Infectious Diseases Flashcards
WHAT ARE THE CAUSATIVE ORGANISMS OF EACH OF THESE DISEASE?
Roseloa
Hand, foot, and mouth
Scarlet Fever
Slapped check/Fifth Disease
Roseloa = HHV6
Hand, foot, and mouth = Coxackie A16
Scarlet Fever = Group A strep
Slapped check/Fifth Disease = Parvovirus A19

What is Kawazaki disease?
Kawasaki disease is a type of vasculitis which is predominately seen in children

What is the cause of Kawazaki disease?
Who is most at risk?
Unknown
Under 5 most at risk
Boys more than girls
Japanese or Korean more at risk
What are the symptoms of Kawazaki disease?
3 stages
1st stage >5 days
Fever > 39 degrees
Red eyes
Swollen lymph nodes
2nd stage
Strawberry tongue
Peeling of skin on hands
Joint pain
Vomiting
3rd stage
Reduction of symptoms, can be as long as 8 weeks

How do you diagnose Kawazaki disease?
Diagnosis of exlcusion
Can test for complications
Blood tests
BNP released when the heart is under stress
ECG
Echocardiogram
Coronary artery aneurysm
What is the treatment of Kawazaki disease?
High dose aspirin
High doses can treat inflammation
Gamma globulin
Reduce the risk of conorary artery problems
What ar the complications of Kawazaki disease?
Coronary arteries anneurysm
Inflammation of the heart muscle
Heart valve problems
What is measles?
Measles, or rubeola, is a viral infection that starts in the respiratory system

What is the cause of measles?
How is measles spread?
Paramyxovirus family
Respiratory droplets
What are the symptoms of measles?
What classic spots are seen?
Prodrome
- Irritable
- Conjunctivitis
- Fever
FEVER FOR 3 - 5 DAYS THEN
**Koplik spots (before rash)** White spots ('grain of salt') on buccal mucosa
Rash
Starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
diarrhoea occurs in around 10% of patients

How do you diagnose measles?
- IgM antibodies
- Throat swab to identify the virus
What is the treatment for measles?
Mainly supportive
Admission may be considered in immunosuppressed or pregnant patients
Notifiable disease → inform public health
What are the complications of measles?
- Otitis media: the most common complication
- Pneumonia: the most common cause of death
- Encephalitis: typically occurs 1-2 weeks following the onset of the illness)
How should management of contacts who have not been vaccinated with measles be treated?
Vaccine given within 72 hours
What is chickenpox?
Chickenpox is an infection caused by the varicella-zoster virus

What are the symptoms of chickenpox?
Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild

What stages does the rash go through in chickenpox?
Raised pink or red bumps (papules), which break out over several days
Small fluid-filled blisters (vesicles), which form in about one day and then break and leak
Crusts and scabs, which cover the broken blisters and take several more days to heal
How do you diagnose chickenpox?
History
Examination
Can do blood tests and a culture of lesion samples
What is the treatment for chickenpox?
No treatment necessary
Antihistamines for the itching
What is the prevention for chicken pox in a pregnant woman <20 weeks and >20 weeks?
<20 weeks
Varicella-zoster immunoglobulin (VZIG) within 10 days
>20 weeks
Varicella-zoster immunoglobulin (VZIG) or acyclovir between 7-14 days
What are the complications of chicken pox?
Pneumonia
Encephalitis (cerebellar involvement may be seen)
Disseminated haemorrhagic chickenpox
Arthritis, nephritis and pancreatitis may very rarely be seen
What is Rubella?
Rubella is a contagious viral infection best known by its distinctive red rash.
It’s also called German measles or three-day measles.

What are the symptoms of rubella?
- Prodrome, e.g. low-grade fever
- Rash: maculopapular, initially on the face before spreading to the whole body, usually fades by the 3-5 day
- Lymphadenopathy: suboccipital and postauricular

What are the complications of rubella?
- Arthritis
- Encephalitis
- Myocarditis
How is rubella spread?
Droplet
How do you diganose rubella?
-
Saliva Sample
- Serologically
- Rubella specific IgM
What is the treatment for rubella?
Viral so nothing
Bed rest
Fluids
What is diphtheria?
Diphtheria is a serious bacterial infection that affects the mucous membranes of the throat and nose

