussis
  • Toxin: tetanus, diaphtheria
  • Live attenuated: MMR, BCG, chicken pox, nasal influenza, rotavirus
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3
Q

Which types of vaccines are capable of causing infection, particularly in immunocompromised?

A
  • MMR
  • BCG
  • Chickenpox
  • Nasal influenza (not the injection)
  • Rotavirus
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4
Q

At what ages are children in UK offered vaccinations?

A
  • 8 weeks
  • 12 weeks
  • 16 weeks
  • 1yr
  • 3yrs 4months
  • 12-13yrs
  • 14yrs
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5
Q

What vaccines are given at ages:

  • 8 weeks
  • 12 weeks
  • 16 weeks
A

8 weeks

  • 6 in 1
  • Meningococcal type B
  • Rotavirus (oral)

12 weeks

  • 6 in 1
  • Pneumoccocal
  • Rotavirus

16 weeks

  • 6 in 1
  • Meningococcal type B
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6
Q

What’s included in the 6 in 1 vaccine?

A
  • Diphtheria
  • Tetanus
  • Pertussis
  • Polio
  • Haemophilus influenza type B
  • Hepatitis B
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7
Q

What vaccines are given at ages:

  • 1yr
  • Yearly from 2-8yrs
  • 3yrs and 4 months
A

1yr

  • 2 in 1 (haemophilus influenza type B, meningococcal type C)
  • Pneumococcal
  • MMR
  • Meningococcal type B

Yearly 2-8yrs

  • Influenza nasal vaccine

3yrs and 4 months

  • 4 in 1 (diphtheria, polio, tetanus, pertussis)
  • MMR
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8
Q

What vaccines are given at:

  • 12-13yrs
  • 14yrs
A

12-13yrs

  • HPV

14yrs

  • 3 in 1 (tetanus, diphtheria, polio)
  • Meningococcal A, C, W & Y
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9
Q

For the HPV vaccine discuss:

  • When it should be given
  • What the current NHS vaccine is and what strains it protects against
A
  • Before they become sexually active to prevent them contracting and spreading HPV
  • Gardasil which protects against strains 6, 11, 16 & 18
    • 6 and 11 cause genital warts
    • 16 & 18 cause cervical cancer
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10
Q

Is the TB vaccine given to all babies?

A

No, offered from birth to babies who are at higher risk e.g. have relatives from countries with high TB prevalence, live in urban areas with high rates of TB, arriving from areas of high TB prevalence or in close contact with people that have TB

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11
Q

Define sepsis

Define septic shock

A

Sepsis= life threatening organ dysfunction due to dysregulated host response to infection which has resulted in widespread inflammation

Septic shock= sepsis leading to cardiovascular dysfunction

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12
Q

The older the child, the less specific and obvious symptoms of sepsis can be; true or false?

A

FALSE

The younger the child the less specific and obvious symptoms of sepsis can be hence must have a low threshold for suspected sepsis.

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13
Q

The older the child, the less specific and obvious symptoms of sepsis can be; true or false?

A

FALSE

The younger the child the less specific and obvious symptoms of sepsis can be hence must have a low threshold for suspected sepsis.

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14
Q

Discuss the pathophysiology of sepsis

A
  • Infection causes macrophages, lymphocytes and mast cells to release lots of cytokines (e.g. interleukins, TNF) to alert immune system to pathogen
  • Cytokines activate other parts of immune system
  • Activation of other parts of immune system causes release of more chemicals e.g. Nitrous oxide
  • Immune response causes inflammation throughout the body
  • Nitrous oxide causes vasodilation
  • Many of the cytokines increases the permeability of endothelium of blood vessels causing fluid to leak out into extravascular space; this leads to oedema and decreased intravascular volume
  • Decreased intravascular volume decreases amount of oxygen delivered to tissues and the oedema also increases the diffusion distance further decreasing the amount of oxygen reaching tissues
  • Blood lactate raises due to anaerobic respiration of hypoperfused tissues
  • The coagulation system is also activated which results in fibrin being deposited throughout circulation and platelets and clotting factors being used p to form blood clots. This not only further compromises oxygen delivery to tissues but also leads to thrombocytopenia hence body is unable to form clots leading to haemorrhages- this is DIC.
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15
Q

