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Y4 paediatrics > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

Macular/maculopapular viral rashes

A

Roseola infantum
Slapped cheek
Measles
Rubella

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2
Q

Macular/maculopapular bacterial rashes

A

Scarlet fever
Rheumatic fever
Typhoid fever
Lyme’s disease

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3
Q

Macular/maculopapular rash other causes

A

Kawasaki’s disease
Juvenile RA

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4
Q

Vesicular, bullous or pustular viral rashes

A

Herpes simplex
Varicella
Hand-foot-and-mouth

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5
Q

Vesicular, bullous or pustular bacterial rashes

A

Boils
Impetigo
Staphylococcal scalded skin

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6
Q

Vesicular, bullous or pustular rashes other causes

A

Erythema multiforme
TEN
SJS

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7
Q

Petechial/purpuric viral rashes

A

Enterovirus
Adenovirus

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8
Q

Petechial/purpuric bacterial rashes

A

Meningococcal
Infective endocarditis

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9
Q

Petechial/purpuric rashes other causes

A

HSP
Thrombocytopenia
Vasculitis

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10
Q

Cellulitis

A

Bacterial infection that affects the dermis and the deeper subcutaneous tissues

Clinical diagnosis

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11
Q

Cellulitis clinical features

A

Commonly occurs on shins → usually unilateral

Erythema → well-demarcated margins

Swelling

Systemic upset - fever, malaise & nausea

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12
Q

Cellulitis classification

A

Eron classification

I - no signs of systemic toxicity & no uncontrolled co-morbidities

II - person is either systemically unwell/systemically unwell but a co-morbidity that may complicate resolution of infection

III - significant systemic upset/unstable co-morbidities/limb-threatening infection due to vascular compromise

IV - sepsis syndrome/severe life-threatening infection

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13
Q

Cellulitis admission criteria

A

Eron class III/class IV cellulitis

Severe or rapidly deteriorating cellulitis

Very young (< 1 year) or frail

Immunocompromised

Significant lymphoedema

Facial cellulitis/periorbital cellulitis

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14
Q

Cellulitis mx

A

Guided by Eron classification

I - oral flucloxacillin, clarithromycin/erythromycin/doxycycline for penicillin allergic

II - admission may not be required if facilities are available in the community & can be monitored closely

III-IV - admit, IV co-amoxiclav/clindamycin/cefuroxime/ceftriaxone

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15
Q

Epiglottitis

A

Acute, life threatening condition, most commonly caused by an infection

Epiglottis = flap of cartilage behind the tongue, designed to protect the larynx during swallowing

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16
Q

Epiglottitis pathophysiology

A

H. influenzae and strep pneumoniae may locally invade the epiglottis → inflammation

Inflammation starts on the lingual surface of the epiglottis before spreading to other laryngeal structures → aryepiglottic folds, the arytenoids and supraglottic larynx

Children are at a higher risk of acute airway obstruction as epiglottis is much more floppy, broader, longer & angled more obliquely to the trachea

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17
Q

Epiglottitis risk factors

A

Children not receiving the HiB vaccine

Male gender

Immunosuppression

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18
Q

Epiglottitis clinical features

A

4 D’s - dyspnoea, dysphagia, drooling & dysphonia

Symptoms < 12 hours & typically no cough

High grade fever, sore throat, dehydration & signs of partial airway obstruction

Stridor is a late sign

Some children may adopt a tripod position → patient leans forward on outstretched arms with neck extended & tongue out

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19
Q

Epiglottitis ix

A

Shouldn’t be examined → high risk of airway obstruction

Throat swabs - bacterial and viral

Blood tests - FBC, cultures & CRP

Lateral neck x-ray

  • thumb-print sign
  • thickened aryepiglottic folds
  • increased opacity of the larynx and vocal cards

CT/MRI only if not responding to the initial treatment

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20
Q

Epiglottitis mx

A

Secure the airway

Oxygen

Nebulised adrenaline

IV antibiotics - cefotaxime/ceftriaxone

IV steroids

IVI - resus and maintenance

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21
Q

Epiglottitis complications

A

Mediastinitis - infection spreads to retropharyngeal space

Deep neck space infection

Pneumonia

Meningitis

Sepsis/bacteraemia

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22
Q

Neonatal HSV aetiology

A

Can occur when the baby comes into contact with primary vesicles in the maternal genital tract during delivery

