Paediatric infections Flashcards
what is a serious complication of pertussis?
hypoxic encephalopathy
how might we treat pertussis?
Clarithromycin 7.5 mg/kg (for child > 1month) up to 500 mg po 12H for 7d
(No Clarithromycin syrup available at present)
Azithromycin 10 mg/kg (for infant < 1 month) daily for five days
how might we ix pertussis?
PCR/serology
what is the 100 day cough?
pertussis
what bugs can cause periorbital celluitis?
staphlococcus
streptococcus
HIB
what pathogen causes epiglottis?
HIB
what do you give for an unvaccinated child with periorbital celluitis?
flucloxacillin
+ ceftriaxone (for haemophillis!)
what are the complications of mumps?
orchitis
encephalitis
how do we ix bronchiolitis?
bronchiolitis is a clinical diagnosis really, but if you had to you could do a nasopharyngeal aspirate and PCR, ABG +/- CXR
who is at risk of bronchiolitis?
preterm babies, babies with chronic illnesses, babies with cardiorespiratory issues/insufficiency
what is the usual age for bronchiolitis?
less than 1 yr old
what alternative diagnosis would we consider for a 1-4 yr old patient with a ‘viral induced wheeze’?
asthma, but really > 4yrs is required for an asthma diagnosis
what are some signs of severe bronchiolitis in a child?
apneoic episodes nasal flaring/tracheal tug/intercostal recession etc cyanosis lethargy irritability problems with feeding
what should we hear on auscultation for a child with bronchiolitis?
widespread crackles and wheeze
inspiratory fine crackles
prolonged expiratory time
what are some things we need to monitor/consider in a child who has been admitted to hospital with bronchiolitis?
Hospital admissions: monitor vitals + O2 sats,
consider NGT feeding, use suction as required
supplemental O2, close monitoring if requiring ICU care;
monitor FLUID STATUS; maintenance fluids
Ensure infection control procedures are followed.
what is the RSV immunoglobulin?
palivizumab, monoclonal antibody given IM
what are the main clinical indicators that croup is severe and the child requires hospitalisation?
stridor at rest and lethargy
what antibiotic is best used for bacterial sinusitis?
augmentin
how might we manage an empyema in a child?
drainage with chest drain
with either fibrinolytic agent (urokinase) or surgical decortication.
surgical decortication is preferred as urokinase can cause adhesions
A young child presents with a fever. They are presumed to have an infection and given antibiotics. A maculopapular rash then appears 1 to 2 days after, and the child is thought to have a drug reaction. What is the most likely situation?
Roseola infection caused by herpes virus 6. Fever presents first and then rash appears later as fever goes down
What are the complications of Kawasaki disease?
Coronary artery dilation or aneurysm formation
Describe the management of Kawasaki’s disease
Administration of IVIG preferably within the first 10 days of illness and then aspirin once a day for at least 6 to 8 weeks plus or minus paracetamol
what are the usual pathogens and clinical cause of haemolytic uraemic syndrome?
Usually bloody diarrhoea and afebrile; child does not look that unwell.
- commonly associated with big outbreaks in uncooked meat
- caused by shiga toxin producing e.coli
what are the pathogens that cause toxic shock syndrome?
streptoccocus pyogenes/ staph aureus
tell me about the signs/symptoms of kawasaki’s with management/ix
Conjunctivitis
Oedema
Lymphadenopathy
Dry cracked lips, desquamation
Strawberry tongue
Ongoing fever (> 5 days)
Rash
Erythema
Aspirin Echocardiogram IVIG/infliximab O (anti-streptolysin O) Up to date vaccinations (influenza/VZV) --> risk of Reye's with aspirin
when does post streptococcal glomerulonephritis present post strep throat?
7-14 days post strep throat infection
what are the clinical presentation of post strep GN and how might we ix this?
clinical presentation= acute fluid overload (e.g. oedema, HT), raised creatinine/oliguria, haematuria
ix= low C3, high anti-streptolysin O titre, red casts in urine, raised UEC and normocytic normochromic mild anaemia
no renal biopsy is usually indicated
you diagnose a child with epididymo-orchitis. What do you do next in terms of ix and why?
you would do a renal tract ultrasound and cysteurethrography. Epididyorchitis is often associated with urinary tract abnormalities.
what do we mean by ‘scarlet fever’
strep pyogenes (group a) infection causing tonsilitis/pharyngitis and toxin mediated diffuse erythematous exantham
what is the clinical presentation of quinsey abscess?
Severe sore throat (often unilateral) “Hot “ potato voice Difficulty swallowing saliva (pooling/drooling) Trismus Neck swelling Referred ear pain
how might we manage quinsey abscess?
Antibiotics:
• Benzylpenicillin 60 mg/kg(max 2 g) IV 6 hourly
• Metronidazole 15mg/kg (max 500 mg)
IV stat then 7.5 mg/kg IV 8 hourly
Refer to ENT for surgical drainage
what is the clinical presentation of EBV mononucleosis?
Fever Protracted illness Cervical lymphadenopathy Fatigue and malaise Variable hepatosplenomegaly Amoxycillin-induced rash
what is your immediate management of epiglottis?
Maintain position of comfort with parents present
Defer invasive examinations/ procedures (IV) or imaging (lateral neck x-ray) in patients with severe respiratory distress due to risk of precipitating respiratory arrest
Early PICU/anaesthetic review
Antibiotics: Ceftriaxone 50 mg/kg (max 2 g) IV 12 hourly
airway support!
what is your management of retropharyngeal abscess?
Lateral neck x-ray initially: A normal x-ray does not exclude the diagnosis. CT with IV contrast is the imaging modality of choice. This should be performed in a setting where advanced airway management is able to be performed.
Antibiotics: Timentin 50 mg/kg (max 3 g) IV 6 hourly
Refer to ENT for surgical drainage
what is the treatment of encephalitis according to RCH?
Aciclovir 20 mg/kg iv 8H (age <3m )
500 mg/m2 iv 8H (age 3m-12y)
10 mg/kg iv 8H (age >12y)
what is the treatment of meningitis less than 2 months old?
cefoxtamine + benzylpenicillin
what is the treatment of orbital cellulitis according to RCH?
Flucloxacillin 50 mg/kg (2 g) iv 6H and
Ceftriaxone 50 mg/kg/dose (2g) iv 12H
what is the treatment of UTIs in children?
If sick or less than 6months old
Benzylpenicillin 60 mg/kg (2 g) iv 6H and
Gent 7.5 (6 if >10y) mg/kg (360 mg) iv daily
If well or greater than 6months old
Trimethoprim 4 mg/kg (150 mg) tablets po 12H or
if syrup necessary then Co-trimoxazole
(8/40 mg per mL) 0.5 mL/kg (20 mL) po 12H
according to RCH guidelines what antibiotics do we use for mild moderate severe pneumonia?
mild- amoxicillin
moderate- benzylpenicillin
severe- flucloxacillin
what is the antibiotic regimen for OM/septic arthritis in children?
Flucloxacillin 50 mg/kg (2 g) iv 4-6H
add Cefotaxime 50 mg/kg (2 g) iv 6-8H if less than 5yrs or not HIB immunised
what is your next line of action if you suspect orbital cellulitis in a child?
a CT scan to identify those with a subperiosteal abscess
what are the clinical features of orbital cellulitis
(proptosis), limited eye movement (ophthalmoplegia), pain on eye movement, or loss of vision