State some signs and symptoms of sepsis in children

A

Remember, younger they are the less specific and obvious the symptoms are:

  • Generally look unwell
  • Fever or hypothermia
  • Poor feeding
  • Deranged behaviour
  • Inconsolable or high pitched crying
  • Weak cry
  • Reduced consciousness
  • Floppy/reduced body tone
  • Skin colour changes (cyanosis, mottled, pale, ashen)
  • Prolonged CRT
  • Deranged physical observations

Shock will have circulatory collapse and hypoperfusion of organs (tachycardia, decreased BP, cool peripheries, low BP)

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16
Q

Infants under what age with what temperature or above must be urgently treated for sepsis until proven otherwise?

A

Infants under 3 months with a temperature of 38 degrees or above need to be treated urgently for sepsis until proven otherwise

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17
Q

Since signs of sepsis may not be obvious or specific in children, NICE have a traffic light system to help you assess the risk of serious illness in children under 5yrs. Describe this traffic light system

A

Categorise pts based on:

  • Colour: normal, cyanotic, ashen, mottled, pale
  • Activity: active, happy, responsive, abnormal responses, drowsy, inconsolable cry
  • Respiratory: normal, respiratory distress, tachypnoea, grunting etc…
  • Circulation hydration: normal skin, moist mucous membranes, tachycardia, dry membranes, poor skin turgor
  • Other signs: e.g. fever >5 days, non-blanching rash, seizures, high temp <6 months old
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18
Q

If, after using NICE’s traffic light system, a child is deemed low risk what would be your management?

A

Can be managed at home but parents must be given clear verbal & written safety information about what to look out for and when and how to seek further medical attention

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19
Q

Discuss the immediate management of sepsis

A

“Give 3, take 3” “BUFALO” & ALWAYS ESCALTE EARLY

  • Oxygen if sats <94% or evidence of shock
  • IV access, bloods (FBC, U&Es, CRP, clotting screen, blood cultures) & blood gas (lactate, acidosis)
  • Urine dipstick (and sample for M,C&S) & monitor urine output
  • Antibiotics (as per local guidelines within 1hr)
  • IV fluids (if in shock or lactate >2mmol/L 20ml/kg bolus of NaCl)- may be repeated
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20
Q

Discuss the management of septic shock

A
  • ALWAYS ESALATE EARLY IN SUSPECTED SEPSIS!
  • IV fluids
  • If IV fluids fail, escalate to HDU or ICU where can be given inotropes (stimulate CVS and improve BP and perfusion)
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21
Q

What antibiotics are given at UHL for sepsis in children/infants:

  • < 1 month
  • 1 - 3 months
  • > 3 months
A
  • < 1 month: gentamicin, amoxicillin, cefotaxime
  • 1 - 3 months: amoxicillin, ceftriaxone
  • > 3 months: ceftriaxone

*NOTE: in paediatric haematology/oncology use piperacillin-tazobactam & teicoplanin

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22
Q

Discuss the further management of sepsis following immediate management

A
  • Continue antibiotic for 5-7 days if bacterial infection suspected or confirmed; alter antibiotic once organism and sensitivities known
  • Additional investigations to find source of infection (e.g. CXR, abdo & pelvic US, lumbar puncture, meningococcal PCR blood test, serum cortisol)

*Could consider stopping abx when low suspicion of bacterial infection, pt is well, blood cultures and two CRP results are negative at 48hrs

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23
Q

What is meningitis?

State some common causative organisms in:

  • Neonates
  • Children 3months and older
A

Meningitis is inflammation of the meninges (arachnoid and pia mater) usually due to bacterial or viral infection.

  • Neonates: group B Streptococcus, Listeria monocytogenes, Escherichia coli
  • Children 3 months & older: Neisseria meningitidis, Streptococcus pneumonia, Haemophilus influenza type B

Children between 1month and 3 month may have any of the above organisms.

