Paeds infectious Flashcards
What is Kawasaki disease?
- systemic, medium-sized vessel vasculitis
- mucocutaenous lymph node syndrome
What is the epidemiology of Kawasaki disease?
- affects young children, usually <5
- more common in Asian: Japanese + Korean
- more common in boys
What are the features of Kawasaki disease?
- conjunctivitis
- rash: widespread erythematous maculopapular
- cervical lymphadenopathy
- strawberry tongue
- skin peeling on palms and soles
- persistent high fever for >5 days
- cracked lips
What investigations are done for Kawasaki disease?
- FBC
- LFTs: hypoalbuminaemia
- inflammatory markers: ESR
- urinalysis: raised wbc without infection
- echocardiogram
Describe the acute phase of Kawasaki disease?
- most unwell
- fever
- rash
- lymphadenopathy
- lasts 1-2 weeks
What is the subacute phase of Kawasaki disease?
- desquamation
- arthralgia
- lasts 2-4 weeks
What is the convalescent stage of Kawasaki disease?
- symptoms settle
- normal bloods
- lasts 2-4 weeks
What is the management of Kawasaki disease?
- high dose aspirin for thrombosis
- IVig for coronary artery aneurysms
- close follow up with echocardiograms
What is meningitis?
- inflammation of the meninges (lining of the brain and spinal cord)
What is meningococcal septicaemia?
- meningococcus bacterial infection in the bloodstream
- causes the non blanching rash
- infection has caused disseminated intravascular coagulopathy (DIC) and subcutaneous haemorrhages
What is meningococcal meningitis?
- bacteria infects the meninges and CSF
What are the bacterial causes of meningitis?
- Neisseria meningitides
- S. pneumoniae
- neonates: GBS
How does bacteria causing meningitis enter the body?
- extra cranial infection: nasal carriage, otitis media, sinusitis
- via bloodstream: bacteraemic
- neurosurgical complications: post op, infected shunts
What are the most common causes of viral meningitis?
- HSV, enterovirus and VZV
- CSF sample sent for PCR testing
- treated with aciclovir
What are symptoms of meningitis?
- fever
- photophobia
- neck stiffness
- non-blanching petechial rash
- vomiting
How does meningitis present in neonates?
- non-specific signs
- poor feeding
- lethargy
- bulging fontanelle
How is meningitis investigated?
- lumbar puncture if
- under 1 mo with fever
- 1-3 mo with fever and unwell
- <1 year and other features of serious illness
What special considerations should be made when treating meningitis?
- allergy to penicillin: if anaphylaxis switch to chloramphenicol
- recent travel: add vancomycin
What are contraindications for a lumbar puncture?
- abnormal clotting (platelets/coagulation)
- petechial rash
- raised ICP
What is seen on LP for bacterial meningitis?
- cloudy
- high protein
- low glucose
- high neutrophils
What is seen on LP for viral meningitis?
- clear
- mildly raised or normal protein
- normal glucose
- high lymphocytes
What are differential diagnoses for meningitis?
- subarachnoid haemorrhage
- migraine
- flu and sinusitis
- malaria
What is the public health response to meningitis?
- notify UK HSA
- identify close contacts
- PEP: ciprofloxacin or rifampicin for close contacts
What is Kernig’s test?
- lie patient on back
- flexing one hip and knee to 90 degrees and slowly straighten knee (keep the hip flexed)
- spinal pain or resistance to movement in meningitis
What is Brudisinski’s test?
- lie patient on back
- gently lift head and neck and flex chin to chest
- patient will involuntarily flex hips and knees
What are the possible complications of meningitis?
- hearing loss
- cerebral palsy
- seizures and epilepsy
- cognitive impairment
- disability
What management is given for meningitis in primary care?
- IV/IM benzylpenicillin if suspected meningitis AND non blanching rash
- immediate hospital referral
What antibiotics are given for meningitis in hospital?
- < 3mo: cefotaxime + amoxicillin
- > 3mo: ceftriaxone
What is the post-exposure prophylaxis for meningitis?
- single dose of ciprofloxacin
What is the definition of encephalitis?
- inflammation of the brain
What are the causes of encephalitis?
