PAEDS - INFECTIONS/ALLERGY TO DO Flashcards
1
Q
FEBRILE CHILD
What system is used to assess a febrile child?
What are the main components?
A
- NICE traffic light system for <5
- Colour (skin, lips, tongue)
- Activity
- Respiratory
- Circulation + hydration
- Other
2
Q
FEBRILE CHILD
In terms of the NICE traffic light system, what is considered amber for…
i) colour?
ii) activity?
iii) respiratory?
iv) circulation and hydration?
v) other?
A
i) Pallor
ii) No smile, decreased activity, not responding to social cues, wakes when roused
iii) Nasal flaring, SpO2 ≤95%, crackles in chest RR>50 (6-12m) or >40 (>12m)
iv) Tachy (>160 if <1y, >150 if 1–2y, >140 if 2–5y), CRT ≥3s, dry mucous membranes, reduced urine output
v) 3-6m temp ≥39, fever ≥5d, rigors, joint swelling, non-weight bearing
3
Q
FEBRILE CHILD
In terms of the NICE traffic light system, what is considered red for…
i) colour?
ii) activity?
iii) respiratory?
iv) circulation and hydration?
v) other?
A
i) Mottled skin
ii) No response to cues, doesn’t wake if roused, weak, high-pitched or constant cry
iii) Grunting, RR>60, mod-severe chest indrawing
iv) Reduced skin turgor, no urine output
v) <3m temp ≥38, non-blanching rash, bulging fontanelle, neck stiffness, status, focal seizures/neuro
4
Q
FEBRILE CHILD
What are some common and uncommon causes of fever?
A
- Common = URTI, tonsillitis, otitis media, UTI
- Uncommon = Meningitis, epiglottitis, kawasaki disease, TB
5
Q
FEBRILE CHILD
What is the management of a green score?
A
- Manage at home with safety netting
- Regular fluids, monitor child, contact if concerned
6
Q
FEBRILE CHILD
What is safety netting?
A
- Clear verbal ± written advice about warning signs with plan of action
- Follow up if required
- Liaise with other HCPs so direct access if child needs
7
Q
FEBRILE CHILD
What is the management of an amber score?
A
- F2F assessment with paeds or specialist for further investigation
- ?Home with safety net
8
Q
FEBRILE CHILD
What is the management of a red score?
A
- Urgent referral to hospital for specialist assessment (?999)
9
Q
CHICKEN POX
What is Ramsay Hunt syndrome?
A
- Herpes zoster oticus > reactivation of varicella zoster virus in geniculate ganglion of CN7
10
Q
MENINGITIS
What are the most common causes of bacterial meningitis?
A
- Neonates = GBS or listeria monocytogenes
- 1m–6y = N. meningitidis (gram -ve diplococci), S. pneumoniae (gram + ve cocci chain), H. influenzae
- > 6y = meningococcus + pneumococcus, rarely TB
11
Q
MENINGITIS
What is the difference between Kernig’s and Brudzinski signs?
A
- Kernig = pain/unable to extend leg at knee when it’s bent
- Brudzinski = involuntary flexion of hips/knees when neck flexed
12
Q
MENINGITIS
You suspect a diagnosis of TB meningitis. How would a lumbar puncture confirm the diagnosis for…
i) appearance?
ii) protein?
iii) glucose?
iv) white cell count?
v) other?
A
i) Turbid/viscous
ii) +++
iii) –––
iv) + lymphocytes
v) Acid fast bacilli
13
Q
MENINGITIS
What are some complications of meningitis?
A
- Hearing (sensorineural) loss is key complication
- Seizures + epilepsy, cerebral abscess, encephalitis + hydrocephalus
- Cognitive impairment, cerebral palsy + LD
14
Q
MENINGITIS
What is the management of bacterial meningitis?
A
- Supportive = correct shock with fluids, oxygen if needed
- <3m = IV cefotaxime + amoxicillin (cover listeria from ?pregnancy)
- > 3m = IV ceftriaxone + IV dexamethasone to reduce frequency + severity of hearing loss + neuro damage (NOT before 3m)
15
Q
MENINGITIS
What are the drawbacks with giving ciprofloxacin to a close contact?
A
- Do not give in myasthenia gravis or previous sensitivity,
- can cause tendinitis
- can trigger seizures
16
Q
MENINGITIS
What are the drawbacks with giving rifampicin to a close contact?
