Infectious Diseases Flashcards

Question

What are the signs of sepsis in a child?

Answer 1

``` Deranged physical obs Prolonged cap refill Fever or hypothermia Deranged behaviour Poor feeding Inconsolable or high pitched crying High pitched or weak cry Reduced consciousness Reduced body tone - floppy Skin colour changes - cyanosis, mottled pale or ashen ``` Shock involves circulatory collapse and hypoperfusion of organs

Answer 2

``` Give oxygen if evidence of shock or sats below 94 Obtain IV access Blood tests - including FBC U&Es, CRP, clotting, blood gas, acidosis Blood cultures Urine dipstick Cultures and sensitivities Antibiotics given within 1 hr IV fluids ``` ``` CXR if pneumonia suspected Abdo and pelvic USS LP Meningococcal PCR Serum cortisol if adrenal crisis suspected ``` Continue abx for 5-7 days

Answer 3

Yeast like fungus normal commensal in human GI tract and vagina

Answer 4

``` Hot humid weather Too much time between diaper changes Poor hygiene Immunocompromise Antibiotics promote growth ```

Answer 5

Oral candidiasis can cause chronic pain, discomfort Impaired speech Impaired eating, chewing, limits to nutrition Candidemia - presence of species in the blood

Answer 6

Admit if evidence of systemic illness, widespread infection e.g. oesophageal candidiasis Exclude risk factors e.g. diabetes, haematinic deficiences, poor dental hygiene Prescribe miconazole oral gel first line if 4 months and over Advise good dental hygiene Rinse mouth after inhalation of inhaled corticosteroid If after 7 days some response to tx, continue miconazole gel or offer 7 day course nystatin suspension

Answer 7

Nappy rash - contact dermatitis, moist warm environment in the nappy can lead to added infection with candida Discrete red spots around the perineum, worse in skin creases Send swab to microbiology

Answer 8

Miconazole cream twice daily for 10 days

Answer 9

Erythematous, hot tender rash | May be associated with swelling and systemic features

Answer 10

Allergic/contact dermatitis Impetigo - crusting lesions Staph scalded skin syndrome Necrotising fasciitis

Answer 11

Dental/max fax review if facial or submandibular Send skin swab for MC&S if skin broken Complex cellulitis - FBC, CRP, blood culture

Answer 12

Severe infection Significant immunosuppression Associated with VZV Post-burn

Answer 13

If mild/mod treat with antibiotics e.g. flucloxacilllin or if penicillin allergy clarithromycin for 5-7 days

Answer 14

Inflammation and infection of the eyelid soft tissue superior and anterior to the orbital septum.

Answer 15

Post-septal | Infection in the muscles and fat of the orbit so the septum can be affected and can lead to ocular dysfunction

Answer 16

Children may develop it secondary to an occult underlying bacterial sinusitis or due to spread from another primary infection e.g. pneumonia Means peri-orbital infection can progress rapidly to orbital cellulitis

Answer 17

Redness and swelling | Can open eye sufficiently to demonstrate normal light reflexes and move in all planes

Answer 18

``` Eyelid swelling that the eye is not visible Toxic/systemically unwell CNS signs or symptoms Severe persistent headache Pain on pressing closed eyelid Pain on eye movement Diplopia Reduced visual acuity Absent light reflexes No improvement on abx ```

Answer 19

Mild - oral abx; 5-7 days co-amoxiclav Orbital cellulitis IV cefotaxime or oral amoxicillin 10-14 days NBM if need for surgery, seek ENT and opthamology advice CT scan orbit, sinuses, brain FBC, blood culture, LP

Answer 20

Inflammation of the conjunctiva of the eye

Answer 21

Chemical - irritation from eye drops given at birth, lasts 2-4 days, does not need treatment Gonococcal - from neisseria gonorrhoea, can be picked up from vaginal birth Inclusion conjunctivitis - from chlamydia trachomatis - swollen red eyelids, fluid leaking from eyelids

Answer 22

Bacteria - staph aureus, strep pneumonia, chlamydia Viruses - HSV, adenoviruses Allergies

