Infectious Diseases Flashcards
Overview of pneumonia
-Reliable signs of pneumonia in children are tachypnoea, respiratory distress and hypoxia
-Respiratory distress = grunting, “indrawing” of chest wall, other signs of increased work of breathing
=Under 3 with signs of sepsis: chest X ray, subtle clinical signs, temp above 38.5, refuse food and drink
=Cough may be absent
=Lethargy, fever, high HR out of proportion to degree of fever, tachypnoea
Overview of whooping cough
-Gram -ve Bordetella pertussis
-Immunised at 2,3,4 months and 3-5 years
-P: catarrhal phase (symptoms are similar to a viral upper respiratory tract infection, lasts around 1-2 weeks)
=Paroxysmal phase (the cough increases in severity, coughing bouts are usually worse at night and after feeding, may be ended by vomiting & associated central cyanosis, inspiratory whoop: not always present (caused by forced inspiration against a closed glottis), infants may have spells of apnoea, persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizures, lasts between 2-8 weeks)
=Convalescent phase (the cough subsides over weeks to months)
-I: per nasal swab culture for Bordetella pertussis - may take several days or weeks to come back. PCR and serology are now increasingly used as their availability becomes more widespread. Suspected if person has an acute cough that has lasted for 14 days or more with paroxysmal cough, inspiratory whoop, post-tussive vomiting, undiagnosed apnoeic attacks in young infants
-M: infants under 6 months with suspect pertussis should be admitted
in the UK pertussis is a notifiable disease
an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread
household contacts should be offered antibiotic prophylaxis
antibiotic therapy has not been shown to alter the course of the illness
school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
Describe chickenpox
Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild
Describe measles
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Describe mumps
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Describe rubella
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
Describe erythema infectiosum
Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
Describe scarlet fever
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Describe hand foot and mouth disease
Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
Overview of UTI
-No source of fever common in first assessment
-Urinary tract infections (UTI) are more common in boys until 3 months of age (due to more congenital abnormalities) after which the incidence is substantially higher in girls. At least 8% of girls and 2% of boys will have a UTI in childhood
-Predisposing factors: incomplete bladder emptying ((infrequent voiding, hurried micturition, obstruction by full rectum due to constipation, neuropathic bladder), vesicoureteric reflux (developmental anomaly in 35% children), poor hygiene not wiping from front to back)
-Crying while passing urine
-Non specific: fever, vomiting, poor feeding, abdo pain, irritability, dysuria in younger children. Older: dysuria, frequency, haematuria
-Urine sample clean catch, full culture if dipstick positive
-E.coli (80%), proteus, pseudomonas
-M: <3 months referred immediately, older with Upper UTI consider admission and cephalosporin or co-amoxiclav 7-10 days, lower UTI trimethoprim or nitrofurantoin
Overview of vesicoureteric reflux
Vesicoureteric reflux (VUR) is the abnormal backflow of urine from the bladder into the ureter and kidney. It is a relatively common abnormality of the urinary tract in children and predisposes to urinary tract infection (UTI), being found in around 30% of children who present with a UTI. As around 35% of children develop renal scarring it is important to investigate for VUR in children following a UTI
Pathophysiology of VUR
ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle
therefore shortened intramural course of the ureter
vesicoureteric junction cannot, therefore, function adequately
Possible presentations
antenatal period: hydronephrosis on ultrasound
recurrent childhood urinary tract infections
reflux nephropathy
term used to describe chronic pyelonephritis secondary to VUR
commonest cause of chronic pyelonephritis
renal scar may produce increased quantities of renin causing hypertension
Investigation
VUR is normally diagnosed following a micturating cystourethrogram
a DMSA scan may also be performed to look for renal scarring
Overview of bone or joint infection
-Signs of bone or joint infection are; not using a limb, limping, or refusing to walk, may not be warmth or redness
-Osteomyelitis or septic arthritis: look at elbow, hip, knee
-Refer to surgery
Overview of Kawasaki disease
-Disease of childhood, usually under 2
-Fever for 5 days? - consider Kawasaki disease =>39 for 5 days
=Rash (maculopapular, non specific)
=Bilateral non-purulent conjunctivitis
=Mucous membrane changes (strawberry tongue, red fissuring lips, diffuse injection of oropharyngeal mucous membrane)
=Cervical lymphadenopathy (node size >1.5cm, usually single)
=Extremity changes (erythema of palms or soles, swelling of fingers or toes, desquamation of fingertips or toes)
=Irritable, cardiac changes myocarditis, coronary artery aneurysm, MI)
-Kawasaki disease needs treating within the first 10 days of fever
Overview of influenza
-Headache, fever, extreme tiredness, joint ache, runny or snuffly nose, sore throat, aches, coughing, vomiting, diarrhoea, rash
-Antiviral if epidemic
-Paracetamol, ibuprofen
Overview of meningitis and meningococcal sepsis
-Neonatal: E.coli, Group B step
-6 weeks to 2 years: Influenza B, pneumococcus meningococcus
-2-16 years: viral, tuberculosis meningococcus B
-Early features of meningitis and septicaemia are non-specific – fever, lethargy, vomiting
-Features of bacterial meningitis in a child death from CNS failure):
=neck stiffness
=bulging fontanelle
=decreased level of consciousness
=convulsive status epilepticus
-Features of meningococcal disease (death by cardiovascular system) include fever and a non-blanching rash, particularly:
=an ill-looking child, fever, rigors
=non-blanching lesions larger than 2 mm in diameter (purpura); blanch in early stages
=a capillary refill time of 3 seconds or longer
=neck stiffness
=Pale or mottled skin, cold hands and feet, difficult to wake, confused, muscle pain
-IM ceftriaxone, penicillin
-Meningitis research foundation
