Paeds Derm + Infectious Disease + Allergy Flashcards
How is sepsis risk calculated
quick SOFA score
what is quick SOFA score
≥ 22 breaths/min RR
<15 GCS
≤ 100 mm Hg. sys
also coagulation (platelets) liver (bilirubin) and renal (creatine)
score of >2/3 = risk
What is the traffic light system for assessment of children under 5 with fever in children
green (low risk), amber (intermediate risk) or red (high risk)
- color -> normal v. cyanosis
- activity –> alert v. absent & appears ill
- respiratory -> >40-50 RR v. red = >60 RR/ grunting
- circulation and hydration -> normal skin and moist membranes v. tachycardia dry membranes and poor skin turgor, cap refil >3sec
- other -> fever >5 days under 3 months, non blanching rash, seizures
What is action for low risk in assessment of children under 5 with fever in children
Child can be managed at home with appropriate care advice, including when to seek further help
What is action for moderate risk in assessment of children under 5 with fever in children
- F2F assessment to judge admission or not
- provide parents with a safety net or refer to a paediatric specialist for further assessment
What is action for severe risk in assessment of children under 5 with fever in children
urgent admission
What are signs of sepsis
Deranged physical observations
Prolonged capillary refill time (CRT)
Fever or hypothermia
Deranged behaviour
Poor feeding
Inconsolable or high pitched crying
High pitched or weak cry
Reduced consciousness
Reduced body tone (floppy)
Skin colour changes (cyanosis, mottled pale or ashen)
What is the immediate management for sepsis
- Give oxygen if the patient has evidence of shock or oxygen saturations are below 94%
- Obtain IV access (cannulation)
- Blood tests, including a FBC, U&E, CRP, clotting screen (INR), blood gas for lactate and acidosis
- Blood cultures, ideally before giving antibiotics
- Urine dipstick and laboratory testing for culture and sensitivities
- Antibiotics according to local guidelines. They should be given within 1 hour of presentation.
- IV fluids. 20ml/kg IV bolus of normal saline if the lactate is above 2 mmol/L or there is shock. This may be repeated.
What investigations can be ordered for sepsis
- Chest xray if pneumonia is suspected
- Abdominal and pelvic ultrasound if intra-abdominal infection is suspected
- Lumbar puncture if meningitis is suspected
- Meningococcal PCR blood test if meningococcal disease is suspected
- Serum cortisol if adrenal crisis is suspected
What is septic shock
when sepsis has lead to cardiovascular dysfunction.
The arterial blood pressure falls, resulting in organ hypo-perfusion.
This leads to a rise in blood lactate as the organs begin anaerobic respiration.
What is management if IV fluid boluses fail to improve the blood pressure and lactate level in children w septic shock
escalated to ICU + give inotropes (noradrenalin) to stimulate the cardiovascular system and improve blood pressure and tissue perfusion.
What is Kawasaki’s
Medium vessel vasculitis
6m - 5yr M, AfroCarbb/Asian
How does Kawasaki’s present
- persistent high fever (above 39ºC) for more than 5 days.
- strawberry tongue
- widespread erythematous maculopapular rash and desquamation on feet and hands
- conjunctivitis
- cervical lymphadenopathy
How is Kawasaki’s investigated
FBC -> anaemia, leukocytosis and thrombocytosis
LFT -> hypoalbuminemia and elevated liver enzymes
Inflammatory markers -> ^ESR
Urinalysis -> ^WCC
Echocardiogram
What is the disease course of Kawasaki’s
Acute Phase
Subacute Phase
Convalescent stage
What is the Acute Phase of Kawasaki’s
The child is most unwell with the fever, rash and lymphadenopathy. This lasts 1 – 2 weeks.
What is the Subacute Phase of Kawasaki’s
The acute symptoms settle, the desquamation and arthralgia occur and there is a risk of coronary artery aneurysms forming. This lasts 2 – 4 weeks.
