Paediatric infectious diseases

Question 1

What is the clinical presentation of Kawasaki disease?

Answer 1

> 5 days of fever + 4 other features:

• conjunctivitis
• red mucous membranes
• cervical lymphadenopathy
• rash
• red/sore/peeling hands and feet

Question 2

What is the main complication of Kawasaki disease?

Answer 2

Coronary artery aneurysms (6 weeks)

Question 3

What is the treatment for Kawasaki disease?

Answer 3

IV immunoglobulins

aspirin

Question 4

What are the symptoms of measles?

Answer 4

fever, cough, coryza, enanthem (Koplik spots) on oral mucosa, maculopapular rash spreading head to toe

Question 5

What is the difference between HSV1 and HSV2? What is the treatment for both?

Answer 5

HSV1 = mainly transferred in saliva
HSV2 = mainly sex, cold sores

Tx = aciclovir

Question 6

What are the possible complications of Herpes simplex virus?

Answer 6

Aseptic meningitis - mainly adolescence (sexually active), HSV2
Encephalitis
Neonatal infection
Eczema herpeticum - skin infection in eczema patient

Question 7

What is the causative organism of chickenpox?

How is it spread?

Answer 7

Varicella Zoster virus

Respitatory droplets - median incubation = 14 days

Question 8

What infection follows the following rash cycle:
papules
vesicles
pustules
crusts

Answer 8

Chicken pox

Question 9

What are the main complications of chickenpox?

Answer 9

Secondary bacterial infection
Encephalitis - within 1 week of rash –> ataxia + cerebellar
Purpura fulminans - necrosis of skin due to vasculitis
Stroke - due too either vasculitis or protein S deficiency
haemorrhagic chickenpox in malnourished or immunocompromised children

Question 10

What is the management for chickenpox?

Answer 10

human varicella zoster immunoglobulin if high risk individuals come into contact with chickenpox
Aciclovir if severe

Question 11

What is shingles?

Answer 11

Latent varicella zoster reactivating –> vesicles in distribution of dermatomes. Adults = nerve pain, children rarely get nerve pain.

Reinfection in childhood may indicate underlying immunue suppression

Question 12

What is the causative organism of glandular fever?

what other condition is it associated with?

Answer 12

Epstein barr virus

Burkitt’s lymphoma

Question 13

What is the presentation of a CMV infection?

Answer 13

mild/ subclinical symptoms in normal hosts
May present like mononucleosis but pharyngitis/lymphadenopathy less prominent than in EBV

Maternal CMV infection may cause congenital infection

Question 14

What organism are organ recipients monitored for?

Answer 14

Cytomegalovirus

Question 15

What infection is commonly known as slapped cheek syndrome? How is it spread?

Answer 15

Parvovirus B19

Respiratory secretions, vertical transmission + contaminated blood products

Question 16

What are the range of presentations caused by parvovirus b19?

Answer 16

1. asymptomatic
2. erythema infectiosum - fever, malaise, myalgia –> slapped cheek after 1 week –> vesicopapular rash on body
3. aplastic crisis - in children with chronic haemolytic anaemias (sickle cell)
4. fetal disease - vertical transmission - causes hydrops

Question 17

4 main types of poliovirus presentations:

Answer 17

1. asymptomatic >90%
2. minor illness - fever, headache, malaise, sore throat
3. CNS involvement with aseptic meningitis
4. paralytic polio - about 4 days after minor illness subsided

Question 18

Name 2 types of enteroviruses?

How are they spread?

Answer 18

Coxsackie + polio

Faecal-oral - mostly in summer and autumn

Question 19

what is the characteristic appearance of impetigo?
What is the causative organism?
What is the treatment?

Answer 19

Confluent honey coloured crusted lesions (starting with red macules which become vesicular and then rupture)

Staph Aureus

Tx = Topical antibiotics if mild, systemic antibiotics if severe - flucloxacilin or erythromycin

Question 20

What is the organism and presentation of scalded skin syndrome?

Answer 20

Fever + irritability + widespread redness –> red blistered skin after 24-48 hours. Heal without scarring.

Staph aureus

Question 21

Treatment of periorbital cellulitis?

Answer 21

IV abx

Question 22

What is thee presentation of toxic shock syndrome?

Answer 22

Release of staph/strep toxins at a point of infection (graze) –> systemic illness, high fever, diffuse macular rash, shock + other symptoms
1-2 weeks later = desquamation of hands and toes

Tx = ICU, surgical debridement, IV immunoogloblin

Question 23

What is the presentation of rubella?

Answer 23

prodrome of mild/no fever
rash (not itchy) starting on face then spreading (fades in 3-5 days)
lymphadenopathy

only management is vaccination

Question 24

What causes hand food and mouth disease?

Answer 24

Coxsackie A virus

Question 25

What is the presentation of HFM / coxsackie?

