BACTERIAL ILLNESS IN CHILDREN Flashcards Preview

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Flashcards in BACTERIAL ILLNESS IN CHILDREN Deck (40):
1

What are the sites most commonly affected by staphylococcus aureus in children?

Skin - impetigo, boils

Wound infections - cellulitis

Bones - osteomyelitis

Joints - septic arthritis

Lungs - pneumonia

2

What are the two bacteria that are normally responsible for impetigo?

Staph aureus

Strep pyogenes

3

Where on the body does impetigo usually manifest?

Face - around the mouth

Creases - eg axilla

4

What are the risk factors for developing impetigo?

Anything that breaks the skin

Eczema

5

What are the clinical features of impetigo?

Erythematous macules

Golden "honey coloured" crusted lesions

Desquamation

6

What is the first line treatment for limited, localised impetigo in children?

Topical fusidic acid

7

What is the second line treatment for limited, localised impetigo in children?

Topical retapamulin

8

What is the treatment for limited, localised impetigo caused by MRSA?

Topical mupirocin

9

What is the first line treatment for extensive impetigo?

Oral flucloxacillin

10

What is the treatment for extensive impetigo in a child who is allergic to penicillin?

Oral erythromicin

11

What is an important source of reinfection that should be cleared in children with impetigo?

Nasal carriage

12

How is nasal carriage of staph aureus cleared in children who have had impetigo to avoid re-infection?

Nasal cream containing chlorhexidine and neomycin

13

What causes staphylococcal scalded skin syndrome?

Epidermolytic exotoxins A and B, which are released by S. aureus and cause detachment within the epidermal layer

14

What are the clinical features of staphylococcal scalded skin syndrome?

Fever

Widespread raw erythematous desquamation

Blistering, scalded appearance

Dehydration

15

How do we manage staphylococcal scalded skin syndrome?

Dermatological emergency

IV fluid resuscitation

IV flucloxacillin - If MRSA is suspected then use IV vancomycin

16

What are the infections that group A streptococcus (strep pyogenes) most commonly cause?

Pharyngitis / Tonsillitis

Cellulitis

Osteomyelitis

Septicaemia

Scarlet fever

Erysipelas

Toxic-shock like syndrome

17

How long is the incubation period of scarlet fever?

2 - 4 days

18

What is the peak age of incidence of scarlet fever?

4 years old (2 - 6 years)

19

What are the clinical features of scarlet fever?

Rash - fine punctate erythema ('pinhead'), larger areas feel like sandpaper.

Desquamation happens later in disease.

Fever

Tonsillitis

Strawberry tongue

20

Where does the rash associated with scarlet fever usually appear?

Appears first on the torso and spares the face although children often have a flushed appearance with perioral pallor.

21

How is a diagnosis of scarlet fever made?

Throat swab

22

What antibiotics should be prescribed for someone presenting with the signs and symptoms of scarlet fever?

Oral Penicillin V

23

What antibiotics should be prescribed for someone with a penicillin allergy who presents with the signs and symptoms of scarlet fever?

Azithromycin

24

Other than antibiotics what other important step must the clinician take in the management of a patient with scarlet fever?

Scarlet fever is a notifiable disease

25

What are the complications of scarlet fever and how long after infection does each occur?

Otitis media: the most common complication, with or straight after infection

Rheumatic fever: typically occurs 20 days after infection

Acute glomerulonephritis: typically occurs 10 days after infection

26

Families from which endemic areas are most at risk of TB?

Indian subcontinent

Sub-Saharan Africa

27

How are children usually infected by Mycobacterium tuberculosis?

Inhalation of droplet nuclei from an adult

Children with the disease (even if active) are almost never infectious, therefore notification to public health is essential in contact tracing.

28

What are the classic features of active pulmonary TB in a child?

Chronic cough of more than 3 weeks - do not assume that this is asthma

Night sweats

Fatigue

Weight loss or failure to thrive

29

What are the rarer features of active pulmonary TB?

Bronchial obstruction by enlarged hilar lymph nodes

This might cause collapse and consolidation

Pleural effusions

Widespread lymphadenopathy

30

What age group are at a particularly high risk of disseminated disease eg TB meningitis?

Under 4 year olds

31

What are the main two tests used to assess exposure to TB?

Tuberculin test (Mantoux)

Interferon-gamma release assay

32

How is the Mantoux TB test performed?

0.1 ml of 1:1,000 purified protein derivative (PPD) injected intradermally

Result read 2-3 days later

33

How are the results of the Mantoux TB test read?

Size of lesion that develops:

Less than 6 mm - negative - may be given BCG vaccine

Between 6 - 15 mm - positive - but not confirmation. Cannot give BCG as may suggest previous exposure

More than 15 mm - strongly positive - highly suggestive of TB infection.

34

What could cause a false negative reading of the Mantoux TB test?

Miliary TB

Sarcoidosis

HIV

Lymphoma

Very young age (e.g.

35

How is the interferon gamma release assay TB test performed?

White cells from a blood sample are exposed to tuberculous antigens. If infection is present the white cells will secrete interferon-gamma.

36

When is the interferon gamma release assay TB performed?

For those in whom the Mantoux test gave an ambiguous reading or in those who have already had the BCG vaccine.

37

How do we culture M. tuberculosis in children?

Early morning gastric washing - sensitivity of 64%

Biopsy from lymph node

38

What are the radiographic features of TB in children?

Hilar lymphadenopathy - primary infection

Calcification point

Wedge of collapse - Consolidation

Cavitations

Millet sized granulomas

39

How do we treat TB in children?

Same as adults:

Rifampicin - 6 months

Isoniazid - 6 months

Pyrazinamide - 2 months

Ethambutol - 2 months

40

How does treatment for TB meningitis differ from pulmonary TB?

Treatment last for 12 months not 6