Infectious diseases Flashcards
What type of disease is Kawasaki disease and who does it mainly affect
systemic vasculitis + infants and young children (under 5 years).
What is diagnosis of Kawasaki disease
Fever > 5 days (unhappy, unwell) + four other features:
- Conjunctivitis,
- Rash,
- Erythema/edema of hands and feet,
- Adenopathy/Lymphadenopathy,
- Mucous membrane changes - red/strawberry tongue. Dry, cracked lips. (CREAM)
Complications of Kawasaki
Coronary artery aneurysm and sudden death
Tx of Kawasaki
IV immunoglobin and aspirin
Why is Kawasaki few scenarios where aspirin is used in children
Usually avoided due to risk of Reye’s syndrome
What type of infection is most common in children and in infants <3 months?
- Children: brief, self-limiting viral infection.
- Infants <3 months: bacterial infection. Uncommon for them to have viral infections due to passive immunity from mothers.
Green, Amber, Red signs of Color (of skin, lips or tongue)
Green: normal colour. Amber: pallor reported by parent/carer. Red: pale/mottled/blue
Green, amber, red for child activity
- Green: responds, content/smile, awake, not crying/strong normal cry
- Amber: not responding to social cue, no smile, wakes only with prolonged stimulation
- Red: no response to social cue, appears ill to health care, does not wake, weak/high pitched/continuous cry
Amber, red respiratory signs of serious illness
Amber: nasal flaring, tachypnoea, oxygen sats <95%, crackles
Red: grunting, severe tachypnoea, chest indrawing
What are the criteria for tachypnoea in 6-12 months, in >12 months and severe tachypnoea
RR > 50 breaths/min. Age 6-12 month
RR > 40. Age >12 months
RR > 60. Severe
Cardiovascular Green, Amber, red signs of serious illness
Green: normal skin and eyes, moist mucous membranes.
Amber: tachycardia, crt>3 seconds, dry membranes, poor feeding, reduced urine output
Red: reduced skin turgor
Criteria for tachycardia in <12 months, 1-2 years, 2-5 years
> 160 bpm. Less than 1 year
150 bpm. 12-24 months
140 bpm. 2-5 years
Other Amber, red signs of serious illness from infection
- Fever; >38 if <3m (red), >39 if 3-6m (amber)
- Fever for >5 days (Amber)
- Rigors, swelling (Amber)
- non blanching rash (red)
- bulging fontanelle (red)
- neck stiffness (red)
- focal neurological signs (red)
Management of febrile children less than 1 month + <3 months
Vital signs, FBC, culture, CRP, urine culture, lumbar puncture (1 month)
As above - LP (<3month just fever)
As above + LP (<3 fever+ ill)
Management of >3 month with fever (+ red, Amber, Green features)
Red: vitals, fbc,culture, crp, urine, LP, CXR
Amber: above unless deemed unnecessary by specialist
Green: urine culture + period of observation
Give antibiotics to <1m, 1-3m, >3m?
Immediately to all <1m with fever, 1-3m with fever + ill. None given to >3m with fever and no focus
- ceftriaxone or cefotaxime
What is meningitis and most common type of infection
Inflammation of meninges. Usually viral (most self-limiting) but bacterial can be very serious
Bacterial causes of meningitis
<3 months: GpB strep, E.Coli, Listeria
>3 months: Meningococcus, Streptococcus Pneumoniae
Viral causes of meningitis
Enterovirus, EBV, Adenovirus, Mumps
Non specific presentation of meningitis
Fever, headache, Lethargy, poor feeding, vomiting, drowsiness
More Specific presentation/signs of meningitis
Photophobia, hypotonia, loss of consciousness, seizures, neck stiffness, bulging fontanelle, positive brudinzki/kernig sign
Investigations for meningitis
FBC (raised WBC?infection), CRP, blood culture (identify causative organism), U&E’s. +/- LP
Do you give LP to every child with suspected meningitis?
LP if <1m and only febrile
LP if 1-3m and febrile & ill
LP if >3m suspected meningitis
What is Brudinzki + Kernig sign
Brudzinski = flexion of neck when supine, causes flexion of knees and hips Kernigs = back pain on extension of knee from flexion when lying supine
Contraindications to LP
Signs of raised ICP (coma, low HR, high BP), focal neurological signs, cardiorespiratory instability
CSF changes in bacterial meningitis
Low glucose, high protein, high neutrophils, cloudy
CSF changes in viral meningitis
Clear, high lymphocytes, normal or raised protein, normal glucose
Treatment of bacterial meningitis
<3month: cefotaxime + amoxicillin,
>3 month: ceftriaxone
What is meningococcal septicaemia
Meningococcal bacteria infection in the bloodstream
Px of Meningococcal Septicaemia
- Red/purple non blanching rash
- cold hands and feet
- tachypnoea, tachycardia, hypotension (shock)
- flu-like symptoms
- +/- meningitis
- altered consciousness level (shock)
- gross oedema
What do you give to a person in community with fever and non-blanching rash
Immediate benzylpenicillin
What type of infection causes Mumps
viral infection spread by respiratory droplets
Px of Mumps
- PAROTID gland SWELLING - uni or bilateral. +/- earache
- coryzal symptoms (discharge, fatigue, cough)
- Complications: pancreatitis (abdo pain), orchitis (testicular pain), meningitis (neck stiffness, headache)
Tx of Mumps
Rest and school exclusion. Notifiable disease.
