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Y5 Paediatrics > Infection and Immunity > Flashcards

Infection and Immunity Flashcards

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1
Q

What counselling should be given to parents with an unvaccinated children?

A
  • Understand why they have not vaccinated – let them talk for however long they need
  • Give examples of how the infections can cause long-term morbidity/mortality
    • Mumps → infertile boys, deafness
    • Rubella → severe deformities to pregnancy
    • Measles → death
    • Polio → massive respiratory problems
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2
Q

What are the long-term morbidity/mortality of mumps?

A
  • Infertility in boys
  • Deafness
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3
Q

What are the long-term morbidity/mortality of measles?

A

Death

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4
Q

What are the long-term morbidity/mortality of rubella?

A

Severe deformities to pregnancy

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5
Q

What are the long-term morbidity/mortality of polio?

A

Massive respiratory problems

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6
Q

What are the congenital and neonatal infections?

A
  • Toxoplasmosis
  • Other - Syphilis, Parvovirus, VZV, HIV, HBV
  • Rubella
  • CMV
  • HSV
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7
Q

What is the management of toxoplasmosis in a child?

A
  • 1st line = Pyrimethamine + Sulfadiazine for 1 year
  • Adjunct = Prednisolone
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8
Q

What is the management of syphilis in a child?

A
  • IM benzathine penicillin
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9
Q

What is the management of syphilis in a child?

A
  • IM benzathine penicillin
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10
Q

What is the management of CMV in a child?

A
  • IV ganciclovir
  • Oral valganciclovir
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11
Q

What is the management of herpes simplex virus in a child?

A
  • Aciclovir (400mg, TDS) if neonate exposed on delivery
    • If not nothing is needed
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12
Q

What can GBS cause in a neonate?

A
  • Pneumonia
  • Meningitis
  • Septicaemia
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13
Q

What is the management of sepsis in a neonate?

A
  • Early onset <72 hours = IV cefotaxime + amikacin + ampicillin
  • Late onset >72 hours = IV meropenem + amikacin + ampicillin
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14
Q

What is the management of GBS in an adult?

A
  • Only for women in labour → IV benzylpenicillin
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15
Q

How does a mother pass listeria monocytogenes to a child?

A
  • Passes to child in placenta → mother has a mild influenza-like illness
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16
Q

What are the consequences of listeria in a mother?

A
  • Spontaneous abortion
  • PTL
  • Neonatal sepsis
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17
Q

What are the signs and symptoms of listeria monocytogenes?

A
  • Meconium staining of liquor in pre-term infant
  • Widespread rash
  • Sepsis
  • Pneumonia
  • Meningitis
  • Mortality 30%
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18
Q

What is the management of listeria monocytogenes?

A
  • IV amoxicillin/ampicillin OR Co-trimoxazole
  • If systemic infection = IV benzylpenicillin + gentamicin
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19
Q

Define Kawasaki Disease.

A

Systemic vasculitis in a child under the age of 4/5 years old.

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20
Q

What are the risk factors for Kawasaki disease?

A
  • Ethnicity - Japanese, Black-Caribbean
  • Peak at 1yo
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21
Q

What are the signs and symptoms of Kawasaki disease?

A
  • Fever for over 5 days +4/5 of the following CRASH symptoms
    • Conjunctivitis
    • Rash - polymorphous; begins hands/feet
    • Adenopathy = Cervical lymphadenopathy
    • Strawberry tongue = Mucous membrane changes
    • Hands & feet swollen - desquamate/peel
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22
Q

What are the complications of Kawasaki disease?

A
  • Cardiovascular
    • Gallop rhythm
    • Myocarditis
    • Pericarditis
    • Coronary aneurysms → require long-term warfarin and close follow-up
  • Sudden death
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23
Q

What are the appropriate investigations for suspected Kawasaki disease?

A
  • Diagnosis on clinical findings (no test)
  • Bloods - FBC (inc. platelets), CRP, ESR
  • Echocardiography - check cardiac function
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24
Q

What is the management of Kawasaki disease?

