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Paediatrics > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

What is a septic screen?

A
  1. FBC including WCC
  2. Blood culture
  3. Acute phase proteins e.g CRP
  4. U+Es
  5. Urine sample
  6. LFTs
  7. Gas including lactate
  8. Consider:
    - CXR
    - LP
    - Rapid antigen screen on blood, CSF, Urine
    - Meningiococcal and pneumocccal PCR on Blood/CSF
    - PCR for viruses in CSF
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2
Q

What are the red flags for a septic child?

A
  1. Fever >38 if under 3 months and fever >39 if 3-6 months
  2. Colour- pale, mottled, blue
  3. Level of consciousness reduced, focal neurological signs, neck stiffness, bulging fontanelle, status epilepticus, seizures
  4. significant respiratory distress
  5. Bile stained vomit
  6. severe dehydration or shock
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3
Q

What are the causes of meningitis in

  1. Neonates-3 months
  2. 1-6 months
  3. > 6 months
A
  1. Neonates-3 months
    - GBS
    - E.Coli
    - Listeria monocytogenes
  2. 1-6 months
    - Neisseria meningitides (gram -ve diplococci)
    - strep pneumoniae
    - H influenza
  3. > 6 months
    - Neisseria meningitides
    - Step pneumoniae
    - h. influenza
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4
Q

What is the pathophysiology of meningitis?

A

Bactaraemia - released into blood
cerebral oedema - raised ICP - reduced cerebral blood flow
Vasculopathy leading to hydrocephalus

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5
Q

What is the presentation of meningitis?

symptoms (6)
signs (6)

A 
Fever
headache
photophobia
lethargy
poor feeding
drowsiness

Signs

  • fever
  • purpuric rash
  • neck stiffness
  • bulging fontanelle
  • brudzinki/kergnigs sign
  • focal neuro
  • altered consciousness
  • opisthotonus
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6
Q

What investigations for meningitis?

A 
1. LP
2 Blood cultures + PCR
3. blood glucose
4. rapid antigen screen on urine
5. throat swabs
* do not delay, start tx
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7
Q

When is LP contraindicated in meningitis?

A

signs of raised ICP

  1. focal neuro signs
  2. papillioedema
  3. bulging fontanelle
  4. DIC
  5. signs of cerebral herniation
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8
Q

What is the management of meningitis?

A
  1. Abx - cefotaxime, ceftriaxone (IV)
    - cefotaxime + amoxicillin if under 3 months
  2. steroid - dexamethsasone to reduce frequency and severity of hearing loss + neuro damage
  3. Fluids
  4. cerebral mointoring - mechanical ventilation if resp distress
  5. public health notification + CIPRFLOXACIN for contacts
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9
Q

What is the proohylaxis for meningitis?

  • meningiococcal and h.influenza
  • Group C meningioccal
A
  1. Ciprofloxacin

2. Group C - give MEN C vaccine

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10
Q

What are viral causes of meningitis?

A

2/3rd

enterovirus, ebv, adenovirus, mumps

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11
Q

What is impetigo and how does it present

What is the cause?

A

highly contagious skin infection
presents as golden crusted skin lesions, usually around mouth but also face, neck and hands

  • can be primary infection
  • or it can be secondary to atopic eczma, scabies or insect bites
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12
Q

what are the causative agents? (impetigo)

How does it spread?

A
  • staph aureus and strep pyogenes

- spread by contact with discharge

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13
Q

What is the tx for impetigo?

school?

A
  • topical fusidic acid
  • topica mupirocin
  • flucloxacillin for extensive infections

exclude from school until crusted or 48hr after starting abx

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14
Q

What is Kawasaki?

What is the main risk for Kawasaki?

A

Kawasaki is a rare systemic vasculitis

Can lead to coronary artery aneurysm***
MI, myocarditis, pericarditis

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15
Q

What is the presentation of Kawasaki?

A
  1. high fever that is ongoing for >5 days, not broken by antipyretics
  2. conjunctivitis
  3. bright red cracked lips
  4. strawberry tongue
  5. cervical lymphadenopathy
  6. red, swollen, peeling palms and feet
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16
Q

What is the management for Kawasaki?

