Paediatric infectious diseases Flashcards
How does kawasaki disease present?
> 5 days fever, strawberry tongue, conjunctivitis, truncal rash, adenopathy, oedema and desquamation of the hands (peeling hands)
How is kawasaki disease treated
high dose aspirin and IV immunoglobulin
Epidemiology of Kawasaki disease
mainly affects children aged 6 months to 4 years.
More common in Japanese children
What is measles caused by
Measles morbillivirus - a RNA virus
How is measles spread?
Person to person contact or airborne droplet spread
How does measles present
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
Diagnosis of measles
ELISA test - measles specific IgM and IgG.
IgG may indicate past infection or prior vaccination
Other options: PCR, culture
Treatment of measles
Mainly supportive
Consider vitamin A supplementation
Admission if immunosupressed or pregnant
Notifiable disease- inform public health England
Complications of measles
Pneumonia, otitis media, encephalitis, subacute sclerosing panencephalitis, febrile convulsions,
presentation of rubella virus
Mild fever
Generalised rash - maculopapular, initially on face then spreads
Lymphadenopathy
Conjunctivitis
Arthralgia
Congenital rubella syndrome presentation
Sensorineural deafness, congenital cataracts, congenital heart disease, growth retardation, hepatosplenomegaly, purpuric skin lesions, salt and pepper chorioretinitis, cerebral palsy
What condition is it hard to differentiate rubella from?
Parvovirus B19
What causes slapped cheek syndrome?
Parvovirus B19 infection
How does parvovirus B19 present
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
What cells does parvovirus B19 effect?
Erythroid progenitor cells
What can parvovirus B19 cause in pregnancy?
Non-immune fetalis hydrops (anaemia of the newborn) and foetal death
Who can parvovirus B19 cause serious complication in?
Pregnant
Immunocompromised
Haematological disorders
Sickle cell disease- aplastic crisis
When are infants vaccinated agaisnt Men B
2,4 and 12 months
What vaccine may be given at birth if there are RF?
BCG vaccine for TB
What vaccines are given at 2 months ?
6 in 1
Oral rotavirus
Men’s
What vaccines are included in the 6 in 1
Diphtheria, tetanus, whooping cough, HiB, Hep B and polio a
What vaccines are given at 3 months
6 in 1
Oral rotavirus
PCV
What vaccines are given at 4 months
6 in 1 and Men B
What vaccines are given at 12-13 months
HiB/MenC, MMR, PCV and MenB
What vaccine is given annually between 2-8 years
Flu vaccines
What vaccine is given at 3-4 years
4 in 1
MMR
What is included in the 4 in 1 vaccine and when is it given
At 3-4 years
Diphtheria, tetanus, whooping cough and polio
What vaccine is given at 12-13
HPV
What vaccines are given between 13 and 18 years
3 in 1 teenage booster (tetanus, diptheria and polio)
And Men ACWY
What is kawasaki’s disease
A systemic medium sized vessel vasculitits
What can be caused by taking high dose aspirin in kawasaki
Reye syndrome- failure of the mitochondria
Complication of kawasaki and how is it screened for
coronary artery aneurysms - echo
criteria for kawasaki diagnosis
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.
What oral findings are there with measles?
Kolpik’s spots- red spots with a bluish- white centre on the buccal mucosa
What rash presents in measles
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
How should measles contacts be managed?
MMR vaccine within 72 hours
What may cause falsely raised IgM in measles
rubella or parvovirus B19 infection
what causes chicken pox?
infection with the varicella zoster virus
How is chicken pox spread
respiratory droplets or direct contact
When is someone with chickenpox infectious
4 days before the rash presents and 5 days after
How does chicken pox present
- initial high fever
- pruritis
- rash that starts on head and trunk then spreads
- systemic upset
Describe how the chicken pox rash develops
begins macular, then becomes papular, then vesicular
Treatment of chickenpox
calamine lotion for itching
School exclusion until all lesions are dry and crusted over
immunocompromised should have IV acyclovir
why shouldn’t NSAIDs be given in chicken pox?
increased the risk of secondary bacterial infection
Complication of chickenpox
secondary bacterial infection- ranging from small area of cellulitis to invasive group A strep skin infection
when are patients with rubella contagious?
from 7 days before symptoms develop to 4 days after they occur
what is another name for scaled skin syndrome
Ritter’s disease
what causes scalded skin syndrome
saphylococcus aureus bacteria producing epidermolytic toxins
pathophysiology of scalded skin syndrome
staphylococcus aureus produces epidermolytic toxins which act as protease enzymes and break down the proteins that hold skin cells together
- specifically target desmoglein 1
How does scalded skin syndrome present
- 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)
What sign is present on examination of scalded skin syndrome?
