Infectious Diseases Flashcards
A Febrile Child is classed as a temperature over 38 degrees. How is temperature measured in Children?
<4 weeks - Electronic Thermometer in Axillary
4 weeks to 5 years - electronic thermometer in Axillary or tympanic thermometer
(Note: Axillary underestimates by 0.5 degrees)
What is your first thought if the Febrile Child is under 3 months?
Infection is likely bacterial as infants are relatively protected against viral infection in first few months due to passive immunity
Start sepsis screen and empirical antibiotics
What is in a Sepsis Screen?
Blood Culture
FBC
CRP
Urine Sample
Consider other investigations depending on PC
Give four red flags in a Febrile Child
Fever >38 (<3 months) or >39 (3 to 6 months)
Reduced level of consciousness
Bilious Vomiting
Severe Dehydration
How should you treat the severely unwell febrile child?
IV Abx (Broad Spectrum + Ampicillin if less than one month to cover for Listeria)
Antipyretics
Define Shock
Circulation is inadequate to meet metabolic demands of the tissue
Why are children more succeptible to shock?
Higher surface area to volume ratio
Higher Basal Metabolic Rate
How does early (compensated) shock present?
Tachypnoea and Tachycardia
Cold Peripheries
Sunken Eyes and Fontanelle
Decreased Urine Output
How does late (decompensated) shock present?
Acidotic (Kussmaul breathing) Bradycardia Confusion Absent UO Hypotension
How is Shock managed?
Fluid rescucitation (0.9% NaCl 20ml/kg)
Trachea intubation
Inotropic support
Renal support
Scarlet Fever is infection with Group A Strep. How does it present?
Fine papular rash on flushed skin (sandpaper texture)
Associated sore throat, strawberry tongue, lymphadenopathy
How is Scarlet Fever managed?
Notify PHE
Penicillin V
Parvovirus is also known as Erythema Infectiosum. How does it present?
Slapped cheek rash appearance
3-7 days prodrome
Evanescent rash for weeks
Arthropathy
How is Parvovirus managed?
Supportive unless neonate (IVIG)
Roseola Infantum is infection with Human Herpes 6 Virus. How does it present?
Temperature for 3 days that improves with appearance of rash
Maculopapular rash
What causes Lyme Disease?
Tick Bites (Spirochaete Borrelia Burgdorfen)
Describe the rash associated with Lyme Disease
Erythema migrans
Painless, non pruritic, circular lesions often with central clearing (target)
What is associated with Lyme Disease?
Localised - fever, headache, myalgia
Disseminated - Meningitis, Facial Nerve Palsy
Late - Large joint arthritis
How is Lyme disease investigated?
Localised - clinical diagnosis
Disseminated - ELISA
How is Lyme Disease managed?
<8 years Amoxicillin
> 8 years Doxycycline
For 2-3 weeks
Another cause of acute rash is Infectious Mononucleosis, how does this present?
Maculopapular rash (esp if treated with Amoxicillin)
Associated - flu like, exudate day pharyngitis, lymphadenopathy
Candidiasis is the most common opportunistic fungal infection. Who is most at risk?
Limited almost entirely to neonates
Children with primary/secondary immunodeficiency
How does Candidiasis present in the different areas?
Skin - ‘Diaper Dermatitis’, moist skin folds Nails - Paronychia Mucous Membranes - Oral Candidiasis Genitals - Thrush, Balanitis Systemic if immunocompromised
What can predispose children to Oral Candidiasis?
Inhaled Steroids
How is Candidiasis investigated?
Fungal Culture Swabs
Look for source
How is Candidiasis managed?
Azoles for immunocompetent
Amphiterecin for immunocompromised
Prevention with infection control measures and prophylaxis with azoles to high risk groups
Define Cellulitis
Infection of the dermis and deep subcutaneous tissue with poorly demarcated borders
(As opposed to Erysipelas which is more superficial with sharply demarcated borders)
Name four organisms commonly causing Cellulitis
Streptococcus Pyogenes
Streptococcus Pneumoniae
Staphylococcus Aureus
MRSA
Give three red flags for Cellulitis
Fever
Numbness/Tingling
Immunocompromised
How would you investigate Cellulitis?
Skin and swab culture
FBC
CRP
How should Cellulitis be managed?
Supportive (rest, elevation, analgesia)
Flucloxacillin
Emollient
How can Conjunctivitis be classified?
