Infectious diseases Flashcards
Macules
Red/Pink discrete flat areas which blanch on pressure
Papules
Solid raised hemispherical lesions, usually tiny, blanch on pressure
Rubella
macular rash
Measles
Maculopapular rash
Purpuric, petechia
non blanching red/purple spots, tested with a glass
some conditions that are purpuric or petechial
- meningococcal
- HSP
- Enterovirus
- Thrombocytopenia
vesicles
raised hemispehrical lesions, <0.5cm diameter, contain clear fluid
infections with vesicles
- Chicken pox
- shingles
- Hand, foot and mouth disease
Pustules/ bullae
raised hemispherical lesions >0.5cm diameter, contain clear or purulent fluid
Infections with pustules/ bullae
- impetigo
- scalded skin syndrome
Desquamation
dry and flaky loss of surface epithelium, often in peripheries
Infections with desquamation
- post- scarlet fever
- kawasaki
measles is caused by
the measles virus
measles
incubation period
around 2 weeks
measles
mode of spread
droplet spread, highly infectious during viral shedding
measles
pathognomic feature
koplik spots
measles
Clinical features
- cough
- conjunctivitis, coryza
- koplik spots
- Maculpapular Rash
measles
Koplik spots
white spots on the buccal mucosa seen against a red background
measles
Rash seen
maculopapular rash starting from behind the ears to the whole body. May desquamate in the second week
measles
Respi complications
- Pneumonia
- Secondary bacterial infection and otitis media
- Tracheitis
measles
Neuro complications
- Febrile convulsions
- EEG abnormalities
- Encephalitis
- SSPE
measles
SSPE
late and rare manifestation by around 7 years. loss of neuro function and 100% death rate
measles
complications
- Respi
- Neuro
- Diarrhea
- Hepatitis
- Appendicitis
- Corneal ulceration
- Myocarditis
measles
Mx
- Symptomatic Rx
- Isolate the child
- Ribavirin for immunocompromised
- Vitamin A to boost immunity
measles
Prevention
MMR vaccine- given at 9 months and 3 years
Chicken pox
MO
Varicella zoster
Chicken pox
Incubation period
around 2 weeks
Chicken pox
Spread
by respiratory droplets. until the last lesion has crusted, child is infectious
Chicken pox
Clinical features
Vesicular rash starting on the head and trunk and progress to peripheries
Chicken pox
Rash
starts as papules, vesicles with sorrounding erythema and pustules for upto one week.
Chicken pox
Why do children present with difficulty eating
lesions may appear on the palate
Chicken pox
Does it leave scars
no unless they are scratched
Chicken pox
lesions appear beyond 10 days
suggests defective cellular immunity
Chicken pox
Complications
- bacterial superinfection
- CNS- cerebellitis, generalised encephalitis, aspetic meningitis
- Immunocompromised- Penumonitis, hemorrhagic lesions, DIC, progressive and disseminated infections
Chicken pox
Rx
- immunocopromised- IV acyclovir
- high- risk immunocompromised following contact- HZV Ig vaccine (VZIG)
- Normal immunity- no Rx
Chicken Pox
Prevention
Immunization against chickenpox
Mumps
Incubation period
15-24 days
Mumps
MO
Measles virus
Mumps
spread by
aerosolized droplets
Mumps
clinical features
- Fever, malaise, parotitis
- Parotitis starts U/L but spreads B/L in the next week
- Earache, pain on eating and drinking (acidic, salty)
Mumps
Parotitis
Usually starts U/L and then spread B/L over the next few days
Mumps
how long does the fever last
around 3-4 days
Mumps
pancreatic involvement
Serum amylase is high
Mumps
how long does the infectivity last
upto a week
Mumps
complications
- transient and U/L hearing loss
- viral meningitis, encephalitis
- Orchitis- uncommon
- Myocarditis
Mumps
risk of subfertility
Mumps complicated with B/L orchitis
Mumps
Prevention
MMR vaccine
SL remedy- ali hakka
Rubella
MO
Rubella virus
Rubella
incubation period
15-20 days
Rubella
Spread
Respiratory
Rubella
Clinical features
- Prodrome- mild fever
- maculopapular rash
- Lymphadenopathy
