Infectious diseases Flashcards
what is used to assess sepsis risk?
qSOFA
(Septic organ failure assessment)
what are the 3 criteria for qSOFA (sepsis risk assessment)?
- > 22 RR
- <15 GCS
- 100mmHg or less systolic
at least 2 our of these 3 = RISK
How do we assess a sick child?
according to traffic light system
what sections are assess in the traffic light system?
CARChO
- Colour
- Activity
- RR
- Circulation / hydration
- Other
what is in the green section of the traffic light system?
Colour:
Normal colour
Activity:
-Responds normally to social cues
-Smiles/content
-stays awake or quickly awakens
-Strong normal crying/not crying
Resp rate normal
Circulation + Hydration:
-Normal eyes
-moist mucous membranes
Other:
-None of the amber or red Sx
what is in the amber section of the traffic light system?
Colour:
-Pallor - reported by parent/carer
Activity:
-Not responding normally to social cues
-No smile
-wakes only with prolonged stimulation
-decreased activity
Resp:
-nasal flaring
-Tachypnoea:
RR>50, 6-12 months
RR >40, >12 months
-Oxygen sats 95% or less on air
-crackles in chest
Circulation + hydration:
-Tachycardia:
>160bpm, <12 months
>150bpm, 12-24 months
>140bpm, 2-5y
-CRT 3+
-Dry mucous membranes
-Poor feeding in infants
-Reduced urine output
Other:
-age 3-6months + 39+*C
-Fever for 5+ days
-Rigors
-Swelling
-Non weight bearing limb/joint
what is in the red section of the traffic light system?
Colour:
-Pale/mottles/ashen/blue
Activity:
-No response to social cues
-Appears ill to a healthcare professional
-Does not wake or if roused doesn’t stay awake
-weak, high pitched cry
RR:
-Grunting
-Tachypnoea:
RR>60
-Moderate or severe chest indrawing
circulation + hydration:
-Reduced tissue turgor
Other:
-Age <3 months, temp 38+*C
-Non blanching rash
-Bulging fontanelle
-Neck stiffness
-Status epilepticus
-Seizures
what are the next steps for Low, moderate and severe risk in the traffic light system?
Low = safety net along
Moderate = + F2F assessment to judge admission or not
Severe = Urgent admission
what is Kawasaki disease?
ages it affects?
Ethnicity it affects?
Medium cell vasculitis
under 5y/o
Males, asian (Japanese + Korean) + afrocarribean
Sx of Kawasaki disease?
CRASH + BURN
-At least 4 out of 5 CRASH
Conjunctivitis (Bilateral)
Rash - maculopapular rash (widespread)
Adenopathy - anterior cervical LN
Strawberry tongue + mucosal involvement
Hands + feet - desquamation (skin peeling)
BURN, At least 5 days 39*C fever
What are the 3 phases of Kawasakis?
Acute phase (1-2 weeks) - fever, rash, LNadenopathy
Subacute phase (2-4 weeks) - Sx settle, desquamation + risk of coronary artery aneurysm
Convalescent stage (2-4 weeks) - remaining Sx settle + blood markers slowly normalise
Dx of Kawasaki?
Bloods = FBC (Low Hb, High WCC + Plt)
LFT = Low albumin, High AST/ALT
High ESR
Urinalysis = High WCC (no infection)
ECHO = CA pathology
Tx of Kawasaki?
IV IG (Sx improvement + lower CA aneurysm risk)
High dose aspirin (anti inflammatory + reduce thrombosis risk)
Do serial ECHO 2w onwards = 20% Px have coronary artery aneurysm as a complication
Why is aspirin usually CI?
what does it cause?
Reye syndrome
Neurohepatic Sx (brain + liver swelling) = encephalitis/AMS, Jaundice, seizures/LOC
What is VZV?
What 2 conditions does it cause?
in what age?
Vericella zoster virus (herpes virus)
Causes:
- Varicella (chicken pox)
-Herpes zoster (shingles)
> 5% children by 5
how is chicken pox spread?
