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Paediatrics > Paediatrics: Infection and Immunity > Flashcards

Paediatrics: Infection and Immunity Flashcards

1
Q

What are the main causes of Bacterial Meningitis

A

Neonate - 3mo = Group B Strep
1 mo - 6yr = N.Meningitides (g-ve), Streptococcus (g+ve), H.Influenzae (g-ve)
>6yr = N.Meningitides or Streptococcus

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2
Q

What are the signs and symptoms of meningitis in paediatrics

A

Very non-specific symptoms:

  1. Fever, convulsions, URTI symptoms, poor feeding
  2. Raised ICP - irritable, high pitched cry, vomiting, drowsy, confused, bulging fonatanelle
  3. Meningism (if old enough) - photophobia, neck stiffness/pain, headache
  4. Non-blanching purpuric rash
  5. Late signs may include - bulging anterior fontanelle, low GCS, opisthotonos (arched back whilst lying), neck stiffness
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3
Q

What are the investigations for meningitis and results?

Ensure you state the differences between viral and bacterial and TB when describing LP.

A
  1. Bloods (FBC, CRP, U+Es, LFT) - ^WCC, ^CRP

2a. LP
(a) bacterial = raised Neutrophil polymorphs (10-5000mg/ml), low CSF glucose (<1/2 of plasma glucose), turbid and opaque colour (cloudy), raised protein (>1g/L)
(b) viral = raised lymphocytes (15-1000/mm3), normal or raised proteins, normal glucose (60-80% of plasma glucose, clear colour
(c) TB = raised lymphocytes (10-1000mm3), raised proteins (>1g/l), low glucose (1/2 of plasma glucose), cloudy colour with fibrin web

2b. whole blood PCR
3. Blood cultures if LP is CI or not tolerated
4. Rapid antigen screen of blood or urine
5. Throat swab if neccessary

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4
Q

What is the management of suspected bacterial meningitis

A
  1. Empirical IM/IV Benzylpenicllin (if non-blanch rash is present)
    1b. Urgently transfer to secondary care services
  2. IV Antibiotics.
    a. if <3 mo –> IV ceftriaxone with ampicillin or amoxicillin
    b. if >3 mo –> IV ceftriaxone
  3. Dexamethasone (0.15mg/kg QDS)
  4. Supportive treatment - Fluids (colloids) + Oxygen (15L/min)
  5. Rifampacin or Ciprofloxacin for family members
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5
Q

What is the treatment for viral meningitis

A
  1. Supportive therapy
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6
Q

What are the main contraindications for LP

A
  1. Raised ICP: bulging fontanelle, drowsy, papilloedema, high BP, low HR
  2. Meningococcal sepsis
  3. Local infection at LP site
  4. Coagulopathy or thrombcytopoenia
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7
Q

What are the two key signs of meningitis

A
  1. Kernigs - flexion of neck whilst supine causes flexion of hips and knees
  2. Brudzinskis - flexion of hip and knee causes back or neck pain
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8
Q

What are the main causes of viral meningitis

A

Enterovirus, adenovirus, HSV1+2, EBV

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9
Q

What are the main causes of septicaemia in paediatrics

A
  1. N.Meningitides (Most common)
  2. Group B Strep (in neonates <48hrs)
  3. Staph (coagulase +ve or aureus if > 48hrs old)
  4. E.Coli and Listeria
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10
Q

What are the investigations for septicaemia

A

Septic screen:

  1. Bloods: FBC (^WCC), ^Lactate, U+E (^K+), glucose, LFTs etc.
  2. Urine/Stool MSC
  3. Blood cultures
  4. LP if meningitis is suspected
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11
Q

What is the management of septicaemia

A

ABCDE

  1. Abx - IM/IV Benzylpenicllin (if community) or IV Ceftriaxone/Cefotaxime (if hospital)
  2. Fluids (20ml/kg bolus) and Oxygen (15L/min)
  3. any other supportive treatment
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12
Q

When do babies have their first vaccinations and what do they receive?

