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3A > Paediatric infectious diseases > Flashcards

Paediatric infectious diseases Flashcards

1
Q

How does kawasaki disease present?

A

> 5 days fever, strawberry tongue, conjunctivitis, truncal rash, adenopathy, oedema and desquamation of the hands (peeling hands)

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2
Q

How is kawasaki disease treated

A

high dose aspirin and IV immunoglobulin

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3
Q

Epidemiology of Kawasaki disease

A

mainly affects children aged 6 months to 4 years.
More common in Japanese children

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4
Q

What is measles caused by

A

Measles morbillivirus - a RNA virus

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5
Q

How is measles spread?

A

Person to person contact or airborne droplet spread

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6
Q

How does measles present

A

Fever,
Maculopapular rash - begins on head and spreads to the trunk and extremities
Cough
Coryza
Conjunctiva
Koplik’s spots- red spots with bluish-white central dots on the erythematous buccal mucosa

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7
Q

Diagnosis of measles

A

ELISA test - measles specific IgM and IgG.
IgG may indicate past infection or prior vaccination

Other options: PCR, culture

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8
Q

Treatment of measles

A

Mainly supportive
Consider vitamin A supplementation
Admission if immunosupressed or pregnant
Notifiable disease- inform public health England

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9
Q

Complications of measles

A

Pneumonia, otitis media, encephalitis, subacute sclerosing panencephalitis, febrile convulsions,

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10
Q

presentation of rubella virus

A

Mild fever
Generalised rash - maculopapular, initially on face then spreads
Lymphadenopathy
Conjunctivitis
Arthralgia

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11
Q

Congenital rubella syndrome presentation

A

Sensorineural deafness, congenital cataracts, congenital heart disease, growth retardation, hepatosplenomegaly, purpuric skin lesions, salt and pepper chorioretinitis, cerebral palsy

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12
Q

What condition is it hard to differentiate rubella from?

A

Parvovirus B19

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13
Q

What causes slapped cheek syndrome?

A

Parvovirus B19 infection

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14
Q

How does parvovirus B19 present

A

Erythematous facial rash- slapped cheek. Later spreads to extremities and torso
Symmetrical polyarthropathy- affecting small joints of hands, knees and ankles,
Low grade fever
Headache,
coryza

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15
Q

What cells does parvovirus B19 effect?

A

Erythroid progenitor cells

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16
Q

What can parvovirus B19 cause in pregnancy?

A

Non-immune fetalis hydrops (anaemia of the newborn) and foetal death

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17
Q

Who can parvovirus B19 cause serious complication in?

A

Pregnant
Immunocompromised
Haematological disorders
Sickle cell disease- aplastic crisis

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18
Q

When are infants vaccinated agaisnt Men B

A

2,4 and 12 months

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19
Q

What vaccine may be given at birth if there are RF?

A

BCG vaccine for TB

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20
Q

What vaccines are given at 2 months ?

A

6 in 1
Oral rotavirus
Men’s

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21
Q

What vaccines are included in the 6 in 1

A

Diphtheria, tetanus, whooping cough, HiB, Hep B and polio a

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22
Q

What vaccines are given at 3 months

A

6 in 1
Oral rotavirus
PCV

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23
Q

What vaccines are given at 4 months

A

6 in 1 and Men B

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24
Q

What vaccines are given at 12-13 months

A

HiB/MenC, MMR, PCV and MenB

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25
Q

What vaccine is given annually between 2-8 years

A

Flu vaccines

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26
Q

What vaccine is given at 3-4 years

A

4 in 1
MMR

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27
Q

What is included in the 4 in 1 vaccine and when is it given

A

At 3-4 years
Diphtheria, tetanus, whooping cough and polio

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28
Q

What vaccine is given at 12-13

A

HPV

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29
Q

What vaccines are given between 13 and 18 years

A

3 in 1 teenage booster (tetanus, diptheria and polio)
And Men ACWY

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30
Q

What is kawasaki’s disease

A

A systemic medium sized vessel vasculitits

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31
Q

What can be caused by taking high dose aspirin in kawasaki

A

Reye syndrome- failure of the mitochondria

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32
Q

Complication of kawasaki and how is it screened for

A

coronary artery aneurysms - echo

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33
Q

criteria for kawasaki diagnosis

A

A fever for >5 days and 4 of the 5 principle features:
- Change in extremities: erythema, oedema and peeling of the hands and soles
- Rash
- non-exudative conjunctivitis
- lip and mouth changes (red cracking lips, strawberry tongue)
- cervical lymphadenopathy.

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34
Q

What oral findings are there with measles?

A

Kolpik’s spots- red spots with a bluish- white centre on the buccal mucosa

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35
Q

What rash presents in measles

A

a maculopapular rash that begins on the head (behind the ears) and spreads down to the trunk and extremeties
Becomes blotchy and confluent.

After a week there may be desquamation of the palms and soles

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36
Q

How should measles contacts be managed?

A

MMR vaccine within 72 hours

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37
Q

What may cause falsely raised IgM in measles

A

rubella or parvovirus B19 infection

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38
Q

what causes chicken pox?