A
  • Admission
  • IVIG (within 10 days)
  • High-dose aspirin - reduce thrombosis risk
    • Other = corticosteroids, infliximab/ciclosporin and plasmapheresis if persistent inflammation and fever
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25
What causes malaria?
* Protozoa Plasmodium * *Falciparum most fatal* * *Ovale*, M*alariae* and Vi*vax* * Spread by female Anopheles mosquito
26
What are the signs and symptoms of malaria?
* Onset 7-10 days after inoculation (\<1yr) * Cyclical fever * Diahorrea and vomting * Flu-like symptoms - *shaking, chills, night sweats, headache, myalgia* * Jaundice * Anaemia * Thrombocytopaenia
27
What are the appropriate investigations for suspected malaria?
* **3 thick and thin blood films** * Thick = parasite * Thin = species, parasitaemia * Malaria rapid antigen detection tests - *plasmodial HRP-II, parasite LDH*
28
What is the prevention of malaria?
* Anti-malarial prophylaxis with **quinine** * **Bite prevention** – repellent and nets
29
What is the management of malaria?
* Arrange immediate admission → Medical emergency * Notify PHE (can have a RAPID deterioration) * Treatment * Non-falciparum = Chloroquinine * Mild falciparum *(not vomiting, parasitaemia \<2% and ambulant)* * 1st line = ACT (Artemisinin Combination Therapy) * 2nd line = Atovaquone-proguanil (cannot give doxycycline to age \<12yo) * Severe/complicated falciparum * 1st line = IV Artesunate * 2nd line = IV Quinine * Primaquine for eradication of hypnozoites - *dormant parasites in liver in vivax and ovale*
30
What can anti-malarial drugs precipitate?
G6PDD
31
What are the causes of typhoid fever?
* Salmonella typhi * Paratyphoid * Both via faeco-oral transmission
32
What are the complications of typhoid fever?
* GI perforation * Myocarditis * Hepatitis * Nephritis
33
What are the signs and symptoms of typhoid fever?
* Fever * Bradycardia * Headache * Travel history * Dry cough * Weight loss/Anorexia * Malaise * Myalgia * GI symptoms - *diarrhoea or constipation* * Splenomegaly * Bradycardia * Rose-spots on trunk
34
What are the appropriate investigations for suspected typhoid fever?
* **Blood culture = Diagnostic** * Bloods – *FBC, LFTs, stool culture*
35
What is the cause of Dengue fever?
Dengue arbovirus
36
What are the signs and symptoms of dengue fever?
* Primary infection: * Headache (retro-orbital) * Fine erythematous sunburn-like rash (50%) * High fever and myalgia * Recent ravel history - 5 day incubation period * Hepatomegaly * Abdominal distension * Severe = Haemorrhage
37
What is Dengue haemorrhagic fever?
* **Secondary infection** * Previously infected child → subsequent infection with a different strain → severe capillary leak, hypotension, haemorrhagic manifestations * Treatment = fluid resuscitation usually helps a lot * Due to partially effective host immune response augmenting the severity of the infection
38
What are the appropriate investigations for suspected dengue fever?
* **Gold standard = PCR viral antigen, serology IgM** * bloods * FBC - low WCC, low platelets, low Hb → espe in severe * LFTs * Serum albumin
39
What is the management of dengue fever?
* Supportive → fluids and monitoring * ITU - *if increased deterioration*
40
How is mumps transmitted?
* Transmission by respiratory secretions * Long incubation period (15-24 days)
41
What are the signs and symptoms of mumps?
* Asymptomatic (in 30% of cases) * **Parotid swelling -** *infectious 5 days before and after* * Headache * Fever * P*ancreatitis* * *Neuritis* * *Arthritis* * *Mastitis* * *Nephritis* * *Thyroiditis* * *Pericarditis*
42
What are the appropriate investigations for suspected mumps?
* Oral fluid IgM sample * **Amylase** is raised in the blood
43
What is the management of mumps?
* Notify HPU * Isolate for 5 days from time of parotid swelling * Supportive care * Rest * Analgesia * Fluids * Safety net for complications: * Mumps orchitis → infertility (very rare) * Viral meningitis → encephalitis (very rare) * Deafness (unilateral and transient)
44
What causes mumps?
Mumps paramyxovirus
45
What are the signs and symptoms of measles?
