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3a Paediatrics > Paeds infection (ILA 1) > Flashcards

Paeds infection (ILA 1) Flashcards

1
Q

What is meningitis?

A

inflammation of the meninges

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2
Q

Name the most common causative organisms causing bacterial meningitis if <3 months old

A

Group B streptococcus
E.coli
Listeria monocytogenes

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3
Q

Name the most common causative organisms causing bacterial meningitis in 1 month - 6 years old

A

SPREAD VIA RESP SECRETION
Neisseria meningitidis = gram - ve diplococci
Streptococcus pneumoniae
Haemophilus influenzae

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4
Q

Name the most common causative organisms causing bacterial meningitis if >6 years old

A

Neisseria meningitidis

Streptococcus pneumoniae

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5
Q

Name the causative organisms of viral meningitis

A

viral meningitis is the most common cause

enterovirus
Epstein Barr virus
adenovirus
mumps

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6
Q

List the symptoms of meningitis

A 
fever
headache
photophobia 
neck stiffness 
lethargy / irritable
poor feeding 
vomiting 
drowsiness
seizures
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7
Q

List the signs of meningitis

A 
fever
purpuric rash 
neck stiffness
bulging fontanelle 
positive brudzinski / kernels sign 
signs of shock
focal neurological signs
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8
Q

What are the best diagnostic tests for meningitis?

A
  1. lumbar puncture and CSF changes
  2. blood culture
  3. PCR - take EDTA blood sample
  4. septic screen!
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9
Q

When should a lumbar puncture not be performed if suspect meningitis?

A

if suspect meningococcus

if raised ICP or focal neurological signs - this is because at risk of coning the cerebellum through the foramen magnum

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10
Q

Outline the typical changes in the CSF in meningitis for bacterial or viral causes

A 
BACTERIAL
turbid appearance 
increased polymorphs
increased protein
decreased glucose
VIRAL
clear appearance 
increased lymphocytes
normal / slightly increased protein
normal/ slightly decreased glucose
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11
Q

how is meningitis managed in a child >3 months old in both the hospital and community?

A 
hospital = IV cefotaxime 
community = IM benzylpenicillin

+ fluids, cerebral monitorting, mechanical ventilation

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12
Q

How is meningitis managed in a child <3 months old?

A

IV cefotaxime + Iv amoxicillin

covers for listeria

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13
Q

What should be given in addition to the antibiotics if suspect the cause to be Haemophilus influenzae in meningitis

A

dexamethasone

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14
Q

What is given as prophylaxis to immediate family members/ close contact of a child with meningitis?

A

ciprofloxacin* or rifampicin

close contact = if live with child

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15
Q

What are the most common causes of encephalitis?

A

enterovirus
respiratory viruses e.g. influenza
herpes virus

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16
Q

How does encephalitis present?

A

presents similar to meningitis …

fever
altered consciousness
seizures

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17
Q

How is encephalitis diagnosed?

A
  1. PCR
  2. EEG
  3. CT/MRI
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18
Q

How is encephalitis treated?

A

high dose acyclovir

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19
Q

What are the most common causative organisms of toxic shock syndrome?

A

staphylococcus aureus

group A streptococcus

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20
Q

What is the diagnostic criteria for toxic shock syndrome?

A
  1. fever >39
  2. hypotension <90 systolic
  3. diffuse erythematous rash and desquamation of rash on palms and soles
  4. > 3 organ systems involved e.g. mucositis, diarrhoea, renal or lover impairment, clotting abnormalities
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21
Q

How is toxic shock managed?

A
  1. manage shock - intensive care
  2. antibiotics e.g. ceftriaxone + clindamycin
  3. IV immunoglobulin
  4. surgical debridement of infected areas
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22
Q

What is necrotising fasciitis?

A

severe subcutaneous infection, involving tissue planes from skin down to fascia and muscle

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23
Q

Name the common causes of necrotising fasciitis?

A

Type 1= mixed anaerobes e.g. post surgery in a diabetic

Type 2= streptococcus progenies, staph. aureus

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24
Q

How does necrotising fasciitis present?

