Paediatrics 6 Flashcards
1
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Herpes simplex virus
A
- Transmission occurs via contact with mucosal secretions from anogenital or oral mucosa or from contact with ulcerative lesions
- HSV-1 is more likely to cause oral infections where as HSV-2 is more likely to cause genitourinary infections however both serotypes can cause infections in either area
2
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Herpes simplex virus: presentation
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- Prodromal features last 5-7 days and mimic flu
- Primary infection presents with crops of painful blisters in a symmetrical distribution over the anogenital mucosa. Tender lymphadenopathy and local oedema
- Dysuria
- Vaginal or urethral discharge
- In secondary infection, presentation is unilateral and usually less severe with each successive infection
- Primary infections can last several weeks whereas recurrent infections don’t tend to last more than a few days
3
Q
Herpes simplex virus investigations
A
- Can be done clinically
- Viral culture and PCR amplification can be used to identify most cases of infection
- Serological tests can take up to 12 weeks to become positive so a negative test before 3 months does not rule out infection
- Urine dipstick/ MSU
- Pelvic USS
4
Q
Herpes simplex virus complications
A
- Chronic pelvic pain, Damage to fallopian tubes, risk of infertility, ectopic pregnancy.
- Herpes keratitis: inflammation of the cornea in the eye
- Herpetic whitlow: painful skin lesion on finger or thumb
5
Q
Herpes simplex virus management
A
- Management is usually supportive however antiretroviral therapy can be given
- Aciclovir 400 mg three times daily; OR
- Valaciclovir, 500 mg twice daily for five days.
- Antiretroviral therapy does not alter the course of the infection or stop recurrence but reduces the severity and duration of the flares
6
Q
Pregnancy and genital herpes
A
- Risk of neonatal herpes simplex infection contracted during labour and delivery: has a high morbidity and mortality
- Primary genital herpes (<28 weeks gestation): aciclovir is given during the initial infection and prophylactic aciclovir is given from 36 weeks onwards. If women is asymptomatic at delivery and is 6 weeks from initial infection can have vaginal delivery otherwise C-section
- Primary genital herpes (>28 weeks gestation): given aciclovir in initial infection then regular prophylactic aciclovir. Always have C-section
- Recurrent genital herpes: infection prior to pregnancy has low risk of transmission even if lesions are present. Regular prophylactic aciclovir is given from 36 weeks
7
Q
HPV
A
- Spread through sexual contact
- Asymptomatic but can cause genital warts
- Vaccine given to 12-13 girls and boys
- Can cause: cervical cancer (Herpes 16,18 and 33), anal cancer, penile cancer, vulval cancer, vaginal cancer, some types of head and neck cancer
- Can prevent transmission with barrier contraception
- Is tested during cervical cancer screening
- No treatment
8
Q
Genital warts
A
- Small rough lumps on the skin around the genital area can bleed or itch
- Caused by Herpes 6 and 11
- First line: topical podophyllum or cryotherapy (solitary or keratinised wart)
- Often resistant to treatment and recurrence is common
9
Q
Indications for splenectomy
A
- Indications for emergency splenectomy include trauma and rupture (e.g. in EBV infection).
- An elective splenectomy is done in cases of hypersplenism, where there is increased uptake of platelets in the spleen, which leads to sequestration of cells in the spleen
- Indications for elective splenectomy include haemolytic anaemia (hereditary or immune) and idiopathic thrombocytopenic purpura.
10
Q
Whats Hyposplenism and blood film post splenectomy
A
Hyposplenism: dysfunctional spleen i.e. in coeliac
Blood film post splenectomy: Howell-Jolly bodies and Pappenheimer bodies
11
Q
Splenectomy susceptible to infections
A
- Reduce response against encapsulated organisms (Haemophilus, pneumococcus and meningococcus)
- Particularly high risk in the first 2 years
- Require low dose prophylactic antibiotics often for life. Normally phenoxymethylpenicillin also known as penicillin V (clarithromycin or erythromycin if patients are allergic to penicillin).
11
Q
Vaccines in splenectomy
A
- Pneumococcal vaccination (with regular boosters every 5 years).
- Seasonal influenza vaccination (yearly, typically every autumn).
- Haemophilus influenza type B vaccination (one-off).
- Meningitis C vaccination (one-off).
12
Q
Congenital Hypothyroidism
A
- Screened on newborn blood test
- Symptoms: prolonged neonatal jaundice, poor feeding, constipation, increased sleeping, reduced activity, slow growth and development
- Child is born with underactive thyroid. Two types:
- Dysgenesis: underdeveloped thyroid gland
- Dyshormogenesis: fully developed gland doesn’t produce enough hormones
13
Q
Acquired Hypothyroidism (paediatrics)
A
- Most common type is Hashimotos thyroiditis associated with anti-TPO antibodies
- Associated with other autoimmune condition particularly type 1 diabetes and coeliac disease
- Symptoms: fatigue, low energy, poor growth, weight gain, poor school performance, weight gain, constipation, dry skin and hair loss
14
Q
JIA
A
Juvenile idiopathic arthritis (JIA) is an umbrella term for a range of arthritis affecting children and young people where the cause is not clear. JIA is a diagnosis of exclusion for children <16 years old who have persistent joint swelling (>6 weeks). Different kinds of JIA include polyarthritis, oligoarthritis and systemic forms.
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