Paediatric infectious diseases Flashcards
What type of infection is measles?
Respiratory viral infection
What pathogen causes measles?
a virus of the family Paramyxoviridae, genus morbillivirus
What type of virus is measles?
Single-stranded, RNA virus
How is measles spread?
respiratory droplets from coughing, sneezing etc.
What is the incubation period for measles?
10 days
What are the typical features of the prodromal phase (2-4 days) of measles?
A fever of 39°C or more without antipyretics, decreases after the rash develops
Cough
Conjunctivitis
Coryza
Diarrhoea
What type of spots do you get in the mouth in measles?
Koplik’s spots
What typ eof rash do you get in measles?
Erythematous, maculopapular rash: beginning on the face and behind the ears and it spreads downwards
What are DDx for measles?
Rubella, Parvovirus B19, Herpes virus type 6, streptococcal infection, Kawasaki disease, EBV, early meningococcal disease.
What are the complications of measles in pregnancy?
Miscarriage or stillbirth
Premature birth
Low birthweight
What are the complications of measles?
otitis media, pneumonia, encephalitis, subacute sclerosing panencephalitis and blindness.
Which pathogen causes chicken pox?
varicella zoster virus (VZV)
What type of rash do you get in chicken pox?
widespread, erythematous, raised, vesicular (fluid filled), blistering lesions. usually starts on the trunk or face
What symptoms do you get in chicken pox apart from a rash?
Fever is often the first symptom
Itch
General fatigue and malaise
What are the complications of chicken pox?
Bacterial superinfection
Dehydration
Conjunctival lesions
Pneumonia
Encephalitis (presenting as ataxia)
Where can chicken pox lie dormant in the body after infection?
sensory dorsal root ganglion cells
What can reactivated chicken pox cause in later life?
shingles or Ramsay Hunt syndrome.
What is given to pregnant women who have not had chicken pox?
varicella zoster immunoglobulins
What drug can be given to those with chicken pox who are immunocompromised, adults, neonates or those at risk of complication.
Aciclovir
What can itching caused by chicken pox be treated with?
calamine lotion and chlorphenamine (antihistamine)
What type of infection is impetigo?
superficial bacterial skin infection
What pathogen causes impetigo?
staphylococcus aureus (sometimes streptococcus pyogenes)
Is impetigo contagious?
Yes
What are the two different types of impetigo?
Bullous and non-bullous
Where does non-bullous impetigo generally occur
Round the mouth or nose
What is characteristic of non-bullous impetigo?
Golden crust round the mouth or nose and patient is generally well
What can be used to treat loaclised, non-bullous imopetigo?
Antiseptic cream is 1st line but Topical fusidic acid can be used
What is used to treat more widespread or severe impetigo?
Flucloxacillin
What is the antibiotic of choice for stapylococcal infections?
Flucloxacillin
Which bacteria is always the cause of bullous impetigo?
Staphylococcus aureus
Which typ eof impetigo is more common in neonates and children under 2?
Bullous impetigo
What is more severe bullous impetigo called when lesions are widespread?
Staphylococcus scalded skin syndrome
In which type of impetigo is there more likely to be systemic symptoms?
Bullous impetigo
What are the complications of impetigo?
Cellulitis if the infection gets deeper in the skin
Sepsis
Scarring
Post streptococcal glomerulonephritis
Staphylococcus scalded skin syndrome
Scarlet fever
What is kawasaki disease also known as?
mucocutaneous lymph node syndrome
What kind of vasculitis is kawasaki disease?
Medium-sized vessel vasculitis
Who does kawasaki disease typically affect?
Young children under 5 years old
Which ethnicity is kawasaki disease more common in?
Asian children, particularly Japanese and Korean children
Which gender is kawasaki disease more common in?
Boys
What is a key complication of kawasaki disease?
coronary artery aneurysm.
How long does a fever last to make you think it could be kawasaki disease?
at least 5 days
What are the key skin findings of kawasaki disease?
widespread erythematous maculopapular rash and desquamation (skin peeling) on the palms and soles
What are the features of kawasaki excluding skin findings and fever?
Strawberry tongue (red tongue with large papillae)
Cracked lips
Cervical lymphadenopathy
Bilateral conjunctivitis
What investigations will be useful for diagnosing kawasaki disease?
Full blood count can show anaemia, leukocytosis and thrombocytosis
Liver function tests can show hypoalbuminemia and elevated liver enzymes
Inflammatory markers (particularly ESR) are raised
Urinalysis can show raised white blood cells without infection
Echocardiogram can demonstrate coronary artery pathology
What happens in the acute phase of kawasaki disease?