Answer 23

``` Itchy irritated eyes Swelling of eyelids Redness of conjunctiva Mild pain looking at light Eyelids stuck together in the morning Clear thin fluid leaking from eyes; virus or allergens Crusty lesion - herpes infection ```

Answer 24

Conjunctivitis of the newborn Occurs within first month of life Bacterial, chlamydial or viral acquired during passage through infected birth canal Redness Profuse discharge Swelling of lids Bilateral symptoms Mucopurulent conjunctivitis Oedema Cornea can be involved, may cause perforation

Answer 25

First line - bath/clean eyelids with cotton wall in sterile saline or boiled then cooled water to remove crusting Treat only if severe as most cases viral, self-limiting Second line - chloramphenicol eye drops, azithromycin eye drops Third line - fusidic acid Herpes simplex - same day eye casualty, <1 month give IV aciclovir, >1 month give oral aciclovir For ophthalmia neonatorum - cefotaxime single dose IV immediately, plus chloramphenicol eye drops

Answer 26

Life threatening emergency Caused by H influenzae B. Intense swelling of epiglottis and surrounding tissues associated with septicaemia

Answer 27

High fever, ill toxic looking child Intensely painful throat, prevents child from speaking or swallowing Saliva drools down chin Soft inspiratory stridor Rapidly increasing respiratory difficulty Immobile, upright with open mouth to optimise airway Onset over hours No cough Not able to drive Reluctant to speak

Answer 28

Attempts to examine throat or perform lateral neck x-ray must not occur Can precipitate total airway obstruction and death

Answer 29

``` Urgent admission Senior anaesthetist, paediatrician, ENT Intubation Secure airway, blood cultures, start IV antibiotics Ceftriaxone Oral stepdown - co-amoxiclav ``` Prophylactic antibiotics rifampicin offered to close household contacts

Answer 30

Exfoliative staphylococcal toxin which causes separation of the epidermal skin through the granular cell layers Fever, malaise, purulent crusting localised infection around eyes nose mouth. Areas of epidermis separate on gentle pressure. IV antibiotics - flucloxacillin Analgesia, monitoring fluid balance

Answer 31

After primary infection, latency is established Long term persistence of virus within the host After certain stimuli, reactivation of infection may occur

Answer 32

Enters body through mucus membranes or skin Site of primary infection may be associated with intense local mucosal damage HSV1 lip and skin lesions HSV2 genital lesions Treatment with aciclovir

Answer 33

Most common form of primary HSV in children Vesicular lesions on lips, gums, anterior surfaces of tongue and hard palate. Progress to extensive, painful ulceration and bleeding. High fever, may persist up to 2 weeks. Management symptomatic Severe disease may need IV fluids and aciclovir

Answer 34

Recurrent HSV1 lesions on the gingival lip margin

Answer 35

Wide spread vesicular lesions develop on eczematous skin | May be complicated by secondary bacterial infection and result in sepsis

Answer 36

Painful erythematous oedematous white pustules on broken skin on fingers Spread by auto-inoculation from gingivostomatitis and infected adults kissing children's fingers HSV2 may be cause in sexually active adolescents

Answer 37

``` Viral - roseola infantum Enteroviral rash Parvovirus slapped cheek Measles Rubella ``` ``` Bacterial Scarlet fever - Group A strep Erythema marginatum - rheumatic fever Salmonella typhi Lyme disease ``` Other Kawasaki disease Juvenile idiopathic arthritis

Answer 38

Viral Chickenpox, shingles Herpes simplex virus Coxsackie - hand, footh, mouth ``` Bacterial Impetigo Boils Staphylococcal bullous impetigo Staphylococcal scalded skin Toxic epidermal necrolysis ``` Other Erythema multiforme Stevens-Johnson syndrome

Answer 39

Bacterial Meningococcal, other bacterial sepsis Infective endocarditis Viral Enterovirus ``` Other Henoch-Schonlein purpura Thrombocytopenia Vasculitis Malaria ```

Answer 40

Respiratory infection caused by influenza virus Spread because children touch noses, eyes, mouths, put things in mouth Spread through droplets in the air, coughing, sneezing, touching surfaces

Answer 41

Sudden fever, chills, shakes, headache, muscle aches Extreme tiredness Dry cough, sore throat Loss of appetite Newborns and infants with high fever that can't be explained Young children - temps over 39.5 and febrile seizures Cause of croup, pneumonia, bronchiolitis Stomach upset, vomiting, diarrhoea, abdominal pain, earaches, red eyes

Answer 42

Common cold Sore throat - pharyngitis, tonsillitis Acute otitis media Sinusitis

Answer 43

Difficulty in feeding in infants - blocked nose Febrile convulsions Acute exacerbation of asthma

Answer 44

Form of pharyngitis | Intense inflammation of tonsils, purulent exudate

Answer 45

Group A beta haemolytic strep EBV - infectious mononucleosis Not possible to distinguish between bacterial and viral

Answer 46

Marked constitutional disturbance, headache, apathy and abdo pain White tonsillar exudate Cervical lymphadenopathy

Answer 47

Paracetamol, ibuprofen for pain >3 years use FeverPAIN to assess symptoms 0-1 no antibiotics 2-3 back up 4-5 antibiotics Phenoxymethylpenicillin for 5 days Clarithromycin if allergy

Answer 48

