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Infection and Immunity Flashcards

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1
Q

Why is an infant unlikely to have a common viral infection when less than 3 months of age?

A

Still has passive immunity from their mothers

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2
Q

What are the components of a septic screen?

A

Blood culture
FBC
CRP
Urine sample

If indicated :

CXR
LP
antigen screen on blood/CSF/urine
meningococcal & pneumococcal PCR on blood/CSF
PCR in viruses in CSF
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3
Q

What are some clinical features of neonatal sepsis?

A 
Fever
Poor Feeding
Vomiting
Apnoea
Bradycardia
Resp. Distress
Jaundice
Neutropenia
shock
seizures

IN MENINGITIS
bulging fontanelle
head retractionn

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4
Q

What are some risk factors for infection?

A

illness of family members

illness in the community

unimmunized

recent travel

contact with animals

immunodeficient

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5
Q

What are some secondary causes of immunodefiency?

A

autosplenectomy

nephrotic syndrome

primary immune deficiency

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6
Q

What are some red flag symptoms in an infected child?

A

if 3 months old, anything higher than 38C
3-6 months higher than 39

pale mottled blue

decreased level of consciousness

neck stiffness

bulging fontanelle

status epilepticus

resp. distress

bile stained vomiting

sever dehydration and shock

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7
Q

What is the immediate management of febrile child?

A
  1. Septic Screen
  2. Abx - > 3 months (cefotaxime, ceftriaxone
    - 1 - 3 months (cefotaxime for septicaemia/meningitis)

(ampicilin for listeria)
(aciclovir if herpes simplex suspected)

  1. antipyretics

child shouldn’t be undressed

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8
Q

What are the potential causes of meningitis?

A

Viral - most common and self-resolving

Bacterial - may have sever consequences, 5-10% mortality and 10% of survivors have long-term neuro impairment

Malignancy

Autoimmune

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9
Q

What is the pathophysiology behind meningitis?

A

Damage and inflamm caused by host response to infection rather than organism itself

  • endothelial damage leads to cerebral edema causing increased ICP
  • inflamm response also causes vasculopath which leads to cerebral cortical infarct
  • fibrin deposits blocks CSF resorption and leads to hydrocephalus
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10
Q

Most common organism causing meningitis in a 3 month old?

A

Group-B strep

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11
Q

Most common organism causing meningitis in above one month olds?

A

Neisseria meningitidis and Strep Penumoniae

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12
Q

How does meningitis present?

A

If child old enough to talk:

  1. Neck Stiffness
  2. Headache
  3. Photophobia

if younger than that symptoms are unspecific

If septicaemic - can present with tachycardia, tachpnoea, prolonged cap refill and hypotension

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13
Q

What assumption is made if a febrile child presents with purpura?

A

meningococcal sepsis

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14
Q

What is a positive Brudzinski sign?

A

flexion of neck when supine causing flexion of knees and hips

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15
Q

What a is a positive Kernig sign?

A

Hips and knees flexed in the supine position , then when knee is extended = back pain

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16
Q

What investigations would you carry out for suspected meningitis?

A

FBC, U&Es, LFC, CRP

blood culture, throat swab, stoll sample, urine sample

rapid antigen test (blood, CSF or urine)

PCR blood and CSF

LP

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17
Q

What are contra-indications for an LP?

A

cardio-resp instability

focal neuro signs

increased ICP

coagulopathy

thrombobytopenia

infection @ LP site

causes delay in abx start

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18
Q

What should be done to a febrile child who has a purpuric rash?

A

given IM benzylpenicillin and transferred urgently to hospital

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19
Q

What are cerebral complications associated with meningitis?

A

Hearing loss - damage to cochlear hair cells

Local Vasculitis - cranial nerve palsies

Local cerebral infarction - seizures could lead to epilepsy

Subdural effusion - assoc w H. infuenzae and pneumococcal meningitis

Hydrocephalus -

Cerebral Abscess - clinical condition deteriorates

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20
Q

What can be prophylactically for meningitis?

A

Rifampicin - not required if patient has been given third-gen cephalosporin

Household contacts who hgad group c meningococcal meningitis should be vaccinated with Men C vaccine

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21
Q

What is partially treated bacterial meningitis?

A

When children are treated with abx for non-specific febrile illness

This will cause cultures to show up negative and mask early meningitis

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22
Q

What is encephalitis?

