Infections Flashcards
(127 cards)
1
Q
meningitis is inflammation of the meninges causes may be ___, ___, ____ or ______. Which is the most common cause NB: usually self-limiting. Name 2 non-infectious causes of meningitis?
A
- bacterial
- viral (this is the most common cause)
- fungal, protozoal (affect immunocompromised more)
- malignancy and autoimmune causes
2
Q
-
-
A
- child’s age
- immunisations
- immunocompetence
3
Q
_____ meningitis is a medical _______ with high ____ and _____.
A
Bacterial is a medical emergency with high morbidity and mortality
4
Q
Children w meningitis often present with non-specific symptoms e.g.__________________
A
- poor feeding
- fever
- lethargy
- irritability
- vomiting
- headache
- myalgia/arthralgia
5
Q
As well as photophobia, and opisthotonus posturing, what signs of meningitis can be elicited? NB: they occur ~late and much less in young children
A
- neck stiffness e.g. cant kiss knee
- Kernig’s sign: resistance to extending knee w hip flexed
- Brudzinski’s sign: hips flex on neck flexion
6
Q
name some severe v late signs of meningitis:
A
- bulging fontanelle
- altered consciousness
- seizures, focal neuro deficit
- abnormal pupils
- blanching rash
7
Q
as well as meningitis, name 2ddx for a child presenting with a “stiff neck”.
A
- tonsillitis
- lymphadenitis
- subarachnoid bleed
8
Q
suggest 5+ investigations you’d do in a child presenting w suspected meningitis e.g. urine dip, stool virology, CXR
A
- FBC, CRP, U&Es
- Clotting
- culture
- meningococal PCR
- blood gas
- LP, glucose
9
Q
Name 5 contraindications for LP in assessing suspected meningitis:
NB: if in doubt give ABx/do not delay IV abx to do an LP
A
- signs of raised ICP
- shock, respiratory insufficiency
- spreading purpura, coagulopathy, low platelets
- local infection at LP site
- during seizure/unstable post seizure
10
Q
In an LP for suspected meningitis, once needle is in place, you want to catch 5-10drops of CSF into _ bottles for urgent ___, ____, _____ and ____.
A
-4bottles
-MC&S, virology, protein and glucose
(NB: do simultaneous paired blood glucose)
11
Q
What steps should be taken to treat pyogenic meningitis before the organism is known?
clue: manage what? give what? Which abx in what setting? What can reduce hearing loss? In which cause? assess for what sign? If needed treat with what?
A
- manage ABC, give high flow O2
- don’t delay abx, give immediate ceftriaxone IV if >3months or IV/IM benzylpenicillin in pre-hospital setting
- dexamethasone(0.15mk/kg/6hr IV for 4days) with 1st abx dose if >3months as reduces hearing loss in pneumococcal meningitis
- assess for signs of raised ICP, treat w hypertonic saline or mannitol over 5min, discuss w senior
12
Q
In the treatment of pyogenic meningitis before the organism is known, you should __ ___ fluids unless there are signs of ____. If patient is ___+ you should treat for _______. And if HSV _______ is suspected you should add _____.
A
- restrict fluid unless signs of SIADH
- if pt is HIV+, treat for cryptococcus
- if HSV encephalitis suspected, add aciclovir
13
Q
Name 3 acute complications of meningitis:
A
- seizures
- raised ICP
- abscesses
- infected subdural effusion
14
Q
Name 3 chronic complications of meningitis:
A
- hydrocephalus
- ataxia, paralysis
- deafness
- decreased IQ
- epilepsy
15
Q
How may the appearance of CSF vary in the following causes of meningitis:
- bacterial
- tubercular
- aseptic/viral
- normal
A
- bacterial: cloudy/turbid
- tubercular: cloudy/yellow
- aseptic/viral: ~clear
- normal: clear
16
Q
Normally CSF should have greater than 2/3rds the level of serum glucose, and protein content should be <0.4 g/dL. What happens to the levels CSF with:
- bacterial
- tubercular
- aseptic/viral meningitis?
