Infectious Diseases Flashcards
Kawasaki Disease
Mucocutaneous, lymph node syndrome - a systemic medium-sized vessels vasculitis
Who does Kawasaki Disease typically present in?
Typically affects young children under 5 years with no clear cause or trigger
Who is Kawasaki Disease more common in?
More common in boys, usually Japanese and Korean children + Afrocarribean children
Symptoms of Kawasaki Disease
Persistent high fever for more than 5 days - Child will be unwell and unhappy -Widespread erythematous maculopapular rash and desquamation on the palms
and soles
- Strawberry tongue
- Cracked lips
- Cervical lymphadenopathy
- Bilateral conjunctivitis
CRASH + BURN for Kawasaki Disease
Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hands (palmar erythema, swelling), fever (>5 days)
Ix for Kawasaki Disease
FBC + LFTs + ESR + Urinanalysis + Echo
What does FBC show for Kawasaki Disease
anaemia, leukocytosis and thrombocytosis
What do LFTs show for Kawasaki Disease
hypoalbuminemia
How is ESR effected in Kawasaki Disease
Raised
What does urinanalysis show in Kawasaki Disease
Raised WBC
Why is an Echo done for Kawasaki Disease
rule out major complication: coronary artery aneurysms
Acute phase of Kawasaki Disease
child will be unwell with fever, rash and lymphadenopathy - 1-2 weeks
Subacute phase of Kawasaki Disease
- acute symptoms will settle but the arthralgia and risk of coronary artery aneurysms form - 2-4 weeks
Convalescent stage of Kawasaki Disease
remaining symptoms return back to normal and blood tests return to normal - 2-4 weeks
Management of Kawasaki Disease
High dose aspirin to reduce the risk of thrombosis - IV immunoglobulins - Public health should be informed
Complication of Kawasaki Disease
Coronary Artery Aneurysm
Measles
Despite significant vaccination, this is still a major cause of morbidity and death worldwide. - Initial exposure occurs through droplet spread and it is highly infectious during viral shedding
What causes measles?
RNA Paramyxovirus
Symptoms of Measles
- Fever
- Koplik spots (blue, white spots on the inside of the cheek)
- Conjunctivitis
- Coryza
- Cough
- Rash which spreads downwards from behind the ears to the whole of the body
- maculopapular rash. ; Infectious from prodome till 4 days after rash starts.
Ix for Measles
IgM ab, raised LFTs, Measles RNA PCR on oral fluid specimen
Management of Measles
- Supportive treatment depending on symptoms - Avoid school for at least 5 days after initial development of rash
How long does a child need to isolate with measles?
4 days after their symptoms resolve
Who should be notified with Measles cases
Notify Public Health
Complications of Measles
Otitis media (most common)
Pneumonia
Febrile convulsions
Encephalitis/Subacute sclerosing panencephalitis
Chickenpox
This is a common virus which is spread by respiratory droplets and is very infectious during viral shedding.
What causes Chicken pox?
Varicella Zoster Virus (VZV)
Symptoms of Chickenpox
Fever - Vesicular rash beginning on head and trunk which spreads to peripheries - Itching can lead to permanent scars/secondary infection
Managment of Chickenpox
Symptomatic treatment - Immunocompromised children/higher risk groups can be given aciclovir - Avoid school until lesions have crusted over (at least 5 days)
Complications of Chickenpox
Bacterial superinfection - Pneumonitis - DIC - Virus reactivation : Shingles
Rubella
A generally mild disease in childhood which occurs in winter and spring
What causes Rubella?
Togavirus , Rubella Virus
How long is the incubation period for Rubella?
Incubation period is 15-20 days
How is Rubella spread?
it is spread through respiratory contact.
Symptoms of Rubella
Symptoms start 2 weeks after exposure. Low grade fever - Maculopapular rash on the face which then spreads across the whole body.
Management of Rubella
No treatment necessary - Diagnosis should be confirmed serologically if there is any risk of exposure for non-immune pregnant women
How long should a child stay off school if they have Rubella?
5 days after the rash appears
Complications of Rubella
Arthritis - Encephalitis - Myocarditis
Congenital Rubella
•Foetal rubella syndrome can occur if a non-immune mother is infected in her 1st trimester of pregnancy → teratogenic, sensorineural deafness, congenital cataracts, CHD, cerebral palsy, microcephaly
What should you do if you suspect congenital rubella?
•If suspected: discuss with local health protection unit
Can you offer the MMR vaccine to preganant women?
NO !! Do NOT offer MMR vaccine to pregnant woman
offer non-immune mothers MMR vaccine in post-natal phase
Diphtheria
- Infection which causes local disease with membrane formation affecting the nose, pharynx or larynx or systemic disease with myocarditis and neurological manifestations. Diphtheria is a bacterial infection caused by Corynebacterium diphtheriae, primarily affecting the respiratory system but can also involve the skin
Is Diphtheria common in the UK?
It has generally been eradicated in the UK.
True or False: Diphtheria is a common disease in children today.
False. Diphtheria is rare in countries with high vaccination rates.
What are common symptoms of respiratory diphtheria in children?
Sore throat
Trouble breathing
Low fever
Husky voice
Stridor (a shrill sound caused when breathing in)
Enlarged lymph glands in the neck
Runny nose
Swelling of the roof of the mouth (palate
Which of the following is a common diagnostic method for diphtheria?