A
- Affect hormonal contraception,
- not advised in pregnancy
- have to monitor LFTs + renal function
17
Q
ENCEPHALITIS
What causes it?
A
- Mostly viral – herpes viruses (HSV 1 if child or 2 if neonate from birth, VZV), enteroviruses, EBV, resp viruses
- Non viral = any bacterial meningitis, TB, lyme disease
- Non-infective = autoimmune antibodies against brain
18
Q
ENCEPHALITIS
What would the CSF analysis show in encephalitis for…
i) appearance?
ii) protein?
iii) glucose?
iv) white cell count?
A
i) Clear
ii) Normal/+
iii) Normal/–
iv) + lymphocytes
19
Q
SEPTICAEMIA
What are the causes of septicaemia?
A
- Most common = N. meningitidis
- Neonates = GBS or gram -ve organisms from birth canal
20
Q
SEPTICAEMIA
How does shock present?
A
- Tachycardia + tachypnoea
- Cold peripheries
- Capillary refill >2s
- Hypotensive
- Oliguria
21
Q
SEPTICAEMIA
What are some risk factors?
A
- Sickle cell disease
- immunodeficiency
22
Q
SCARLET FEVER
What are some complications of scarlet fever?
A
- Otitis media (#1),
- quinsy,
- post-strep glomerulonephritis,
- rheumatic fever
23
Q
KAWASAKI DISEASE
What is the diagnostic criteria for Kawasaki disease?
A
CRASH and BURN (fever)
- Conjunctivitis
- Rash
- adenopathy (unilateral, cervical)
- strawberry tongue and red/dry cracked lips
- Hands and feet swell and later desquamate
- Fever >39 degrees for >5 days
24
Q
KAWASAKI DISEASE
What are the side effects of IVIG in the management of Kawasaki disease?
A
- anaphylaxis,
- aseptic meningitis,
- organ dysfunction
25
MEASLES
What are the investigations for measles?
Clinical Dx with serological (blood or saliva) testing for epidemiology
26
MEASLES
What are some important complications of measles?
- Otitis media (commonest complication)
- Pneumonia (commonest cause of death)
- Diarrhoea
- Febrile convulsions, encephalitis
- Subacute sclerosing panencephalitis rare where 5-10y after primary measles > loss of neuro function, dementia + death
27
RUBELLA
What is the clinical presentation of rubella?
- Mild prodrome (low-grade fever, sore throat, coryza)
- Pink maculopapular rash starts on face then spreads down to cover whole body
- Rash not itchy in children but is in adults
- Suboccipital + postauricular lymphadenopathy
28
RUBELLA
What are some complications of rubella?
How can it be reduced?
- Rare but > encephalitis, arthritis, myocarditis + thrombocytopenia
- Congenital rubella syndrome > cataracts, CHD + sensorineural deafness
- Avoid pregnant women, school exclusion 4d from rash, ensure vaccinated
29
MUMPS
What are some complications of mumps?
- Viral meningitis + encephalitis
- Orchitis (usually unilateral, may reduce sperm count + lead to infertility)
- Pancreatitis
30
GLANDULAR FEVER
What are the investigations for glandular fever?
- FBC (lymphocytosis)
- positive Monospot test with heterophile antibodies
31
GLANDULAR FEVER
What are the complications of glandular fever?
- Splenic rupture,
- haemolytic anaemia,
- chronic fatigue,
- EBV associated with Burkitt's lymphoma
32
SLAPPED CHEEK
What is slapped cheek syndrome, or erythema infectiosum?
- Caused by parvovirus B19, outbreaks common during spring months
33
SLAPPED CHEEK
How is it spread?
- Respiratory secretions,
- vertical transmission
- transfusions
34
SLAPPED CHEEK
What is the clinical presentation of slapped cheek syndrome?
- Prodromal Sx = fever, malaise, headache, myalgia
- Followed by classic rose-red rash on face week later (slapped-cheek)
- Progresses to maculopapular, 'lace-like' rash on trunk + limbs
35
SLAPPED CHEEK
What is important to note in slapped cheek syndrome?
Infects red cell precursors in bone marrow which can cause complications
36
SLAPPED CHEEK
What are some complications of slapped cheek syndrome?
- Aplastic crisis (most serious) more common in chronic haemolytic anaemias like sickle cell, thalassaemia + in immunocompromised
- Vertical transmission can lead to foetal hydrops + death due to severe anaemia
37
IMPETIGO
What is bullous impetigo?
