what organisms are likely in neonate- 3m meningitis
group B strep, E coli, listeria
what is added to cef antibiotics in neonatal meningitis
ampicillin
what organisms likely in 3m-6y meningitis
Neisseria meningitides, strep pneum, H influenza
what organisms likely in >6y
Neisseria meningitides, strep pneum
signs meningococcal infection
purpuric rash, non blanching. give IM benzlypenicillin straight away
contraindications to LP
cardiorespiratory instability, coagulopathy, signs incr ICP, local infection, thrombocytopenia, focal neuro signs
if CI to LP in meningitis what can be done
PCR, rapid antigen test
LP results bacterial
turbid, incr polymorphs, incr protein, low glucose
LP results viral
clear, incr lymphocytes, normal or incr protein, normal or low glucose
LP results TB
clear, turbid or viscous, incr lymphocytes, very high protein, very high glucose
treatment meningitis
cefotaxime or ceftriaxone. dexamethasone
complications meningitis
hearing loss, hydrocephalus, local vasculitis, local cerebral infarction, subdural effusion, cerebral abscess
what organisms can cause viral meningitis
enteroviruses, adeno, EBV, mumps.
what organisms may be more likely in the immunocompromised
mycoplasma and borelia (lyme)
commonest cause septicaemia in children
meningococcus
signs of septicaemia
fever, tachycardia, tachypnoea, purpuric rash, shock.
treatment septicaemia
antibiotics, fluids, circulatory support (inotropes), FFP and platelets for DIC
what can cause impetigo
staph/strep
signs impetigo
lesions on face, hands, neck. erythematous macules which can become vesicular and pustular, can rupture and leak. honey coloured cruster lesions
when can go to school with impetigo
when the lesions are dry
treatment impetigo
topical mupirocin, flucloxacillin, co amoxiclav
how to eradicate carriage impetigo
need to eradicate nasal carriage. nasal cream- mupirocin or neomycin
signs periorbital cellulitis
fever, erythema, tender, oedema eyelid. unilateral.
how can periorbital cellulitis occur
may follow local trauma. spread from paranasal sinus infection or dental abscess. treat promptly with IV antibiotics to prevent progression to orbital
signs orbital cellulitis
proptosis, painful eye movements, decr visual acuity. do CT
signs infectious mononucleosis
fever, malaise, tonsillopharyngitis, lymphadenopathy, petechiae on soft palate, spleno/hepatomegaly, maculopapular rash, jaundice
diagnosis infectious mononucleosis
monospot test. IgM and IgG to EBV antigens
what should you not give in EBV infection
amoxicillin or ampicillin as causes maculopapular rash in EBV
treatment EBV
symptomatic. corticosteroids if severe airway compromised. penicillin if group A grown
features measles
temp, maculopapular rash- starts behind the ears and involves the whole body, conjunctivitis, Kopliks spots, cough, coryza
what are pathognomonic in measles
Kopliks spots- white spots on buccal mucosa
complications measles
pneumonia, otitis media, febrile convulsions, encephalitis, subacute sclerosing panencephalitis, hepatitis, diarrhoea, appendicitis, croup
when does encephalitis come on in measles
8d after initial infection. initially- headache, lethargy, irritable. convulsions and coma.
long term complications encephalitis (measles)
hearing problems, hemiplegia, LD
when does subacute sclerosing panencephalitis occur
can occur 7-13y after infection. primary infection usually
signs subacute sclerosing panencephalitis
loss of neuro function- behaviour changes, myoclonus, choreoatheotosis, dystonia, leading to dementia and death
what can you give if patient is immunocompromised in measles and what to give patients in developing world
ribavirin (anti viral drug). vitamin A
how is measles spread
droplets
incubation measles
7-12 days, infective from prodrome until 5 days after rash starts
infectivity rubella
5 days before to 5 days after start of rash.
signs rubella
macular rash, suboccipital lymphadenopathy
is the rubella vaccine a live virus
yes
complications rubella
small joint arthritis, malformations in utero.
what malformations in first four weeks if infected rubella in utero
eye anomaly
malformation 4-8 weeks infection rubella in utero
cardiac abnormalities
malformation 8-12 weeks rubella infection in utero
deafness
spread of mumps
droplets, saliva
immunity mumps
lifelong once infected
infectivity mumps
7 days before and 9 days after parotid swelling
signs mumps
prodromal malaise, incr temp, painful parotid swelling, bilateral in 70%.