Answer 25

URTI mouth/tongue ulcers after 1-2 days then red blistering / itchy spots around mouth, hands and feet Mx = supportive, resolves after 1 week-10 days, highly contagious

Question 26

What are the symptoms of scarlet fever?

Answer 26

first = flu like Sx - fever, sore throat, lymphadenopathy | red rash = face chest and armpits, feels like sandpaper, flushed cheeks, white coating on tongue

Question 27

What is the causative organism in scarlet fever?

Answer 27

group A haemolytic streptococcus

Question 28

What is the treatment in scarlet fever?

Answer 28

IV penicillin 10 days

Question 29

What type of candida is common in neonates?

Answer 29

Oral thrush - pseudomembranous candidiasis caused by candida albicans

Question 30

What is the treatment for oral candida?

Answer 30

first line = miconozole oral gel for children >4 months second line = nystatin suspension if miconozole is unsuitable (do not use in neonates)

Question 31

What are the causative organisms of meningitis in: 1. neonates <3 months 2. 1 month- 6 years 3. >6 years

Answer 31

1. group B streep, E.coli, listeria monocytogenes 2. Neisseria meningitidis, strep pneumoniae, Haemophilus influenzae 3. Neirsseria meningitidis + strep pneumoniae

Question 32

What is the key extra feature in neonates with meningitis?

Answer 32

bulging fontanelle and arched back

Question 33

When is a lumbar puncture recommended?

Answer 33

<1 month and fever 1-3 months fever and unwell <1 year with unexplained fever and other featurees of serious illness

Question 34

What two special tests can check for meningitis?

Answer 34

Kernig's test - lie patient on back, flex hip and knee to 90, straighten knee but keep hip flexed --> causes pain or resistance if meningitis Brudzinski's test - lie patient on back and lift head, positive test = knees will come to chest

Question 35

What is the management for meningitis

Answer 35

IM benpen in communicty LP in hospital (but do not delay antibiotics) Abx: <3 months = cefotaxime + amoxicillin >3 months = ceftriaxone Contact prophylaxis = rifampicin steroids inform PHE

Question 36

What are the pathological causes of encephalitis?

Answer 36

direct invasian of cerebrum by neurotoxic virus delayed brain swelling following immune response to a virus (eg. after chickenpox) slow virus infection eg. HIV

Question 37

What is the key difference between meningitis and encephalopathy?

Answer 37

Initially hard to tell - commence treatment for both initially Encephalopathy may present insidiously and can include a behaviour change

Question 38

What is the presentation of encephalitis? what are the most common causative organisms?

Answer 38

fever, altered consciousness, seizures enteroviruses, respiratory viruses and herpes viruses (HSV very rare cause but long term consequences so always give aciclovir to cover this possibility)

Question 39

What are the symptoms of primary TB? What is the test?

Answer 39

prolonged fever, malaise, cough, anorexia, weight loss + CXR changes 50% infants and 90% of older children are asymptomatic at primary infection Mantoux test - positive test suggests active infection

Question 40

What might the presentation be for post-primary TB (reactivation)

Answer 40

local or miliary TB (bones, joints, kidneys, pericardium, CNS) Infants + young children - CNS infection most likely causing tuberous meningitis

Question 41

What is tuberous meningitis?

Answer 41

Insidious onset meningitis caused by contact with tuberculosis. Meningism may be minimal Dx = most will have a positive mantoux test, acid-fast bacilli identified with Ziehl-Nielsen / auramine staining . early morning urine samples

Question 42

What is the treatment for TB?

Answer 42

``` RIPE for 2 months Rifampicin Isoniazid Pyrazinamide Ethambutol ``` Contact tracing

Question 43

What type of organism is HIV?

Answer 43

RNA retrovirus (HIV1 is the most common, HIV2 is uncommon outside West African countries)

Question 44

How can vertical transmission of HIV be prevented?

Answer 44

mode of delivery according to viral load of mother: - normal vaginal if <50 - C section if >50 - IV zidovudine if unknown viral load or >10000 Prophylaxis treatment for babies: - low risk (<50) = 4 weeks of zidovudine - high risk (>50) = 4 weeks zidovudine, lamivudine and nevirapine

Question 45

What are the options for HIV testing in children?

Answer 45

HIV antibody screen - standard test but can give false positives if HIV +ve mum HIV viral load - no risk of false positive but may be 'undetectable' if on antiretroviral therapy

Question 46

How is paediatric HIV managed?

Answer 46

ART Vaccines - may delay live vaccines if severe Prophylactic co-trimoxazole (Septrin) if low CD4 count (protect against pneumoncystis jiroveci) Tx of opportunistic infection MDT

Question 47

How does dipteria present?

Answer 47

Recent foreign travel similar to bacterial tonsilitis but thick grey membrane at back of throat can cause heart failure, paralysis, death tx = penicillin