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infections Flashcards

1
Q

name 4 inactivated vaccines?

A

involves giving a killed version of the pathogen - cannot cause infection and safe in immunocomp

  • Polio
  • Flu
  • Hepatitis A
  • Rabies
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2
Q

name 7 subunit and conjugate vaccines

A

only contain parts of organism used to stimulate immune response - cannot cause infection and safe for immunocomp

  • Pneumococcus
  • Meningococcus
  • Hepatitis B
  • Pertussis
  • Haemophilus influenza type B
  • HPV
  • Shingles
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3
Q

name 5 live attenuated vaccines?

A

weakened version of the pathogen - can cause infection esp in immunocomp

  • MMR
  • BCG
  • Chickenpox
  • Nasal influenza
  • Rotavirus
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4
Q

give 2 examples of toxin vaccines

A

contain a toxin that is normally produced by the pathogen - cause immunity to the toxin and not the pathogen itself

diphtheria and tetanus

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5
Q

what vaccines are given at 8 weeks?

A
  • 6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
  • Meningococcal type B
  • Rotavirus (oral vaccine)
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6
Q

what vaccines are given at 12 weeks?

A
  • 6 in 1 vaccine (again)
  • Pneumococcal (13 different serotypes)
  • Rotavirus (again)
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7
Q

what vaccines are given at 16 weeks?

A
  • 6 in 1 vaccine (again)
  • Meningococcal type B (again)
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8
Q

what vaccines are given at 1 year?

A
  • 2 in 1 (haemophilus influenza type B and meningococcal type C)
  • Pneumococcal (again)
  • MMR vaccine (measles, mumps and rubella)
  • Meningococcal type B (again)
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9
Q

what vaccine is given yearly ages 2-8?

A
  • Influenza vaccine (nasal vaccine)
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10
Q

what vaccines is given at 3 years and 4 months?

A
  • 4 in 1 (diphtheria, tetanus, pertussis and polio)
  • MMR vaccine (again)
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11
Q

what vaccine is given as 12-13 years?

A

Human papillomavirus (HPV) vaccine (2 doses given 6 to 24 months apart)

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12
Q

what vaccine is given at 14 years?

A
  • 3 in 1 (tetanus, diphtheria and polio)
  • Meningococcal groups A, C, W and Y
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13
Q

what is the HPV vaccine and when is it given?

A

human papillomavirus

given to girls and boys before they become sexually active - prevent contraction and spread HPV once they become sexually active

Gardasil - protects against 6, 11, 16, 18 (6 and 11 genital warts & 16 and 18 cervical cancer)

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14
Q

what is the BCG vaccine?

A

for TB

offered from birth to babies who are at higher risk of TB - relatives from countries with high TB prevalence or who live in urban areas with high rate of TB. may also be given to children arriving from areas of high TB prevalence or in close contact with people that have TB

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15
Q

what is paediatric sepsis?

A

syndrome that occurs when an infection causes the child to become systemically unwell - result of a severe systemic inflammatory response

It is a life threatening condition and there should be a low threshold for treating suspected sepsis.

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16
Q

what is septic shock?

A

Septic shock is diagnosed when sepsis has lead to cardiovascular dysfunction. The arterial blood pressure falls, resulting in organ hypo-perfusion. This leads to a rise in blood lactate as the organs begin anaerobic respiration.

hypoperfusion of organs

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17
Q

how is septic shock managed?

A

aggressive IV fluids to improve BP and tissue perfusion

if IV fluid bolus fails to improve blood pressure and lactate level - children should be escalated to HDU/ITU where medications like inotropes can be used to stimulate cardiovascular system and improve BP and tissue perfusion

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18
Q

what are some signs of sepsis?

A
  • Deranged physical observations
  • Prolonged capillary refill time (CRT)
  • Fever or hypothermia
  • Deranged behaviour
  • Poor feeding
  • Inconsolable or high pitched crying
  • High pitched or weak cry
  • Reduced consciousness
  • Reduced body tone (floppy)
  • Skin colour changes (cyanosis, mottled pale or ashen)
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19
Q

what is the traffic light system for sepsis?

A

This categorises children as green (low risk), amber (intermediate risk) or red (high risk).

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20
Q

what needs to happen to children under 3 months with a temperature of 38 or above?

A

treated urgently for sepsis until proven otherwise

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21
Q

what is the immediate management of sepsis?

