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3a > Paediatrics: Infectious Disease > Flashcards

Paediatrics: Infectious Disease Flashcards

1
Q

What is Kawasaki disease? Key complication ?

A

systemic medium sized vessel vasculitis that can cause coronary artery aneurysms
(may be autoimmune)

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2
Q

what age children does Kawasaki disease typically affect ?

A

young children < 5 yr

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3
Q

what is another name for Kawasaki disease ?

A

mucocutaneous lymph node syndrome

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4
Q

What causes Kawasaki ?

A

no clear cause or trigger
(thought to be possible infective orgnasam but it is not contagious)

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5
Q

diagnostic symptoms criteria for Kawasaki disease ?

A

temp (>38) for 5 days or more PLUS one of:
- conjunctival infection in both eyes
- Changes to the mouth or throat
- Changes to the hands or feet
- Rash
- Cervical lymphadenopathy

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6
Q

Describe what the chains to the mouth and throat could be in Kawasaki disease ?

A
  • cracked lips
  • strawberry tongue (red tongue with large papillae)
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7
Q

describe the rash associated with Kawasaki disease ?

A

widespread erythematous rash

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8
Q

describe the changes to hands and feet in Kawasaki disease ?

A
  • swollen or painful hands
  • peeling (desquamation)
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9
Q

What investigations would you do in Kawasaki ? what might you find ?

A
  • FBC (anaemia, leukocytosis, thrombocytosis)
  • LFT
  • Raise inflam markers
  • Echo (to look for coronary artery pathology)
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10
Q

how many parts are there to Kawasaki disease course ? name em

A

3 stages
- acute phase
- sub-acute pahse
- convalescent phase

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11
Q

what happens in the acute phase of Kawasaki ? how long does it last

A

the child is most unwell
- fever, rash, lymphadenopathy
- last 1-2 weeks

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12
Q

what happens in the sub-acute phase of Kawasaki ? how long does it last

A

acute symptoms settle
- desquamation
- increase coronary artery aneurysm risk
- Last 2-4 weeks

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13
Q

what happens in the convalescent phase of Kawasaki ? how long does it last

A
  • remaining symptoms settle
  • Coronary aneurysms may regress
  • last 2-4 weeks
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14
Q

Kawasaki managent ?( 3) why each thing

A
  • high dose aspirin (reduce risk of thrombosis)
  • IVIG (reduce risk of coronary artery aneurysms)
  • Ongoing echo monitoring
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15
Q

aspiring is usually avoided in paediatrics ? why is this ?name a condition its used in ?

A

usually avoided due to risk of Reyes syndrome
- used in management of Kawasaki disease

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16
Q

what is exanthema ? how many viral ones are there generally in kids ?

A

it is an eruptive widespread rash
- 6 red rashes in children

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17
Q

What are the 6 red rashes in children ?

A
  • Measles
  • Scarlett fever
  • Rubella
  • Dukes disease
  • Parvovirus B19
  • Roseola infantum
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18
Q

What pathogen cause rubella ? type ?

A

rubella virus

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19
Q

How is rubella spread ?

A

highly contagious + spread by respiratory droplets

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20
Q

Rubella presentation ? (5)

A
  • Rash: erythematous macular rash
  • mild fever
  • joint pain
  • sore throat
  • lymphadenopathy
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21
Q

describe the rash in rubella ? where does it start ?

A

erythematous macular rash (milder than measles tho)
spotty rash that starts on the face or behind the ears and spreads to the neck and body

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22
Q

rubella management ? (2)

A
  • supportive + condition is self-limiting
  • public health: notifiable disease
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23
Q

lifestyle advice for rubella management ? (2)

A
  • Stay off school for >5 days since rash appears
  • Avoid pregnancy women
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24
Q

rubella complications ?

A

(rare)
- Thombocytopenia, encephalitis

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25
Q

rubella complication in pregnancy ? presentation ?

A

congenital rubella syndrome
- Triad: deafness, blindness, CHD

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26
Q

What pathogen causes measles ? pathogen type ?

A

cause by measles virus
- RNA virus

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27
Q

describe the infectivity of measles ? how spread ?