A
  1. high dose aspirin
  2. Intravenous immunoglobulins
  3. Echo to detect coronary artery aneurysm
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17
Q

What is the presentation of measles?

A
  1. fever, coryzal, cough, conjunctivitis
  2. kopliks spot (white spots) on buccal mucosa
  3. widespread maculopapular rash, beginning behind ears
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18
Q

What are possible complications of measles?

A
  1. otitis media
  2. pneumonia
  3. encephalitis
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19
Q

What is the management of measles?

A
  1. suppotive
  2. isolate
  3. immunocompromised - antirectroval
  4. vitamin A in low income countries
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20
Q

When is measles infectious

what is the incubation period?

A

prodrome to 4 days post rash

icubation = 10-14 days

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21
Q

How does rubella present?

A
  1. low grade fever
  2. pink maculopapular rash, spreading from face. gone by day 3-5
  3. lymphadenopathy (suboccipital and pericauricular)
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22
Q

What are complications of rubella?

A
  1. arthritis
  2. encephalitis
  3. thrombocytopenia
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23
Q

What is the incubation period for rubella?

A

14-21 days

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24
Q

What is slapped cheek syndrome caused by?

A
  • slapped cheek (erythema infectiosum) caused by parvovirus B19
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25
Q

What is the presentation of parvovirus?

A
  • fever
  • malaise
  • rash on face,
  • spreads to maculopapular rash on trunk and limb
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26
Q

What can parvovirus lead to?

A

aplastic crisis (when not enough new RBCs made) e.g in sickle cell disease

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27
Q

what does parvovirus fetal disease lead to?

A

-fetal hydrops, death due to anaemia

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28
Q

What type of bacterium causes diphtheria?

A

Gram +ve

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29
Q

What does diphtheria bacterium cause?

A

Exotoxin causes local necrosis and pseudomembrane in nose, tonsils and or pharynx
rash
cervical lymphadenopathy
heart block (necrosis of heart, neural and renal tissue)

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30
Q

How do you manage diphtheria?

A

penicillin

antitoxin

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31
Q

What is a risk factor for diphtheria?

A

recent travel to eastern europe, asia

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32
Q

Which virus causes Mumps?

A

paramyxovirus

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33
Q

What is the presentation of Mumps?

A
  • fever
  • malaise
  • parotitis (first unilateral then bi)) may get earchache or pain on eating
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34
Q

How is mumps transmitted?

A

via droplets

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35
Q

What investigation result may be raised in mumps?

A

Amylase

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36
Q

Whats the complication of mumps

A

pancreatitis
epididymo-orchitis
menongioencephalitis

37
Q

What is the management of mumps

A
  1. rest
  2. paracetamol
  3. notifiable disease
38
Q

When is someone with mumps infectious

When is the incubation stage?

A
  1. 7 days before and 9 days after parotid gland swlling

2. incubation = 14-21 days (same as rubella)

39
Q

What causes scalded skin syndrome

A
  • mainly staphylococcus auerus, can be epidermidis in neonates and ITU
40
Q

How does staphylococcal skin infection present?

A
  • fever
  • extremely tender red peeling skin at flexures e.g -neck, axilla, groin

Nikolsky’s sign - separation of skin on gentle pressure

  • can be prodrome of conjunctivis and sore throat
41
Q

What causes Skin peeling in staohylococcal scalded skin syndrome

A
  • staph releases endotoxins between layers of skin - proteins are proteases break down proteins holding skin tohetjer
42
Q

What is the management of SSSS? (7)

A 
1st line Abx = flucloxacillin IV
Fluids and electrolytes
topical therapy - fusidic acid/mupirocin
analgesia
emolliant 
physio due to affecting limb flexures
43
Q

What pathogens cause hand foot and mouth disease?

A
  1. Cosackie 16

2. Enterovirus 17

44
Q

What is the presentation of hand foot and mouth?

A
  1. start with mild symptoms of sore throat, fever, oral ulcers
  2. Painful vesicles on hands, feet, mouth (oral ulcers) and buttocks
45
Q

How contagious is hand foot and mouth?