Viral
Bacterial
Allergic
Contact
Viral Conjunctivitis is highly contagious, give two examples of causative organisms
Adenovirus
Herpes Simplex
Bacterial Conjunctivitis is the most common form in children. Name four common causative organisms.
Haemophilia Influenza
Staphylococcus Aureus
Moraxella Catarrhalis
Strep Pneumoniae
How does Bacterial Conjunctivitis present?
Bilateral red eye with irritation/grittiness/discomfort
Mucopurlent discharge sticking lashes together
Oedema of lids/conjunctiva
How does Viral Conjunctivitis present?
Bilateral red eye with irritation/grittiness/discomfort Sore Watery discharge History of URTI Preauricular lymphadenopathy
How does Allergic Conjunctivitis present?
Bilateral symptoms
Itchy
Watery discharge
Oedema of eyelids
What signs of conjunctivitis can be seen OE?
Conjunctival oedema and dilated conjunctival vessels Conjunctival Follicles (white nodules on inferior eyelid) Conjunctival Papillae (Red dots of varying size on inferior eyelids - cobblestone)
How is Conjunctivitis investigated?
May just be a clinical diagnosis
Swab if in doubt
Fluorosceine 0.25% drops for corneal ulcer
How should Bacterial Conjunctivitis be managed?
Self limiting
If persisting for >2 weeks then Chloramphenicol eye drops
How should Viral Conjunctivitis be managed?
Self resolving
Wash hands frequently
Use separate towels
Consider topical steroids
How should Allergic Conjunctivitis be managed?
Remove allergen
Cold Compress
Antihistamines
What are Neonatal ‘Sticky Eyes’?
Common, beginning on day 3/4 of life
Only require washing with Saline/Water
How should you manage a Neonatal red eye?
Treat as bacterial conjunctivitis and refer urgently to ophthalmologist
How should you manage a purulent eye within the first 48h of life?
Gram stain and culture discharge
Treat with IV Cefotaxime (Risk of permanent loss of vision, likely Gonococcal)
How should you manage eye discharge occuring in first two weeks of life?
Immunoflourorescent staining
Likely Chlamydia
Treat with Azithromycin Eye Drops and Oral Erythromycin
Define Epiglottitis
Inflammation and swelling of epiglottis caused by infection
Normally infection with HiB, but can be Staph Aureus or Staph Saprophyticus
Can also be non infectious - thermal (steam), foreign bodies, trauma
Give 6 clinical features of Epiglottitis
Sore Throat Stridor Drooling Tripod Position Fever Muffled Voice
How is Epiglottitis investigated?
Don’t without sufficient airway management capabilities
Lateral X-ray Neck - Thumbprint
Fibre optic Laryngoscopy in operating theatre setting
How would you manage Epiglottitis ?
Don’t distress the patient
Involve Senior Paediatrician and Anaesthetist
Be prepared to intubate
IV Ceftriaxone and Dexamethasone
What is the main complication of Epiglottitis?
Epiglottic Abscess
Treated the same as Epiglottitis
What are the different types of Influenza?
Influenza A - most commonly, characterised by haemagglutinin and neuraminidase
Influenza B - Less severe
Influenza C - akin to common cold
Paediatric Influenza can present atypically. How could it present in babies?
Apnoea
Reduced tone
Poor feeding
BRUE
Paediatric Influenza can present atypically. How could it present in younger children?
Haematemesis Photophobia Chest Pain Apnoea Rigors
Drowsiness in 50% of under 4s
The management is mainly supportive for Influenza. State two important points.
Avoid Aspirin in <16y (Reyes Syndrome)
If at risk then offer Oseltamivir
State three complications of Influenza
Bronchitis
Secondary Bacterial Pneumonia
Otitis Media
What is the route of infection with Herpes Simplex Virus?
Through mucous membranes/skin
What are the two types of Herpes Simplex Virus?
HSV1 - associated with lip and skin lesions
HSV2 - more commonly genital lesions
HSV infection is mostly asymptomatic, but can present as Gingivostomatitis, describe this.
