Infection and Immunity Flashcards by Toby Curtis-Mackenzie

A febrile child:

Assess risk
paracetamol or ibuprofen if >38C + distres/unwell
- NOT simultaneously try one then the other
Advice:
- dehydration Sx and fluids advice
- Check regularly
- keep away from other children if it persists

How well did you know this?

Not at all

Perfectly

Safety net for febrile children

Sxs of dehydration
Seizure
non-blaching rash
>5d fever
generally unwell
Distress/concern that they cant look after child

How well did you know this?

Not at all

Perfectly

Bacterial Meningitis Ix

LP
Culture
FBC, CRP, U+E, glucose
Coag.
CT head (before LP)
Admit emergency sepsis siiix

How well did you know this?

Not at all

Perfectly

bacterial meningitis Mx

Single dose IM/IV benzylpenicillin (second line moxifloxacin/vancomycin)
IV ceftriaxone:
- H. influenzae 10d
- S. pneumoniae 14d
- N. meningitidis 7d
?Dexamethasone
?IV saline
Notify health protection unit

How well did you know this?

Not at all

Perfectly

indications for dex in bacterial meningitis

frankly purulent CSF
CSF WCC >1000/ul
Rasied CSF WCC + protein conc. >1g/L
Bacteria on gram stain
1+ months and H. influenzae
NOT in meningococcal

How well did you know this?

Not at all

Perfectly

Discharge and follow up of bacterial meningitis

r/v 4-6w
Cx: hearing loss, ortho., skin, neurodevelopmental
purpura fulminans: acute often fatal thrombotic dx (bruising, skin necrosis, DIC - may need FFP, debridement or amputation)
Formal audiological assessment
Consider testing for complement def. if >1 episode of meningococcus or abnormal serotype dx
treating contacts: cipro>rifampicin, includes everyone who has had close contact w/patient in 7d before

How well did you know this?

Not at all

Perfectly

PACES counselling

Infection in tissue surrounding brain
Serious, but we have ABx
Requires admission
Can be long term Cx: hearing loss, will offter audiological assessment
FU 4-6wks
cipro proph. for close contacts
support: meningitis now

How well did you know this?

Not at all

Perfectly

Encephailitis in children Ix

FBC,
CT/MRI head
LP
Blood culture

How well did you know this?

Not at all

Perfectly

Encephalitis in children Mx

Proven and suspected HSV encephalitis w/high dose IV aciclovir for 3 weeks
(untreated mortality rate >70%)

How well did you know this?

Not at all

Perfectly

Toxic shock syndome

Ix: FBC, culture, coag
Intensive care
debridement
Abx:
- clinamycin (acts on ribosome to prevent toxin production)
- vanc/mero
IVIG may neutralise toxin
1-2 wks after onset you will see desquamation of palms soles fingers toes

How well did you know this?

Not at all

Perfectly

Necrotising fasciitis

Surgical emergency
debride all infected and devitalised tissue
IV fluids
Empirical IV Abx

How well did you know this?

Not at all

Perfectly

Impetigo

Clinical dx
Leaflets from BAD
usually heals no scarring
hygiene important (wash area, hands after touching, no sharing towels)
avoid school until lesions are dry and scabbed 
FU if no improvement in 7d:
- r/v dx
- check compliance
- take swab
- consider PO abx

How well did you know this?

Not at all

Perfectly

medical Mx of impetigo

Localised: topical fusidic acid t/qds for 7d
Extensive: PO fluclox qds 7d(clari if allergic)
bullous infection: oral fluclox or clari

How well did you know this?

Not at all

Perfectly

Cellulitis in children

Ix: mark area, FBC, culture/molecular diagnosis
Mx: high dose fluclox (clari 2L)
48hr r/v
If occurring on top of VZV: fluclox + amox (cipro+clari 2L)
NO need for regular swabs/bloods if mild
Paracetamol/ibuprofen
seek help if worsens/doesnt improve in 48hr

How well did you know this?

Not at all

Perfectly

Erysipelas

presents similarly but rash is very well demarcated

Penicillin V

How well did you know this?

Not at all

Perfectly

Periorbital cellulitis

contrast CT of sinus and orbits
Prompt IV abx (ceftriaxone)
I+D if necessary

How well did you know this?

Not at all

Perfectly

Staphylococcal scalded skin syndrome

IV fluclox
analgesia
hydration

How well did you know this?