Risk is low with recurrent herpes infection

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23
Q

Neonatal HSV clinical features

A

Vesicular lesions on the skin

Eye involvement

Oral mucosa involvement, without internal organ involvement

Disseminated features - seizures, encephalitis, hepatitis, sepsis

Features commonly appear in first week of birth but manifestation can be as late as fourth week of life

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24
Q

Neonatal HSV ix

A

Identifying presence of virus in the newborn - PCR, virus culture, DFA testing

MRI brain - cases of suspected encephalitis

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25
Q

Neonatal mx

A

Parenteral acyclovir with intensive supportive therapy for severe cases

Elective c-section/intrapartum IV acyclovir may be advised if active primary herpes lesions are present on mother at term OR primary outbreak within 6 weeks of labour

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26
Q

8 weeks vaccine

A
  • 6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenza type B (Hib) and hepatitis B)
  • meningococcal type B
  • rotavirus (oral vaccine)
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27
Q

12 weeks vaccine

A
  • 6 in 1 vaccine
  • pneumococcal
  • rotavirus
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28
Q

16 weeks vaccine

A
  • 6 in 1 vaccine
  • meningococcal type B
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29
Q

1 year vaccine

A
  • 2 in 1 (haemophilus influenza type B and meningococcal type C)
  • pneumococcal
  • MMR vaccine
  • meningococcal type B
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30
Q

Yearly from age 2-8 vaccine

A

influenza vaccine (nasal vaccine)

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31
Q

3 years 4 months vaccine

A
  • 4 in 1 (diphtheria, tetanus, pertussis and polio)
  • MMR vaccine
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32
Q

12-13 years vaccine

A

HPV vaccine

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33
Q

14 years vaccine

A
  • 3 in 1 (tetanus, diphtheria and polio)
  • meningococcal groups A, C, W & Y
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34
Q

Malaria

A

Disease caused by Plasmodium protozoa which is spread by the female Anopheles mosquito

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35
Q

Malaria protective factors

A

Sickle-cell trait

G6PD deficiency

HLA-B53

Absence of Duffy antigens

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36
Q

Features of severe malaria

A

Schizonts on a blood film

Parasitaemia > 2%

Hypoglycaemia

Acidosis

Temperature > 39

Severe anaemia

Complications

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37
Q

Malaria complications

A

Cerebral malaria - seizures, coma

Acute renal failure - blackwater fever, secondary to intravascular haemolysis

ARDS

Hypoglycaemia

DIC

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38
Q

Uncomplicated falciparum malaria management

A

Artemisinin-based combination therapies as first-line

E.g. artesunate + amodiaquine

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39
Q

Severe falciparum malaria management

A

Parasite count > 2% → parenteral mx irrespective of clinical state

IV artesunate

Parasite count > 10%, exchange transfusion should be considered

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40
Q

Non-falciparum features

A

General features of malaria - fever headache, splenomegaly

Plasmodium vivax/ovale - cyclical fever every 48 hours, plasmodium malariae - cyclical fever every 72 hours

Plasmodium malariae - associated with nephrotic syndrome

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41
Q

Non-falciparum management

A

Artemisinin-based combination therapy or chloroquine

ACTs avoided in pregnant women

Patients with ovale/vivax - given primaquine following acute mx with chloroquine to destroy liver hypnozoites & prevent relapse

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42
Q

Measles clinical features

A

Prodromal phase - irritable, conjunctivitis, fever

Koplik spots - typically develop before the rash, white (’grain of salt’) on the buccal mucosa

Rash - starts behind ears then to the whole body, discrete maculopapular rash becoming blotchy & confluent

  • desquamation that typically spares the palms & soles may occurs after a week

Diarrhoea (10%)

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43
Q

Measles ix

A

Measles-specific IgM and IgG serology (ELISA)

  • most sensitive 3-14 days after onset of the rash

Measles RNA detection by PCR

  • best for swabs taken 1-3 days after rash onset
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44
Q

Measles mx

A

Mainly supportive

Vitamin A in children < 2 years

Admission may be considered in immunosuppressed/pregnant patient

Notifiable disease → inform public health

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45
Q

Measles complications

A

Otitis media

Pneumonia

Encephalitis

Subacute sclerosing panencephalitis - 5-10 years after illness

Febrile convulsions

Keratoconjunctivitis, corneal ulceration

Diarrhoea

Increased risk of appendicitis

Myocarditis

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46
Q

Measles mx of contacts

A

Child not immunised against measles comes into contact → MMR should be offered

  • given within 72 hours
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47
Q

