Paediatrics - infectious disease and ENT Flashcards
what are examples of inactivated vaccines
polio
flu vaccine
hepatitis A
rabies
what are examples of subunit and conjugate vaccines
pneumococcus
meningococcus
hepatitis B
pertussis
haemophilus influenza type B
HPV
shingles
what are examples of live attenuated vaccines
MMR
BCG
chicken pox
nasal influenza
rotavirus
what are examples of toxin vaccines
diphtheria
tetanus
what vaccines would a 8 week old receive
6 on 1 vaccine (diphtheria, tetanus, pertussis, polio, Hib and hepatitis B)
meningococcal type B
rotavirus (oral vaccine)
what vaccines would a 12 week old receive
6 in 1
pneumococcal - 13 different serotypes
rotavirus
what vaccines would a 16 week old receive
6 in 1
meningococcal type B
what vaccinations would a 1 year old receive
2 in 1 (haemophilus influenza type B and meningococcal type C)
pneumococcal
MMR vaccine
meningococcal type B
what vaccination will a child receive yearly between the ages of 2-8
influenza vaccine
what vaccine will a child receive at 3 years and 4 months
4 in 1 (diphtheria, tetanus, pertussis , polio)
MMR vaccine
what vaccine will a child receive between 12-13 years
the HPV vaccine - 2 doses given 6 to 24 months apart
what vaccines would a 14 year old receive
3 in 1 (tetanus, diphtheria, polio)
meningococcal groups A, C, W and Y
what is the current NHS HPV vaccine
Gardasil - protects against strains 6, 11, 16 and 18
what is kawasaki disease
systemic vasculitis which mainly affects infants and young children
what are infective causes of prolonged fever
localised infection
bacterial infections
deep abscesses
infective endocarditis
tuberculosis
non tuberculosis mycobacterial infections
viral infections
parasitic infections
what are non infective causes of prolonged fever
systemic juvenile idiopathic arthritis
systemic lupus erythematosus
vasculitis
inflammatory bowel disease
sarcoidosis
malignancy
macrophage activation syndromes
drug fever
fabricated or induced illness
what age does kawasaki disease normally present
6 months to 4 years old
what is the cause of kawasaki disease
exact cause is unknown, although it is likely to be a result of immune hyperreactivity to a variety of triggers in a genetically susceptible host
how is kawasaki disease diagnosed
no diagnostic test - diagnosis made on the clinical findings
what are features of kawasaki disease
fever for over 5 days and four other features of:
- non purulent conjunctivitis
- red mucous membranes
- cervical lymphadenopathy
- rash
- red oedematous palms and soles or peeling of the fingers and toes
how many children with kawasaki will have coronary artery involvement
in about 1/3 of children within the first 6 weeks of illness
what is the treatment of Kawasaki disease
prompt treatment with intravenous immunoglobulins within the first 10 days
aspirin used to reduce the risk of thrombosis
echocardiogram at 6 weeks
children with giant coronary artery aneurysms may require long term warfarin therapy and close follow up
persistent inflammation and fever may require treatment with infliximab, steroids or ciclosporin
what are complications of kawasaki disease
coronary artery aneurysm
sudden death
what are clinical features of measles
fever
cough
runny nose
conjunctivitis
marked malaise
koplik spots - white spots on the buccal mucosa
maculopapular rash initially and then becomes blotchy and confluent
where does the rash in measles start
starts on the face
how long is someone with measles infectious for
4 days before and 4 days after the onset of the rash
how is measles diagnosed
clinical
blood film - leukopenia and lymphopenia
LFTs - raised transaminases
oral fluid test: measles RNA on oral fluid specimen confirms the diagnosis
serum serology
what is the management of measles
acute treatment: generally supportive but can include antibiotics for secondary bacterial infection
prevention: MMR
vitamin A
what are complications of measles
acute otitis media
lower respiratory tract infection
encephalitis
subcutaneous sclerosing panencephalitis
what is subcutaneous sclerosing panencephalitis
it is a rare and fatal neurological disease with progressive intellectual deterioration, ataxia and seizures about 7 years after measles infection
what age does chicken pox tend to occur between
1 and 6 years
when is the maximal transmission of chicken pox
between winter and spring
what are signs and symptoms of chicken pox
rash; usually starts on the head and trunk and then the rest of the body
lesions start as red macules and then progress through stages: papule, vesicle, pustule and crusting
headache
anorexia
signs of upper respiratory tract infection
fever
itching
what is the infectious period for chicken pox
starts 2 days before the vesicles appear and end when the last vesicle crusts over