- usually viral
- HSV 1 in children
- HSV2 in neonates
- VZV
- CMV
- EBV
How does encephalitis present?
- altered consciousness and cognition
- unusual behaviour
- acute onset of focal neurological symptoms
- acute onset focal seizures
- fever
What are the investigations for encephalitis?
- LP: lymphocytic CSF and viral PCR
- CT/MRI
What are the contraindications to LP in encephalitis?
- GCS <9
- haemodynamically unstable
- active seizures or post-ictal
What is the management of encephalitis?
- aciclovir if HSV or VZV
- ganciclovir if CMV
- supportive
What are complications of encephalitis?
- lasting fatigue
- changes in personality or mood
- changes to memory or cognition
- headaches
- seizures
What is impetigo?
- superficial bacterial skin infection
- usually caused by S. aureus
- contagious
What causes impetigo?
- bacteria entering via a break in the skin
- healthy
- or related to eczema or dermatitis
What is the epidemiology of impetigo?
- mainly affects infants and school children
- bullous: neonates and children <2
What is non-bullous impetigo?
- occurs around nose or mouth
- exudate dries to form golden crust
- no systemic symptoms
How is non-bullous impetigo treated?
- topical fusidic acid
- oral flucloxacillin if serious
What measures should be taken to stop the spread of impetigo?
- don’t touch or scratch lesions
- hand hygiene
- don’t share face towels
- off school until lesions healed or treated with Abx for 48hrs
What is bullous impetigo and what causes it?
- always caused by S. aureus
- bacteria produce epidermolytic toxins breaking down proteins that hold together skin cells
How does bullous impetigo present?
- 1-2cm fluid filled vesicles
- grow in size and burst forming golden crust
- heal without scarring
- painful and itchy
How does a severe form of bullous impetigo present and what is it called?
- feverish
- unwell
- widespread lesions: staphylococcus scalded skin syndrome
How is bullous impetigo investigated and treated?
- swabs for bacteria and Abx sensitivities
- oral flucloxacillin, IV if unwell
What are the complications of impetigo?
- cellulitis
- sepsis
- post strep glomerulonephritis
- scalded skin syndrome
- scarlet fever
What is staphylococcus scalded skin syndrome?
- condition caused by type of S. aureus producing epidermolytic toxins
- usually affects children <5
How does SSSS present?
- generalised patches of erythema
- skin looks thin and wrinkled
- followed by bullae which burst
- appearance of burn/scald
What is Nikolsky sign?
- gentle rubbing of skin causes it to peel
- positive in SSSS
What are systemic symptoms of SSSS?
- fever
- irritability
- lethargy
- dehydration
How is SSSS managed?
- IV Abx: flucloxacillin
- fluid and electrolyte balance
- avoid dehydration
What causes chickenpox?
- varicella zoster virus
- infected once then develop immunity
How does chickenpox present?
- widespread erythematous rash
- raised and vesicular
- starts on trunk/face and spreads outwards
- lesions then scab over
What are the systemic symptoms of chickenpox?
- fever
- itch
- fatigue
- malaise
How infectious is chickenpox and how does it spread?
- spreads through direct contact with lesions
- infected droplets
- symptomatic from 10 days-3 weeks after
- stop when lesions have crusted over
What are complications of chickenpox?
- bacterial superinfection
- dehydration
- conjunctival lesions
- pneumonia
- encephalitis
- shingles or Ramsay Hunt syndrome
How is chickenpox managed?
- Aciclovir in immunocompromised
- calamine lotion and chlorphenamine for itching
- keep off school until lesions crust
What causes hand, foot and mouth disease and what is the incubation period?
- Coxsackie A virus
- incubation 3-5 days
How does hand, foot and mouth disease present?
- URTI: tired, sore throat, dry cough, temp
- after 1-2 days, small mouth ulcers
- blistering red spots mostly on hands and feet
- painful mouth ulcers on tongue
How is hand, foot and mouth disease diagnosed and managed?
- clinical appearance
- no treatment
- supportive management and simple analgesia
How is transmission of hand, foot and mouth disease prevented?
- avoid sharing towels, bedding
- wash hands
What are complications of hand, foot and mouth disease?
- dehydration
- bacterial superinfection
- encephalitis