Most common form in children
Vesicular lesions on lips, gums, anterior tongue surface, hard palate
Progresses to extensive painful bleeding and ulceration
Describe three skin manifestations of HSV
Cold Sores - Recurrent HSV lesions on gingival/lip lesions
Eczema Herpeticum - Widespread vesicular lesions on eczematous skin, can get secondary bacterial
Herpetic Whitlows - Painful erythematous oedematous white pustules on broken skin
Describe Disseminated HSV infection in immunocompetent
Cutaneous lesions may spread to involve distant sites (Oesophagitis, Proctitis)
Can cause pneumonia
Describe Disseminated HSV infection in Neonates
More common in preterm, often through vaginal canal transmission
Can cause encephalitis or localised lesions
HSV can be diagnosed with a swab, how should symptomatic patients be managed?
Acyclovir
State three subtypes of Malaria and describe the pathophysiology
Falciparum, Vivax, Ovale
Spread by female anopheles mosquito, causing release of sporozoites into blood which travel to become merozoites in liver
Reproduce in RBC every 48h causing Haemolytic Anaemia
How do Neonates with Malaria present?
If occurring within 7 days implies trans placental transmission
Fever, Irritable, Refusing feeds, Anaemia, Jaundice
How do young children with malaria present?
Present the same as any febrile illness (so investigate if any recent travel to endemic area)
Restless, Drowsy, Apathetic
Describe three possible investigations for Malaria
Blood Film
LP (if Seizing)
Dipstick for Plasmodium Falciparum
Describe the use of a blood film for the diagnosis of Malaria
3 samples sent over 3 days
Thick and thin
Giemsa staining destroys erythrocytes, showing parasites and leukocytes
Ear Lobe/Finger prick/Big toe
If uncomplicated Malaria, how should it be managed?
1) Riamet
2) Malarine
3) Quinine Sulphate
4) Doxycycline
How is Severe (Falciparum)/Complicated Malaria managed?
1) Artesunate
2) Quinine Dihydrochloride
Should be admitted as they can deteriorate quickly
Malaria can be prevented using mosquito spray/nets and antimalarials. State three antimalarials.
Malarone (daily 2d before, during and one week after)
Mefloquine (once weekly 2w before, during and for four weeks after)
Doxycycline
State three complications of Malaria
Seizures
Reduced Consciousness
DIC
Define Measles
Notifibable infection caused by single stranded RNA Morbillivirus
One of the most contagious infectious diseases
How is Measles transmitted?
Transmission is air borne via respiratory droplets (but can remain on surfaces for two hours)
Person is infectious from first onset of symptoms to four days after rash
Describe the prodromal phase of Measles
Lasts 2-4 days
Fever, cough, runny nose, mild conjunctivitis, diarrhoea
Kopliks (small red spots with white spot on buccal mucosa)
Describe the characteristic rash of Measles
Morbilliform
Initially on forehead and neck, then spreading to involve trunk and limbs
Rash fades 3-4 days later in order of appearance, leaving discolouration behind
How is Measles investigated?
Salivary swab/serum sample for measles specific IgM within 6 months of onset
RNA defection in salivary swabs
How is Measles managed?
Self limiting and supportive
Notifiable disease
PEP can be given within 72h of exposure
State two respiratory complications of Measles
Bronchopneumonia
Giant Cell Pneumonitis
State two neurological complications of Measles
Acute demyelinating encephalitis (fluctuating consciousness progressing to coma)
Subacute Sclerosing Panencephalitis (5-10 years later, results in rigidity and death)
Blindness is a complication of Measles, who is most at risk?
Vitamin A Deficiency
Define Meningitis
Inflammation of the brain and spinal cord, normally secondary to bacterial or viral infection
What is the difference between Meningococcal Meningitis and Meningococcal Septicaemia
Meningitis - Neisseria affects the meninges and CSF
Septicaemia - when Neisseria is in the blood, characterised by ‘non blanching rash’ (indicative of DIC and a Subcut Haemorrhages)
What are the common organisms of Meningitis in Neonates and Children respectively?
Neonates - E.Coli, GBS, Listeria
Children - Neisseria Meningitidis, Strep Pneumoniae
How would a Neonate with Meningitis typically present?
Hypotonia
Poor Feeding
Bulging Fontanelle
How would a child typically present with Meningitis?
Fever Neck Stiffness Headache Vomiting Seizures
How would you investigate Meningitis? Give four
Bloods (FBC, CRP, Clotting, U&Es)
Blood Culture
Lumbar Puncture
ABG
What are the criteria for doing a LP (prior to antibiotics) in suspected Meningitis?