complications mumps
usually none. orchitis (+- infertility), arthritis, meningitis, pancreatitis, deafness
features hand foot and mouth disease
mildly unwell child, vesicles on palms soles and mouth, may cause discomfort until they heal without crusting
cause hand foot and mouth
coxsackie virus a16 or enterovirus 71
signs erythrovirus (parvovirus 19)
mild acute infection wth malar erythema (slapped cheek) and rash mainly on the limbs ( glove and socks syndrome)
complications erythrovirus
aplastic crisis. fetal death in pregnancy- hydrops fetalis.
what is roseola infantum
mild self limiting. incr temp, maculopapular rash, ulcers.
what causes roseola infantum
herpes virus 6
what is Kawasaki disease
systemic vasculitis. 6m-4y
features Kawasaki disease
prolonged fever >5 days. conjunctiva, mucous membranes, cervical lymphadenopathy, rash, extremities (red, peeling)
treatment Kawasaki disease
IvIg. aspirin- 6 weeks. persistent inflammation- infliximab, steroids
what can be affected in 1/3 Kawasaki patients
coronary arteries- aneurysms (give warfarin),MI
what is chicken pox
primary varicella zoster infection. spread by resp droplets
features chicken pox
vesicular rash- papules vesicles and pustules. starts on head and trunk then spreads to peripheries. temperature.
complications chicken pox
bacterial superinfection, staph, strep, toxic shock syndrome, nec fasciitis, encephalitis, meningitis, pneumonitis, DIC, purpura fulminans
treatment chicken pox
in immunocompromised- IV acyclovir. then switch to oral valaciclovir. varicella zoster IG to immunocompromised
can chicken pox be caught from someone with shingles
yes
treatment bacterial superinfection in chickenpox
flucloxacillin
what is shingles
herpes zoster. reactivation of latent varicella zoster
features shingles
vesicular eruption in dermatomal distribution. unlikely to get neuralgic pain in childhood. common in the thoracic region. if recurrent- immunocompromised
treatment shingles
oral analgesia. acyclovir in immuno.
what can be given as prophylaxis in pregnancy
varicella zoster globulin
what happens if pregnant lady gets infected with varicella zoster
aciclovir
what does HSV1 cause
lip and skin
what does HSV2 cause
genital lesions
what is the most common presentation of herpes simplex in children
gingivostomatitis
features gingivostomatitis
vesicles on lips, gum, tongue, palate can ulcerate and bleed. 10m-3y. fever and miserable child
what is a herpetic whitlow
painful white pustules on site of broken skin. fingers and thumbs
eye complications herpes simplex
blepharitis, conjunctivitis, cornea- scarring, loss vision
investigations in osteomyelitis
MRI shows infection with pus and debris, radionuclide bone scan
when is the mother at risk of passing on HIV
during pregnancy, during delivery, breastfeeding
when is HIV vertical transmission more likely
high viral load or symptomatic
diagnosing vertically acquired HIV
HIV DNA PCR- to be clear need 2 negative in first 3m of life 2 weeks after postnatal antiretrovirals
how long do children have placentally transferred IgG antibodies HIV
18 months so don’t use standard tests
when should you consider HIV in children
PUO, lymphadenopathy, hepatosplenomegaly, persistent diarrhoea, parotid enlargement, shingles decr platelets, failure to thrive, clubbing, CMV
decreasing vertical transmission HIV
antiretrovirals to mother, avoid breastfeeding, pre labour C section, avoid prolonged rupture of membranes
treatment vertically transmitted HIV
highly active antiretroviral therapy PENTA regimen- start at once if AIDs defining conditions or CD4
features diphtheria
nasal discharge, bull neck, sore throat, airway obstruction, cardiac and neuro toxins
opportunistic infections in HIV
aspergillus, candida, Cryptococcus, cryptosporidium, pneumocystitis, HH8 (Kaposi sarcoma), pseudomonas, CMV encephalitis, TB encephalitis, lymphoma, toxoplasmosis
what does cryptosporidium cause (HIV)
chronic diarrhoea
what does Cryptococcus cause (HIV)
meningo encephalitis
treatment PCP
co trimoxazole
what is Kaposi sarcoma
cause HHV-8. 4 types. skin not always involved. can get purple macules papules nodules and plaques affecting limbs, face +- periorbital purpura/raccoon eyes