how is chicken pox diagnosed
clinical - characteristic rash
other: serology, electron microscopy of vesicle fluid
how is chicken pox managed
symptoms: treat fever and itching
school exclusion: 5 days from the stark of skin eruption
antivirals can be used in severe vzv infection, encephalitis, pneumonia, babies and immunosuppressed patients
VZIG can be used as prophylaxis
immunisation (non currently part of vaccination schedule)
what are complications of chicken pox
secondary bacterial infection with group A strep can lead to necrotising fasciitis or toxic shock
purpura fulminans
cerebrovascular stroke
encephalitis
what are the signs and symptoms of rubella
prodrome: child may have mild illness with a low grade fever
maculopapular rash which starts on the face and then spreads to cover the whole body
suboccipital and post auricular lymphadenopathy
sore throat
runny nose
headache
joint pain
malaise
pink eye
how is rubella diagnosed
serology - risk if non immune pregnant women is exposed
clinical features
what is the management of rubella
supportive treatment - paracetamol or ibuprofen
prevention: MMR vaccine
how is rubella spread
droplet infection or direct contact
how long are you infectious with rubella for
about a week before and a week after the rash appears
what are the symptoms of congenital rubella
vision loss - cataracts and glaucoma
hearing loss
heart defects
neurological affects - microcephaly, inflammation, learning and behavioural difficulties
bone disease
thrombocytopenia, anaemia
thyroid disease
hepatosplenomegaly
type 1 diabetes
what are the symptoms of diphtheria
thick grey membrane covering the throat and tonsils
sore throat and hoarseness
swollen glands in the neck
difficulty breathing or rapid breathing
nasal discharge
fever and chills
tiredness
what is cutaneous diphtheria
it is a second type of diphtheria which affects the skin, causing pain, redness and swelling
may also present with ulcers covered by a grey membrane
what is the cause of diphtheria
it is caused by the bacterium Corynebacterium diphtheriae which multiples on or near the surface of the throat or skin
how is diphtheria spread
airborne droplets
contaminated personal or household items
what are risk factors for developing diphtheria
children and adults without up to date vaccines
people living in crowded or unsanitary conditions
anyone who travels to an area where diphtheria infections are more common
what are complications of diphtheria
breathing problems
heart damage - myocarditis
nerve damage - caused by toxin leading to difficulty swallowing and weakness in the arms and legs
how is diphtheria diagnosed
clinical examination
culture and microscopy
tissue biopsy
what is the treatment of diphtheria
treat first if you suspect before you know diagnosis
antibiotics - penicillin, erythromycin
antitoxin - to counteract diphtheria toxin
supportive therapy
to those exposed - prophylaxis and a booster vaccine
what is scalded skin syndrome
it is a rare, severe, superficial blistering skin disorder characterised by the detachment of the epidermis
what causes scalded skin syndrome
it is caused by exotoxin release from specific strains of staphylococcus aureus bacteria
what age group is scalded skin syndrome most common in
in children younger than 5, peak age being between 2-3 years old
why is scalded skin syndrome most common in children under 5
thought to be due to an immature:
immune system
renal clearance
what causes scalded skin syndrome
toxigenic staphylococcus aureus - releases exfoliative toxins A and B
these toxins bind to a specific desmosome present in the epidermis known as desmoglein-1 and breaks it down, leading to skin cells becoming loose and unstuck
what are the clinical features of scalded skin syndrome
starts with nonspecific symptoms in children: irritability, lethargy, fever
within 24-48 hours there is a painful widespread red rash on the skin followed by large, fragile fluid filled blister
where does the rash in scalding skin syndrome start
starts on the face and the flexural regions (groin, axilla, neck) and then spreads rapidly to other parts of the body including the arms, legs and trunk
where do you find the large fluid filled blisters in scalding skin syndrome
frequently found in areas of friction such as the axillae, groin and buttocks as well as the centre of the face and body orifices
what are complications of scalding skin syndrome
scarring
loss of bodily fluids and salts leading to dehydration and electrolyte imbalance
hypothermia
secondary infections
renal failure
how is scalding skin syndrome diagnosed
skin swabs
blood cultures
Tzanck smear
skin biopsy
what is the treatment for scalding skin syndrome
IV antibiotics: flucloxacillin
other options are ceftriaxone, clarithromycin, cealozin