<1 month with fever
1-3 months with fever and unwell
>1y with fever and other features
If the child with suspected Meningitis is over 2y, they may show positive Kernig’s and Brudzinski’s sign. What are these?
Kernig’s - Flex Hip and knee at 90 degrees then straighten knee while hip flexed (painful due to meningism)
Brudzinski’s - Flex patients head and neck involuntarily which will cause involuntary flexion of knees and hips
How many white cells are expected in a normal CSF?
<5 lymphocytes
Describe the typical CSF composition in a Bacterial Meningitis
Cloudy
High Protein
Low Glucose
High White Cells (Polymorphs)
Describe the typical CSF composition in a Viral Meningitis
Clear Normal/High Protein Normal/Low Glucose Increase White Cells Increased White Cells (Lymphocytes)
How would you immediately manage suspected Meningococcal Septicaemia in the community?
IV or IM Benzylpenicillin
Describe the antibiotics used in hospital for a Meningitis
<28d - Cefotaxime, Amoxicillin, Gentamicin
1-3m - Ceftriaxone and Amoxicillin
> 3m - Ceftriaxone (and Amoxicillin if Listeria suspected)
Steroids are given as an adjunct in Meningitis if the child is over 3 months. Why is this?
Reduces hearing loss and neurological damage
What do you do to manage Meningitis from a Public Health perspective?
Notify Public Health
PEP for those who have had prolonged contact for >7 days (Single dose Ciprofloxacin)
When is an LP contraindicated in Meningitis?
Shock
Convulsions
Coagulation Abnormality
Septicaemia
How would Viral Meningitis be treated?
General less severe so just supportive
If HSV suspected then Aciclovir
One of the main differentials for Meningitis is Encephalitis. How would this present and how would you manage?
Altered consciousness, cognition and focal neurological symptoms
Managed with empirical Acyclovir
State 5 complications of Meningitis
Hearing Loss Cerebral Abscess Nerve Palsies Hydrocephalus Epilepsy
Mumps is a viral infection spread by respiratory droplet’s. How would it present?
Flu like prodrome
Parotid Gland Swelling (either unilateral or bilateral, painful due to capsular distension inner ages by trigeminal)
How is Mumps investigated?
PCR of Saliva
Blood Mumps Specific IgM
How is Mumps managed?
Supportive only
Notify public health
Normal recovery in 2-4 weeks
State three complications of Mumps
Pancreatitis
Orchitis (Testicular Pain and Swelling)
Sensorineural Hearing Loss
Define Orbital Cellulitis
Potentially sight threatening and life threatening ophthalmic emergency due to infection of soft tissue behind orbital septum (usually from locally spreading infection)
What is Preseptal Cellulitis?
More common and less serious infection of anterior to orbital septum
Common in young children
Describe the pathophysiology of Orbital Cellulitis
Extension of infection from periorbital structures (eg sinuses)
Extension of Preseptal infection
Direct Inoculation
Haematogenous
H.Influenza, S.Aureus, S.Pneumoniae, S.Pyogenes
How does Preseptal Orbital Cellulitis present?
Acute onset of swelling/warmth/redness/tenderness of eyelid
No orbital signs
How would Orbital Cellulitis present?
Anteriorly - Acute unilateral swelling of conjunctiva and lid (oedema, erythema, pain)
Orbital - Muscle Opthalmoplegia, Proptosis, Pain on eye movement, Blurred vision
Systemic - Fever, Malaise
Anyone with suspected Preseptal Cellulitis should be assumed to have Orbital until proven otherwise. How is it investigated?
FBC/CRP/Culture
Nose Swab
ENT and Opthalmology review
CT of sinuses and orbit
How is Orbital Cellulitis managed?
IV Ceftriaxone
4 hourly obs
Give two complications of Pre Septal and Orbital Cellulitis respectively
Preseptal - Orbital progression, Lid abscess
Orbital - Vein Occlusion, Meningitis
There are many different subtypes of Otitis Media. Define Acute Otitis Media.
Inflammation of middle ear that can be bacterial or viral in origin
There are many different subtypes of Otitis Media. Define Acute Supparative Otitis Media.
Presence of pus in the middle ear
There are many different subtypes of Otitis Media. Define Otitis Media with Effusion.
Chronic inflammatory condition following slowly resolving acute otitis media
Effusion behind intact Tympanic Membrane
There are many different subtypes of Otitis Media. Define Chronic Supparative Otitis Media.