Rubella
Rash
Maculopapular rash starting from the face and spreading centrifugally to the whole body
Rubella
Lymphadenopathy locations
- Suboccipital
- Postauricular
Rubella
Complications
- Arthritis
- Encephalitis
- Thrombocytopenia
- Myocarditis- rare
Rubella
Prevention
MMR vaccine
Impetigo
MO
Staphylococcal
Streptococcal
Impetigo
most common in
children with pre- existing skin disease
Impetigo
lesions location
- Face
- Neck
- Hands
Impetigo
rash
- begins as erythematous macules
- become vesicles/ pustules/ bullae
- rupture
- honey- colored crusted lesions
Impetigo
Infection spread
autoinculation
Impetigo
Rx
- Mild cases- topical ABx (Mupirocin)
- Severe- flucloxa, co-amoxiclav
- Isolate the child
- Nasal cream of mupirocin, chlorhexidine
SSSS
Pathophysiology
exfoliative toxin of staph seperates the epidermal skin from the dermis
SSSS
affected age groups
Infants, young children
SSSS
Clinical features
- fever, malaise
- purulent, crusting, localized infection around the eyes, nose, mouth
- widespread erythema and tenderness of skin
- subtle pressure cause epidermis to peel off, leaving denuded skin
- denuded areas dry and heal without scarring
SSSS
Mx
- iv ABx- flucloxa, vancomycin
- iv morphine
- fluid balance- NS
- Losing protein- high protein diet (NG tube, TPN)
HIV
Spread
- mother- to child transmission- during PG, at delivery, through breastfeeding
- infected blood products- abuse, contaminated needles
HIV
Sx of mild HIV
- lymphadenopathy
- parotitis
HIV
Sx of moderate HIV
- Recurrent bacterial infections
- candidiasis
- chronic diarrhea
- lymphocytic interstitial pneumonitis (LIP)
HIV
Sx of severe HIV
- opportunistic infections- pneumocystis carinii pneumonia
- severe failure to thrive
- encephalopathy
- malignancy
HIV
- Dx of <18 months
- > 18 months
- <18 months- HIV DNA PCR
- > 18 months- HIV Ab
HIV
How to know the infant is not infected anymore
Two negative PCR within first 3 months of life at least two weeks after the completion of postnatal antiretroviral therapy
HIV
confirmatory test that the infant is free of HIV
loss of transplacental maternal HIV Ab from the infant’s circulation after 18 months of age
HIV
screening Dx
all infants born to HIV infected mothers needs to be tested whether they are symptomatic or not
HIV
Rx
- ART- combo of 3-4 drugs
- Prophylaxis against Pneumocystis jiroveci carinii pneumonia- Co- trimoxazole
- MDT approach
HIV
immunization
- no live vaccines- BCG not given
HIV
MDT consists of
- Pediatrician
- venerologist
- Psychiatrist
- social workers
HIV
prevention
- antenatal ART
- offer LSCS
- avoid breastfeeding
Malaria
MO
- Plasmodium vivax
- Plasmodium falciparum
- Pl ovale
- Pl malariae
Malaria
incubation period
7- 10 days
Malaria
spread
Female anopheles mosquito
Malaria
Sx
- high- grade cyclical fever
- diarrhea, vomiting
- flu- like Sx
- Jaundice
- Anemia, thrombocytopenia
- Chills, rigors
Hepatosplenomegaly
High- grade fever
chills and rigors
Recent travel Hx to Africa
Malaria!
Malaria
complications
- severe anemia
- hepatic, liver failure
- renal failure
- cerebral malaria
Malaria
Dx
- thick film- +/- to malaria
- thin film- the causative species
Malaria
Rx
- Quinine
- Artemether
- Artesunate
Malaria
Rx for Pl vivax malaria
- Chloroquine
- Primaquine
Malaria
Cerebral edema risk is highest
Pl falciparum
Malaria
Malaria MO that are mostly seen in SL
- Pl falciparum
- Pl vivax
Malaria
Immediate Dx test
RAT
Malaria
Prevention
- prophylaxis- primaquien before traveling to high risk areas
- mosquito nets, repellants
- cleaning breeding areas
Malaria
Best drug for the hepatic form of Pl vivax
Primaquine
Malaria
ADRS of Quinine
hypoglycemia
Malaria
ADRS for Primaquine, Chloroquine
G6PD deficiency. Not given during PG
Typhoid
MO
Salmonella typhi
Salmonella paratyphi
Typhoid
Incubation period
7-14 days
Typhoid
spread
Feco- oral route
Typhoid
Salmonella is G+ or G-?
