Paeds infection Flashcards
Management threadworms
- anthelmintic with hygiene measures for all members of the household
mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists
TB pathogen and histology
mycobacteria - acid fast bacilli
resistant to gram stain
stain with Zeil Neelson –> red/pink
Drugs for TB
RIPE
Rifampicin
Isonizad
Pyrazinamide
Ethanbutol
Side effects rifamicin
R
Red/oragne urine
Hepatitis
Side effects Isonizid
Hepatitis
Neuropathy
Side effects pyrazinamide
hepatitis
Arthralgia / gout
rash
Side effects ethanbutol
optic neuritis
Complications of mumps
Pancreatitis
Orchitis
Meningitis
Sensorineural hearing loss
How good is MMR at protecting against mumps
80% effective
Diagnosis mumps
PCR testing on a saliva swab.
oral fluid sample (salivary IgM)
Along with treating patient for mumps, what else do you need to do?
Notify Public health england
incubation period and presentation mumps
14 – 25 days
prodrome general illness
unilateral or bilateral parotid gland swelling
May also have:
Abdominal pain (pancreatitis)
Testicular pain and swelling (orchitis)
Confusion, neck stiffness and headache (meningitis or encephalitis)
Screening for Hep B
HBcAb (for previous infection/vacciantion)
and HBsAg (for active infection)
Management of neonates born to mothers with Hep B
Give at birth:
Hepatitis B vaccine
Hepatitis B immunoglobulin infusion
Infants are given an additional hepatitis B vaccine at 1 and 12 months of age.
They will also receive the hepatitis B vaccine as part of the normal 6 in 1 vaccine given to all infants aged 8, 12 and 16 weeks.
They are tested for the HBsAg at 1 year to see if they have contracted hepatitis B.
Breastfeeding and Hep B
Safe to breastfeed provided their babies are properly vaccinated
Hep B type of virus and spread
DNA virus. It is transmitted by direct contact with blood or bodily fluids.
Testing for Hep C
Hepatitis C antibody is the screening test
Hepatitis C RNA testing is used to confirm the diagnosis of hepatitis C, calculate viral load and identify the genotype
Management babies born to mothers with hep C
tested at 18 months of age using the hepatitis C antibody test
can breastfeed
Presentation infectious mononucelosis
Fever
Sore throat
Fatigue
Lymphadenopathy (swollen lymph nodes)
Tonsillar enlargement
Splenomegaly and in rare cases splenic rupture
Testing for EBV
heterophile antibodies 6 weeks after
Monospot test: this introduces the patient’s blood to red blood cells from horses. Heterophile antibodies (if present) will react to the horse red blood cells and give a positive result.
Paul-Bunnell test: this is similar to the monospot test but uses red blood cells from sheep.
100% specific but only 7-0% sensitive
It is possible to test for specific EBV antibodies. These antibodies target something called viral capsid antigen (VCA):
The IgM antibody rises early and suggests acute infection
The IgG antibody persists after the condition and suggests immunity
Complications EBV
Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue
EBV infection is associated with certain cancers, notable Burkitt’s lymphoma (a type of non-hodgkins lymphoma)
how to reduce chance of splenic rupture ebv
Advise against contact sports and heavy lifting for 1 month to minimise risk of splenic rupture
presentations mumps
1) Parotitis: The parotid glands are almost always affected, usually bilaterally (though can be unilateral). Swelling can be severe enough to prevent the mouth from being opened and usually lasts 3-4 days. Prior to parotitis, there may be flu-like symptoms such as headache, malaise and myalgia.
2) Orchitis: Epididymo-orchitis is the second most common extra-salivary symptom of Mumps, which presents as severely painful swelling of one or both testicles and/or backache. It usually develops 4-5 days after onset of parotitis. 7% of post-pubertal females get oophoritis, with rare cases of infertility and premature menopause as a result.
3) Aseptic meningitis: A relatively common complication in 4-25% of cases. Usually mild and self-limiting
4) Encephalitis: Rare complication presenting as headache, vomiting, seizures, unconsciousness.
5) Deafness: A rare cause of acute or insidious sensorineural hearing loss (usually unilateral) in children.
6) Other: Pancreatitis, nephritis, arthritis, thyroiditis, pericarditis.
parotitis
parotitis (‘earache’, ‘pain on eating’)