A

severe painful erythematous lesion
systemic illness
acute onset
MEDICAL EMERGENCY

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25
Q

How is necrotising fasciitis managed?

A

IV antibiotics

surgical debridement of the necrosis tissue

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26
Q

What is kawasaki disease?

A

systemic vasculitis affecting children 6 months - 4 years old and most common in children of Japanese or Afro caribbean descent

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27
Q

How is a clinical diagnosis of kawasaki disease made?

A 
CRASH AND BURN (>5 days fever difficult to control)
C- conjunctivitis
R- rash (erythematous and desquamation)
A- adenopathy (cervical lymphadenopathy)
S- strawberry tongue and cracked lips
H- hands and feet red and oedematous

+/- irritable, inflammation of BCG site

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28
Q

Which investigation is necessary to screen for complications of kawasaki disease?

A

ECHOCARDIOGRAM to screen for coronary artery aneurysm

children may require long term warfarin therapy if have coronary artery aneurysm

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29
Q

How is kawasaki disease managed?

A
  1. high dose aspirin
    SE: REYES SYNDROME (encephalopathy), tarry stool, Abdominal pain
  2. IV immunoglobulin
    SE: anaphylaxis, AKI, haemolytic anaemia
30
Q

how does TB spread?

A

spreads by respiratory route and increasing transmission includes…

  • close proximity
  • infectious load
  • underlying immunodeficiency
  • crowding
31
Q

What is the causative organism of TB?

A

mycobacterium tuberculosis

32
Q

How does active TB present?

A

prolonged fever
malaise
weight loss
focal signs of infection e.g. lymph node swelling
resp = cough, sputum production, night sweats
extra pulmonary disease = genitourinary, meningitis, osteoarticular

33
Q

Which test is used to screen for latent TB?

A

Mantoux test / tuberculin skin test

inject purified protein derived from tuberculin into forearm and read after 48-72 hours
>5/6mm = positive

34
Q

How is TB diagnosed?

A
  1. Interferon gamma release assays
    blood test for TB, +ve = TB
  2. sputum samples
    use Ziehl Neelsen statins for acid fast bacilli
35
Q

How is active TB treated?

A

quadruple therapy of…

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

36
Q

How is latent TB treated? (positive Mantoux test and asymptomatic)

A

3 months of rifampicin and isoniazid

BCG vaccination

37
Q

How is TB prevented?

A

BCG vaccination

38
Q

How is HIV transmitted to children?

A
  1. mother to child transmission e.g. during pregnancy, at delivery, breast feeding
  2. infected blood products
  3. contaminated needles
  4. sexual abuse
39
Q

What is the pathology behind HIV?

A

Human Immunodeficiency Virus causes low levels of CD4 t cells so more susceptible to opportunistic infections

40
Q

How might HIV present in children if mild/ moderate/severe immunocompromised?

A
  1. MILD IMMUNOCOMPROMISED
    lymphadenopathy, parotid enlargement
  2. MODERATE IMMUNOCOMPROMISED
    recurrent bacterial infections, chronic diarrhoea, lymphocytic interstitial pneumonitis
  3. AIDS
    opportunistic infections e.g. pneumocytisis jirovecii pneumonia, encephalopathy, malignancy
41
Q

How is HIV diagnosed?

A

HIV DNA PCR

if born to infected mothers, will have transplacental maternal IgG HIV antibodies

42
Q

How is HIV managed?

A
  1. anti-retroviral therapy (ART)
  2. prophylaxis of cotrimoxazole
  3. immunisations up to date
  4. MDT management
  5. regular follow ups
43
Q

What are the most common causes of sepsis?

A

E.coli * = early onset in neonates
group B streptococcus = early onset in neonates
staphylococcus aureus = late onset in neonates
Neisseria meningitidis
streptococcus pneumonia

44
Q

What is sepsis?

A

inflammatory response to bacterial infection of the blood causing organ dysfunction

45
Q

How does sepsis present?

A 
fever
lethargy 
irritable, miserable 
poor feeding
history of focal infection e.g. meningitis, osteomyelitis, gastroenteritis, cellulitis
46
Q

What are the signs of sepsis?