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24
Q

Explain the difference between meningococcal meningitis and meningococcal septicaemia

A
  • Meningococcal meningitis: Neisseria meningitidis infecting the meninges and CSF
  • Meningococcal septicaemia: Neisseria meningitidis infection in the blood stream. Causes the _non-blanching rash._ Non-blanching rash indicates DIC and subcutaneous haemorrhages

****Neisseria meningitidis commonly known as meningococcus

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25
Q

State some common causes of viral meningitis

A
  • Herpes simplex virus
  • Enterovirus
  • Varicella zoster virus (VZV)
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26
Q

In neonates, the most common cause of meningitis is Group B Streptococcus; where does this infection come from?

A

GBS usually contracted during birth from GBS that harmlessly live in mother’s vagina

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27
Q

Discuss the presentation of meningitis (think about any differences for neonates and children)

A

Neonates & babies can present with non-specific signs:

  • Poor feeding
  • Lethargy
  • Hypothermia
  • Fever
  • Hypotonia/floppy
  • Bulging fontanelle

May present with more specific signs & symptoms:

  • Fever
  • Neck stiffness
  • Headache
  • Vomiting
  • Photophobia
  • Altered consciousness
  • Seizures
  • If meningococcal septicaemia may have non-blanching rash
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28
Q

State, and describe, two special tests you can perform to look for meningitis

A
  • Kernig’s test: lie pt flat on back, flex one hip and knee to 90 degrees then slowly straighten/extend knee whilst keeping hip flexed at 90 degrees. If produces pain or there is resistance to movement this indicates meningitis (as this position slightly stretches the meninges)
  • Brudzinski’s test: lie pt flat on back and gently life their head & neck off the bed and flex their chin to their chest. If this causes the pt to involuntarily flex their hip and knees it’s positive and indicates meningitis
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29
Q

NICE recommend lumbar puncture as part of investigations for all children in what 3 scenarios?

A
  • <1 month presenting with fever
  • 1-3 months with fever and are unwell
  • <1yr with unexplained fever and other features of serious illness
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30
Q

What investigations would you do if you suspect meningitis?

A
  • Blood glucose
  • Capillary blood gas
  • Bloods (FBC, U&Es, LFTs, CRP, coagulation screen, blood culture, meningococcal PCR if suspect meningococcal disease)
  • Lumbar puncture
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31
Q

State some contraindications for lumbar puncture

A
  • Signs suggesting raised intracranial pressure
    • Reduced or fluctuating consciousness
    • Relative bradycardia & hypertension
    • Unequal, dilated or unresponsive pupils
    • Papilloedema
    • Dolls eye movements
    • Focal neurological signs
    • Abnormal posture
  • Shock
  • Coagulation abnormalities
  • Local superficial infection at lumbar puncture site
  • After convulsions until stabilised
  • Extensive or spreading purpura
  • Respiratory insufficiency (lumbar puncture is considered to have a high risk of precipitating respiratory failure in the presence of respiratory insufficiency)
  • Concerns about meningococcal septicaemia
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32
Q

What is the advantage of sending a meningococcal PCR as opposed to blood culture?

A
  • Can give results quicker than blood culture (depending on local services)
  • Will still be positive after bacteria treated with abx
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33
Q

Remind yourself how a lumbar puncture is done and what analysis the CSF is sent for

A
  • Insert needle into L3-L4/L4-L5 intervertebral space
  • Go through skin, supraspinatus ligament, intraspinous ligament, ligamentum flavum, epidural space, dura, arachnoid
  • Send sample for bacterial culture, viral PCR, WCC, protein & glucose
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34
Q

Compare normal, bacterial, viral and TB CSF in terms of:

  • Appearance/colour
  • Opening pressure
  • WCC
  • Protein
  • Glucose
  • Culture
A

Rather than rote learning, think about if the bacteria or virus was living there

  • *Bacteria release proteins and use up glucose*
  • *Viruses release small amount of protein but not as much as bacteria and don’t use glucose*
  • *Immune system release neutrophils in response to bacteria and lymphocytes in response to viruses*
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35
Q

