Paediatrics 1 (infections) Flashcards
Pathophysiology of bronchiolitis.
Increased mucus in bronchioles (already very narrow in children.)
Causes wheeze/crackles and >resp effort.
List O2 sats for admission for bronchiolitis
- < 90% if > 6 weeks
- < 92% if < 6 weeks or having underlying condition e.g. congenital heart defects.
For discharge: they must maintain sats above aforementioned values for at least 4 hours and have good oral fluid intake.
Others:
- feeding < 50%
- Persistent respiratory distress e.g. recessions, grunting
- Apnoea
Main management option for bronchiolitis in hospital.
Supportive management: e.g.
- O2 supplementation
- Fluids (PO ideally)
- Apnoea/secretions require suction, otherwise not needed.
- CPAP if impending respiratory failure. (+CBG)
Community Mx: supportive.
Whooping cough treatment.
Macrolides i.e. clarithromycin or azithromycin.
If <1 mo: clarithryomycin
If pregnant: erithromycin
If unsuitable: co-trimoxazole (but CI in pregnancy and <6 weeks)
Describe how a rash starts for:
- Measles
- Rubella
- Chickenpox
- Scarlet fever
- Roseola infantum (HHV-6)
- Slapped cheek disease
Measles: post-auricularly, spreads to trunk
Roseola infantum: pink, lacy rash starting from trunk, spreads to face.
Describe the measles morbillivirus. (Class and genetics)
A Paramyxovirus, a single-stranded RNA virus.
Presentation of measles
Skin and others.
- 3Cs: cough, coryza, conjunctivitis (prodrome)
- Koplik spots preceding rash (prodrome)
- Rash starting post-auricularly, spreading to trunk
Spread through droplets. (Hence CCC) Disseminates systemically, where rash is due to auto-immune destruction of endothelial cells of small blood vessel.s
A 21-year-old male presents with altered behavior, irritability, and cognitive decline over six months. (rapid onset).
He had measles as a child.
What is a diagnosis specific to his case to consider?
Subacute sclerosing panencephalitis. (SSPE)
Best prevented with measles vaccine to avoid measles infection.
Rare and devastating neurological disorder caused by a persistent infection with the measles virus.
Notifiable childhood infectious diseases
- MMR
- Pertussis
Whooping cough vaccination regime for babies?
3 doses
8 weeks, (+4) 12 weeks, (+4), 16 weeks
When is the first MMR vaccine given?
12 months
Kawasaki is a widespread vasculitis of ____________ - sized arteries, such as _____________ arteries.
Medium-sized arteries, such as coronary arteries
Leads to aneurysms –> thrombus and MI/death
Caused by immune activation: Initial triggering event (e.g., infection) → activation of innate and adaptive immunity.
Two main treatment options for Kawasaki disease.
- IVIG
- Aspirin (high dose, then low dose)
A 4 year-old patient presents with 7 days of persistent fever, often accompanied by bilateral red eyes without discharge, cracked red lips, and a ras over the trunk. They may also exhibit swollen, red hands and feet with peeling skin and unilateral neck swelling. The child appears irritable and unwell, and parents may report recent viral illness symptoms.
What’s the likely diagnosis?
Kawasaki disease.
Diagnosis with these symptoms i.e. 5 days of high fever with 4 other symptoms.
Supported by blood tests - inflammation.
When does the rash for roseola infantum start?
Starts abruptly after fever cessation (high-grade 3-5 days)
Pink, starts from trunk, non-pruritic. ‘Nagayama’ spots in mouth.
Clinical diagnosis
What is the appearance of the rash in slapped-cheek disease?
Lacy, reticular. On the cheeks.
Unlike Scarlet fever — no strawberry tongue.
Which groups of people do toxoplasmosis affect?
Lifelong infection and usually just causes self-limiting lymphadenopathy
- Pregnant women (due to immune system changes) —can cause encephalitis.
- Immunocompromised people e.g. HIV
CMV presentation in CMV-infected infants.
- Rash (resembles small, blue or purple spots, similar to the appearance of blueberry muffins),
- Jaundice, microcephaly (small head), low birth weight
