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Infection and Immunity Flashcards

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1
Q

Red flags in infection

A

Fever >38’c (<3 months) >39’c (3-6 Months)
Pale, mottled, cyanosis
Reduced consciousness: does not wake or remain awake when roused
Bulging fontanelles
Neck stiffness
Status epilepticus
Focal neurology
Severe dehydration/shock: reduced skin turgor, tachycardia, < cap refill, dry mucous membranes, poor feeding
Bile stained vomit
Significant respiratory distress: grunting, tachypnoea (RR>60), moderate or severe chest indrawing
No response to social cues
Weak, high-pitched or continuous cry

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2
Q

Mx sepsis

A

Ceftriaxone, IV fluids

Correction of clotting in DIC: FFP, cryoprecipitate, platelet transfusion

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3
Q

Causative organisms sepsis

A

Associated with staph aureus or staph pneumonia in children

In neonates group B stress or E.coli

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4
Q

Features bacterial meningitis

A

Usually follows bacteraemia
Release of inflammatory mediators and activated leukocytes cause cerebral odea, and fibrin deposits block resorption of CSF

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5
Q

Causative organisms bacterial meningitis

A

Neonates: GBS, E.coli, Listeria
1month-3 months: Neisseria meningitidis, strep pneumonia, H. influenza
>6 years: N. meningitidis, step pneumonia

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6
Q

Mx bacterial meningitis

A

Administer antibiotics and supportive therapy: third gen cephalosporin
Prophylaxis rifampin or ciprofloxacin given to eradicate nasal carriage in household contacts and vaccination against Men C

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7
Q

Causative organism viral meningitis

A

Usually enterovirus, EBV, adenovirus and mumps

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8
Q

Atypical organisms meningitis

A

Mycoplasma, borrelia bordefei, TB, fungal infection

Usually in immunodefiency

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9
Q

Features encephalitis

A

nflammation of the brain substance
Most commonly enterovirus, respiratory virus and herpes virus
High dose acyclovir given to all in case of HSV encephalitis
HSV encephalitis:
-Rare cause
-Detected by PCR
-CT/MRI shows focal lesions due to the destructive nature of virus
-High mortality with severe neurological sequelae

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10
Q

Mx toxic shock syndrome

A

Usually requires ICU to managed shock
Areas of infection need surgical debridement
Third cephalosporin antibiotics to switch of bacterial toxin production
IVIg can be used to neutralise circulation toxin

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11
Q

Features toxic shock syndreom

A

Toxin producing bacteria: staph aureus, group A strep
Characterised by: fever over 39’c, hypotension, diffuse erythema, macular rash
Multiple organ dysfunction
Desquamation of palms and soles can occur 1-2 weeks following onset of illness

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12
Q

Features necrotising faciitis

A

Severe cutaneous infection involving skin place to fascia/muscle
Typically staph aureus or group A strep
Severe pain and systemic illness
Usually requires ICU
IV antibiotics are not sufficient alone
Surgical intervention and debridement of necrotic tissue

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13
Q

Features Kawasaki

A

Systemic vasculitis: requires immediate treatment
Affects children aged 6 months- 4yars with peak onset at year 1
More common in Japanese and Balck carribean origin
Typically high fever over 5 days resistant to antipyretics
Conjunctival injection, bright red/cracked lips, strawberry tongue, cervical lymphadenopathy, red palms on hands and soles of feet
Clinical diagnosis, no specific testing

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14
Q

Mx Kawasakis

A

High dose aspirin: reduces thrombosis, given until the fever subsides and inflammatory markers return to normal
Lower dose given for 6 weeks after normal echo
IVIg given within first 10 days
Echocardiogram: screening for coronary artery aneurysm (giant aneurysm requires warfarin)

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15
Q

Presentations of staph

A 
Impetigo
Boils
Periorbital cellulitis
Orbital cellulitis
Staphylococcal scalded skin syndrome
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16
Q

Presentations of H. influenzae

A

otitis media, pneumonia, epiglottitis, cellulitis, osteomyelitis, septic arthritis