Discuss the management of suspected meningitis in primary care (think about additional measures if have meningococcal septicaemia)

A
  • If suspect meningitis and there is not a non-blanching rash, blue light to hospital
  • If have suspected meningitis with a non-blanching rash or suspect meningococcal septicaemia give urgent/stat injection of IM or IV benzylpenicillin prior to transfer to hospital (HOWEVER, giving abx should not delay transfter to hospital and if there is true penicillin allergy then transfer takes priority over finding other abx)
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36
Q

Discuss the management of bacterial meningitis in hospital

A

Early escalation as with sepsis.

  • IV antibiotics
    • <3 months: cefotaxime + amoxicillin (amoxicillin to cover Listeria) + gentamicin
    • 1-3 months: ceftriaxone + amoxcillin
    • >3 months: ceftriazone
    • Add vancomycin if risk of penicillin resistant pneumococcal infection (e.g. recent foreign travel or prolonged abx exposure)
  • Dexamethasone QDS for 4/7 if >3 months & lumbar puncture suggests bacterial meningitis
  • Supportive e.g. fluids, NG feeds
  • Notify public health
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37
Q

Discuss the management of viral meningitis

A

Idea that cannot distinguish between bacterial and viral clinically therefore would start bacterial management until have results. Once know it is viral:

  • Supportive e.g. fluids, NG feeds
  • Acyclovir in suspected or confirmed HSV or VZV infection
38
Q

State some potential complications of meningitis; split into acute and long term

A

Acute

  • Seizures
  • Sepsis
  • Intracerebral abscess
  • Raised ICP leading to brain herniation
  • Septic arthritis

Chronic

  • Sensorineural hearing loss
  • Cognitive impairment & learning disability
  • Cerebral palsy (with focal neurological deficits e.g. limb weakness)
  • Epilepsy
39
Q

Discuss post-exposure prophylaxis for meningitis

A
  • Highest risk for those who had prolonged contact within 7 days of onset of illness. Risk decreases 7 days after exposure therefore if no symptoms developed 7 days after exposure they are unlikely to get ill
  • Single dose of ciprofloxacin is given to those at risk ASAP (ideally within 24hrs of diagnosis)
40
Q

Encephalitis, inflammation of the brain parenchyma, can be due to infective or non-infective causes; state some examples of each

A

Infective

  • Viral is most common cause
    • HSV is most common viral cause ( type 1 in children, type 2 in neonates as contracted during birth)
    • Varicella zoster virus
    • Epstein-Barr virus (associated with infectious mononucleosis)
    • Cytomegalovirus (associated with immune deficiency)
    • Enterovirus
    • Adenovirus
    • Influenza virus
    • Others: polio, mumps, rubella, measles
  • Bacterial (rare in UK)
  • Fungal (rare in UK)

Non-infective

  • Autoimmune
41
Q

Describe the clinical features of encephalitis

A
  • Fever
  • Headache
  • Altered consciousness
  • Altered cognition
  • Acute onset of focal neurological symptoms e.g. aphasia
  • Acute onset of focal seizures
  • Unusual behaviour
42
Q

What investigations would you do if you suspect encephalitis?

A
  • Swabs e.g. throat, vesicle: help to establish causative organism
  • Lumbar puncture: send CSF for viral PCR
  • EEG: not routinely required
  • CT scan: if lumbar puncture contraindicated
  • MRI: after lumbar puncture to visualise brain in better detail
43
Q

Discuss the management of encephalitis

A
  • IV antivirals. Aciclovir is started empirically in suspected encephalitis until organism confirmed. Following treatments for specific viruses; other viruses have no effective treatment and management is supportive
    • Aciclovir: HSV & VZV
    • Ganciclovir: cytomegalovirus
  • Follow up, support & rehabilitation to help manage with complications

Repeat lumbar puncture usually done to confirm successful treatment prior to stopping abx.