Resp (airborne)
Direct contact
what are the Sx of chicken pox?
Prodrome?
Contagious 4 days before - exanthema (rash) - 5 days after (incubation period = 3 weeks)
Prodrome =
Fever (1st Sx), Itch, general fatigue, malaise
Macular - papular - vesicular - crusting (widespread erythematous raised vesicular fluid filled lesions) - start at trunk or face to whole body in 2-5 days
when is chicken pox no longer infectious?
When the rash has crusted
Dx of chicken pox?
Clinical
Tx of chicken pox?
Self limiting, supportive
Acyclovir if severe (immunocompromised)
Itchy = calamine lotion
How long is school exclusion in chicken pox?
5 days post exanthem (crusted over)
Complications of shingles?
Dormant VZV, reactivates in immunocompromised, dermatomal scarring
what is a main complication of VZV and what does it cause?
Ramsey hunt
Encephalitis, Foetal varicella (cutaneous scars, limb defect, eyes/CNS abnormalities), pneumonia
what should NOT be given in VZV and why?
DO NOT GIVE NSAIDS in VZV - can precipitate necrotising fasciitis
Is measles notifiable to PHE?
Yes
What is Measles caused by?
How is it spread?
Contagious?
Incubation period?
Morbillivirus (RNA Paramyxoviridae)
Spreads via resp droplets
Very contagious
10-14 day incubation
Sx of measles?
Prodromal (3-5days)
Cough
Coryza
Conjunctivitis
(+ 10% diarrhoea)
Then exanthem
(macular papular face + trunk rash)
Buccal koplik spots
(Pathagnomic white buccal mucosa spots)
Dx of measles?
Clinical
IgM/G
Tx of measles?
School exclusion?
when is it no longer contagious?
School exclusion 4 days after rash (not contagious)
Notify PHE
MMR vaccine <72hrs
Contact management
What are the MC complications of measles?
Otitis media!!!!!
Encephalitis, SPSE, Febrile convulsions
what is the MC cause of death in measles?
Pneumonia
In measles, where does exanthem affect?
what also affects the child 1 week later?
Exanthem = behind ears to trunk + body
Desquamation on palms + soles = 1 week later
what is mumps caused by?
what does it affect?
how is it spread?
what ages are usually affected?
what time of year?
RNA Pymyxovirus
Salivary + parotid glands
Resp droplets + direct contact spread
15-20y
Winter, spring
is mumps notifiable to PHE?
Yes
Sx of mumps?
Fever, malaise, muscular pain,
Parotitis (parotid gland swelling) - U/L initially B/L in 70%
Incubation period of mumps?
12-25 days
Dx of mumps?
PCR on saliva swab
Blood/saliva serology = mumps viral Abs
ECG changes (15%) = ST-T depression, T inversion, PR prolongation
Tx of Mumps?
School exclusion?
Prophylaxis?
Supportive (Rest and analgesia)
Notify PHE
School exclusion 5 days after parotitis
Prophylaxis = MMR
Complication of Mumps?
Orchitis (1/3 Px)
Meningitis
Pancreatitis
What is rubella caused by?
how is it spread?
what is it also called?
is it a severe or mild disease?
when does it usually occur?
Togavirus
Resp droplets
‘German measles’
Mild disease
Winter + spring
is Rubella notifiable to PHE?
Yes
Sx of rubella?
Prodrome:
Low grade fever, sore throat, Coryza
Then
-Exanthem (macular papular rash), –Arthralgia
-Forsccheimer spots (small, red spots on the soft palate, occasionally preceding a rash)
-LNadenopathy 2 weeks after exanthem (post auricular, suboccular)
Dx of rubella?
IgG titre
Tx of rubella?
School exclusion time?
Supportive
4 days after exanthem , go back to school
Notify PHE
Complications of rubella?
1/3 = Cytokine release syndrome
(SNHL + B/L cataract + PDA + BM rash)
Encephalitis
Is hand foot and mouth notifiable to PHE?