A) Blood culture
B) Throat culture
C) Chest X-ray
D) Skin biopsy
B) Throat culture
Explanation: A throat culture can confirm the presence of Corynebacterium diphtheriae.
What is the primary treatment for diphtheria in children?
A) Antiviral medication
B) Antibiotics and antitoxin
C) Antifungal medication
D) Surgery
B) Antibiotics and antitoxin
Explanation: Treatment includes antibiotics to eliminate the bacteria and antitoxin to neutralize the diphtheria toxin.
What are potential complications of diphtheria in children?
Damage to the heart, kidneys, and nervous system
Asphyxiation due to airway obstruction
True or False: Vaccination is the primary method of preventing diphtheria.
True. Vaccination is the most effective way to prevent diphtheria.
What is the typical mortality rate for diphtheria in children?
A) 1-2%
B) 5-10%
C) 15-20%
D) 25-30%
B) 5-10%
Explanation: The mortality rate for diphtheria is approximately 5-10%, but it can be higher in children under five years old.
How is diphtheria transmitted?
A) Airborne droplets
B) Direct contact with skin lesions
C) Both A and B
D) Contaminated food and water
C) Both A and B
Explanation: Diphtheria is transmitted through respiratory droplets and direct contact with skin lesions.
What is the recommended vaccination schedule for diphtheria in children?
DTaP vaccine at 2, 4, and 6 months
Booster doses at 15-18 months and 4-6 years
Td or Tdap booster every 10 years thereafter
Scaled Skin Syndrome is caused by ____
Caused by an exfoliative staphylococcal toxin which causes separation of the epidermal skin through the granular cell layers
Symptoms of Scaled Skin Syndrome
- Fever
- Malaise
- Purulent, crusting, localised infection around eyes/nose/mouth with widespread erythema and tenderness
- Areas of epidermis separate on gentle pressure (Nikolsky sign) leaving denuded areas of skin which then dry and heal without scarring
Management of Scaled Skin Syndrome
IV anti-staph antibiotics such as flucloxacillin
Analgesia
Fluid balance
What is Staphylococcal Scalded Skin Syndrome (SSSS)?
SSSS is a bacterial skin infection caused by Staphylococcus aureus, leading to redness, blistering, and peeling of the skin.
True or False: SSSS is most common in adults.
False. SSSS primarily affects infants and young children.
What are common symptoms of SSSS in children?
Fussiness (irritability)
Tiredness (malaise)
Fever
Redness of the skin
Fluid-filled blisters that break easily
Large sheets of the top layer of skin that peel away
Which of the following is a common diagnostic method for SSSS?
A) Skin biopsy
B) Blood culture
C) Throat culture
D) Urine analysis
A) Skin biopsy
Explanation: A skin biopsy can confirm the diagnosis of SSSS.
What is the primary treatment for SSSS in children?
A) Oral antibiotics
B) Intravenous antibiotics
C) Topical steroids
D) Antifungal medication
B) Intravenous antibiotics
Explanation: Treatment typically involves intravenous antibiotics to combat the Staphylococcus aureus infection.
What are potential complications of SSSS in children?
Dehydration
Shock
Secondary bacterial infections
Scarring
True or False: SSSS is always fatal in children.
False. With prompt treatment, the prognosis is generally good, and most children recover without scarring.
Which of the following is a preventive measure for SSSS?
A) Regular handwashing
B) Vaccination
C) Avoiding sun exposure
D) Using moisturizers
A) Regular handwashing
Explanation: Regular handwashing can help prevent the spread of Staphylococcus aureus, thereby reducing the risk of SSSS.
How is SSSS transmitted?
A) Airborne droplets
B) Direct contact with infected skin
C) Contaminated food
D) Insect bites
B) Direct contact with infected skin
Explanation: SSSS is transmitted through direct contact with infected skin or mucous membranes
Which condition should be considered in the differential diagnosis of SSSS?
A) Chickenpox
B) Impetigo
C) Measles
D) Eczema
B) Impetigo
Explanation: Impetigo is a superficial skin infection that can present with similar symptoms to SSSS
Whooping Cough
Bacterial URTI (bronchitis)
What causes Whooping Cough ?
Bordetella Pertussis - Gram -ve bacillus (highly contagious)
How long can Whooping Cough last for without treatment?
6-8 weeks
Incidence of Whooping Cough is reduced nowadays due to ___
Vaccination programme
When are the Whooping Cough Vaccines administered
: 2,3,4 months, booster at 3 years 4 months
What are the 2/3 phases of Whooping Cough
Catarrhal Phase: Lasts 1-2 weeks: coryzal symptoms
Paroxysmal Phase: Occurs week 3-6: characteristic ‘inspiratory whoop
Convalescent phase - downgrade of cough, may last up to 3 months
Symptoms of Whooping Cough
Cough worse at night
Spasmodic coughing episodes
Can lead to vomiting
Low grade fever
Sore throat
Ix for Whooping Cough
Nasal-pharyngeal swab with pertussis - FBC - Antibody test
Tx for Whooping Cough
Macrolide e.g. Clarithromycin
Prophylactic Abx given to close contacts who are in higher risk health groups
Isolation for 21 days after symptom onset or 5 days after antibiotics
Complications of Whooping Cough
Seizures
Pneumonia
Bronchiectasis
Encephalopathy
Otitis Media
What is polio, and what causes it?