44
Q

State some potential complications of encephalitis

A
  • Chronic fatigue
  • Change in personality
  • Change in mood
  • Memory loss
  • Cognitive impairment (concentration, planning, problem solving)
  • Epilepsy
  • Headaches
  • Learning disability
  • Movement disorders
  • Difficulty with swallowing and speech
45
Q

For mumps, discuss:

  • Causative organism
  • How it is spread
  • Incubation period
  • Duration of illness
A
  • Viral infection caused by Mumps virus (an RNA paramyxovirus)
  • Respiratory droplets
  • Incubation: 14-25 days
  • Usually self-limiting, lasts ~1 week

**NOTE: MMR vaccine provides 80% protection against mumps

46
Q

Discuss clinical features of mumps

A

Prodrome of flu-like symptoms:

  • Fever
  • Muscle aches
  • Lethargy
  • Reduced appetite
  • Headache
  • Dry mouth

Followed by parotid swelling (may be uni- or bilateral) with associated pain.

May also present with symptoms of complications:

  • Testicular pain & swelling (orchitis)
  • Abdominal pain (pancreatitis)
  • Neck stiffness, headache (meningitis)
  • Confusion, headache (encephalitis)
47
Q

How is mumps diagnosed?

What must you do once you have diagnosed mumps?

A
  • Saliva swab for PCR testing
  • Saliva swab or blood test for mumps antibodies

Must notify public health.

48
Q

Discuss the management of mumps

A

Usually self-limiting condition therefore management is supportive:

  • Encourage rests
  • Fluids
  • Analgesia
  • To apply warm or cold packs to the parotid gland as it may ease discomfort.
  • To stay off school or work for 5 days after the initial development of parotitis.

Complications are also managed with supportive treatment.

49
Q

State some complications of mumps

A
  • Orchitis (uncommon in pre-pubertal, occurs in 35-35% pubertal. Typically 1-5 days after parotitis)
  • Pancreatitis
  • Meningitis
  • Encephalitis
  • Sensorineural hearing loss (usually unilateral and transient)
50
Q

Why do we vaccinate against mumps if it is usually self-limiting?

A
  • Contagious
  • Potential serious complications
  • Potential serious complications in pregnant women
51
Q

What is infectious mononucleosis also known as?

What organism causes glandular fever and what cells does it infect?

How is it spread?

A
  • Glandular fever, kissing disease, mono
  • 90% caused Epstein Barr virus (EBV) (also known as HHV-4). Other causes include cytomegalovirus and HHV-6
  • Infects B cells in oropharynx hence spread via saliva of infected individuals therefore spread by kissing, sharing cups or toothbrushes or other things that transmit saliva
52
Q

When is a person with infectious mononucleosis infective?

A

Can be infectious few weeks before illness begins and intermittently for rest of pts life

53
Q

Children are often severely ill when infected with EBV but adolescents & adults have mild infections with few symptoms; true or false?

A

FALSE

Most people are infected with EBV as children, when it causes very few symptoms. When infection occurs in teenagers or young adults, it causes more severe symptoms.

54
Q

Discuss the typical presentation of infectious mononucleosis

A

Classic triad highlighted. Symptoms typically resolve after 2-4 weeks:

  • Fever
  • Sore throat
  • Fatigue
  • Lymphadenopathy
  • Tonsillar enlargement
  • Splenomegaly (rare cases splenic rupture)
  • Hepatitis (transient rise in ALT)
  • Haemolytic anaemia secondary to cold agglutin’s (IgM)

!!!! Development of an itchy maculopapular rash in response to amoxicillin or cephalosporins

55
Q

We can test for antibodies to determine whether someone has or has had infectious mononucleosis; discuss what antibodies we can test for

A
  • Heterophile antibodies (multipurpose antibodies not specific to EBV antigens. Tests are 100% specific but not everyone develops them and can take up to 6 weeks to develop so sensitivity is 70-80%). Two tests:
    • Monospot test: mix pts blood with RBCs from horses; heterophile antibodies will react to produce positive result
    • Paul-Bunnell test: mix pts blood with RBCs from sheep; heterophile antibodies will react
  • Specific antibody tests (target viral capsid antigen):
    • IgM antibody for early infection
    • IgG antibody suggests immunity
56
Q

When diagnostic test does NICE recommend for mumps?

