Paediatric infection Flashcards
incubation period of measles
7-14 days
define SSPE
subacute scerlosing panencephalitis
-type of encephalitis occurs after measles infections
-at least 2 to 10 years for symptoms to develop after MEASLES infections
infectivity period of measles
1-2 days before syx to 4 days afteer appearnace of rash
prodrome of measles 4
prodrome (3-5 days)
-fever, coryza, cough, conjunctivitis and Kopliks spots (small red/white dots on inside of cheeks)
features of measles after prodrome 3
then maculopapular rash starts behind the eyes, migrates to face and trunk then to limbs
-also cervical lymphadenopathy
-high fever
complications of measles 8
otitis media
lympadenitis
interstilal pneumonitis
secondary bacterial brnachopneumonia
myocarditis
post-infectious demyelening encephalomyelitis
SSPE
treatment for measles
supportive
prevention for measles
MMR vaccine
incubation period of chicken pox (Varicella Zoster)
14-21 days
infectivity period of chicken pox (Varicella Zoster)
2 days before until 5 days post rash
prodrome of chicken pox (Varicella Zoster) 4
48hrs of fever, malaise, headahce and abdo pain
clinical features of chicken pox (varicella zoster) after prodrome 1
followed by:
-itchy crops of erythematous macules, evolve into papules then vesicles containing serous fluid
*-different stages of vesciles present simultaneously
where do chicken pox (Varicella Zoster) usually start
on trunk then spread to limbs
complicatinos of chicken pox (Varicella Zoster) 9
secondary bacterial infection
pneumonia
encephalitis
progressive dissemeniated variclella
cerebellar ataxia
thrombocytopenia
purpura fulminans
post infectious encephalitis
which secondary bacterial infections are common in chicken pox (Varicella Zoster) 2
group A streoptococcus
S. aureus
treatment for chicken pox (Varicella Zoster) 2
supportive,
aciclovir in high risk patients
prevention for chicken pox (Varicella Zoster) 2
vaccination for high risk patients
post exposure prophylaxis w varicella zoster immunoglobulin (IVIG) for severe disease
-especially if immunocompormised
incubcation periods of mumps
14-21 days
infectivity period of mumps
1-2days prior to parotid swelling
9 days after
prodrome of mumps 3
prodrome- mumps, anorexia, headache
clinical features of mumps after prodrome 2
followed by painful uni/bilateral salivary ± submandibular gland swelling
complications of mumps 9
menignoencephalitis
deafness
orchitis
epididymitis
pancreatits
nephritis
myocarditis
arthitis
thrydoiditis
treatment for mumps 1
supportive
prevention of mumps 1
MMR vaccine
incubation of erythema infectiosum / slapped cheeck/ fifths disease (Parovirus B19)
4-14 days
infectivity period of erythema infectiosum / slapped cheeck/ fifths disease (Parovirus B19)
not infectious once rash appears
prodrome of erythema infectiosum / slapped cheeck/ fifths disease (Parovirus B19) 2
low grade fever
general malaise
features of erythema infectiosum / slapped cheeck/ fifths disease (Parovirus B19) after prodrome 4
few days of maculopapular spots on cheeks
-coalesce to give slapped cheeks appearance
fine rash extends to trank & limbs
fades w central cleaning giving a lacy appearance
assocaited:
-arthralgia
-arthitis
complciations of erythema infectiosum / slapped cheeck/ fifths disease (Parovirus B19)
aplastic crisis in chornic haemolytic disease eg sickle cell disease, thalassaemia and immunocompormised
treatment for erythema infectiosum / slapped cheeck/ fifths disease (Parovirus B19) 1
supportive
prevention of erythema infectiosum / slapped cheeck/ fifths disease (Parovirus B19) 1
none
incubation period of rubella
14-21 days
infectivity period of rubella
1-2 days before to 7 days after the rash appears
prodrome of rubella 2
coryza
tender cervical lymphadenopathy
clinical features of rubella after prodrome 3
fine maculopapular rash