A

Very contagious

46
Q

What is the management of hand foot and mouth ? School?

A
  1. supportive - hydration and analgesia

2. dont need to be excluded from school but should stay home until feeling better

47
Q

What causes Scarlet fever?

A

Reaction to erythrogenic toxin released by Group A haemolytic streptococci

48
Q

How does scarlet fever present?

A
  1. Fever - lasting 24-48hrs
  2. Malaise, headache, N+V
  3. sore throat
  4. strawberry tongue
  5. Rash: fine punctuate erythema, starting in torso, sparing face and palms/soles, can have sandpaper texture, pallor around mouth
49
Q

What is the incubation period for scarlet fever?

How do does scarlet fever spread?

A

2-4 days

spreads via resp droplets or direct contact with nose/throat discharge

50
Q

What is the investigation for scarlet fever?

A

throat swab

start Abx immediately

51
Q

What is the management? (3)

A
  1. Oral Penicillin V for 10 days (Azithromycin for allergic)
  2. Can go back to school 24 hrs after starting Abx
  3. Notifiable disease
52
Q

Describe scarlet fever rash

complications?

A

fine punctuate erythema (pinhead) starting in torso and sparing face, palms and soles. Can have a sandpaper texture, pallor around mouth

  1. otitis media
  2. rheumatic fever
  3. glomerulonephritis
53
Q

What virus causes chickenpox?

A

Varicella zoster virus

54
Q

How is chicken pox transferred?

A

spread via respiratory route

can be caught from someone with shingles

55
Q

When is someone with chickenpox infectious, what is the incubation period?

A

4 days before rash 5 days after

incubation period is 10-21 days

56
Q

What is the presentation of chickenpox

A
  • fever, systemic upset

- papules -> vesicles –> pustules –> crust

57
Q

What is the management for chicken pox in normal situation?

A

keep cool, trim nails
calamine lotion
school exclusion until crusted

58
Q

What is the management of chickenpox in immunocompromised and Neonate exposed peripartum? What should you give if Chickenpox develops?
What should you not use?

A

Varicella zoster immunloglobulins
IV acyclovir

Do not use NSAIDs - increased risk of secondary bacterial infections

59
Q

How does septicaemia present? (4)

A

Red/purple non-blanching rash.
Cold hands and feet.
Tachypnoea.
Flu like symptoms

60
Q

How does immune deficiency present?

A

severe disease presents in neonates/infants and ummunological emergency

  1. Failure to thrive
  2. Skin problems
  3. chronic chest problems
  4. organomeglady
  5. lymphadenopathy
61
Q

What is the normal infant lymphocyte count?

A

> 2.5

62
Q

What is a type of immune deficiency?

A

Severe combined immune deficiency (SCID)

63
Q

When should you investigate immune deficiency? (3)

A
  1. frequent or unsually severe infection
  2. infection with unsual organism
  3. family hx
64
Q

What investigations should you do for immune deficiency?

A
  1. FBC - low total WBC, neutrophils and lymphocytes
  2. Total Ig G,A,M +/-E
  3. responses to routine immunisations
  4. lymphocyte subsets - number of T and B
  5. Lymphocyte function
65
Q

What is the management of immune deficiency?

A
  1. Antiobiotic/antiviral promptly
  2. replacement immunoglobulins
  3. bone marrow transplant
66
Q

Which immunglobulins do new born infants

  • make themselves
  • make some of
  • most from mother
A
  • make themselves - IgM
  • make some of: IgA
  • most from mother - IgG
67
Q

How can HIV be transmitted from mother to child?

A

usually beyond 36 weeks
intrapartum
or
breastfeeding

68
Q

How is HIV managed to reduce transmission during pregnancy and shortly after?

A
  1. Regular CD4 and viral load tes (low cd4 and high viral load most suceptible)
  2. HAART meds (highly active antiretovial therpay) and prophylaxis agains Pneumocystis carnii pneumonia
  3. C- section
  4. avoid breasfeeding
  5. HAART 1st 6 weeks of infants life
69
Q

What causes candida infections?

A

candida albicans - commensual in mouth and GI tract

70
Q

How do you manage oral thrush in children not immunocompromised?

