Paediatrics: Infectious Disease Flashcards
What is Kawasaki disease? Key complication ?
systemic medium sized vessel vasculitis that can cause coronary artery aneurysms
(may be autoimmune)
what age children does Kawasaki disease typically affect ?
young children < 5 yr
what is another name for Kawasaki disease ?
mucocutaneous lymph node syndrome
What causes Kawasaki ?
no clear cause or trigger
(thought to be possible infective orgnasam but it is not contagious)
diagnostic symptoms criteria for Kawasaki disease ?
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
Describe what the chains to the mouth and throat could be in Kawasaki disease ?
- cracked lips
- strawberry tongue (red tongue with large papillae)
describe the rash associated with Kawasaki disease ?
widespread erythematous rash
describe the changes to hands and feet in Kawasaki disease ?
- swollen or painful hands
- peeling (desquamation)
What investigations would you do in Kawasaki ? what might you find ?
- FBC (anaemia, leukocytosis, thrombocytosis)
- LFT
- Raise inflam markers
- Echo (to look for coronary artery pathology)
how many parts are there to Kawasaki disease course ? name em
3 stages
- acute phase
- sub-acute pahse
- convalescent phase
what happens in the acute phase of Kawasaki ? how long does it last
the child is most unwell
- fever, rash, lymphadenopathy
- last 1-2 weeks
what happens in the sub-acute phase of Kawasaki ? how long does it last
acute symptoms settle
- desquamation
- increase coronary artery aneurysm risk
- Last 2-4 weeks
what happens in the convalescent phase of Kawasaki ? how long does it last
- remaining symptoms settle
- Coronary aneurysms may regress
- last 2-4 weeks
Kawasaki managent ?( 3) why each thing
- high dose aspirin (reduce risk of thrombosis)
- IVIG (reduce risk of coronary artery aneurysms)
- Ongoing echo monitoring
aspiring is usually avoided in paediatrics ? why is this ?name a condition its used in ?
usually avoided due to risk of Reyes syndrome
- used in management of Kawasaki disease
what is exanthema ? how many viral ones are there generally in kids ?
it is an eruptive widespread rash
- 6 red rashes in children
What are the 6 red rashes in children ?
- Measles
- Scarlett fever
- Rubella
- Dukes disease
- Parvovirus B19
- Roseola infantum
What pathogen cause rubella ? type ?
rubella virus
How is rubella spread ?
highly contagious + spread by respiratory droplets
Rubella presentation ? (5)
- Rash: erythematous macular rash
- mild fever
- joint pain
- sore throat
- lymphadenopathy
describe the rash in rubella ? where does it start ?
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
rubella management ? (2)
- supportive + condition is self-limiting
- public health: notifiable disease
lifestyle advice for rubella management ? (2)
- Stay off school for >5 days since rash appears
- Avoid pregnancy women
rubella complications ?
(rare)
- Thombocytopenia, encephalitis
rubella complication in pregnancy ? presentation ?
congenital rubella syndrome
- Triad: deafness, blindness, CHD
What pathogen causes measles ? pathogen type ?
cause by measles virus
- RNA virus
describe the infectivity of measles ? how spread ?
highly contagious spread by respiratory droplets
- Resp viral infection
Measles presentation ?
- Rash
- Kolpick spots
- Fever
- Coryzal symptoms + cough
- Conjunctivitis
patient presents with greyish white spots on buccal mucosa. What are these called ? which disease have they got ?
Kolpik spots
- Pathognomic for measles
Describe the rash associated with measles ? distribution ?
erythematous macula-papular rash
- start on the face (behind the ears) and spread to rest of body
(similar to rubella one)
what investigaitons would you do for measles ?
serology: measles specific IgM/IgG serology
measles management (3)
self resolving (7-10 days)
- supportive management
- Public health: notifiable disease
- Children should isolate till 4 days after symptoms resolve
when is a Px with measles infectious ?
infectious while symptomatic till 4 days after
complications of measles ? (4)
- Pneumonia
- Diarrhoea + dehydration
- Encephalitis + meningitis
- Hearing + vision loss
what has made measles prevalence decrease a lot ?
MMR vaccine used to prevent measles
What is chicken pox ? caused by ? what pathogen ?
it is caused by the varicella zoster virus (VZV)
how long does chicken pox immunity last ?
life long
describe the infectivity of chicken pox ? how spread ?