A

highly contagious spread by respiratory droplets
- Resp viral infection

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28
Q

Measles presentation ?

A
  • Rash
  • Kolpick spots
  • Fever
  • Coryzal symptoms + cough
  • Conjunctivitis
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29
Q

patient presents with greyish white spots on buccal mucosa. What are these called ? which disease have they got ?

A

Kolpik spots
- Pathognomic for measles

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30
Q

Describe the rash associated with measles ? distribution ?

A

erythematous macula-papular rash
- start on the face (behind the ears) and spread to rest of body
(similar to rubella one)

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31
Q

what investigaitons would you do for measles ?

A

serology: measles specific IgM/IgG serology

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32
Q

measles management (3)

A

self resolving (7-10 days)
- supportive management
- Public health: notifiable disease
- Children should isolate till 4 days after symptoms resolve

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33
Q

when is a Px with measles infectious ?

A

infectious while symptomatic till 4 days after

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34
Q

complications of measles ? (4)

A
  • Pneumonia
  • Diarrhoea + dehydration
  • Encephalitis + meningitis
  • Hearing + vision loss
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35
Q

what has made measles prevalence decrease a lot ?

A

MMR vaccine used to prevent measles

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36
Q

What is chicken pox ? caused by ? what pathogen ?

A

it is caused by the varicella zoster virus (VZV)

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37
Q

how long does chicken pox immunity last ?

A

life long

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38
Q

describe the infectivity of chicken pox ? how spread ?

A
  • highly contagious
  • Spread by direct contact or droplet (cough, sneeze)
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39
Q

chicken pox presentation ? (4)

A
  • Rash
  • Fever
  • Itch
  • Generalised fatigue + malaise
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40
Q

describe the rash in chicken pox ? distribution ? development ?

A

widespread erythematous raised vesicular (fluid filled) blistering lesions
- Starts on trunk/face and spread outward affecting whole body
- eventually they scab over + stop being contagious

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41
Q

chicken pox complications ? (4)

A
  • dehydration
  • conjunctivitis
  • pneumonia
  • meningitis
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42
Q

who is chicken pox reactivated ? describe ? what is this called ?

A

after infection the virus can lie dormant in sensory dorsal root ganglion cells + cranial nerves which reactivate later as shingles or ramsy-hunt syndrome

43
Q

chicken pox management ? lifestyle ?

A

usually mild + self-limiting
- Aciclovir may be considered in adults (or >14), neonates
- patients kept off school + avoid pregnant women

44
Q

What are the main types of intracranial infection ? (4)

A
  • Meningitis
  • Extradural abscess
  • Subdural empyema
  • Cerebral infections (cerebral abscess, encephalitis)
45
Q

what are the main routes of spread to cause intracranial infection ? (3)

A
  • Haematogenous (via choroid plexus)
  • direct extension from adjacent tissues
  • inoculation from interventional procedures
46
Q

why is it bad once a pathogen gets passed the BBB ?

A

once pathogen has entered, due to limited infiltration of peripheral immune cells by BBB => rapid progress + spread of pathogen

47
Q

What is meningitis ? usually due to what ?

A

it is inflammation of th meninges (lignin of brain + spinal cord) usually due to viral or bacterial infection

48
Q

what is meningococcal septicaemia ?

A

septic infection due to Meisserea meningitides infection
- causes non=blanching rash (indicates DIC)

49
Q

which pathogens usually responsible for bacterial meningitis ? (2) in neonates ? (1)

A
  • N. Meningitidis
  • Strep pneumonia
  • GBS (from mothers vagina)
50
Q

symptoms of bacterial meningitis ? neonates ?

A
  • Fever
  • Neck stiffness
  • Vomiting
  • Photophobia
  • Altered consciousness
  • Seizures
    neonates
  • hypotonia, poor feeding, lethargy, bulging fontanelle
51
Q

investigations for suspected bacterial meningitis ? (4)

A
  • LP
  • FBC
  • Kernigs test
  • Brudzinskis test
52
Q

bacterial meningitis management ? in community (1) ? in hospital (3)?