Long standing middle ear infection with persistently perforated tympanic membrane
There are many different subtypes of Otitis Media. Define Mastoiditis.
Acute inflammation of the mastoid periosteum and air cells when infection from middle ear spreads
There are many different subtypes of Otitis Media. Define Cholesteatoma.
Retraction of Pars Flaccida and squamous proliferation in middle ear
Describe the pathophysiology of Otitis Media
Infective organisms reach middle ear via Nasopharynx
In young children the angle between sustainable tube and pharynx is not acute so allows easy spread
Give two bacterial and two viral causes of Otitis Media
Bacterial - H.Influenza, S.Pneumoniae
Viral - RSV, Rhinovirus
Name four risk factors for Otitis Media
Male
Household smoking
Nursery attendance
Craniofacial abnormalities
Give four SYMPTOMS for Otitis Media
Pain (young children tug at ear)
Malaise
Poor Feeding
Fever
How would the Tympanic Membrane appear in Otitis Media?
Red/Yellow/Cloudy
Bulging
Air fluid level behind
How would you investigate Otitis Media?
Normally a clinical diagnosis
Culture discharge if chronic/recurrent/grommets
CT/MRI if complications suspected
Describe the use of antibiotics in Otitis Media
Aim not to and explain why
Can give delayed (‘if not improving in 4 days’)
Give if systemically unwell/at risk of complications/not improving after four days
5 days Amoxicillin
Give three complications of Otitis Media
Chronic Supparative Otitis Media
Mastoiditis
Meningitis
Rubella (AKA German Measles) is an RNA airborne virus. How does it present?
Prodrome (low fever, mild conjunctivitis, rhinorrhoea)
Pink discrete macules that coalesce, spreading cephalocaudally
Forcheimers Sign (Petichiae on soft palate)
How would you investigate suspected Rubella?
PCR
FBC (increased lymphocytes, low platelets)
How would you manage Rubella?
No specific treatment
NSAIDs (Not Aspirin - Reyes)
Keep child away from school for 4d from rash onset
Describe the different subtypes of Otitis Externa (inflammation of ear canal)
Acute (<3 weeks) Chronic (>3 weeks) Localised (infection of follicle/boil) Diffuse Malignant (Osteomyelitis of Temporal and Mastoid Bone)
Describe the aetiology of Otitis Externa
Bacterial - Pseudomonas Auerginosa, Staph Aureus (secondary to blockage of canal, absence of wax, trauma)
Fungus
Name three risk factors for Otitis Externa
Hot and Humid
Swimming
Eczema
How would Otitis Externa present?
Pain Itching Discharge Hearing Loss Preauricular Lymphadenopathy
What advice would you give a patient with Otitis Externa?
Avoid getting ear wet
Remove discharge using cotton wool (not bud)
Remove hearing aids and earrings
Take simple pain relief
How would you manage Otitis Externa medically?
topical antibiotic and steroid
Lymphadenopathy - Oral Flucloxacillin
Chronic - Acetic Acid and Corticosteroids
If not resolving then swab
Give three complications of Otitis Externa
Abscess
Ear Canal Stenosis
Perforated Ear Drum
Describe the pathophysiology of Mastoiditis
Infection causes a breakdown of fine trabecular in mastoid air cells and allows collection of pus
The build up of pus causes local bone necrosis and subperiosteal abscess (behind pinna, superior to pinna, or over squamous temporal)
How would Mastoiditis present?
Otalgia
Pyrexia
Tenderness behind pinna (MacEwans Triangle)
Pinna may be pushed forward
On a background of acute or recurring Otitis Media
If Mastoiditis is advanced, how could it present?
Abducens/Facial/Opthalmic Nerve Palsy
Investigations for Mastoiditis shouldn’t delay treatment. What should you do?
CT head and mastoid with contrast
Will show coalescing air cells, opaque mastoid and middle ear
How is Mastoiditis managed?
Initial IV Abx (Co-Amoxiclav or Ceftriaxone)
Oral Abx for 14d
Surgery if not improving after 48h of IV, or if complications
Define Tonsillitis
Inflammation of palatine tonsils (concentrated lymphoid tissue) as a result of bacterial/viral infection
Can occur with other areas of inflammation (tonsulopharyngitis, adenotonsillitis)
Describe the pathophysiology of Tonsillitis
Tonsils are naturally at their largest between 4-8y
Majority of infections are viral (Adenovirus, EBV) but can be bacterial (S.Pyogenes)
How does Tonsillitis present?