Who is it seen in?
- Epidermolytic toxins breakdown proteins that hold skin cells together > fluid-filled vesicles (bullae)
- Rupture + fluid exudation > classic golden/honey crusted lesions
- More common in neonates or <2y, commonly systemically unwell
38
IMPETIGO
What are some complications of impetigo?
- Risk of SSSS
- Post-strep glomerulonephritis
39
IMPETIGO
What is the management of impetigo?
- Swab vesicles, avoid sharing towels, cutlery, try not to scratch
- Hydrogen peroxide 1% cream (or mupirocin)
- PO flucloxacillin if severe + systemically unwell
- School exclusion until lesions crusted + healed or 48h after Abx
40
STAPH SCALDED SKIN
What is staphylococcal scalded skin syndrome (SSSS)?
- Caused by type of S. aureus that produces epidermolytic toxins that breakdown proteins that hold skin together
41
STAPH SCALDED SKIN
What is the clinical presentation of SSSS?
- Starts as generalised patches of erythema on the skin, skin looks thin + wrinkled
- Bullae formation which burst + leave very sore, erythematous skin below (like a burn/scald)
- Nikolsky sign = gentle rubbing causes peeling
- Systemic Sx = fever, lethargy, dehydration > sepsis
42
STAPH SCALDED SKIN
Who is it more common in?
Children <5y as when older they develop immunity to toxins
43
STAPH SCALDED SKIN
What is the management of SSSS?
- Most need admission for IV flucloxacillin, fluid balance + analgesia
44
TOXIC SHOCK SYNDROME
What is the pathophysiology?
- Toxin producing S. aureus + group A strep released from infection acts as a superantigen to cause multi-organ dysfunction
45
TOXIC SHOCK SYNDROME
What is the clinical presentation of toxic shock syndrome?
- Fever ≥39
- Hypotension (shock)
- Diffuse erythematous rash
- Desquamation of rash (esp. palms + soles) 1-2w after
- Multi-organ dysfunction
46
TOXIC SHOCK SYNDROME
Give some examples of multi-organ dysfunction in toxic shock syndrome
- GI = D+V
- CNS = confusion
- Thrombocytopenia
- Renal failure
- Hepatitis
- Clotting abnormalities
47
HERPES SIMPLEX
What are the various manifestations of herpes simplex infection?
- Gingivostomatitis
- Cold sores on lip
- Eczema herpeticum
- Herpetic whitlows
- Eyes = blepharitis or conjunctivitis
- CNS = aseptic meningitis, encephalitis
48
HERPES SIMPLEX
What is gingivostomatitis?
How may it present?
- Vesicular lesions on lips, gums, tongue which can lead to painful ulceration + bleeding
- High fever, miserable child, oral intake may hurt
49
HERPES SIMPLEX
How is eczema herpeticum managed?
IV aciclovir as life-threatening, bacterial infection will need Abx
50
HIV
When should HIV be suspected?
- Persistent lymphadenopathy
- Hepatosplenomegaly
- Recurrent fever
- Parotitis
- Serious, persistent, unusual, recurrent (SPUR) infections
51
HIV
How is HIV investigated?
- <18m cannot use antibody (transplacental HIV IgG if exposed anyway)
- 2x HIV DNA PCR blood test (double negative to exclude) for viral load
– Within first 3m + at least 2w after completion of postnatal antiretroviral
52
HIV
How should HIV be managed?
- Antiretrovirals based on viral load + CD4 count
- Co-trimoxazole prophylaxis (PCP)
- ?Additional vaccines but not BCG as live
- Regular follow up, check development, psychological support
- Safe sex education when older
53
TUBERCULOSIS
What is the pathophysiology of tuberculosis (TB)?
- Lung lesion + (mediastinal) lymph nodes = Ghon or primary complex
- Primary infection > caseating granulomas followed by period of dormancy with ?reactivation (secondary TB)
- If immune system unable to cope it disseminates > miliary TB
54
TUBERCULOSIS
Where can miliary TB affect?
- Pleura,
- CNS,
- pericardium,
- lymph nodes,
- GI/GU tract
55
TUBERCULOSIS
What are some investigations for TB?
- Mantoux 'tuberculin' test
- Interferon gamma release assays
- 3x samples of sputum MC&S = gold standard
- CXR
56
TUBERCULOSIS
When diagnosing TB, what would you see on CXR?