A

medical emergency
- community (GP): urges IM or IV benzylpenecillin
- Hospital: blood culture + LP, Abx, dexamethosone
- notify public health

53
Q

what is the dexamethosome for in bacterial meningitis management ?

A

prevent hearing loss + hear damage

54
Q

causes of viral meningitis ? (3)

A

HSV
enterovirus
VZV

55
Q

which is worse - viral or bacterial meningitis ?

A

viral not as severe: usually only requires supportive treatment + maybe acyclovir

56
Q

complications of meningitis ?

A
  • hearing loss
  • Seizures + epilepsy
  • cognitive impariment
  • CP
57
Q

CSF with bacterial infection: describe the: appearance? protein? glucose? WCC (+which one in particular)? culture?

A

appearance: cloudy
protein: high
glucose: low
WCC: high (neutrophils)
culture: positive (bacteria)

bacteria will release protein and use of the glucose and immune system release neutrophils in response to bacteria

58
Q

CSF with viralinfection: describe the: appearance? protein? glucose? WCC (+which one in particular)? culture?

A

appearance: clear
protein: small raise or normal
glucose: normal
WCC: high (lymphocytes)
culture: negative

viruses don’t use glucose but may release a small amount of protein

59
Q

What is encephalitis ? as result of what ?

A

It is inflam of the brain as a result of infection or non infective (autoimmune)

60
Q

name infective causes of paediatric encephalitis ?

A

usually viral
- HSV (type 1 in children from cold sores, type 2 in neonates from genital herpes)

61
Q

encephalitis presentation ? (5)

A
  • altered consciousness
  • Unusual behaviour
  • Focal symptoms
  • Focal seizures
  • Fever
62
Q

what additional test is recommended for all patients with encephalitis ?

A

HIV testing

63
Q

how is encephalitis diagnosed ?

A

LP (CSF for PCR testing)h

64
Q

how is encephalitis mangmented ?

A

usually viral
- IV antiviral: acyclovir

65
Q

encephalitis complications ? (4)

A
  • losing fatigue
  • Change in personality
  • Change in memory + cognition
  • Leraning difficulties
66
Q

What is staphylococcal scalded skin syndrome ? caused by what ? be specific

A

caused by a type of s.aureus that produces epidermolytic toxins

67
Q

describe SSSS pathophys

A

staphylococcal scalded skin syndrome
- s.aureus toxins are protease enzymes that breakdown the proteins that hold skin together => skin damage + breakdown

68
Q

staphylococcal scalded skin syndrome presentation ? (4) describe how it changes? age ?

A

<5 yrs
- generalised patches of erythema
- skin look thin + wrinkled => then progress to fluid filled blisters => burst + leave sore erythematous kin behind (looks like a scold)
- systemic symptoms: fever, irritability, lethargy, dehydration, sepsis

69
Q

staphylococcal scalded skin syndrome managmetn ?

A

admission + treatment with IV Abx (flucloxacillin) (due to sepsis risk)
- prone to dehydration due to scolds so monitor fluid + electrolytes

70
Q

what is hand foot and mouth disease ? what is the causative organism ? type ?

A

disease caused by cosackie A virus

71
Q

hand foot and mouth Px ? (2)

A
  • typical viral URTI 9sore throat, dry cough, high temp)
  • then small mouth ulcers + red spots across body (mainly hand, feet, around mouth)
72
Q

hand foot and mouth Mx ?

A

Dx made OE (appearance of rash)
- supportive
- adequate fluid intake

73
Q

describe the vertical trasmsionn of HIV ? (3)

A

can be transited during birth, pregnancy or breastfeeding
( also unprotected sex, open mucous membranes, blood, wound)

74
Q

How to prevent HIV transmission in birth ? (4) depends on what ?

A

depends on viral load
- normal vaginal del <50
- CS >50
- IV zidovudine + CS (>1000)

prophysoacit zidovudine to baby

75
Q

breastfeeding in HIV Mx ?

A

advised not to

76
Q

describe the testing for HIV in babies ? who would you test ? (3)

A

test babies of HIV parents, when immodefieicy suspected, young sexually active
- babies: HIV viral load (3 months), HIV antibody (24 months)

77
Q

HIV treatment ?

