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a Paediatrics by themes > Infection and Immunity > Flashcards

Infection and Immunity Flashcards

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
Q

What causes malaria?

A
  • Protozoa Plasmodium
    • Falciparum most fatal
    • Ovale, Malariae and Vivax
  • Spread by female Anopheles mosquito
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26
Q

What are the signs and symptoms of malaria?

A
  • Onset 7-10 days after inoculation (<1yr)
  • Cyclical fever
  • Diahorrea and vomting
  • Flu-like symptoms - shaking, chills, night sweats, headache, myalgia
  • Jaundice
  • Anaemia
  • Thrombocytopaenia
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27
Q

What are the appropriate investigations for suspected malaria?

A
  • 3 thick and thin blood films
    • Thick = parasite
    • Thin = species, parasitaemia
  • Malaria rapid antigen detection tests - plasmodial HRP-II, parasite LDH
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28
Q

What is the prevention of malaria?

A
  • Anti-malarial prophylaxis with quinine
  • Bite prevention – repellent and nets
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29
Q

What is the management of malaria?

A
  • 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
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30
Q

What can anti-malarial drugs precipitate?

A

G6PDD

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31
Q

What are the causes of typhoid fever?

A
  • Salmonella typhi
  • Paratyphoid
  • Both via faeco-oral transmission
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32
Q

What are the complications of typhoid fever?

A
  • GI perforation
  • Myocarditis
  • Hepatitis
  • Nephritis
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33
Q

What are the signs and symptoms of typhoid fever?

A
  • Fever
  • Bradycardia
  • Headache
  • Travel history
  • Dry cough
  • Weight loss/Anorexia
  • Malaise
  • Myalgia
  • GI symptoms - diarrhoea or constipation
  • Splenomegaly
  • Bradycardia
  • Rose-spots on trunk
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34
Q

What are the appropriate investigations for suspected typhoid fever?

A
  • Blood culture = Diagnostic
  • Bloods – FBC, LFTs, stool culture
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35
Q

What is the cause of Dengue fever?

A

Dengue arbovirus

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36
Q

What are the signs and symptoms of dengue fever?

A
  • 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
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37
Q

What is Dengue haemorrhagic fever?

A
  • 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
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38
Q

What are the appropriate investigations for suspected dengue fever?

A
  • Gold standard = PCR viral antigen, serology IgM
  • bloods
    • FBC - low WCC, low platelets, low Hb → espe in severe
    • LFTs
    • Serum albumin
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39
Q

What is the management of dengue fever?

A
  • Supportive → fluids and monitoring
  • ITU - if increased deterioration
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40
Q

How is mumps transmitted?

A
  • Transmission by respiratory secretions
  • Long incubation period (15-24 days)
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41
Q

What are the signs and symptoms of mumps?

A
  • Asymptomatic (in 30% of cases)
  • Parotid swelling - infectious 5 days before and after
  • Headache
  • Fever
  • Pancreatitis
  • Neuritis
  • Arthritis
  • Mastitis
  • Nephritis
  • Thyroiditis
  • Pericarditis
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42
Q

What are the appropriate investigations for suspected mumps?

A
  • Oral fluid IgM sample
  • Amylase is raised in the blood
43
Q

What is the management of mumps?

A
  • 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
Q

What causes mumps?

A

Mumps paramyxovirus

45
Q

What are the signs and symptoms of measles?

A
  • Prodrome = high fever, irritability, conjunctivitis/coryza
    • Febrile convulsions
  • Maculopapular rash - infectious 4 days before and after
  • Koplik spots
  • Cough
  • No lymphadenopathy
46
Q

What are the appropriate investigations for suspected measles?

A
  • 1st line = Measles serology (IgM and IgG) from Oral Fluid Test
  • 2nd line = PCR of blood or saliva
47
Q

What is the management of measles?

A
  • 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
Q

What is Sub-acute sclerosing panencephalitis?

A

Measles dormant in the CNS

  • S/S = Dementia and Death
49
Q

What is the cause of rubella?

A

Togavirus

50
Q

What are the signs and symptoms of rubella?

A
  • 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
Q

What are the appropriate investigations for suspected rubella?

A
  • 1st line = Rubella serology (IgM and IgG) from Oral Fluid Test
  • 2nd line = RT-PCR
52
Q

What is the management of rubella?

A
  • Notify HPU
  • Isolate for 4 days after development of rash
  • Supportive
    • Fluids
    • Analgesia
    • Rest
  • Safety net the complications – haemorrhagic complications due to thrombocytopenia
53
Q

What are the signs and symptoms of parvovirus?

A
  • 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
Q

What are the appropriate investigations for suspected parvovirus B19?

A
  • 1st line = B19 serology (IgM and IgG)
  • 2nd line = RT-PCR
55
Q

What are the complications of parvovirus B19 in children?

A
  • 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
Q

What is the management of parvovirus B19?

A
  • 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
Q

What is the cause of chickenpox?

A

Varicella zoster virus - HHV-3

58
Q

What are the signs and symptoms of chickenpox?

A
  • 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
Q

What are the appropriate investigations for suspected chickenpox?

A

Clinical diagnosis

60
Q

What is the management chickenpox?

A
  • 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
Q

What are the complications of chickenpox?

A
  • 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
Q

What is the management of chickenpox in immunocompetent adolescents or adults?