``` Fever - during prev 24 hrs Purulence - pus on tonsils Attend rapidly - within 3 days Severely Inflamed tonsils No cough or coryza ```

Answer 49

Inflammation of tympanic membrane Severe pain Presents over course of days to weeks

Answer 50

Bacterial infection Nasopharyngeal organisms migrating via eustachian tube Infection more likely due to short straight wide tube S pneumonia H influenza M catarrhalis S pyogenes Viral - respiratory syncytial virus, rhinovirus

Answer 51

``` Age - peak 6-15 months Gender - more in boys Passive - parenteral smoking Bottle feeding Craniofacial abnormalities ```

Answer 52

Use of pacifiers Those fed supine first episode of AOM occurred <6 months AOM most common in winter season

Answer 53

Pain, malaise, fever Coryzal symptoms Last few days May tug or cradle ear that hurts Disinterested in food Have vomiting

Answer 54

Tympanic membrane erythematous, bulging on otoscopy Perforation may lead to small tear and purulent discharge Test and document function of facial nerve, check for any intracranial complications, cervical lymphadenopathy.

Answer 55

Chronic suppurative otitis media Otitis media with effusion Otitis externa

Answer 56

Most can be diagnosed clinically Blood tests, FBC, CRP Fluid sent for MC&S Blood cultures

Answer 57

Most will resolve spontaneously 24 hrs - 3 days Simple analgesia Antibiotics should be avoided, watch and wait Oral abx considered if Systemically unwell RFs e.g. congenital heart disease, immunosuppression Unwell 4 days or more Discharge from ear Children younger than 2 with bilateral infections Systemically unwell adults

Answer 58

All children under 3 months with temp of >38 3-6 months with temp >39 Consider for those with evidence of AOM complication or systemically unwell Those with cochlear implant

Answer 59

``` Mastoiditis Meningitis Facial nerve paresis Intracranial abscess Sigmoid sinus thrombosis Chronic otitis media ```

Answer 60

Glue ear | Viscous inflammatory fluid within the middle ear, causing a conductive hearing impairment

Answer 61

``` Bottle fed Parental smoking Atopy Genetic disorders - mucociliary e.g. CF or primary ciliary dyskinesia Craniofacial disorders e.g. Down's ```

Answer 62

Difficulty hearing - in young children may be difficulty in attention, poor speech and language development Sensation of pressure Popping and crackling On examination Tympanic membrane dull Light reflex lost - fluid, bubble behind TM External ear normal

Answer 63

Pure tone audiometry and tympanometry - conductive hearing loss Reduced membrane compliance

Answer 64

Active surveillance, 50% cases resolve in 3 months If no resolution - hearing aid insertion, or myringotomy and grommet insertion Persistent disease and multiple grommit insertion consider adenoidectomy

Answer 65

Inflammation of the external ear canal, acute or chronic Acute < 3 weeks Chronic > 3 months Malignant is when the infection spreads to the mastoid and temporal bones causing osteomyelitis

Answer 66

Infection of skin in external auditory canal Bacterial infection - pseudomonas aeruginosa, staph aureus Bacteria enter due to blockage, absence of cerumen due to excess cleaning, trauma, alteration of pH Fungal infection

Answer 67

``` Hot and humid Swimming Older age Diabetes Narrowing of ear canal Excessive cleaning Wax build up Eczema Trauma Radiotherapy to the ear ```