What is the Convalescent Phase of Kawasaki’s
remaining symptoms settle, the blood tests slowly return to normal and the coronary aneurysms may regress. This last 2 – 4 weeks.
How is Kawasaki’s managed
- High dose aspirin to reduce the risk of thrombosis
- IV immunoglobulins to reduce the risk of coronary artery aneurysms
- Echo
what is a complication of Kawasaki’s
coronary artery aneurysms
Why is aspirin usually avoided in children
risk of Reye’s syndrome.
What is Inactivated vaccines
giving a killed version of the pathogen
cannot cause an infection
are safe for immunocompromised patients
give an example of Inactivated vaccines
Polio - salk version
Flu vaccine
Hepatitis A
Rabies
what is Subunit and conjugate vaccines
only contain parts of the organism used to stimulate an immune response
cannot cause infection
are safe for immunocompromised patients.
give an example of Subunit and conjugate vaccines
Pneumococcus
Meningococcus
Hepatitis B
Pertussis (whooping cough)
Haemophilus influenza type B
Human papillomavirus (HPV)
Shingles (herpes-zoster virus)
what is a Live attenuated vaccines
contain a weakened version of the pathogen.
They are still capable of causing infection, particularly in immunocompromised patients.
give an example of Live attenuated vaccines
Measles, mumps and rubella vaccine: contains all three weakened viruses
BCG: contains a weakened version of tuberculosis
Chickenpox: contains a weakened varicella-zoster virus
Nasal influenza vaccine (not the injection)
Rotavirus vaccine
Typhoid
what are toxin vaccines
contain a toxin that is normally produced by a pathogen.
They cause immunity to the toxin and not the pathogen itself
given an example of a toxin vaccine
diphtheria
tetanus
What vaccines are given at 8 weeks
6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
Meningococcal type B
Rotavirus (oral vaccine)
what is in the 6 in 1
diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B
‘Parents Will Immunise Toddlers Because Death’
what vaccines are given at 12 weeks
6 in 1 vaccine (again)
Pneumococcal (13 different serotypes)
Rotavirus (again)
what vaccines are given at 16 weeks
6 in 1 vaccine (again)
Meningococcal type B (again)
what vaccines are given at 1 year
2 in 1 (haemophilus influenza type B and meningococcal type C)
Pneumococcal (again)
MMR vaccine (measles, mumps and rubella)
Meningococcal type B (again)
what vaccines are at 3 years 4 months
4 in 1 (diphtheria, tetanus, pertussis and polio)
MMR vaccine (again)
what is in the 4 in 1
diphtheria, tetanus, pertussis and polio
what vaccine is given at 12-13 years
Human papillomavirus (HPV) vaccine (2 doses given 6 to 24 months apart)
what vaccine is given at 14 years
3 in 1 (tetanus, diphtheria and polio)
Meningococcal groups A, C, W and Y
what is in the 3 in 1
tetanus, diphtheria and polio
what strains of HPV cause genital warts
6 and 11
what strains of HPV cause cervical cancer
16 and 18
what is chickenpox
caused by primary infection with varicella zoster virus
what is shingles
reactivation of the dormant virus in dorsal root ganglion
how does chickenpox present
fever initially
itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
systemic upset is usually mild
when does chickenpox infectivity continue til
infectivity continues until all the lesions are dry and have crusted over
what are complications of chickenpox
common - secondary bacterial infection of the lesions –> group A streptococcal
rare:
pneumonia
encephalitis (cerebellar involvement may be seen)
disseminated haemorrhagic chickenpox
arthritis, nephritis and pancreatitis may very rarely be seen
what is 1st disease
Measles
what is 2nd disease
Scarlet Fever
what is 3rd disease
Rubella (AKA German Measles)
what is 4th disease
Dukes’ Disease
what is 5th disease
Parvovirus B19
what is 6th disease
Roseola Infantum
what is measles
caused by the measles virus. It is highly contagious via respiratory droplets.
how does measles present
Koplik spots - spots inside the mouth (pathognomonic)
erythematous, maculopapular rash with flat lesions starts on face behind ears after fever then spreads to rest of body
how is measles managed
self resolving after 7 – 10 days of symptoms.
