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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
What is the initial treatment, before receiving cultures given for meningitis in hospital?
IV broad spec antibiotic; E.g. cephalosporin - Ceftriaxone 80mg/kg/day OR Cefotaxime 50mg/kg/tds
26
What must be given to all contacts if child has meningitis?
Rifampicin prophylaxis
27
What is a purpuric rash?
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.
28
What are the causes of a purpuric rash?
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
What are the clinical features of a purpuric rash?
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
What investigations should you do for a purpuric rash?
Bloods- culture, FBC, U&Es, LP if suspected meningitis.
31
What is the management of a purpuric rash?
Immunoglobulins and steroids, meningitis.
32
What is septicaemia?
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
What are the gram negative causes of septicaemia and how are they usually acquired in children and neonates?
Neisseria Meningitides (causing meningococcal septicaemia)- most common in children. Acquired in the birth canal- E.coli is most common cause in NEONATES
34
What are the gram positive causes of septicaemia?
Staph aureus, group B strep (most common in neonates and acquired via birth canal, listeria monocytogenes.
35
What are the clinical features of septicaemia?
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
What is involved in the septic screen?
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
Management of sepsis?
• 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
What is the major complication of sepsis?
Septicaemia is the most common cause of DIC (disseminated intravascular coagulation) in children.
39
Which two types of shock can sepsis lead to?
Distributive and cardiogenic
40
Why has the incidence of septicaemia reduced massively?
Since the introduction of the Men C vaccine.
41
What disease does salmonella cause in children?
Enteric fever
42
What disease does shigella cause in children?
bacillary dysentery
43
What age does chicken pox tend to affect?
1-6- 95% of adults are IMMUNE. (maximal transmission occurs in winter and spring)
44
What causes chicken pox?
Varicella zoster virus
45
What is the incubation period of chicken pox?
11-21 days
46
When is the infectious period of chicken pox?
2 days before the rash occurs until all the lesions have scabbed over.
47
How is VZV spread?
Respiratory droplets and direct contact with lesions.
48
How does the VZV rash distribute?
It starts at the head and drunk then disperses to the rest of the body.
49
How do the lesions progress in VZV?
They begin as red macules then progress to papules then to vesicles then to pustules and then they crust.
50
How long does it normally take the lesions to completely heal?
2 weeks
51
What symptoms do you get with VZV?
headache, fever, sore throat, URTI symptoms, itching
52
How long should you keep kids off school with chicken pox for?
Exclude from school for 5 days from the start of the skin eruption.
53
How is VZV treated?
Fluids, paracetamol, soothing creams (calamine), acyclovir in severe cases
54
What are the complications of VZV?
Rare but can get conjunctival lesions, encephalitis which presents a week after the rash but prognosis is good (ataxia).
55
Which secondary infection may occur with VZV?
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
What is opthalmia neonatorum?
Neonatal conjunctivitis
57
What are 'sticky eyes'?
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
Which bacteria can sometimes cause sticky eyes & how is this treated?
Staph aureus or pseudomonas aeringuosa causing troubling discharge and redness. This is treated with a topical antibiotic treatment- neomycin.
59
How do you recognise gonococcal conjunctivitis?
This should be suspected when purulent discharge and eyelid swelling occurs within the first 48 hours of life.
60
How do you treat gonococcal conjunctivitis?
IV antibiotics- cephalosporin
61
How do you recognise clamydial conjunctivitis?
Usually presents at the end of the first week of life with purulent discharge and eye swelling
62
How is the diagnosis of clamydial conjunctivitis established?
Diagnosis is established with a monoclonal antibody test from conjunctival secretions.
63
How do you treat clamydial conjunctivitis?
2 week course of oral erythromycin or topical tetracycline ointment.
64
Note: Purulent discharge in first 48 hours → gonococcal likely
Purulent discharge at latter end of first week → suspect chlamydial
65
How can you tell the difference between a bacterial/viral and an allergic 'red eye' in childhood?
Viral- watery sticky discharge Bacterial- thick yellow/green discharge (mucopurulent) Allergic- watery/clear discharge (may not be any present)
66
What would itchy/gritty eyes indicate?
Allergic due to corneal involvement.
67
Eye infections usually start in one eye and spread to the other, if it was unilateral what should be considered?
Acute glaucoma
68
What is the treatment for a bacterial/viral/allergic red eye?
Chloramphenicol/ supportive & analgesia/ anti-histamines/montelucast
69
What are cobblestoneing chemosis?
Seen in 'allergic eye', small dots at the bottom

Paediatrics (23 decks)

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