A
- bacterial: glucose levels in CSF decrease, protein levels increase to ~3g/dL
- tubercular: glucose levels decrease, protein increase ~2g/dL
- aseptic/viral meningitis: glucose is normal, protein levels vary ~>0.4 and <1.5
17
Q
What is the predominant cell type in CSF from the following types of meningitis:
-bacterial
-tubercular
-aseptic/viral meningitis?
NB: normal CSF should have <5lymphocytes, 0 neutrophils
A
- bacterial: polymorphs
- tubercular: mononuclear
- aseptic/viral meningitis: mononuclear
18
Q
Meningococcal disease comprises of ____ ____ _____, ____ or both.
A
- neisseria meningitidis meningitis
- sepsis
19
Q
What are the key points to remember about meningococcal disease?
A
- progresses rapidly, narrow window to diagnose
- early signs may be subtle
- consider in any seriously ill baby/child
- if any suspicion of mening. sepsis, do NOT DELAY ABx
20
Q
What are the abx choices in the treatment of meningococcal disease:
- in >3months old
- in <3month old
- in a pre-hospital setting
A
- > 3months give IV cefotaxime
- <3months: IV cefotaxime plus amoxicillin/ampicillin
- give benzylpenicillin in pre-hospital setting
21
Q
General early fts of meningococcal disease include: fever, headache, anorexia, vomiting, sore throat… what are the next septic features that occur after ~6hrs?
A
- cold hands/feet
- limb pain
- abnormal colour (pale/mottled)
- thirst
- respiratory distress in young
- DIC, tachycardia, hypotension, tachypnoea
22
Q
The meningococcal disease late sign (after 8-19hrs) of a non-blanching rash develops over hours, what are the 3 stages the rash goes through?
A
- non-specific
- petechial
- purpuric/haemorrhagic
23
Q
What are the following signs of: neck stiffness, photophobia, bulging fontanelle
A
meningeal signs
24
Q
How can we prevent deaths from meningococcal disease?
-what do we need to manage? to look out for?
NB: stop parents smoking 37% cases are from aerosolised from smokers cough cause.
A
- get help and treat early
- ITU, manage ABC, high flow O2
- IV ceftriaxone 80-100mg/kg
- 2 large bore cannula
- blood gas, U&Es, clotting, x-match, CRP
- meningitis PCR
- treat if signs of shock w 20ml/kg bolus
- treat if signs of raised ICP, hypoglycaemia, anaemia, acidosis and coagulopathy
25
Meningitis damage is mainly from host response, with infection, the release of inflammatory mediators and activated leukocytes w endothelial damage -->cerebral ____, raised ___, and decreased cerebral ___ ___. Cerebral cortical ____ results and ____ deposits may block the ______ of ___ by the ______ ___ resulting in h______.
- -> cerebral oedema, raised ICP and decreased cerebral blood flow
- cerebral cortical infarction
- fibrin deposits block reabsorption of CSF by arachnoid villi
- hydrocephalus
26
What are 2 common causative organisms of meningitis in neonates->3months, how does this differ from in a child >6yrs
- group B streptococcus, e.coli/choliforms, listeria monocyogenes
- vs. 6yrs+: neisseria meningitides, strep. pneumoniae
27
For what reason are there many contraindications to LP in meningitis e.g raised ICP, coagulopathy etc, what is the risk you want to avoid? Where may you be able to confirm diagnosis in these cases?
- coning of the cerebellum through the foramen magnum
| - blood culture/PCR/rapid antigen screen from blood/urine
28
What is given to all household contacts for meningococcal meningitis and HIb infection to eliminate nasopharyngeal carriage?
-Rifampicin or ciprofloxacin prophylaxis
| meningococcal group C vaccine given to contacts of pts with men C infection
29
What viruses can cause central nervous system infections-name 2 and how can the diagnosis be confirmed?