- highly contagious
- Spread by direct contact or droplet (cough, sneeze)
chicken pox presentation ? (4)
- Rash
- Fever
- Itch
- Generalised fatigue + malaise
describe the rash in chicken pox ? distribution ? development ?
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
chicken pox complications ? (4)
- dehydration
- conjunctivitis
- pneumonia
- meningitis
who is chicken pox reactivated ? describe ? what is this called ?
after infection the virus can lie dormant in sensory dorsal root ganglion cells + cranial nerves which reactivate later as shingles or ramsy-hunt syndrome
chicken pox management ? lifestyle ?
usually mild + self-limiting
- Aciclovir may be considered in adults (or >14), neonates
- patients kept off school + avoid pregnant women
What are the main types of intracranial infection ? (4)
- Meningitis
- Extradural abscess
- Subdural empyema
- Cerebral infections (cerebral abscess, encephalitis)
what are the main routes of spread to cause intracranial infection ? (3)
- Haematogenous (via choroid plexus)
- direct extension from adjacent tissues
- inoculation from interventional procedures
why is it bad once a pathogen gets passed the BBB ?
once pathogen has entered, due to limited infiltration of peripheral immune cells by BBB => rapid progress + spread of pathogen
What is meningitis ? usually due to what ?
it is inflammation of th meninges (lignin of brain + spinal cord) usually due to viral or bacterial infection
what is meningococcal septicaemia ?
septic infection due to Meisserea meningitides infection
- causes non=blanching rash (indicates DIC)
which pathogens usually responsible for bacterial meningitis ? (2) in neonates ? (1)
- N. Meningitidis
- Strep pneumonia
- GBS (from mothers vagina)
symptoms of bacterial meningitis ? neonates ?
- Fever
- Neck stiffness
- Vomiting
- Photophobia
- Altered consciousness
- Seizures
neonates - hypotonia, poor feeding, lethargy, bulging fontanelle
investigations for suspected bacterial meningitis ? (4)
- LP
- FBC
- Kernigs test
- Brudzinskis test
bacterial meningitis management ? in community (1) ? in hospital (3)?
medical emergency
- community (GP): urges IM or IV benzylpenecillin
- Hospital: blood culture + LP, Abx, dexamethosone
- notify public health
what is the dexamethosome for in bacterial meningitis management ?
prevent hearing loss + hear damage
causes of viral meningitis ? (3)
HSV
enterovirus
VZV
which is worse - viral or bacterial meningitis ?
viral not as severe: usually only requires supportive treatment + maybe acyclovir
complications of meningitis ?
- hearing loss
- Seizures + epilepsy
- cognitive impariment
- CP
CSF with bacterial infection: describe the: appearance? protein? glucose? WCC (+which one in particular)? culture?
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
CSF with viralinfection: describe the: appearance? protein? glucose? WCC (+which one in particular)? culture?
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
What is encephalitis ? as result of what ?
It is inflam of the brain as a result of infection or non infective (autoimmune)
name infective causes of paediatric encephalitis ?
usually viral
- HSV (type 1 in children from cold sores, type 2 in neonates from genital herpes)
encephalitis presentation ? (5)
- altered consciousness
- Unusual behaviour
- Focal symptoms
- Focal seizures
- Fever
what additional test is recommended for all patients with encephalitis ?
HIV testing
how is encephalitis diagnosed ?
LP (CSF for PCR testing)h
how is encephalitis mangmented ?
usually viral
- IV antiviral: acyclovir
encephalitis complications ? (4)
- losing fatigue
- Change in personality
- Change in memory + cognition
- Leraning difficulties
What is staphylococcal scalded skin syndrome ? caused by what ? be specific
caused by a type of s.aureus that produces epidermolytic toxins
describe SSSS pathophys
staphylococcal scalded skin syndrome
- s.aureus toxins are protease enzymes that breakdown the proteins that hold skin together => skin damage + breakdown
staphylococcal scalded skin syndrome presentation ? (4) describe how it changes? age ?
<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
staphylococcal scalded skin syndrome managmetn ?
admission + treatment with IV Abx (flucloxacillin) (due to sepsis risk)
- prone to dehydration due to scolds so monitor fluid + electrolytes
what is hand foot and mouth disease ? what is the causative organism ? type ?
disease caused by cosackie A virus
hand foot and mouth Px ? (2)
- typical viral URTI 9sore throat, dry cough, high temp)
- then small mouth ulcers + red spots across body (mainly hand, feet, around mouth)
hand foot and mouth Mx ?