What is the cause of diphtheria?
How is it spread?
- Corynebacterium diphtheriae
- The condition is typically spread through person-to-person contact or through contact with objects that have the bacteria on them, such as a cup or used tissue.
- You may also get diphtheria if you’re around an infected person when they sneeze, cough, or blow their nose.
What are the symptoms of diphtheria?
- A thick, gray membrane covering your throat and tonsils
- A sore throat and hoarseness
- Swollen glands (enlarged lymph nodes) in your neck
- Difficulty breathing or rapid breathing
- Nasal discharge
- Fever and chills
- Malaise

What are the complications of diphtheria?
Breathing problems
Heart damage
Nerve damage
How is diphtheria diagnosed?
- Culture of throat swab
- Uses tellurite agar or Loeffler’s media
What is the treatment of diphtheria?
Antibiotics
Penicillin OR erythromycin
Antitoxin

What is scalded skin syndrome?
Staph scalded skin syndrome (SSSS) is an illness characterised by red blistering skin that looks like a burn or scald, hence its name staphylococcal scalded skin syndrome.

What causes scalded skin syndrome?
Staphylococcus aureus
Two exotoxins (epidermolytic toxins A and B) from toxigenic strains of the bacteria
Desmosomes are the part of the skin cell responsible for adhering to the adjacent skin cell.
The toxins bind to a molecule within the desmosome called Desmoglein 1 and break it up so the skin cells become unstuck.
What are the symptoms of scalded skin syndrome?
SSSS usually starts with fever, irritability and widespread redness of the skin.
Within 24-48 hours fluid-filled blisters form.
These rupture easily, leaving an area that looks like a burn
Rash characteristics include:
Tissue paper-like wrinkling of the skin is followed by the appearance of large fluid-filled blisters (bullae) in the armpits, groin and body orifices such as the nose and ears.
Rash spreads to other parts of the body including the arms, legs and trunk. In newborns, lesions are often found in the diaper area or around the umbilical cord.
Top layer of skin begins peeling off in sheets, leaving exposed a moist, red and tender area. Nikolsky sign is positive (ie gentle strokes result in exfoliation)
How do you diagnose scalded skin syndrome?
- Tzanck smear (skin scraping)
- Skin biopsy, which shows intraepidermal cleavage at the granular layer
- Bacterial culture from skin, blood, urine or umblical cord sample (in a newborn baby)
What is the treatment for scalded skin syndrome?
Hospitalisation
IV Flucloxacillin
Nafcillin, oxacillin, cephalosporin and clindamycin.
Vancomycin is used in infections suspected with methicillin resistance (MRSA)
What is whooping cough?
Whooping cough is an infection caused by a germ (bacterium) called Bordetella pertussis.
Whooping cough is also known as ‘pertussis’
What are the symptoms of whooping cough?
Early stage (catarrhal stage)
Sore throat, runny nose, mild cough
Main coughing stage (paroxymal phase)
Cough becoems paroxysmal, bouts of intense coughing
Whooping noise is on the inspiration (not always present)
Easing stage (convalescent phase)
The bouts of coughing then ease gradually over a period which can last up to three months or more

When are you vaccinated against pertusis?
2 Months (8 weeks)
3 Months (12 weeks)
4 Months (16 weeks)
4 Months - 3 Years (4-in-1 preschool booster)
What is the diagnostic criteria for whooping cough?
Acute cough that has lasted for 14 days or more without another apparent cause + 1 or more of the following:
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
How do you diagnose whooping cough?
-
A nasal swab culture and test
Make take days or weeks to come back -
A chest X-ray
Complication of pneumonia in whooping cough
How do you treat whooping cough?
-
Antibiotics (Marcolides) to kill the baceria
- Erythromycin
- Clarythromycin
- Azithromycin

