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Flashcards in Fever, Rashes and Inflammation Deck (41):
1

What are the pathogens responsible for bacterial meningitis at different ages?

0-3 months: Group B Strep, E. coli, Listeria monocytogenes

1m-6y: Neisseria meningitides, Strep. pneumoniae, Haemophilus influenzae

>6y: Neisseria meningitides, Strep. pneumoniae

2

What are the features of meningitis?

Fever, headache, stiff neck, irritability, lethargy, petechial rash (meningococcal disease), bulging fontanelle, altered GCS, shock, focal neurological deficits, seizures.

3

What investigations are performed for meningitis?

LP if there are NO signs of raised ICP (reduced GCS, very bad headache, fits, neuro deficit)

FBC, CRP, coagulation, cultures, PCR, glucose, gases.

4

What is the management of bacterial meningitis?

>3m: IV ceftriaxone

<3m: IV cefotaxime + amoxicillin

Re-adjust therapy once pathogen is known.

Give dexamethasone (0.15mg/kg QDS) ASAP (within 12 hours of starting ABx) if CSF shows: purulent, raised WCC, raised protein, bacteria on Gram stain.

5

If encephalitis is a possibility, what drug must be given and why?

Acyclovir to cover for HSV until proven otherwise (PCR of CSF).

6

What is the typical presentation of Kawasaki disease?

Aged 6m-5y. Fever lasting >5 days, irritability, erythema, desquamation, conjunctivitis, rash, inflammation of lips, mouth, tongue [strawberry], cervical lymphadenopathy.

7

What investigations are required for Kawasaki disease?

CRP, ESR, FBC, echo (coronary aneurysms)

8

What is the management of Kawasaki disease?

Aspirin, IV immunoglobulin, steroids, infliximab and ciclosporin.

F/u for ?coronary aneurysms.

9

What is the pathogen responsible for toxic shock syndrome?

Staph. aureus and Group A Strep. which release a super-toxin at any site of infection.

10

What are the features of toxic shock syndrome?

Fever >39C, hypotension, diffuse erythematous macular rash, mucositis, D&V, renal and liver impairment, clotting disorders.

There is desquamation of the hands and feet after 1-2 weeks.

11

How is toxic shock syndrome treated?

Broad spectrum ABx (ceftriaxone + clindamycin)

Surgical debridement of wounds

IVIg

12

What is the management of necrotising fasciitis?

Surgical debridement, IVIg, ABx.

13

Which children are at particular high risk of Pneumococcal infections?

Those with hyposplenism / asplenism (e.g. in sickle cell) and those with nephrotic syndrome.

14

What diseases can occur post-streptococcal infection?

Toxic shock syndrome
Scarlet fever
Rheumatic fever
Post-Strep glomerulonephritis
PANDAS

15

What are the features of scarlet fever?

Fever followed by rash 12-48 hours later. Frequently evolves from tonsillar or pharyngeal infection.

The rash starts on neck and chest, then trunk and legs. It has a coarse, sandpaper-like texture.

May go onto have skin desquamation.

The tongue may start as white-furry with prominent papillae (white strawberry tongue) and then lose the fur (red strawberry tongue).

16

What are the features of rheumatic fever?

Occurs after 2-6 week latent period, post-pharyngeal or skin infection.

Characterised by polyarthritis, mild fever and malaise.

It can lead to long term cardiac damage (mostly mitral valve).

17

What is the management of rheumatic fever?

Aspirin, steroids, ABx if any persisting infection.

Follow by prophylaxis with penicillin.

18

What management options are there for impetigo?

Topical ABx: e.g. fusidic acid

Oral narrow spectrum: e.g. flucloxacillin

Oral broad spectrum: e.g. co-amoxiclav

19

What is management of peri-orbital cellulitis?

IV ceftriaxone followed by CT / MRI for ?posterior spread.

20

What are the features of Staphylococal scalded skin syndrome?

Fever, malaise and widespread skin erythema. The skin seperates on gentle pressure, due to exfoliative Staph. toxin, which gives scalded appearance.

21

What is management of herpes zoster?

Most children require no intervention.

Immuno-compromised require IV acyclovir.

Human VZV immunoglobulin for immuno-compromised and in contact with chickenpox.

22

What are the features of EBV infection?

Fever, malaise, tonsil/pharyngitis, cervical lymphadenopathy.

Can also get splenomegaly, hepatomegaly, jaundice and a maculopapular rash.

23

What investigations are required for EBV?

FBC (raied WCC, lymphocytes)

Blood film showing atypical lymphocytes (numerous large T-cells)

Monospot test +ve

24

What is prognosis for EBV?

Symptoms gradually resolve over 1-3 months. Fatigue is a dominant feature.

25

What ABx must be avoided in EBV?

Amoxicillin / ampicilin. Causes a florid maculopapular rash. Instead, Penicillin V is given if needing to treat Strep infection.

26

What is roseola infantum?

Macular rash following infection with HHV-6/7.

27

What pathogen is responsible for slapped-cheek syndrome?

Human parvovirus B19 (fifth disease)

28

Which infants are at high risk of parvovirus B19?

Those with chronic haemolytic anaemias (sickle cell or thalassaemia) or immuno-compromised.

It can trigger an aplastic crisis.

29

What pathogens are most commonly responsible for Hand, Foot and Mouth disease?

Coxsackie virus A16 and entero virus 71.

30

What are the features of HFMD?

Prodromal viral phase.

Mouth lesions: macular lesions which develop into vesicles.

Skin lesions: erythematous macules which develop into vesicles.

31

What are the features of measles?

Fever, cough, coryzal, conjunctivitis, malaise.

Koplik spots and maculopapular rash starting at hairline and spreading caudally.

32

What are the complications of measles?

Pneumonia, encephalitis, SSPE

33

What are the features of rubella?

Mild prodromal coryzal, fever etc.

Maculopapular rash starts on face then spreading centrifugally.

Prominent lymphadenopathy.

34

What are the complications of rubella?

Arthritis, encephalitis, thrombocytopenia, myocarditis.

35

What are the features of mumps?

Fever, malaise and parotitis.

36

What are the complications of mumps?

Meningitis, encephalitis, orchitis, hearing loss.

37

What is juvenile idiopathic arthritis (JIA)?

Persistent joint swelling (>6 weeks) before 16 years of age in absence of any other cause.

38

What is management of JIA?

NSAIDs
Joint injections
Methotrexate
Steroids
Biologics

39

What are the features of HSP?

Preceded by URTI

Extensor surface rash (maculopapular and purpuric, palpable)
Arthralgia
Peri-articular oedema
Abdo pain
Glomerulonephritis

40

What is the pathophysiology unerlying HSP?

Antigen exposure increases circulating IgA levels and produces IgA-IgG complexes which deposit in organs.

41

What are the features of IgA nephpropathy?

HSP without the rash; get glomerulonephritis post URTI.

Macroscopic haematuria. Caution of progression to CKD.