Paediatric ID Flashcards
Management of bacterial meningitis in a child <3 mnths
IV cefotaxime plus IV amoxicillin
Management of bacterial meningitis in a child >3mnths
IV Ceftriaxone
What is also given for management of bacterial meningitis in children >3mnths ?
- Dexamethasone 4x daily for 4 days
What is the most common cause of encephalitis in children ?
- Viral : HSV-1 from cold sores
- In neonates : HSV-2 from genital herpes
Give 6 features of encephalitis
- Altered consciousness
- Altered cognition
- Unusual behaviour
- Acute onset of focal neurological symptoms
- Acute onset of focal seizures
- Fever
How is encephalitis investigated ?
- LP : sending CSF for viral PCR
- CT if LP CI
How is encephalitis manged ?
- IV Aciclovir : covers HSV and VZV
- Ganciclovir covers CMV
What causes infectious mononucleosis ?
- EBV
How does IM present ?
TRIAD :
- Fever
- Sore throat
- Lymphadenopathy
- Fatigue
- Tonsillar enlargement
- Splenomegaly and in rare cases splenic rupture
How does IM typically present in an exam ?
- Adolescent with a sore throat
- Develops itchy rash after taking amoxicilin
(IM causes intensely itchy maculopapular rash in response to amoxacillin or cefalosporins )
What advice is givento someone with IM ?
- Avoid playing contact sports for 4 wks after having glandular fever to reduce the risk of splenic rupture
How can IM be test for ?
- Monospot test : +ve result = presence of heterophile antibodies
How does mumps present ?
- Prodromal flu like symptoms
- Parotid gland swelling (initially unilateral before becoming bilateral).
4 complications of mumps
- Orchitis
- Pancreatitis
- Meningitis
- Encephalitis
- Sensorineural hearing loss
How is mumps spread and how is it diagnosed ?
- Respiratory droplets
- PCR testing on viral swab
What is the mode of delivery in a mother with HIV with a viral load <50 copies/ml
Normal vaginal delivery
When is a CS considered in mothers with HIV ?
Viral load >50 copies /ml
What is given to mothers with HIV during a CS if viral load is unknown or there are >10000 copes / ml
IV zidovudine
When and what prophylactic treatment is given to a baby when the mother has HIV ?
- > Low risk babies, where mums viral load is < 50 copies per ml, should be given zidovudine for 4 weeks
- > High risk babies, where mums viral load is > 50 copies / ml, should be given zidovudine, lamivudine and nevirapine for 4 weeks
When is breast feeding recommended in HIV +ve mother ?
Never
When are babies to HIV positive parents test for HIV?
- > HIV viral load test at 3 mnths. If this is negative, the child has not contracted HIV during birth and will not develop HIV unless they have further exposure
- > HIV antibody test at 24 months. This is to assess whether they have contracted HIV since their 3 month viral load.
what are the principles of medical care in a child with HIV ?
- ART
- Prophylactic co-trimoxazole (septrin) for children with low CD4 to protect against pneumocystis jirovecii pneumonia
How is the risk of a baby contracting hepatitis B from a hep B +ve mother reduced ?
- Hepatitis B vaccine
- Hepatitis B immunoglobulin infusion
- Additional Hep B vaccine at 1 and 12 mnths
When are babies to hepatitis C +ve mothers tested ?
18 mnths of age
Features of measles
- Prodromal : conjunctivits, fever
- Koplik spots of buccal mucosa before the rash : white spots
- Rash : starts behind the ears before spreading
Most common complication and most common cause of death following measles and complication that can occur 5-10 yrs later
- Complication : measles
- Death : pneumonia
- 5-10 yrs later : subacute sclerosing panencephalitis
Threadworm treatment
- Oral mebendazole
- Including all household contacts
Chickenpox
- Fever initially
- Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
- Systemic upset is usually mild
Measles
- Prodrome: irritable, conjunctivitis, fever
- Koplik spots: white spots (‘grain of salt’) on buccal mucosa
- Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Mumps
- Fever, malaise, muscular pain
- Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Rubella
- Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
- Lymphadenopathy: suboccipital and postauricular
Erythema infectosum
- Also known as fifth disease or ‘slapped-cheek syndrome’
- Caused by parvovirus B19
- Lethargy, fever, headache
- ‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
Scarlett fever
- Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
- Fever, malaise, tonsillitis
- ‘Strawberry’ tongue
- Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Hand, foot and mouth disease
- Caused by the coxsackie A16 virus
- Mild systemic upset: sore throat, fever
- Vesicles in the mouth and on the palms and soles of the feet
