Paediatrics 2 Flashcards
What is eczema?
A skin condition that is caused by defects in the continuity of the the skin barrier leading to inflammation of the skin
Where does eczema usually present?
It usually presents in infancy with dry, red, itchy sore patches of skin over the flexor services
What are the two types of management for eczema?
- Maintenance
- Management of flares
What is key to the maintenance of eczema?
Creating an artificial barrier over the skin to compensate the defective skin barrier
This is done using emollients and they should be used as soap substitutes when washing.
Also avoid breaking down skin barrier with things such as hot baths, scratching or scrubbing skin
What is used to treat flares?
Thicker emollients, topical steroids, “wet wraps” (covering affected areas in a thick emollient and applying a wrap to keep moisture locked in overnight) and treating any complications such as bacterial or viral infections. Very rarely IV antibiotics or oral steroids might be required in very severe flares.
What are the thin emollients used in eczema?
E45
Diprobase cream
Oilatum cream
Aveeno cream
Cetraben cream
Epaderm cream
What are the thick emollients used in eczema?
50:50 ointment (50% liquid paraffin)
Hydromol ointment
Diprobase ointment
Cetraben ointment
Epaderm ointment
What are the dangers of using steroids in eczema?
They can lead to thinning of the skin which can then make the skin more prone to infection. It can also lead to systemic absorption
The general rule is using the weakest steroid for the shortest period of time to get the skin under control
What is the steroid ladder?
Mild: Hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)
What is Stephens-Johnson syndrome and toxic epidermal necrolysis (TEN)?
A disproportional immune response which causes epidermal necrosis resulting in blistering and shedding of the top layer of skin.
Typically SJS affects less than 10% of skin and TEN affects more than 10% of skin
Certain HLA subtypes are more at risk of developing it
What are some medications which can cause SJS?
- Anti-epileptics
- Antibiotics
- Allopurinol
- NSAIDs
What are some infections that can cause SJS?
- HSV
- Mycoplasma pneumonia
- CMV
- HIV
What is the presentation of SJS?
- Starts with non-specific symptoms such as fever, cough, sore throat, sore mouth, eyes and itchy skin
- They then develop a purple or red rash that spreads across the skin and starts to blister
- A few days after the blistering starts, the skin starts to break away and shed leaving the raw tissue underneath. Pain, erythema, blistering and shedding can also happen to the lips and mucous membranes. Eyes can become inflamed and ulcerated. It can also affect the urinary tract, lungs and internal organs.
What is the management of SJS?
- Steroids
- Immunoglobulins
- Immunosuppressants
What are the complications of SJS?
Secondary infection: The breaks in the skin can lead to secondary bacterial infection, cellulitis and sepsis.
Permanent skin damage: Skin involvement can lead to scarring and damage to skin, hair, nails, lungs and genitals.
Visual complications: Depending on the severity, eye involvement can range from sore eyes to severe scarring and blindness.
What is allergic rhinitis?
A IgE-mediated type 1 hypersensitivity reaction caused by environmental allergens in the nasal mucosa.
What can cause allergic rhinitis?
Seasonal, for example hay fever
Perennial (year round), for example house dust mite allergy
Occupational, associated with the school or work environment
What are the symptoms of allergic rhinits?
Runny, blocked and itchy nose
Sneezing
Itchy, red and swollen eyes
Allergic rhinitis is associated with a personal or family history of other allergic conditions (atopy).
Diagnosis is usually made based on the history. Skin prick testing can be useful, particularly testing for pollen, animals and house dust mite allergy.
What is the management of allergic rhinitis?
Non-sedating antihistamines include cetirizine, loratadine and fexofenadine
Sedating antihistamines include chlorphenamine (Piriton) and promethazine
Nasal corticosteroid sprays such as fluticasone and mometasone can be taken regularly to suppress local allergic symptoms.
Nasal antihistamines may be a good option for rapid onset symptoms in response to a trigger.
What causes urticaria?
Urticaria are caused the release of histamine and other pro-inflammatory chemicals by mast cells in the skin.
