Infectious diseases Flashcards
(96 cards)
1
Q
What is sepsis?
A
SIRS + suspected/proven infection
2
Q
What is SIRS?
A
Systemic inflammatory response syndrome: Fever/hypothermia Tachycardia Tachypnoea Leucocytosis or leucocytopenia
3
Q
What is severe sepsis?
A
SEPSIS + multi-organ failure >2 of: - Respiratory failure - Renal failure - Neurologic failure - Haematological failure - Liver failure
4
Q
What is ARDS?
A
Acute respiratory distress syndrome - inflammatory response of the lungs
5
Q
Which sex des sepsis occur in more?
A
Male
6
Q
What are the responsible pathogens of sepsis in neonates?
A
Group B streptococci
E.coli
Listeria monocytogenes
7
Q
What are the responsible pathogens of sepsis in children?
A
Strep pneumoniae
Meningococci
Group A strep
Staph aureus
8
Q
What are symptoms of paediatric sepsis?
A
Fever/hypothermia Cold hands/feet Mottled skin Prolonged cap refill time Chills/rigors Limb pain Vomiting/diarrhoea Muscle weakness Muscle/joint aches Skin rash Reduced urine output
9
Q
What is probably the best sign of sepsis?
A
Tachycardia
10
Q
What is the treatment for sepsis?
A
ABC
DEFG - don’t ever forget glucose
Antibiotics with broad-spectrum and CSF penetration
Cephalosporins
11
Q
What blood investigations would you do for sepsis and the likely results?
A
FBC - leucocytosis, thrombocytopenia
CRP - elevated
Coag factors - deranged clotting due to DIC
U&Es, LFTs - renal and hepatic dysfunction
Blood gas - metabolic acidosis, raised lactate
Glucose - hypoglycaemia
Culture
12
Q
What CSF investigations would you do for sepsis and what are the likely results?
A
Cell count & culture - increased WCC
Protein & glucose - increased protein level, low glucose
13
Q
What other investigations would you do for sepsis?
A
Blood CSF Urine culture Skin biopsy culture Imaging: CT/MRI head
14
Q
What are the responsible pathogens of meningitis in neonates?
A
Group B strep
E.coli
Listeria monocytogenes
15
Q
What are the responsible pathogens of meningitis in children?
A
Strep pneumoniae
Meningococci
Haemophilus influenza
16
Q
What are the symptoms of meningitis in children?
A
Nuchal rigidity Headaches, photophobia Diminished consciousness Focal neurological abnormalities Seizures
17
Q
What are the symptoms of meningitis in neonates?
A
Lethargy, irritability Bulging fontanelle Seizures High temp Sleepy Breathing fast/difficulty breathing Shivering Vomiting/refusing to feed Blotchy skin Stiff body with jerky movements Cold hands/feet
18
Q
What is the treatment of meningitis?
A
Chemoprophylaxis
Steroids
19
Q
Where does strep pneumoniae colonize?
A
Upper airways
20
Q
What is the transmission of strep pneumoniae?
A
Droplets
21
Q
What are signs of pnuemococcal meningitis?
A
Brain damage
Hearing loss
Hydrocephalus
22
Q
Is strep pneumoniae gram neg or pos?
A
Gram positive
23
Q
Is haemophilus influenza type B gram pos or neg?
A
Gram negative
24
Q
What can haemophilus influenza type B cause?
A
Bacteraemia
Meningitis
Pneumonia
Epiglottitis
25
What are long term complications for survivors of meningitis?
Amputation
Skin scarring
Cognitive impairment/epilepsy/hearing loss
26
What are vaccine preventable diseases?
Meningococcal disease
| Haemophilus influenzae B Pneumococcal disease
27
What are the first signs of scarlet fever after 2-4 days?
Malaise
Fever
Flu-like symptoms
Pharyngitis
28
If progressive strep infection what is the next sign after flu-like symptoms?
Rash
29
What happens to the tongue in scarlet fever
Strawberry tongue
30
What can happen to hands and fingers in scarlet fever?
Peeling
31
What time of year is scarlet fever most common?
Winter
32
When can Group A strep cause complicated presentations?
Immunosuppressed
| Chickenpox
33
What is the treatment for scarlet fever?
Penicillin 10 days
34
What are some complications of scarlet fever?
```
Impetigo
Necrotising fasciitis
Erysipelas
Rheumatic fever
Glomerulonephritis
```
35
What infections can staph aureus cause?
```
Impetigo
Cellulitis
Infected eczema
Ulceration
Staph scalded skin syndrome
Toxic shock syndrome
```
36
Is streptococci gram positive or gram negative?
Gram positive
37
What is streptococci treated with?
Penicillin
38
Does streptococci have resistance issues?
Not usually
39
Is staphylococci gram positive or gram negative?
Gram positive
40
What is staphylococci treated with?
Flucloxacillin
41
Does staphylococci have resistance issues?
Yes - resistance big issue e.g. MRSA
42
What is impetigo caused by usually?
S. Pyogenes
| S. Aureus
43
How does impetigo present?
‘Golden’ sores and blisters
| No systemic symptoms
44
What is SSSS usually caused by?
S. Aureus
45
How does SSSS usually present?
Fever
Widespread redness
Fluid-filled blisters - rupture easily, especially in skin folds
46
What is TSS usually caused by?