- e.g. enteroviruses, EBV, adenoviruses, mumps
| - culture/PCR of CSF/stool/urine/nasopharyngeal aspirate/throat swabs/serology
30
Name a few organisms that may cause atypical meningitis (unusual clinical course/non responsive to abx) in immunocompromised children
- mycoplasma species
- borrelia burgdorferi (Lyme disease)
- TB
- fungal infections
31
In neonates with sepsis, the most common organisms are CoNS which means _____.., also s___ __ and non-pyogenic ___ and s___ ___.
- Coagulase negative Staphylococcus
- staphylococcus aureus
- non-pyogenic streptococci
- streptococcus pneumonia
32
In neonatal sepsis, signif hypovolemia often occurs, due to fluid _______ because of the release of v____ m____ by host. There is loss of ____-vascular ___ and fluid which can happen due to "capillary leak" caused by _____ cell dysfunction. Circulating ___ is lost into the ______ fluid.
- fluid maldistribution
- vasoactive mediators
- intravascular proteins
- endothelial cell dysfunction
- plasma is lost into the interstitial fluid
33
In neonatal sepsis, signif hypovolemia often occurs. Capillary leak into the ____ causes ______ oedema which may lead to ______ failure, necessitating mechanical ____
- into the lungs causes pulmonary oedema
- respiratory failure
- mechanical ventilation
34
In neonatal sepsis, myocardial dysfunction occurs as inflamm. cytokines and circulating ___ depress myocardial c_____, ____ support may be required.
- circulating toxins depress myocardial contractility
| - ionotropic support
35
In neonatal sepsis, DIC can occur with widespread microvascular ____ and _____ of clotting factors. If bleeding occurs, correct clotting derangement with ___, c_______ and ____ infusions.
- microvascular thrombosis and consumption of clotting factors
- correct w FFP, cryoprecipitate and platelet infusion
36
what is the main cause of gastroenteritis in young children? (>60%) name 2 other viral causative organisms:
Rotavirus
| others include adenovirus, norovirus, calicivirus, coronavirus and astrovirus
37
In a child with gastroenteritis, if there is ___ in the stools it may suggest infection of ____ cause, name 3 organisms that could be responsible for this type of infection.
- blood in the stools suggest bacterial cause
| - e.g. Campylobacter jejuni, shigella, salmonellae, cholera, E. coli
38
Name 2 protozoan parasitic organisms that can cause gastroenteritis.
- G_____
- C_______
- Giardia
| - Cryptosporidium
39
Shigella and some salmonellae produce a d_____ type of gastroenteritis with ____ and __ in the stool, pain and t_____.
- dysenteric type
- blood and pus in stools
- pain and tenesmus
40
Shigella caused gastroenteritis may be accompanied by a ___ ___.
-high fever
41
Cholera and enterotoxigenic E.coli gastroenteritis infections are associated with profuse, rapidly ______(!) diarrhoea.
-dehydrating
42
In gastroenteritis, there is a sudden change to ____ stools often + ____. There may be contact with a person w ___ or recent ___ ____. When in doubt re: diagnosis, refer to ____.
- change to loose/watery stools
- often +vomiting
- D&V or recent travel abroad
- refer to hospital
43
What is the most serious complication of gastroenteritis that treatment aims to prevent/correct?
-dehydration leading to shock
44
Give examples of child groups that are at an increased risk of dehydration from gastroenteritis
clue: age? passes #d/v, fluid/nutrition?
- infants esp <6months old or born w low birthweight
- if have passed >6 diarrhoeal stools in 24hrs
- if have vomited 3+ times in 24hrs
- if have been unable to tolerate/not offered fluids
- if they are malnourished
45
Why are infants at an increased risk of dehydration vs older children from gastroenteritis? give 3+ reasons
- they have a greater SA:weight ratio so have more insensible water losses (~300ml/m^2)
- they have higher basal fluid requirements (~100ml/kg/day)
- immature renal tubular absorption
- unable to obtain fluid for themselves when thirsty
46
What is the most accurate means of assessing dehydration in a child with gastroenteritis? How is this used to categorise no clinically detectable dehydration, clinical dehydration and shock.