What is polio?
Polio is a contagious viral illness that in its most severe form causes nerve injury leading to paralysis, difficulty breathing and sometimes death.
What is the cause of polio?
Poliovirus can be transmitted through direct contact with someone infected with the virus or, less commonly, through contaminated food and water
When is the polio vaccine administered?
- 2 months old - 6 in 1
- 3 months old - 6 in 1
- 4 months old - 6 in 1
- 3 years and 4 months of age – as part of the 4-in-1 (DTaP/IPV) pre-school booster
- 14 years of age – as part of the 3-in-1 (Td/IPV) teenage booster
What are the symptoms of polio?
A small number of people will experience a flu-like illness 3 to 21 days after they’re infected.
Symptoms can include:
A high temperature (fever) of 38C (100.4F) or above
A sore throat
A headache
Abdominal (tummy) pain
Aching muscles
Feeling and being sick
How do you diagnose polio?
Medical history
Neck and back stiffness, abnormal relfexes, and difficulty swallowing and breathing
CSF
Test of polio virus
What is the treatment for polio?
No cure for polio
Supportive treatments
What is tuberculosis (TB)?
Tuberculosis (TB) is an ongoing (chronic) infection caused by bacteria. It usually infects the lungs.
What are the stages of TB?
Exposure
Latent TB infection
TB disease
What cause TB in a child?
TB is caused by bacteria.
It’s most often caused by Mycobacterium tuberculosis (M. tuberculosis).
Many children infected with M. tuberculosis never develop active TB and remain in the latent TB stage.
What are the symptoms of TB?
Coughing that lasts three or more weeks
Coughing up blood
Chest pain, or pain with breathing or coughing
Unintentional weight loss
Fatigue
Fever
Night sweats
Chills
Loss of appetite
What is the vaccination for TB?
Bacillus Calmette-Guerin (BCG)
How do you diagnose TB?
Latent TB
- Mantoux test
Active TB
- Sputum culutre - GOLD STANDARD
-
Sputum smear
Stained for the presence of acid-fast bacilli (Ziehl-Neelsen stain) -
Chest x-ray
Upper love cavitation
Bilteral hilar lymphadenopathy - NAAT testing
What is the treatment for TB?
Rifampicin - 6 months
Isoniazid - 6 months
Pyrazinamide - 2 months
Ethambutol - 2 months
What is HIV?
The human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS)
How is HIV transmitted?
HIV can be transmitted during sexual intercourse, pregnancy (i.e., from mother to fetus), childbirth, breastfeeding, and other forms of exposure to bodily fluids that carry the virus
How is HIV transmitted to children?
More than 90 percent of HIV infections in children result from mother-to-child-transmission
Where the virus is passed from a mother living with HIV to her baby during pregnancy, childbirth, or breastfeeding
What are the symptoms of HIV?
- Lack of energy
- Delayed growth and development
- Persistent fever, sweating
- Frequent diarrhea
- Enlarged lymph nodes
- Repeated or prolonged infections that don’t respond well to treatment
- Weight loss
- Failure to thrive
What infections are HIV infected indiviuals more likely to develop?
Sinus infections
Sepsis
Pneumonias
Tuberculosis
Urinary tract infections
Intestinal illness
Skin disease
Meningitis
How do you diagnose HIV?
- Serology looking for antibodies
- Look for antigens
What is the treatment for HIV?
ART therapy
What is meningitis?
Meningitis is an inflammation of the membranes that surround the brain and the spinal cord
What causes meningitis?
Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid (CSF).
What bacteria and viruses cause meningitis?
Neonatal to 3 months
- Listeria monocytogenes
- Group B Streptococcus
- E. coli and other Gram -ve organisms
1 month and above
- Neisseria meningitidis (meningococcus)
- Streptococcus pneumoniae (pneumococcus)
- Haemophilus influenzae
1 month to 6 years
H. influenzae
What are the symptoms of meningitis?
- Neck and/or back pain
- Headache
- Sleepiness
- Confusion
- Irritability
- Fever
- Refusing to eat
- Decreased level of consciousness
- Seizures
- Photophobia (sensitivity to light)
- Nausea and vomiting
- Neck stiffness
What is the diagnosis for meningitis?
-
Lumbar puncture - CT to check if at risk patient
Gram stain, culute and sensitivity
Cell count
Biochemistry - glucose, protein, lactate - Blood cultures
-
Blood testing
FBC, U&Es, LFTs - Glucose
What is the treatment for meningitis?
IM benzylpenicillin
<3 months
Cefotaxime + Amoxocillin
>3 months
Ceftriaxone
Sometimes dexamethosome added to help inflammatory response
What do you give to contacts of meningitis for prophylaxis?
Rifampicin OR Ciprofloxacin
What is encephalitis?
Encephalitis is inflammation of the brain
What are some causes of encephalitis?
- HSV - Number 1 cuase in UK
- HIV
- Measles
- Mumps
- Poliomyelitis
- Coxsackie virus
- Herpes zoster
What are the symptoms of encephalitis?
Encephalitis presents in a similar manner to an abscess:
A short history of:
- Headache, pyrexia, confusion, vomiting
- An important negative is the absence of neck stiffness
Developing into:
- Epilepsy
- Focal neurological signs
- Cognitive impairment
What are the investigations for encephalitis?
- CSF: lymphocytosis, elevated protein
- PCR for HSV
- CT: medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients
- MRI is better
- EEG pattern: lateralised periodic discharges at 2 Hz
What is the treatment for encephalitis?
- IV acyclovir
What are the complications of encephalitis?
- SIADH
- DIC
- Cardiac and respiratory arrest
What is slapped cheek syndrome?
What other name does it go by?
Condition caused by parvovirus
It’s sometimes called slapped-cheek disease because of the distinctive face rash that develops.
Parvovirus infection has also been known as fifth disease because, historically, it was fifth in a list of common childhood illnesses characterized by a rash