A

8 weeks

  1. DTaP/IPV/Hib
  2. PCV
  3. Men B2
  4. Rotavirus
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13
Q

When are a babies 2nd vaccinations and what do they receive?

A

12 weeks

  1. DTaP/IPV/Hib
  2. Rotavirus
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14
Q

When are a babies 3rd vaccinations and what do they receive?

A

16 weeks

  1. DTaP/IPV/Hib
  2. PCV
  3. Men B2
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15
Q

What vaccinations do children receive at 1 years old?

A
  1. MMR
  2. PCV
  3. Men B2
  4. Hib/Men C
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16
Q

What vaccinations do children have between 2 and 7 years old

A

Annual LAIV (live attenuated influenza vaccination)

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17
Q

What vaccinations do girls have during their teens? what is the exact age

A

12-13 years

1. HPV (2 doses, 6-24 months apart)

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18
Q

When are a healthy child’s final vaccinations and what do they receive?

A

14 years old

  1. Men ACWY
  2. Td/IPV
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19
Q

What vaccinations do children have at 3 years and 4 months old?

A
  1. DTaP/IPV

2. MMR booster

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20
Q

What are the symptoms and signs of chicken pox

A
  1. Prodrome: Fever, Coryza

2. Vesicular, itchy rash on head and trunk (macular –> papular –> vesicular –> pustule –> crust)

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21
Q

What is the causative organism of chicken pox and whom does it most commonly occur

A

VZV

1-6 year old children

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22
Q

How long is the infection period of chicken pox

A

2 days before rash onset –> last vesicle crusts over

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23
Q

What are the main complications of chicken pox

A
  1. Necrotising fasciitis - group B strep infection –> NF –> Toxic shock
  2. Shingles - VZV lies dormant until later life –> flares as vesicular rash following nerve distribution
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24
Q

What are the causative organisms of conjunctivitis in paediatrics

A
  1. Bacterial - staph or Hib, consider gonorrhoea in neonates
  2. Viral - adenovirus
  3. Allergy -
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25
Q

What are the classic signs of conjunctivitis and how do they vary depending on cause?

A

Signs are typically bilateral

  1. Red eye - injected conjunctival vessels which blanch with pressure
  2. Discharge
    a. Viral - watery and sticky
    b. Allergy - watery and clear
    c. Bacteria - thick yellow/green
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26
Q

A neonate presents to you <48hrs since birth with conjunctivitis. What is the likely possible organism and how will it present?

A

Gonorrhoea

  1. Red eye B/L
  2. Purulent yellow thick discharge
  3. Upper eye lid swelling
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27
Q

How would you treat gonorrhoeal conjunctivitis

A

IV Cephalosporin

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28
Q

What commonly occurs in conjunction with gonorrhoeal conjunctivitis. How would you detect this?

A

concomitant chlamydial infection, detect via monoclonal Ab screen of conjunctival secretions

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29
Q

How does allergic conjunctivitis present

A
  1. Clear, watery discharge
  2. Swelling of lips
  3. Chemosis i.e. conjunctival oedema
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30
Q

What are food allergies caused by?

A

an abnormal immune reaction to specific food antigens causing IgE response

31
Q

What are the common foods causing allergies

A

Shell fish, fish peanuts, eggs, cows milk protein, soya,

32
Q

Give an example of a non-IgE mediated food allergy

33
Q

What are the symptoms of a food allergy (mild)?

A
  1. Diarrhoea, nausea + vomiting
  2. Maculopapular rash development (peri-oral)
  3. Anorexia
34
Q

What are the common features of a child with allergy in terms of demographics

A
  1. FHx of atopy
  2. Hx or FHx of asthma
  3. Symptoms of GORD
35
Q

What is the main complications of a food allergy and how does this present?