Meningitis

A
  • inflammation of the meninges
  • meningococcal septicaemia = meningococcus (N. meningitidis) infection in the bloodstream
    • causes ‘non-blanching rash’ → DIC & subcutaneous haemorrhages
  • bacterial meningitis - neisseria meningitidis & strep pneumoniae; in neonates = GBS
48
Q

Meningitis presentation

A

Fever

Neck stiffness

Vomiting

Headache

Photophobia

Altered consciousness

Seizures

Meningococcal septicaemia → non-blanching rash

Neonates & babies → hypotonia, poor feeding, lethargy, hypothermia & bulging fontanelle

Kernig’s test & Brudzinski’s test

49
Q

Management of bacterial meningitis

A
  • community - suspected meningitis & a non blanching rash should receive an urgent stat injection (IM/IV) of benzylpenicillin prior to transfer to hospital
  • hospital → blood culture & LP for CSF should be performed prior to starting abx
    • if pt is acutely unwell → abx should not be delayed
  • sent blood tests for meningococcal PCR
  • typical abx:
    • under 3 months: cefotaxime & amoxicillin (cover listeria)
    • above 3 months: ceftriaxone
    • vanc can be added if there is a risk of penicillin resistant pneumococcal infection
  • steroids → reduce frequency & severity of hearing loss and neurological damage
  • notifiable disease
50
Q

Meningitis post exposure prophylaxis

A

Risk highest for people that have had close prolonged contact within the 7 days prior to the onset of the illness

Single dose of ciprofloxacin

51
Q

Viral meningitis

A

Most common causes - HSV, enterovirus & VZV

Sample of CSF should be sent for viral PCR testing

Supportive treatment, aciclovir can be used to treated suspected/confirmed HSV or VZV infection

52
Q

Meningitis complications

A

Hearing loss

Seizures & epilepsy

Cognitive impairment and LD

Memory loss

Cerebral palsy

53
Q

Mumps

A
  • viral infection spread by respiratory droplets
  • incubation period is 14-25 days
54
Q

Mumps clinical features

A

Initial period of flu-like symptoms known as the prodrome

  • fever
  • muscle aches
  • lethargy
  • reduced appetite
  • headache
  • dry mouth

Parotid gland swelling after flu-like symptoms, either unilateral/bilateral

Abdominal pain

Testicular pain & swelling

Confusion, neck stiffness & headache

55
Q

Mumps mx

A

Diagnosis confirmed with PCR testing on a saliva swab

Blood/saliva can be tested for antibodies to the mumps virus

Notifiable disease

Supportive management → rest, fluids & analgesia

56
Q

Mumps complications

A

Pancreatitis

Orchitis

Meningitis

Sensorineural hearing loss

57
Q

Preseptal cellulitis

A

Infection of the soft tissues anterior to the orbital septum - the eyelids, skin and subcutaneous tissue of the face

Can progress to orbital cellulitis

58
Q

Preseptal cellulitis epidemiology

A

Most commonly occurs in children

  • 80% of pts are < 10
  • median age is 21 months

More common in the winter due to the increased prevalence of RTIs

59
Q

Preseptal cellulits aetiology

A

Staph aureus

Staph epidermidis

Streptococci

Anaerobic bacteria

60
Q

Preseptal cellulitis clinical features

A

Red, swollen, painful eye of acute onset

Fever

Oedema of the eyelids

Partial/complete ptosis of the eye due to swelling

Orbital signs - must be absent

61
Q

Preseptal cellulitis ix

A

Bloods

Swab of any discharge present

Contrast CT may help to differentiate between preseptal and orbital cellulitis

62
Q

Preseptal cellulitis mx

A

All cases should be referred to secondary care for assessment

Oral abx are frequently sufficient → co-amoxiclav

Children may require admission for observation

63
Q

Orbital cellulitis

A

Result of an infection affecting the fat & muscles posterior to the orbital septum, within the orbit but not involving the globe