This may be part of an allergic reaction in acute urticaria or an autoimmune reaction in chronic idiopathic urticaria.
What are some causes of acute utricaria?
Allergies to food, medications or animals
Contact with chemicals, latex or stinging nettles
Medications
Viral infections
Insect bites
Dermatographism (rubbing of the skin)
What are the three types of chronic urticaria?
Chronic idiopathic urticaria
Chronic inducible urticaria
Autoimmune urticaria
Describe each type of chronic utricaria?
Chronic idiopathic urticaria describes recurrent episodes of chronic urticaria without a clear underlying cause or trigger.
Chronic inducible urticaria describes episodes of chronic urticaria that can be induced by certain triggers, such as:
Sunlight
Temperature change
Exercise
Strong emotions
Hot or cold weather
Pressure (dermatographism)
Autoimmune urticaria describes chronic urticaria associated with an underlying autoimmune condition, such as systemic lupus erythematosus.
What is the main treatment for utricaria?
Fexofenadine or oral steroids
What are some specialist treatments for urticaria?
Anti-leukotrienes such as montelukast
Omalizumab, which targets IgE
Cyclosporin
What is the presentation of anaphylaxis?
Urticaria
Itching
Angio-oedema, with swelling around lips and eyes
Abdominal pain
Additional symptoms that indicate anaphylaxis are:
Shortness of breath
Wheeze
Swelling of the larynx, causing stridor
Tachycardia
Light-headedness
Collapse
What is given to treat anaphylaxis after the A-E assessment has been done?
Intramuscular adrenalin, repeated after 5 minutes if required as it has a short half-life
Antihistamines, such as oral chlorphenamine or cetirizine
Steroids, usually intravenous hydrocortisone
What can be measured to confirm anaphylaxis?
Measure serum mast tryptase. It stays in the blood for 6 hours
How do you use an adrenalin auto-injector (epi pen)
Prepare the device by removing the safety cap on the non-needle end. There is a blue cap on EpiPen and a yellow cap on Jext.
Grip the device in a fist with the needle end pointing downwards. The needle end is orange on EpiPen and black on Jext. Do not put your thumb over the end, because if the device is upside down you will inject your thumb with adrenalin and could risk losing it.
Administer the injection by firmly jabbing the device into the outer portion of the mid thigh until the device clicks. This can be done through clothing. EpiPen advise holding it in place for 3 seconds and Jext advise 10 seconds before removing the device.
Remove the device and gently massage the area for 10 seconds.
Phone an emergency ambulance. A second dose may be given (with a new pen) after 5 minutes if required.
What concentration of adrenalin is given in anaphylaxis?
Adrenaline (IM*) 1:1000
What are the different doses of adrenalin used?
- Children older than 12: 500 micrograms
- Children aged 6-12: 300 micrograms
- Children aged 6 months to 6 years: 150 micrograms
What is Kawasaki disease?
It is a systemic, medium-sized vessel vasculitis. It affects young children typically under 5 year. There is no clear cause or trigger
It is more common among Asian children particularly Japanese and Korean and more common in boys
What are the clinical features of Kawasaki disease?
- A persistent high fever for more than 5 days.
- A widespread erythematous maculopapular rash and desquamation on the palms and soles of the feet
What are some other features of Kawasaki’s diease?
Strawberry tongue (red tongue with large papillae)
Cracked lips
Cervical lymphadenopathy
Bilateral conjunctivitis
What are the investigations for Kawasaki’s disease?
- FBC can show anaemia and Leukocytosis and thrombocytosis
- LFT can show hypoalbuminemia and elevated liver enzymes
- Inflammatory markers (ESR) are raised
- Urinalysis can show raised white blood cells without infection
- Echocardiogram can demonstrate coronary artery pathology
What are the 3 phases of Kawasaki disease?
- Acute phase: the rash with the fever and lymphadenopathy 1-2 weeks
- Subacute phase: The acute symptoms settle, the desquamation and arthralgia occur and there is a risk of coronary artery aneurysms forming. This lasts 2 – 4 weeks.
