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Paediatrics > Infection and immunity > Flashcards

Infection and immunity Flashcards

1
Q

Give some examples of causative organisms for bacterial meningitis

A

< 1 month = Group B strep

> 1 month:

  • Neisseria meningitis
  • Streptococcus pneumoniae
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2
Q

What are the symptoms and signs of meningitis in infants and children?

A

Symptoms:

  • Infants = very non specific, e.g. irritability, lethargy, poor feeding
  • Older children who are able to talk may be able to also describe the classical symptoms of headache, neck stiffness and photophobia

Signs:

  • Fever
  • Non-blanching purpuric rash
  • Positive Kernig’s sign (with the child lying supine and the hips and knees flexed, extension of the knee elicits back pain)
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3
Q

Describe the investigation of suspected meningitis

A

Septic screen:

  • FBC
  • CRP
  • Blood cultures
  • Urine culture
  • LP (contraindicated in meningococcal septicaemia)
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4
Q

Describe the management of suspected meningitis in infants and children (and their contacts)

Which other medication is given in the treatment of bacterial meningitis to children over 3 months?

A
  • Community/GP: IM benzylpenicillin
  • Hospital: IV broad spectrum antibiotics*
  • Household contacts: ciprofloxacin
  • Choice of antibiotics depends on age:
  • < 3 months old = cefotaxime + amoxicillin (listeria cover)
  • > 3 months old = ceftriaxone

Dexamethasone

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5
Q

What is the organism that causes chickenpox?

A

Varicella zoster virus (VZV)

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6
Q

What are the clinical features of chickenpox?

A
  • Fever

- Itchy, vesicular rash which covers the whole body

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7
Q

Describe the management of chickenpox for the patient and contacts

Do children need to be excluded from school?

A
  • Patient = supportive treatment
  • Contacts (who are non-immune PLUS immunocompromised or pregnant) = VZIG 7-14 days post exposure
  • Yes, until all lesions have crusted over
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8
Q

What are the potential complications of chickenpox?

A
  • Encephalitis
  • Secondary bacterial infection
  • Disseminated disease in immunocompromised
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9
Q

Describe the clinical features of measles

A
  • Fever
  • 3 C’s (and 1 K): coryza, cough, conjunctivitis, Koplik spots (white spots on buccal mucosa)
  • Erythematous widespread rash
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10
Q

Describe the management of measles

Do children need to be excluded form school?

A

Supportive

Yes, until 4 days after onset of rash

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11
Q

Describe the clinical features of mumps

A
  • Fever

- Parotitis

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12
Q

Describe the management of mumps

Do children need to be excluded form school?

A

Supportive

Yes, until 5 days after onset of swollen glands

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13
Q

What are the potential complications of mumps?

A
  • Encephalitis
  • Hearing loss (usually transient and unilateral)
  • Orchitis
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14
Q

Which organism causes hand, foot and mouth disease?

A

Coxsackie virus (a type of enterovirus)

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15
Q

What are the clinical features of hand, foot and mouth disease?

A
  • Fever

- Painful vesicular lesions on the hands, feet and mouth (and often also on the buttocks)

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16
Q

Describe the management of hand, foot and mouth disease

Do children need to be excluded form school?

A

Supportive

No

17
Q

Describe the NHS vaccination programme for…

  • Babies aged under 1 year
  • Children aged 1-15 years
A 
Babies under 1 year:
8 weeks: 6MR
- 6-in-1 (diphtheria, tetanus, polio, pertussis, hep B, Hib)
- MenB
- Rotavirus

12 weeks: 6PR

  • 6-in-1
  • Pneumococcal vaccine
  • Rotavirus

16 weeks: 6M

  • 6-in-1
  • MenB
Children aged 1-15 years:
1 year: PMHM
- Pneumococcal
- MenB
- Hib/Men C
- MMR

2-10 years:
- Flu vaccine (every year)

3 years 4 months:

  • MMR
  • 4-in-1 pre-school booster (diphtheria, tetanus, polio, pertussis)

12-13 years:
- HPV vaccine for girls AND boys

14 years:

  • 3-in-1 teenage booster (diphtheria, tetanus, polio)
  • MenACWY
18
Q

Describe the aetiology of scarlet fever

A

Scarlet fever is a bacterial infection caused by Streptococcus pyogenes (group A streptococcus)

19
Q

What are the clinical features of scarlet fever?