No
What is hand foot and mouth caused by?
ages affected?
Coxsackie A16 virus
<5y/o
Sx of hand foot and mouth?
Mild URTI (upper resp tract infect)
1-2 days = small mouth ulcers
Blistering red painful vesicular lesions +/- itchy on hands, feet, mouth, tongue + buttocks
Dx of hand foot and mouth?
Clinical
Tx of hand foot and mouth?
exclusion from school?
Supportive, fluids, PRN analgesia
No exclusion from school
what is slapped cheek also called?
Erythema infectiosum
5th disease
cause of slapped cheek syndrome?
transmission?
what time of year?
Parovirus B19
Resp secretions, vertical transmission, transfusions
Spring
Sx of slapped cheek syndrome?
1 week preceding = Fever, malaise, headache, myalgia
2-5 days = rose red rash on both cheeks - progresses to macular papular rash on trunk and limbs
Tx of slapped cheek syndrome?
supportive
what can parvovirus B19 precipitate if baby has preexisting haemolytic anemia?
Aplastic crisis
Foetal hydrops fetalis
What is roseola caused by?
HHV - 6 (+ HHV-7)
Sx of roseola?
age affected?
2-3y/o with high grade fever (>40^C) then lace like rash (NOT ITCHY) on arms, legs + trunk
Cold, dissapears for a few days then rash
Tx of roseola?
Supportive
Complication of roseola?
febrile convulsion
In a febrile convulsion in roseola, what would you do if:
Drowsy >2hrs?
Simple?
complex?
Drowsy >2hr = refer
simple = 1st seizure <5m
Complex = >5m or multiple
Is scarlet fever notifiable to PHE?
Yes
What is Scarlett fever caused by?
what can it cause?
Reaction to strep pyogenes toxin (exotoxin B, C, F)
Pharyngitis (tonsillitis, strawberry tongue, forchheimer spots - red spots on soft palate)
Peak ages of scarlet fever?
how is it spread?
2-6y/o (<10y/o)
peak age 4y/o
Spread via inhalation of resp droplets, direct contact with nose/throat discharge
Sx of scarlet fever?
Fever (24-48hrs)
Sandpaper red/pink rash from trunk outwards,
strawberry tongue,
cervical LNadenopathy,
exudative tonsils
Dx of scarlet fever?
Throat swab (but start Abx)
ASOT
Tx of scarlet fever?
school exclusion time?
PO Penoxymethylpenicillin 10 days
school exclusion until 24hr post Abx
Complications of scarlet fever?
quinsy
otitis media
post strep glomerulonephritis
Rheumatic fever
S.aureus + S.pyogenes cause which 4 diseases?
Impetigo
Cellulitis
Necrotising fascitis
Staph scolded skin syndrome (SSSS)
What is impetigo?
caused by?
how is it spread?
age?
where can it be caught?
Superficial bacterial skin infection
s.aureus + s.pyogenes - direct contact with Px
<10y at daycare
warm weather
what is the main symptom in impetigo?
when is it not infectious?
school exclusion?
Honey crusted perioral lesions
When dry = non infectious
crusted over or 2 days after Abx
what are the 2 types of impetigo and which is MC and LC?
Describe each and Sx?
Bullous (LC):
More severe, always s.aureus
Non bullous (MC):
Around nose/mouth, exudate dries, golden crust (no systemic Sx)
Dx of impetigo?
Swabs of vesicles +/- exudate post Abx rash
Tx of impetigo?
- 1% hydrogen peroxide cream
- topical fusidic acid
- PO Flucoxicillin
what is CI in impetigo?
Clarythromycin
what is cellulitis?
caused by?
SC + Dermal group A strep infection
LL calf
Sx of cellulitis?
Shiny erythematous oedematous poorly defined
what is the severity classification used in cellulitis?
Eron classification 1-4
Dx of cellulitis?
R/O DVT
(bloods, D-dimer)
Tx of cellulitis?