- Convalescent stage: The remaining symptoms settle, the blood tests slowly return to normal and the coronary aneurysms may regress. This last 2 – 4 weeks.
What is the treatment for Kawasaki disease?
- High dose aspirin to reduce the risk of thrombosis
- IV immunoglobulins to reduce the risk of coronary artery aneurysms
Why is aspirin not usually used to treat children?
Because of the risk of Reye’s sydrome
When do symptoms usually appear after exposure to measels?
10-12 days
What are the first symptoms of measels?
Fever, coryzal and conjunctivitis
What is the the diagnostic feature of measels?
Koplik spots, they are greyish white spots on the mouth.
They appear 2 days after the fever if you see them you can diagnose them (pathognomonic)
When does the rash appear in measles and where does it start to show first/
The rash starts on the face, classically behind the ears, 3 – 5 days after the fever. It then spreads to the rest of the body. The rash is an erythematous, macular rash with flat lesions.
How long does measles take to resolve and how long do children need to isolate if they have it?
Measles is self resolving after 7 – 10 days of symptoms. Children should be isolated until 4 days after their symptoms resolve.
Measles is a notifiable disease and all cases need to be reported to public health. 30% of patients with measles develop a complication.
What are the complications of measles?
- Pneumonia
- Diarrhoea
- Dehydration
- Encephalitis
- Meningitis
- Hearing loss
- Vision loss
- Death
When do symptoms appear with rubella?
2 weeks after exposure
What are the symptoms of ubella?
It presents with a milder erythematous macular rash compared with measles. The rash starts on the face and spreads to the rest of the body. The rash classically lasts 3 days.
It can be associated with a mild fever, joint pain and a sore throat. Patients often have enlarged lymph nodes (lymphadenopathy) behind the ears and at the back of the neck.
What is the management of rubella?
Management is supportive and the condition is self limiting. Rubella is a notifiable disease and all cases need to be reported to public health.
Children should stay off school for at least 5 days after the rash appears. Children should avoid pregnant women.
What are the complications of rubella?
- Thrombocytopenia
- Encephalitis
It is also dangerous in pregnancy and can lead to congenital rubella syndrome:
- Deafness
- Blindness
- Congenital heart disease
What causes slapped cheek syndrome?
Parvovirus B19
How does SCS present?
Parvovirus infection starts with mild fever, coryza and non-specific viral symptoms such as muscle aches and lethargy.
After 2 – 5 days the rash appears quite rapidly as a diffuse bright red rash on both cheeks, as though they have “slapped cheeks”.
A few days later a reticular mildly erythematous rash affecting the trunk and limbs appears that can be raised and itchy. Reticular means net-like.
Who is at risk of complications with slapped cheek syndrome?
- Immunocompromised patients
- Pregnant women
- Sickle cell
- Thalassaemia
- Hereditary spherocytosis
Patients with haematological condition will require FBC checking
What are the complications of SCS?
- Aplastic anaemia
- Encephalitis
- Fetal death
- Hepatitis
- Myocarditis
- Nephritis
What causes chickenpox?
Varicella zoster virus
What is the presentation of chickenpox?
Chickenpox is characterised by widespread, erythematous, raised, vesicular (fluid filled), blistering lesions. The rash usually starts on the trunk or face and spreads outwards affecting the whole body over 2 – 5 days. Eventually the lesions scab over, at which point they stop being contagious.
Other symptoms:
Fever is often the first symptom
Itch
General fatigue and malaise
What are the complications of chickenpox?
Bacterial superinfection
Dehydration
Conjunctival lesions
Pneumonia
Encephalitis (presenting as ataxia)
What is the presentation of diptheria?
Usually mild.
Smptoms often develop gradually, beginning with a sore throat and fever.
In severe cases, a grey or white patch develops in the throat, which can block the airway, and create a barking cough similar to what is observed in croup.
May involve lymph node swelling, and can involve skin, eyes and genitals
What is Scaled skin syndrome?