Polio, or poliomyelitis, is an infectious disease caused by the poliovirus, which is a member of the enterovirus group.
How is the poliovirus transmitted?
It is transmitted via the fecal-oral route or through respiratory droplets from infected individuals.
What are the three main serotypes of poliovirus?
Types 1, 2, and 3.
What are the clinical stages of polio infection?
Asymptomatic infection
Abortive poliomyelitis (minor illness)
Non-paralytic poliomyelitis (aseptic meningitis)
Paralytic poliomyelitis
What is the hallmark feature of paralytic poliomyelitis?
Acute onset of asymmetric flaccid paralysis without sensory loss.
Which part of the nervous system does poliovirus primarily affect?
The anterior horn cells of the spinal cord and brainstem motor nuclei.
Poliovirus primarily spreads through the - route.
Fecal-oral
The __________ vaccine is an inactivated polio vaccine administered by injection.
Salk
The __________ vaccine is a live attenuated oral polio vaccine.
Sabin
Paralytic poliomyelitis is characterized by __________ paralysis without sensory involvement.
Flaccid
The eradication of polio requires maintaining __________% immunization coverage globally.
95
Which vaccine is used in the global polio eradication program?
A. BCG vaccine
B. Oral polio vaccine (OPV)
C. DTaP vaccine
D. Rotavirus vaccine
B. Oral polio vaccine (OPV)
What is the most common outcome of poliovirus infection?
A. Paralytic disease
B. Non-paralytic aseptic meningitis
C. Asymptomatic infection
D. Abortive poliomyelitis
C. Asymptomatic infection
Which serotype of poliovirus is most frequently associated with outbreaks?
A. Type 1
B. Type 2
C. Type 3
D. All types equally
A. Type 1
Scenario: A 6-year-old child presents with fever, headache, stiff neck, and muscle weakness. The child has not been fully immunized against polio.
Q: What is the likely diagnosis, and how would you confirm it?
Likely diagnosis: Poliomyelitis (non-paralytic or paralytic). Confirmation: Stool or throat swab for poliovirus PCR and serology.
Scenario: A patient who recovered from polio 20 years ago presents with new muscle weakness and fatigue.
Q: What is the likely diagnosis, and how is it managed?
Likely diagnosis: Post-polio syndrome. Management: Supportive care, physical therapy, and symptom management.
Place these steps in the progression of poliovirus infection in the correct order:
A. Infection of the oropharynx and gastrointestinal tract
B. Viremia
C. Spread to the central nervous system
D. Destruction of anterior horn cells
A → B → C → D
Abortive poliomyelitis
Mild febrile illness with no CNS involvement
Non-paralytic poliomyelitis
Aseptic meningitis with headache and stiff neck
Paralytic poliomyelitis
Acute flaccid paralysis with asymmetric motor involvement
Post-polio syndrome
Late-onset muscle weakness in previously affected individuals
What are the pros and cons of using the oral polio vaccine (OPV)?
Pros:
Provides intestinal immunity
Easy to administer
Effective in halting community transmission
Cons:
Risk of vaccine-derived poliovirus (VDPV)
Requires careful cold chain storage
Why is polio considered a good candidate for eradication, and what challenges remain?
Reasons for eradication feasibility:
No animal reservoirs
Effective vaccines available
Clear clinical diagnosis in paralytic cases
Challenges:
Vaccine-derived poliovirus (VDPV) in poorly immunized areas
Political and logistical barriers in endemic regions
Describe how the introduction of the global polio eradication initiative has impacted poliovirus cases worldwide.
Since the initiative began in 1988, global cases of polio have decreased by over 99%, with endemic transmission confined to a few regions.
Is Tuberculosis common ?
TB had a real decline however there is increased incidence in patients with HIV infection and the emergency of drug resistant strains
How is Tuberculosis spread?
It is spread through respiratory droplets.
Tuberculosis Infection
TB infection is latent TB and is more likely to progress to TB disease in infants and young children however children will generally not be infectious compared to adults
Symptoms of TB in children
Asymptomatic children will have minimal signs of infection as a local inflammatory reaction limits the progression of the disease however it remains latent and so a Mantoux test may become positive.
How does TB spread throughout the body?
If the local infection response fails, it can spread through the lymphatic system causing fever, anorexia and weight loss, cough and chest x-ray changes such as hilar lymphadenopathy. There may be enlargement of the peribronchial lymph nodes which can cause consolidation, bronchial obstruction and pleural effusions.
- There may also be other organ involvement including the gut, skin and superficial lymph nodes.
What happens in the dormant stage of TB?
A dormant stage occurs and this can be reactivated and present as post-primary TB where the infection can be local or spread across systems including bones, joints, kidneys and CNS (can lead to TB meningitis)
Ix for TB
Given the difficulty in obtaining sputum samples, gastric washings on 3 consecutive mornings can be obtained to culture acid-fast bacilli through an NG tube. - Mantoux tests can be performed however this can be positive due to past vaccination rather than infection. - IGRA is a new blood test which is used to assess the response of T cells to antigens found in TB but not the BCG vaccine.
Tx for Tuberculosis
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol therapy initially and then reduced to just Rifampicin and Isoniazid after 2 months. This whole therapy normally lasts around 6 months.
How do you change TB tx after puberty
After puberty, pyridoxine is given weekly to minimise the peripheral neuropathy side effects of isoniazid
Why is contact tracing essential for TB?
