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Paediatrics > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

How might thread worm present in a child?

A

Perianal itching and possibly small threads of slowly moving white cotton around the anus or in the stools

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2
Q

How do you treat thread worm?

A

Prescribe a single dose of mebendazole for whole household and issue hygiene advice.

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3
Q

What is the most likely cause of a barking cough?

A

Croup

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4
Q

When do the symptoms of croup tend to worsen?

A

night time

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5
Q

What is an important differential for croup?

A

Bacterial tracheitis and epiglottitis

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6
Q

What is bacterial tracheitis and how does this present?

A

Bacterial infection of the trachea results in purulent secretions, with the child appearing septic with a high fever.

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7
Q

What symptom would be seen in epiglottitis that wouldn’t be present in croup?

A

Drooling

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8
Q

What is the difference between epiglottitis and croup in terms of history?

A

Epiglottitis would normally have a shorter history of stridor and drooling and the child cannot swallow secretions- they may have a muffled voice and are septic in appearance.

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9
Q

Why is bacterial tracheitis more common than epiglottitis and more likely to occur?

A

Immunisation programme

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10
Q

How do you treat mild croup?

A

Largely self-limiting but treatment with a single dose of corticosteroid (eg dexamethasone 150 micrograms/kg) by mouth is of benefit

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11
Q

How do you treat severe croup?

A

Single dose of dex (oral or injection) or pred 150micrograms/kg or 1-2mg/kg. In hosp dex or budesonide 2mg by nebulisation.
If it is not effectively treated by corticosteroid treatment, nebulised adrenaline 1 in 1000 can be give, 400 micrograms a kilo (max 5mg) repeated after 30 mins if necessary.

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12
Q

What is kussmaul breathing?

A

Deep, laboured breathing associated with metabolic acidiosis

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13
Q

What are the viral causes of meningitis?

A

Enteroviruses, CMV, Herpes, EBV, mumps

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14
Q

What are the bacterial causes of meningitis?

A

Strep pneumoniae (gram +ve), neisseria meningitides (gram-ve cocci), haemophilis influenzae (gram-ve rod). Tb (mycobacterium tuberculosis)

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15
Q

What is the pathophysiology of meningitis?

A

Colonisation and invasion of nasopharyngeal epithelium, invasion of the blood stream, attachment and invasion of the meninges, initiation of body’s response using inflammatory markers- leak of proteins & cerebral odema, alteration in BF and metabolism- cerebral vasculitis.

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16
Q

Which organisms commonly cause meningitis in 0-3 months?

A

Group B strep, e.coli & listeria monocytogenes

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17
Q

Which organisms commonly cause meningitis in 1 month-6 years?

A

Neisseria meningitidis, strep pneumoniae, haem inflluenza,

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18
Q

Which organisms commonly cause meningitis in >6?

A

Neisseria meningitis, strep pneumoniae.

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19
Q

What percentage of meningitis sufferers have seizures?

A

30%

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20
Q

Have a low threshold for LP in infants with unexplained seizures/fever, who should you not perform an LP in though?

A

Focal neuro signs, signs of raised ICP, coagulopathy, thrombocytopenia. (this may cause coning through foramen magnum so instead perform blood culture, throat swabs etc.)

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21
Q

What are the typical changes in the CSF of bacterial meningitis?

A

Turbid appearance increased polymorphs, increased protein and DECREASED glucose (bacteria using glucose as substrate)

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22
Q

What are typical changes seen in the CSF of viral meningitis?

A

Clear appearance, increased lymphocytes (initially may be polymorphs), normal or decreased glucose, normal or increased protein.

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23
Q

What typical changes are seen in the CSF of tb meningitis?

A

Turbid/clear/viscous appearance, increased lymphocytes, very increased protein and very decreased glucose.

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24
Q

What should feverish child with be purpuric rash be given in the community?

A

IV/IM benzylpenicillin

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25
Q

What is the initial treatment, before receiving cultures given for meningitis in hospital?

A

IV broad spec antibiotic; E.g. cephalosporin - Ceftriaxone 80mg/kg/day OR
Cefotaxime 50mg/kg/tds

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26
Q

What must be given to all contacts if child has meningitis?

A

Rifampicin prophylaxis

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27
Q

What is a purpuric rash?

A

Red-purple non-blanching skin discolouration caused by the extravasation of RBCs (bleeding in the dermis)- not a disease but a manifestation of a disease.

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28
Q

What are the causes of a purpuric rash?

A

Thrombocytopenic →
• Increased platelet destruction
• Immune Thombocytopenic Purpura (ITP)
• Coagulation disorders - DIC; Vit C deficiency (scurvy)
• Impaired platelet production - e.g. Leukaemia
• Non-Thrombocytopenic →
• Meningococcal septicaemia
• Vascular - Vasculitis (E.g. HSP); hypertensive states, trauma

29
Q

What are the clinical features of a purpuric rash?

A

Positive glass test (doesn’t blanch under glass), hepatosplenomegaly- indicates leukaemia, neuro symptoms e.g. neck stiffness, photophobia indicates meningism, swollen ankles/knees indicates HSP.

30
Q

What investigations should you do for a purpuric rash?

A

Bloods- culture, FBC, U&Es, LP if suspected meningitis.

31
Q

What is the management of a purpuric rash?

A

Immunoglobulins and steroids, meningitis.

32
Q

What is septicaemia?

A

Infection of the blood with large amounts of bacteria, usually as a result of another infection, most commonly meningococcal septicaemia- the host response includes loss of cytokines and activation of endothelial cells- septic shock.

33
Q

What are the gram negative causes of septicaemia and how are they usually acquired in children and neonates?