A condition caused by a type of S.aureus bacteria that produces epidermolytic toxins
These toxins are protease enzymes that break down proteins that hold skin cells together
What age usually get SSS?
Children under age of 5 as older children have developed immunity to the toxins
What is the presentation of SSS?
- Patches of erythema of the skin, this causes the skin to look thin and wrinkled
This is followed by the formation of fluid filled blisters called bullae which burst and leave sore skin below
What is a sign that is a positive test for SSS?
Nikolsky sign is where very gentle rubbing of the skin causes it to peel away.
What is the management of SSS?
Iv antibiotics
What is whooping cough?
An upper respiratory tract infection caused by Bordetella pertussis (a gram neg).
It is called whooping cough because the coughing fits are so severe that the child can’t take in any air between coughs
What are some presentations of whooping cough?
More severe coughing fits start after a week or more. These involve sudden and recurring attacks of coughing with cough free periods in between. This is described as a paroxysmal cough.
Coughing fits are severe and keep building until the patient is completely out of breath. Patient typically produces a large, loud inspiratory whoop when the coughing ends.
Patients can cough so hard they faint, vomit or even develop a pneumothorax. Bear in the mind that not all patients will “whoop” and infants with pertussis may present with apnoeas rather than a cough.
What is the initial presentation of whooping cough?
Pertussis typically starts with mild coryzal symptoms, a low grade fever and possibly a mild dry cough
How is whooping cough diagnosed?
A nasal swab with PCR testing or bacterial culture within 2-3 weeks if symptoms
Can be tested for the anti-pertussis toxin immunoglobulin G. This is tested for in the oral fluid of children aged 5 to 16 and in the blood of those aged over 17.
What is the management of whooping cough?
Macrolide antibiotics such as azithromycin, erythromycin and clarithromycin can be beneficial in the early stages (within the first 21 days) or vulnerable patients. Co-trimoxazole is an alternative to macrolides.
Close contacts with an infected patient are given prophylactic antibiotics if they are in a vulnerable group, for example pregnant women, unvaccinated infants or healthcare workers that have contact with children or pregnant women
What are the complications of whooping cough?
The symptoms typically resolve within 8 weeks, however they can last several months. It is also known as the “100-day cough” due to the potential long duration of the cough. A key complication of whooping cough is bronchiectasis.
What is polio?
Poliomyelitis an acute clinical disease caused by a polio virus
It remains endemic in Afghanistan and Pakistan
What are the symptoms of polio?
Presentation: Incubation 7–10d. Flu-like prodrome in ~25%.
Pre-paralytic stage: fever, increased HR, headache, vomiting, neck stiffness,
tremor, limb pain.
~1 in 200 progress to paralytic stage: LMN/bulbar signs ± respiratory failure
What type of bacteria causes TB?
Mycobacterium tuberculosis.
It is an acid-fast bacilli and will be seen using a Zeihl-neelson stain and turn bright red
How does TB lead to the formation of Ghon complexes? (Primary/active TB)
Macrophages struggle to clear TB due to its waxy mycolic acid capsule.
Instead of being broken down and cleared, A focal caseating granuloma typically forms in the lower lobe known as a Ghon focus.
The Ghon focus can then spread to the Hilar Lymph nodes in the lungs, which together form a ghon complex
These ghon complexes can under go fibrosis and calcification, leading to the appearance of ranke complexes on xray
What is latent TB?
- occurs after primary infection, immune system encapsulates sites of infection and stop the progression of the disease.
- Patients remain asymptomatic and the bacteria remains dormant, resulting innegative sputumcultures but apositive Mantoux test.
- These patients arenotinfectious.
- However, if patients areimmunocompromised, the disease can progress or reactivate at a later stage to becomeactive TB.
Outline what happen in secondary TB.
Where in the lung is it most likely to happen and why?
Immunocompromised patients may develop secondary TB when latent TB reactivates
- Patients are infectious.