Contact tracing is essential as children often pick up the infection from adults
HIV prevalence in children + main route of transmission
Affecting over 2 million children a year, the main route of transmission is mother-children transmission during pregnancy, at delivery or through breast feeding.
Ix for HIV in children > 18 months
In children over 18 months, presence of antibodies is diagnostic.
Ix for HIV in children < 18 months
In those under 18 months, a HIV DNA PCR is needed as antibodies may be present from merely exposure not active infection.
Presentation of HIV in children
A proportion of HIV infected infants progress rapidly to symptomatic disease and AIDS in the first year of life however most children will remain asymptomatic for several years.
HIV presentation in children with mild immunosuppression
may present with lymphadenopathy, those with moderate may have recurrent bacterial infections, chronic diarrhoea and lymphocytic interstitial pneumonitis.
Severe AIDS diagnosis can be indicated with ____
pneumocystis jirovecii pneumonia, severe faltering growth and encephalopathy.
Tx for HIV
Antiretroviral therapy, Immunisations, MDT approach, Regular follow up including weight, development and clinical signs of disease.
- Antiretroviral therapy should be started in all infants and some older children depending on _____
clinical status, HIV load and CD4 count
Why are immunisations important for HIV treatment?
Immunisations are important due to the higher risk of other infections
Mothers who test positive for HIV, should be on _____ to reduce viral load at time of delivery.
Antiretroviral drugs
Mothers who have HIV should also avoid ___
They should also avoid breastfeeding and active management of labour and delivery to prevent prolonged rupture of membranes
If breastfeeding cannot be avoided (in women who have HIV) then what should be given to both the mother + the baby?
Antiretroviral drugs
Meningitis
Inflammation of the meninges which are the lining of the brain and the spinal cord
Which bacteria cause Meningitis
Neisseria meningitidis is a gram negative diplococcus bacteria which occur in pairs
What is meningococcal meningitis?
Meningococcal meningitis is when the bacteria is infecting the meninges and the CSF
Most common bacterial causes of meningitis
Most common cause is Neisseria Meningitidis and Streptococcus pneumoniae
Most common cause of Bacterial Meningitis in neonates
, the most common cause is Group B Strep which is contracted during birth from GBS bacteria that live in the mothers vagina
Symptoms of Meningitis
Fever, neck stiffness, vomiting, headache, photophobia, altered consciousness and seizures. Neonates and babies can have non specific symptoms such as hypotonia, poor feeding, lethargy, hypothermia and a bulging fontanelle.
Kernig’s test
Lay patient on back and flex one hip and knee then straighten the knee whilst keeping the hip flexed, this will product pain/resistance in meningitis
Brudzinski’s test
Lay the patient on their back and lift their head and neck off the bed and flex chin to the chest, this will cause involuntary flexion of hips and knees.
All children under 1 month with a fever, 1-3 months with a fever and unwell and under 1 year with unexplained fever and other signs of serious illness should have _____
a LP
Community Management of Meningitis
Stat injection of benzylpenicillin and then transfer to hospital
Hospital Management of Meningitis
blood culture and LP should be performed before antibiotics are started and a meningococcal PCR should be sent
Tx for Meningitis for children under 3 months
IV Cefotaxime plus IV Amoxicillin
above 3 months = IV Ceftriaxone.
Dexamethasone is sometimes used
Who should be informed with a new case of Meningitis?
- Public health should be informed
What is given as post exposure prophylaxis for Meningitis?
- A single dose of ciprofloxacin should be given as post exposure prophylaxis.
Viral Meningitis is most commonly caused by ____
Most common causes are HSV, enterovirus and VZV
Ix for viral Meningitis
Sample of CSF should be sent for viral PCR
Tx for viral Meningitis
Only supportive treatment is needed, sometimes aciclovir can be used
Cerebrospinal Fluid in Bacterial Meningitis: Appearance
Cloudy
Cerebrospinal Fluid in Viral Meningitis: Appearance
Clear
Cerebrospinal Fluid in Bacterial Meningitis: Protein
High
Cerebrospinal Fluid in Viral Meningitis: Protein
Mildly raised or normal
Cerebrospinal Fluid in Bacterial Meningitis: Glucose
Low
Cerebrospinal Fluid in Viral Meningitis: Glucose
Normal
Cerebrospinal Fluid in Bacterial Meningitis: White Cell Count
High (neutrophils)
Cerebrospinal Fluid in Viral Meningitis: White Cell Count
High (lymphocytes)
What’s the difference between Meningitis and Menigococcal Septicaemia?
Meningitis : invasion of meninges.
Septicaemia : when the infection spreads to the rest of the body
Encephalitis
Inflammation of the brain which can be either infectious or non-infections (this is usually autoimmune)
Most common cause of Encephalitis
The most common cause is viral however bacterial and fungal are also possible.
Most common type of Encephalitis
The most common type is herpes simplex 1 from cold sores in children and herpes simplex 2 in neonates from genital herpes contracted during birth.
Name some other causes of Encephalitis
Other causes include VZV associated with chickenpox, EPV, enterovirus, adenvirus and influenza.