A

infection with the varicella zoster virus

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39
Q

How is chicken pox spread

A

respiratory droplets or direct contact

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40
Q

When is someone with chickenpox infectious

A

4 days before the rash presents and 5 days after

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41
Q

How does chicken pox present

A
  • initial high fever
  • pruritis
  • rash that starts on head and trunk then spreads
  • systemic upset
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42
Q

Describe how the chicken pox rash develops

A

begins macular, then becomes papular, then vesicular

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43
Q

Treatment of chickenpox

A

calamine lotion for itching
School exclusion until all lesions are dry and crusted over
immunocompromised should have IV acyclovir

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44
Q

why shouldn’t NSAIDs be given in chicken pox?

A

increased the risk of secondary bacterial infection

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45
Q

Complication of chickenpox

A

secondary bacterial infection- ranging from small area of cellulitis to invasive group A strep skin infection

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46
Q

when are patients with rubella contagious?

A

from 7 days before symptoms develop to 4 days after they occur

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47
Q

what is another name for scaled skin syndrome

A

Ritter’s disease

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48
Q

what causes scalded skin syndrome

A

saphylococcus aureus bacteria producing epidermolytic toxins

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49
Q

pathophysiology of scalded skin syndrome

A

staphylococcus aureus produces epidermolytic toxins which act as protease enzymes and break down the proteins that hold skin cells together
- specifically target desmoglein 1

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50
Q

How does scalded skin syndrome present

A
  • starts with generalised areas of erythema
  • skin appears think and wrinkled
  • blisters start to appear
  • blisters burst and leave the skin red and sore (appears like a burn)
  • Systemic upset will also be present (fever, dehydration etc)
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51
Q

What sign is present on examination of scalded skin syndrome?

A

Nilkolsky’s sign - gentle rubbing of the skin causes it to peel away

52
Q

How is scalded skin diagnosed

A

predominately clinical however a skin biopsy may be used to differentiate with toxic epidermal necrolysis

53
Q

How is scalded skin syndrome treated

A

usually needs hospitalisation
- IV Abx- flucloxacillin
- Analgesia
- hydration
- physiotherapy

54
Q

Complications of scalded skin syndrome

A

sepsis, dehydration, cellulitis, pneumonia

55
Q

What causes slapped cheek syndrome

A

parvovirus B19

56
Q

what is another name of slapped cheek syndrome

A

fifth disease

57
Q

What cells does parvovirus target ?

A

erythroid progenitor cells

58
Q

How is parvovirus spread?

A

respiratory secretions

59
Q

What is the most common complication of measles

A

otitis media

60
Q

What pathogen causes rosela infantum

A

herpes virus 6

61
Q

How does rosela infantum present?

A

high fever for 3-5 days followed by 2 da maculopapular rash on the chest and spreading to the limps

Nagayama spots on uvula and soft palate

febrile convuslions in 10-15 %

often diarrhoea and vomiting

62
Q

what age group is typically affected by rosela infantum

A

6 months to 2 years

63
Q

risk factors for developmental dysplasia of the hip

A

female, breech, family history, firstborn, oligohydramnios, macrosomnia

64
Q

What infection causes hand foot and mouth disease?

A

coxsackie A16 virus or enterovirus 71

65
Q

How does coxsackie virus present?

A

mild systemic upset- fever, malaise, sore throat
vesicles on palms and soles

66
Q

management of coxsackie virus

A

symptomatic treatment - hydration and analgesia
children do not need to be excluded from school

67
Q

What causes scarlet fever?

A

group A haemolytic strep - usually streptococcus pyogenes

68
Q

RF for scarlet fever

A

extremes of age
postpartum women
immunosuppression
concurrent influenza or chicken pox
IV drug use
alcohol dependence

69
Q

How does scarlet fever present?

A

fever
malaise
headache
pinpoint sandpaper like blanching rash
strawberry tongue
flushed with circumoral pallor (pallor around the mouth)

70
Q

How is scarlet fever treated?

A

oral penicillin V for 10 days

71
Q

When can children with scarlet fever return to school

A

24 hours after starting antibiotics

72
Q

Is scarlet fever a notifiable disease?

A

yes

73
Q

complications of scarlet fever

A

otitis media
rheumatic fever
acute glomerulonephritis

74
Q

describe the rash associated with scarlet fever

A

pinpoint sandpaper like blanching rash
Develops on the trunk 12-48 hours after initial symptoms develop

75
Q

how does the rash of slapped cheek syndrome (parvovirus) present?

A

erythematous facial rash- spreads to a maculopapular rash which spreads to extremities and torso- has a lacy reticular appearance

76
Q

How does slapped cheek syndrome present?

A

erythematous facial rash- spreads to torso and extremities
symmetrical polyarthropathy
low grade fever
headache
nasal discharge

77
Q

what pathogen causes whooping cough

A

bordatella pertussis

78
Q

when are children vaccinated against whooping cough

A

2, 3, 4 months and 3-5 years

79
Q

does infection or immunisation against whooping cough lead to lifelong protection

A

no so adolescents and adults may still develop the illness

80
Q

how does whooping cough present

A

catarrhal phase of URTI, mild coryza, low grade fever
paroxysmal phase of severe coughing fits with inspiratory whoops, usually worse at night, can be associated with vomiting or fainting
infants may have apnoeas rather than coughing
convalescent phase: the cough slowly recovers overs weeks- months

81
Q

how long does the paroxysmal phase of whooping cough last?