A
  • Give oxygen if the patient has evidence of shock or oxygen saturations are below 94%
  • Obtain IV access (cannulation)
  • Blood tests, including a FBC, U&E, CRP, clotting screen (INR), blood gas for lactate and acidosis
  • Blood cultures, ideally before giving antibiotics
  • Urine dipstick and laboratory testing for culture and sensitivities
  • Antibiotics according to local guidelines. They should be given within 1 hour of presentation.
  • IV fluids. 20ml/kg IV bolus of normal saline if the lactate is above 2 mmol/L or there is shock. This may be repeated.
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22
Q

what further investigations can be done when investigating sepsis in children?

A
  • Chest xray if pneumonia is suspected
  • Abdominal and pelvic ultrasound if intra-abdominal infection is suspected
  • Lumbar puncture if meningitis is suspected
  • Meningococcal PCR blood test if meningococcal disease is suspected
  • Serum cortisol if adrenal crisis is suspected
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23
Q

further management for sepsis regarding antibiotic use

A

Continue antibiotics for 5 – 7 days if a bacterial infection is suspected or confirmed.

Alter the antibiotic choice and duration once a source of infection is found and an organism is isolated.

Bacterial culture and sensitivities can be very helpful in guiding antibiotics. A microbiologist can provide advice on the choice and duration of antibiotics.

Consider stopping antibiotics where there is a low suspicion of bacterial infection, the patient is well and blood cultures and two CRP results are negative at 48 hours.

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24
Q

what is meningitis?

A

inflammation of meninges - lining of the brain and spinal cord. This inflammation is usually due to a bacterial or viral infection

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25
Q

what is meningococcal septicaemia?

A

Meningococcus bacterial infection in the bloodstream - causes non-blanching rash

rash indicates the infection has causes DIC and subcutaneous haemorrhages

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26
Q

what are the most common organisms causing bacterial meningitis in children and adults? and neonates?

A

children and adults = Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus)

neonates - group B strep (GBS)

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27
Q

how does meningitis present?

in neonates?

A
  • Fever
  • Neck stiffness
  • Vomiting
  • Headache
  • Photophobia
  • Altered consciousness and seizures
  • Septicaemia= non-blanching rash

neonates - can be very nonspecific - hypotonia, poor feeding, lethargy, hypothermia, bulging fontanelle

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28
Q

when does NICE recommend a lumbar puncture

A
  • Under 1 month presenting with fever
  • 1 to 3 months with fever and are unwell
  • Under 1 year with unexplained fever and other features of serious illness

?CRP >10???

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29
Q

what are the 2 special tests you can perform to look for meningeal irritation?

A

Kernig’s test - lie pt on back and flex 1 hip and knee to 90 degrees and then slowly straighten knee whilst keeping hip flexed - meningitis = spinal pain or resistance to movement

Brudzinski’s test - lie pt flat on back, lift their head and neck off the bed and flex chin to chest - positive = pt involuntary flexes hip and knees

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30
Q

how is bacterial meningitis managed in the community?

A

seen by GP with suspected meningitis and non-blanching rash = urgent IM/IV benzylpenicillin prior to hospital transfer

(true pen allergy, transfer to hospital priority, not alternative abx)

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31
Q

how is bacterial meningitis managed in hospital?

A
  • ideally LP for CSF before abx but when child unwell do not delay abx
  • blood for meningococcal PCR if meningococcal disease suspected - tests directly for meningococcal DNA
    • quicker result than blood culture
  • low threshold for treating ?bacterial meningitis
  • abx - under 3 months = cefotaxime + amoxicillin (cover listeria contracted during pregnancy), >3 months - ceftriaxone
    • pen resistant pneumococcal infection - vancomycin
  • steroids - reduce frequency and severity of hearing loss and neuro damage
    • dexamethasone - 4 times daily for 4 days to children >3 months if lumbar puncture suggestive of bacterial meningitis
  • notifiable disease
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32
Q

what is post exposure prophylaxis?

A

significant exposure to pt with meningococcal infection - particularly in 7 days prior to onset of illness

risk decreases 7 days after exposure

single dose of ciprofloxacin

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33
Q

what are some causes of viral meningitis and how is it diagnosed?

A

herpes simplex virus (HSV)

enterovirus

varicella zoster virus (VZV).

sample of the CSF from the lumbar puncture should be sent for viral PCR testing.

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34
Q

how is viral meningitis treated?

A

Aciclovir in suspected/confirmed HSV or VZV infection

supportive management

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35
Q

what is a lumbar puncture?

A

involves inserting a needle into the lower back to collect a sample of cerebrospinal fluid (CSF).