- Patchy consolidation,
- pleural effusions,
- hilar lymphadenopathy
57
TUBERCULOSIS
When diagnosing TB, what would you see on Mantoux test?
- >15mm suggests active TB,
- 6-15mm ?previous exposure (may be BCG)
58
TUBERCULOSIS
When diagnosing TB, what would you see on interferon gamma release assays?
Confirms latent TB + differentiates from BCG
59
TUBERCULOSIS
When diagnosing TB, what would you see on sputum MC&S?
Acid fast bacilli stain red with Ziehl-Neelson stain on Lowenstein-Jenson culture medium
60
TUBERCULOSIS
What are some complications of TB?
- Pleural + pericardial effusions
- Lung collapse
- Lung consolidation
61
TUBERCULOSIS
What are the side effects of rifampicin?
Red urine
62
TUBERCULOSIS
What are the side effects of isoniazid? How can it be prevented?
- Peripheral neuropathy (I'm-so-numb-azid)
- co-prescribe pyridoxine (vit B6) after puberty as prophylaxis
63
TUBERCULOSIS
What are the side effects of pyrazinamide?
- Gout due to hyperuricaemia,
- rash
64
TUBERCULOSIS
What are the side effects of ethambutol?
Optic neuritis, reduced acuity + colour (eye-thambutol)
65
TUBERCULOSIS
What is the management of latent TB?
- Isoniazid (+ vit B6) for 6m
- Isoniazid (+vit B6) + rifampicin for 3m
66
VACCINATIONS
What vaccines are attenuated?
- MMR, BCG, nasal flu, rotavirus + Men B
67
VACCINATIONS
Which vaccines are included in the 6-in-1 injection?
- diphtheria
- tetanus
- pertussis DTaP (whooping cough)
- polio IPV
- Haemophilus influenza B (HiB)
- Hepatitis B
68
VACCINATIONS
What vaccines are given at...
i) 2m?
ii) 3m?
iii) 4m?
i) 6-in-one, rotavirus + men B
ii) 6-in-one, rotavirus + PCV
iii) 6-in-one, men B
69
VACCINATIONS
What vaccines are given at...
i) 1y?
ii) 3y + 4m?
iii) 12-13y?
iv) 14y?
i) Men B, PCV, Hib/Men C + MMR
ii) MMR, 4-in-one preschool booster (diptheria, tetanus, whooping cough + polio)
iii) HPV
iv) men ACWY, 3-in-1 teenage booster (diptheria, tetanus + polio)
70
VACCINATIONS
When in the vaccination schedule would at risk individuals get...
i) hep B vaccine?
ii) BCG?
i) Neonate, 1m and 1y (as well as 2m, 3m, 4m as normal schedule)
ii) Neonate
71
ALLERGY
What is an allergy?
Give examples
- Hypersensitivity reaction initiated by specific immunoglobulins
- Food allergy, eczema, allergic rhinitis, asthma, urticaria, insect sting, drugs, latex + anaphylaxis
72
ALLERGY
Define hypersensitivity
Objectively reproducible symptoms/signs following a defined stimulus at a dose tolerated by a normal person
73
ALLERGY
Define atopy
Personal/familial tendency to produce IgE in response to ordinary exposures to allergens (triad = eczema, asthma + rhinitis)
74
ALLERGY
What are two theories of allergy and briefly explain them?
- Hygiene hypothesis = high microbial exposure means less allergy
- Skin sensitisation theory = regular exposure via food + preventing exposure via breaks in skin before food means less allergies
75
ALLERGY
What is the Gell and Coombs hypersensitivity classification?
- Type 1 = IgE trigger mast cells + basophils to release histamines + cytokines
- Type 2 = IgG/M bind to cell-surface antigens which is a host cell but activates immune system as considers foreign > cytotoxic
- Type 3 = immune complex mediated with activation of complement/IgG
- Type 4 = T-cell mediated delayed type hypersensitivity
76
ALLERGY
what is the pathophysiology of a type 1 hypersensitivity reaction?
IgE trigger mast cells + basophils to release histamines + cytokines
77
ALLERGY
Give an example of a type 1hypersensitivity reaction
- acute anaphylaxis,
- hayfever
78
ALLERGY
what is the pathophysiology of a type 2 hypersensitivity reaction?
