Paed:Infective Flashcards
Risk factors for febrile child
Illness of other family members
Unimmunised
recent travel abroad
contact with animals
Red flag signs for febrile child
Fever >38 if below 3 months or Fever >39 if 3-6months
Colour: Pale/Mottled blue
Decreased LoC, neck stiffness, bulging fontanelle, seizures
Significant resp distress
Bile stained vomit
Severe dehydration/Shock
What is in a Septic Screen?
- Urine Sample
- Blood tests
- Lumbar Puncture
What blood tests would you do in a septic screen?
Blood cultures, FBC (+WCC), CRP, Blood gas, U+E’s, Creatinine, Clotting screen
What other tests can be done in addition to septic screen?
CXR, other cultures (resp, wound, catheter ports)
Rapid antigen screen on blood/csf/ruine
PCR
Red flag sepsis criteria
Hypotension Resp rate >60 High blood lactate CRT >5seconds Oxygen req to maintain sats >92
What is septicaemia?
Bacteria proliferating in the bloodstream leading to septicaemia. The host response involves the release of infmallatory cytoines and activation of the endothelial cells, which may lead to septic shock.
Commonest cause of Septicaemia?
Neonates: Group B Strep, or G-ve organisms from BC
Children: Meningococcal infection
Pneumococcus is the commonest cause of bacteraemia.
Treatment of septicaemia
- Antibiotics (?IV)
- Fluids
- Inotropic support
What is a complication of septicaemia?
Disseminated Intravascular Coagulation - Treat with FFP and platelet transfusions
What is meningitis?
Inflammation of the meninges. Confirmed by presence of inflammatory cells in the CSF
What type of Meningitis is more common?
Viral - although it is usually self limiting. Bacterial is more severe
Causative organisms of bacterial meningitis?
Neonatal: Group B Strep, E.Coli, Listeria Monocytogenes
1month-6years: Neisseria Meningitidis, Strep Pneumoniae, Haemophilus Influenzae
>6years: Neisseria meningitidis, Strep Pneumoniae
Presentation of meningitis
Non specific infection sx if under 18months.
Other: Fever, headache, purpuric rash, neck stiffness, bulging fontanelle, Opisthotonos, +Ve brudzinski/kernigs, reduced conscious level
What is brudzinskis sign?
Flexion of neck w/ child supine causes flexion of knees and hips
What is kernigs sign?
Child supine with knees and hips flexed, pain in back on extension of legs.
Diagnosis confirming investiagtion in meningitis?
LP
Investigations in meningitis
FBC, CRP, Coag Screen, U+E’s, LFTS, blood glucose
Cultures: blood, throat, urine, stool
Rapid antigen test
Lumbar puncture site
L3-L5
Contraindications to LP
- Raised ICP (signs: papilloedema, fluctuating consciousness, high BP, reduced HR)
- Infection over site of LP
- DIC
- Cardiorespiratory instability
- Focal neurological signs
- If it causes a delay in abx treatment
Risks of LP
Infection
Bleeding
Unsuccessful
CSF changes in bacterial meningitis
Appearance: Turbid
WBC: Increased polymorphs
Protein: Increased
Glucose: Decreased
CSF changes in viral menigitis
Appearance: Clear
WBC: Increased lymphocytes
Protein: Normal/increased
Glucose:Normal/decreased
CSF changes in TB meningitis
Appearance: Turbid/Clear/Viscous
WBC: Increased lymphocytes
Protein: Increased (more than bacterial)
Glucose: Decreased (less than bacterial)
Hospital management for bacterial meningitis
Ceftriaxone or Cefotaxime
What can be given as immediate management for bacterial meningitis?
IM Benzylpenicillin
Cerebral complications of meningitis
- Hearing loss
- Local vasculitis
- Local cerebral infarction
- subdural effusion
- hydrocephalus
- cerebral abcess
What is the cause of purpura?
Blood leaking and skin being necrotic.
How is meningitis spread?
Droplet spread
First line tx to reduce risk of disease in close contacts of meningitis
Ciprofloxacin: Single dose, no interaction with OC, readily available
Who shouldnt have Rifampicin?
- People on OC pill
- Renal/Hepatic impairment
- Pregnant women
How is a close contact defined?
Has had prolonged close contact with the case in a household type setting during the 7 days before onset of illness.