Weight loss during the diarrhoeal illness
- no clin. dehydration = less than 5% loss of body weight
- clin dehydration = 5-10% loss of body weight
- shock = >10% loss of body weight
47
gastroenteritis can cause iso/hypo/hyper-natraemic dehydration. Most common is __. Hyponatraemic can occur when children with diarrhoea_____________..
- most common is iso (plasma sodium still in normal range)
- hypo when children w diarrhoea drink large quantities of water/hypotonic solutions --> greater net loss of sodium than water so plasma sodium falls
48
Hypernatramic dehydration occurs if ___ loss exceeds the relative ___ loss so plasma ___ ___ increases. It usually occurs from high ____ water losses (give 2 reasons this could be) or from profuse low-____ diarrhoea.
- water loss exceed the relative sodium loss, plasma sodium increases
- high insensible water loss (e.g. hot, dry environment or high fever) or from profuse low-sodium diarrhoea.
49
In hypernatraemic dehydration from gastroenteritis, the ECF is hypertonic so water shifts into here from the ICF compartment, what does this mean for recognising clinical signs of dehydration? Especially in ____ children.
- the signs of ECF depletion are less obvious per unit fluid loss
- e.g. (depressed fontanelle, less tissue elasticity, sunken eyes... all less obvious)
- esp in obese.
50
Why is hypernatraemic dehydration from gastroenteritis particularly dangerous with regards to the brain/fluid/skull... what complications could arise.
NB: transient hyperglycaemia can occur but is often self-limiting
- water is drawn out brain --> cerebral shrinkage within a rigid skull...
- ...-->jittery movements, increased muscle tone, hyperreflexia, altered consciousness, seizures, multiple small cerebral haemorrhages.
51
There is usually no need for investigations for gastroenteritis.
Name 3_ indications for investigations with stool culture.
- if child appears septic
- if there is blood/mucus in stools
- if child is immunocompromised
- if post-recent foreign travel diarrhoea has not improved after 1 week
- if diagnosis is uncertain
52
There is usually no need for investigations for gastroenteritis, but if IV fluids are required or there are fts suggestive of hypernatraemia, what blood tests should be carried out?
- U&Es
- creatinine
- glucose
53
There is usually no need for investigations for gastroenteritis, but if abx need to be started what must be taken?
a blood culture
54
Treatment principles of gastroenteritis:
- without clin. dehydration aim is:
- if with clin dehydration aim is: __ with..
- if shock/dehydration/persistent vomiting: give __
- w/o: aim is preventing dehydration (+/-oral rehydration)
- with: aim is oral rehydration w solutions
- shock: IV fluids
55
How should children with hypernatraemic clinical dehydration from gastroenteritis be treated? If IV fluids are needed, risk is a rapid ___ in plasma __ conc/osmolality will lead to a shift of ___ into ___ cells and can result in ___ and cerebral ____.
- oral rehydration therapy
- rapid reduction in plasma Na+
- shift of water into cerebral cells
- seizures or cerebral oedema
56
Children with hypernatraemic clinical dehydration from gastroenteritis should be treated slowly (!), replace the fluid deficit over __hrs w saline, measure ___ __ regularly, aim to reduce it at less than ___mmol/L/hr
- replace over 48hrs
- measure plasma Na+
- reduce <0.5mmol/L/hr
57
Give 2+ reasons why there is no use in medications for the D&V of gastroenteritis (antidiarrhoeal/antiemetics).
