Paeds INFECTION Flashcards
Recall a long-term complication of mumps, rubella and polio
Mumps: infertile boys, deafness
Rubella: severe deformities to pregnancy
Polio: massive respiratory problems
In what age range does Kawasaki disease present?
6 months to 4 years: peak at 1 year
What is Kawasaki’s disease?
Systemic vasculitis
What is the main cause of mortality in KD?
Coronary aneurism
What are the signs and symptoms of Kawasaki disease?
CRASH + Burn
C: conjunctivitis
R: rash (polymorphous, begins at hands + feet)
A: Adenopathy
S: Strawberry tongue
H: hands + feet swollen
Burn (fever >5 days)
How is kawasaki disease diagnosed?
CLINICALLY
Do bloods + echo to guide management
How is kawasaki disease managed?
ADMISSION
IV Ig + high dose aspirin
By what vector is malaria spread?
Female anopheles mosquito
How fast is the onset of malaria after innoculation?
7-10 days
What are the signs and symptoms of malaria?
Cyclical fever with spikes
D+V
Jaundice
Anaemia
Thrombocytopaenia
Flu-like Sx
What are the appropriate investigations for malaria?
3 thick + thin blood films (thick = parasite, thin = species)
Malaria rapid antigen detection tests
What is used for anti-malarial prophylaxis?
Quinine
How should malaria be managed?
Arrange immediate admission
Notify PHE
Treatment is very variable
Non-falciparum: chloroquinine
Mild falciparum (not vomiting): ACT (Artemisinin Combination Therapy) + Atovaquone-proguanil
Severe/ complicated falciparum: IV Artesunate is 1st line
What is the route of transmission of typhoid?
Faeco-oral
What are the signs and symptoms of typhoid?
May be bradycardic
Cough
Malaise
Anorexia
Diarrhoea or constipation by 2nd week
Rose spots on trunk
How is typhoid diagnosed?
Blood culture is diagnostic
How should typhoid be managed?
1st line = IV ceftriaxone
2nd line = PO azithromycin
What is the vector of dengue virus?
Aedes aegyptii mosquito
Where is dengue usually imported from?
SE Asia + South Africa
What are the expected FBC abnormalities in Dengue?
Low WCC
Low platelets
Low Hb
What are the signs and symptoms of dengue?
Retro-orbital headache
Sunburn-like rash
High fever + myalgia
Hepatomegaly + abdo distention
What is dengue haemorrhagic fever?
Secondary infection by a different strain that causes severe capillary leakage –> hypotension + haemorrhagic manifestations
Due to partial host reponse augmenting severity of host infection
How should dengue haemorrhagic fever be managed?
Fluid resuscitation
What is the gold standard investigation for dengue diagnosis?
PCR viral antigen, serology IgM
What is the pathogen that causes mumps?
Mumps paramyxovirus
How is mumps transmitted?
Respiratory secretions
For how long is mumps infectious?
5 days before + 5 days after parotid swelling
What are the signs and symptoms of mumps?
Asymptomatic in 30%
Headache, fever + parotid swelling
Recall the 2 key investigations for mumps
Oral fluid IgM sample
Amylase in blood is raised
How should mumps be managed?
Notify HPU, isolate for 5 days from time of parotid swelling
Supportive care (rest, analgesia)
Safety net for complications
What are the possible complications of mumps?
Mumps orchitis (leading to infertility)
Viral meningitis (encephalitis)
Deafness (unilateral and transient)
How is measles transmitted?
Respiratory secretions
For how long is measles infectious?
4 days before + 4 days after rash
Recall the signs and symptoms of measles
Prodrome of high fever, irritability, conjunctivitis + febrile convulsions
Maculopapular rash (face/ neck –> hands/ feet)
Koplick spots (small white spots surrounded by red ring in mouth)
Cough
No lymphadenopathy
What investigations should be done in suspected measles?
1st line is measles serology (IgM/ IgG) from Oral fluid test (OFT)
2nd line is PCR of blood/ saliva
How should measles be managed?
Notify HPU
Isolate for 4 days following development of rash
Rest + supportive tx
Immunise close contacts
Safety net complications of encephalitis/ SSPE/ otitis media (most common), pneumonia
What is SSPE?
