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Paediatrics > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

What type of disease is Kawasaki disease and who does it mainly affect

A

systemic vasculitis + infants and young children (under 5 years).

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2
Q

What is diagnosis of Kawasaki disease

A

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)
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3
Q

Complications of Kawasaki

A

Coronary artery aneurysm and sudden death

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4
Q

Tx of Kawasaki

A

IV immunoglobin and aspirin

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5
Q

Why is Kawasaki few scenarios where aspirin is used in children

A

Usually avoided due to risk of Reye’s syndrome

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6
Q

What type of infection is most common in children and in infants <3 months?

A
  • Children: brief, self-limiting viral infection.
  • Infants <3 months: bacterial infection. Uncommon for them to have viral infections due to passive immunity from mothers.
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7
Q

Green, Amber, Red signs of Color (of skin, lips or tongue)

A

Green: normal colour. Amber: pallor reported by parent/carer. Red: pale/mottled/blue

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8
Q

Green, amber, red for child activity

A
  • 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
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9
Q

Amber, red respiratory signs of serious illness

A

Amber: nasal flaring, tachypnoea, oxygen sats <95%, crackles
Red: grunting, severe tachypnoea, chest indrawing

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10
Q

What are the criteria for tachypnoea in 6-12 months, in >12 months and severe tachypnoea

A

RR > 50 breaths/min. Age 6-12 month
RR > 40. Age >12 months
RR > 60. Severe

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11
Q

Cardiovascular Green, Amber, red signs of serious illness

A

Green: normal skin and eyes, moist mucous membranes.
Amber: tachycardia, crt>3 seconds, dry membranes, poor feeding, reduced urine output
Red: reduced skin turgor

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12
Q

Criteria for tachycardia in <12 months, 1-2 years, 2-5 years

A

> 160 bpm. Less than 1 year
150 bpm. 12-24 months
140 bpm. 2-5 years

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13
Q

Other Amber, red signs of serious illness from infection

A
  • 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)
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14
Q

Management of febrile children less than 1 month + <3 months

A

Vital signs, FBC, culture, CRP, urine culture, lumbar puncture (1 month)
As above - LP (<3month just fever)
As above + LP (<3 fever+ ill)

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15
Q

Management of >3 month with fever (+ red, Amber, Green features)

A

Red: vitals, fbc,culture, crp, urine, LP, CXR
Amber: above unless deemed unnecessary by specialist
Green: urine culture + period of observation

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16
Q

Give antibiotics to <1m, 1-3m, >3m?

A

Immediately to all <1m with fever, 1-3m with fever + ill. None given to >3m with fever and no focus
- ceftriaxone or cefotaxime

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17
Q

What is meningitis and most common type of infection

A

Inflammation of meninges. Usually viral (most self-limiting) but bacterial can be very serious

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18
Q

Bacterial causes of meningitis

A

<3 months: GpB strep, E.Coli, Listeria

>3 months: Meningococcus, Streptococcus Pneumoniae

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19
Q

Viral causes of meningitis

A

Enterovirus, EBV, Adenovirus, Mumps

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20
Q

Non specific presentation of meningitis

A

Fever, headache, Lethargy, poor feeding, vomiting, drowsiness

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21
Q

More Specific presentation/signs of meningitis

A

Photophobia, hypotonia, loss of consciousness, seizures, neck stiffness, bulging fontanelle, positive brudinzki/kernig sign

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22
Q

Investigations for meningitis

A

FBC (raised WBC?infection), CRP, blood culture (identify causative organism), U&E’s. +/- LP

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23
Q

Do you give LP to every child with suspected meningitis?

A

LP if <1m and only febrile
LP if 1-3m and febrile & ill
LP if >3m suspected meningitis

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24
Q

What is Brudinzki + Kernig sign

A 
Brudzinski = flexion of neck when supine, causes flexion of knees and hips
Kernigs = back pain on extension of knee from flexion when lying supine
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25
Q

Contraindications to LP

A

Signs of raised ICP (coma, low HR, high BP), focal neurological signs, cardiorespiratory instability

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26
Q

CSF changes in bacterial meningitis

A

Low glucose, high protein, high neutrophils, cloudy

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27
Q

CSF changes in viral meningitis

A

Clear, high lymphocytes, normal or raised protein, normal glucose

28
Q

Treatment of bacterial meningitis

A

<3month: cefotaxime + amoxicillin,

>3 month: ceftriaxone

29
Q

What is meningococcal septicaemia

A

Meningococcal bacteria infection in the bloodstream

30
Q

Px of Meningococcal Septicaemia

A
  • Red/purple non blanching rash
  • cold hands and feet
  • tachypnoea, tachycardia, hypotension (shock)
  • flu-like symptoms
  • +/- meningitis
  • altered consciousness level (shock)
  • gross oedema
31
Q

What do you give to a person in community with fever and non-blanching rash

A

Immediate benzylpenicillin

32
Q

What type of infection causes Mumps

A

viral infection spread by respiratory droplets

33
Q

Px of Mumps

A
  • PAROTID gland SWELLING - uni or bilateral. +/- earache
  • coryzal symptoms (discharge, fatigue, cough)
  • Complications: pancreatitis (abdo pain), orchitis (testicular pain), meningitis (neck stiffness, headache)
34
Q

Tx of Mumps

A

Rest and school exclusion. Notifiable disease.