A
57
Q

Discuss the course/progression of infectious mononucleosis

A

Usually self limiting lasting 2-4 weeks however fatigue can last for months

58
Q

Discuss the management of infectious mononucleosis

A

Management is supportive:

  • Rest
  • Drink plenty of fluids
  • Avoid alcohol (EBV impairs liver’s ability to process the alcohol)
  • Avoid contact sports, during and up to 8 weeks after illness, due to risk of splenic rupture
  • Simple analgesia
59
Q

State some potential complications of infectious mononucleosis

A
  • Chronic fatigue
  • Splenic rupture
  • Haemolytic anaemia
  • Thrombocytopenia
  • Glomerulonephritis
  • Cancers e.g. Nasopharyngeal carcinoma, Burkitt’s lymphoma, Hodgkin’s lymphoma
60
Q

For measles, discuss:

  • Causative organism
  • Spread
  • Incubation period
  • Infectivity
A
  • Measles virus (an RNA paramyxovirus)
  • Droplet spread
  • 10-14 days
  • Infective from prodrome until 4 days after rash
61
Q

Describe the typical measles presentation

A

Prodrome of fever, irritability & conjunctivitis followed by:

  • Koplik spots (white spots on buccal mucosa)
  • Then develop a rash (starts behind ears then moves to whole body. Maculopapular rash becoming blotchy & confluent)
  • Diarrhoea in 10%
62
Q

What investigations can you do for measles?

A

Test for IgM antibodies (detectable within few days of onset of rash)

63
Q

Discuss the management of measles

A
  • Consider admission if immunosuppressed or pregnant
  • Inform public health

Supportive as usually self-limiting resolving in 7-10 days:

  • Rest
  • Fluids
  • Simple analgesia for pain & fever
  • Use cotton wool soaked in water to clean eyes if conjunctivitis
64
Q

State some potential complications of measles

A

Common

  • Otitis media
  • Diarrhoea & vomiting
  • Pneumonia
  • Febrile seizures

Uncommon

  • Encephalitis
  • Hepatitis
  • Squint

Rare

  • Myocarditis
  • Subacute sclerosing panencephalitis (can occur years later, fatal)
65
Q

If a child has come into contact with measles and not been immunised what should you do?

A

Offer MMR vaccine as vaccine induced antibodies develop more rapidly- ideally within 72hrs of exposure

66
Q

For oral candidiasis, discuss:

  • Causative organism
  • Which age of children common in
  • Risk factors
  • Symptoms & signs
  • Management
A
  • Candida albicans (yeast-like fungus usually found in GI tract)
  • Common in infants due to immune system being weaker
  • Risk factors: DM, inhaled or oral corticosteroids, recent abx, poor dental hygiene, severe anaemia, immunosuppression
  • Symptoms & signs: yellow or white plaques anywhere in mouth, easily removed, underlying mucosa is red and not painful
  • Management in children:
    • Exclude risk factors
    • Advice: dental hygiene, rinsing mouth after ICS,
    • Miconazole oral gel for 7 days
    • Alternative is oral nystatin
67
Q

For cellulitis, discuss:

  • What it is
  • Two common causative organisms
  • Risk factors
  • Presentation
  • Classification system
  • Management in children
A
  • Acute bacterial infection of the dermis & hypodermis
  • Staphylococcus aureus & Streptococcus pyogenes
  • Risk factors: skin trauma (e.g. wounds, bites), chronic skin conditions (e.g. eczema, tinea pedis), chicken pox, obesity
  • Presentation: swelling, warm to touch, red, painful, fever
  • Eron Clasification (see image)
  • Management:
    • Class I: flucloxacillin 5-7 days
    • If in danger triangle prescribe co-amoxiclav
    • Admission if under 1yr, immunocompromised, class III or IV, involves eye (opthalmology)
68
Q

