Peadiatric Infectious Disease

Question 1

How does bacterial meningitis and septicaemia present, is diagnosed and managed?

Answer 1

Presentation of sepsis
- fever or hypothermia, cold hands or feet, mottled, prolonged cap refill time, chills/rigor, limb pain, vomiting +/or diarrhoea, muscle weakness/ ache, joint ache, skin rash, diminished urine output

Investigations: FBC, CRIP, UEs, LFTs, blood gas, glucose, culture, coagulation factors, csf cell count and culture, protein and glucose in csf, urine culture, skin biopsy culture, CT/MRI head

Treatment: support ABC(DEFG), test cause eg antibiotics with broad spec and good csf penetration, third ten cephalosporins (+ amoxicillin if neonate)

Meningitis +/- sepsis
Symptoms: nuchal rigidity, headaches, photophobia, diminished consciousness, focal neurological abnormalities, seizures. Neonates: lethargy, irritability, bulging fontanelle, seizures
Signs: rash
Treatment: chemoprophylaxis, steroids

Strep pneumoniae complications: brain damage, hearing loss, hydrocephalus

Question 2

What are the common patterns of streptococcal and staphylococcal infection and their treatment?

Answer 2

Group A strep pattern: malaise, fever, pharyngitis, rash, strawberry tongue, squamation of hands, feet
- common in wintertime, usually toddler to school age
- complicated presentations in immunosuppressed, chickenpox
- treatment is 10d course of penicillin
- complications: impetigo, erysipelas, necrotising fasciitis, rheumatic fever, glomerulonephritis
= PENICILLIN

Staph: causes impetigo, cellulitis, infected eczema, ulceration, staph scalded skin syndrome, toxic shock syndrome
= FLUCLOXACILLIN

Question 3

How do you recognise herpes simplex, varicella zoster and enterovirus infection and their treatment?

Answer 3

Varicella zoster
Mild malaise and fever, itchy, exanthema, complications include secondary strep/staph infections, meningoencephalitis, cerebellum is, arthritis
Treatment is aciclovir if immunosuppressed

Herpes simplex
Self limiting
Recurrent cold sores, complications: kerstoconjunctivitis, encephalitis, systemic neonatal infections (can disseminate very quickly esp. to cns), immunocompromised children
Treatment: topical aciclovir

Enterovirus
Hand foot mouth disease (coxsackie A16, enterovirus 71)
Usually children under 10: exanthema, painful lesions, recovery in 5 to 10 days. May cause complicated illness in neonates

Question 4

How does Kawasaki disease present?

Answer 4

Self limiting vasculitis of medium arteries
Can cause persistent fever and rash
Aetiology unknown
Leading cause of acquired heart disease in developed world eg coronary aneurysm

Symptoms: fever for 5 days plus conjunctivitis (no discharge, more red eyed), cracked lips/strawberry tongue, cervical lymphadenopathy, polymorphous rash, changes of the extremities

Exclude differentials

Treatment: prevent complications

• immunoglobulins
• aspirin
• steroids
• other immunosuppression
• cardiology assessment

Question 5

What are the presenting features of an underlying immunodeficiency including HIV and what is the initial approach to assessing these children?

Answer 5

Primary (usually genetic role) or secondary IMD (acquired via HIV or prolonged steroid use)

Presentation:

• antibody deficiencies = recurrent bacterial infections
• cellular IMDs = unusual or opportunistic infections, recurrent/severe viral infections or failure to thrive
• innate immune disorders = sepsis, abscess, fungal infections
• other diagnoses w/ similar presentations eg inflammatory, auto immune malignancy

Assessment:

• take a good history eg characteristics, severity, frequency, particular organisms, sites/organs, age at onset, FH, other systemic features
• investigations eg FBC, immunoglobulins, HIV test, functional antibodies, lymphocyte subsets, NBT (nitrile blue? test), complement

Children presenting with HIV may have a side range of presentations and symptoms