Not at all

Perfectly

HSV in children

Study These Flashcards

paracetamol/ibuprofen

aciclovir considered

Chickenpox in children

Study These Flashcards

Admit if any serious Cx (pneumonia, encephalitis, dehydration)
Consider PO aciclovir 800mg 5d in adolescents if presenting within 24hrs of rash onset or if severe

Advise for chickenpox

Study These Flashcards

fluid intake
dress appropriately in smooth cotton
short nails
most infectious 1-2d before rash appears, lasts until all lesions crusted
when infectious AVOID: IC, pregnant, <4w infants
AWAY from school until lesions crusted
Seek help:
- bacterial superinfection (high grade fever, redness, tenderness on lesions)
- dehyration (red. urine output, lethargy, cool peripheries

Immunocompromised children and chickenpox

Study These Flashcards

IV aciclovir
PO valaciclovir later on
VZIG used in t cell def. after contact (not absolute protection)

EBV in children

Study These Flashcards

Paracetamol/ibuprofen
2-3wks 
Dont have to avoids school
limit spread
avoid contact sport for 8wks
corticosteroids rarely for airway compromise
AVOID: amoxicillin and ampiciilin

Seek help in EBV:

Study These Flashcards

Stridor, resp difficulty
dysphagia
dehydration
systemically unwell
abdopain

CMV in children

Study These Flashcards

self limiting
if necessary:
- IV ganciclovir, PO valgan
foscarnet ( all have serious SE)

HHV6 + 7

``` Roseola infantum will resolve over days/wk paracetamol/ibuprofen hydration risk of febrile seizure ```

Parvovirus B19

paracetamol/ibuprofen

Measles in children

``` Notify HPT usually self-limiting but can cause: rash, fever, conjunctivitis, cough, convulsion Ix: serology (IgM/G), consider PCR Rest and drink plenty ibuprofen/paracetamol Stay away from school at least 4d after developing rash safety net encourage vaccinations once episode over Isolate children Ribavirin if IC ```

Measles safety net

SOB uncontrolled fever convulsions/altered consciousness

Mumpsin children

``` Notify HPT Ix: salivary IgM, amylase Self limiting Rest and fluids paracetamol/ibuprofen stay away from school 5d after developing parotitis ```

Mumps safety net

meningitis epididymo-orchitis immunisation status of close contacts

Rubella in children

``` Call HPT IgM serology, viral PCR Dx oral fluid sample self limitng rest and fluids admit if haemorrhagic Cx or encephalitis ```

Kawasaki Disease

``` Ix: FBC, ESR/CRP, Echo IVIG High dose aspirin (consider steroids, infliximab) Children w/large coronoary artery aneurysm may need long term warfarin and FU CV risk assessment necessary ```

Tuberculosis in children

notify HPT Ix: CXR, sputum AFB smear, sputum culture (takes >4w) NAAT: result in 8hr, use if smear +ve to confirm M. tuberculosis, FBC Admit if active TB and unwell if well send to specialist TB service (includes key worker) Contact tracing TB alert (website)

Requirements for AFB smear

3 specimens, at least 8hrs apart | includes one early morning specimen

Medical Mx of tuberculosis

Rifampicin and isoniazid 6m Pyrazinamide and ethambutol for first 2m In adolescent: pyroxidine given weekly (peripheral neuropathy) If TB meningitis: dexamethasone NB. asymptomatic children who are mantoux/IGRA +ve (latent) should be Rx to reduce reactivation Risk assessment for drug-resistance

Latent TB Rx

Isoniazid 6m | Rifampicin and isoniazid 3m

HIV in children

Decision to start Rx based on clinical status, VL and CD4 Start on ART early with infants bc higher risk of progression PCP prophylaxis w/co-trim. for infants who are HIV infected and for older pts w/low CD4 Immunisations (except BCG) MDT Regular FU w/weight + development

Reducing vertical transmission of HIV

``` VL >50 c-section babies born to HIV+ mothers zidovudine for 6weeks Avoidance of bf perinatal transmission <1% bc: - ART in pregnancy - PEP for baby - avoidance of bf - active mx to prevent prolonged labour - c-section early if VL>50 ```

Hereditary Immunodeficiency Antimicrobial proph.

T cell and neutrophil: co-trimox. for PCP, itraconazole for other infections B cell:azithromycin

Hereditary Immunodeficiency antibiotic Rx

Prompt longer courses low IV threshold

Hereditary Immunodeficiency screening for end organ Dx

CT in Ig deficiency for bronchiectasis

Hereditary Immunodeficiency immunoglobulin replacement therapy

for antibody def.

BMT in Hereditary Immunodeficiency

SCID, chronic granulomatous Dx

MMR CI and SE

CI: severe IS Allergy to neomycin another live vaccine by injection in last 4 weeks IG therapy in the last 3m Adverse effects: Malaise, fever, rash can occur after 5-10d lasts 2-3d

Infection and Immunity Flashcards

(44 cards)