for MRSA infection use vancomycin
pain relief
monitoring and maintaining fluid intake
skincare : gentle washing, emollients
what bacteria causes pertussis
Bordetella pertussis
how is pertussis transmitted
via respiratory secretions generated by coughing or sneezing or via objects contaminated with respiratory secretions
what is the incubation period of pertussis/whooping cough
approximately 7-10 days
what are complications of pertussis
apnoea
pneumonia
seizures
cerebral hypoxia
encephalopathy
otitis media
subconjunctival haemorrhage
epistaxis
ulceration of tongue and surrounding area
unilateral hearing loss (rare)
pneumothorax
umbilical and inguinal hernias
rib fracture
severe dehydration
malnutrition
what are the three phases of whooping cough symptoms
catarrhal
paroxysmal
convalescent
what is the catarrhal phase of whooping cough
begins 7-10 days after exposure and lasts 1-2 weeks
rhinorrhoea
malaise
mild cough
sore throat
conjunctivitis
what is the paroxysmal phase of whooping cough
lasts 1-6 weeks but can last up to 10
characterised by rapid violent and uncontrolled coughing fits
short expiratory burst followed by an inspiratory gasp (whoop)
occur frequently at night
may be triggered by external stimuli
associated with post-tussive vomiting
can cause cyanosis
what is the convalescent phase of whooping cough
usually lasts 2-3 weeks
gradual improvement in cough frequency
paroxysms can recur
what is the most infectious phase of whooping cough
the catarrhal phase
how do you diagnose whooping cough
examination and clinical findings
laboratory tests: culture, PCR, serological testing or oral fluid testing
how is whooping cough managed
need to notify public health england
if admission not necessary and onset of cough is within the last 14 days prescribe azithromycin or clarithromycin
if macrolides contraindicated prescribe co-trimoxazole
analgesia
adequate fluid intake
stay off from school until they have completed 48hrs of antibiotics
hospitalisation if there are significant breathing difficulties
what are the different kinds of polio infection
abortive polio
nonparalytic polio
paralytic polio
post polio syndrome
what are symptoms of abortive polio
mild flu like illness that lasts 2-3 days
fever
headache
muscle aches
sore throat
stomach ache
loss of appetite
nausea
vomiting
what are symptoms of non paralytic polio
more severe form
more severe flu like symptoms
neck pain and stiffness
aches and stiffness in the arms or legs
severe headache
decreased reflexes
muscle weakness
what is paralytic polio
begins more like non paralytic and then progresses:
intense pain
extreme sensitivity to touch
tingling or pricking sensations
muscle spasms or twitching
muscle weakness progressing to paralysis
can have paralysis in the breathing muscles
difficulty swallowing
what are symptoms of post polio syndrome
new signs or symptoms or progression which normally happens decades after having polio
- progressive muscle or joint weakness or pain
- fatigue
- muscle wasting
- breathing or swallowing issues
- sleep related breathing disorders
- lowered tolerance of cold temperatures
what is the cause of polio
caused by poliovirus which targets nerve cells mainly in the spinal cord and brain stem
naturally occurring poliovirus (wild type) has been eliminated in most countries, where as vaccine derived poliovirus is more widespread
how did vaccine derived poliovirus develop
due to communities or regions where not enough people are vaccinated, the weakened virus in the oral vaccine can spread, giving it a chance to mutate and behave like the wild type illness
how does polio spread
faeces
droplets by sneezing or coughing
contact of saliva
contaminated water
what are complications of polio
permanent paralysis
muscle shortening that causes deformed bones or joints
chronic pain
post polio syndrome
how is polio prevented
vaccine
the CDC recommends 4 doses of vaccine at 2 months, 4 months, between 6-18 months and between 4-6 years old
how is polio diagnosed
clinical symptoms
stool sample
throat swab during the first week of illness
lumbar puncture
how is polio treated
there is no cure for polio the focus is on supportive therapy
bed rest
analgesia
hot moist packs to control muscle pain and spasms
ventilation to help with breathing
physical therapy to prevent bone deformity and loss of muscle function
splints or other devices
how is TB spread
respiratory route
close proximity to someone infected
what are the symptoms of TB
fever
anorexia and weight loss
tender lymph nodes
cough
haemoptosis
breathlessness
chest pain
joint pain
headache
chest pain
rash
what is the pathophysiology of TB
after exposure the bacterium M.tuberculosis is engulphed by macrophages in the lung. most people will clear it at this point, but those who dont will have primary TB.