Symptoms normally for 5-7 days (if longer consider glandular fever)
Odynophagia, Fever, Halitosis, Red Inflamed Tonsils
What is the Centor Criteria?
1) Tonsilar Exudate
2) Lymphadenopathy
3) Fever or Hx of fever
4) Absence of cough
> /=3 means that bacterial is likely
What is the FeverPAIN Score?
1) Fever in past 24h
2) Purulence
3) Attend Rapidly (within 3d)
4) Inflamed Tonsils
5) No Cough/Coryza
1 - Abx not indicated
2 to 3- Consider delayed
4 to 5 - Abx indicated
How is Tonsillar Size graded?
0 - not visible beyond anterior pillar 1 - occupy >25% oropharynx 2 - occupy 25-50% oropharynx 3 - occupy 25-75% oropharynx 4 - tonsils meet in midline
Give three differentials for tonsillitis
Quinsy
Glandular Fever
Epiglottitis
What medication should be used for Tonsillitis?
10 days Pen V (or Clarithromycin)
If unable to swallow consider IV Benzylpenicillin
Paracetamol/Ibuprofen/Topical Benzydramine spray
When should you consider a tonsillectomy in a child?
> 7 episodes in a year
5 episodes each year for 2 years
3 episodes each year for 3 years
Give three complications of Tonsillitis
Peritonsillar Abscess
Retropharyngeal Abscess
Post Strep Glomerulonephritis
Peritonsillar Abscesses are collections of pus in peritonsillar space. Describe the pathophysiology.
Palatine tonsils sit between tonsillar pillars and within a thin capsule
Pus collects between capsule and superior pharyngeal constrictors
How do Peritonsillar Abscesses present?
Severe sore throat (worse unilaterally) Drooling Trismus ‘Hot Potato Voice’ Unilateral uvular deviation
How should Peritonsillar Abscesses be investigated?
FBC/CRP/Glandular Fever Screen
CT is suspecting retropharyngeal abscess
How are Peritonsillar Abscesses managed?
Aspiration and drainage
Co- Amoxiclav/Benzylpenicillin + Metronidazole
IV rehydration
What is Toxic Shock Syndrome?
S.Aureus and Group A Strep release toxins which act as superantigens causing fever/hypotension/diffuse rash
Toxic Shock Syndrome causes dysfunction of all organ systems to varying degrees. Describe some management options
ICU Support
Debridement of infection areas
IV Ceftriaxone and Clindamycin
IVIG to neutralise toxin
What can occur 1-2 weeks after Toxic Shock Syndrome?
Desquamation of palms/soles/fingers/toes
Describe the pathophysiology of Tuberculosis in children
Latent TB is more likely to progress to active TB in infants and young children
Children normally acquire TB from infected adults in same household
Children normally aren’t infectious as they are paucibacillary
How does symptomatic TB present?
Fever, Anorexia, Weight Loss, Cough, Pleural Effusions
How does a Post Primary TB present?
Can be localised or disseminated
Infants and young children are more prone to tuberculous meningitis
Diagnosis of TB is difficult is in children ad they swallow sputum until age of around 8. What can be done as an alternative?
Gastric washings via NG on three separate mornings and then ZN stain
What is the Mantoux test?
Can be positive due to previousBCG
Intradermal injection of purified protein derivative
Induration >5mm is TB positive
What is the IGRA Test?
Assess response to TB proteins via blood sample
Not affected by vaccination status
Done in conjunction with Mantoux in under 5s
How is latent TB treated?
3 months Rifampicin and Isoniazid
Or
6 months Isoniazid
How is Active TB managed?
2 months Rifampicin/Isoniazid/Pyrazinamide/Ethambutol
Followed by 4 months Rifampicin and Isoniazid
Pyridoxine required in older children
When should you give prophylactic Isoniazid?
If less than 2 years and significant contact with a sputum positive
If Mantoux and IGRA are negative at 6 weeks it can be discontinued
What is encompassed in the term ‘URTI’?