Sub-acute Sclerosing Panencephalitis
Seen 7 years after measles infection
Measles has been dormant in CNS
Signs + Sx = dementia + death
What type of virus causes rubella?
Togavirus
What is the infectious period of rubella?
1 week before to 5 days after rash onset
Recall the signs and symptoms of rubella
Prodrome of mild fever or sometimes asymptomatic
Pink maculopapular rash (face –> whole body) which fades pretty quickly
In 20% there are Forcheimer spots (red spots on soft palate)
Lymphadenopathy (none in measles)
No koplik spots or conjuntivitis
How should rubella be investigated?
Rubella serology (IgG and IgM) from oral fluid test
RT-PCR is 2nd line
How should rubella be managed?
Notify HPU, isolate for 4 days after development of rash
Supportive care
Safety net the complications (haemorrhagic complications due to thrombocytopaenia)
Recall some other names for this roseola infantum
Fifth disease/ erythema infectiosum/ slapped cheek
How is parvovirus B19 transmitted?
Respiratory secretions/ vertically
Which cells does pB19 infect?
RBC precursors
What is the infectious period of parvovirus?
10 days before to 1 day after rash develops
Recall the signs and symptoms of parvovirus B19
1st: asymptomatic or coryzal illness for 2-3 days then latent for 7-10 days
2nd: most commonly, erythema infectiosum - ‘red slapped cheek’ rash on face
Progresses to maculopapular (‘lace like’) rash in trunk and limbs
How should parvovirus B19 be investigated?
B19 serology (IgG and IgM) - similar to rubella
2nd line is RT-PCR
How should pB19 be managed?
Supportive (virus, fluids, analgesia, rest)
No need to stay off school or avoid pregnant women (once rash develops it’s not really infectious)
Complications to safety net = anaemia, lethargy, pregnancy
What is the infectious period of VZV?
48 hours before rash to last crusted over lesion
What are the stages of the rash appearance in chickenpox?
Papule –> vesicle –> crust
How should VZV be investigated?
Clinical dx
How shoulod VZV be managed?
Supportive
No ibuprofen
Keep home from school
What advice would you give to parents if their child has VZV?
Keep nails short
When should you admit in VZV?
Pneumonia, encephalitis, dehydration
Secondary bacterial superinfection (sudden high fever, toxic shock, necrotising fasciitis)
Purpura fulminans: large necrotic loss of skin from cross-activation of anti-viral Abs
What is the pathogen that causes hand, foot and mouth disease?
Usually coxsackie A16
Atypical: coxsackie A6
Severe: enterovirus 71
What are the signs and symptoms of hand, foot and mouth disease?
Painful, itchy, vesicular lesions on hands, feet, mouth + buttocks
Mild systemic features: fever, sore throat, spots in mouth- develop into ulcers
How should hand, foot and mouth disease be managed?
Supportive
Will clear in 7-10 days
Safety net for dehydration
What pathogen causes roseola infantum?
HHV6
What is another name for roseola infantum?
6th disease
Describe the epidemiology of roseola infantum
Most children infected by age 2: it’s highly infectious for the whole period of disease
What are the signs and symptoms of roseola infantum?
High fever + malaise for 3-4 days, followed by generalised macular rash (small pink spots) that goes neck- arms
Non-itchy
Febrile convulsions in 10-15%
Sore throat, lymphadenopathy, coryzal Sx, D+V
Nagayama spots (spots on the uvula + soft palate)
How should roseola infantum be investigated?
HHV6/7 serology (IgG or IgM)
Measles + rubella serology: as have a similar presentation
How should roseola infantum be managed?
Supportive
No need to stay off school
Safety net the complications: febrile convulsions
How should children be investigated for HIV?
<18 months: PCR of virus at birth, on discharge, at 6w, 12w + 18 months
>18 months: antibody detection via ELISA
How should childhood HIV be managed?
Cord clamped ASAP + bathed straight after birth
Zidovudine monotherapy for 2-4w (if low/med risk) or PEP combination 4w (if high risk)
Women not to breastfeed
Give all immunisations
How does the aetiology of conjunctivitis differ between children and adults?
In adults is usually viral or allergic, in children is more likely to be bacterial
What is the most likely cause of sticky eyes in a <48 hours neonate?