Children should be isolated until 4 days after their symptoms resolve
what are notifiable diseases
Measles
Scarlet Fever
Rubella (AKA German Measles)
what are complications of measles
Otitis media
Pneumonia
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death
what is scarlet fever
caused by an exotoxin produced by the streptococcus pyogenes (group A strep) bacteria
how does scarlet fever present
red-pink, blotchy, macular rash with rough “sandpaper” skin starts on trunk and spreads
Fever
Lethargy
Flushed face
Sore throat
Strawberry tongue
Cervical lymphadenopathy
how is scarlet fever managed
phenoxymethylpenicillin (penicillin V) for 10 days.
Children should be kept off school until 24 hours after starting antibiotics.
what other conditions are associated with group a strep infection
Post-streptococcal glomerulonephritis rheumatic fever
what is rubella
caused by the togavirus virus
highly contagious
spread by respiratory droplets
how does rubella present
milder erythematous macular rash compared with measles
starts on face spreads to body
mild fever, joint pain and a sore throat
lymphadenopathy
how is rubella managed
supportive and the condition is self limiting
Children should stay off school for at least 5 days after the rash appears.
Children should avoid pregnant women.
what are complications of rubella
thrombocytopenia and encephalitis
Arthritis of the small joints
what can rubella in pregnancy lead to
congenital rubella syndrome, which is a triad of deafness, blindness and congenital heart disease.
what is Parvovirus B19
caused by the parvovirus B19
also known as fifth disease, slapped cheek syndrome and erythema infectiosum
how does Parvovirus B19 present
starts with mild fever, coryza and non-specific viral symptoms such as muscle aches and lethargy
After 2 – 5 days the rash appears quite rapidly as a diffuse bright red rash on both cheeks, as though they have “slapped cheeks
few days later a reticular (net-like) mildly erythematous rash affecting the trunk and limbs appears that can be raised and itchy.
how is parovirus b19 managed
self limiting and the rash and symptoms usually fade over 1 – 2 week
when is parovirus b19 infectious
infectious prior to the rash forming, but once the rash has formed they are no longer infectious and do not need to stay off school.
who is at risk of parovirus b19 complucations
mmunocompromised patients, pregnant women and patients with haematological conditions such as sickle cell anaemia, thalassaemia, hereditary spherocytosis and haemolytic anaemia
what are complications of parovirus b19
Aplastic anaemia
Encephalitis or meningitis
Pregnancy complications including fetal death
Rarely hepatitis, myocarditis or nephritis
what is Roseola Infantum caused by
human herpesvirus 6 (HHV-6) and less frequently by human herpesvirus 7 (HHV-7).
what is main complication of Roseola Infantum
febrile convulsions
how does Roseola Infantum present
3-5 day high fever followed by a 2 day maculopapular rash which starts on the chest and spreads to the limbs.
what is Staphylococcal Scalded Skin Syndrome
caused by a type of staphylococcus aureus bacteria that produces epidermolytic toxins –> protease enzymes that break down the proteins that hold skin cells together.
how does SSSS present
generalised patches of erythema on the skin
formation of fluid filled blisters called bullae
burst & leave very sore, erythematous skin below
what is Nikolsky sign
very gentle rubbing of the skin causes it to peel away.
what are complications of SSSS
untreated lead to sepsis and potentially death.
How is SSSS managed
admission and treatment with IV antibiotics.
Fluid and electrolyte balance
What is whooping cough
upper respiratory tract infection caused by Bordetella pertussis (a gram negative bacteria).
how does whooping cough present
starts with mild coryzal symptoms, a low grade fever and possibly a mild dry cough.