- Reactivation typically occurs in thelung apexwhere pO2is highest, as mycobacteria are aerobic.
bacteria can spread locally, to form caseating granulomata, or systemically (miliary TB).
Outline what Miliary TB is, and what happens in it.
Miliary TB - Where immune system cannot control the infection and it becomes disseminated
Extrapulmonary TB - where TB infects other areas
What are the risk factors for catching TB?
- Close contact with active TB
- Immigrants from areas with high prevalence
- Immunocompromised
- Malnutrition, homelessness, drug users, smokers and alcoholics
What is the BCG vaccine?
Involves an intradermal injection of **live attenuated Mycobacterium bovis bacteria (a close relative of M. tuberculosis that does not cause disease in humans).
The vaccine protects against severe and complicated TB but less against pulmonary TB
What needs to be tested before the BCG vaccine can be given?
he Mantoux test and only given the vaccine if this test is negative. They are also assessed for the possibility of immunosuppression and HIV due to the risks related to a live vaccine.
What is the presentation of TB?
Cough
Haemoptysis (coughing up blood)
Lethargy
Fever or night sweats
Weight loss
Lymphadenopathy
Erythema nodosum (tender, red nodules on the shins caused by inflammation of the subcutaneous fat)
Spinal pain in spinal tuberculosis (also known as Pott’s disease of the spine)
What are the investigations for previous TB infections?
- Mantoux test
- Interferon-gamma release assay
What is the Mantoux test?
he Mantoux test involves injecting tuberculin into the intradermal space on the forearm. Tuberculin is a collection of tuberculosis proteins isolated from the bacteria. It does not contain any live bacteria.
The infection creates a bleb under the skin. After 72 hours, the test is “read”. This involves measuring the induration of the skin at the injection site. An induration of 5mm or more is considered a positive result.
What will a chest x-ray show for TB?
Primary tuberculosis may show patchy consolidation, pleural effusions and hilar lymphadenopathy
Reactivated tuberculosis may show patchy or nodular consolidation with cavitation (gas-filled spaces), typically in the upper zones.
Disseminated miliary tuberculosis gives an appearance of millet seeds uniformly distributed across the lung fields.
What is used to assess the genetic material of a TB sample?
NAAT test
What is the treatment for latent TB?
Isoniazid and rifampicin for 3 months or Isoniazid for 6 months
What is the treatment of active TB?
R – Rifampicin for 6 months
I – Isoniazid for 6 months
P – Pyrazinamide for 2 months
E – Ethambutol for 2 months
What are the side effects of rifampicin?
can cause red/orange discolouration of secretions, such as urine and tears. It is a potent inducer of the cytochrome P450 enzymes and reduces the effects of drugs metabolised by this system, such as the combined contraceptive pill.
What are the side effects of isoniazid?
can cause peripheral neuropathy. Pyridoxine (vitamin B6) is co-prescribed to reduce the risk.
What are the side effects of pyrazinamide?
Pyrazinamide can cause hyperuricaemia (high uric acid levels), resulting in gout and kidney stones.
What are the side effects of ethambutol?
can cause colour blindness and reduced visual acuity.
Outline basic pathophysiology of HIV
The virus enters and destroys the CD4 T helper cells.
Uses reverse transcriptase enzyme to transcribe a piece of complimentary proviral DNA, to make a double strand with the original RNA strand.
This double stranded DNA then pops itself into the DNA of the cell (via integrase enzyme.) , ready to be transcribed into another virus cell, when the old immune cell becomes activated and starts trying to transcribe proteins for the immune response. (sneaky)
How can HIV spread to children?
Sexual abuse/unprotected sex
- Mother to child at any stage of pregnancy, birth or breastfeeding (vertical transmission)
Mucous membrane, blood or open wound exposure to infected blood or bodily fluids. This could be through sharing needles, needle-stick injuries or blood splashed in an eye.
what is the mode of delivery for mothers with HIV?