For conjunctivitis, discuss:

  • What it is
  • Presentation
  • Management
A
  • Inflammation of the conjunctiva due to infection (viral, bacterial, fungal, parasitic)
  • Most common cause= viral (and most common viral cause is adenovirus). Most common bacterial causes= S.aureus, S.pneumonia, H.influenza
  • Presentation: conjuncitival erythema, ‘grittiness’, discharge, watering
  • Managment:
    • Advice most cases self-limiting
    • Self care measures: bathing/cleaning eyelids, cool compress, lubricating drops
    • Advice about infection control e.g. don’t share towels
    • Safety net e.g. pain, visual disturbance, swelling
    • Consider delayed prescription of topical chloramphenicol
      *
69
Q

What is ophthalmia neonatorum?

Common causes and which are of most concern?

Management?

A
  • Any conjunctivitis occurring within first 28 days of life
  • Can be non-infective cause (due to blocked lacrimal duct or irritant) or due to infection with bacteria (most commonly S.aureus but also chlamydia trachomatis, Neisseria gonorrhoea) or viral (e.g. HSV, adenovirus)
  • Chlamydial & gonococcal ON are of concern due to complications which may be sight threatening. Get during birth if mother infected- both present with purulent discharge & oedema. Gonococcal presents in first few days. Chlamydia presents 5-14 days after birth.
  • Management:
    • If mild with no discharge: bathe eyelids with water or saline & cotton pad.
    • If no improvement after above or discharge evident prescribe topical chloramphenicol
    • If suspect Gonococcal, IV cefotaxime
    • If suspect chlamydia, oral erythromycin
70
Q

What is peri-orbital/pre-septal cellulitis?

Who does it commonly affect?

State some causative organisms and methods as to how became infected

A
  • Infection of soft tissues anterior to the orbital septum (eyelids, skin, subcutaneous tissue of face)
  • Common in children (80% <10yrs, median age is 21 months)
  • Causative organisms: S.aureus, S.epidermis, Streptococci
  • Spread from breaks in skin, resp tract infections, sinus infections (particularly ethmoid sinus). *More common in winter due to more resp infections
    *
71
Q

Describe clinical features of peri-orbital cellulitis

A

Clinical features

  • Erythema
  • Oedema
  • Partial or complete ptosis of eye due to swelling
  • Absence of: pain on movement, restricted eye movement, proptosis, visual disturbance, chemosis, RAPD (shown in image)
72
Q

What investigations may you do if you suspect periorbital cellulitis?

A
  • Swabs of any discharge
  • Bloods: FBC, CRP
  • Contrast CT of orbit (if there is suspicion of orbital cellulitis)
73
Q

Discuss the management of periorbital cellulitis

State any potential complications

A

Management

  • Paediatrics requires urgent admission to hospital to be managed by paediatricians, ophthalmology & ENT and for IV abx (e.g. cefotaxime) for 2-5 days and daily review as difficult to differentiate between peri-orbital and orbital as children unable to give full history and be examined
  • Adults can be managed with oral antibiotics (e.g. co-amoxiclav) & safety net

Complications

  • Orbital cellulitis
74
Q

What is orbital cellulitis?

Common causative organisms

Mean age of hospitalisation for oribital cellulitis?

A
  • Infection of the fat & muscles posterior to the orbital septum, within the orbit but not involving the globe.
  • Mean age: 7-12yrs
  • Staphylococcus aureus, Streptococci, Haemophilus influenza B
75
Q

State some risk factors for orbital cellulitis

A
  • Sinus infection (particularly ethmoid)
  • Peri-orbital cellulitis
  • Orbital trauma
  • Dental infection
  • Ear infection
  • Facial cellulitis
  • Not had Haemophilus influenza B vaccine
76
Q

Describe clinical features of orbital cellulitis

A
  • Erythema
  • Swelling
  • Ptosis
  • Severe ocular pain
  • Visual disturbance
  • Proptosis
  • Ophthalmoplegia/pain with eye movements
  • If meningeal involvement: drowsiness, nausea/vomiting etc…
77
Q

What investigations would you do if you suspect orbital cellulitis?