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17
Q

Presentations of pneumococcus

A

pharyngitis, otitis media, conjunctivitis, sinusitis

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18
Q

Features herpes virus infection

A

gastroenteritis, cold sores, eczema herpeticum, herpetic whitlows (edematous white pustules, typically on finger), eye disease, dissemination

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19
Q

Features chicken pox

A

Common skin condition of childhood with characteristic rash and prodrome including fever, headache, malaise, abdominal pain
Self resolving in most children

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20
Q

Prophylaxis indications chicken pox

A

IV acyclovir and IVIg in immunocompromised and pregnancy with exposure to children

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21
Q

Features EBV

A

Tropism for B lymphocytes and epithelial cells of the oropharynx
Oral transmission
Fatigue prominent feature
Fever, malaise, tonsillitis, pharyngitis, lymphadenopathy, petechiae, splenomegaly, hepatomegaly, maculopapular rash, jaundice
Long course typically 1-3m

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22
Q

Mx EBV

A

Symptomatic treatment
Corticosteroids given where airway is compromised
Group A strep commonly concurrent- penicillin
Avoid amoxicillin and ampicillin which can cause a florid maculopapular rash

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23
Q

Ix EBV

Study These Flashcards
A

Blood film shows atypical lymphocytes and numerous large T cells
Monospot test positive (Poor sensitivity)
Seroconversion with antibodies