Common Cold
Sore Throat (Pharyngitis, Tonsillitis)
Acute Otitis Media
Sinusitis
Define Viral Exanthem
A rash accompanied by systemic symptoms such as fever/headache/malaise. Due to organism’s toxins, damage by organism itself or by immune response
Give three Viral Exanthems starting on the face
Measles
Rubella
Erythema Infectiosum
Give two Viral Exanthems starting on the trunk
Roseola
Scarlet Fever
Give a papulovesicular Viral Exanthem
Chickenpox
What is Gianotti Crosti Syndrome?
Normally caused by EBV
Discrete non pruritic monomorphic papules lasting 2-8 weeks
Seen over face/buttocks/extensor surfaces
Hand Foot and Mouth Disease is a self limiting disease normally caused by Coxsackie Virus. How does it present?
Brief 12-36 hour prodrome
Painful ulcers on hard palate, tongue, buccal mucosa
Tongue may become red and oedematous
Erythematous macules with central grey vesicles on hands and feet (normally sides of fingers and for sum)
Viral causes of GE include Rotavirus, Noravirus and Adenovirus. What is the most common cause?
Norovirus
Rotarix vaccine given at 8-12 weeks
What’s the most common cause of bacterial GE in children?
Campylobacter
Can cause bloody diarrhoea
Consumption of undercooked meat and underpasteurised milk
Other than Gastrienteritis, what can VTEC cause?
Haemorrhagic Colitis
Haemolytic Uraemic Syndrome
Who is at greatest risk of dehydration with Gastroentetitis?
Children under 6 months
>5 diarrhoeal stools in 24 hours
>2 vomits in 24 hours
Children who have stopped breast feeding due to GE
GE is normally a clinical diagnosis. When should you send stools for microscopy?
Suspected septicaemia
Blood/Mucous in stools
Immunocompromised child
How should you manage dehydration in GE?
Give IV if shock is suspected/any red flag symptoms/persistent vomit
Oral 50ml/kg over 4h to replace deficit plus maintenance
If refusing oral feed - NG
What advice should you give parents after GE?
Avoid fruit juice and carbonated water
Don’t attend school for 48h since last episode
Child shouldn’t swim for two weeks
State three complications of GE
Haemolytic Uraemic Syndrome
Reactive Arthritis
Secondary Lactose Intolerance
Why can a HIV antibody test come back positive if <18 months?
Due to maternal antibodies that have crossed placenta
When should you test children for HIV? Give four examples
Babies to HIV parents
When immunodeficiency suspected
Young sexually active people
Needle stick/IVDU
If a child is born to HIV positive parents, when should they be screened?
Viral load test at 3m (shows whether HIV contracted at birth)
Anti body test at 24m (see if they’ve contracted it since - eg via breast feeding)
How is HIV managed in children?
Antiretrovirals
Normal childhood vaccines
Prophylactic Co-Trimoxazole
Treatment of opportunistic infections
When should you test children for Hep B?
Hep B positive mothers
Migrants from endemic areas
Close contacts
How should a child born to a Hep B positive mother be managed?
Within 24h - Hep B Vaccine and Hep B IVIG
Additional vaccines at 1 and 12 months (alongside normal schedule)
Tested for HbSag at 1 year
Can Hep B positive mothers breast feed?
Yes as long as child is fully vaccinated
How should children born to Hep C positive mothers be managed?
Antibody Tested at 18 months
Children often clear virus spontaneously
Mothers can breast feed as long as nipples aren’t cracked
How should chronic Hep C in children be managed?
Consider Peg Interferon in over 3s
Treatment is more effective in adults so normally delayed
What vaccines contain egg?
Live Influenza
Yellow Fever
Rabies
Name 5 live vaccines
MMR BCG Chickenpox Nasal Influenza Rotavirus
What vaccinations are given at 8 weeks?
Diphtheria/Tetanus/Pertussis/Polio/HiB/Hep B
Men B
Rotavirus
What vaccinations are given at 12 weeks?
Diphtheria/Tetanus/Pertussis/Polio/HiB/Hep B
Pneumococcal
Rotavirus
What vaccinations are given at 16 weeks?
Diphtheria/Tetanus/Pertussis/Polio/HiB/Hep B
Men B
When is the MMR vaccine given?
3 years 4 months
When is the Men ACWY vaccine given?
14 years
Describe the paediatric sepsis six
O2 Bloods IV Abx Fluids Escalation Consider Inotropic Support
What is the Paediatric Maintenance fluid of choice?
0.9% Sodium Chloride + 5% Dextrose