- ineffective
- can prolong the excretion of bacteria in stools
- associated side effects
- add unnecessary cost
- focus attention away from oral rehydraion
58
Even if a bacterial cause is identified, abx are not routinely needed to treat gastroenteritis. Name a few scenarios which would indicate need for abx:
- suspected/confirmed sepsis
- extra-intestinal spread of bacterial nature
- for Salmonella cause in <6month old
- malnourished or immunocompromised child
- certain specific bacterial/protozoal infections
59
Name 3 certain specific bacterial/protozoa pathogens in gastroenteritis that require antibiotic treatment.
c. diff associated pseudomem. colitis
- cholera
- shigellosis
- giardiasis
60
In developing countries, multiple episodes of ____ is a major contributing factor to development of _____. So following diarrhoea, _____ ____ should be increased and due to association with ___ deficiency, ________ can be useful.
- diarrhoea --> malnutrition
- nutritional intake should be increased
- association with zinc deficiency. so supplementation
61
What is post-gastroenteritis syndrome?
| NB: treat by restarting oral rehydration therapy
-rarely after an episode of gastroenteritis, the introduction of a normal diet results in a return of watery diarrhoea
62
What advice should be given following an episode of gastroenteritis?
clue: e.g. for parents regarding diet, drinks, hygiene and childcare
- reintroduce solid food
- avoid fruit juice/carbonated drinks
- advise diligent hand washing
- do not share towels used by infected child
- dont return to childcare facility until 48hrs post last ep
63
What is the risk of a pregnant women getting chickenpox in the first 20weeks of pregnancy what is the risk to the fetus?
- the virus can cross the placenta leading to fetal varicella syndrome
- skin scarring, eye defects, limb hypoplasia, microcephaly and learning disabilities
64
If a pregnant women <20weeks has chicken pox and an urgent blood check shows she doesn't have varicella antibodies, what post-exposure prophylaxis will she be given? (effective up to 10 days post-exposure)
VZIG
65
If a pregnant women >20weeks gestation presents with chickenpox and has no varicella antibodies, you can either give VZIG or ________ 7-14 days after the rash onset
-aciclovir
66
If the mother develops a chicken pox rash 5 days before - 2 days after birth, the fetus will have high viral load with no antibodies, (!) what is this called and what do we give?
NB: 20% mortality
- severe neonatal varicella
| - VZIG given to baby as soon as born
67
Most common infection causing encephalitis?
Herpes Simplex
68
Roseola Infantum aka Sixth Disease aka Exanthem subitum, is caused by which virus? What is typical about the presentation of the conditions in terms of fever and rash?
NB: <2 years mostly
- Herpes Virus (HHV 6, 7)
| - few days of high fever, rapid defevescence then rash appears (macular/mac-pap) child well
69
What is the differential of Roseola Infantum aka Fith Disease aka Exanthem subitum..
-think infant goes to GP, gets rx, fever resolves, then they get a rash so HCPs conclude it is what?
-Antibiotic allergy, child is labelled as penicillin allergic when actually it was the natural course of the disease
70
In rubella characteristically there is a pink macular rash starting on face and speaks centrally to extremities. There is lymphadenopathy of a certain group of LNs, which ones?
-sub occipital and post auricular
71
Koplik spots in the mouth are pathognomonic of which childhood infection?
Measles
72
How do children with measles present?
- 2-6 day prodrome of:
- rash is....
- systemically:
- prodrome: coryza, conjunctivitis, fever, cough
- rash is maculopapular, starts behind ears to face to trunk and extremities, discrete spots coalesce
- irritable, fever, systemically unwell, rash may desquamate
73
Suggest 2 complications of measles:
- pneumonia
- diarrhoea
- encephalitis
- death
74
Pharyngitis, spenohepatomegaly and petichiae on the back of the palate, is characteristic of which infection caused by which herpes virus?
When does this condition present with a rash and why?
```
Infectious Mononucleosis (Glandular fever)
Epstein Barr Virus
Presents with rash if Amoxicillin is given (not an allergy, it's just an interaction with the virus !)
```
75
What virus caused hand foot and mouth disease?
-Coxsackie virus
76
Slapped cheek syndrome aka Erythema infectiosum aka Fifth disease is caused by which virus?
