Infectious Dse in Children Flashcards
Chickenpox has a complication of only____,
1%
Chickenpox is a highly contagious infection
caused by the varicella zoster virus, a DNA virus
within the________________
herpes virus family.
Severe neonatal varicella
infection can result from perinatal varicella (especially if___________
contracted from 5 days before
the birth to 2 days after
rash of varicella
_________, including oral mucosa
‘_____________: vesicles, papules, crusting
lesions present together
Pruritic
Centripetal distribution
Cropping’ phenomenon
Varicella
Death rare except in the _______ and _____
immunocompromised and
neonates with congenital varicella
Varicella
Give paracetamol for the fever (avoid ___________in
children due to the possibility of Reye
syndrome).
aspirin
Varicella
___________ or similar agents can be life-saving in
the immunocompromised host
Aciclovir
Varicella
Exclusion is recommended until the ________
blisters have
dried, usually at least 5 days in unimmunised children
but possibly shorter in those immunised
Prevention in contacts who are immunocompromised
or at high risk (e.g. neonates) and in contact with
varicella, is possible with _____
zoster immune globulin
ZIG
Measles (rubeola) is a highly contagious disease
caused by an _____
RNA paramyxovirus
acute febrile exanthematous illness with characteristic
lesions on the buccal mucosa
measles
tiny
white spots like grains of salt, opposite the molars).
Koplik spots
If an
acute exanthematous illness is not accompanied by a
______, it is unlikely to be measles
dry cough and red eyes
Measles
Laboratory diagnosis is by serology, with IgM rising
_____after the onset of the rash.
3–5 days
Transmission of measles
Measles is transmitted by patient-to-patient contact
through oropharyngeal and nasopharyngeal droplets
expelled during coughing and sneezing
Measles
The incubation period is 10–14 days and the
patient is infectious until about _____
4 days after the onset
of the rash
Stages of meales
Prodromal stage
Exanthema (rash) stage
Convalescent stage
What stage of measles
This usually lasts 3–4 days. It is marked by fever, malaise, anorexia, diarrhoea and ‘the three Cs’: cough, coryza and conjunctivitis
Sometimes a non-specific rash appears a day before the Koplik spots
Prodromal stage.
Identified by a typically
blotchy, bright red maculopapular eruption; this
stage lasts 4–5 days
Exanthema (rash) stage
rash of measles
The rash begins behind the ears; on the first day it spreads to the face the next day to the trunk and
later to the limbs.
The rash fades, leaving a
temporary brownish ‘staining’. The patient’s
cough may persist for days, but usually good
health and appetite return quickly
Convalescent stage
Cx of measles
otitis media (9%), pneumonia (6%) and diarrhoea (8%).
cx of measles
________ late complication, occurring on average
7 years after infection in 0.5–1/100 000 cases, and
is manifested by universally fatal progressive brain
damage.
Subacute sclerosing panencephalitis
(SSPE) is a
Vaccines for measles
Live
attenuated measles virus vaccinations combined with
mumps and rubella (MMR) are recommended at the
age of 12 months and then MMRV (with varicella) at 18
months.
Multiple features of ______are
usually evident, which include intellectual disabilities,
cataracts, deafness, cardiac abnormalities, intrauterine
growth disorders (IUGR) and inflammatory lesions
of the brain, liver, lungs and bone marrow
Congenital Rubella syndrome
All women of child-bearing age should have________
and if not their immune status should be assessed
serologically.
2
documented doses of rubella-containing vaccines
Rubella-containing vaccinations are contraindicated
________ and ________
in pregnant woman and pregnancy should be avoided
for 28 days after vaccination
Only
______ of women of child-bearing age are seronegative, though the risk is higher in women born overseas.
2.5%
Rubella
T or F
Approximately one-third of infections are
asymptomatic (subclinical). Infection usually confers
temporary immunity
f
lifelong
Rubella
A _______ rash, sometimes pruritic,
may be the only evidence of infection.
Other symptoms are usually mild and short-lived.
There is often a reddened pharynx but sore throats are
unusual. An exudate may be seen as well as______
generalised, maculopapular
palatal
exanthem.