IgG/M bind to cell-surface antigens which is a host cell but activates immune system as considers foreign > cytotoxic
79
ALLERGY
Give an example of a type 2 hypersensitivity reaction
- autoimmune disease,
- haemolytic disease of newborn,
- transfusion reaction
80
ALLERGY
what is the pathophysiology of a type 3 hypersensitivity reaction?
immune complex mediated with activation of complement/IgG
81
ALLERGY
Give an example of a type 3 hypersensitivity reaction
- SLE,
- RA,
- HSP,
- post-strep glomerulonephritis
82
ALLERGY
what is the pathophysiology of a type 4 hypersensitivity reaction?
T-cell mediated delayed type hypersensitivity
83
ALLERGY
Give an example for of a type 4 hypersensitivity reaction
- TB,
- contact dermatitis
84
ALLERGIC RHINITIS
What are the different types of antihistamines that can be taken for allergic rhinitis?
- Non-sedating = cetirizine, loratadine
- Sedating = chlorphenamine (Piriton) + promethazine
- Nasal may be good option for rapid onset Sx in response to trigger
85
ANAPHYLAXIS
What investigation confirms anaphylaxis?
- Serum mast cell tryptase within 6h of event = mast cell degranulation
86
ANAPHYLAXIS
What is the acute management of anaphylaxis?
- Airway = secure
- Breathing = oxygen, salbutamol to help wheeze, monitor SpO2, RR
- Circulation = IV fluid bolus with collapse, monitor BP, ECG
- Disability = lie pt flat to improve cerebral perfusion
- Exposure = look for flushing, urticaria + angioedema
87
ANAPHYLAXIS
What medications can be given in anaphylaxis?
- IM adrenaline (EpiPen if community), repeat after 5m if necessary
- Antihistamines like chlorphenamine or cetirizine
- Steroids like IV hydrocortisone
88
IMMUNE DEFICIENCY
What are the 6 types of immune deficiency?
- T-cell defects
- B-cell defects
- Combined B- + T-cell defects
- Neutrophil defect
- Leucocyte function defect
- Complement defects
89
IMMUNE DEFICIENCY
What are T-cell defects?
- Severe/unusual viral + fungal infections + failure to thrive in first 2m
90
IMMUNE DEFICIENCY
Give some examples of T-cell defects
- DiGeorge syndrome
- HIV
- Duncan syndrome (X-linked lymphoproliferative disease)
- Ataxic telangiectasia
- Wiskott-Aldrich
91
IMMUNE DEFICIENCY
What are B-cell defects?
Give some examples
- Present beyond infancy as passively acquired maternal antibodies, severe bacterial infections, esp. (lower) RTIs.
- Selective IgA deficiency (#1)
- X-linked (Bruton) agammaglobulinaemia
- Common variable immune deficiency
92
IMMUNE DEFICIENCY
Give some examples of combined B- and T-cell disorders
- Severe combined immunodeficiency = group of inherited disorders of profound defective cellular + humoral immunity
- Hyper IgM syndrome = B cells produce IgM but prevented from IgG/A
93
IMMUNE DEFICIENCY
What do neutrophil defects lead to?
Give an example
- Recurrent bacterial infections
- Chronic granulomatous disease = X-linked recessive, defect in phagocytosis as fail to produce superoxide after ingestion
94
IMMUNE DEFICIENCY
What are leucocyte function defects?
Give an example
- Delayed separation of umbilical cord, wound healing, chronic skin ulcers
- Leucocyte adhesion deficiency = deficiency of neutrophil surface adhesion molecules so inability to migrate to sites of infection
95
IMMUNE DEFICIENCY
What are complement defects?
Examples
- Recurrent bacterial infections (meningococcal, HiB, pneumococcus), SLE-like illness
- Hereditary angioedema (measure C4 levels)
- Mannose-binding lectin deficiency
96
IMMUNE DEFICIENCY
What are some investigations for immune deficiency?
- FBC (WCC, lymphocytes, neutrophils)
- Blood film
- Complement
- Immunoglobulins
97
IMMUNE DEFICIENCY
What prophylaxis should be given in immune deficiency?
- T-cell + neutrophil = co-trimoxazole for PCP, fluconazole for fungal
- B-cell = azithromycin for recurrent bacterial infections
98
IMMUNE DEFICIENCY
What is the management of immune deficiency?