Will be determined by the viral load of the mother
Normal vaginal is recommended for women with viral load <50 copies/ml
Caesarean sections are considered in patients with > 50 copies copies / ml and in all women with > 400 copies / ml
IV zidovudine should be given during the caesarean if the viral load is unknown or there are > 10000 copies / ml
What is the prophylactic treatment for babies at risk of HIV?
Low risk babies, where mums viral load is < 50 copies per ml, should be given zidovudine for 4 weeks
High risk babies, where mums viral load is > 50 copies / ml, should be given zidovudine, lamivudine and nevirapine for 4 weeks
Can mothers who have HIV breastfeed?
NO
When should children with HIV positive parents be tested?
Twice:
HIV viral load test at 3 months. If this is negative, the child has not contracted HIV during birth and will not develop HIV unless they have further exposure.
HIV antibody test at 24 months. This is to assess whether they have contracted HIV since their 3 month viral load, for example through breast feeding. If the 3 month test is negative and they are not breastfed, this should be negative.
Note that the antibody test can be positive in infants who do not have HIV for up to 18 months of age. This is due to maternal antibodies that have crossed the placenta during pregnancy.
What is the treatment for paediatric HIV?
ART to suppress the HIV
ormal childhood vaccines, avoiding or delaying live vaccines if severely immunosuppressed.
Prophylactic co-trimoxazole (Septrin) for children with low CD4 counts, to protect against pneumocystis jirovecii pneumonia (PCP)
Treatment of opportunistic infections
The aim of antiretroviral therapy (ART) is to achieve a normal CD4 count and undetectable viral load
What is meningitis?
Inflammation of the meninges. They make up the lining of the spinal cord and brain. The inflammation is usually due to a bacterial or viral infection
What is the most common cause of bacterial meningitis in adults and children?
Neisseria meningitidis a gram-negative diplococcus bacteria and streptococcus pneumoniae
What is the most common cause of meningitis in neo-nates?
Group B strep which is contracted form birth
What are the symptoms of meningitis in children?
Fever, neck stiffness, vomiting, headache, photophobia, altered consciousness and seizures.
Can also present with non-blanching rash in meningococcal septicaemia
What does the non-blanching rash indicate in meningitis?
. This rash indicates the infection has caused disseminated intravascular coagulopathy (DIC) and subcutaneous haemorrhages.
What are the presentations of meningitis in neonates?
- Hypotonia
- Poor feeding
- Lethargy
- Hypothermia
- Bulging fontanelle
When is a lumbar puncture indicated in a neonate?
- 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
What are the two tests to look for meningeal irritation?
Kernig’s test
Brudzinski’s test
What is Kernig’s test?
Involves lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees. This creates a slight stretch in the meninges. Where there is meningitis it will produce spinal pain or resistance to movement.
What is brudzinski’s test?
Involves lying the patient flat on their back and gently using your hands to lift their head and neck off the bed and flex their chin to their chest. In a positive test this causes the patient to involuntarily flex their hips and knees.
How is bacterial meningitis managed in the community?
If they have suspected meningitis and a non blanching rash give IM injection of benzylpenicillin.
What should ideally be performed before starting antibiotics in meningitis?
Ideally a blood culture and a lumbar puncture for cerebrospinal fluid (CSF) should be performed prior to starting antibiotics, however if the patient is acutely unwell antibiotics should not be delayed.
Send blood tests for meningococcal PCR if meningococcal disease is suspected. This tests directly for the meningococcal DNA. It can give a result quicker than blood culture depending on local services, and will still be positive after the bacteria has been treated with antibiotics.
What is the treatment for bacterial meningitis?
Under 3 months: give Cefotaxime plus amoxicillin ( the amoxicillin is to cover listeria)
Above 3 months: Ceftriaxone
Vancomycin should be added if there is a risk of Penicillin resistant pneumococcal infection
What is given to reduce the severity of hearing loss and neurological damage in meningitis?
Dexamethasone given 4 times daily for 4 days
Is bacterial meningitis a notifiable disease?
YES
What is given as post-exposure prophylaxis in meningitis?