What is the cause of slapped cheek syndrome?
Human parvovirus B19
What are the symptoms of slapped cheek syndrome?
RASH
Several days after the appearance of early symptoms, a distinctive bright red rash may appear on your child’s face — usually on both cheeks. Eventually it may spread to the arms, trunk, thighs and buttocks, where the rash has a pink, lacy, slightly raised appearance. The rash may be itchy, especially on the soles of the feet.
Fever
Upset stomach
Headache
Runny nose
What is the treatment for slapped cheek syndrome?
For an uncomplicated parvovirus infection, self-care treatment at home is generally sufficient.
People with severe anemia may need to stay in the hospital and receive blood transfusions.
Those with weakened immune systems may receive antibodies, via immune globulin injections, to treat the infection.
WHAT IS SCARLET FEVER?
Scarlet fever results from an infection with Streptococcus pyogenes or group A beta haemolytic streptococci that produces an erythrogenic toxin
Group A beta haemolytic streptococci is commonly found on the skin or in the throat and is responsible for causing bacterial sore throat or “strep throat”

What are the symptoms of scarlet fever?
- Fever: typically lasts 24 to 48 hours
THEN
- Malaise, headache, nausea/vomiting
- Sore throat
- ‘Strawberry’ tongue
-
Rash
- - Fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
- - It is often described as having a rough ‘sandpaper’ texture
- - Desquamination occurs later in the course of the illness, particularly around the fingers and toes

How do you diagnose scarlet fever?
- Throat swab
- Treatment should be started immediately rather than waiting for the results
What is the treatment for scarlet fever?
- Oral penicillin V for 10 days
- If allergic then azithromycin
- Children can return to school 24 hours after commencing antibiotics
- Scarlet fever is a notifiable disease
What is hand, foot and mouth disease?
Acute viral illness characterized by vesicular eruptions in the mouth and papulovesicular lesions of the distal limbs
What viruses cause hand, foot and mouth disease?
Coxsackie A16 virus, although other group A and B Coxsackie viruses may be causative.
Less commonly, but more seriously, it can be caused by enterovirus 71.
What are the symptoms of hand, foot and mouth disease?
- Mild systemic upset: sore throat, fever
- Oral ulcers
Followed later
- By vesicles on the palms and soles of the feet
What is the diagnosis of hand, foot and mouth disease?
Diagnosis is usually based on clinical grounds
Diagnosing techniques include:
- Coxsackie A (generally A16) virus is isolated from lesions and stools
- Serum testing may reveal a specific antibody
What is the management for hand, foot and mouth disease?
Symptomatic treatment only
General advice about hydration and analgesia
Reassurance no link to disease in cattle
Children do not need to be excluded from school
The HPA recommends that children who are unwell should be kept off school until they feel better
They also advise that you contact them if you suspect that there may be a large outbreak.
WHAT IS ROSEOLA INFANTUM?
Roseola infantum (also known as exanthem subitum, occasionally sixth disease)
caused by the human herpes virus 6 (HHV6)
What is roseola infantum caused by?
Caused by the human herpes virus 6 (HHV6)
At what age does roseola occur?
6-18 months
What are the symptoms of roseola infantum?
Whats spots are seen and where are they?
- High fever lasting a few days
Followed later by a
- Maculopapular rash
- Nagayama spots: papular enanthem on the uvula and soft palate
- Febrile convulsions occur in around 10-15%
- Diarrhoea and cough are also commonly seen