What is the appearance of the rash on when it spreads to the body and how long does it last?
Parvovirus
- lacey, reticular rash on body
- lasts for up to 3 weeks ( may come and go )
77
What effect can parvovirus(slapped cheek syndrome) have on bone marrow? When is this a problem?
The virus targets the bone marrow and targets and destroys red cells (red cell aplasia)
Those w RBC problems e.g. SC, thalassaemia won't be able to turn over RBCs quick enough so will quickly become anaemic
78
2 sx of perio-orbital cellulitis and suggest from where the infection may have arisen?
- sx: mostly unilateral, fever, erythema, tenderness and oedema around eye
- arisen: post-trauma to the skin, or spread from paranasal sinus infection or dental abscess
79
Treatment of periorbital cellulitis must be prompt to prevent posterior spead of the infection --> ____ cellulitis. What abx may be used?
- orbital cellulitis
| - V high-dose abx e.g. ceftriaxone
80
- orbital cellulitis = proptosis, painful/limited ocular movements +/- decreased visual acuity
- state a complication of this
- what ix should be done to assess for posterior spread of the infection?
- complications: abscess formation or cavernous sinus thrombosis
- CT/MRI scan
81
Staph and strep infections often caused by direct invasion of the organisms. They may release toxins that act as superantigens. hence they bind to part of the T-cell receptor which is ____ by many ...
so
-bind to part of TCR which is shared by many T-cells so stimulates massive T-cell proliferation + cytokine release
82
Impetigo = a localised highly contagious infection, commonly caused by?
-natural history of presentation?
- caused by staph aureus/strep pyogenes infection in children with pre-existing skin disease e.g. eczema
- lesions begin as erythematous macule-> vesicular/pustular/bullous
- rupture of vesicles + fluid exudation -> characteristic gold-crust lesion
83
What cream is recommended 1st line to treat impetigo in children who are systemically well/not high risk? What topical abx is an alternative?
What oral abx is used for extensive disease?
1% hydrogen peroxide cream
- topical fusidic acid or mupirocin are alternative agents
- oral flucloxacillin is for extensive disease
84
What is the exclusion from school advice for a child with impetigo?
- excluded from school until the lesions are crusted/healed over
- or 48 hours after commencing antibiotic treatment
85
What happens in staphylococcal scalded skin syndrome?
| -the exfoliative staph toxin -> ..
- -> separation of the epidermal skin through the granular cell layers
- so areas of epidermis separate on gentle pressure leaving denuded areas of skin
86
in staphylococcal scalded skin syndrome, infants/young children are affected with fever, malaise localised infection and widespread erythema/tender skin. What is the aim of managment?
- IV anti-staph abx e.g. flucloxacillin
- analgesia
- hydration/fluid balance
87
Infectious period of common viral infections usually begins a 1-2days before the rash appears. What is the general advice for nursery/school exclusion based on how long the infectious period lasts?
-exclusion until rash has resolved or lesions have dried up
88
The hallmark of most herpesviruses = after primary infection
latency is established, there long-term persistence of the virus in the host in a dormant state. After certain stimuli, re-activation of infection may occur.
89
What is the most common form of primary HSV illness in children? G_______
how does it present?
e.g. where. what, other systemic sx, difficult to tolerate anything? hence may need IV fluids + aciclovivir
- Gingivostomatitis (10months-3yrs mainly)
- vesicular lesions on lips, gums and ant tongue/hard palate
- can progress-> extensive painful ulceration w bleeding
- high fever, miserable child, hard to eat/drink so may -> dehydration
- illness for up to 2 weeks
90
What widespread viral infective vesicular lesions develop on eczematous skin and may be complicated by secondary bacterial infections (+sepsis risk)
-eczema herpeticum
91
HSV can cause blepharitis or conjunctivitis and may -> dendritic lesions on cornea, why do you need urgent opthalmic assessment if child has herpetic lesion near eye?