A

inflammation of the brain matter when exposed to a virus or foreign protein

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23
Q

How does encephalitis present?

A

fever
altered consciousness
seizures

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24
Q

How would you differentiate encephalitis from meningitis?

A

Its hard to distinguish, therefore if in doubt treat both

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25
Why should all children with encephalitis be treated with high-dose acyclovir?
while rare Herpes Simplex Virus can be very bad and have long-term consequences. Acyclovir can treat it
26
What organisms cause toxic shock syndrome?
Staph Aureus and group A strep which release toxins
27
How does Toxic Shock Syndrome present?
temperature above 39 degrees hypotension diffuse erythematous macular rash resemblibg sunburn palms and soles mucositis vomiting/diarrhoea clotting abnormalities altered consciousness
28
How would you manage toxic shock syndrome?
ICU support for shock debride sites of infection 3rd gen cephalosporin Clindamycin ( turns off toxin product) IV immunoglobin
29
What is panton-valentine leukocidin producing S. aureus?
particularly bad form of s. aureus that can cause necrotising fasciitis and necrotising haemorrhaging pneumonia
30
How does a Meningococcal infection present?
Septicaemia and purpuric rash with legions that are non-blanching, irregular size and a necrotic centre
31
What is management for any child that presents with a purpuric rash?
Treatment with systemic abx such as penicilllin
32
Which is the most dangerous strain of meningococcal infection?
B as there is vaccination available for A and C
33
What are some complications/presentations of a staphylococcal and group a streptococcal infections?
impetigo boils periorbital cellulitis scalded skin syndrome
34
How do human herpes viruses operate?
primary infection - latency established - long-term persistence in host in dormant state - certain stimuli might cause re-activation
35
Which body parts do HSV 1 & 2 normally infect?
HSV1 - lip & skin - gingivostomatitis - cold sores HSV2 - genitals
36
How does chicken pox present? A rough timeline of the symptoms?
fever papules - vesicles - pustules - crusts 200-500 lesions on head and trunk which spread to peripheries
37
When is a chicken pox infection at its most infectious?
-2 to 6 days of illness
38
What complications can arise from a chicken pox infection?
secondary bacterial infection encephalitis purpura fulminans if immunocompromised - progressive disseminated disease
39
What organism is responsible for chicken pox?
primary varicella zoster
40
What is shingles?
reactivation of latent varicella- zoster virus vesicular eruption in dermatomal distribution of sensory nerves
41
In children which population are more likely to develop shingles?
Those who had a primary varicella-zoster virus infection in the first year of life
42
What conditions do Epstein - barr cause?
Glandular fever (infectious mononucleosis) Burkitt lymphoma, lymphoproliferative disease and nasopharyngeal carcinoma
43
How does infectious mononucleosis present? how long do they last?
fever malaise tonsillopharyngitis lymphadenopathy also petechiea on soft palate, splenomegaly, hepatomegaly, maculopapular rash jaundice last for 1 -3 months
44
How would you diagnose infectious mononucleosis?
atypical lymphocytes +ve monospot test
45
How do measles present?
cough throughout conjunctivitis and coryza start to middle of infection koplik's spots (white spots on buccal mucosa) in middle of infection rash towards the end
46
What complications associated with measles?
Encephalitis Subacute sclerosing panencephalitis (SSPE) - on average presents 7 years after infect - can cause neuro dysfunction - dementia - death
47
What is most feared compication associated with mumps?
Orchitis - unusual in pre pubertal males
48
What is Kawasaki's? Why is it's diagnoses impt?
Systemic Vasculitis can cause aneurysms of coronary arteries which can be potentially fatal
49
What age group and ethnicities are affected by Kawasaki's?
6 months- 4 years Japanese and afro-carribean
50
What are the diagnostic criteria for Kawasaki's?
Fever lasting more than 5 days 4 of these 5 : conjunctival infection mucous membrane changes (red, dry cracked lips, strawberry tongue) cervical lymphadenopathy rash extremities ( red oedematous palms + soles + peeling of fingers and toes
51
What is the treatment for Kawasaki's?
IV immunoglobulin aspirin to reduce the risk of thrombosis antiplatelet aggregation infliximab for persistent inflamm and fever
52
How would diagnoses of HIV be done in a child older than 18 months?
diagnosing antibodies to the virus
53