A
  • Swab of conjunctiva & nasopharynx for M,C&S
  • FBC: elevated WCC
  • CRP: may be elevated
  • Blood culture
  • CT orbit with contrast
78
Q

Discuss the management of orbital cellulitis

A

Medical emergency requiring urgent admission, & senior review by paediatrics, ophthalmology & ENT.

  • IV antibiotics for 7-10 days
  • If orbital collection/abscess found may need surgical intervention
79
Q

State some potential complications of orbital cellulitis

A
  • Orbital abscess (and others)
  • Meningitis
  • Ocular compartment syndrome
80
Q

Discuss which children are given flu vaccine

A

Children given nasal flu vaccine:

  • 1st dose at 2-3yrs then annually after that up until 15yrs
  • LIVE vaccine
  • More effective than injectable vaccine
  • Only children aged 2-9 years who have not received an influenza vaccine before need 2 doses
81
Q

State some contraindications to nasal flu vaccine in children

A
  • immunocompromised (should have injectable as this is not live)
  • aged < 2 years
  • current febrile illness or blocked nose/rhinorrhoea
  • current wheeze (e.g. ongoing viral-induced wheeze/asthma) or history of severe asthma (BTS step 4)
  • egg allergy
  • pregnancy/breastfeeding
  • if the child is taking aspirin (e.g. for Kawasaki disease) due to a risk of Reye’s syndrome
82
Q

State some side effects of intranasal flu vaccine

A
  • Blocked nose
  • Rhinorrhoea
  • Headache
  • Anorexia
83
Q
  • Discuss the management of influenza in children (including whether you routinely test children)
A

Key points:

  • Don’t routinely test (only if very ill or get severe risk factors)
  • Oseltamivir (PO) is treatment (should be within 48hrs but if child is very unwell can give after 48hrs)
84
Q

Be sure to revise malaria from Yr3 Medicine Infectious diseases

A
85
Q

For rubella, discuss:

  • Causative organism
  • Whether it is common
  • Incubation & infectivity
  • Presenting features
  • Complications
A
  • Toga virus
  • Very rare after introduction MMR vaccine (<5 cases in UK per year)
  • Incubation time 14-21 days. Infectious 7 days before rash appears and 4 days after
  • Features:
    • Prodrome e.g. low grade fever
    • Maculopapular rash initially on face
    • Lymphadenopathy
  • Complications:
    • arthritis
    • thrombocytopaenia
    • encephalitis
    • myocarditis
86
Q

Remind yourself of viral exanthema in childhood (7)

A
87
Q

What is toxic shock syndrome?

A

Rare, life-threatening condition caused by bacteria entering body and releasing harmful toxins; caused by either Staphylococcus or Streptococcus bacteria

88
Q

State some risk factors for toxic shock syndrome

A

Less relevant in children:

*NOTE: don’t develop immunity so can get it more than once!

89
Q

Describe clinical features of toxic shock syndrome

A
  • Fever
  • Hypotension
  • Diffuse erythematous rash and desquamation of rash (especially of the palms and soles)
  • Involvement of three or more organ systems (required as part of diagnostic criteria):
    • Gastrointestinal (diarrhoea and vomiting)
    • Renal failure
    • Hepatitis
    • Thrombocytopenia
    • CNS involvement (e.g. confusion)
    • Mucous membrane erythema
90
Q

Discuss the management of toxic shock syndrome

A
  • Removal of infection focus (if there is one)
  • IV fluids
  • IV antibiotics
91
Q

When should we give premature babies their routine vaccinations?

A

Babies who were born prematurely should receive their routine vaccinations according to chronological age; there should be no correcting for gestational age. Babies who were born prior to 28 weeks gestation should receive their first set of immunisations at hospital due to risk of apnoea.

92
Q

Summary of duration of antibiotics for different diagnoses

A

Yr4: Child Health (21 decks)

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