Answer 68

``` Pain, itching, discharge, hearing loss Oedema Erythema Exudate Mobile tympanic membrane ``` Pain on moving tragus Pre-auricular lymphadenopathy

Answer 69

Avoid getting ear wet Remove discharge Remove hearing aids, earrings Use painkillers Topical acetic acid or topical antibiotic If cellullitis or extends out of ear canal - fluclox If perforation ciprofloxacin Topical neomycin sulphate

Answer 70

Intratemporal complication of otitis media, spreads to mastoid air cells Air filled spaces in the mastoid process of the temporal bone, communicate with middle ear

Answer 71

More common in young children Immunocompromised patients Pre-existence of cholesteatoma

Answer 72

``` Unwell child, lethargic Red bulging eardrum Ear discharge, perforation Oedema Tenderness behind pinna Pinna can be pushed forwards ``` Advanced disease - abnormal findings in abducens nerve or facial nerve

Answer 73

Ear swab Bloods - WCC, CRP CT head and mastoid with contrast MRI head

Answer 74

IV abx inpatient acute | Co-amoxiclav or ceftriaxone

Answer 75

Infectious mononucleosis Most common in teenagers and young adults, 18-22 Most common transmission route is exchange of saliva by kissing Incubation period 6 weeks ``` Sore throat Head and neck complaints General systemic upset Swollen neck Snoring, sleep apnoea ``` Feverish, headaches, nausea and vomiting, TATT Cervical lymphadenopathy Abdo tenderness, splenomegaly, hepatomegaly

Answer 76

FBCs LFTs Monospot for IgM ELISA immunoassays

Answer 77

Benzylpenicillin if bacterial superinfection present Hospital admission if stridor, dehydration severe, complication e.g. splenic rupture

Answer 78

``` Post-viral fatigue Malignancy - lymphomas Guillain Barre syndrome Encephalitis Splenic rupture ```

Answer 79

Any signs of airway compromise; stridor, dysphonia, drooling Any signs of oesophageal perforation e.g. chest pain, features of sepsis, surgical emphysema Any history of button battery ingestion Mediastinal widening

Answer 80

Systemic vasculitis Mainly affect 6 months to 4 years old Young children more commonly affected, incomplete cases - not all symptoms

Answer 81

Infective - localised infection, bacterial infections, IE, TB, virus e.g. EBV, CMV, HIV Parasites e.g. malaria ``` Non infective - SLE, Kawasaki IBD Sarcoidosis Malignancy Drug fever Fabricated ```

Answer 82

Unknown | Likely to be immune hyperreactivity to variety of triggers in genetically susceptible host

Answer 83

Made on clinical findings Irritable children High fever hard to control High inflammatory markers Platelet count rises after 2nd week of illness Coronary arteries can be affected, can lead to aneurysms

Answer 84

Prompt treatment with IV immunoglobulin in first 10 days to reduce risk of coronary artery aneurysms Aspirin reduces risk of thrombosis High dose until inflammatory markers are normal, then at antiplatelet dose until echo reveals present or absent aneurysms Persistent inflammation and fever may require treatment with infliximab, steroids of ciclosporin.

Answer 85

High grade fever lasts for >5 days, resistent to antipyretics Conjunctival infection Bright red, cracked lips Strawberry tongue Cervical lymphadenopathy Red palms of the hands and soles of feet, later peel

Answer 86

Risk of Reye's syndrome - severe progressive encephalopathy | accompanied by fatty infiltration of liver, kidneys and pancreas

Answer 87

Plasmodium falciparum Vivax Ovale Malariae

Answer 88

Sickle-cell G6PD deficiency HLA-B53 Absence of Duffy antigens

Answer 89

Fever, headache, splenomegaly malariae associated with nephrotic syndrome Diarrhoea, vomiting, flu like symptoms, jaundice, anaemia, thrombocytopenia Children particularly vulnerable to severe anaemia and cerebral malaria - seizures, coma ``` Falciparum, severe malaria - Schizonts on blood film Parasitaemia Hypoglycaemia Acidosis Temp >39 ```

Answer 90

Observation in hospital for at least 24 hours due to possibility of rapid progression Artemisinin combination therapy first line Oral quinine alternative, can add doxycycline or clindamycin

Answer 91

Children under 12 years | Due to risk of dental hypoplasia and permanent discolouration of teeth

Answer 92

Artemisinin combination therapy or chloroquine Primaquine can be given with chloroquine for radical cure, but screen for G6PD deficiency

Answer 93

Rarely seen in developed world RNA paramyxovirus Infective from prodrome until 4 days after rash starts

Answer 94

Prodrome - irritable, conjunctivitis, fever Koplik spots - before rash, white spots on buccal mucosa Rash starts behind ears, then whole body, discrete maculopapular rash becomes blotchy and confluent May desquamate in second week Diarrhoea Encephalitis - headache, lethargy, irritability, convulsions, coma Subacute sclerosing panencephalitis - loss of neurological function

Answer 95