Gonorrohoea
What is the most likely cause of sticky eyes in a neonate in first 1-2w?
Chlamydia - often co-presents with pneumonia
How should neonatal gonorrhoeal infection be investigated and treated?
Ix: Gram stain and culture
Mx: 3rd gen cephalosporin (e.g. ceftriaxone)
How should neonatal chlamydia infection be investigated and treated?
Ix: immunofluorescent staining
Mx: oral erythromycin
For how long should a child be excluded from school if they have scarlet fever?
24 hours after antibiotics
For how long should a child be excluded from school if they have whooping cough?
48 hours after Abx
For how long should a child be excluded from school if they have measles?
4 days from onset of rash
For how long should a child be excluded from school if they have rubella?
4 days from onset of rash
For how long should a child be excluded from school if they have chickenpox?
Until all lesions crusted over
For how long should a child be excluded from school if they have impetigo?
Until all lesions crusted over
For how long should a child be excluded from school if they have mumps?
5 days from onset of swollen glands
For how long should a child be excluded from school if they have influenza?
Until recovered
What infections are children with DiGeorge syndrome particularly at risk of and why?
Candidiasis
No thymus –> no T cells
Give 2 causes of evanescent salmon pink rash
Listeriosis (neonate)
Juvenile idiopathic arthritis
Recall 3 conditions that cause rigors in children?
Pyelonephritis
Influenza
Malaria
What is the triad of features seen in Rubella syndrome?
Cataracts
Deafness
Cardiac abnormalities
What abnormalities would be seen in a baby who is born to a mother with syphillis?
Saddle nose
Rhinitis
Deafness
Jaundice
Hepatosplenomegaly
Which babies are at highest risk of developing NEC?
Premature or LBW
What is the aetiology of NEC?
Mostly unknown but thought to be a combination of poor blood flow and infection
What are the early signs of NEC?
Bilious vomiting (green)
Feeding intolerance
What will be seen on AXR in NEC?
Gas cysts
What are the appropriate investigations to do in NEC?
AXR
Blood cultures
What are the criteria used to decide management of NEC?
Bell’s staging
Recall the elements of NEC management
- Bowel rest: stop oral feed + switch to parenteral nutrition
- Broad-spectrum Abx (eg Tazocin): duration depends on stage
- Laparotomy (if perforation is seen on AXR)
What is the most common causative agent of meningitis in children?
Neisseria meningitides
When is the meningococcal C vaccine given?
Routinely given at 12 months and at 14 years as part of the MenACWY vaccine
When is the meningococcal B vaccine given?
At 8 and 16 weeks, followed by a booster at 1 year
What is the most common causative strain of meningococcus?
Group B - accounts for 60% of meningococcal disease, the other 40% is accounted for by Group A
What causative agents of meningitis are seen in neonates?
Group B strep
E. coli
Listeria
Pneumococcus
Staph aureus
What causative agents of meningitis are seen in babies > 1 month?
Meningococcus
Pneumococcus
Haemophilus influenzae B (used to be more common before vaccination programme)
How may meningitis present in babies/children?
Classical triad of meningism (headache, neck stiffness and photophobia) is less common in children and not seen in babies.
Instead they may present with non-specific and vague symptoms.
What are the 3 reliable ways to measure temperature in children?
Axillary electronic
Axillary chemical dot
Tympanic infra red
DON’T use anything else
What risk factors/signs in the history suggest potential need for admission for a febrile illness?
Aged 3-6m
Temp > 39
Fever for more than 5 days
Rigors - sign of bacterial infection
Swelling of limb or joint
Non-weight bearing limb or joint
What are the common causative agents of fever in infants < 1 month?
Listeria
Group B strep
E. coli
What are the typical antibiotics used for fever in infants < 1 month?
Cefotaxime and amoxicillin
How do you collect a urine sample in a child that is not toilet trained?
Wait with bottle (clean catch)
Catheter aspirate
Suprapubic aspirate (US-guided)
Never rely on cotton wool in nappy or sterile bag as these can be contaminated with skin flora.
What is the immediate management of sepsis in children?
If shocked:
- 20ml/kg 0.9% saline bolus (may also be 10ml/kg given recent research)
- Reassess need for further boluses
- Immediate IV antibiotics
