BCG if risk factors: - TB in family in past 6 months - contact / travel to certain countries?

6 in 1 - diphtheria - tetanus - whooping cough - polio - Hib - hepatitis B Oral rotavirus Pneumococcal conjugate vaccine (PCV)

Paeds Written - Infections Flashcards by Rebecca Thompson

Red flag features in febrile child

Pale, mottled, ashen, blue skin, lips or tongue

No response to social cues
Appears ill to HCP
Does not wake or, if roused, does not stay awake
Weak, high pitched or continuous cry

Grunting
Moderate-severe chest indrawing (recessions)

Reduced skin turgor

Age <3 months + temp >38
Bacterial meningitis signs/Sx
HSV encephalitis signs/Sx

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Key features of neonatal toxoplasmosis

Cerebral calcification
Chorioretinitis
Hydrocephalus

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Key features of neonatal syphillis

Early:

snuffles, rhinitis
desquamative rash - palms, soles
splenomegaly

Late:

small teeth
Saber shins
sensorineural deafness

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Key features of neonatal Rubella

Sensorineural deafness
Congenital cataracts
Congenital heart disease - PDA
Glaucoma

+ salt & pepper chorioretinitis

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Key features of CMV neonatal infection

Growth retardation

Purpuric skin lesions (blueberry muffin rash?)

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Vaccines at birth

BCG if risk factors:

TB in family in past 6 months
contact / travel to certain countries?

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Vaccines at 6-8 weeks

DTaP = 6 in 1

diphtheria
tetanus
whooping cough
polio
HiB
Hep B

Oral rotavirus

Men B

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Vaccines at 12 weeks

6 in 1

diphtheria
tetanus
whooping cough
polio
Hib
hepatitis B

Oral rotavirus

Pneumococcal conjugate vaccine (PCV)

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Vaccines at 16 weeks

16 weeks = 6 (in 1) + 1 extra (Men B)

6 in 1: diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B

Men B

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Vaccines at 12-13 months

Hib/Men C

MMR

PCV

Men B

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Vaccines from 2-8 years old

Annual influenza

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Vaccines at 3-4 years

4 in 1 pre-school booster

diptheria
tetanus
whooping cough
polio

MMR

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Vaccines in secondary school

12-13 years = HPV (strains 6, 8, 11, 16)

13-18 years

teenage 3 in 1 booster (diphtheria, tetanus, polio)
Men ACWY

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How should vaccinations be scheduled in premature babies?

According to chronological age NOT corrected gestational age

Premature <28 weeks should have first set in hospital due to apnoea risk

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Infective period for measles

From prodrome (4 days before rash) –> 4 days after

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Key clinical features of measles infection

Prodrome: fever, conjunctivitis, irritability

Koplik spots - ‘grains of salt’ on buccal mucosa

Rash - starts behind ears, spread + becomes confluent, desquamates after 1 week

No lymphadenopathy

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Non medical aspects of Measles management

Inform PHE - notifiable disease

4 days exclusion from rash onset

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Important complications of measles

Encephalitis

1-2 weeks after illness
headaches, irritability, seizures
coma, death (15%)

Subacute sclerosis panencephalitis

5-10 years after illness
very rare
dementia + death from measles lying dormant in CNS

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Most common complication of measles?

Otitis media

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Infectious period of rubella

1 week BEFORe to 5 days after rash onset

Clinical features of rubella

Prodrome: fever or asymptomatic

Pink maculopapular rash

face then whole body
Forchheimer spots in 20% (red spots on soft palate)

Lymphadenopathy

Management of rubella infection

Notify PHE
Isolate for 4 days from rash onset

Supportive: fluid, analgesia, rest

Safety net for complications - haemorrhagic D/T thrombocytopenia

Infectious period for Slapped Cheek / Parvovirus B19

10 days BEFORE –> 1 day AFTER rash onset

Complications of Parvovirus B19

Foetal disease - maternal transmission –> hydrops fetalis (death due to severe anaemia)

Aplastic crisis - children with chronic haemolytic anaemia e.g. sickle cell OR immunodeficiency

Key clinical features of parvovirus B19 infection

Asymptomatic / coryza period for 2-3 days Latent 7-10 days Erythema infectiosum = slapped check --> maculopapular lace-like rash (trunk + limbs) 1 week later

Management principles for Parovirus B19 infection

Supportive: fluids, rest, analgesia No need for school exclusion / avoiding pregnancy women - not really infectious once rash present Safety net complications!