Rubella
The patient is infectious for_________
a week before and at least 4 days after the onset of the rash
Rash of measles vs rubella
A discrete pale pink maculopapular rash (not confluent as
in measles
School exclusion in pts with rubella
The child is usually excluded until fully recovered or
for at least 4 days from the onset of the rash
CX of rubella
Encephalitis (rare) Polyarthritis, especially in adult women (this complication abates spontaneously) Thrombocytopenia (rare) Congenital rubella syndrome
This mild childhood infection may be caused by a
number of viruses, especially the enteroviruses,
and produces a rubella-like rash that may be
misdiagnosed as rubella
Viral exanthema (fourth syndrome
4th syndrome vs rubella rash
In 4th syndrome: The rash, which is usually
non-pruritic and mainly confined to the trunk, does
not desquamate and often fades within 48 hours
Parvovirus, also known as ‘slapped cheek’ syndrome,
is a childhood exanthem caused by______
parvovirus strain
B19.
Rash of Parvovirus
The bright macular rash erupts on the face first then, after a day or so, a maculopapular
rash appears on the limbs
_________is a mild illness but, if the
parvovirus infection occurs during pregnancy, fetal
complications including miscarriage can occur
Erythema infectiosum
Pregnant women should be tested for parvovirus IgM and IgG if: 1 2 3
• in the same room as the infected person for
>15 minutes
• face-to-face contact
• household contact
parvovirus IgM and IgG
- IgG alone detected—______
- IgM detected—_______
immune
false positive or early infection
If Parvo infection occurs in the first half of pregnancy,
the fetus may become
1
2
anaemic (the virus replicates in erythroid progenitor cells) and hydrops fetalis and miscarriage can occur
_______ is a viral infection (human herpes virus 6)
of infancy, affecting children at the age of 6 months
and 2 years;
Roseola
SSx of Roseola
- Sudden ______
- Runny nose
- Temperature falls after _____
- ________ rash appears
high fever (up to 40 ° C)
3 days (or so) then
Red macular or maculopapular
This is a mild vesicular eruption caused by
enteroviruses, the most common being Coxsackie
A-16, with EV-71 being less common
Hand, foot and mouth (HFM) disease
Other name for HFM
Sometimes referred to as ‘crèche
disease’, it often occurs among groups of children in
child care centres
Rash of HFM
• Starts as a red macule, then progresses to vesicles
• Vesicles lead to shallow ulcers on buccal mucosa,
gums and tongue
• Greyish vesicle with surrounding erythema
Scarlet fever results when a _______ organism produces erythrogenic toxin
Group A Streptococcus
pyogenes
Rash of scarlet fever
• First appears on neck
• Rapidly generalised
• Punctate and red, a ‘boiled lobster’ or sunburnt
appearance
Where is the rash of scarlet predominant?
Prominent on neck, in axillae, cubital fossa
(Pastia lines), groin, skinfolds
Tx of scalet
__________(dose according to age) for
10 days with rapid resolution of symptoms. Children
can return to school 24 hours after taking antibiotics
and feeling well
Phenoxymethylpenicillin
This is an uncommon but important systemic
vasculitis, usually in children under 5 years of age,
likely caused by an infection, though the presumed
agent remains unknown
Kawasaki disease
Features of KD
• polymorphous rash
• bilateral (non-purulent) _______
• ___________, e.g. reddened or dry
cracked lips, strawberry tongue, diffuse redness
of oral or pharyngeal mucosa
• __________, e.g. erythema of the palms
or soles, oedema of the hands or feet (and in
convalescence desquamation)
•_________(>15 mm diameter,
usually unilateral, single, non-purulent and
painful)
conjunctival infection
mucous membrane changes
peripheral changes
cervical lymphadenopathy
Cx of KD
The majorcomplication is vasculitis, which causes _______________ in 15–25% of untreated cases,
and which can lead to ischaemic heart disease and
sudden death either at the time or years later
coronary
aneurysms and ectasia
Tx of KD
Early treatment with_____ and ____ has been shown to be effective in reducing the prevalence of coronary artery abnormalities
immunoglobulin and aspirin
_______ is an acute infectious disease caused by a
paramyxovirus with an affinity for the salivary
glands and meninges
Mumps
Transmission of mumps
It is usually transmitted by
respiratory secretions or saliva
The ______ occurs
in only two-thirds of clinical cases of mumps and is usually
bilateral
classic parotitis
Mumps can result in________
if contracted in the first trimester of pregnancy
spontaneous abortion
How to differentiate parotitis vs CLAD
Lymph nodes
are posteroinferior to the ear lobe; the parotid gland
is anterior and, when enlarged, obscures the angle of
the mandible
________ is associated with
toxaemia and results in a high leucocyte count
Bacterial (suppurative) parotitis
Common Cx of mumps
Orchitis Meningeal symptoms (10%) Abdominal pain (transient)
Rare Cx of mumps
Oophoritis Encephalitis Arthritis (one or several joints) Deafness (usually transient) Pancreatitis
Children with mumps should be excluded until ____
9 days
after the onset of the parotitis
Pertussis (whooping cough) is a respiratory infection
(a bronchitis) caused by________and occurs
worldwide
Bordetella pertussis
Other organisms that can cause Pertussis
Bordetella parapertussis,
Mycoplasma pneumoniae, Chlamydia pneumoniae
The _______ followed by ________ is
less common in older children and adults, or children
who have partial immunity from vaccination
classical
paroxysmal cough followed by an inspiratory whoop
The fatality rate of pts with pertussis in
unvaccinated infants less than 6 months is______
8 per 1000
cases.