A 
fever
tachycardia
tachypnoea
low blood pressure 
shock
multiorgan failure
47
Q

List the features of a septic screen?

A
  1. blood cultures
  2. FBC
  3. U&E
  4. urine sample and MC&S
  5. Chest X-ray
  6. lumbar puncture and CSF
  7. CRP and ESR
48
Q

How is sepsis managed?

A
  1. ABCDE - assess for signs of shock
  2. IV antibiotics - start without delay
  3. IV fluids - catheterise to monitor urine output, central venous pressure monitoring
  4. circulatory support
49
Q

What are the 4 most common key infections in children?

A
  1. respiratory infection (pneumonia)
  2. UTI
  3. sepsis
  4. meningitis
50
Q

What is the cause of purpura?

A

purple red lesions on the skin, non blanching

caused by blood vessels damaged by bacteria/ toxins of the infection and leaking blood under the skin

51
Q

What are the contraindications of rifampicin and possible side effects?

A

do not wear contact lenses
pregnancy

SE= urine and tears red

52
Q

How is chickenpox caused?

A

Primary Varicella zoster virus

53
Q

Describe the features of chicken pox

A

Fever, unwell
Vesicular rash on face and trunk
Papules -> vesicles -> pustules -> crusts
Itchy

54
Q

How is chicken pox managed?

A

Calamine lotion
Human varicella zoster immunoglobulin if immunocompromised or in close contact
School exclusion for 5 days after rash

55
Q

How does measles present?

A

C- cough
C- coryza
C- conjunctivitis
K- koplik spots - white spots on buffalo mucosa

+ maculopapular rash behind ears to whole of body , fever

56
Q

How is measles confirmed?

A

PCR- igM antibodies within few days of rash

57
Q

How is measles managed?

A
  1. Supportive
  2. Ribavirin if immunocompromised
  3. Notify public health
  4. If close contacts unvaccinated, have MMR within 72 hrs
58
Q

How is parvovirus caused?

A

Human parvovirus B19

Transmission via real secretions, vertical transmission, infected blood products

59
Q

How does parvovirus present?

A

Slapped cheek syndrome - erythema infectiosum

With fever, malaise, headache and myalgia

60
Q

What causes roseola infantum?

A

Human herpes virus 6

61
Q

How does roseola infantum present?

A

Hugh fever
Maculopapular rash
Febrile convulsions
Diarrhoea and cough

Comp: a sceptic meningitis, hepatitis

62
Q

How does mumps present?

A

Hugh fever
Malaise
Parotitis - swelling on one side of face, ear ache, pain on eating or drinking
Infertility in boys

63
Q

How is mumps diagnoses?

A

Plasma amylase elevated

64
Q

How does herpes simplex virus 1 present?

A

Vesicular lesions on lips and gums and tongue - painful, ulceration, bleeding
Eating and drinking painful
Hugh fever
For 2 weeks

65
Q

How is herpes simplex virus managed?

A

Aciclovir - viral DNA polymerase inhibitor

66
Q

What causes glandular fever / infectious mononucleosis?

A

Epstein Barr virus (HHV4)

67
Q

How does glandular fever present?

A
  1. Cervical lymphadenopathy
  2. Fever
  3. Painful sore throat

+ malaise, myalgia, fatigue, splenomegaly, Petechie on soft palate, jaundice

68
Q

How is glandular fever diagnosed?

A

Mono spot test - antibodies test

FBC- lymphocytes

69
Q

How is glandular fever managed?

A
  1. Supportive care - fluids, analgesia, avoid alcohol, rest

2. No contact sports for 8 weeks

70
Q

How is scarlet fever caused?

A

Reaction to strep toxin after sore throat

71
Q

How does scarlet fever present?

A

Strawberry tongue - white coat and red papillae
Rash on torso , sandpaper
Tonsillitis

72
Q

Describe the rash in meningococcal septicaemia

A

non blanching purpuric

purpura occurs because toxins form the infection damage the blood vessels causing them to leak under the skin

3a Paediatrics (9 decks)

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