Usually caused by a spreading URTIs

Medical emergency requiring hospital admission & urgent senior review

64
Q

Orbital cellulitis risk factors

A

Childhood - 7-12 years

Previous sinus infection

Lack of Hib vaccination

Recent eyelid infection/insect bite on eyelid

Ear or facial infection

65
Q

Orbital cellulitis clinical features

A

Redness and swelling around the eye

Severe ocular pain

Visual disturbance

Proptosis

Ophthalmoplegia/pain with eye movements

Eyelid oedema & ptosis

Drowsiness +/- N&V in meningeal involvement

66
Q

Orbital cellulitis ix

A

FBC - WBC elevated, raised inflammatory markers

Clinical examination - complete ophthalmological assessment

CT with contrast

Blood culture & microbiological swab to determine the organism

67
Q

Orbital cellulitis mx

A

Admission to hospital with IV abx

68
Q

OM

A
  • infection in the middle ear
  • often preceded by a viral URTI → bacteria enter from the back of the throat through the eustachian tube
69
Q

OM bacteria

A

Most common - streptococcus pneumoniae

Other common causes: haemophilus influenzae, moraxella catarrhalis & staph aureus

70
Q

OM presentation

A

Ear pain

Reduced hearing in the affected ear

General symptoms of URTI → fever, cough, coryzal symptoms, sore throat & generally unwell

Can cause balance issues & vertigo when the infection affects the vestibular system

Can be discharge if tympanic perforation

Non-specific symptoms in young children → fever, vomiting, lethargy or poor feeding

71
Q

OM examination

A

Bulging, red, inflamed looking membrane

If perforation → may see discharge in the ear canal & hole in the tympanic membrane

72
Q

OM mx

A

Consider referral to paediatrics for assessment or admission if symptoms are severe or there is diagnostic doubt

Most cases of otitis media will resolve without antibiotics

Simple analgesia to help with pain and fever

First line antibiotic → amoxicillin for 5 days

  • alternatives are erythromycin and clarithromycin
73
Q

OM complications

A

Otitis media with effusion

Hearing loss (usually temporary)

Perforated eardrum

Recurrent infection

Mastoiditis

Abscess

74
Q

Rubella

A

Viral infection caused by the togavirus

75
Q

Rubella timeline

A

Outbreaks more common around winter and spring

Incubation period is 14-21 days

Individuals are infectious from 7 days before symptoms appear to 4 days after onset of the rash

76
Q

Rubella features

A

Prodrome - low grade fever

Rash - maculopapular, initially on face before spreading to the whole body, usually fades by 3-5 days

Lymphadenopathy - suboccipital & postauricular

77
Q

Rubella complications

A

Arthritis

Thrombocytopaenia

Encephalitis

Myocarditis

78
Q

Features of congenital rubella syndrome

A

Sensorineural deafness

Congenital cataracts

Congenital heart disease

Growth retardatation

Hepatosplenomegaly

Purpuric skin lesions

79
Q

Suspected rubella in pregnant women diagnosis

A

Discussed immediately with local health protection unit

IgM antibodies are raised in women recently exposed to the virus

Very difficult to distinguish rubella from parvovirus B19 → important to check parvovirus B19 serology

80
Q

Suspected rubella in pregnant women management

A

Discussed with local HPU

Advised to keep away from those who might have rubella

Non-immune mothers should be offered the MMR vaccination in post-natal period

  • should not be administered to women known the be pregnant/attempting to become pregnant
81
Q

Tonsillitis

A

Inflammation of the palatine tonsils as a result of either a bacterial or viral infection

82
Q

Tonsillitis organisms

A

Viral - adenovirus, EBV

Bacteria - group A strep

83
Q

Tonsillitis risk factors

A

Smoking

84
Q

Tonsillitis clinical features

A

Sore throat

Fever

Pain on swallowing

Red, inflamed & enlarged tonsils

Anterior cervical lymphadenopathy

85
Q

Tonsillitis Centor criteria

A

Can be used to estimate the probability that tonsilitis is due to bacterial infection & will benefit from abx