* **Prodrome = high fever, irritability, conjunctivitis/coryza** * *Febrile convulsions* * **Maculopapular rash** - infectious 4 days before and after * Koplik spots * Cough * No lymphadenopathy
46
What are the appropriate investigations for suspected measles?
* 1st line = Measles serology (IgM and IgG) from Oral Fluid Test * 2nd line = PCR of blood or saliva
47
What is the management of measles?
* Notify HPU * Isolate for 4 days after development of rash - children in hospital * Rest and supportive treatment * Fluids * Antipyretics * Rest * Immunise close contacts and encourage vaccination after acute episode * Safety net the complications: * Encephalitis * Sub-acute Sclerosing Panencephalitis * Otitis media * Pneumonia * Keratoconjunctivitis
48
What is Sub-acute sclerosing panencephalitis?
Measles dormant in the CNS * S/S = Dementia and Death
49
What is the cause of rubella?
Togavirus
50
What are the signs and symptoms of rubella?
* **Prodrome = mild fever or asymptomatic** * Pink maculopapular rash that fades in 3-5 days - infectious 1 week before and 5 days after * 20% → Forchheimer spots (red spots on soft palate) * Lymphadenopathy - suboccipital, postauricular
51
What are the appropriate investigations for suspected rubella?
* 1st line = Rubella serology (IgM and IgG) from Oral Fluid Test * 2nd line = RT-PCR
52
What is the management of rubella?
* Notify HPU * Isolate for 4 days after development of rash * Supportive * Fluids * Analgesia * Rest * Safety net the complications – haemorrhagic complications due to thrombocytopenia
53
What are the signs and symptoms of parvovirus?
* 1st = **Asymptomatic or coryzal illness** for 2-3 days * Latent for 7-10 days * 2nd = **Erythema infectiosum** * Red ‘slapped cheek’ rash on face - fever, malaise, headache, myalgia - infectious 10 days before and 1 day after rash * Progresses (1 week later) to maculopapular like rash in trunk and limbs
54
What are the appropriate investigations for suspected parvovirus B19?
* 1st line = B19 serology (IgM and IgG) * 2nd line = RT-PCR
55
What are the complications of parvovirus B19 in children?
* **Aplastic crisis** * Occurs in children with chronic haemolytic anaemia or immunodeficient * **Fetal disease** * Maternal transmission → leads to fetal hydrops, death due to severe anaemia
56
What is the management of parvovirus B19?
* Supportive * Fluids * Analgesia * Rest * No need to stay off school or avoid pregnant women → not really infectious once the rash develops * Safety net the complications → anaemia, lethargy, pregnancy
57
What is the cause of chickenpox?
Varicella zoster virus - HHV-3
58
What are the signs and symptoms of chickenpox?
* Crops of **itchy vesicles** appear over 3-5 days * *Head, neck, trunk (less on limbs)* * Papule → vesicle → crust * Infectious 48 hours before and until rash crusted over * Pyrexia * Headache * Abdominal pain * Malaise
59
What are the appropriate investigations for suspected chickenpox?
Clinical diagnosis
60
What is the management chickenpox?
* Supportive * Fluids * Analgesia - not ibuprofen * Rest * Advice * Nails short * Loose clothing * Isolate (until rash has crusted over or 5 days from onset) from: * Immunocompromised * Neonates (\<28d old) * Pregnant women * Keep home from school
61
What are the complications of chickenpox?
* **Secondary bacterial superinfection** - sudden high fever, toxic shock, necrotising fasciitis * **Encephalitis** - ataxic with cerebellar signs * **Purpura fulminans** - large necrotic loss of skin from cross-activation of antiviral Abs → inhibit the inhibitory coagulation proteins factors C and S → increased clotting and purpuric skin rash * **Dehydration** * **Disseminated haemorrhagic VZV** * **Pneumonia** * **Myocarditis** * **Transient arthritis** * **Cerebellar atxia**
62
What is the management of chickenpox in immunocompetent adolescents or adults?
Oral aciclovir - 800mg 5/day for 7 days
63
What is the management of chickenpox in immunocompromised children?
IV aciclovir → oral aciclovir * Prophylactic prevention = human VZV IVIG
64
What is the cause of Hand, Foot and Mouth Disease?
* Most common = **Coxsackie A16 virus** * Severe = Enterovirus 71 * Atypical = Coxsackie A6
65
What are the signs and symptoms of hand, foot and mouth disease?