``` Otitis media Pneumonia - most common cause of death Febrile convulsions SSPE, encephalitis Hepatitis Appendicitis Corneal ulceration Myocarditis ```

Answer 96

Mainly supportive Admission if immunocompromised or pregnant Notifiable disease If immunocompromised, ribavirin may be used - antiviral Vitamin A may modulate immune response, given in developing countries

Answer 97

Viral infection spread by respiratory droplets Incubation period 14-25 days Self limiting, lasts 1 week

Answer 98

Flu like symptoms prodrome, before parotid swelling ``` Fever Muscle aches Lethargy Reduced appetite Headache Dry mouth ``` Parotid gland swelling is unilateral or bilateral, pain Abdominal pain - pancreatitis Testicular pain and swelling - orchitis Confusion, neck stiffness, headache - meningitis, encephalitis

Answer 99

Diagnosis confirmed with PCR Blood or salvia for antibodies to mumps virus Notifiable disease Management supportive Rest, fluids, analgesia

Answer 100

Pancreatitis Orchitis Meningitis Sensorineural hearing loss

Answer 101

German measles Can cause damage to fetus Incubation period 15-20 days Spread by respiratory route

Answer 102

Prodrome of low grade fever Maculopapular rash Initially covers face, then spreads across body Rash not itchy in kids Lymphadenopathy - suboccipital and postauricular

Answer 103

Arthritis Thrombocytopenia Encephalitis Myocarditis

Answer 104

If contracted in pregnancy, is a risk ``` Sensorineural deafness Congenital cataracts Congenital heart disease Growth retardation Hepatosplenomegaly Purpuric skin lesions Microphthalmia Cerebral palsy ```

Answer 105

TB infection - latent TB compared to disease | Children usually acquire TB from an infected adult in the household

Answer 106

Due to mycobacterium tuberculosis Chronic granulomatous disease Spread by inhalation of infected droplets First encounter - host macrophages engulf and carry to hilar lymph nodes Small granulomas form containing mycobacteria Miliary TB - primary not well controlled, invades bloodstream

Answer 107

``` More non-specific than adults Prolonged fever Malaise Anorexia Weight loss Focal signs of infection ``` Nearly half of infants and older children show minimal signs Disease remains latent, may develop into active disease at later time CXR changes Cough Post primary TB upon reactivation Miliary TB to bones, joints, kidneys, pericardium, CNS

Answer 108

Sputum sample generally hard as swallow sputum Gastric washings on three consecutive mornings to culture acid-fast bacilli NG into stomach, rinsed with saline before food urine, lymph node excision, CSF, radiology if appropriate If suspected - mantoux test but could be positive if past infection Interferon gamma release assay blood test

Answer 109

RIfampicin, isoniazid, ethambutol, pyrazinamide Rifampicin and isoniazid after 2 months After puberty, pyridoxine given weekly to prevent peripheral neuropathy associated with isoniazid therapy Tuberculous meningitis - dexamethasone given for first month at least Asymptomatic children who are mantoux positive and therefore latently infected treated e.g. rifampicin and isoniazid for 3 months

Answer 110

Weakened (attenuated) or inactive version of pathogen | Stimulates immune response and leads to immunity

Answer 111

Killed version of infection Safe for immunocompromised Polio Flu vaccine Hepatitis Rabies

Answer 112

Contain part of the organism, which is needed to stimulate an immune response Also safe for immunocompromised ``` Pneumococcus Meningococcus Hepatitis B Pertussis - whooping cough Haemophilus influenza type B HPV Shingles - HZV ```

Answer 113