Score > 3, appropriate to offer abx

Fever > 38

Tonsillar exudates

Absence of cough

Tender anterior cervical lymph nodes

86
Q

FeverPAIN score

A

Higher score = more chance of bacterial infection

Fever during previous 24 hours

Purulence

Attended within 3 days of the onset of symptoms

Inflamed tonsils

No cough or coryza

87
Q

Tonsillitis mx

A

1st line - Penicillin V 500mg QDS for 5-10 days

Alternative in penicillin allergy: clarithromycin/erythromycin PO BD for 5 days

Delayed prescriptions can be considered

88
Q

Tonsillitis complications

A

Peritonsillar abscess

Otitis media

Scarlet fever

Rheumatic fever

89
Q

Tonsillitis post-streptococcal conditions

A

Post-streptococcal glomerulonephritis

Post-streptococcal reactive arthritis

90
Q

Toxic shock syndrome

A

Severe systemic reaction to staphylococcal exotoxins, the TSST-1 superantigen toxin

91
Q

Toxic shock syndrome diagnostic criteria

A

Temperature > 38.9

Hypotension: systolic BP < 90 mmHg

Diffuse erythematous rash

Desquamation of rash, especially of the palms and soles

Involvement of three or more organ systems: eg, GI (D&V), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement

92
Q

Toxic shock syndrome mx

A

Removal of infection focus

IV fluids

IV abx

93
Q

Viral exanthema

A

First disease - measles
Second disease - scarlet fever
Third disease - rubella
Fourth disease - duke’s disease
Fifth disease - parvovirus B19
Sixth disease - roseola infantum

94
Q

Scarlet fever

A

Associated with group A strep infection, usually tonsilitis (not caused by a virus !)

Caused by an exotoxin produced by streptococcus pyogenes

95
Q

Scarlet fever presentation

A

Characterised by a red-pink, blotchy, macular rash with rough ‘sandpaper’ skin that starts on the trunk & spreads outwards

Fever

Lethargy

Flushed face

Sore throat

Strawberry tongue

Cervical lymphadenopathy

96
Q

Scarlet fever mx

A

Phenoxymethylpenicillin for 10 days - kept off school until 24 hours after starting antibiotics

Notifiable disease

97
Q

Scarlet fever associations

A

Post-streptococcal glomerulonephritis

Acute rheumatic fever

98
Q

Duke’s disease

A

Never used in clinical practice

Used to describe the non-specific viral rashes

99
Q

Parvovirus B19 presentation

A

Mild fever, coryza and non-specific viral symptoms

After 2-5 days → rash appears quite rapidly as a diffuse bright red rash on both cheeks

Few days later → a reticular mildly erythematous rash affecting the trunk & limb appears that can be raised and itchy

100
Q

Parvovirus B19 mx

A

Self limiting & rash and symptoms usually fade over 1-2 weeks

Once rash has formed can go back to school

101
Q

Parvovirus B19 complications

A

Aplastic anaemia

Encephalitis or meningitis

Pregnancy complications including fetal death

Rarely → hepatitis, myocarditis or nephritis

102
Q

Roseola infantum

A

Caused by human herpesvirus 6 and less frequently by human herpesvirus 7

102
Q

Roseola infantum clinical features

A

1-2 weeks after infection with a high fever (up to 40 degrees) that comes on suddenly, lasts for 3-5 days & then disappears suddenly

Coryzal symptoms, sore throat & swollen lymph nodes

Rash → when fever settles, appears for 1-2 days, not itchy

103
Q

Roseola infantum mx

A

Make a full recovery within a week

Do not need to be kept off nursery if they are well enough to attend

104
Q

Roseola infantum complications

A

Febrile convulsions due to high temperature

Immunocompromised patients → myocarditis, thrombocytopenia and Guillain-Barre syndrome

105
Q

No school exclusion

A

Conjunctivitis

Fifth disease (slapped cheek)

Roseola

Infectious mononucleosis

Head lice

Threadworms

Hand, foot and mouth

106
Q

Scarlet fever school exclusion

A

24 hours after commencing antibiotics

107
Q

Whooping cough school exclusion

A

2 days after commencing abx OR

21 days from onset of symptoms if no abx

108
Q

Measles school exclusion

A

4 days from onset of rash

109
Q

Rubella school exclusion

A

5 days from onset of rash

110
Q

Chickenpox school exclusion

A

All lesions crusted over

111
Q

Mumps school exclusion

A

5 days from onset of swollen glands

112
Q

D&V school exclusion

A

Until symptoms have settled for 48 hours

113
Q

Impetigo school exclusion

A

Until lesions are crusted and healed OR

48 hours after commencing abx treatment

114
Q

Scabies school exclusion

A

Until treated

115
Q

Influenza school exclusion

A

Until recovered

Y4 paediatrics (8 decks)

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