A

Oral aciclovir - 800mg 5/day for 7 days

63
Q

What is the management of chickenpox in immunocompromised children?

A

IV aciclovir → oral aciclovir

  • Prophylactic prevention = human VZV IVIG
64
Q

What is the cause of Hand, Foot and Mouth Disease?

A
  • Most common = Coxsackie A16 virus
  • Severe = Enterovirus 71
  • Atypical = Coxsackie A6
65
Q

What are the signs and symptoms of hand, foot and mouth disease?

A
  • 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
Q

What is the management of hand, foot and mouth disease?

A
  • 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
Q

What causes Roseola Infantum?

A
  • HHV6
  • HHV7 can present very similarly
    • HHV6 is more common = Roseola Infantum
    • Most children are infected by 2
68
Q

What are the signs and symptoms of roseola infantum?

A
  • 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
Q

What are the appropriate investigations for suspected roseola infantum?

A
  • HHV6/7 serology (IgG and IgM)
  • Rule out measles and rubella serology (similar presentation)
70
Q

What is the management of roseola infantum?

A
  • 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
Q

What are the appropriate investigations for suspected HIV in a child?

A
  • >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
Q

What is the management of HIV in a child?

A
  • 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
Q

What are the examples of T-cell defects in children?

A
  • SCID
  • Wiskott-Aldrich syndrome
  • DiGeorge syndrome
  • Duncan disease
  • Ataxia telangiectasia
  • HIV
74
Q

What are the examples of B-cell defects in children?

A
  • SCID
  • Bruton’s a-gammaglobulinaemia
  • Hyper IgM
  • Common variable ID
  • IgA deficiency
75
Q

What are the signs and symptoms of T-cell defects?

A
  • <1 year old
  • Severe viral/fungal infections
76
Q

What are the signs and symptoms of B-cell defects?

A
  • >6 months but <2 year old - IgG
  • Severe bacterial infections
77
Q

What are the examples of neutrophil defects in children?

A

Chronic granulomatous disease

78
Q

What are the examples of NK cell defects in children?

A
  • SCID
  • Bruton’s a-gammaglobulinaemia
  • Hyper IgM
  • Common variable ID
  • IgA deficiency
79
Q

What are the examples of leucocyte function defects in children?

A
  • Leucocyte adhesion deficiency
80
Q

What are the examples of complement defects in children?

A
  • Early complement deficiency (C1, C2, C4)
  • Late complement deficiency (C5-C9)
81
Q

What are the signs and symptoms of neutrophil defects?

A
  • Recurrent bacterial infections
  • Invasive fungal infections
82
Q

What are the signs and symptoms of neutrophil defects?

A
  • Recurrent bacterial infections
  • Invasive fungal infections
83
Q

What are the signs and symptoms of complement defects?

A
  • Recurrent bacterial infections - especially encapsulated bacteria
  • SLE-like illness
84
Q

What are the signs and symptoms of neutrophil defects?

A
  • Recurrent bacterial infections
  • Invasive fungal infections
85
Q

What are the signs and symptoms of Hyper-IgE (Job/Buckley) syndrome?

A
  • Eczema
  • Coarse facial features
  • Recurrent RTIs
  • Cold abscesses
  • Candidiasis
86
Q

What is Ataxia Telangiectasia?

A

Defective DNA repair

87
Q

What is associated with ataxia telangiectasia?

A

Increased risk of Lymphoma

88
Q

What are the signs and symptoms of ataxia telangiectasia?

A
  • Cerebellar ataxia
  • Developmental delay
  • Telangiectasia in the eyes
89
Q

What is Wiskott-Aldrich syndrome?

A
  • X-linked
  • Impaired Wiskott-Aldrich gene
  • Rare
90
Q

What are the signs and symptoms of Wiskott-Aldrich syndrome?

A
  • Present at 7 months
  • Eczema
  • Recurrent infections
  • Thrombocytopenia
    • Petechiae
    • Bloody diarrhoea
      • Wiskott-Aldrich Thrombocytopenia Eczema Recurrent infections → may look like ITP
91
Q

What is the management of Wiskott-Aldrich syndrome?

A

IVIG → HSCT

92
Q

What is Duncan disease?

A
  • X-linked lymphoproliferative disease
    • Inability to generate a normal response to EBV
93
Q

What are the signs and symptoms of Duncan disease?

A
  • Death to initial EBV
  • Secondary B-cell lymphoma
94
Q

Describe X-linked SCID.

A
  • 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
Q

What are the signs of SCID?

A
  • 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
Q

What is DiGeorge syndrome?

A
  • 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
Q

What are the signs of DiGeorge syndrome?

A
  • 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
Q

What is Bruton’s X-linked a-gammaglobulinaemia?

A
  • 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
Q

What are the signs of Bruton’s X-linked a-gammaglobulinaemia?

A
  • 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
Q

What is Hyper IgM syndrome?

A
  • 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
Q

What are the signs of Hyper IgM syndrome?

A
  • 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
Q

What is Common variable immune deficiency?

A
  • 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
Q

What are the signs of common variable immune deficiency?

A
  • 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
Q

What is Selective IgA deficiency?

A
  • Genetic condition with unknown cause
  • Prevalence = 1:600
    • 2/3rd = Asymptomatic
    • 1/3rd = Recurrent respiratory tract infections

a Paediatrics by themes (26 decks)

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