A

2-8 weeks

82
Q

diagnosis of whooping cough

A

nasal culture swab or PCR/serolgoy

83
Q

management of whooping cough

A

infants under 6 months should be admitted
oral macrolide if onset of cough is within 21 days- clarithromycin, azithromycin
antibiotic prophylaxis to household contacts
school exclusion until 48 hours after antibiotic initiation

84
Q

When are pregnant women offered the whooping cough vaccine

A

16-32 weeks

85
Q

Describe the relationship between the onset of fever and rash in rosela infantum

A

fever develops before the rash

86
Q

what virus causes rubella

A

togavirus

87
Q

How does rubella present?

A

a prodrome of low grade fever
rash- maculopapular rash starting on the face and then spreading to the whole body, fades after 2-3 days
lymphadenopathy - suboccipital and postauricular

88
Q

Complications of rubella

A

arthritis
thrombocytopenia
encephalitis
myocarditis

89
Q

At what age are children vaccinated against rubella

A

1 year and 3/4-5years

90
Q

features of congenital rubella syndrome

A

sensorineural deafness
congenital cataracts
congenital heart disease (PDA)
growth retardation
hepatosplenomegaly
purpuric skin lesions
salt and pepper chorioretinitis
microphthalmia
cerebral palsy

91
Q

what bacteria causes diphtheria

A

corynebacterium diphitheriae

92
Q

presentation of diphitheria

A

URTI- sore throat, fever
- characteristic grey pseudomembrane that covers the tonsils and the mucosa of the pharynx, larynx and nose
Cervical lymph nodes- bull neck appearance

Can get cutaneous diphtheria with cutaneous sores or shallow ulcers

93
Q

How is diphitheria diagnosed?

A

1st line - culture and microscopy from nose and throat swabs
gold- elek test for toxigenicity

94
Q

Treatment of diphitheria

A

hosptalization
Diphitheria antitoxin- euqine, produced by horse serum
Antibiotic- either procaine benzylpenicillin, azithromycin or clarithromycin
airway protection +/- ventilation

95
Q

What is a complication of chickenpox

A

necrotizing fascitis

96
Q

How does necrotising fascitiis present?

A

severe pain, erythema, blistering and disrporportionate tenderness

97
Q

which organsims commonly causes necrotising fasciitis in chickenpox

A

group A strep

98
Q

in what timeframe does neonatal sepsis occur?

A

within the first 28 days of life

99
Q

in scarlet fever where is the rash most intense?

A

cubital fossa

100
Q

how is a patients tongue described in scarlet fever?

A

crimson , strawberry tongue

101
Q

What is the most common cause of impetigo

A

staphylococcus aureus and streptococcus pyogenes

102
Q

Incubation period of impetigo

A

4-10 days

103
Q

How is impetigo spread

A

direct contact with discharges from the scabs
Can spread within a person via autoinnoculation

104
Q

how does impetigo present?

A

honey coloured golden crusted lesions- typically around the mouth
Can occur anywhere around the body but commonly the face, flexures and limbs not covered by clothing

105
Q

1st line treatment of mild impetigo

A

1% hydrogen peroxide cream

106
Q

2nd line treatment of impetigo

A

topical antibiotic:
- topical fusidic acid
- mupirocin

107
Q

Management of severe, extensive impetigo

A

oral flucloxacillin or erythromycin in penicillin allergic

108
Q

How long should children with impetigo be off school

A

until all lesions are dry and crusted over OR 48 hours after starting antibiotics

109
Q

What conditions can impetigo be a complication of

A

eczema, scabies, insect bites

110
Q

complications of scarlet fever

A

rheumatic fever
glomerulonephritis
ear and throat infections
pneumonia
arthritis

111
Q

when are vaccines for Men B given

A

8 weeks, 16 weeks and 1 year

112
Q

what complication of measles might not present until years after infection

A

subacute sclerosing panencephalitis

113
Q

first light treatment of scarlet fever

A

pen V

114
Q

how long after exposure does measles present

A

3-5 days

115
Q

what is another name of measles

A

rubeola

116
Q

how long after the rash appears are children no longer infectious of measles

A

4 days

117
Q

what type of virus is parvovirus B19

A

a single stranded DNA virus

118
Q

what pathogen most commonly causes the common cold

A

rhinovirus

119
Q

when are children with slapped cheek syndrome no longer infectious

A

once the rash appears

120
Q

example of group A strep

A

strep pyogenes

121
Q

example of group B strep

A

strep agalacticae

122
Q

what are pastias lines

A

red skin creases associated with scarlet fever

123
Q
A
124
Q

When can children with measles go back to school

A

4 days after development of the rash

125
Q

When can children with measles go back to school

A

4 days after development of the rash

3A (33 decks)

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