A
  • Fever
  • 3 S’s: Sore throat (strep pharyngitis), Strawberry tongue, Sandpaper rash
  • Rash: erythematous, widespread
20
Q

Describe the management of scarlet fever

Do children need to be excluded from school?

Are there any complications of scarlet fever?

A

Management:
- 10 day course of penicillin

Yes, until 24 hours after commencing antibiotics

Complications:
- Rheumatic fever

21
Q

‘Slapped cheek syndrome’ is also known as…?

A
  • Fifth disease
22
Q

Describe the aetiology of slapped cheek syndrome

A

Parvovirus B19

23
Q

Describe the clinical features of slapped cheek syndrome

Are there any complications of slapped cheek syndrome?

A

Clinical features:

  • Fever
  • Coryza
  • Rash: erythematous; on the cheeks

Complications:
- Aplastic crisis (reticulocytopenia) in children with chronic haemolytic anaemia (e.g. sickle cell anaemia, thalassaemia)

24
Q

Describe the management of slapped cheek syndrome

Do children need to be excluded from school?

A

Supportive

No

25
Q

If you suspect a case of measles, mumps or rubella - aside from management of the patient, what further action is required?

A

Notification (PHE)

26
Q

Describe the aetiology of roseola infantum

A

Human Herpesvirus 6 (HH6) = most common cause (also known as ‘sixth disease’)

27
Q

What are the clinical features of roseola infantum?

A
  • Fever (typically lasting 3 days), FOLLOWED by erythematous rash (develops as child is getting better)
28
Q

Describe the management of roseola infantum

Do children need to be excluded form school?

A

Supportive

No

29
Q

What is shingles?

A

Reactivation of VZV

30
Q

What are the clinical features of shingles?

A
  • Erythematous rash

- Dermatomal distribution (does not cross the midline)

31
Q

Describe the management of shingles for the patient and contacts

A
  • Patient = oral aciclovir

- Contacts (who are non-immune PLUS immunocompromised or pregnant) = varicella zoster immunoglobulin (VZIG)

32
Q

Which mnemonic can you use to remember the components of the NICE febrile child traffic light guidelines?

A

AARCH (+other):

  • Appearance
  • Activity
  • Respiratory
  • Circulation and Hydration
    + other (fever)
33
Q

Describe the AMBER criteria of the NICE febrile child traffic light guidelines

A

Appearance:
- Pallor (reported by parent/carer)

Activity:

  • Not responding normally to social cues
  • Wakes only with prolonged stimulation
  • No smile
Respiratory:
- Nasal flaring
- Tachypnoea:
>50 breaths/min (6-12 months)
>40 breaths/min (>12 months)
- Oxygen sats <95%
Circulation + Hydration:
- Tachycardia:
>160 bpm (<12 months)
>150 bpm (12-24 months)
>140 bpm (2-5 years)
- CRT >3 seconds
- Dry mucous membranes
- Reduced oral intake/urine output

Other:

  • 3-6 months with fever >39 degrees
  • Fever 5 days+
34
Q

Describe the RED criteria of the NICE febrile child traffic light guidelines

A

Appearance:
- Pallor/cyanosis

Activity:

  • No response to social cues
  • Does not wake when roused
  • Weak/high-pitched/continuous cry

Respiratory:

  • Grunting
  • Moderate/severe chest indrawing
  • Tachypnoea (>60 breaths/min)
  • Oxygen sats <92%

Circulation + Hydration:
- Reduced skin turgor

Other:
- <3 months with fever >38 degrees

35
Q

Which class of drugs is used to treat whooping cough? Give examples.

When must this drug be given?

Do children need to be excluded form school if they have whooping cough?

A

Macrolide antibiotics, e.g. azithromycin/clarithromycin

Up to 21 days from onset of symptoms

Yes, until 2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics)

Paediatrics (17 decks)

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