S. Pyogenes
| S. Aureus
47
How does TSS present?
Widespread redness, desquamation, multi-organ involvement
48
What is Kawasaki disease?
Self-limited vasculitis of medium-sized arteries
49
What is the leading cause of acquired heart disease in developed world?
Kawasaki disease
50
What are the signs/symptoms of Kawasaki disease?
Fever for 5 days plus:
- bilateral conjunctival injection
- cracked lips/strawberry tongue
- cervical lymphadenopathy >1.5cm
- polymorphus rash
- changes of the extremities
51
What is the diagnostic test for Kawasaki disease?
None - exclude differentials
| Throat swab/microbiology
52
What is the main acquired heart disease caused by Kawasaki disease?
Coronary aneurysm
53
What is the aim of Kawasaki disease treatment?
Aim to prevent complications
54
What is the treatment of Kawasaki disease?
```
Immunoglobulins
Aspirin
Steroids
Immunosuppressive agents
Cardiology assessment
```
55
What are examples of persistant fever and rashes?
Henoch-Schonlein purpura
| Vasculitis
56
What are three categories of rash?
Erthematous maculopapulous
Vesiculobullous
Petechial and purpuric
57
What viruses may present with an erythematous maculopapulous rash?
```
Measles
Rubella
Enterovirus
Cytomegalovirus
Human herpesvirus 6
Human herpesvirus 7
Parvovirus B19
Epstein-Barr virus
```
58
How does a erythematous maculopapulous rash appear?
Red, patchy rash, often raised
59
What viruses may present with a vesticulobullous rash?
VZV
Herpes simplex virus
Enterovirus
60
How does a vesiculobullous rash appear?
Small vesicles, fluid/pus filled, or bullous
61
What viruses may present with a petechial or purpuric rash?
Rubella (congential)
Cytomegalovirus (congenital)
Enterovirus
62
What are the types of VZV infections?
Primary infection: varicella, chickenpox
| Recurrent infection: zoster
63
What is the incubation period for VZV infections?
14 (10-21) days
64
What are the clinical signs of chickenpox?
```
Mild malaise
Fever
Generally not unwell
Itchy
Exanthema
```
65
What is the natural history of exanthema in chickenpox?
Papules -> vesicles -> pustules -> crustae -> scarring ‘cropping’
66
What are the complications of chickenpox?
Secondary strep/staph infections of skin
Meingoencephalitis
Cerebellitis
Arthritis
67
What is the therapy for chickenpox?
None
| Aciclovir if immunosuppressed
68
When is a VZV infection more fatal?
<1yr
| T-cell deficiencies
69
What are the warning signs of a more fatal VZV infection?
High fever
New lesions >day 10
Inflammed lesions
General malaise
70
What are signs of HSV infection?
Herpes stomatitis
| Whitlow’s on fingertips
71
Which type of herpes is HSV 1?
Oral
72
Which type of herpes is HSV 2?
Genital
73
What is the primary symptom of HSV 1?
Stomatitis - recurrent cold sores
74
What are serious complications of HSV?
Keratoconjunctivitis
Encephalitis
Systemic neonatal infections
75
What is the therapy for HSV infections?
Self-limiting
| Aciclovir
76
How can HSV infections be spread to neonates?
Birth canal/direct contact
77
Why are HSV infections serious in neonates?
Not great immune system, disseminates
78
What disseminated infections can HSV cause in neonates?
Sepsis
Meningoencephalitis
Hepatitis
Skin/eye/mouth (SEM) disease
79
What is the treatment for neonates with HSV infection?
Acyclovir
80
What is the usual cause of hand-foot-mouth disease?
Enteroviruses
81
What age group is most susceptible to hand-foot-mouth disease?
<10yrs
82
When is hand-foot-mouth disease most prevalent?
Summer and early autumn
83
What is the incubation period for hand-foot-mouth disease?
3-6 days
84
What is clinical presentation of hand-foot-mouth disease?
Exanthema
| Painful lesions
85
What type of bacteria is usually responsible for scarlet fever?
Group A strep (GAS)
86
What are primary immunodeficiencies caused by?
Missing or improper function of body’s immune system//single genetic defects
87
What is more common: primary or secondary immunodeficiencies?
Secondary immunodeficiencies
88
What is the most common cause of secondary immunodeficiency?
Prolonged steroid use
89
What are warning signs that it could be a primary immunodeficiency?
```
Serious
Persistent
Unusual
Recurrent
FH
```
90
What investigations should you do if you suspect a primary immunodeficiency?
```
FBC
Immunoglobulins
HIV test
Functional antibodies
Lymphocyte subsets
NBT - Nitroblue tetrazolium blood test
Complement
```
91
What does the Nitroblue tetrazolium blood test check for?
Screen for Chronic Granulomatous Disease (CGD)
92
What are different causes of immunodeficiency?
Antibody deficiencies
Cellular immunodeficiencies
Innate immune disorders
93
What is transmission for most paediatric HIV cases?
Vertical transmission
94
What is the main risk factor for vertical transmission of HIV?
High viral load
95
What is the treatment postnatally for HIV?
Mother - ART
| Baby - prophylaxis until further testing, no breastfeeding
96
What is the treatment for children with HIV?
ART