Symptoms of Encephalitis
- Altered consciousness - Altered cognition - Unusual behaviour - Acute onset of focal neurological symptoms - Acute onset of focal seizures - Fever
Ix for Encephalitis
LP, CT, MRI, HIV
Why is a lumbar puncture done in Encephalitis
to send CSF fluid for PCR testing
What do you do if LP in contraindicated in Encephalitis
CT scan
Contraindications for LP
active seizures, hemodynamically unstable
Why is an MRI done in Encephalitis
after the LP for visualisation
___ testing is also recommended in all patients with encephalitis
HIV
Managment of Encephalitis caused by Herpes/ VZV
Aciclovir to treat Herpes and VZV
Management of Encephalitis caused by CMV
Ganciclovir to treat Cytomegalovirus
Management of Encephalitis also involved repeated LP - why?
Repeat LP are needed to ensure successful treatment before antivirals are stopped
Complications of Encephalitis
Lasting fatigue
Change in personality/mood/memory/cognition
Headaches and chronic pain
Sensory disturbance
Seizures
Hand, Foot and Mouth Disease is caused by___
Coxackie Virus
Symptoms of Hand, Foot and Mouth Disease
URT symptoms first 1-2 days, Mouth ulcers, including on the tongue, then blistering spots on the body mainly hands and feet, mainly in children under 10
Dx of Hand, Foot and Mouth Disease
Based on clinical findings
Management of Hand, Foot and Mouth Disease
-supportive with analgesia and fluid intake. Avoid sharing towels etc
How long does Hand, Foot and Mouth Disease last?
~ 10 days
Roseola Infantum
known as the ‘3 day fever’
Roseola Infantum affects ____
children < 2 y/o
What causes Roseola Infantum?
HHV-6
Symptoms of Roseola Infantum
Rose coloured rash, starts from trunk, spreads peripherally.
Nagayama spots : enathem on uvula and soft palate.
May have febrile convulsions prior to rash.
Tx for Roseola Infantum
Self - resolving withing 2-5 days, Supportive Tx
What is molluscum contagiosum?
Molluscum contagiosum is a common, self-limiting viral skin infection caused by the molluscum contagiosum virus (MCV), a member of the poxvirus family.
How is molluscum contagiosum transmitted?
It is transmitted through direct skin-to-skin contact, shared items such as towels, and autoinoculation (spreading the virus by scratching).
What are the characteristic features of molluscum contagiosum lesions?
Small, firm, dome-shaped, pearly papules with a central dimple or umbilication.
In which age group is molluscum contagiosum most commonly seen?
It is most common in children, particularly those aged 1–10 years.
What is the typical duration of molluscum contagiosum?
It typically resolves spontaneously within 6–12 months, though it may persist for up to 2 years.
Molluscum contagiosum is caused by a __________ virus.
Pox
Molluscum contagiosum lesions typically have a central __________ or __________.
Dimple; umbilication
The condition is self-limiting and usually resolves within __________ to __________ months.
6; 12
Molluscum contagiosum spreads through __________ contact or shared __________.
Direct; items
What is the most common mode of transmission for molluscum contagiosum?
A. Airborne droplets
B. Fecal-oral route
C. Direct skin-to-skin contact
D. Bloodborne transmission
C. Direct skin-to-skin contact
Which feature is characteristic of molluscum contagiosum lesions?
A. Scaling and redness
B. Dome-shaped papules with central umbilication
C. Vesicular rash with crusting
D. Hyperpigmented macules
B. Dome-shaped papules with central umbilication
What is the first-line management for uncomplicated molluscum contagiosum?
A. Topical antibiotics
B. Observation and reassurance
C. Surgical excision
D. Oral antivirals
B. Observation and reassurance
Scenario: A 6-year-old child presents with multiple small, pearly, dome-shaped lesions on their torso and arms. The lesions have a central dimple, and the child reports no pain or itching.
Q: What is the likely diagnosis, and how should it be managed?
Likely diagnosis: Molluscum contagiosum. Management: Reassurance and observation, as the condition is self-limiting.
Scenario: A 9-year-old child with atopic dermatitis develops molluscum contagiosum. The lesions appear to be increasing in number, and the child is scratching them.
Q: What complications might occur, and how can they be prevented?
Complications: Secondary bacterial infection or widespread lesions. Prevention: Minimize scratching, maintain good hygiene, and manage underlying eczema.
Arrange the steps in the pathophysiology of molluscum contagiosum in order:
A. Viral entry via micro-abrasions in the skin
B. Formation of dome-shaped papules with central umbilication
C. Resolution as the immune system clears the infection
D. Replication of the molluscum contagiosum virus in keratinocytes
A , D, B, C
What are the pros and cons of treating molluscum contagiosum versus observing it?
Pros of treatment:
Can speed up lesion resolution
Reduces risk of autoinoculation or transmission to others
Cons of treatment:
Most cases resolve spontaneously
Treatments can cause discomfort or scarring
Increased cost and unnecessary intervention
Why might molluscum contagiosum persist longer in immunocompromised individuals, and how should it be managed in these cases?
Reason for persistence: Reduced immune response to the virus allows lesions to persist or multiply.
Management: Consider active treatment such as cryotherapy, curettage, or topical agents, and address underlying immunosuppression.
Provide an example of a situation where molluscum contagiosum may spread rapidly in a community.
In swimming pools, where shared towels and close skin contact can facilitate transmission among children.
Slapped Cheek Syndrome/ Fifth Disease is caused by
Parvovirus B19 causes erythema infectiosum/slapped cheek syndrome
When are Slapped Cheek Syndrome/ Fifth Disease outbreaks common?
