Paediatric infectious disease Flashcards
At birth immunisation
BCG if risk factors (see below) - At birth the BCG vaccine should be given if the baby is deemed at risk of tuberculosis (e.g. Tuberculosis in the family in the past 6 months).
2 months immunisation
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B
3 months immunisation
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
PCV
4 months immunisation
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Men B
12-13m immunsations
Hib/Men C
MMR
PCV
Men B
2- 8 years annual vaccination
Flu vaccine annually
3-4 years vaccination
‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
MMR
12-13 years vaccination
HPV vaccination
13-18 years vaccination
‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY
IM benzypenicillin dose for Meningitis <1 year
300mg
IM benzypenicillin dose for Meningitis 1-10 years
600mg
IM benzypenicillin dose for Meningitis >10 years
1200mg
Scarlet fever causative agent
Group A haemolytic strep
Scarlet fever epi
children aged 2-6 peak incidence at 4 years
scarlet fever spread
resp route
scarlet fever presentation
Fever: typically for 23 to 48 hours
Malaise, headache, nausea/vomiting
Sore throat
‘strawberry tongue’
Rash
Scarlet fever rash type/pattern
• fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
• children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures
• it is often described as having arough ‘sandpaper’ texture
desquamination occurs later in the course of the illness, particularly around the fingers and toes
Scarlet fever diagnosis
a throat swab is normally taken but antibiotic treatment should be commenced immediately, rather than waiting for the results
Scarlet fever management
• oral penicillin V for 10 days
• patients who have apenicillin allergy should be given azithromycin
• children can return to school 24 hours after commencing antibiotics
scarlet fever is anotifiable disease
Scarlet fever complications
• otitis media: the most common complication
• rheumatic fever: typically occurs 20 days after infection
• acuteglomerulonephritis: typically occurs 10 days after infection
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness
Roseola infantum definition
Roseola infantum (also known as exanthem subitum, occasionally sixth disease)
roseola infantum cause
HHV6
roseola infantum incubation period
5-15 days
Roseola infantum target age range
6 months to 2 years
Roseola infantum features
• high fever: lasting a few days,followed laterby a
• maculopapular rash
• Nagayama spots: papular enanthem on the uvula and soft palate
• febrile convulsions occur in around 10-15%
• diarrhoea and cough are also commonly seen
roseola infantum complications
• Aseptic meningitis
• Hepatitis
Febrile convulsions 10-15% of cases
roseola infantum school exclusion ?
Not needed
NICE traffic light - Categories
Colour, activity, respiratory Circulation and hydration, Other
NICE traffic light Colour normal features
Normal colour
NICE traffic light colour: Amber findings
Pallor reported by parent/carer
NICE traffic light colour: Red flag
• Pale/mottled/ashen/blue
NICE traffic light: Activity Green findings
• Responds normally to social cues
• Content/smiles
• Stays awake or awakens quickly
• Strong normal cry/not crying
NICE traffic light: Activity Amber findings
normally to social cues
• Content/smiles
• Stays awake or awakens quickly
• Strong normal cry/not crying • Not responding normally to social cues
• No smile
• Wakes only with prolonged stimulation
• Decreased activity
NICE traffic light: Red findings
• No response to social cues
• Appears ill to a healthcare professional
• Does not wake or if roused does not stay awake
• Weak, high-pitched or continuous cry
NICE traffic light: respiratory amber findings
• Nasal flaring
• Tachypnoea: respiratory rate
>50 breaths/minute, age 6-12 months;
>40 breaths/minute, age >12 months
• Oxygen saturation <=95% in air
• Crackles in the chest
NICE traffic light: respiratory Red findings
• Grunting
• Tachypnoea: respiratory rate >60 breaths/minute
• Moderate or severe chest indrawing
NICE traffic light Circulation and hydration Green
• Normal skin and eyes
• Moist mucous membranes
NICE traffic light Circulation and hydration Amber findings
• Tachycardia:
>160 beats/minute, age <12 months
>150 beats/minute, age 12-24 months
>140 beats/minute, age 2-5 years
• Capillary refill time >=3 seconds
• Dry mucous membranes
• Poor feeding in infants
• Reduced urine output
NICE traffic light Circulation and hydration Red findings
reduced skin turgor
NICE traffic light other amber findings
• Age 3-6 months, temperature >=39ºC
• Fever for >=5 days
• Rigors
• Swelling of a limb or joint
• Non-weight bearing limb/not using an extremity
NICE traffic light other Red findings
• Age <3 months, temperature >=38°C
• Non-blanching rash
• Bulging fontanelle
• Neck stiffness
• Status epilepticus
• Focal neurological signs
• Focal seizures
NICE traffic light patient in green category - management
Child can be managed at home with appropriate care advice, including when to seek further help
NICE traffic light patient in Amber category
provide parents with a safety net or refer to a paediatric specialist for further assessment
a safety net includes verbal or written information on warning symptoms and how further healthcare can be accessed, a follow-up appointment, liaison with other healthcare professionals, e.g. out-of-hours providers, for further follow-up
NICE traffic light patient in Red group
refer urgently to a paediatric specialist