A

Anaphylaxis:

  1. D, N+V
  2. Laryngeal and angioedema
  3. Wide spread maculopapular rash over entire body
  4. Respiratory distress: ^RR, SoB, IC/SC recessions, laryngeal tug, nasal flare
  5. Low BP –> Shock –> Death
  6. Fits
36
Q

What are the investigations for food allergy

A
  1. ELISA and RAST test - detects food specific IgE Ab
37
Q

What is the treatment for anaphylaxis

A

ABCDE

  1. IM Adrenaline ± epi-pen
  2. Hydrocortisone
  3. IV Fluid resuscitation (20ml/Kg bolus)
  4. Oxygen
38
Q

What is the management for patients with food allergy?

A
  1. Dietary advice
  2. Anti-histamines
  3. food challenge - if 6-12 months symptom free
39
Q

What is the causative organism of glandular fever?

A

EBV (90%) also CMV

40
Q

What is infectious mononucleosis

A

Glandular fever - oropharyngeal secretions containing EBV infect lymphocytes –> inflammation

41
Q

What are the symptoms and signs of glandular fever?

A
  1. Sore throat –> Tonsilitis (can contain pus and have pruiritis on soft palate)
  2. Tender LNs
  3. Wide spread pruritic rash
  4. Weight loss and LoA
  5. Hepato/splenomegaly
42
Q

What is the treatment for glandular fever

A
  1. Supportive - fluids, analgesia
  2. Steroids - if obstruction
  3. Abx - amoxicillin if strep B infection
43
Q

What are the symptoms and signs of glandular fever?

A
  1. Sore throat –> Tonsilitis (can contain pus and have petechiae on soft palate)
  2. Tender LNs
  3. Wide spread pruritic rash
  4. Weight loss and LoA
  5. Hepato/splenomegaly
44
Q

What are the main complications of glandular fever?

A
  1. Splenic rupture - occurs in 50% of children with splenomegaly
  2. Post-viral tiredness
45
Q

What is the criteria for glandular fever

A

Clinical symptoms and:

  1. Lymphocytosis (80-90% of WBC)
  2. At least 10% atypical lymphocytes
  3. +ve serology
46
Q

What are the other investigative results of glandular fever

A
  1. Raised IgM and IgG
  2. Raised ALT/AST
  3. Thrombocytopeania (maybe)
47
Q

What is Kawasaki’s disease and how is it caused?

A

It is immune hyperactivity –> Systemic vasculitis –> coronary arteritis –> High risk of coronary aneurysms
- Polymorphism of IPTKC gene (chr.19) a -ve regulator of T-Cells

48
Q

Who does Kawasaki’s disease typically affect

A

Children < 5yo

49
Q

What is the acronym for remembering Kawasaki symptoms?

A

CLLEAR
Conjunctivitis
Lymphadenopathy
Lips - dry and cracked, strawberry tongue
Extremity changes - red fingers and toes –> peeling skin (desquamation)
Aneurysm
Rash - polymorphous starting at genitals

50
Q

What is the treatment for patients with Kawasaki’s disease

A
  1. High dose Aspirin (300mg)
  2. IV Immunogloubulins
    - give within 10 days of symptoms onset
51
Q

How long does the subacute phase of Kawasaki’s last and how does it present?

A
  1. Peeling of skin off hands and feet
  2. D, N+V
  3. Abdominal pain
  4. Joint and muscular pain
  5. Prolonged jaundice
  6. Headache
  7. Drosy and lethargic
  8. Pyuria
52
Q

What are the investigations to order and what are the findings?

A
  1. MSU - Pyuria and mononuclear cells with cytoplasmic inclusion
  2. Echo - detect any aneurysms
  3. Bloods - ^Neut, ^ESR, ^Platelets
53
Q

What are the investigative findings?

A
  1. Blood film - leucopenia and lymphopoenia

2. LFTs - raised AST/ALT

54
Q

What are the primary complications of Kawasaki’s? how would you manage this

A
  1. Coronary aneurysm –> death - manage with warfarin

2. Persistant fever - manage with inflixamab, steroids and cyclosporine

55
Q

What are the main complications of measles?

A
  1. OM (10%)

2. LRTI - pneumonia, bronchiolitis

56
Q

What are the signs of rubella?