24
Q

Features CMV

Study These Flashcards
A

subclinical in most immunocompetent hosts

25
Mx CMV
IV ganciclovir and valganciclovir | Used as prophylaxis in immunocompromised .e.g. transplant
26
Features HPV B19
Causes slapped cheek syndrome Commonly occurs in outbreaks typically in the summer Effects erythroblastosis red cell precursors in bone marrow Multiple clinical syndromes: erythema infectiosum; aplastic crisis;fetal disease
27
Features mumps
Replicated in epithelial cells: access to parotid via widespread dissemination Fever, malaise, parotitis often unilateral and becomes bilateral Can cause orchitis especially in post pubertal males: unilateral hence infertility is uncommon Transient hearing loss associated Pancreatic involvement causes abdo pain
28
Features tuberculosis
Latent disease is asymptomatic: more likely to progress to active disease in children Local inflammatory responses typically limits progression of infection Lymphatic spread occurs in failure of immune response in children, causing systemic symptoms of fever, anorexia, weight loss, cough
29
Ix Tuberculosis
Sputum sample difficult to acquire in children <8years of age Gastric washing can be used to collected swallow septum in children Culture shows acid fast bacilli and PCR Mantoux test positive for previous infection and vaccination Induration of 5mm is positive of active TB regardless of previous vaccination ChestXray shows hilar lymphadenopathy, collapse and consolidation/pleural effusion
30
Mx tuberculosis
Quadruple therapy: rifampicin, isoniazid, pyrimidine, ethambutol for 2 months then decreasing to rifampicin and isoniazid for 4 months Pyridoxine is given weekly in adolescents to prevent peripheral neuropathy associated with isoniazid BCG vaccination for high risk individuals only Dexamethasone given in meningitis Latent TB in children can be treated prophylactically to decrease reactivation in later life
31
Features rheumatic fever
Rare in developed world Response to group A beta haemolytic strep Affects children aged 5-15 Prevention by use of antibiotics for 10 days in initial strep infection Latent period of 2-6 weeks Main manifestations: -Endocarditis -Myocarditis and heart failure -Pericarditis (friction rub, effusion, tarde) -Sydenham Chorea -Migratory arthritis: ankles, knees and wrists -Erythema Marginatum: rash on trunk and limbs -Subcutaneous nodules: extensor surfaces Heart disease is often long term damage from scarring and fibrosis of valvular tissue- associated with mitral stenosis developing in adult life
32
Ix Rheumatic fever
GAS titre including culture or antigen- raised in acute phase Prolonged PR interval on ECG
33
Mx Rheumatic fever
Bed rest and anti-inflammatories High dose aspirin effective in suppression of inflammatory responses Corticosteroids for non-resolving fever and inflammation Heart failure controlled by diuretics and ACE inhibitors Recurrence prevented by daily oral penicillin or monthly injection of benzylpenicillin (erythromycin in penicillin allergy) Prophylaxis given for 10 years post infection or until age 21
34
Topical infections examples
``` Malaria Typhoid Dengue Chiniingiya Zika virus Viral haemorrhagic fever ```
35
Examples T cell defects
``` Severe combined immunodeficiency Wiskott Aldrich syndrome DiGeorge Duncan disease Ataxia telangiectasia ```
36
Features T cell defect immunodeficiency
Severe and unusual viral and fungal infection and faltering growth in the first few months Abnormal FBC and lymphocyte subsets
37
Mx T cell immunodeficiency
Cotrimoxazole to prevent PCP and itraconazole/fluconazole to prevent fungal infection
38
Features wiskott aldrich syndrome
Triad of immunodeficiency, thrombocytopenia and eczema | X linked
39
Features Duncan disease
poor response to EBV | Susceptible to lymphoma
40
Features ataxia telangiectasia
Defect in DNA repair Increased risk of lymphoma Cerebellar ataxia Developmental Delay
41
Dx HIV
Diagnosis is by antibody detection in children over 18 months Before 18 months, maternal IgG is present: HIV PCR is diagnostic test 2 negative tests within first 3 months confirms lack of HIV
42
Mx HIV
All children followed up with ART following diagnosis Prophylaxis for PCP given in low CD4 count Reduction in vertical transmission during pregnancy by good regimen HAART and no breastfeeding, good labour management including possible C section
43
Childhood presentation HIV
Mild: lymphadenopathy or parotid enlargement Moderate: recurrent bacterial infections, candidiasis, chronic diarrhoea, lymphocytic interstitial pneumonitis Severe: opportunistic infections, severe growth faltering, encephalopathy, malignancy
44
Features B cell immunodeficiency
In first 2 years severe bacterial infections, especially hearts, sinus, pulmonary, and skin infections. Recurrent diarrhoea and faltering growth Immunoglobulin levels and subclasses
45
Mx B cell deficiency
Antibiotic prophylaxis .e.g. Azithromycin to prevent recurrent bacterial infections
46
Examples B cell defects
X-linked ammaglobulinaemia Common variable immune deficiency Hyper IgM syndrome Selective IgA deficiency
47
Features leukocyte function defects
Delayed separation of the umbilical cord, delayed wound healing, chronic skin ulcers, deep-seated infections Leukocyte adhesion deficiency: Deficiency of neutrophil surface adhesion molecules causes inability of neutrophils to migrate to sites of infection and inflammation
48
Features Complement Defects
Recurrent bacterial infections SLE like illness Recurrent meningococcal, pneumococcal and H.influenzae infection E.g. Early complement component deficiency, terminal complement component deficiency, mannose-binding lectin deficiency
49
Ix complement defects
Tests of classical and alternative complement pathways, mannose binding lectin levels and assay for individual complement proteins.
50
dDx infectious rashes
``` Chicken pox Measles Rubella Erythema Infectiosum Scarlet fever Hand, foot, and mouth ```
51
Features chicken pox rash
Initially a fever Itchy rash, starting on head/trunk before spreading. Initially macular then popular than vesicular Systemic illness usually mild
52
Features Measles
Irritable, conjunctivitis, fever prodrome Koplick spots: white spot on buccal mucosa Rash starting behind ears spreading to whole body Discrete maculopapular rash become blotchy and confluet
53
Features Rubella
Pink maculopapular initially on face before spreading to whole body Usually afdes by day 3-5 Lymphadenopathy affecting suboccipital and postauricular
54
Features Erythema Infectiosum
Slapped cheek syndrome Associated with parvovirus B19 Lethargy, fever, headache, , cheek rash spreading to arms and extensor surfaces
55
Feasture Scarlet fever
Group A haemolytic streptococci Fever, malaise, tonsillitis, strawberry tongue Rash is fine punctate sandpaper rash sparing around the mouth (circumoral pallor)
56
Features hand foot and mouth
Coxsackie A16 virus Mild systemic upset of sore throat and fever Vesicles in the mouth and on palms and soles of feet

Paediatrics (22 decks)

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