Nilkolsky’s sign - gentle rubbing of the skin causes it to peel away
How is scalded skin diagnosed
predominately clinical however a skin biopsy may be used to differentiate with toxic epidermal necrolysis
How is scalded skin syndrome treated
usually needs hospitalisation
- IV Abx- flucloxacillin
- Analgesia
- hydration
- physiotherapy
Complications of scalded skin syndrome
sepsis, dehydration, cellulitis, pneumonia
What causes slapped cheek syndrome
parvovirus B19
what is another name of slapped cheek syndrome
fifth disease
What cells does parvovirus target ?
erythroid progenitor cells
How is parvovirus spread?
respiratory secretions
What is the most common complication of measles
otitis media
What pathogen causes rosela infantum
herpes virus 6
How does rosela infantum present?
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
what age group is typically affected by rosela infantum
6 months to 2 years
risk factors for developmental dysplasia of the hip
female, breech, family history, firstborn, oligohydramnios, macrosomnia
What infection causes hand foot and mouth disease?
coxsackie A16 virus or enterovirus 71
How does coxsackie virus present?
mild systemic upset- fever, malaise, sore throat
vesicles on palms and soles
management of coxsackie virus
symptomatic treatment - hydration and analgesia
children do not need to be excluded from school
What causes scarlet fever?
group A haemolytic strep - usually streptococcus pyogenes
RF for scarlet fever
extremes of age
postpartum women
immunosuppression
concurrent influenza or chicken pox
IV drug use
alcohol dependence
How does scarlet fever present?
fever
malaise
headache
pinpoint sandpaper like blanching rash
strawberry tongue
flushed with circumoral pallor (pallor around the mouth)
How is scarlet fever treated?
oral penicillin V for 10 days
When can children with scarlet fever return to school
24 hours after starting antibiotics
Is scarlet fever a notifiable disease?
yes
complications of scarlet fever
otitis media
rheumatic fever
acute glomerulonephritis
describe the rash associated with scarlet fever
pinpoint sandpaper like blanching rash
Develops on the trunk 12-48 hours after initial symptoms develop
how does the rash of slapped cheek syndrome (parvovirus) present?
erythematous facial rash- spreads to a maculopapular rash which spreads to extremities and torso- has a lacy reticular appearance
How does slapped cheek syndrome present?
erythematous facial rash- spreads to torso and extremities
symmetrical polyarthropathy
low grade fever
headache
nasal discharge
what pathogen causes whooping cough
bordatella pertussis
when are children vaccinated against whooping cough
2, 3, 4 months and 3-5 years
does infection or immunisation against whooping cough lead to lifelong protection
no so adolescents and adults may still develop the illness
how does whooping cough present
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
how long does the paroxysmal phase of whooping cough last?
2-8 weeks
diagnosis of whooping cough
nasal culture swab or PCR/serolgoy
management of whooping cough
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
When are pregnant women offered the whooping cough vaccine
16-32 weeks
Describe the relationship between the onset of fever and rash in rosela infantum
fever develops before the rash
what virus causes rubella
togavirus
How does rubella present?
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
Complications of rubella
arthritis
thrombocytopenia
encephalitis
myocarditis
At what age are children vaccinated against rubella
1 year and 3/4-5years
features of congenital rubella syndrome
sensorineural deafness
congenital cataracts
congenital heart disease (PDA)
growth retardation
hepatosplenomegaly
purpuric skin lesions
salt and pepper chorioretinitis
microphthalmia
cerebral palsy
what bacteria causes diphtheria
corynebacterium diphitheriae
presentation of diphitheria
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
How is diphitheria diagnosed?
1st line - culture and microscopy from nose and throat swabs
gold- elek test for toxigenicity
Treatment of diphitheria
hosptalization
Diphitheria antitoxin- euqine, produced by horse serum
Antibiotic- either procaine benzylpenicillin, azithromycin or clarithromycin
airway protection +/- ventilation
What is a complication of chickenpox
necrotizing fascitis
How does necrotising fascitiis present?
severe pain, erythema, blistering and disrporportionate tenderness
which organsims commonly causes necrotising fasciitis in chickenpox
group A strep
in what timeframe does neonatal sepsis occur?
within the first 28 days of life
in scarlet fever where is the rash most intense?
cubital fossa
how is a patients tongue described in scarlet fever?
crimson , strawberry tongue
What is the most common cause of impetigo
staphylococcus aureus and streptococcus pyogenes
Incubation period of impetigo
4-10 days
How is impetigo spread
direct contact with discharges from the scabs
Can spread within a person via autoinnoculation
how does impetigo present?