Dx made OE (appearance of rash)
- supportive
- adequate fluid intake
describe the vertical trasmsionn of HIV ? (3)
can be transited during birth, pregnancy or breastfeeding
( also unprotected sex, open mucous membranes, blood, wound)
How to prevent HIV transmission in birth ? (4) depends on what ?
depends on viral load
- normal vaginal del <50
- CS >50
- IV zidovudine + CS (>1000)
prophysoacit zidovudine to baby
breastfeeding in HIV Mx ?
advised not to
describe the testing for HIV in babies ? who would you test ? (3)
test babies of HIV parents, when immodefieicy suspected, young sexually active
- babies: HIV viral load (3 months), HIV antibody (24 months)
HIV treatment ?
aim to achieve normal CD4 count
- antiretroviral (ART), avoid live vaccines (if immunocompromised)
what is listeria ? describe ? can cause what ?
gram +ve bacteria that causes listeriosis (much more common during pregnancy)
listeria presentation during pregnancy ? (4)
asymptomattic
- flu like illness
- pneumonia
- meningoencephalitis
complications of listeria during pregnancy ? (3)
- miscarriage
- fetal death
- severe neonatal infection
how is listeria transmitted ?
unpasteurised diary products
- processed meats
(avoid blue cheese)
What is Scarlett fever ? infective organism ? describe
associated with GAS (usually tonsillitis), not viral
- stop pyogenes (GAS) produces endotoxin
Scarlett fever characterised by ? (3) Px ?
characterised by red-pink blotchy, macular rash, with rough sand paper skin
- fever, lethargy, flushed face, sore throat
- strawberry tongue
- cervica lymphadenopathy
Scarlett fever Mx ? (2) school rules ?
- Abx (phenoxymethylpenicillin) for 10 days
- notifiable disease
- keep of school until 24 hrs after starting Abx
conditions associated with Scarlett fever ? (3)
- tonsilitis
- post-strep glomerulonephritis
- acute rheumatic fever
What is polio ? caused by ?
illness caused by poliovirus that affects nerves in spinal cor + brain stem
polio presentaiton ? different types
- mostly asymptomatic
- flu like: fever, headache, muscle aches, sore throats, N&V, anorexia
- paralytic polio
- post polio syndrome
symptoms of paralytic polio ?
- intense pain
- sensitivity to touch
- muscle spasms
- paralysis of msucles involved in breathing
symtoms of post polio syndrome ?
- progressive muscle weakness
- fatigue
- breathing problems
when is polio vaccine given ? how many ?
5 times
- 6-in-1: 8,12,16 weeks
- 4-in-1: 3 yrs 4 months
- 3-in-1: teenage
polio Dx ?
stool sample
polio Mx ?
symptomatic
what is slapped cheek syndrome also known as ? (3)
- parvovirus B19
- fifth disease
- erythema infectiousum
parvovirus B19 disease cause?
self limiting
- rash + sx fade over 1-2 weeks
parvovirus B19 Px ? describe rash
non-specific viral sx => rash appear (Diffuse bright red rash on both cheeks “slapped cheeks” => milder rash affecting trunk + limbs (slightly itchy)
describe the infectivity of parvovirus ? when ?
infectious 7-10 days prior to rash (not infectious once rash appears)
complications of parvovirus during pregnancy ? (4) when worst ?
(1st, 2nd trimester)
- miscarriage or fetal death
- severe fetal anaemia
- hydros fettles (fetal HF)
- maternal preeclampsia like syndrome
what Ix for parvovirus during pregnancy ? (3)
- IgM (acute, in the last 4 weeks)
- IgG (long term immunity)
- Rubella Ab (differential)
parvovirus Mx during pregnancy ? (2)
- supportive
- referral to feat medicine
Fetal complications of parvovirus B19 ? (3)
- aplastic anaemia
- encephalitis
- meningitis
what is molluscum contagiosum ? causative organism ? peak incidence ?
common skin infection caused by molluscum contagiosum virus (MCV)
- peak incidence: 1-4 yrs
How is molluscum contagiosum transmitted ?
close personal contract
fomites (towels)
molluscum contagiosum Px ?
pinkish/pearly white papules
- appears in clusters
molluscum contagiosum Mx ?
self limiting (resolution <18 months)
- encourage to not scratch
- clean towels (/other fomites)
