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paeds > infection and immunity > Flashcards

infection and immunity Flashcards

1
Q

How to safety net febrile child

A 
come back if:
seizures
unwell > 5 days
rashes
child looks generally unwell
concerned you can't look after child
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2
Q

What organisms cause meningitis

A 
<3 months
group b strep
e. coli
listeria
3 months - 6 years
n. meningitides
strep pneumonia
h. influenza
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3
Q

what are the contraindications for LP

A

neuro signs of inc. ICP
cardio resp fragility
thrombocytopenia
coagulopathy

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4
Q

Mx meningitis

A
  1. benzylpenicillin ASAP
  2. 3rd gen cephalosporin (+ supportive - anticonvulsants, saline)
  3. Dexamethasone if: v. turbid csf, CSF WCC >1000, bacteria on gram stain
    don’t use steroids in meningococcal speticaemia

give ciprofolxacin prophylaxis to all household after meningococcal meningitis or h.influenza

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5
Q

Causes of atypical meningitis

A

Lyme’s disease
TB
mycoplasma
fungal

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6
Q

Mx encephalitis

A 
treat all w/ IV aciclovir until cause is determined
supportive care in ICU
HSV1+2 - IV aciclovir
VZV- aciclovir/ganciclovir
CMV - ganciclovir +foscarnet
EBV - aciclovir
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7
Q

What causes toxic shock syndrome

A

toxin producing staph a

group a streptococci

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8
Q

how does toxic shock syndrome present

A

fever
hypotension
widespread erythematous macular rash
NB- some staph a have PVL which causes necrotising fasciitis

after 2 weeks get desquamation of palms + soles

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9
Q

Mx of toxic shock syndrome

A

ICU
surgically debride infected areas
start BSA before cultures come back

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10
Q

What does impetigo look like

A

honey crusted lesions on nose and mouth

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11
Q

Mx impetifo

A

advice about hand washing

topical or oral abx

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12
Q

mx

A

admission
IV abx (flucloxacillin)
emollient

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13
Q

How does HSV present in most children

A

gingivostomatitis

secondary presentations (from reactivation):
cold sores
eczema herpeticum (can get overlying bacterial infection)
herpetic whitlow on skin by nails
eye problems

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14
Q

Which children get disseminated HSV

A

neonates
immunocompromised
get encephalitis and aseptic meningitis

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15
Q

Mx HSV

A

symptomatic

if severe: aciclovir and IV fluids

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16
Q

complications of VZV

A

Secondary bacterial infections - staph aureus, group a strep causing necrotising fasciitis + TSS
Encephalitis - prognosis quite good. Typically get VZV cerebllitis so present ataxic
Purpura fulminans - VZV viral Ab attack skin (also get increased risk of clot)

17
Q

Mx VZV

A

Advice:
most contagious 1-2 days before rash
stops being contagious when everything crusted over

avoid contact w/:
pregnant women
immunocompromised
<4 weeks old

Mild disease:
oral paracetamol and emollients to stop itching (keep nails short)

moderate disease:
oral aciclovir
oral paracetamol, emollient
admit if serious complications

severe:
IV aciclovir
+ others

immunocompromised:
human VZVIg IV

18
Q

Symptoms of EBV

A 
fever
tonsiliitis/pharyngitis
lymphadenopathy
splenomegaly
maculopapular rash
19
Q

Dx of EBV

A

atypical lymphocytes on
Monospot test (heterophile Ab positive)
seroconversion with 3 antibodies

20
Q

Mx of EBV

A

paracetamol/ibuprofen
lasts 2-4 weeks
don’t need to stay home but avoid contact sports

come back if stridor, difficulty breathing, abdo pain

NB - ampicillin and amoxicillin cause maculopapular rash

21
Q

How does CMV present

A

Mononucleosis like syndrome
pharyngitis
atypical lymphocytes
BUT heterophile Ab negative (unlike EBV)

22
Q

what causes roseola infantum and how does it presetn

A

HHV6 + 7
High fever
macular rash (comes on as fever starts to wane)

23
Q

what does parvovirus B19 cause

A

slapped cheek syndrome (erythema infectiosum)

24
Q

natural hx of parvovirus b19

A

fever + myalgia
red cheeks after a week
lace-like purpuric rash on trunk + limbs after a week

can get aplastic crisis if underlying anaemias/thalassemia
avoid pregnant woman (get hydrops)

25
Q

Mx parvovirus

A

Avoid pregnant women

pain killers and hydration

26
Q

What can enteroviruses cause

A

Hand foot and mouth disease (painful vesicles)
herpangina (vesicles on soft palate and uvula)
myocarditis (rare)
enteroviral neonatal sepsis (intrapartum infection)

27
Q

Features of measles

A

Rash
koplik’s spots on buccal mucosa
coryzal symptoms

rarely encephalitis and long term neuro damage

28
Q

mx measles

A

NOTIFIABLE DISEASE
hydration and rest
vitamin a given if hospitalised or <2

29
Q

how does measles present

A

parotitis + fever

if abdo pain and plasma amylase high then think pancreatic involvement

30
Q

Mx measles

A

notifiable disease
stay away from school for 5 days after development of parotitis
warn about mumps orchitis

31
Q

mx rubella

A

notifiable disease
low grade fever
maculopapular rash on face which lasts 3-5 days
lymphadenopathy

32
Q

features of kawaski

A 
Crash and Burn
conjunctivitis
rash 
adenopathy (cervical)
strawberry tongue
hands - erythema and swelling

burn - fever

systemic vasuclitis - can cause coronary aneurysm

33
Q

mx kawasaki

A

IVIg
high dose aspirin for 8 weeks (to reduce risk of thrombosis)
(can give steroids as second line)

carry out risk assessment for MI at 8 weeks
low risk - no fruther treatment
high risk - low dose aspirin til aneurysm regress

34
Q

Diagnosis of TB in children

A

can’t do sputum in chidlren <8 so do gastric washing

tuberculin test - induration >5mm = latent TB

35
Q

Mx TB

A

notifiable disease
if unwell and active TB admit, if well refer to clinic

Rifampicin, isoniazid, ethambutol, pyrazinamide 4 months
pyrazinamide and ethambutol 2 months
pyridoxine (B6) given to prevent neuropathy from isoniazid

latent TB -iosniazid 6 months, rifampicin + isoniazid 3 months

36
Q

Dx of HIV

A

> 18 months they have Ab that they’ve produced themselves so identifying this = dx of HIV

<18 months still have maternal Ig so it only proves exposure
Do HIV RNA PCR in these people

37
Q

What does lyme disease look like

A 
erythema migrans (target rash) at site of infection (painless)
fever and myalgia
38
Q

mx for immundeficiency

A

antimicrobial prophylaxis
t cell + neutrophil defects - cotrimoxazole for PCP, itraconazole for fungal stuff

B cell defects - azithromycin for recurrent bacterial infections

paeds (19 decks)

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