G- flagellated
Typhoid
Clinical features
- Worsening fever, headache, cough, abd pain, anorexia, malaise, myalgia
- GI Sx- Starts with constipation upto diarrhea
- mild to mod soft splenomegaly, bradycardia, rose- colored spots on the trunk
Typhoid
Complications
- GI perforation - Peritonitis
- Myocarditis
- Hepatitis
- Nephritis
- Meningitis
- Osteomyelitis
Typhoid
Dx
- 1st week- Blood culture
- 2nd week- urine and stool culture
- after first week BM culture can be done
- Standard agglutination test (SAT)- after one week. H Ag and O Ag
Typhoid
SAT which antigen is most specific of typhoid
O Ag
Typhoid
Rx
iv 3rd Gen cephalosporin + azithromycin - cefotaxime +clarithromycin (7-10 days)
Typhoid
Prevention
- Practicing safe food hygiene methods
- vaccination against typhoid (3 yearly)
Typhoid
Typhoid vaccine is included in the EPI or not
not included
Constipation, fever turning into abd pain, diarrhea
Hx of food intake from outside
Rose spots
Relative bradycardia
Typhoid
Typhoid
Carriers
MO lodge in the gall bladder and cholecystectomy should be offered
Typhoid
Typical Abdomen
Doughy abdomen
Typhoid
Drug used in the past but not given anymore
Chloramphenicol - aplastic anemia
Typhoid
Why is ciprofloxacin not given to children
cause cartilage, growth problems
Typhoid
3rd Gen cephalosporins cover
Both G+ and G- but mostly G- coverage
Leptospirosis
MO
Leptospira
Leptospirosis
Incubation period
7-14 days
Leptospirosis
Spread
Via contaminated soil or water mainly muddy water, paddy fields. Bacteria infect domestic and wild animals and are excreted in animal urine to soil or water
Leptospirosis
Clinical features during the first week
- fever, chills
- headache
- muscle soreness in the calves
- redness of the eyes- conjunctivitis, conjunctival suffusions
- Abd pain, nausea, vomiting
- skin rash over the shins ( pretibial)
Leptospirosis
how long does the fever last
around a week and it settles for 1-3 days and again returns with additional Sx
* Uveitis, iritis
* Meningitis
* Hepatitis
* Lymphadenitis
Leptospirosis
Dx
- IgG, IgM in blood samples
- Culture of leptospira- body fluids or tissue
- Dark field microscopy
Leptospirosis
Ix
- FBC
- LFT
- RFT
- Coagulation studies
Leptospirosis
Complications
- Hepatitis, Jaundice
- Bleeding
- Kidney failure
- Irregular heart rhythm
- Hemorrhagic pneumonitis
- Meningitis
Leptospirosis
Hepatitis and Jaundice
Weil’s disease
Leptospirosis
Rx- prophylaxis
- <8 y/o- PO amoxicillin
- > 8y/o- doxycycline
Leptospirosis
Rx
- iv penicillin
Leptospirosis
why is doxycycline not given to children <8 years
cause teeth abnormalities- teeth staining
Leptospirosis
Prevention
- Personal hygiene- protective boots
- Avoid muddy waters
- Vaccination of pets
Scrub typhus
MO
Rickettsia (Orientia tsutsugamishi)
Scrub typhus
Incubation period
5-20 days
Scrub typhus
Spread
- Bite of an infected mite larvae or chigger
- Transmitted to humans and rodents by the mites
- Children goes to jungles, tree areas with no shirts
Scrub typhus
Sx
- Chigger bites
- Headache
- Fever
- Shaking chills
- Conjunctivitis
- Lymphadenopathy
- Spotted rash on trunk
- splenomegaly
- Hepatomegaly
Scrub typhus
chigger bite
Painless, localized itch, an eschar seen on the groin, axilla, genitalia, neck
Scrub typhus
Eschar
Resembles cigarette burn marks
Scrub typhus
complications
- CNS, pulmonary, cardiac involvement
- Renal failure
- Shock
- DIC
Scrub typhus
Dx
- Early lymphopenia
- Late lymphocytosis
- Decreased CD4:CD8 ratio
- Thrombocytopenia
- Increased AST, ALT
- Hypoalbuminemia
- IgM, IgG elevated
Scrub typhus
Rx
- > 8y/o- Doxycycline
- <8y/o- Azithromycin
Scrub typhus
Prevention
- Vector control
- Protective clothing
Congenital Rubella
Sx
- LBW
- Microcephaly
- Cataracts
- PDA
- Pulm Stenosis
- Hepatosplenomegaly
- Thrombocytopenia
- Rash
CMV
Sx
- LBW
- Microcephaly
- Chorioretinitis
- Brain calcification
- Hepatosplenomegaly
CMV
Dx
Urine sample for CMV
CMV
Mx
- Anti- viral
- Acyclovir
Toxoplasmosis
Sx
- Hydrocephalus
- Diffuse calcification in basal ganglia
- Eye abnormalities
Toxoplasmosis
Vector
Domestic pets
Toxoplasmosis
Mx
Anti- parasitic drugs
Congenital infection
Signs
- Baby too small <2.5kg
- PG mom has fever+ rash
- SGA baby
- Microcephaly
- Abnormal eyes- cataracts
- PDA
- Bleeding manifestations
- Hepatosplenomegaly
Congenital infections
TORCH
- toxoplasmosis
- Rubella
- CMV
- Hepatitis, HIV, Herpes