The lung lesion plus the lymph node affected will constitute the Ghon (primary) complex.
in most people this will lead to asymptomatic latent TB. This can reactivate.
some people will develop primary progressive or extrapulmonary TB
what is Extrapulmonary TB
this is TB in an organ other than the lungs and it can affect almost any organ
- genitourinary: sterile pyuria, pyelonephritis
- CNS: meningitis
- GI: peritonitis
- Cardiac: pericarditis
- lymphatics: lymphadenitis
- spinal vertebrae: Potts disease
what is miliary TB
this is disseminated TB where the bacteria spreads through the bloodstream and affects multiple organs throughout the body
what are risk factors for developing TB
close contact with an infected individual
ethnic minority groups
recent travel to high prevalence areas
extremes of age
homelessness
immunodeficiency
what are the clinical findings of someone with TB
sputum pots with purulent or blood stained sputum
enlarged and tender lymph nodes
crackles or bronchial breathing over consolidation
dullness to percussion and decreased fremitus over pleural effusions
what investigations are done in someone with suspected TB
Urine dip
ECG
bloods: inflammatory markers, renal and liver profile
viral screen
sputum microscopy: culture and sensitivities
bronchoscopy with lavage
mantoux and interferon gamma release assay to diagnose latent TB
how are TB samples analysed
with Ziehl-Neelson stain for acid-fast bacilli
what can be seen on a chest X ray in someone with TB
lobar or patchy consolidation
linear or nodular opacities
Miliary TB = small, uniformly distributed nodules
cavitating lesions
tuberculoma = caseating
calcified tuberculoma (ghon focus) or lymph nodes
lymphadenopathy
pleural effusion
how is TB managed
need to notify public health england
triple or quadruple therapy; RIPE
- rifampicin
- isoniazid
- pyrazinamide
- ethambutol
which is then decreased to rifampicin and isoniazid after 2 months
the treatment for uncomplicated or lymph node TB is 6 months
longer treatment is required for disseminated TB
how are asymptomatic children treated for TB
with rifampicin and isoniazid for 3 months as this will decrease the risk of reactivation later in life
who is the BCG vaccination offered to in the UK
high risk groups
- ethnic minorities
- TB in a family member in the previous 5 years
- local area has high prevalence
what are complications of TB
pleurisy
pleural effusions
empyema
pneumothorax
bronchiectasis
respiratory failure
what drugs used to treat TB do you get hepatitis as a side effect
rifampicin
isoniazid
pyrazinamide
what drug used to treat TB causes visual disturbance
ethambutol
what drug used to treat TB causes peripheral neuropathy
isoniazid
what drug used to treat TB causes red urine/tears
rifampicin
what is meningitis
it is inflammation of the meninges of the brain
what is the most common cause of meningitis
viral meningitis
what are causes of bacterial meningitis in neonates - 3 months
Group B streptococcus
Ecoli and other coliforms
listeria monocytogenes
what are causes of bacterial meningitis in 3 month-6 years
Neisseria meningitidis
streptococcus pneumoniae
haemophilus influenzae
what are causes of bacterial meningitis in >6 year olds
neisseria meningitidis
streptococcus pneumoniae
what are symptoms of meningitis
fever
headache
photophobia
lethargy
poor feeding or vomiting
irritability
hypotonia
drowsiness
loss of consciousness
seizures
what is seen on examination in someone with meningitis
fever
purpuric rash (meningococcal disease)
neck stiffness
bulging fontanelle
arching of back
positive brudzinski/kernig signs
signs of shock
focal neurological signs
altered conciousness levels
pappiloedema (rare)
what investigations would you do in someone with suspected meningitis
full blood count
blood glucose and gas
coagulation screen
U+E
culture of blood