- Prompt, appropriate + longer Abx courses
- Screen for end-organ disease (CT scan)
- Ig replacement therapy if antibody deficient
- Bone marrow transplantation for SCID, chronic granulomatous disease
99
WHOOPING COUGH
What are some complications of pertussis?
- Pneumonia
- Convulsions
- Bronchiectasis
100
WHOOPING COUGH
What is the management of pertussis?
- Notify PHE
- Prophylaxis = vaccine (esp. infants + pregnant women) or if close contact macrolide (erythromycin)
- PO macrolides (azithromycin, clarithromycin) 1st line if onset <21d
- School exclusion for 48h following Abx or 21d from onset if no Abx
101
WHOOPING COUGH
When should you admit a child to hospital with pertussis?
- Suffering from cyanotic attacks
- <6m
102
POLIO
what is the cause?
poliovirus type 1
103
POLIO
what is the pathophysiology?
- transmitted via faecal-oral route
- incubation period is 3-30 days + can be excreted for up to 6 weeks
- replicates in nasopharynx + GI tract and can spread to CNS where it can affect anterior horn cells, motor neurons and the brainstem
104
POLIO
what is the clinical presentation?
90-95% of cases are asymptomatic
fatigue
fever
nausea and vomiting
diarrhoea
sore throat
headache
photophobia
105
POLIO
what are the clinical features of a more serious polio infection?
acute flaccid paralysis (AFP)
- initially fatigue, fever N+V
- asymmetrical lower limb weakness and flaccidity
can progress to life-threatening bulbar paralysis and respiratory compromise
106
POLIO
what are the investigations?
- virus culture from stool, CSF or pharynx
- CSF analysis
- serum antibodies to poliovirus
- MRI of spinal cord
- EMG of affected limb(s)
107
POLIO
what is the management?
- supportive care with rehydration and neurological monitoring
- physiotherapy
- intubation and ventilation for respiratory paralysis
108
POLIO
what are the complications?
post-poliomyelitis syndrome (PPS) - this usually occurs years after the initial infection
- demonstrates the same features as polio infection
- treated in the same way as polio
109
DIPHTHERIA
what is the cause?
Corynebacterium diphtheriae
110
DIPHTHERIA
what is the pathophysiology?
- it infects the epithelium of the skin and the mucosa of the upper resp tract
- it forms a grey pseudomembrane
111
DIPHTHERIA
what is the clinical presentation?
- sore throat
- low grade fever
- dysphagia, dysphonia, dyspnoea and croupy cough can occur in serious illness
112
DIPHTHERIA
what are the investigations?
- throat + nose swabs, microscopy and culture
- diphtheria antibodies
- PCR
113
DIPHTHERIA
what is the management?
- hospitalisation, isolation
- diphtheria anti-toxin
- antibiotic (procaine benzylpenicillin)
114
DIPHTHERIA
what is the management for close-contacts?
prophylactic antibiotics - erythromycin
diphtheria toxoid immunisation
115
CANDIDIASIS
what is the management?
oral or topical anti-candidial drugs e.g. nystatin, fluconazole
116
SCHOOL EXCLUSION
what are the rules for scarlet fever?
24hrs after commencing antibiotics
117
SCHOOL EXCLUSION
what are the rules for measles?
4 days from onset of rash
118
SCHOOL EXCLUSION
what are the rules for whooping cough?
2 days after commencing antibiotics (or 21days from onset of symptoms if no antibiotics)
119
SCHOOL EXCLUSION
what are the rules for rubella?
5 days from onset of rash
120
SCHOOL EXCLUSION
what are the rules for chicken pox?
all lesions have crusted over
121
SCHOOL EXCLUSION
what are the rules for mumps?
5 days from onset of swollen glands
122
SCHOOL EXCLUSION
what are the rules for diarrhoea and vomiting?
until symptoms have settled for 48hrs
123
SCHOOL EXCLUSION
what are the rules for scabies?
until treated
124
SCHOOL EXCLUSION
what are the rules for influenza?
until recovered
125
SCHOOL EXCLUSION
what are the rules for conjunctivitis?
no exclusion
126
SCHOOL EXCLUSION
what are the rules for hand, foot and mouth?
no exclusion
127
SCHOOL EXCLUSION
what are the rules for infectious mononucleosis?
no exclusion
128
SCHOOL EXCLUSION
what are the rules for headlice?
no exlcusion
129
SCHOOL EXCLUSION
what are the rules for threadworms?
no exclusion