OR
People who have had transient close contact with the case only if they have been directly exposed to large particle droplets from resp tract of case around time of admission
Common causes of viral meningitis
Enteroviruses, EBV, adenoviruses, mumps
Viral mengitis confirmed by?
Culture/PCR of CSF, stool culture, serology
3 main symptoms of encephalitis?
Fever, altered consciousness, seizures
Commonest causes of encephalitis
Enterovirus, respiratoryviruses, HSV, VZV,
Treatment of encephalitis
Aciclovir
What causes Toxic Shock Syndrome?
Toxin producing Staph Aureus and Group A Strep
3 main symptoms of TSS
Fever >39
Hypotension
Diffuse erythematous macular rash
Treatment of TSS
Abx: Clindamycin + Flucloxacillin
Also: IV Immunoglobulin
What is Necrotising fasciitis/cellulitis?
Severe subcutaneous infection involving tissue from the skin down to the fascia and muscle. Leaves necrotic tissue at centre
Organism causing Necrotising Fasc?
Group A strep or S. Aureus
Treatment of Necrotising Fasciitis
Antibiotics (Benzypenicllin) and IV Ig and Surgical Debridement
What causes Scalded Skin Syndrome?
Exfoliative staphylococcal toxin
Symptoms of SSS?
Fever, malaise
Purulent, crusting, localised infection around eyes/noes/mouth
widespread erythema and skin tenderness
What is Nikolsky’s sign?
Areas of the epidermis separate on gentle pressure. Seen in SSS
Treatment of SSS
IV flucloxacillin
Treatment of Herpes Simplex infections
Aciclovir
Primary varicella zoster infection is better known as:
Chickenpox
Clinical features of Chickenpox:
Vesicular rash, starting on head and trunk, 200-500 lesions and then moves to peripheries.
Papules>Vesicles>Pustules>Crusts.
Complications of chickenpox
Secondary bacterial infection
Encephalitis
Purpura Fulminans
Treatment of chickenpox
Normally self limiting.
If immunocompromised give IV Aciclovir.
If adolescent/adult give IV Valaciclovir.
Human varicella zoster IG may be given to at risk immunocompromised.
What is shingles?
Reactivation of latent VZV causing a vesicular eruption in the dermatomal distribution of sensory nerves. Commonly thoracic.
Symptoms of EBV infection
Fever, malaise, tonsillopharyngitis, lymphadenopathy.
On exam: petechiae on soft palate, splenomegaly, hepatomegaly, maculopapular rash, jaundice.
Diagnosis of EBV
- Atypical lymphocytes (large T cells on film)
- positive monospot test (presence of heterophile antibodies)
- Seroconverion with production of IgM and IgG to EBV antigens
Treatment of EBV infection
Symptomatic or steroids if airway compromised.
How is CMV transmitted?
Saliva, genital secretions, breastmilk, blood products
Treatment of CMV
Ganciclovir of Foscarnet
What can CMV cause in compromised pts
Retinitis, colitis, pneumonitis, enchephalitis, hepatitis, oesphagitis, bm failure
What is Parvovirus b19 infection called?
Slapped cheek syndrome/ fitfth disease / eyrthema infectiosum
How is Parvovirus B19 transmitted?
Resp secretions or MTCT
What are clinical syndromes of Parvovirus B19?
- Aysmptomatic
- Erythema infectiosum
- aplastic crisis
- fetal disease
How are enteroviruses transmitted?
Faeco-oral route
How is measles spread?
Droplet spread. Caused by Rubeola virus
Clinical features of measles?
- Fever
- rash - spreads downards from behind ears to whole of body
- Kopliks spots - white spots on buccal mucosa, seen against bright red background
- conjunctivitis and coryza
- cough
How to prevent measles?
IMMUNISATION U FOOLS (DR HR isnt happy)
Complications of measles
Otitis media, croup, tracheits, pneumonia,
encephalitis, convulsions
diarrhoea
How is mumps spread?
Spread by droplet infection. Attacks parotid gland
Clinical features of mumps
Fever
Malaise
Parotitis
Earache
What enzyme can be raised in mumps?
Amylase
How is rubella spread?
Droplet spread
Symptoms of rubella
Low grade fever
maculopapular rash
lymphadenopathy
Complications of rubella
Arthritis
encephalitis
thrombocytopenia
myocarditis
What is impetigo?
localised, highly contagious, staphylococcal and/or streptococcal skin infection
Main route of transmission of HIV in paeds?