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
1st line treatment of mild impetigo
1% hydrogen peroxide cream
2nd line treatment of impetigo
topical antibiotic:
- topical fusidic acid
- mupirocin
Management of severe, extensive impetigo
oral flucloxacillin or erythromycin in penicillin allergic
How long should children with impetigo be off school
until all lesions are dry and crusted over OR 48 hours after starting antibiotics
What conditions can impetigo be a complication of
eczema, scabies, insect bites
complications of scarlet fever
rheumatic fever
glomerulonephritis
ear and throat infections
pneumonia
arthritis
when are vaccines for Men B given
8 weeks, 16 weeks and 1 year
what complication of measles might not present until years after infection
subacute sclerosing panencephalitis
first light treatment of scarlet fever
pen V
how long after exposure does measles present
3-5 days
what is another name of measles
rubeola
how long after the rash appears are children no longer infectious of measles
4 days
what type of virus is parvovirus B19
a single stranded DNA virus
what pathogen most commonly causes the common cold
rhinovirus
when are children with slapped cheek syndrome no longer infectious
once the rash appears
example of group A strep
strep pyogenes
example of group B strep
strep agalacticae
what are pastias lines
red skin creases associated with scarlet fever
When can children with measles go back to school
4 days after development of the rash
When can children with measles go back to school
4 days after development of the rash
Pathophysiology of poliomyelitis
the virus is spread by faecal-oral transmission
It spreads around the body via the blood stream and can enter motor neurones
presentation of poliomyelitis
acute flaccid paralysis
- decreased tone and motor function
- decreased tendon reflexes
- muscle atrophy
Can lead to bulbar paralysis and muscle atrophy
How is poliomyelitis diagnosed
CSF PCR showing poliovirus RNA
What are key features of diphtheria on examination (2)
grey pseudomembrane on tonsils
anterior cervical lymphadenopathy causing bull neck appearance
How is diphtheria treated?
antitoxin- from horse serum
antibiotic- erythromycin or intramuscular penicillin
How does diphtheria present (4)
sore throat with diphtheric membrane (Grey pseudomembrane)
bull neck appearance
heart block
Neuritis
What are the two types of immunodeficiency, explain each one.
primary immunodeficiency= a genetically determined defect in the innate immune system
Secondary immunodeficiency= caused by another disease or treatment such as malignancy or chemotherapy, malnutrition, splenectomy
What is the inheritance patterns of most types of primary immunodeficiency
x linked recessive or autosomal recessive
what type of primary immunodeficiencies are there?
T cell defects- e.g. DiGeorge syndrome
B cell defects
Neutrophil defects
Leucocyte defects
complement defects
combined
what is severe combined immunodeficiency?
most commonly an x linked recessive disorder
caused by defects in both T and B cells
Presentation of immunodeficiency
severe, prolonged, unusual or recurrent infections (SPUR)
Warts
extensive candidiasis
complications following live vaccines
How are immunodeficiencies managed?
- antimicrobial prophylaxis
- prompt antibiotic treatment for infections with a low criteria for IV treatment
- immunoglobulin replacement
- bone marrow transplantation
What is toxic shock syndrome?
a severe systemic reaction to staphylococcal endotoxins - toxin secreting stap aureus or group A strep
RF for toxic shock syndrome
wounds
tampon use
postoperative infections
packed wounds
sinusitis
tracheities
IV drug use
how does toxic shock syndrome present?
triad of:
- fever > 39
- hypotension
- diffuse erythematous rash
Organ dysfunction might include:
- mucositis
- GI impairment: diarrhoea and vomiting
- renal impairment
- liver impairment
- clotting abnormalities
- altered consciousness
1-2 weeks after the illness begins there will be desquamation of the palms soles fingers and toes
What is the diagnostic criteria of toxic shock syndrome?
- fever >38.9
- hypotensions <90
- diffuse erythematous rash
- desquamation of the rash
- involvement of 3 or more organ systems (GI, mucous membrane, renal failure, hepatitis, thrombocytopenia, CNS involvement)
How is toxic shock syndrome treated?
removal of the cause
IV fluids
IV antibiotics (ceftriaxone, clindamycin)
IV immunoglobulins might be used for the toxin
What viruses most commonly cause hand foot and mouth disease?
coxsackie A16 and enterovirus 71
How does hand foot and mouth disease present
prodrome- low grade fever, malaise, myalgia, sore throat, couhg
2nd stage: tender oral ulcerative lesions, typically yellow and surrounded by red haloes
3rd stage: maculopapular rash develops of the hands and feet, start erythematous and the become grey vesicles with an erythematous base
- may also be on trunk, thighs, buttocks and genitalia
How is hand foot and mouth disease treated?
supportive
do not need to be excluded from school
