Infectious diseases Flashcards
What is the most prevalent malarial species in sub-Saharan Africa
Plasmodium falciparum
What are the gold standard investigations if concerned about malaria
Thick and thin blood film, however if a child is unwell a rapid dipstick antigen test would be the quickest way to establish a diagnosis
If the first blood film is negative at least 2 further should be done in the next 48 hours
What results may you see on blood tests ina child with malaria
- thrombocytopenia and anaemia (Leukocytosis)
- G6PD activity
- Abnormal LFTs
- hyponatraemia and raised Cr
- Hypoglycaemia (severe)
Symptoms of malaria
Fever, often recurring Chills Rigors Headache Cough Myalgia Gastrointestinal upset
Signs of malaria
Fever Splenomegaly Hepatomegaly Jaundice \+/- abdominal tenderness
Differential diagnoses of Malaria
Typhoid Hepatitis Dengue fever Influenza HIV Meningitis/encephalitis Viral haemorrhagic fevers
drug of choice for the treatment of all non-falciparum malaria
Chloroquine
What are the red flag symptoms of skin/lipstongue
pale
mottled
ashen
blue
What are the red flag resp symptoms
grunting
tachypnoea
RR >60
Moderate/severe chest indrawing
What are the red flag symptoms relating to activity in children
no response to social cies
Appears ill to HCP
Unrousable/drowsey
weak/high pitched or continuous crying
What is group B strep
common bacterium (bug) which is carried in the vagina and rectum in 2–4 in 20–40% woman
What is considered early onset group B strep infection
symptoms in the first 0-7 days
What is considered late onset group B infection
8-90 days
What are the symptoms of late onset group B strep
- irritable/high pitched/ whimpering cry
- Blank, staring or trance-like expression;
- Floppy, may dislike being handled,
- Tense or bulging fontanelle
- Turns away from bright light;
- Involuntary stiff body or jerking movements
- Pale, blotchy skin.
What is the management of Group B strep in infants
3-4 weeks systemic penicillin,
+/- clindamycin or vanc
Signs and symptoms of meningococcal disease
Non-blanching rash with >1
- Ill looking cgld
- purpura - lesions >2mm
- Cap refil >3s
- Neck stiffness
Signs and symptoms of bacterial meningitis
Neck stiffness
Bulging fontanelle
Deceased level of conciousness
Convulsive status epilepticus
Signs and symptoms of herpes simplex encephalitis
Focal neurological signs
Focal seizres
Decreased level of conciousness
Signs and symptoms of pneumonia
tachypnoea crackles nasal flaring chest indrawing cyanosis Sats <95%
Signs and symptoms of UTI
Vomiting Poor feeding Lethargy Irritability Abdo pain/tenderness LUTs
Signs and symptoms of septic arthritis
swelling of limb or joint
Not using an extremity
Non weight bearing
Signs and symptoms of kawasaki disease
Fever >5 days and 4 of:
- Bilateral conjunctivitis
- Change in mucous membranes
- Change in extremities
- cervical lymphadenopathy
- polymorphos rash
What bacteria can cause purpura (non blanching rash >2mm)
meningococcus
Listeria
Pneumococcus
What is the pre-hospital management of suspected bacterial meningitis in patients with a purpuric rash
intramuscular or intravenous benzylpenicillin
In children <3 months, what is the antibiotic guidance for suspected meningitis
cefotaxime
Amoxicillin or ampicillan
Vanc - If out of the country or lots of Abx
Which infants should not be given ceftriaxone (cefataxime instead)
premature
babies with jaundice
acidosis
low albumin
In children >3 months what is the antibiotics guidance for suspected bacterial meningitis
ceftriaxone
Treat bacterial meningitis due to L monocytogenes with
- IV amoxicillin or ampicillin for 21 days in total,
- gentamicin for at least the first 7 days.
Treat bacterial meningitis due to Group B streptococcus
IV cefotaxime for at least 14 days
Who should be given corticosteroids in suspected or confirmed bacterial meningitis
- frankly purulent CSF
- CSF WBC count greater than 1000/microlitre
- raised CSF WBC count with protein concentration greater than 1 g/litre
- bacteria on Gram stain.
What corticosteroid should be given in patients with suspected of confirmed bacterial meningitis
0.15 mg/kg to a maximum dose of 10 mg, four times daily for 4 days
Who should not be given corticosteroids in suspected or confirmed bacterial meningitis
- <3 months
- If antibitiocs were started over 12 hours ago
- if infant is shocked that is not responsive to vasopressors
What follow up should be given in all children with bacteral meningitis
- paediatrician w/i 6 weeks
- audiometry ASAP or within 4 weeks of being fit
What is the empirical antibiotic of choice for sepsis (not bacterial) in neonates
- benzylpenicillan + gent
- If gram negative suspcted add in cefotaxime
- Once gram neg confirmed, stop benzylpenicillan
If you are giving a second dose of gent, when is it usually administed in neonates
After 36 hours
What dose of fluid bolus should you give ina shocked child
20ml/kg stat
When are children allowed to return to school following chickenpox
all lesions have crusted over
no new crops occurring
What pathogen usually causes scarlett fever
Group A streptococcus (streptococcus pyogenes)
What are the symptoms of scarlett fever
- Sore throat
- fever
- sandpaper rash - starts on neck, chest and scapular
- red/strawberry tongue
- flushed face
- desquamation of skin may appear
What is the incubation period of scarlett fever
1-7
IS scarlett fever notifiable
yes
What features may you find in the mouth with scarlet fever
- exudate
- cervical lymphadenopathy
- haemorrhagic spots on palette
What is the management of scarlett fever
- penicillin or azithromycin (pen allergic)
- fluids
- analgesia
Why do we avoid aspirin in children under 16
Increase risk of reyes syndrome
When can a child return to school after diagnosis with scarlet fever
Can return after 24 hours of antibiotics
What are the rare side effects of scarlet fever
- rheumatic fever
- AKI - post-streptococcal glomerulonephritis