MTCT
- Intrauterine - in pregnancy
- intrapartum - at delivery
- postpartum - breastfeeding
Diagnosis of HIV
> 18months: HIV detected by antibodies to the virus
<18months: - Born to infected mothers –> will have transplacental maternal IgG HIV antibodies
- HIV DNA PCR is most sensitive
Clinical features of HIV
Mild immunosupression: Lymphadenopathy, parotitis
Moderate immunosuppresiion: recurrent bacterial infections, candidiasis, chronic diarrhoea
Severe: opportunistic infections eg. Pneumocystis jiroveci pneumonia, severe FtT
Treatment of HIV
Antiretroviral therapy
Prophylaxis against Pneumocystis jiroveci pnia –> co-trimaxole
How to reduce vertical transmission?
- Use of ART in mother
- Birth via C section
- Avoid breastfeeding
- Avoid prolonged rupture of membranes
What causes Scarlet Fever?
Exotoxin released from Strep Pyogenes
Signs of scarlet fever?
Red prinprick blanching rash (chest, axilla, behind ears) , facial flushing w/ circumoral pallor, strawberry tongue.
Develops after initial sore throat and fever.
Treatment of scarlet fever?
Phenoxymethylpenicillin
What is Kawasaki disease?
Systemic vasculitis that can lead to coronary artery aneurysms and myocardial infection.
Diagnostic criteria for Kawasaki disease?
Fever >38.5 >5days and 4outof5 of:
- Non-purulent bilateral conjunctivitis
- Red mucous membranes (dry cracked lips, strawberry tognue)
- Cervical lymphadenopathy
- Polymorphous rash
- Extremities changes (red, oedemaotus, peeling palms)
What test results would you see in Kawa Disease?
Anaemia Increased WCC Increased CRP Increased ESR Icnreased liver enzymes Urine: mononuclear WBC w/o bacteria Increased platelets Note: You would perfrom an echo to check for cardiac changes.
Management of Kawasaki disease?
High dose IV Ig
Aspirin
Complications of treatment of KD with Aspirin?
Reyes Syndrome (hepatic encephalitis)
Complications of treament of KD with IV IG
Steven Johnson syndrome
What are some predisposing factors for Candida albicans infection?
- moist body folds
- treatment with broad-spec abx
- immunosuprresion
- diabetes mellitus
What are the variants of candida?
- cutaneous candidiasis: well demarcated macular erythema, slight scaling and small outline ‘satellite’ lesions, worse in body folds
- chronic paronychia
- chronic mucocutaenous granulomatous candidiasis (secondary to congenital immunodeficiency disorder)
Ix of candida
Skin scrapings for microscopy and culture
Tx of candida
oral or topical anti-candida drugs (e.g. nystatin, fluconazole)
What is candida?
Fungal skin infection
What is a coxsackie virus?
RNA virus that can cause hand, foot and mouth disease. Usually self-limiting
What is Diptheria?
This is an acute upper respiratory tract infection, but sometimes it infects the skin. Caused by Corynebacterium diphtheriae.
Polio? Tell me about it
Poliomyelitis (polio) is caused by infection with the poliovirus, an enterovirus. The virus may invade lymphatic tissue and spread into the bloodstream. It can be neurotropic, destroying motor neurons, particularly in the anterior horn of the spinal cord and brain stem. This causes flaccid paralysis which may be spinal or bulbar.
What is protected against in the 6in1 vaccine?
Diphtheria, Tetanus, Pertussis, Polio, Hib disease, hepatitis B
When is the 6in1 given?
8, 12 and 16 weeks
When is pneumococcal (PCV) vaccine given?
8 and 16 weeks
WHen is Meningococcal group B vaccine given?
8 weeks, 16 weeks and one year.
When is rotavirus vaccine?
8 and 12 weeks
When is Hib and Men C vaccine?
1 year old
MMR vaccine when?
1 year old
3years 4 months
Preschool/4in1 booster?
Diphteria, tetanis, pertussis, polio. 3years4months.
HPV vaccine when?
12-13yr olds
Teenage booster?
Tetanus, diphtheria and polio. teenage.
When give MenACWY?
4 types of meningococcal disease. teenage