-starts on face from where it fades as it spreads down the drunk
arthralgia
palatal petechiae
complicaitons of rubella 3
encephalitis
thrombocytopenia
congenital rubella syndrome (most feotal dameg if esposed in 1st 10 weks of pregnancy)
treatment of rubella 1
supportive
prevention of rubella 1
MMR
incubation of roseola infantum/ sixth disease (human herpes virus 6)
7-14 days
infectivty period of roseola infantum/ sixth disease (human herpes virus 6)
until fever subsides
prodrome of roseola infantum/ sixth disease (human herpes virus 6) 2
sudden onset high fever
milkd coryza
no other physical findings
clinical features of roseola infantum/ sixth disease (human herpes virus 6) after prodrome 2
day 3-4 fever resolves
-maculopapular rash appears on trunk/ limbs and lasts for 1-2days
complications of roseola infantum/ sixth disease (human herpes virus 6) 2
febrile convulstions- one of the commonest causes of febrile convulsions in 6-18 mnth olds
-usually on first day of illness
encephalitis
treatment for roseola infantum/ sixth disease (human herpes virus 6) 1
supportive
prevention for roseola infantum/ sixth disease (human herpes virus 6) 1
none
incubation period of pertussis
7-14 days
infectiveity period of pertussis
whilst coughing
risk of transmision greated in catarrhal phase
phases of pertussis 3
*-in chronological order
catarrhal phase
paroysmal phase
convalescent stage
features of catarrhal phase of pertussis
lwo grade fever
coryza
conjunctivtis 1-2 weeks
features of paroxysmal phase of pertussis 4
*-follows catarrhal phase
paroxysm of severe cough withor without whoop
post-tussive vomiting
cyannosis
apnoea
can last for 2-8 weeks
features of convalescent phase of pertussis 1
cough subsides over weeks to months
complications of pertussis 3
apneoa
secondary bacterial pneumonia
weight loss secondary to feeding dificulties and post-tussive vomiting
severe complciations of pertussis 8
subsewuent bornchietisis
otitis media
seizures
encephalopahty
subocnjunctival, subarachnoid or intraventitrrilcuar haemorrhage
umbilial or inguinal hernia
rupture of diaphragm
diagnosis of pertussis 3
pernasal swab for PCR testing
culture
lymphocytosis
treatment of pertussis 2
supportive
-low threshold for admission if neonates
macroslides
benefits of using macroslides in pertussis infection 3
modify course of early disease
later reduce infectivitivty
and reduce secondrary bacterial complciatiosn
preveniton of pertussis
vaccination
most common cuases of bacterial meningitis in uk children 2 (3 others)
Neisseria meningitdis (mainly B)- 60-70% of cases
-incidence decreasing with routine vaccinatin
streptococcus pneumonia around 30%
H. Infunzae, TB and group B strep the rest
common cause of viral meningitis 1
enterovirus
common cuase of menigoencephalitis 1
herpes simplex
neonates cause of meningitis 1
50-60% of cases are due to Group B strep (colonisation of the birth canal)
other causes of noenates meningitis 2
listeria monocytogenes (eg mother eating unpasteurieiszed cheese during pregnancy)
gram-neg organmis s like E.coli
presenation of meningitisin children 10
*-bacterial meningitis MEDICAL EMERGENCY
fever
headache
vomiting
neck stiffness
photophobia
lethargy
decreased level of consciousness
seizures
postive kernigns and brudzinski tests
define kernings test
hip flexed-> extended knee= pain
define brudzinkis sign
neck flexed-> hip & knee flex
presenation of infants with meningitis 7
unexplained fever
lethargy
high pitched/ iritable cry that cannot be soothed by parents
poor feeding
apnoeic or cyanotic attacks
posturing
seizures
advanced sign of meningitis in infants
bulging fontanelle
-sign of rasied ICP
*-can be masked by dehydration
diagnosis of meningitis 1
lumbar puncture
contraindications to a lumbar puncture 4
cardiovascular compormise
signs of raised ICP (risk of cerebral herniation)