Timeline of roseola infantum

High fever + malaise for several days THEN maculopapular rash (as fever wanes) - can be up to 1-2 weeks later - lasts 1-2 days

Specific derm feature seen in Roseola infantum?

Nagayama spots - erythematous papular enanthem on uvula + soft palate

Management for Roseola infantum

Supportive: fluids, analgesia, rest No school exclusion needed Safety net - febrile convulsions advice

Mumps infectious period

5 days BEOFRE --> 5 days AFTER parotid swelling

Investigations for Mumps

Serology (IgM) from Oral fluid test sample | Amylase - raised in blood

Complications of mumps

Orchitis --> infertility (very rare) Viral meningitis / encephalitis (very rare) Deafness - unilateral, transient

Complications of Chickenpox

Secondary bacterial infection - range from single infected lesion --> small area of cellulitis --> invasive Group A strep infection - AVOID NSAIDs - increase risk of necrotising fasciitis Purpura fulminans / Disseminated haemorrhagic chickenpox - cross reactive Abs - inhibit the anti-coagulation protein C and S - clotting + purpuric skin rash

When to treat chickenpox?

Adolescent/adult with chickenpox = oral acyclovir 800mg 5x/day for 7 days Immunocompromised or neonate - disease = IV acyclovir - exposure = VZ Ig Encephalitis = IV acyclovir

Advice RE school exclusion in Hand, foot & mouth disease

No exclusion required BUT advised to keep off school until they feel better Contact PHE if large outbreak suspected

Causative organisms of Hand, Foot & Mouth disease

Coxsackie A16 - most common Enterovirus 71 - severe Coxsackie A6 - atypical

Causative Organism in Scarlet Fever

Streptococcus pyogenes (Group A strep)

Key clinical features of scarlet fever

'Sandpaper' rash Pastia's lines - rash in prominent skin creases White tongue --> desquamated Strawberry tongue

Management of Scarlet fever

1st line = Phenoxymethylpenicillin 2nd line = azithromycin Notify PHE Exclusion from nursery/school for 24 hours from starting Abx

Testing for HIV in infant

<18 months - viral PCR - cannot use serology as have maternal anti-HIV IgG from mother >18 months = serology - Ab detection using ELISA

When is HIV PCR measured in at-risk infant?

At birth On discharge 6 weeks (2 weeks after stopping prophylaxis) 12 weeks (8 weeks after stopping prophylaxis) 18 months

HIV prophylaxis options for neonate?

Low-medium risk = Zidovudine monotherapy 2-4 weeks High risk = PEP (2 NRTI + 1 Integrase inhibitor) 4 weeks

High risk features for recurrence of febrile convulsion

Age of onset <18 months Fever <39 Shorter duration of fever before seizure Family Hx

Features of simple febrile convulsion

<15 mins Generalised No recurrence within 24 hours Complete recovery within 1 hour

Typical age for febrile convulsion

6 months --> 5 years

Criteria for admission after febrile convulsion

``` First febrile convulsion <18 months old Features of complex seizure Diagnostic uncertainty Currently taking Abx ```

Advice for parents RE: febrile convulsions

Call ambulance if >5 mins seizing (or >10 mins after giving meds) During seizure: - protect from injury - do not restrain After: check ABC + put in recovery position Regular antipyretics do NOT prevent future seizure Recurrent seizures - can be trained to give medication e.g. buccal midazolam, rectal diazepam

Threadworm symptoms

Asymptomatic - 90% Perianal itching (especially at night) +/- vulval Sx

Management of threadworm

<6 months = consult ID + hygiene advice for 6 weeks > 6 months = mebendazole (Obex) single dose for ALL OF HOUSEHOLD