More severe coughing fits start after a week or more
large, loud inspiratory whoop when the coughing ends
what is a paroxysmal cough
Coughing fits are severe and keep building until the patient is completely out of breath.
how is whooping cough diagnosed
within 2-3 weeks = nasopharyngeal or nasal swab with PCR testing or bacterial culture
more than 2 weeks = anti-pertussis toxin immunoglobulin G.
how is whooping cough managed
notifiable disease
supportive care
within first 3 weeks = Macrolide antibiotics such as azithromycin, erythromycin and clarithromycin
close contacts = prophylactic antibiotics
what is a complication if whoopung cough
bronchiectasis.
what is TB
infectious disease caused by Mycobacterium tuberculosis, a small rod-shaped bacteria (a bacillus)
what stain is used for M. tuberculosis and what does it look like
Zeihl-Neelsen stain, which turns them bright red against a blue background.
acid fast bacilli
what are the 4 possible outcomes of TB disease course
- Immediate clearance of the bacteria (in most cases)
- Primary active tuberculosis (active infection after exposure)
- Latent tuberculosis (presence of the bacteria without being symptomatic or contagious)
- Secondary tuberculosis (reactivation of latent tuberculosis to active infection)
what is miliary tuberculosis
When the immune system cannot control the infection, disseminated and severe disease can develop
what happens in latent TB
the immune system encapsulates the bacteria and stops the progression of the disease.
what is secondary TB
When latent tuberculosis reactivates, and an infection develops, usually due to immunosuppression
what is MC site of TB infection
lungs
What are Extrapulmonary tuberculosis sites
Lymph nodes
Pleura
Central nervous system
Pericardium
Gastrointestinal system
Genitourinary system
Bones and joints
Skin (cutaneous tuberculosis)
what is a cold abscess
firm, painless abscess caused by tuberculosis usually in neck
what are RF for TB
Close contact with active tuberculosis (e.g., a household member)
Immigrants from areas with high tuberculosis prevalence
People with relatives or close contacts from countries with a high rate of TB
Immunocompromised (e.g., HIV or immunosuppressant medications)
Malnutrition, homelessness, drug users, smokers and alcoholics
WHat is the vaccine for TB
Bacillus Calmette–Guérin (BCG)
live attenuated (weakened) Mycobacterium bovis bacteria (close relative)
who is TB vax offered to
increased risk of TB, such as those from areas of high TB prevalence, with close contact with TB (e.g., family members) and healthcare workers
how does TB present
Cough
Haemoptysis (coughing up blood)
Lethargy
Fever or night sweats
Weight loss
Lymphadenopathy
Erythema nodosum (tender, red nodules on the shins caused by inflammation of the subcutaneous fat)
Spinal pain in spinal tuberculosis (also known as Pott’s disease of the spine)
what are the two tests for an immune response to TB cause by previous infection, latent or actiev TB
Mantoux test
Interferon‑gamma release assay (IGRA)
what investigations can support TB diagnosis
Chest x-ray
Cultures
what is Mantoux test
injecting tuberculin into the intradermal space on the forearm.
infection creates a bleb under skin
induration of skin measured 5mm or more = positive test
what is Interferon-Gamma Release Assays
mixing a blood sample with antigens from the M. tuberculosis bacteria.
positive result is when interferon-gamma is released during the test.
what does primary TB show on XRay
patchy consolidation, pleural effusions and hilar lymphadenopathy.
what does Reactivated TB show on XRay
patchy or nodular consolidation with cavitation (gas-filled spaces), typically in the upper zones.
what does Disseminated miliary TB show on XRay
appearance of millet seeds uniformly distributed across the lung fields.
what are ways to collect TB culture sample
Sputum cultures (3 separate sputum samples are collected)
Mycobacterium blood cultures (require special blood culture bottle)
Lymph node aspiration or biopsy
Sputum induction with nebulised hypertonic saline
Bronchoscopy and bronchoalveolar lavage (saline is used to wash the airways and collect a sample)
how is latent TB treated
Isoniazid and rifampicin for 3 months
or
Isoniazid for 6 months