Flucoxacillin
MRSA = Vancomycin/gentamycin
what is necrotising fascitis?
caused by?
RF?
Invasive group A transdermal total infection
RF = immunocompromised, skin condition, SGLT-2 use
Sx of necrotising fascitis?
Pain disproportionate to appearance
(then >24hr = gangrene, high fever|)
Tx of necrotising fascitis?
surgical debridement
IV Flucloxacillin
what is staph scalded skin syndrome?
caused by?
MC?
RF?
<1y/o desquamating rash due to epidemolytic toxins
Can be MC = S.Aureus or Invasive Group A strep
Immunocompromised, CKD
Sx of staph scalded skin syndrome?
Nikolsky +ve - (rubbing = skin peels off)
Erytheroderma (+90%)
No mucosal involvement
Systemic Sx
Dx and Tx of staph scalded skin syndrome?
GS = skin biopsy
ABCDE in hosp, IV Fluid + Abx (flucloxacillin)
what is Steven Johnson syndrome / toxic epidermal necrolysis?
what is the difference?
T4 hypersensitivity
(SJS<10% skin, TEN >10% ~30%)
RF for Steven Johnson syndrome / toxic epidermal necrolysis?
Causes?
Drugs MC
Lamotrigine!!!
Carbamezapine (anti epileptics)
Allopurinol
Beta lactam
NSAIDs
Other = EBV, malignancy, HIV
Sx of Steven Johnson syndrome / toxic epidermal necrolysis?
Erythroderma
Nikolsky +ve, 2+ mucosal surfaces - mouth, pharynx, urethra, rectum, vagina, eyes
Targeted lesions
Dx of Steven Johnson syndrome / toxic epidermal necrolysis?
GS = skin biopsy
Blood = Low RBC, low WCC, low platelet, High IgE
LFTs
what score is used in Steven Johnson syndrome / toxic epidermal necrolysis and what does it assess?
Scorten 7 = evaluates morality in SJS/TEN
Tx of Steven Johnson syndrome / toxic epidermal necrolysis?
Supportive
Admit + IV fluid
Analgesia
eye care (daily opthamology review)
What is toxic shock syndrome?
caused by?
Invasive group A strep (s.pyogenes)
Staph aureus
who does toxic shock syndrome affect?
scenario?
Teen girls with prolonged tampon use / menstrual cup (up to 50y)
Exposed wound infection, contraceptive diaphragm, post birth
Sx of toxic shock syndrome?
Fever 39^c+
Hypotension <90mmHg systolic
Diffuse erythematous rash
Desquamation of palms + soles
Dx of toxic shock syndrome?
Bloods, swabs, BP, ECG, Urine dip
Tx of toxic shock syndrome?
ITU; ABCDE, Remove tampon (if still in)
Advice = use pads
Sepsis 6 = including fluclox, IV fluids, Abx
toxic shock syndrome:
Involvement of 3+ organ systems (damaged), what Sx do you get?
AKS
Deranged LFT
Clotting changes
what are the 2 types of HSV?
1 AND 2
HSV 1
affects where?
Sx?
affects HEAD
(oral ulcers + encephalitis)
HSV 2
Affects where?
Sx?
affects Genetalia
(genital ulcers)
Complication of HSV?
eczema herpeticum - superimposed HSV on eczematous skin
what is erythema multiforme?
Rash (target lesion)
What is TB?
Caused by?
Spread how?
where?
T4 hypersensitivity infection by mycobacterium tuberculosis
(acid fast bacillus) - ziehl Neilson stain
Spread via saliva drops
Africa + asia (India + china)
What is the pathology of TB?
1^ Ghon focus (granuloma, upper RHL)
1^ Ghon complex (+ LN)
Millary (systemic) or latent (Asx - immune system encapsulates bacteria)
Sx of TB?
Resp and systemic?
Resp = haemoptysis, weight loss, night sweats, fever, sputum
Systemic = meningitis, scrofulous (skin + LN infection), spondylitis, Addisons
Dx of latent TB?
Mantoux skin test
Dx for active TB?