What causes measles
Measles virus, highly contagious via respiratory droplets.
Clinical features of Measles
- 1st stage: 4 C’s -> cough, cranky, coryza (+ fever), conjunctivitis
- 2nd stage -> maculopapular rash with Koplik spots (greyish white spots). Starts on face and spreads down
Complications of measles
- most common is otitis media
- pneumonia
- dehydration
- meningitis
- death
Mx of Measles
- self resolving
- children should be isolated until 5 days after symptoms resolve
What causes rubella
Rubella virus. Highly contagious and spread by respiratory droplets
Px of rubella
- pink erythematous macular rash (milder than measles). Starts on face and spread to rest of body.
- coryzal prodome (mild fever, joint pain, sore throat)
- lymphadenopathy (enlarged lymph nodes)
- Arthralgia is common
Mx of rubella
- rash, isolation for 5 days after rash appears
- avoid pregnant women
Complications of rubella
- thrombocytopenia
- encephalitis
- pregnancy - congenital rubella syndrome -> deafness, blindness/cataracts and congenital heart disease triad.
What causes 5th disease
Parvovirus B19
Px of 5th disease/parvovirus B19 disease/slapped cheek syndrome?
- coryzal prodome, fever (headache, sore throat, rhinitis, malaise)
- malar rash/slapped cheeks (usually disappear after 2-4 days)
- generalised rash on body, arm, legs (glove and stocking)
- arthropathy
Complications of 5th disease
- parvovirus B19 has an affinity for red blood cell precursors. Can cause aplastic crisis in sickle cell, thalassaemia, HS.
- in pregnancy can cause fetal loss and hydrops fetalis (severe oedema in fetus/baby).
Mx of 5th disease
- illness is self limiting and rash/symptoms usually fade over 1-2 weeks.
What causes Hand, foot and mouth disease
coxsackie A virus
Px of Hand, foot and mouth
- URTI symptoms -> sore throat, dry cough, fever
- small mouth ulcers, followed by blistering red spots across body
- notably on hands, feet, around mouth.
Mx of hand, foot and mouth
No treatment. Supportive - adequate fluid intake and simple analgesia if required. Self-limiting.
- NO school exclusion until all blisters disappear
What is tonsilitis and what causes it?
- inflammation in the tonsils
- most common cause is viral infection
- most common bacterial cause is group A beta heamolytic strep (strep pyogenes)
Px of tonsilitis
- painful throat and on swallowing. May be referred to ears (otitis media)
- throat is reddened, tonsils swollen and may have patches of pus (exudates)
What is the FeverPAIN score for tonsilitis
- Fever during previous 24 hours
- Purulence
- Attended within 3 days of onset of symptoms
- Inflamed tonsils (severely)
- No cough or coryza
- Score 2-3 = 30-40% chance of Strep bacterial tonsilitis
- Score 4-5 = 60% chance of Strep
Tx of tonsilitis
Bacterial: Phenoxymethylpenicillin (penicillin V) for 7-10 days
Clarithromycin if penicillin allergy
What causes Scarlet fever and what is it associated with
- exotoxins from group A beta haemolytic strep infection (strep pyogenes)
- Usually tonsilitis
Px of Scarlet fever
- Fever
- Red-pink blotchy, macular rash with rough ‘sandpaper’ feel
- Strawberry tongue
- flushed face
Tx of Scarlet fever
- Phenoxymethylpenicillin (penicillin V) for 10 days
- notifiable disease
- kept off school until 24 hours after starting antibiotics
What causes Chickenpox and how many times can you catch it
- Caused by varicella zoster virus (VZV). Highly contagious.
- Once developed immunity, will not be affected again
Px of Chickenpox
- widespread, macular (flat, reddened area), with papular (raised) vesicles/blister rash.
- Fever, itch, general fatigue
Tx of Chickenpox
- Usually self-limiting and doesnt require treatemnt
- Aciclovir if immunocompromised
- If become infected with bacteria e.g. staph aureus then give flucloxacillin
Complications of Chickenpox
- bacterial infection
- pneumonia
- encephalitis
What is Impetigo
- a highly contagious superficial bacterial skin infection, usually by staph aureus.
- Peaks at 2-5 years old
Px of non-bullous and bullous Impetigo
- Majority of cases non-bullous
- tiny pustules/vesicles that dry to form a ‘golden crust’.
- bullous = fluid filled vesicles burst (due to bacterial toxins) forming a ‘golden crust’. More painful as bursting.
Tx of Impetigo
- 1st line: topical fusidic acid (hydrogen peroxide cream)
- Oral flucloxacillin used to treat more widespread/severe
- School exclusion until lesions have crusted over
What are the 2 varying presentations of TB in children
- asymptomatic: immune system limits progression and disease remains dorment
- symptomatic: host response fails to contain inhaled tubercule bacilli so spreads to lymph nodes. = non specific symptoms: fever, weight loss, cough, chest XRAY
What are the investigations for suspected TB
- Mantoux test -> injecting tuberculin for previous, latent or active TB
- Chest X-RAY in active disease
- Ziehl Neelsen- acid fast bacilli
Mx of TB
RIPE: Rifampicin Isoniazid Pyrazinamide Ethambutol