Outbreaks are common during the spring months and transmission is via respiratory secretions from infected patients/mother to foetus.
What does Slapped Cheek Syndrome/ Fifth Disease infect?
It infects the erythroblastosis red cell precursors in the bone marrow
Symptoms of Slapped Cheek Syndrome/ Fifth Disease
Asymptomatic infection
Erythema Infectiosum : Slapped Cheek Syndrome/ Fifth Disease
- the most common illness with fever, headache and myalgia followed by a characteristic rash on the face which progresses to maculopapular rash on the trunk and limbs
Aplastic Crisis : Slapped Cheek Syndrome/ Fifth Disease
occurs in children with haemolytic anaemia where there is an increased rate of red cell turnover and immunodeficiency
Foetal disease : Slapped Cheek Syndrome/ Fifth Disease
Foetal disease where transmission can lead to foetal death due to severe anaemia.
Managment of Slapped Cheek Syndrome/ Fifth Disease
Supportive therapy
Complications of Slapped Cheek Disease
In someone who has haemolytic anaemia (e.g. SCD), infection can trigger an aplastic crisis, pancytopenia. In pregnant women, infection can cause hydrops fetalis in baby.
Impetigo
A superficial bacterial skin infection usually caused by the staphylococcus aureus bacteria
What causes Impetigo?
Staphylococcus aureus or Strep Pyogenes
What is characteristic of Impetigo ?
A ‘golden crust’ is characteristic for this
Where does Non-Bullous Impetigo occur?
This typically occurs around the nose or mouth and the exudate from the lesions dries to form a golden crust
Are there any symptoms of Non-Bullous Impetigo?
The children will have no systemic symptoms and will not be unwell
What is the Treatment of local Non-Bullous Impetigo?
This can be treated with topical fusidic acid or antiseptic cream if it is localised.
What is the treatment of widespread Non-Bullous Impetigo?
For widespread, oral flucloxacillin is used
What should patients with Non-Bullous Impetigo avoid doing?
Patients should avoid touching or scratching the lesions
What is Bullous Impetigo caused by?
- This is always caused by S.aureus which produce toxins that break down the proteins that hold skin cells together causing 1-2 cm fluid filled vesicles to form on the skin which then burst and form the golden crust.
Are there symptoms with Bullous Impetigo?
This is much more common in neonates and children under 2 and patients will have systemic symptoms such as fever and malaise
How do you diagnose Bullous Impetigo?
Swabs of the vesicles can confirm diagnosis
How do you treat Bullous Impetigo?
flucloxacillin.
Complications of Impetigo?
Sepsis
Scarring
Post strep glomerulonephritis -
Scarlet fever
Staphylococcal scalded skin syndrome
What is candida in paediatrics?
Candida is a fungal infection caused by Candida species, most commonly Candida albicans. It can affect the skin, mucous membranes, and other areas of the body.
What are common presentations of candida infections in paediatrics?
Common presentations include oral thrush, diaper dermatitis (candida nappy rash), and systemic candidiasis in immunocompromised children.
What factors predispose children to candida infections?
Factors include prolonged antibiotic use, immunosuppression, use of corticosteroids, poor hygiene, and chronic illnesses like diabetes.
How does oral thrush typically present in children?
Oral thrush presents as white, creamy plaques on the tongue, inner cheeks, and sometimes the gums, which can be wiped off, leaving a red, raw surface.
How is candida diaper dermatitis differentiated from other types of diaper rash?
It typically presents with beefy red plaques, satellite lesions, and involvement of skin folds, which are less common in other types of diaper rash.
Candida infections are most commonly caused by __________.
Candida albicans
Oral thrush presents as __________, __________ plaques on the mucous membranes.
White; creamy
Candida nappy rash often involves __________ and is characterized by __________ lesions.
Skin folds; satellite
Prolonged use of __________ is a risk factor for candida infections in children.
Antibiotics
Which of the following is a common presentation of candida infections in children?
A. Erythema nodosum
B. Oral thrush
C. Scaly plaques on the scalp
D. Impetigo
B. Oral thrush
What is a hallmark feature of candida diaper dermatitis?
A. Absence of skin fold involvement
B. Beefy red plaques with satellite lesions
C. Linear excoriations
D. Scaly rash on the palms
B. Beefy red plaques with satellite lesions
Which medication is most commonly used to treat oral thrush in children?
A. Amoxicillin
B. Fluconazole
C. Nystatin
D. Clotrimazole
C. Nystatin
T/F: Candida infections are always confined to the skin and mucous membranes.
False. Candida infections can affect not only the skin and mucous membranes but also internal organs and the bloodstream, leading to systemic infections such as candidemia and invasive candidiasis, especially in immunocompromised individuals.
T/F: Satellite lesions are a characteristic feature of candida diaper dermatitis.
t
T/F: Oral thrush is more common in children who are breastfed.
False. Oral thrush is not necessarily more common in breastfed children. However, breastfeeding can be a risk factor if the mother has a Candida infection on her nipples, which can lead to transmission between mother and baby. Other risk factors for oral thrush in infants include antibiotic use, a weakened immune system, and poor oral hygiene
Scenario: A 2-month-old infant presents with a persistent diaper rash despite regular diaper changes and use of barrier creams. The rash involves the skin folds and has small red spots around it.
Q: What is the likely diagnosis, and how should it be treated?
Likely diagnosis: Candida diaper dermatitis. Treatment: Topical antifungal agents like clotrimazole or miconazole.