A

Neisseria Meningitides (causing meningococcal septicaemia)- most common in children. Acquired in the birth canal- E.coli is most common cause in NEONATES

34
Q

What are the gram positive causes of septicaemia?

A

Staph aureus, group B strep (most common in neonates and acquired via birth canal, listeria monocytogenes.

35
Q

What are the clinical features of septicaemia?

A

Fever, SoB, rigors, hypotensive, poor urine output, RAPID appearance of WIDESPREAD MACULAR RASH which becomes purpuric (non-blanching), it typically appears before your eyes- signs of meningism may be present.

36
Q

What is involved in the septic screen?

A

Bloods - cultures, virology, U&Es, clotting screen (for DIC), LFTs, G&S
• LP - culture, glucose, white cell count
• Urine - MSU, culture
• Stool - culture, virology
• BUFALO

37
Q

Management of sepsis?

A

• Rapid stabilisation is important & may require transfer to PICU
• Bloods - cultures, FBC, LFT, U&Es (assess renal function as sepsis may cause end organ
damage), CRP, clotting (DIC risk)
• Urine - monitor output
• Fluids - significant hypovolaemia due to maldistribution of fluid is often present; inflammatory
mediators cause vasodilation & loss of fluid/ proteins
• Antibiotics - depends on age; < 8 weeks usually GroupB Strep (ampicillin); ceftriaxone/
cefotaxime
• Lactate - raised lactate indicates tissue hypoxia, hypoperfusion & possible damage
• Oxygen

38
Q

What is the major complication of sepsis?

A

Septicaemia is the most common cause of DIC (disseminated intravascular coagulation) in children.

39
Q

Which two types of shock can sepsis lead to?

A

Distributive and cardiogenic

40
Q

Why has the incidence of septicaemia reduced massively?

A

Since the introduction of the Men C vaccine.

41
Q

What disease does salmonella cause in children?

A

Enteric fever

42
Q

What disease does shigella cause in children?

A

bacillary dysentery

43
Q

What age does chicken pox tend to affect?

A

1-6- 95% of adults are IMMUNE. (maximal transmission occurs in winter and spring)

44
Q

What causes chicken pox?

A

Varicella zoster virus

45
Q

What is the incubation period of chicken pox?

A

11-21 days

46
Q

When is the infectious period of chicken pox?

A

2 days before the rash occurs until all the lesions have scabbed over.

47
Q

How is VZV spread?

A

Respiratory droplets and direct contact with lesions.

48
Q

How does the VZV rash distribute?

A

It starts at the head and drunk then disperses to the rest of the body.

49
Q

How do the lesions progress in VZV?

A

They begin as red macules then progress to papules then to vesicles then to pustules and then they crust.

50
Q

How long does it normally take the lesions to completely heal?

A

2 weeks

51
Q

What symptoms do you get with VZV?

A

headache, fever, sore throat, URTI symptoms, itching

52
Q

How long should you keep kids off school with chicken pox for?

A

Exclude from school for 5 days from the start of the skin eruption.

53
Q

How is VZV treated?

A

Fluids, paracetamol, soothing creams (calamine), acyclovir in severe cases

54
Q

What are the complications of VZV?

A

Rare but can get conjunctival lesions, encephalitis which presents a week after the rash but prognosis is good (ataxia).

55
Q

Which secondary infection may occur with VZV?

A

Secondary infection may occur in the lesions with group A strep, leading to necrotising fasciitis
or TSS. Also VZV remains dormant in the dorsal nerve roots; upon reactivation in later life a more severe
rash may occur, limited to specific dermatomes; this is known as Shingles

56
Q

What is opthalmia neonatorum?

A

Neonatal conjunctivitis

57
Q

What are ‘sticky eyes’?

A

These are common in the neonatal period and usually start on the 3rd-4th day- swabs usually negative and simple cleaning measures are all thats required.

58
Q

Which bacteria can sometimes cause sticky eyes & how is this treated?

A

Staph aureus or pseudomonas aeringuosa causing troubling discharge and redness. This is treated with a topical antibiotic treatment- neomycin.

59
Q

How do you recognise gonococcal conjunctivitis?

A

This should be suspected when purulent discharge and eyelid swelling occurs within the first 48 hours of life.

60
Q

How do you treat gonococcal conjunctivitis?

A

IV antibiotics- cephalosporin

61
Q

How do you recognise clamydial conjunctivitis?

A

Usually presents at the end of the first week of life with purulent discharge and eye swelling

62
Q

How is the diagnosis of clamydial conjunctivitis established?

A

Diagnosis is established with a monoclonal antibody test from conjunctival secretions.

63
Q

How do you treat clamydial conjunctivitis?

A

2 week course of oral erythromycin or topical tetracycline ointment.

64
Q

Note: Purulent discharge in first 48 hours → gonococcal likely

A

Purulent discharge at latter end of first week → suspect chlamydial

65
Q

How can you tell the difference between a bacterial/viral and an allergic ‘red eye’ in childhood?

A

Viral- watery sticky discharge
Bacterial- thick yellow/green discharge (mucopurulent)
Allergic- watery/clear discharge (may not be any present)

66
Q

What would itchy/gritty eyes indicate?

A

Allergic due to corneal involvement.

67
Q

Eye infections usually start in one eye and spread to the other, if it was unilateral what should be considered?

A

Acute glaucoma

68
Q

What is the treatment for a bacterial/viral/allergic red eye?

A

Chloramphenicol/ supportive & analgesia/ anti-histamines/montelucast

69
Q

What are cobblestoneing chemosis?

A

Seen in ‘allergic eye’, small dots at the bottom

Paediatrics (23 decks)

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