abnormla clotting studies/ low platelets (risk of subdural or epidural haematoma)
skin infection at lumbar puncture site (risk of introducing infectoin)
signs of raised ICP 8
GCS<9 or drop of 3 or more
relative bradycardia and hypertension
focal neuro signs
abnormal posute/posturing
unequal
dilated or poorly repsonsive pupils
papilloedema
abnormal dolls eyes mvoemeonts
CSF analysis in meningitis
-White cell count cut off for children and neonates
children >5cells /mcl
neonates >20 cells/mcl
type of WCC seen in CSF of bacterial meningitis
polymorphs
type of WCC seen in CSF of viral mengitis after 24 hours
lymphocytes
protein and glucose in CSF of bacterial/TB meningitis
elevated protein >0.4g/L
decreased glucose <0.6 CSF:blood ratio
important point on gram staining for bacterial mengitis
60% of bacterial meningitis are negavtive for staining
-DO A CULTURE
CSF investigations for TB meningitis 2
ZN/auramine stain
mycobacterial culture
when to do PCR of CSF for what type sof meningitis 6
pneumococcus
meningococcus
HiB
HSC
VZV
enterovirus
emperical treatment for suscpected bacterial meningitis :
<6wks
6wks-3mnths
> 3mnth
<6wks- cefotaxime, amox, gent
6wks-3mnths- cefotaxime
> 3mnths- cefotaxime and dexamethasone
when should dexamethazone be used in menigitits, what age and why
if no petechiae or purpuric lesions
child over 3 months
reduces risk of deafness from Hib meningitis
definitve treawtment for N. meningitiidis meningitis 2
7 days IV cefotaxime/ceftriaxone
definitive treatment for S. pneumoniae meningitis 2
14 days IV cefotaxime/ceftriaxone
if somneone has confirmed meningitis who should also be informed and what sohuld occur
refer to public health
contact tracing for chemoprophylaxis
complications of meningitis 7
hydrocephalus
deafness- routine hearing tests after meningitis in children
neuromotor disordeers
seizures
visual disorders
speech/ language disordrs
learning difficulties and behaviorual problems ‘
what is released in meningococcal sepsis (1) and what do they do (4)
endotoxins from cell wall cuase activation of proinflammaotry cytokines leading to:
-capillary leak
-coagulopathy
-myocardial depression
-metabolic derangement (low K, Ca, Mg & Ph)
presentation of meningococcal sepsis 2
fever
petechial/purpuric rash (may be erytheamtous at onset)
*-can rapdily deteriotate and lead to severe sepsis and septic shock
presenation of septic shcok 6
breahting difficulties
tachycardia
hypotension
cool extremities
leg pain
CRT>2s
decreaed GCS
managemnet of meningococcal sepsis 5
high flow O2 15l via facemask w reservoir bag
signs of shcok IV fluid bolus
-20ml/kg 0.9% saline
-repeat
-if more than two= DW PICU/anaestjeitc team for ventilation/intubation/inotropic support
IV cefotaxime (50mg/kg)
correct metabolic derangement
treat coagulopathy
what causes acute epiglottitis
Haemophilus influenzae type B
-rare but serious
*use to be children mainly affected but since immunisation now more adults
features of acute epiglottitis 5
rapid onset
high temp
stridor
drooling of saliva
TRIPOD POSITION
- paitent finds it easier to breath if they are leaning forward and extending their neck in a seated posiotin
diagnosis of acute epiglottitis 2
direct visulisation
-ONLY BY SENIOR STAFF
-risk of acute airway obstruction
x-ray aswell
xray findings in acute epiglottitis 1
*why is xray helpful here
lateral view- show swelling of epiglottis - ‘thumb sign’
*Xray also helpful to assess for foreign body
xray findings in croup
posterior-anterior view show subglottic narrowing
-‘steeple sign’
management of acute epiglottitis 4
immediate senior involmemet
-endotracheal intubation may be necessary to protect teh airway
Oxyrgen
IV ABx (cefotaxime)
management of acute epiglottitis 4
immediate senior involmemet
-endotracheal intubation may be necessary to protect teh airway
Oxyrgen
IV ABx