``` Measles, mumps, rubella BCG Chickenpox Nasal influenza Rotavirus ```

Answer 114

Contain a toxin normally produced by the pathogen, not the pathogen itself Diphtheria and tetanus

Answer 115

6 in 1 Diphtheria, tetanus, pertussis, polio, Hib, Hep B Meningococcal type B Rotavirus - oral vaccine

Answer 116

6 in 1 - again Pneumococcal Rotavirus - again

Answer 117

6 in 1 again | Meningococcal B again

Answer 118

2 in 1 - haemophilus and meningococcal type C Pneumococcal - again MMR Meningococcal type B again

Answer 119

Influenza - nasal vaccine

Answer 120

4 in 1 Diphtheria, tetanus, pertussis and polio MMR - again

Answer 121

HPV vaccine | 2 doses given 6 to 24 months apart

Answer 122

3 in 1 - tetanus, diphtheria, polio | Meningococcal ACWY

Answer 123

Given before sexually active Gardasil Protects against strains 6 and 11 - genital warts, strains 16 and 18 - cervical cancer

Answer 124

Secondary bacterial infection with staphylococci, group A strep Encephalitis Purpura fulminans - consequence of vasculitis in the skin Fever from chickenpox which settles and then recurs is likely due to secondary bacterial infection CNS - cerebellitis, encephalitis, aseptic meningitis Immunocompromised - haemorrhagic lesions, pneumonitis, DIC

Answer 125

Papules, become vesicles, becomes pustules, becomes crusty rash Rash comes in crops for 3-5 days 200-500 lesions start on head and trunk, progress to peripheries

Answer 126

Symptomatic Valaciclovir if immunocompromised Human varicella zoster immunoglobulin given for immunocompromised high risk patients

Answer 127

A T cell immune defect More common in those who had chickenpox primary infection in first year of life Due to reactivation of varicella zoster virus

Answer 128

Saliva, genital secretions, breast milk | More rarely blood products, organ transplants

Answer 129

Atypical lymphocytes Most common cause of non-genetic hearing loss at birth Pneumonia, hepatitis, rash Tiredness, muscle aches, headache, fever, mono symptoms IV ganciclovir

Answer 130

First disease - measles Second disease - Scarlet fever - streptococcus third disease - Rubella - rubella virus Fifth disease - erythema infectiosum - parvovirus B19 Sixth disease - roseola - human herpes 6B or 7

Answer 131

Eruptive lesions of the mucous membranes occurring as a symptom of disease

Answer 132

Group A beta haemolytic strep Sore throat, headache, fever, tender cervical lymphadenopathy, malaise Erythematous rash Strawberry tongue Pharyngitis Do strep antibody test, throat swab Notifiable disease, treat with penicillin V or erythromycin or cephalosporin

Answer 133

Slapped cheek Asymptomatic Infectiosum - fever, malaise, headache, slapped cheek rash one week later Aplastic crisis - serious consequence in those with chronic haemolytic anaemias or immunodeficient Fetal disease - transmission of maternal infection could lead to fetal hydrops Treatment largely symptomatic

Answer 134

Sixth disease Herpesvirus 6 or 7 HHV-6 common benign illness, common cause of fever and febrile seizures ``` Palpebral oedema Uvulopalatal junction ulcers Erythematous papules on soft palate - Nagayama's spots Diarrhoea Cough ```

Answer 135

Infection of the gastrointestinal tract, usually by rotavirus Usually self limiting If untreated can result in morbidity and mortality secondary to dehydration, electrolyte imbalance, metabolic acidosis

Answer 136

``` Vomiting Non-bloody diarrhoea Hyperactive bowel sounds Abdominal pain Low grade fever Evidence of dehydration Decreased body weight ```

Answer 137

``` Age <5 years Poor personal hygiene Exposure to those with it Day-care attendance Winter months Poverty Lack of immunisation against rotavirus Lack of breastfeeding Immunodeficiency ```

Answer 138

``` Clinical examination Serum electrolytes, urea, creatinine FBC Stool microscopy Stool culture ```

Answer 139

No dehydration - fluids, age appropriate diet, ondansetron for vomiting If mod dehydration - 100ml/kg oral rehydration therapy over 4 hours, or may need NG tube If severe dehydration - Ringer's lactate over 1 hour or 20ml/kg IV normal saline over 1 hour