Lecture 32: Fever and Rash Flashcards

1
Q

What are the two main fever+rash concerns in children?

A
  • Measles

- Meningitis

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2
Q

6 m/o child comes in with fever. Hx of being unwell last two days. Rapid pulse and has not had wet nappy for two days. What initial concerns should you recognise?

A

Signs and symptoms of vaccine preventable disease:
i.e Measles, pertussis, meningococcal and pneumococcal disease

Rash commonly associated with infection

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3
Q

What Hx details do you look for in small children when concerned about immunisatiomn?

A
  • Must know NZ schedule and age child actually received vaccines
  • Where they were born, overseas travel etc
  • Is there an outbreak of anything atm?
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4
Q

Describe measles infectivity, prodrome, complications and why people are hospitalised:

A
  • Highly infectious
  • Prodrome; 2-3 days fever, conjuctivitis, corzya, kopliks spots (buccal mucosa)
  • Characteristic rash day 3-7, most unwell at time of rash
  • Complications; ~10% have secondary inf. i.e ear, pneumonia, croup

Hospitalisations ~30%

  • 0.1% encephalitis
  • Rarely subacute sclerosing panencephalitis 7-10 yrs later. fatal. persistent measles infection. (SHES NEVER SEEN BEFORE AND HOPES NEVER TO)
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5
Q

Why was there a measles outbreak?

A
  • 90’s kids had a drop in immunisation

- Covid saw a drop in immunisation again

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6
Q

6 m/o child comes in with fever. Hx of being unwell last two days. Rapid pulse and has not had wet nappy for two days. Fine widepsread rash: Whats of concern.

A

6 months = no measles vaccine yet (given 12 months)

- Rash + fever -> looking towards measles…

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7
Q

What sorts of infections causes rash + fever in children?

A
  • Measles
  • Rubella
  • Scarlet fever
  • Parvovirus (‘slapped cheek’)
  • Roseola (herpes V6)
  • CMV, EBV etc
  • Enterovirus (common viral meningitis)

But most of these things are historic because of vaccination

Take away: Many causes of rash and fever

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8
Q

Child comes in, fever + irritability last 24hrs. Not sure if all immunisations are up to date. What examinations can you complete?

A

Examine for:

  • General wellbeing
  • Rash
  • Fortanelle
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9
Q

Febrile infant scenario:

Child comes in;

  • Fever
  • NO RASH
  • Tense fortanelle

What is the next step?

A
  • Fluid resus
  • Blood culture
  • Lumbar puncture
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10
Q

Whats a possible cause of meningitis in febrile infants?

A

heamophilus influenzae; Gram negative coccobacilli

  • Vaccine preventable
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11
Q

What are some causes of meningitis?

A

Bacterial

  • N meningitidis (Gram -ve, cocci)
  • S. pneumoniae (Gram +ive cocci)
  • Heamophilus influenzae type B rarely seen.

Viral

  • Herpes simplex
  • Enterovirus

Tuberculosis

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12
Q

What do the three common bacterial causes of meningitis have in comon?

A

All are encapsulated bacteria - polysaccharide coating around or part of bacterial cell wall

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13
Q

How do age, polysaccharide and vaccines interlate?

A
  • Young children <2yrs produce very weak antibody responses to polysaccharide antigens
  • Poor immunological memory to polysaccharide antigens
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14
Q

How do conjugate vaccines work in relation to polysaccharides?

A
  • Polysaccharide attached to a carrier protein
  • Taken up by B cells, digested and presented to helper T cells
  • Converts a T cell independent CHO antigen into a t-cell dependent antigen

= Good immunogenicity in those <2yrs of age, good production of memory cells.

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15
Q

The Hib vaccine lasts 30 years and is an example of another conjugate vaccine, write some notes detailing why its been so effective at eliminating heamophilus influenzae b:

A
  • PRP polysac linked to immunogenic protein
  • Effective in young infants
  • Reduces or eliminates nasopharyngeal colonisation
  • If vaccine uptake is >80% invasive disease is virtually eliminated in a population
  • Protective efficacy of vaccine >98%
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16
Q

In the girl with a fever, she becomes increasingly drowsy, whats the importance of this?

A

Progression of illness.

In this case it was streptococcus pneumoniae causing bacterial meningitis.

17
Q

Write some notes on streptococcus pneumoniae:

A
  • 20-40% kids have colonies in nasopharynx
  • Gram +ive coccus
  • CHO external capsule, but 90 serotypes identified
  • Capsule plays essential role in escaping phagocytosis
18
Q

Invasive pneumococcal disease is where pneumococci isolate from the usual sterile sites i.e CSF, blood, lung tissue. What does it cause in children and all ages?

A

In children:
- Common cause of otitis media

In all ages:

  • Bacterial pneumonia
  • Bacterial meningitis in young children
19
Q

Write some notes on the streptococcus pneumoniae vaccine:

A
  • Contains capsular polysaccharide from each of the 23 most common infecting serotypes (/90)
  • Used in high risk groups, but not long lasting and not all encompassing
20
Q

Describe N. meningitidis as a microbe:

  • Transmission route
  • Virulence factors
A
  • Human pathogen transmitted by droplets from colonised upper resp. mucosa
  • Polysaccahride is an important virulence factor
  • Many serotypes, but A,B,C and W135 + Y most important and can cause epidemics
21
Q

What is meningococcal disease?

A

Rare.
Disease onset is sudden and often dramatic
- Clinical presentations are meningitis and/or septicemia
- Significant case fatality and morbidity rate despite treatment
- Fatal without treatment

22
Q

What virulence factors make vaccination for meningitidis difficult?

A
  • AB play major role in protection
  • Polysac been major target for serotypes other than B…… b/c this is composed with same sugars found on surface of human immature neural cells

MENACTRA = A,C,W135,Y