What are the comps?

A

Rash appearing on face then spreads to whole body
Suboccipital lymphadenopathy

Comps - teratogenic

  1. Myocarditis
  2. Encephalitis
  3. Arthritis
  4. Thrombocytopoenia
57
Q

What are the signs of measles?

What are the comps?

A

Prodrome phase (@2-3d)

  • Fever, coryza, cough, conjunctivitis
  • Koplick spots (inside mouth)
Exanethamtous phase (@5-7d) 
- Maculopapular rash (blotchy and confluent) appears first behind ears then spreads to thorax

Comps - OM, LRTI (bronchiolitis, pneumonia)

58
Q

What are the signs of Mumps?

What are the complications?

A

Parotitis - swelling of parotid gland initially U/L then spreads B/L –> causes ear each when eating or opening mouth
Muscular pain
Malaise

comps - infertility

59
Q

What are the signs of Polio?

A

Headache, neck stifneess,
Left leg weakness –> paralysis and falls
No change in sensation
Loss of reflexes

60
Q

What are the signs of Tetanus?

A

Hyperextended neck
Overarching back
Flexed limbs
Appears to be smiling

61
Q

What are the signs of parvovirus B19?

A

Slapped cheek rash which eventually spreads to proximal arms and extensors
Fever, malaise

62
Q

What are the signs of coxsackie virus?

A

Hand, foot and mouth disease - vesicular lesions

Sore throat, fever

63
Q

What are the signs of scarlett fever?

A

Group B Streptoccous infection

  • Sore throat –> tonsilitis
  • Fever
  • Strawberry tongue
  • Punctate rash sparing the face
64
Q

Describe the clinical sequelae of HIV in children?

A

Initial (1-6 weeks post-exposure) - flu like symptoms

  1. Mild - Recurrent fever, parotitis, lymphadenopathy
  2. Moderate - Candiasis, recurrent infections (lung), chronic diarrhoea
  3. Severe - FTT, opportunistic infections, encephalopathy, malignancy
65
Q

How do you diagnose HIV

A
  1. Determine risk - African, IVDU, unprotected sex etc, breast feeding (from HIV patient)
  2. Illicit SPUR sx - severe, persistant, unusual, recurrent inf.
  3. Bloods
    - >18 mo - HIV Ab found in blood
    - < 18 mo - Maternal Ab may be found in blood
    +ve test only confirms exposure
    must do x2 HIV DNA PCR within 3 months to confirm Dx
    Or do after completion of anti-retroviral therapy
  4. Monitor CD4 count and viral load
66
Q

How do you treat HIV?

A
  1. HAART (highly active anti-retroviral therapy)
    - 2NNRTI, 1PI/1NRTI
  2. Supportive therapy and education
67
Q

What are the main complications of HIV?

A
  1. Opportunistic infections
  2. Encephalopathy
  3. Malignancy
  4. AIDS
68
Q

What are the two routes of HIV transmission?

A

Vertical - breastfeeding or birth

Horizontal - Blood products or sexual intercourse

69
Q

Define HIV?

A

Human immunodeficiency virus replication characterised by destruction of CD4+ T-cells

70
Q

What is the definition of SIRS?

A

Severe inflammatory response syndrome
- response to infection (bacterial, viral, fungal) or inflammatory process (e.g. burns, pancreatitis)

  • Temp < 36 or > 38.3
  • RR > 20
  • glucose > 7.7mmol/L
  • HR > 90
  • WCC < 4 or >12
71
Q

what is the definition of Sepsis

A

SIRS with known or presumed infection

  • BP < 90 or fall of > 40 mmHg from baseline
  • HR > 135
  • RR > 25
  • MAP < 65mmHg
  • V, P or U (AVPU)
72
Q

What is the definition of severe sepsis

A

sepsis with end organ damage or hypoperfusion

73
Q

What is the definition of septic shock?

A

Severe sepsis with persistently low blood pressure which has failed to respond to IV fluids

Paediatrics (10 decks)

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