* Painful, itchy, vesicular lesions on hands, foot, mouth, tongue, buttocks * *Some spots in mouth can develop into ulcers* * Mild systemic features * Fever * Sore throat
66
What is the management of hand, foot and mouth disease?
* Supportive - clears up in 7-10 days * Fluids * Analgesia * Rest * Safety net/Reassure * Very common under 10 years old * Report back if: * Severely dehydration * If it doesn’t clear up in 2 weeks * Pregnancy
67
What causes Roseola Infantum?
* **HHV6** * *HHV7 can present very similarly* * *HHV6 is more common = Roseola Infantum* * *Most children are infected by 2*
68
What are the signs and symptoms of roseola infantum?
* High fever and malaise (3-4 days) * Generalised macular rash * Rash starts on neck/body and spread to arms, lasting 1-2 days, non-itchy, blanching * Febrile convulsions in 10-15% * Sore throat * Lymphadenopathy * Coryzal symptoms * Diarrhoea and vomiting * Nagayama spots (spots on the uvula and soft palate
69
What are the appropriate investigations for suspected roseola infantum?
* HHV6/7 serology (IgG and IgM) * Rule out measles and rubella serology (similar presentation)
70
What is the management of roseola infantum?
* Supportive - clears up in a week * Fluids * Analgesia * Rest * No need to stay off school * Safety net the complications – high fever → febrile convulsions (10-15%)
71
What are the appropriate investigations for suspected HIV in a child?
* \>18 months = **antibody detection (ELISA)** * \<18 months = **PCR of virus** * Would still have transplacental anti-HIV IgG from mother * Measured at birth, on discharge, 6 weeks, 12 weeks and finally, at 18 months if mother is HIV +ve
72
What is the management of HIV in a child?
* Cord clamped as soon as possible and baby bathed immediately after birth * Low/medium = Zidovudine monotherapy for 2-4w * High risk = PEP combination (x2 NRTI + x1 INI) for 4w * Women not to breastfeed * Give all immunisations including BCG * Infant testing for HIV at 6 and 12 weeks *(at least 2 and 8 weeks after stopping prophylaxis)*
73
What are the examples of T-cell defects in children?
* SCID * Wiskott-Aldrich syndrome * DiGeorge syndrome * Duncan disease * Ataxia telangiectasia * HIV
74
What are the examples of B-cell defects in children?
* SCID * Bruton's a-gammaglobulinaemia * Hyper IgM * Common variable ID * IgA deficiency
75
What are the signs and symptoms of T-cell defects?
* \<1 year old * Severe viral/fungal infections
76
What are the signs and symptoms of B-cell defects?
* \>6 months but \<2 year old - IgG * Severe bacterial infections
77
What are the examples of neutrophil defects in children?
Chronic granulomatous disease
78
What are the examples of NK cell defects in children?
* SCID * Bruton's a-gammaglobulinaemia * Hyper IgM * Common variable ID * IgA deficiency
79
What are the examples of leucocyte function defects in children?
* Leucocyte adhesion deficiency
80
What are the examples of complement defects in children?
* Early complement deficiency (C1, C2, C4) * Late complement deficiency (C5-C9)
81
What are the signs and symptoms of neutrophil defects?
* Recurrent bacterial infections * Invasive fungal infections
82
What are the signs and symptoms of neutrophil defects?
* Recurrent bacterial infections * Invasive fungal infections
83
What are the signs and symptoms of complement defects?
* Recurrent bacterial infections - *especially encapsulated bacteria* * SLE-like illness
84
What are the signs and symptoms of neutrophil defects?
* Recurrent bacterial infections * Invasive fungal infections
85
What are the signs and symptoms of Hyper-IgE (Job/Buckley) syndrome?
* Eczema * Coarse facial features * Recurrent RTIs * Cold abscesses * Candidiasis
86
What is Ataxia Telangiectasia?
Defective DNA repair
87
What is associated with ataxia telangiectasia?
Increased risk of **Lymphoma**
88
What are the signs and symptoms of ataxia telangiectasia?
* Cerebellar ataxia * Developmental delay * Telangiectasia in the eyes
89
What is Wiskott-Aldrich syndrome?
* **X-linked** * Impaired Wiskott-Aldrich gene * Rare
90
What are the signs and symptoms of Wiskott-Aldrich syndrome?