Scenario: A 6-year-old child undergoing chemotherapy develops fever and signs of systemic infection. Blood cultures grow Candida species.
Q: What is the diagnosis, and what is the appropriate management?
Diagnosis: Systemic candidiasis. Management: Systemic antifungal therapy with agents like fluconazole or amphotericin B, depending on the severity.
Arrange the following steps in the pathophysiology of candida infection:
A. Disruption of normal microbiota
B. Candida overgrowth
C. Breach of epithelial barrier
D. Localized or systemic infection develops
A → B → C → D
Oral thrush
White, creamy plaques in the mouth
Candida diaper dermatitis
Beefy red rash with satellite lesions
Systemic candidiasis
Fever, sepsis-like symptoms, and positive blood cultures
What are the pros and cons of topical versus systemic antifungal treatment for candida infections in paediatrics?
Pros of topical treatment:
Targeted action
Fewer systemic side effects
Cons of topical treatment:
Ineffective for systemic infections
Requires frequent application
Pros of systemic treatment:
Effective for systemic and widespread infections
Can treat multiple sites simultaneously
Cons of systemic treatment:
Risk of systemic side effects
Potential for drug interactions
Why is it important to distinguish between candida diaper dermatitis and irritant diaper dermatitis?
Candida diaper dermatitis requires antifungal treatment, while irritant diaper dermatitis is managed with barrier creams and improved hygiene. Misdiagnosis may delay appropriate treatment, worsening symptoms.
Give an example of a clinical situation where a candida infection might occur in an otherwise healthy child.
A breastfed infant develops oral thrush after a course of antibiotics, which disrupted the normal oral flora.
Toxic Shock Syndrome is caused by
Toxin producing Staphylococcus aureus and group A streptococci
Symptoms of Toxic Shock Syndrome
Diffuse erythematous, macular rash
Signs of Toxic Shock Syndrome
Characterised by fever > 39 - Hypotension
Causes of organ dysfunction in Toxic Shock Syndrome
- Mucositis: Conjunctivae, oral mucosa, genital mucosa
- Gastrointestinal: Vomiting/Diarrhoea
- Renal impairment
- Liver impairment
- Clotting abnormalities and thrombocytopenia
Managment of Toxic Shock Syndrome
- Intensive care support is needed to manage the shock and areas of infection should be debrided - Antibiotics such as ceftriaxone with clindamycin are used to stop toxin production - After 1-2 weeks, there is desquamation of the palms, soles, fingers and toes. - There is a risk of recurrent skin and soft tissue infections
Scarlet Fever
- An infectious disease caused by toxin producing strains of the bacterium Streptococcus pyogenes.
Transmission of Scarlet Fever
- It is highly contagious and is transmitted through infected saliva or mucus with aerosol transmission or direct contact.
Scarlet Fever is common in those between ____
2-8 years of age
What is the cause of Scarlet Fever?
Group A Streptococcus usually strep pyogenes
Risk Factors of Scarlet Fever
- Neonates - Immunocompromised
- Concurrent chickenpox or influenza
Symptoms of Scarlet Fever
Initial sore throat, fever, headache, fatigue and nausea/vomiting - Pinpoint, sandpaper like blanching rash initially on the trunk then spreads to the rest of the body and flexures.
Signs of Scarlet Fever
Strawberry tongue - Cervical lymphadenopathy
Management of Scarlet Fever
Oral antibiotics such as benzylpenicillin for 10 days (or phenoxymethylpenicillin)
How long does the child need to be kept off school if they have Scarlet Fever?
until 24hrs after the Abx
Who needs to be notified with cases of Scarlet Fever
Public Health
Complications of Scarlet Fever
Otitis Media + Rheumatic Fever
What is Coxsackie’s disease?
Coxsackie’s disease is a viral infection caused by Coxsackie viruses, part of the enterovirus group. It commonly affects children and causes a range of illnesses, including hand, foot, and mouth disease (HFMD) and herpangina.
What are the common types of Coxsackie viruses, and what conditions do they cause?
The two common types are:
• Coxsackie A: Causes hand, foot, and mouth disease and herpangina.
• Coxsackie B: Causes pleurodynia, myocarditis, and pericarditis.
How is Coxsackie’s disease transmitted?
: It is transmitted through respiratory droplets, fecal-oral contact, or contact with contaminated surfaces.
What are the characteristic symptoms of hand, foot, and mouth disease?
Symptoms include fever, painful oral ulcers, and a vesicular rash on the hands, feet, and sometimes the buttocks.
What is herpangina, and how does it present?
Herpangina is a condition caused by Coxsackie A viruses, characterized by high fever, sore throat, and vesicles or ulcers in the oropharynx.
Coxsackie’s disease is caused by viruses from the __________ group.
Enterovirus
Hand, foot, and mouth disease is most commonly caused by Coxsackie __________ virus.
A
Coxsackie virus spreads via the __________ and __________ routes.
Respiratory droplet; fecal-oral
Herpangina presents with __________ and vesicular lesions in the __________.
High fever; oropharynx
Which of the following conditions is caused by Coxsackie B virus?
A. Hand, foot, and mouth disease
B. Herpangina
C. Pleurodynia
D. Scarlet fever
C. Pleurodynia
The rash in hand, foot, and mouth disease primarily involves:
A. Palms, soles, and oral mucosa
B. Face, neck, and chest
C. Scalp and back
D. Trunk and extremities
A. Palms, soles, and oral mucosa
How is Coxsackie’s disease most commonly diagnosed?