The child is most unwell with the fever, rash and lymphadenopathy. This lasts 1 – 2 weeks.
What happens in the subacute phase of kawasaki disease?
The acute symptoms settle, the desquamation and arthralgia occur and there is a risk of coronary artery aneurysms forming. This lasts 2 – 4 weeks.
What happens in the convalescent phase of kawasaki disease?
The remaining symptoms settle, the blood tests slowly return to normal and the coronary aneurysms may regress. This last 2 – 4 weeks.
What are two first line medical treatments given to patients with Kawasaki disease?
High dose aspirin to reduce the risk of thrombosis
IV immunoglobulins to reduce the risk of coronary artery aneurysms
Why is aspirin usually contraindicated in kawasaki disease?
due to Reye’s syndrome
What does encephalitis mean?
inflammation of the brain
What does encephalitis mean?
inflammation of the brain
What is the non-infective cause of encephalitis?
Autoimmune
What is the most common cause of encephalitis?
Viral
What is the most common viral cause of encephalitis?
herpes simplex virus (HSV)
What is the most common HSV in children to cause encephalitis?
HSV-1 from cold sores
What is the most common HSV in neonates?
HSV-2 from genital herpes
What are the other viral causes of encephalitis apart from HSV?
varicella zoster virus (VZV), cytomegalovirus, EBV, polio, mumps, rubella and measles
What is VZV associated with?
chickenpox, cytomegalovirus
What is cytomegalovirus associated with?
Immunodeficiency
What is EBV associated?
infectious mononucleosis, enterovirus, adenovirus and influenza virus
What is the presentation of encephalitis?
Altered consciousness
Altered cognition
Unusual behaviour
Acute onset of focal neurological symptoms
Acute onset of focal seizures
Fever
What investigations are done for encephalitis?
Lumbar puncture, sending cerebrospinal fluid for viral PCR testing
CT scan if a lumbar puncture is contraindicated
MRI scan after the lumbar puncture to visualise the brain in detail
EEG recording can be helpful in mild or ambiguous symptoms but is not always routinely required
Swabs of other areas can help establish the causative organism, such as throat and vesicle swabs
HIV testing is recommended in all patients with encephalitis
What is used to treat HSV and VZV?
Aciclovir
What is used to treat cytomegalovirus?
Ganciclovir
What are the complications of encephalitis?
Lasting fatigue and prolonged recovery
Change in personality or mood
Changes to memory and cognition
Learning disability
Headaches
Chronic pain
Movement disorders
Sensory disturbance
Seizures
Hormonal imbalance
Give some examples of inactivated vaccines.
Polio
Flu vaccine
Hepatits A
Rabies
What are subunit and conjugate vaccines?
only contain parts of the organism used to stimulate an immune response- cannot cause infection and safe for immunocompromised patients
Give some examples of subunit and conjugate vaccines
Pneumococcus
Meningococcus
Hepatitis B
Pertussis
Haemophilus influenza type B
Human papillomavirus
Shingles
Give some examples of live, attenuated vaccines
Measles, mups and rubella vaccine
BCG (TB)
Chickenpox
Nasal influenza
Rotavirus
Give some examples of toxin vaccines
Diptheria and tetanus
What vaccines do children have at 8 weeks?
6 in 1 vaccines (diptheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hep B)
Meningiococcal type B
Rotavirus (oral)
What vaccines do children have at 12 weeks?
6 in 1 vaccine again
Pneumococcal
Rotavirus again
What vaccines do children have at 16 weeks?
3rd 6 in 1 vaccine
Meningococcal type B 2nd
What vaccines do children have at 1 year?
2 in 1 (haemophilus influenza type B and meningococcal type C)
Pneumococcal 2nd
MMR vaccine
Meningococcal type B 3rd
What vaccines do children have yearly from age 2-8?
influenza vaccine
What vaccines do children have at 3 years and 4 months?
4 in 1 (diptheria, tetanus, pertussis and polio)
MMR vaccine 2nd
What vaccine do children have at 12-13 years?
Human papillomavirus vaccine (2 doses 6 to 24 months apart)
What vaccine do children have at 14 years?
3 in 1 (tetanus, diptheria and polio)
Meningococcal groups A,C,W and Y
Which strains of HPV cause genital warts?
6 and 11
Which strains of HPV cause cervical cancer?
16 and 18