The most common cause of death is pertussis
_______ sometimes complicated by _____ and ______
pneumonia,
seizures and
hypoxic encephalopathy
Pertussis is also referred to as the
‘________ This can lead to issues with sleep
disturbance, work performance (especially when
dealing with machinery or driving) and rarely rib
fractures.
100 day cough’.
Phases of Pertussis
Classic whooping cough is characterised by cough
and coryza for 1 week (_______) followed by paroxysms of a more pronounced cough _____
catarrhal
(paroxysmal phase).
Cx of pertussis
Complications
- Neurological:_____
- Pulmonary: _______
asphyxia, hypoxia, seizures, cerebral haemorrhages
atelectasis, pneumonia, pneumothorax, bronchiectasis
Abx for Pertussis
• azithromycin — <6 months: 10 mg/kg daily for 5 days — >6 months: 10 mg/kg on day 1 (up to 500 mg) then 5 mg/kg (up to 250 mg) for a further 4 days
• clarithromycin
— >1 month: 7.5 mg/kg (up to 500 mg) bd for
7 days
• erythromycin
— >1 month: 10 mg/kg (up to 250 mg, or
400 mg if ethyl succinate) qid for 7 days
T or F
High-risk contacts of a pertussis case (those with
close/household contact and who may be vulnerable
to complications, or transmit to others who are
vulnerable) should be treated with the same
medications
T
Prevention strategies for pertussis:
a________’ strategy of vaccinating any adults
who are or will be in close contact with an
infant
‘cocoon
Prevention strategies for pertussis:
mothers should be vaccinated in pre-pregnancy
planning or straight after delivery. Alternatively,
if more than 5 years has elapsed since their last
previous dose, a pertussis vaccine should be
given in their ________
third trimester (which will boost
maternal antibodies that are transmitted in utero
to the about-to-be-newborn)
HSV
The specific gingivostomatitis occurs in ______of cases and can be severe and acute
25–30%
Cx of HSV
• encephalitis can develop in otherwise healthy children • \_\_\_\_\_\_\_—children can get widespread severe herpetic lesions • disseminated HSV infection in \_\_\_\_\_ (avoid contact until recovered) • HSV can be a serious issue in the immunocompromised patient
eczema herpeticum
neonates
Impetigo (school sores) is a contagious superficial
bacterial skin infection caused by______ or ________ or a combination of
these two virulent organisms
Streptococcus
pyogenes or Staphylococcus aureus
2 forms of impetigo
1 vesiculopustular with honey-coloured crusts
(either strep or staph)
2 bullous type, usually S. aureus
Abx for impetigo
If extensive and causing systemic symptoms:
flucloxacillin/dicloxacillin 12.5 mg/kg up to
500 mg) 6 hourly for 10 days
or
cephalexin 25 mg/kg up to 1 g 12 hourly for
10 days
Head lice is an infestation caused by the louse
Pediculus
humanus capitis
Spread of head lice
Head lice spread from person to person by direct
contact, such as sitting and working very close to one
another
Insecticides used to treat head lice include:
1
2
3
- malathion
- permethrin
- phenothrin
Caution for head lice insecticides
These applications can be irritating to the scalp,
so use caution in children prone to atopic dermatiti