A. Clinical examination
B. Blood culture
C. Chest X-ray
D. Skin biopsy
A. Clinical examination
T/F: Hand, foot, and mouth disease is highly contagious.
t
T/F: Coxsackie B viruses are a common cause of myocarditis in children.
t
T/F: Antibiotics are the first-line treatment for Coxsackie’s disease.
False. Antibiotics are not effective for treating Coxsackievirus infections, as they are viral infections. Treatment typically focuses on relieving symptoms, such as pain and fever, with supportive care.
Scenario: A 3-year-old presents with a fever, painful ulcers in the mouth, and a vesicular rash on the hands and feet. The mother reports a recent outbreak of similar symptoms at the daycare.
Q: What is the likely diagnosis, and how should it be managed?
Likely diagnosis: Hand, foot, and mouth disease. Management: Supportive care with hydration, pain relief using paracetamol or ibuprofen, and monitoring for complications like dehydration.
Scenario: A 5-year-old child has fever, chest pain, and difficulty breathing. The physician suspects myocarditis.
Q: Which Coxsackie virus is most likely responsible, and what investigations should be done?
Likely virus: Coxsackie B. Investigations: ECG, echocardiogram, and viral serology.
Arrange the progression of symptoms in hand, foot, and mouth disease:
A. Fever
B. Painful oral ulcers
C. Vesicular rash on palms and soles
D. Resolution of symptoms
A → B → C → D
What are the pros and cons of diagnosing Coxsackie’s disease clinically versus using laboratory investigations?
Clinical diagnosis:
• Pros: Quick, non-invasive, and cost-effective.
• Cons: May miss atypical presentations or differentiate poorly from similar conditions.
Laboratory investigations:
• Pros: Confirms diagnosis, especially in severe cases like myocarditis.
• Cons: Time-consuming and expensive.
Why is hydration particularly important in children with hand, foot, and mouth disease?
Painful oral ulcers may lead to reduced oral intake, increasing the risk of dehydration. Maintaining hydration prevents complications and supports recovery.
Give an example of a scenario where a child with Coxsackie’s disease might require hospitalization.
A child with hand, foot, and mouth disease develops dehydration due to refusal to drink fluids because of painful oral ulcers or a child with myocarditis caused by Coxsackie B virus presents with severe chest pain and cardiac dysfunction
What is primary immunodeficiency (PI)?
PI refers to a group of more than 450 rare, chronic conditions where part of the body’s immune system is missing or does not function properly.
True or False: Primary immunodeficiencies are always present at birth.
True. PI often has a genetic cause and is present at birth, though symptoms may not appear until later.
PI often has a ________ cause and runs in ________.
genetic; families
Name the six broad categories of primary immunodeficiency disorders.
- B cell (antibody) deficiencies
- T cell deficiencies
- Combination B and T cell deficiencies
- Defective phagocytes
- Complement deficiencies
- Unknown (idiopathic)
True or False: Primary immunodeficiency disorders are rare but can present at any age.
t
In the UK, the estimated prevalence of primary immunodeficiency disorders is approximately ________ per 100,000 individuals.
5
List common signs and symptoms of primary immunodeficiency in children.
Recurrent infections (e.g., otitis media, pneumonia)
Poor growth or failure to thrive
Chronic diarrhea
Autoimmune manifestations
Unusual or severe infections
Children with primary immunodeficiency often present with ________ infections and may have a history of ________ to thrive.
recurrent; failure
True or False: Persistent oral thrush in a child can be an indicator of primary immunodeficiency.
True
What initial investigations are recommended when suspecting primary immunodeficiency in a child?
Full blood count with differential
Serum immunoglobulin levels
Lymphocyte subsets
Specific antibody responses
A family history of ________ immunodeficiency is a significant risk factor for the condition in children.
primary
What are common treatment approaches for primary immunodeficiency disorders in children?
Prompt treatment of infections
Immunoglobulin replacement therapy
Prophylactic antibiotics
Hematopoietic stem cell transplantation in severe cases
Immunoglobulin replacement therapy is indicated for children with significant ________ deficiencies.
antibody
True or False: Live vaccines are contraindicated in children with severe T-cell deficiencies.
True
List potential complications associated with primary immunodeficiency in children.
Chronic lung disease
Autoimmune disorders
Increased risk of malignancy
Growth retardation
Children with primary immunodeficiency are at increased risk of developing ________ disorders and certain types of ________.
autoimmune; cancer
True or False: With appropriate treatment, many children with primary immunodeficiency can lead relatively normal lives.
True
Early diagnosis and ________ management are crucial for improving outcomes in children with primary immunodeficiency.
appropriate
Mumps is caused by __
mumps virus
How is Mumps spread?
Respiratory droplets
Symptoms of Mumps
flu-like prodrome, followed by parotid swelling. can have muscle aches, reduced appetite, dry mouth
Ix for Mumps
: PCR testing on saliva swab
Management for Mumps
supportive: rest, fluids and analgesia
Isolation advice for Mumps
self - isolate for 5 days
Who should be notified for Mumps
Public Health
How long does Mumps last?
-self-limiting, lasts around 1 week
Complications of Mumps
Mengitis and orchitis are rare (otitis media most common Cx) but serious