- Chest xray (bilateral hilar infiltrates, RUL consolidation, pleural effusion)
GS. Sputum MC + S
Tx of TB?
RIPE
What does RIPE stand for?
how long is each given for?
SE of each?
Rifampicin
6m, Red secretion
Isoniazid
6m, peripheral neuropathy (give pyridoxine)
Pyrazinamide
2m, hepatitis, gout
Ethambutol
2m, optic neuritis
What prophylaxis can be given for TB?
when?
Bacillus calmette - guerin vaccine, if at risk at birth
is TB and polio notifiable to Public Health England?
yes
Polio
ASx in how many Px?
spread?
1% causes?
Complication?
ASx in 70-90%
Feco-oral spread
1% = anterior horn disease = flaccid paralysis
Comp = bulbar palsy
Dx of polio?
Tx?
Prophylaxis?
Dx = viral swab, IgG
Tx = Supportive
Prophylaxis = IPV (3 in 1, 4 in 1, 6 in 1)
What is diptheria caused by?
Spread?
mainly affects where?
Corynebacterium diptheriae (bacteria), only when infected by bacteriophage - produce diphtheria toxin
Resp spread
mainly affects nose + throat
Sx of diphtheria?
Fever
Pseudomembrane (grey) on tonsils / throat
Bullneck
Swollen glands (LN) in neck
Pseudomembranous croup
Dx of diphtheria?
+ve ELEK test (toxin isolated) + grows on Loeffler Meoia
Tx of diphtheria?
prophylaxis?
DAT (antitoxin)
PO azithromycin
DTaP vaccine
what are 2 complications of diphtheria?
neuritis + myocarditis
What is scabies?
transmission?
T4 hypersensitivity vs sarcoptes scabiei protein - skin to skin transmission
Sx of scabies?
Longitudinal burrows therefore severe itch (between finger webs, worse at night + in warmth)
what is the itchy rash in scabies caused by?
10-15 mites
Dx of scabies?
Ink burrow test +ve
Tx of scabies?
Permethrin cream + hygiene advice to all household 6+ months
Complication of scabies?
Tx?
Crusted norweigen scabies (1000+ mites)
Tx = Inpatient + ivermectin
Nodular scabies = penile + groin
What is Henloch Schonlein purpura?
IgA mediated small cell vasculitis = inflammation = affecting skin + joints + GI tract + kidneys
Age of getting Henloch Schonlein purpura?
M or F?
Peaks when?
post?
<10y/o
M>F
Peaks during winter months
Post URTI or gastroenteritis
Sx of Henloch Schonlein purpura?
Purpura (100%): Legs to buttocks
Joint pain (75%) = knees / ankles
Abdo pain (50%)
Renal (50%) = IgA nephritis, H/Puria
Dx of Henloch Schonlein purpura?
Exclude Ddx of non blanching rash:
FBC / Blood film (sepsis/leukemia)
Renal profile
Albumin (nephrotic)
CRP
Urine dip
BP
Monitor urine dip for renal involvement (+ BP for htn)
Tx of Henloch Schonlein purpura?
prognosis?
Supportive - analgesia for arthralgia
Good, self limiting
Complications of Henloch Schonlein purpura?
Renal (20-55%) = Glomerulonephritis, nephrotic syndrome
GI (50-75%) = Bowel infarction, intussusseption, GI haem, bowel perf
What is molluscum contagiosum due to?
Sx?
Tx?
POX virus
Fleshy umbilical papule occurring in crops
Sx = raised itchy ring, erythamtous rash
Self limiting
What is ringworm caused by?
Sx?
Tx?
Fungi Trichophyton (tines corporis)
Raised itchy ring shaped erythematous rash
Tx = ketonazole shampoo
what is Lyme disease caused by?
spread how?
Sx? early and late
Tx?
Borelia (-ve spirochete)
Spread by ticks
Early = Bulls eye (erythema migrans)
Late = Neuroborreliosis + joint involvement
Tx = PO doxycycline