35
Q

What causes measles

A

Measles virus, highly contagious via respiratory droplets.

36
Q

Clinical features of Measles

A
  • 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
37
Q

Complications of measles

A
  • most common is otitis media
  • pneumonia
  • dehydration
  • meningitis
  • death
38
Q

Mx of Measles

A
  • self resolving

- children should be isolated until 5 days after symptoms resolve

39
Q

What causes rubella

A

Rubella virus. Highly contagious and spread by respiratory droplets

40
Q

Px of rubella

A
  • 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
41
Q

Mx of rubella

A
  • rash, isolation for 5 days after rash appears

- avoid pregnant women

42
Q

Complications of rubella

A
  • thrombocytopenia
  • encephalitis
  • pregnancy - congenital rubella syndrome -> deafness, blindness/cataracts and congenital heart disease triad.
43
Q

What causes 5th disease

A

Parvovirus B19

44
Q

Px of 5th disease/parvovirus B19 disease/slapped cheek syndrome?

A
  • 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
45
Q

Complications of 5th disease

A
  • 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).
46
Q

Mx of 5th disease

A
  • illness is self limiting and rash/symptoms usually fade over 1-2 weeks.
47
Q

What causes Hand, foot and mouth disease

A

coxsackie A virus

48
Q

Px of Hand, foot and mouth

A
  • URTI symptoms -> sore throat, dry cough, fever
  • small mouth ulcers, followed by blistering red spots across body
  • notably on hands, feet, around mouth.
49
Q

Mx of hand, foot and mouth

A

No treatment. Supportive - adequate fluid intake and simple analgesia if required. Self-limiting.
- NO school exclusion until all blisters disappear

50
Q

What is tonsilitis and what causes it?

A
  • inflammation in the tonsils
  • most common cause is viral infection
  • most common bacterial cause is group A beta heamolytic strep (strep pyogenes)
51
Q

Px of tonsilitis

A
  • painful throat and on swallowing. May be referred to ears (otitis media)
  • throat is reddened, tonsils swollen and may have patches of pus (exudates)
52
Q

What is the FeverPAIN score for tonsilitis

A
  • 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
53
Q

Tx of tonsilitis

A

Bacterial: Phenoxymethylpenicillin (penicillin V) for 7-10 days
Clarithromycin if penicillin allergy

54
Q

What causes Scarlet fever and what is it associated with

A
  • exotoxins from group A beta haemolytic strep infection (strep pyogenes)
  • Usually tonsilitis
55
Q

Px of Scarlet fever

A
  • Fever
  • Red-pink blotchy, macular rash with rough ‘sandpaper’ feel
  • Strawberry tongue
  • flushed face
56
Q

Tx of Scarlet fever

A
  • Phenoxymethylpenicillin (penicillin V) for 10 days
  • notifiable disease
  • kept off school until 24 hours after starting antibiotics
57
Q

What causes Chickenpox and how many times can you catch it

A
  • Caused by varicella zoster virus (VZV). Highly contagious.

- Once developed immunity, will not be affected again

58
Q

Px of Chickenpox

A
  • widespread, macular (flat, reddened area), with papular (raised) vesicles/blister rash.
  • Fever, itch, general fatigue
59
Q

Tx of Chickenpox

A
  • Usually self-limiting and doesnt require treatemnt
  • Aciclovir if immunocompromised
  • If become infected with bacteria e.g. staph aureus then give flucloxacillin
60
Q

Complications of Chickenpox

A
  • bacterial infection
  • pneumonia
  • encephalitis
61
Q

What is Impetigo

A
  • a highly contagious superficial bacterial skin infection, usually by staph aureus.
  • Peaks at 2-5 years old
62
Q

Px of non-bullous and bullous Impetigo

A
  • 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.
63
Q

Tx of Impetigo

A
  • 1st line: topical fusidic acid (hydrogen peroxide cream)
  • Oral flucloxacillin used to treat more widespread/severe
  • School exclusion until lesions have crusted over
64
Q

What are the 2 varying presentations of TB in children

A
  • 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
65
Q

What are the investigations for suspected TB

A
  • Mantoux test -> injecting tuberculin for previous, latent or active TB
  • Chest X-RAY in active disease
  • Ziehl Neelsen- acid fast bacilli
66
Q

Mx of TB

A 
RIPE:
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Paediatrics (14 decks)

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