rapid antigen testing
lumbar puncture
PCR
chest X ray and Mantoux test if TB suspected
what are contraindications to performing a lumbar puncture
cardiorespiratory instability
focal neurological signs
signs of raised ICP
coagulopathy
thrombocytopenia
local infection at the site of LP
if it causes undue delay in starting antibiotics
what is Brudzinski sign
flexion of the neck with the child supine causes flexion of the knees and hips
what is Kernig sign
with the child laying supine with hips and knees flexed there is back pain on extension of the knee
what is the management of bacterial meningitis
antibiotics - cefotaxime or ceftriaxone
in children under 3 months give IV cefotaxime plus amoxicillin/ampicillin to cover listeria
supportive therapy
what are complications of meningitis
hearing loss
local vasculitis
local cerebral infarction
subdural effusion
hydrocephalus
cerebral abscess
what is aseptic meningitis
when CSF has whit cells on microscopy but the gram stain is negative and no bacteria are cultured
in primary care what do you do if someone is suspected of having bacterial meningitis
URGENT transfer to hospital
IM or IV benzylpenicillin
how are contacts of someone with bacterial meningitis treated
prophylactic antibiotics given within 24 hours: ciprofloxacin or rifampicin
what are causes of viral meningitis
enterovirus
EBV
adenovirus
mumps
how is viral meningitis diagnosed
PCR of CSF
culture of stool, urine
throat swab
serology
what is slapped cheek syndrome
it is infection with parvovirus, which causes a distinctive rash that develops across the face
what are symptoms of slapped cheek syndrome
can be asymptomatic
fever
upset stomach
headache
runny nose
several days after the early symptoms, a bright red rash may appear on the childs face across the cheeks
after a few days a light pink rash may appear on the chest, stomach, arms and thighs. This may be raised, lace like and itchy
how long will the rash in slapped cheek syndrome
will fade within a week or two
occasionally the body rash may come and go for a few weeks after the infection has passed
what can be done as management for slapped cheeked syndrome
rest
drink plenty of fluids
paracetamol or ibuprofen
emollient on itchy skin
antihistamines
children can return to school once the rash has formed
what patients are at risk of complications with slapped cheek syndrome
immunocompromised patients
pregnant women
patients with haematological conditions: sickle cell, thalassaemia, hereditary spherocytosis, haemolytic anaemia
what are the complications of slapped cheek syndrome
Aplastic anaemia
Encephalitis or meningitis
Pregnancy complications including fetal death
Rarely hepatitis, myocarditis or nephritis
how is slapped cheek syndrome spread
droplet infection
- inhaled droplets someones sneezed or coughed out or touching a contaminated surface
what causes slapped cheek syndrome
Parvovirus B19
what is impetigo
common and highly contagious skin infection that causes sores and blisters
what are the two types of impetigo
non-bullous impetigo - most common
bullous impetigo
what are the symptoms of non bullous impetigo
begins with red sores normally around the nose and mouth, but other areas of the face and limbs can be affected as well
exudate from the lesions dries to form a thick golden crust
after crusts dry they leave a red mark that fade without scarring
sores arent painful but they can be itchy
swollen glands
what are symptoms of bullous impetigo
fluid filled blisters which usually occur on the central part of the body between the waist and neck, or arms or legs
blisters may spread quickly before bursting after several days to leave a yellow crust
blisters may be painful
skin surrounding may be itchy
fever
swollen glands
what are the causes of impetigo
skin infected with bacteria
- staphylococcus aureus
- streptococcus pyogenes