How would diagnoses of HIV be done in a child younger than 18 months?
transplacental maternal IgG HIV antibodies would confirm exposure not infection HIV DNA PCR is most sensitive - two negative HIV DNA PCRs within the first 3 months, after 2 weeks completing antiretroviral therapy = not infected - confimed by loss of transplacental maternal HIV antibodies
54
How would HIV present?
Some symptomatic in the first year Others asymptomatic till later in life If mild - lymphadenopathy, parotitis moderate - recurrent bacterial infections, candidiasis, chronic diarrhoea and lymphotic interstitial pneumotitis
55
What is treatment for HIV?
infants - starts antiretroviral in older - prophylaxis against organisms with - co-trimoxazole immunise except for BCG
56
What immunisations are given to newborns?
Only in high-risk infants - BCG jab is given
57
What does the 5-in-1 jab consist of? when is it given?
diptheria, tetanus, pertussis, h. influenzae b and polio 2,3 and 4 months
58
What is the PCV13 vaccine? When is it given?
pneumococcal conjugate vaccine 2, 4 and 13 months
59
When is the rotavirus vaccine given? what route?
2 and 3 months orally
60
What jabs are given between 12 and 13 months?
booster Hib, Men C and MMR
61
How would immunune deficiencies present?
recurrent bacterial infections sever infections such as meningitis, osteomyelitis and pneumonia infections usually severe severe long-lasting warts extensive candidiasis abscesses of internal organs
62
What organism is responsible for scalded skin syndrome?
localised staphylococcal infection
63
What are the clinical features of scalded skin syndrome?
fever, irritability then redness of skin formation of blisters 24-48 hrs after top layer of skin begins to peel of - Nikolsky sign
64
How would you treat scalded skin syndrome?
IV flucloxacillin
65
What organism responsible for Slapped-Cheek?
parvovirus B19
66
How does slapped-cheek present?
mild feverish illness rose-red rash which makes cheeks red (doesn't involve palms and soles) Child feels better as rash appears
67
What is treatment for slapped cheek?
normally none needed
68
What is peculiar about the rash in slapped cheek?
Can be triggered months after infection by heat, warm bath, sunlight
69
What organism responsible for Scarlet fever?
Group A haemolytic strep
70
How does scarlet fever present?
incubation period of 2-4 days fever malaise, headache, nausea/vomiting sore throat strawberry tongue fine pin head rash on torso and more obvious on flexures 'sandpaper' desquamation around fingers and toes in late disease
71
How would you diagnose scarlet fever and treat?
throat swab oral penicillin V for 10 days
72
What complications can arise from scarlet fever?
otitis media rheumatic fever acute glomerulonephritis
73
What organism responsible for hand, foot and mouth?
Coxsackie A16
74
How does hand, foot and mouth present?
mild fever and sore throat oral ulcers vesicles on palms and soles
75
What form of TB is more common in children?
Paubacillary, TB more likely to progress from TB infection to TB disease in children and infants *in adults its more likely to be TB INFECTION
76
How would asymptomatic TB present?
50% of infants and 90% of older children will show minimal signs and symptoms of infection disease will remain latent and develop into active disease later in time Matoux test may be positive > initiaite treatment
77
How would symptomatic TB present?
fever anorexia and weight loss cough local enlargement of peribronchial lymph nodes pleural effusions
78
Where can a extra-pulmonary TB infection manifest?
central nervous system (tuberculous meningitis - the most serious complication) vertebral bodies (Pott's disease) cervical lymph nodes (scrofuloderma) renal gastrointestinal tract
79
How would you diagnose TB in children?
NG tube to get gastric aspirate Mantoux test - >10mm, >15mm with BCG interferon-gamma release assays (IGRA) CXR - hilar lymphadenopathy (can be mistaken for lymphoid interstitial pneumonitis)
80
What from patients history should be taken into account when doing Mantoux test?
BCG vaccination
81
Disadvatage of Mantoux test?
can't reliably distinguish between TB infection and TB disease will be non-responsive if patient has HIV (immunocompromised)
82
How would you treat TB?
Rifampicin Isoniazid Pyrazinamide Ethambutol Rifampicin and Isoniazid after 2 months * in tuberculous meningitis give dexa for first month atleast * if Mantoux positive but asymp > rifampicin and isoniazid for 3 months
83
What does High IgG + high IgM mean?
recent infection
84
What does High IgG + normal IgM mean?
previous infection or vaccination
85
What does Normal IgG + normal IgM mean?
no previous exposure

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