What are the complications of roeola infantum?
- Febrile convulsions
- Aseptic meningitis
- Hepatitis
What is the management of roseola infantum?
Supportive
What conditions don’t require exclusion from school?
- Fifth disease (slapped cheek)
- Roseola
- Head lice
- Threadworms
- Hand, foot and mouth
What disease require exclusion 24 hours after starting antibiotics?
Scarlet fever

What disease requires 2 days exclusion after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics)?
Whooping cough

What conditions require 4 days exclsuion from onset of rash?
- Measles
- Rubella

What requires exclusion 5 days after swollen glands?
Mumps

What condition require exclusion after all vesicles have crusted over?
Chicken pox

What is impetigo?
Impetigo is a superficial bacterial skin infection usually caused by either Staphylcoccus aureus or Streptococcus pyogenes.
It can be a primary infection or a complication of an existing skin condition such as eczema (in this case), scabies or insect bites.

What are the symptoms of impetigo?
Multiple lesions affecting the face or extremities. They may be macules, vesicles, bullae or pustules.
Characteristic honey coloured or golden, gummy crusts in streptococcal infection which leave denuded red areas when removed.
Bullae are more prominent in staphylococcal infection and in infants.

How do you diagnose impetigo?
Usually clinical
What is the treatment for impetigo?
- Localised non-bullous impetigo, you can consider prescribing Hydrogen peroxide 1% cream
- Only if this is ‘unsuitable’, should you consider topical antibiotics
* *fusidic acid 2% - first line**
* *Mupirocin 2% - second line if fusidic acid resistance is suspected or confirmed)**
Neither referral nor admission are required for this simple primary care presentation
What are the different causative agents for meningitis?
Neonatal to 3 months
Group B Streptococcus: usually acquired from the mother
E. coli and other Gram -ve organisms
Listeria monocytogenes
1 month to 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
**Greater than 6 years** Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus)
What is candidia (nappy rash)?
Candidiasis is commonly superimposed on napkin dermatitis. It causes a bright red rash involving the flexures. Discrete satellite lesions may be present. Oral thrush is common.

What are the characteristic lesions in nappy rash candidia?
- Satelite lesions

What is the treatment of candida (nappy rash)?
- Nystatin cream
- Imidazole cream - Canesten or Daktarin.
What is oral candidia?
Oral candidiasis is a common fungal infection of the oral mucosa
What are the risk factors for oral candidia infection?
- Hematinic deficiency - vitamin B12, ferritin, folic acid
- Immunosuppressive drugs
- Endocrine disease – diabetes, hypothyroidism, hypoparathyroidism
- Blood dyscrasias or advanced malignancy
What are the symptoms of oral candida?
- Often asymptomatic
* *Can present with** - Dysphagia
- Burning and soreness as well as sensitivity to acidic and spicy foods
- Altered taste sensation
What is the treatment of candidiasis in children?
- Miconazole oral gel - 7 days
-
If under 4 months
Nyastatin - 7 days
What is staph toxic shock syndrome?
Staphylococcal toxic shock syndrome describes a severe systemic reaction to staphylococcal exotoxins, the TSST-1 superantigen toxin
What are the causes of staph toxic shock syndrome?
- Young females at the time of menstruation - increase in females who use vaginal tampons
What are the clinical features of toxic shock syndrome?
Fever
Temperature > 38.9ºC
Hypotension
Systolic blood pressure < 90 mmHg
Diffuse erythematous rash
Desquamation of rash, especially of the palms and soles
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
What is the management for toxic shock syndrome?
- Removal of infection focus (e.g. retained tampon)
- IV fluids
- IV antibiotics - Flucloxacillin
What is the mnemonic for day of rash appearing after fever?

What are each of these bacteria responsible for causing?
Group A haemolytic Strep
Coxsackie A16
Parovirus B19
Group A haemolytic Strep = Scarlett Fever
Coxsackie A16 = Hand, foot and mouth
Parovirus B19 = Slapped Cheek Syndrome
How long does the fever last in these conditions before a rash appears?
Measles
Scarlett Fever
Fifth Disase
Roseola
- Scarlett Fever - 1-2 days
- Measles - 2-4 days
- Roseola - 3-5 days
- Fifth disease - 4-14 days
How does the rash spread in measles?
Start on head and spreads to trunk and extemities
How does the rash present in scarlett fever?
Fine, erythematous papular eruption
How does the rash present in fifth disease?
Pruritic, lacy rash sparing palmes and soles

How does the rash present in roseola?
Tiny eryrthematous papules on trunk spreading to neck/extremities