* Present at 7 months * Eczema * Recurrent infections * Thrombocytopenia * Petechiae * Bloody diarrhoea * Wiskott-Aldrich Thrombocytopenia Eczema Recurrent infections → may look like ITP
91
What is the management of Wiskott-Aldrich syndrome?
IVIG → HSCT
92
What is Duncan disease?
* X-linked lymphoproliferative disease * Inability to generate a normal response to EBV
93
What are the signs and symptoms of Duncan disease?
* Death to initial EBV * Secondary B-cell lymphoma
94
Describe X-linked SCID.
* 45% of all SCID * Mutation of common gamma chain on chromosome Xq13.1 * Shared by cytokine receptors for IL-2, IL-4, IL-7, IL-9, IL-15 and IL-21 * Inability to respond to cytokines causes early arrest of T cell and NK cell development and production of immature B cells * Phenotype * Very low or absent T cell numbers * Very low or absent NK cell numbers * Normal or increased B cell numbers but low Igs
95
What are the signs of SCID?
* Unwell by 3 months of age * Infections of all types * Failure to thrive * Persistent diarrhoea * Unusual skin disease * Colonisation of infant’s empty bone marrow by maternal lymphocytes * Graft versus host disease * Family history of early infant death
96
What is DiGeorge syndrome?
* Deletion at 22q11.2 → *TBX1 may be responsible for some features* * Usually sporadic rather than inherited * Normal numbers B cells * Reduced numbers T cells * Homeostatic proliferation with age * Immune function usually only mildly impaired and improves with age
97
What are the signs of DiGeorge syndrome?
* High forehead * Developmental defects in the pharyngeal pouch * Low set * Abnormally folded ear * Cleft palate * Small mouth and jaw * Hypocalcaemia * Oesophaegeal atresia * Underdeveloped thymus * Complex congenital heart disease
98
What is Bruton's X-linked a-gammaglobulinaemia?
* Abnormal B cell tyrosine kinase (BTK) gene * Pre B cells cannot develop to mature B cells * Absence of mature B cells * No circulating Ig after 3 months
99
What are the signs of Bruton's X-linked a-gammaglobulinaemia?
* Boys present in first few years of life * Recurrent bacterial infections * Otitis media * Sinusitis * Pneumonia * Osteomyelitis * Septic arthritis * Gastroenteritis * Viral, Fungal and Parasitic infections * Enterovirus, Pneumocystis * Failure to thrive
100
What is Hyper IgM syndrome?
* **Mutation in CD40 ligand gene** (CD40L, CD154) * *Member of TNF Receptor family* * *Encoded on Xq26* * *Involved in T-B cell communication* * *Expressed by activated T cells but not B cells* * Normal number circulating B cells * Normal number of T cells but activated cells do not express CD40 ligand * No germinal centre development within lymph nodes and spleen * Failure of isotype switching * Elevated serum IgM * Undetectable IgA, IgE, IgG
101
What are the signs of Hyper IgM syndrome?
* Boys present in first few years of life * Recurrent infections → particularly bacterial * Subtle abnormality in T cell function predisposes to: * Pneumocystis jiroveci infection * Autoimmune diseas * Malignancy * Failure to thrive
102
What is Common variable immune deficiency?
* Heterogenous group of disorders * Many different genetic defects → *many unidentified* * Failure of full differentiation/function of B lymphocytes * Defined by * Marked reduction in IgG, with low IgA or IgM * Poor/absent response to immunisation * Absence of other defined immunodeficiency
103
What are the signs of common variable immune deficiency?
* Recurrent bacterial infections * *Pneumonia* * *Persistent sinusitis* * *Gastroenteritis* * *Often with severe end-organ damage* * Pulmonary disease * *Interstitial lung disease* * *Granulomatous interstitial lung disease (also LN, spleen)* * *Obstructive airways disease* * Gastrointestinal disease * *Inflammatory bowel like disease* * *Sprue like illness* * *Bacterial overgrowth* * Autoimmune disease * *Autoimmune haemolytic anaemia or thrombocytopenia* * *Rheumatoid arthritis* * *Pernicious anaemia* * *Thyroiditis* * *Vitiligo* * Malignancy * *Non-Hodgkin lymphoma*
104
What is Selective IgA deficiency?
* Genetic condition with unknown cause * Prevalence = 1:600 * 2/3rd = Asymptomatic * 1/3rd = Recurrent respiratory tract infections

Y5 Paediatrics (26 decks)

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