Paediatric infectious diseases

Question 1

Meningitis : Definition

Answer 1

1. Meningitis is defined as inflammation of the meninges.
2. The meninges are the lining of the brain and spinal cord.
3. This inflammation is usually due to a bacterial or viral infection.

Question 2

Bacterial meningitis : Pathophysiology

(common pathogens)

Answer 2

• Inflammation of the meninges caused by a bacterial infection

2. Common pathogens are;
   * Children > 6 years
   i) Neisseria meningitides (meningococcus)
   ii) Streptococcus Pneumonia (Pneumococcus)

• Children : 1 month - 6 years
  i) Neisseria meningitides (meningococcus)
  ii) Streptococcus Pneumonia (Pneumococcus)
  iii) Haemophilius influenca
• Neonates :
  i) Group B strep : contracted from vaginal flora during birth
  ii) Ecoli, Listeria

Question 3

Bacterial meningitis : Clinical features

Answer 3

• Fever,
• Neck stiffness
• Vomiting
• Headache + photophobia
• Seizures

1. In Neonates
   * ‘Bulging fontanelle’
   * Systemic sx : poor feeding, lethargy

Question 4

Meningococcal Septicaemia : Clinical features

Answer 4

1. Sepsis caused by Neisseria Meningitidis in the blood
2. Clinical feature :
   * ‘Non-blanching rash’ - indicates DIC and subcutaneous haemorrhages

Question 5

Bacterial meningitis : Investigation

Answer 5

1. Meningococcal PCR
2. NICE recommend a lumbar puncture as part of the investigations for all children:
   * Under 1 month presenting with fever
   * 1 to 3 months with fever and are unwell
   * Under 1 year with unexplained fever and other features of serious illness

Question 6

Bacterial meningitis : Management

Answer 6

Step 1 : Antibiotics

Primary care
1. Suspected meningitis AND Non-blanching rash
* IM Benzylpenicillin + admit

Secondary care
1. Ix } LP prior to Abx + PCR
* < 3 months : IV Cefotaxime + IV Amoxicillin (covers listeria from vaginal flora)
* >3 months : IV Cefotxime

Step 2 : Steroids
* Reduces risk of complications such as hearing loss

Step 3 : Fluids

Question 7

Bacterial meningitis : Complications

Answer 7

1. Hearing loss : most common

Question 8

Bacterial meningitis : PEP

Answer 8

Indication : Contact < 7 days
Mx :
1. Refer to public health - notifiable disease
2. Treatment : Single dose of Ciprofloxacin

Question 9

Infectious Mononucleosis : Definition

Answer 9

1. Infectious mononucleosis is a condition caused by infection with the Epstein Barr virus(EBV*)
2. Virus transmitted by via saliva

Question 10

Infectious Mononucleosis :Clinical features

Answer 10

The classic triad of sore throat, pyrexia and lymphadenopathy is seen in around 98% of patients

1. Fever
2. Sore throat } tonsillar enlargement
3. Lymphadenopathy + Splenomegaly

Question 11

Infectious Mononucleosis : Investigations

Answer 11

• Bloods;
  1. Hepatitis : transient ALT rise
  2. Lymphocytosis
• Antibody testing
  1. Heterophil antibody test (Monospot test)

Question 12

Infectious Mononucleosis : Diagnosis

Answer 12

1. Heterophil antibody test (Monospot test)
   * NICE : FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.

Question 13

Mumps : definition

Answer 13

Viral infection spread by respiratory droplets
-MMR vaccine protects against mumps

Question 14

Mumps : Clinical Presentation

Answer 14

1. Early symptoms (1-3 days)
   * Systemic sx : Fever, lethargic, myalgia
2. Parotid gland swelling and pain : -Unilateral or bilateral
   * ‘Ear ache’ or ‘Pain on eating

Question 15

Mumps : Complications

Answer 15

• Abdominal pain (pancreatitis)
• Testicular pain and swelling (orchitis)
• Confusion, neck stiffness and headache (meningitis or encephalitis)
• Hearing loss

Question 16

Mumps : Management

Answer 16

1. Conservative Mx : Fluids and analgesia
2. Notify public health

Question 17

School exclusion : No exclusions (8)

Medical conditions which do not require school exclusion

Answer 17

1. Fifth disease (slapped cheek)
2. Hand, foot and mouth
3. Roseola
4. Infectious mononucleosis
5. Hand, foot and mouth
6. Conjunctivitis
7. Head lice
8. Threadworms

Question 18

School exclusion : 24 hour after Antibiotics

Answer 18

Scarlet fever

Question 19

School exclusion : 48 hour after Antibiotics

Answer 19

1. Whooping cough } : 21 days after onset of symptoms
2. Impetigo : or until lesions crusted or healed

Question 20

School exclusion : 4 days from onset of rash

Answer 20

Measles

Question 21

School exclusion : 5 days from onset of rash

Answer 21

Rubella

Question 22

School exclusion : All lesions crusted over

Answer 22

1. Chicken pox
2. Impetigo

Question 23

Infective gastroenteritis : Clinical features

Answer 23

• Sudden onset diarrhoea and vomitting
• Febrile
• Bloody diarrhoea Campylobacter and E.coli

Question 24

Infective gastroenteritis : Causative organism

Answer 24

• Viral pathogens (most common cause of gastroenteritis)
  1. Rota virus : most common cause of viral gastroenteritis in children
• Declining prevalence since rotavirus vaccine

2. Norovirus
   Most common cause of gastroenteritis in the UK

Bacterial pathogens - associated with bloody diarrhea
1 . Campylobacter Jejuni
* Most common bacterial cause of gastroenteritis
* Common cause of travellers diarrhoea

2 . E coli
Including shiva toxin-producing E.coli

Question 25

Infective gastroenteritis : Complication

Answer 25

1 . Dehydration , electrolyte imbalance, AKI

1 . Haemorrhage colitis
* Complication from shiva toxin coli
* Associated : acute bloody diarrhoea and severe abdominal pain

1 . Haemolytic uraemia syndrome
* Life threatening complication occurs in mostly in children < 5 year old
* Assoc Ecoli and Campylobacter

1 . Sepsis /Osteomyelitis : infection with salmonella

Question 26

Infective gastroenteritis : Features of dehydration

Answer 26

1. Altered responsiveness : irritable, lethargic
2. Decreased urine output
3. Sunken eyes
4. Dry mucous membrane
5. Reduced skin turgor
6. Vitals : Tachycardia, Tachypnea
   Hypotension
   Weak peripheral pulse
   Reduced skin turgor

Question 27

Infective gastroenteritis : Investiagtions

Answer 27

1. Stool sample if;
   * Suspected food poisoning / Travel abroad
   * Systemically unwell/Immunocompromised
   * Diarrhoea >7 days

Question 28

Infective gastroenteritis : Management

Answer 28

Hospital admission if;
1. Severe dehydration : vitals impaired
2. Billous vomitting
3. Painful, bloody diarrhoea

Primary care management;
1. Increase fluid intake - avoid fruit juice or carbonated drink as can worsen diarrhoea
2. Oral dehydration solution

No attendance at school >48 hours after last D+V episode