-can lead to corneal scarring and ultimately loss of vision
92
Herpetic whitlows are painful, erythematous, oedematous pustules. What colour? where? spread by autoinoculation from who and where?
- white pustules
- on site of broken skin esp. fingers
- spread is from gingivostomatitis and infected adults kissing their kids fingers
93
is neonatal HSV serious?
- yes, can be focal (e.g. skin/eyes/encephalitis) or disseminated
- morbidity and mortality are high
94
Secondary bacterial infection of chickenpox e.g. group A strep can lead to further complications. suggest 1:
-toxic-shock syndrome
-necrotising fasciitis
(consider if there is onset of new fever/persistently raised temp after 1st few days)
95
An ataxic child with cerebellar signs early during the chickenpox disease is suggestive of what? It has good prognosis, should resolve within ____
- encephalitis (VZV-associated cerebellitis)
| - resolves within a month
96
Rarely after VZV infection, anti-viral abs cross-react to inactivate the inhibitory coag factors protein C and S leading to what? (common with meningococcal disease) p_____ f_____. The consequence can be what?
- purpura fulminans (increased risk of clotting -> purpuric rash)
- the vasculitis can lead to loss of large areas of skin by necrosis
97
What is the mortality associated with severe progressive disseminated varicella disease in the immunocompromised host? What change happens to the vesicular eruptions? Rx?
- 20% mortality
- the vesicular eruptions persist and may become haemorrhagic
- IV acyclovir, human VZ Immunoglobulin
98
Give 2 complications of chickenpox in the immunocompromised child:
- haemorrhagic lesions
- pneumonitis
- progressive and disseminated infection
- DIC
99
Normal chicken pox lasts up to __ days
7 days
100
If there is maternal chickenpox shortly before/after delivery what should be given to the neonate?
-human VZ immunoglobulin
101
EBV causes infectious mononucleosis, but is also involved in the pathogenesis of what haem disease?
- Burkitt lymphoma
- lymphoproliferative disease (in immunocompromised)
- nasopharyngeal carcinoma
102
EBV fts either asymptomatic or fever, malaise, tonsillitis, lymphadenopathy. Suggest 2 other systemic fts that may be seen?
- petechiae on the soft palate
- splenomegaly (50%), hepatomegaly (10%)
- maculopapular rash
- jaundice
103
Diagnosis of an EBV infection can be supported by various investigations, name 2:
-atypical lymphocytes on blood film (numerous large T-cells)
+ monospot
-seroconversion with production of 3 abs: IgG and IgM VCA and EBNA antibodies
104
Treatment for EBV is symptomatic
| -when airway is severely compromised what medication may be considered?
-corticosteroids
105
-suggest 3 common ways CMV can be transmitted
- saliva
- genital secretions
- breastmilk
- (blood products, organ transplants, trans-placenta = rare)
106
CMV is often mild/subclinical in healthy people but can cause morbidity in immunocompromised.
How does it present, if symptomatic, an immunocompetent patient?
-mononucleosis-like syndrome +/- atypical lymphocytes on blood film
107
CMV is often mild/subclinical in healthy people but can cause morbidity in immunocompromised.
Suggest 4 ways it could present, in the immunocompromised patient?
- retinitis
- pneumonitis
- bone marrow failure
- encephalitis
- hepatitis
- oesophagitis
- enterocolitis
108
Suggest 2 medications that may be used in the treatment of CMV disease:
- IV ganciclovir
- oral valganciclovir
- foscarnet
109
CMV is a risk in transplants. Suggest 2 ways risk is minimised in recipients:
- close monitoring for evidence of CMV reactivation with PCR
- use of CMV-negative blood for transfusions
- antiviral prophylaxis (ganciclovir)
- where poss, transplant cmv negative organs into cmv negative recipients
110
HH6 and HH7 are v prevelent. most children are infected by 2yrs via transmission from the ____ secretions of a ________ member.