A

aim to achieve normal CD4 count
- antiretroviral (ART), avoid live vaccines (if immunocompromised)

78
Q

what is listeria ? describe ? can cause what ?

A

gram +ve bacteria that causes listeriosis (much more common during pregnancy)

79
Q

listeria presentation during pregnancy ? (4)

A

asymptomattic
- flu like illness
- pneumonia
- meningoencephalitis

80
Q

complications of listeria during pregnancy ? (3)

A
  • miscarriage
  • fetal death
  • severe neonatal infection
81
Q

how is listeria transmitted ?

A

unpasteurised diary products
- processed meats
(avoid blue cheese)

82
Q

What is Scarlett fever ? infective organism ? describe

A

associated with GAS (usually tonsillitis), not viral
- stop pyogenes (GAS) produces endotoxin

83
Q

Scarlett fever characterised by ? (3) Px ?

A

characterised by red-pink blotchy, macular rash, with rough sand paper skin
- fever, lethargy, flushed face, sore throat
- strawberry tongue
- cervica lymphadenopathy

84
Q

Scarlett fever Mx ? (2) school rules ?

A
  • Abx (phenoxymethylpenicillin) for 10 days
  • notifiable disease
  • keep of school until 24 hrs after starting Abx
85
Q

conditions associated with Scarlett fever ? (3)

A
  • tonsilitis
  • post-strep glomerulonephritis
  • acute rheumatic fever
86
Q

What is polio ? caused by ?

A

illness caused by poliovirus that affects nerves in spinal cor + brain stem

87
Q

polio presentaiton ? different types

A
  • mostly asymptomatic
  • flu like: fever, headache, muscle aches, sore throats, N&V, anorexia
  • paralytic polio
  • post polio syndrome
88
Q

symptoms of paralytic polio ?

A
  • intense pain
  • sensitivity to touch
  • muscle spasms
  • paralysis of msucles involved in breathing
89
Q

symtoms of post polio syndrome ?

A
  • progressive muscle weakness
  • fatigue
  • breathing problems
90
Q

when is polio vaccine given ? how many ?

A

5 times
- 6-in-1: 8,12,16 weeks
- 4-in-1: 3 yrs 4 months
- 3-in-1: teenage

91
Q

polio Dx ?

A

stool sample

92
Q

polio Mx ?

A

symptomatic

93
Q

what is slapped cheek syndrome also known as ? (3)

A
  • parvovirus B19
  • fifth disease
  • erythema infectiousum
94
Q

parvovirus B19 disease cause?

A

self limiting
- rash + sx fade over 1-2 weeks

95
Q

parvovirus B19 Px ? describe rash

A

non-specific viral sx => rash appear (Diffuse bright red rash on both cheeks “slapped cheeks” => milder rash affecting trunk + limbs (slightly itchy)

96
Q

describe the infectivity of parvovirus ? when ?

A

infectious 7-10 days prior to rash (not infectious once rash appears)

97
Q

complications of parvovirus during pregnancy ? (4) when worst ?

A

(1st, 2nd trimester)
- miscarriage or fetal death
- severe fetal anaemia
- hydros fettles (fetal HF)
- maternal preeclampsia like syndrome

98
Q

what Ix for parvovirus during pregnancy ? (3)

A
  • IgM (acute, in the last 4 weeks)
  • IgG (long term immunity)
  • Rubella Ab (differential)
99
Q

parvovirus Mx during pregnancy ? (2)

A
  • supportive
  • referral to feat medicine
100
Q

Fetal complications of parvovirus B19 ? (3)

A
  • aplastic anaemia
  • encephalitis
  • meningitis
101
Q

what is molluscum contagiosum ? causative organism ? peak incidence ?

A

common skin infection caused by molluscum contagiosum virus (MCV)
- peak incidence: 1-4 yrs

102
Q

How is molluscum contagiosum transmitted ?

A

close personal contract
fomites (towels)

103
Q

molluscum contagiosum Px ?

A

pinkish/pearly white papules
- appears in clusters

104
Q

molluscum contagiosum Mx ?

A

self limiting (resolution <18 months)
- encourage to not scratch
- clean towels (/other fomites)

3a (43 decks)

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