A

Miconazole oral gel

71
Q

What is a possible cause of oral candida in children and what should you advise? (5)

A

corticosteroid use

  1. advise good oral hygiene
  2. rinsing mouth with water after use
  3. good inhaler technique
  4. advise using a spacer
  5. consider stepping down dose where appropriate
72
Q

How do you manage skin and vaginal candida?

A

imidazole for both

+/- pessary for vaginal

73
Q

How does encephalitis in present?

A
  1. Flu like prodrome
  2. reduced consciousness
  3. odd behaviour
  4. vomiting
  5. fits
  6. fever
  7. meningism (headache, neck stiffness, photophobia)
74
Q

What are possible causes of encephalitis?

A
  1. HSV
  2. mumps
  3. Varacilla zoster
  4. parvovirus
    5 TB
75
Q

What investigations should you do for encephalitis?

A
  1. CSF MC+S and PCR
  2. bloods
  3. stool (enteroviruses)
  4. urine
76
Q

What causes toxic shock syndrome?

What else does this cause?

A

Group A staphylococcus aerus

Also causes staphylococcal scalded skin syndrome

77
Q

How does toxic shock syndrome present? (4)

What is the management?

A
  1. Fever (39+)
  2. hypotension
  3. diffuse erythematous rash
  4. desquamation of rash - palms and soles

Emergency

  1. ABCDE
  2. O2
  3. IV broad spectrum Abx and IVIG
  4. IV fluids
  5. debridement
78
Q

What do you expect to see in LP

  1. Appearance
  2. Proteins
  3. Glucose level
  4. White cell count

in Bacteria and Viral

A

Bacteria

  1. Cloudy
  2. raised proteins
  3. low glucose
  4. raised white cells - neutrophils

Viral

  1. clear
  2. mildly raised/normal proteins
  3. Normal glucose
  4. raised whit cell - Lymphocytes
79
Q

What is the presentation of shingles?

A

acute unilateral painful blistering rash

does not cross midline

caused by reactivation of varicella zoster virus

80
Q

What are the complications of shingles? (3)

A
  1. pneumonia
  2. encephalitis
  3. group A streptococcal skin infections
81
Q

Advice for parents on nappy rash? (6)

A
  1. leave nappy off as much as possible
  2. change nappy often
  3. use wipes free from fragrance and alcohol
  4. dry bottom, not rub
  5. thin layer of barrier cream (zinc and castor oil ointment)
  6. mild steroid cream - hydrocortisone
    NO TO TALCUM POWDER
82
Q

What causes Roseola infatum?

Triad of presentation and other symptoms?

Age range?

Management?

A

Human herpes virus 6

High fever, maculopapular rash, convulsions (10-15%)

6months - 2 yrs

supportive, resolves on its own

83
Q

Who does molluscum contagiosum present in?

What is the cause?

A
  1. often children with atopical eczma, 1-4 yr olds

2. viral skin infection - molluscum contagiosum virus

84
Q

Key signs and symptoms of molluscum contagiosuM

What is the treatment?

A

flesh coloured papules
have a central dimple
very contagious

tx = topical wart meds e.g salicylic acid
goes away on its own in a year

85
Q

What causes scabies?

Where is classical location of rash and where does it spread?

How long before symptoms appear?

A

super itchy (type IV hypersensitivity reaction), small red spots

classic location = fingerwebs, spreads to whole body, can take up to 8 weeks before symptoms appear

86
Q

What causes scabies?

What is the management

A

Mites - burrow under skin and lay eggs

  1. wash ALL
  2. 5% premethrin cream - cover for 8 hours then wash off
  3. all household and close contacts all treated same
87
Q

How does ringworm present?

Name ringworm in scalp, feet, groin, body?

A

itchy circular red scaly and well demarcated rash - fungal

scalp = tinea capitis
feet = tinea pedis
groin = tinea cruris
body = tinea corporis
88
Q

What is the management of ringworm?

What will make it worse?

A

antigfungal cream - Clotrimazole/miconazole

oral antifungal - fluconzaole

Streoid cream will make it worse!

Paediatrics (9 decks)

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