Single dose of ciprofloxacin
What can cause viral meningitis?
herpes simplex virus (HSV), enterovirus and varicella zoster virus (VZV)
Where is a lumbar puncture taken from?
L3-L4
What are the differences in the lumbar puncture between viral and bacterial meningitisd?
Appearance= cloudy in bacterial
Protein= High in bacterial
Glucose= Low in bacterial
White cells= Neutrophils in bacterial
White cells= Lymphocytes in viral
What is encephalitis?
It means inflammation of the brain. It can be the result of infective or non-infective causes.
Non-infective causes are autoimmune
What is the most common cause of encephalitis in children?
HSV-1 from cold sores
What is the most common cause of encephalitis in neo-nates?
HSV-2 contracted from genital herpes at birth
What are some other causes of encephalitis?
Varicella zoster virus (VZV) associated with chickenpox,
cytomegalovirus associated with immunodeficiency,
Epstein-Barr virus associated with infectious mononucleosis,
enterovirus, adenovirus and influenza virus
What is the presentation of encephalitis?
- Altered consciousness
- Altered cognition
- Unusual behaviour
- Acute onset of focal neurological symptoms
- Acute onset of focal seizures
- Fever
What are the investigations required to establish a diagnosis of encephalitis?
- Lumbar puncture sending CSF for viral PCR testing
- CT scan if LP contraindicated
- MRI after LP
- Swabs of other areas can help establish the causative organism, such as throat and vesicle swabs
- HIV testing is recommended in all patients with encephalitis
What are some contraindications for LP?
- GCS below 9
- Haemodynamically unstable
- Active seizures
- Post-ictal
What is used to treat encephalitis?
- Acyclovir treats herpes simplex virus (HSV) and varicella zoster virus (VZV)
- Ganciclovir treat cytomegalovirus (CMV)
What are the complications of encephalitis?
Lasting fatigue and prolonged recovery
Change in personality or mood
Changes to memory and cognition
Learning disability
Headaches
Chronic pain
Movement disorders
Sensory disturbance
Seizures
Hormonal imbalance
What are the two types of impetigo?
- Bullous
- Non-bullous
What is non bullous impetigo?
occurs around the nose or mouth. The exudate from the lesions dries to form a “golden crust”. They are often unsightly but do not usually cause systemic symptom
What is the treatment for non-bullous impetigo?
- Topical fusidic acid can be used to treat localised non-bullous impetigo
- antiseptic cream (hydrogen peroxide 1% cream) first line rather than antibiotics for localised non-bullous impetigo.
What is bullous impetigo?
- Always caused by S.aureus
- They produce epidermolysis toxins that break down proteins that hold skin cells together
Which group does bullous impetigo typically affect?
Neonates and children under 2
What can happen if the lesions are widespread and severe in bullous impetgio?
Can cause severe infection called staphylococcus scalded skin syndrome
- Treat with flucloxacillin
What are the complications of impetigo?
Cellulitis if the infection gets deeper in the skin
Sepsis
Scarring
Post streptococcal glomerulonephritis
Staphylococcus scalded skin syndrome
Scarlet fever
What causes nappy rash? How should it be treated?
Nappy rash is skin inflammation, mainly due to a reaction of the skin to urine and poo.
Switching to highly absorbent nappies (disposable gel matrix nappies)
Change the nappy and clean the skin as soon as possible after wetting or soiling
Use water or gentle alcohol free products for cleaning the nappy area
Use a thin layer of barrier cream
Ensure the nappy area is dry before replacing the nappy
Maximise time not wearing a nappy
In nappy rash, breakdown in skin and the warm moist environmentcan lead to added infection with candida (fungus) or bacteria, usually staphylococcus or streptococcus. - What are Signs that would point to a candidal infection rather than simple nappy rash?
Rash extending into the skin folds
Larger red macules
Well demarcated scaly border
Circular pattern to the rash spreading outwards, similar to ringworm
Satellite lesions, which are small similar patches of rash or pustules near the main rash
Check for oral thrush with a white coating on the tongue, as this is likely to indicate a fungal infection in the nappy area.