Infectious diseases Flashcards
What are inactivated vaccines?
Contain dead form of the pathogen therefore safe to use in immunocompromised patients.
Hep A
Polio
Flu vaccine
Rabies
What are subunit/conjugate vacines?
Contain part of the orgnaism, therofre safew to use in immunocompromised patients.
Meningococcus Pneumococcus Pertussis Hep B HiB HPV Shingles
What are live attenuated vaccines?
Contain a live but weakened form of the vaccine, therefore not suitable in immunocompromised patients.
MMR Chicken pox Rotavirus Influenza (nasal) BCG
What are toxin vaccines?
Cause immunity to the toxins and not the pathogen.
Diphtheria
Tetanus
What is the UK vaccination programme?
At birht- If increased risk give BCG
2 months- 6 in 1 (diphtheria, tetanus, polio, whooping cough, Hep B, HiB), Men B, oral Rotavirus.
3 months- 6 in 1 (diphtheria, tetanus, polio, whooping couhg, Hep B, HiB), oral Rotavirus, PCV.
4 months- 6 in 1 (diphtheria, tetanus, polio, whooping cough, Hep B, HiB), Men B.
12-13 months- PCV, MMR, Men B, PCV, 2 in 1 (HiB, Men C)
2-8 yrs old- Annual influenza vaccine
3-4 yrs old- Pre-school booster 4 in 1 (diphtheria, polio, tetanus, whooping cough), MMR
12-13 yrs old- HPV
13-18 yrs old- 3 in 1 (diphtheria, polio, tetanus), Men ACWY
What does HPV vaccine prevent?
Give to children before they become sexually active.
Protect against
HPV 6,11- genital warts
HPV 16,18- cervical cancer
What is the NICE traffic light system?
Assesses fever in children to determine the need to admit.
Look at CARCO- Colour, Activity, Respiratory, Circulation/hydration and Other.
Green- Low risk
Normal colour
Responds well to cues, smiling, strong cry if crying
Normal moist mucus membranes.
Amber- Medium risk
Pallor
Not responding to cues, not smiling, unhappy baby
RR>50 (6-12 months), 40 (>12 months), O2 sat <95%
HR> 160 (1yr), >150 (1-2yrs), >140 (2-5yrs), CRT>3 seconds
3-6 months with fever >39 degrees, fever >5 days, rigors etc
Red- High risk (Need admittance)
Pale
No response, looks unwell to healthcare worker, high pitched cry
RR>60, grunting
Reduced skin turgor
<3 months with temperature >39 degrees, status epilepticus, bulging fontanelles, non-blanching rash
How is sepsis managed?
Initial: O2 if <94% IV cannula FBC, U+Es, CRP, LFTs, Clotting profile Blood cultures and lactate Urine dip for MCS IV fluids IV Abx
Further: CXR if suspect pneumonia AXR if suspect perforation LP if suspect meningitis Meningococcal PCR if suspect meningococcal disease Serum cortisol if suspect adrenal crisis
Stop Abx if bacterial infection unlikely OR patient is well WITH negative blood cultures and 2 CRP over 48hrs.
What is bacterial meningitis?
How does it present?
Inflammation of the meninges due to a bacterial cause.
In adults and children this is neiserria.meningitidis or strep.pneumonia.
In neonates this is GBS.
Presentation: Neck stiffness Photophobia Vomiting Fever Altered consciousness Headache
If the N.meningitidis was to enter the blood stream this would lead to meningococcal sepsis which gives the characteristic non-blanching rash (due to DIC)
How is bacterial meningitis investigated?
Need LP in:
<1 month with a fever
1-3 months fever and unwell
<1 yrs if unexplained fever and serious illness
Brudinksi’s test- Patient lies flat on their back. Examiner slowly flexes head towards the chin. +ve result- patient flexes at hip and knees.
Kernig’s test- Patient lies flat on back. Examiner flexes hip and knees. On attempt to straighten the knee, this will elicit pain along the spine (stretch of the meninges)
How is bacterial meningitis managed?
If in primary care suspected meningitis + non-blanching rash- NEED STAT DOSE OF BENZYLPENICILLIN (IM/IV), before admittance to hospital as time is of the essence. Should not delay admittance, if true penicillin allergy, focus on admitting rather than finding an alternative.
Need LP and meningococcal PCR- should wait before starting Abx but this should not delay Abx treatment if pt acutely unwell.
Have a low threshold for meningococcal meningitis.
<3 months- Cefotaxime + Amoxicillin (Listeria cover)
> 3 months- Ceftriaxone
If <3 months and LP suggestive of NM; give dexamethasone QDS for 4 days to prevent hearing loss and neurological damage.
Who gets post exposure prophylaxis to meningitis?
Anyone in contact within 7 days of the patient presenting.
If nothing has developed within 7 days of exposure then unlikely to develop.
Should ideally receive 1 single dose of ciprofloxacin within 24hrs of patient presenting.
What are the causes of viral meningitis?
How does it present?
How is it managed?
HSV, VZV, enterovirus.
Presents more mild than the bacterial meningitis.
Send LP for viral PCR.
Management is supportive, but can give acyclovir against HSV and VZV
What are the results of a LP where CSF contains bacteria vs virus?
Bacteria- Cloudy, high protein, low glucose, high WBC (neutrophils).
Bacteria will use up glucose and release proteins, the body responds through neutrophils.
Viral- Clear, mild raised protein, normal glucose, high WBC (lymphocytes).
What are the complications of bacterial meningitis?
Hearing loss Memory loss Cerebral palsy Seizures/epilepsy Cognitive impairment/learning disabilities