They classically cause e_____ s_____ (aka R___ ____) characterised by a ____ ___ with malaise lasting a few days. Followed by what?
- oral secretions of a family member
- exanthema subitum (roseola infantum), a high fever + malaise.
- followed by a rash (generalised, macular - appears as fever wanes)
111
Parovirus B19 causes erythema ______ or ____ disease aka _____ _____ syndrome. Outbreaks common in spring. Suggest 2 ways it can be transmitted:
- erythema infectiosum or fith disease, aka slapped cheek
| - transmission via respiratory secreations, vertical transmission and transmission via infected blood products
112
Parovirus B19 infects the e______ red cell _____ in the _____ ____. Can be asymptomatic but whar is the most common presentation ("erythema infectiosum") like?
- erythroblastoid red cell precursors in the bone marrow
- viraemic phase of fever, malaise, headache + myalgia followed by characteristic slapped-cheek rash a week later
- rash progresses to a maculopapular 'lace-like' rash on trunk and limbs
113
What is a serious consequence of parovirus b19 infection and in what group of children is it most likely to occur?
- asplastic crisis
- in children with chronic haemolytic anaemias hence increased rate of red cell turnover,
- or immunocompromised children who can't produce an antibody response to neutralise the infectious agent
114
Transmission of materal parovirus-B19 infection can lead to fetal _____ and death due to severe _____ (although most infected fetuses recover)
- fetal hydrops
| - severe anaemia
115
The enterovirus Herpangia causes vesicular and ulcerated lsions where? What does this lead to symptomatically? And what treatment may severe cases require?
- lesions on the soft palate and uvula
- leads to anorexia, pain on swallowing, fever
- may need IV fluids and analgesia
116
Pleurodynia (Bornholm disease) is an acute illness with what additional sx? NB: recovery in couple of days
-sx: pleuritic chest pain (may hear pleural rub o/e), muscle tenderness
117
Measles carrys complications. 1/5000 cases develop encephalitis with 15% mortality. Almost half will have long-term sequelae resulting from this. Suggest 3
- seizures
- deafness
- hemiplegia
- severe learning difficulties
118
~7yrs after a measles infection as a baby, in 1/100,000 cases, what ilness can develop due to a variant of measles that persists in the CNS. Presentation?
-SSPE: (Subacute sclerosing panencephalitis) loss of neuro function over yrs -> dementia -> death
119
Measles rx is supportive byt what antiviral drug may be given to immunocompromised patients? R____
-Ribavirin
120
How is mumps spread?
-droplet infection to respiratory tract where the virus replicates within epithelial cells
121
If mumps is symptomatic how does it present?
- fever, malaise, parotitis -> (e.g. earache/pain on eating/drinking)
- if abdo pain, may be element of pancreatitis
122
Rubella aka German measles, is generally a mild disease in childhood. How is it spread? What is often the first sign of infection and what is the pattern?
What other systemic manifestation is prominent?
- spread by respiratory route
- 1st sign = maculopapular rash, on face then spreading centrifugally to cover body
- also Lymphadenopathy (esp. suboccipital and post-auricular)
123
How is the diagnosis of rubella confirmed?
-serologically
124
What is the causative organism of whooping cough?
Bordetella Pertussis
125
Whooping cough (pertussis) has epidemics every few yrs. After a week or coryza (aka _____ phase) what does the child develop (known as the paroxysmal phase - lasts up to 3 months) until sx gradually decrease in the ______ phase.
- catarrhal phase
- paroxysmal phase (spasmodic cough) worse at night, may -> vomit. during a paroxysm child goes red/blue face and mucus flows from nose & mouth
- convalescent phase
126
Suggest 2 complications of whooping cough
- epistaxis, conjunctival haemorrhage after vigorous coughing
- pneumonia, seizures, bronchiectasis more rare
127
Diagnosis of pertussis whooping cough is indicated by?
- culture of nasal swab
- marked lymphocytosis
- PCR