The spinal cord ends at the L1 – L2 vertebral level, so the needle is usually inserted into the L3 – L4 intervertebral space

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36
Q

what are LP samples sent for?

A

bacterial culture

viral pcr

cell count

protein

glucose

also send blood glucose so can be compared to CSF

send sample immediately

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37
Q

what are LP results for bacterial and viral meningitis?

A
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38
Q

what are some complications of meningitis?

A
  • Hearing loss is a key complication
  • Seizures and epilepsy
  • Cognitive impairment and learning disability
  • Memory loss
  • Cerebral palsy, with focal neurological deficits such as limb weakness or spasticity
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39
Q

what is encephalitis in children?

A

inflammation of the brain

can be result of infective or non-infective causes (autoimmune)

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40
Q

what is the most common cause of encephalitis?

A

viral

herpes simplex virus - HSV 1 in children, HSV 2 in neonates (from genital herpes)

other causes - varicella zoster virus

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41
Q

how does encephalitis present?

A
  • Altered consciousness
  • Altered cognition
  • Unusual behaviour
  • Acute onset of focal neurological symptoms
  • Acute onset of focal seizures
  • Fever
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42
Q

how is encephalitis diagnosed?

A
  • Lumbar puncture, sending cerebrospinal fluid for viral PCR testing
  • CT scan if a lumbar puncture is contraindicated
  • MRI scan after the lumbar puncture to visualise the brain in detail
  • EEG recording can be helpful in mild or ambiguous symptoms but is not always routinely required
  • Swabs of other areas can help establish the causative organism, such as throat and vesicle swabs
  • HIV testing is recommended in all patients with encephalitis
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43
Q

what are some contraindications for lumbar puncture?

A

GCS below

haemodynamically unstable

active seizures or post-ictal

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44
Q

how is encephalitis managed?

A

iv anti viral medications

  • aciclovir - HSV, VZV
  • ganciclovir - cytomegalovirus
  • Repeat
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45
Q

how is encephalitis managed?

A

iv anti viral medications

  • aciclovir - HSV, VZV
  • ganciclovir - cytomegalovirus
  • Repeat
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46
Q

how is encephalitis managed?

A
  • iv anti viral medications
    • aciclovir - HSV, VZV
    • ganciclovir - cytomegalovirus
  • Repeat LP to ensure successful tx prior to stopping antivirals
  • aciclovir started empirically in suspected encephalitis until results available
  • follow up, support and rehab required after encephalitis with help managing complications
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47
Q

what are some complications of encephalitis?

A
  • Lasting fatigue and prolonged recovery
  • Change in personality or mood
  • Changes to memory and cognition
  • Learning disability
  • Headaches
  • Chronic pain
  • Movement disorders
  • Sensory disturbance
  • Seizures
  • Hormonal imbalance
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48
Q

what is infections mononucleosis?

A

condition caused by infection with the Epstein Barr virus (EBV)

aka kissing disease, glandular fever, mono

virus found in saliva of infected individuals - spread by kissing or sharing cups, toothbrushes and other equipment that transmits saliva

can be infectious several weeks before illness begins and intermittently for the remainder of the patients life

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49
Q

what are some features of infectious mononucleosis

A
  • Fever
  • Sore throat
  • Fatigue
  • Lymphadenopathy (swollen lymph nodes)
  • Tonsillar enlargement
  • Splenomegaly and in rare cases splenic rupture
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50
Q

what are heterophile antibodies in infectious mononucleosis?

A

infectious mononucleosis - body produces something called heterophile antibodies, which are antibodies that are more multipurpose and not specific to the EBV antigens. It takes up to 6 weeks for these antibodies to be produced.

can test for them with monospot test - introduces the patient’s blood to red blood cells from horses. Heterophile antibodies (if present) will react to the horse red blood cells and give a positive result.

paul-bunnell test - similar to monospot test but rbc from sheep

are almost 100% specific for infectious mononucleosis but not everyone with IM produces heterophile antibodies

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51
Q

what specific antibodies can be tested for in infectious mononucleosis?

A

specific EBV antibodies

target viral capsid antigen

IgM antibody - rises early and suggests acute infection

IgG antibody - persists after condition and suggests immunity

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52
Q

what is the management of infectious mononucleosis?

A

self limiting

acute illness usually lasts 2-3 weeks

can leave pt with fatigue for several months once infection is cleared

advised to avoid alcohol and EBV impacts ability of liver to process alcohol

and advised to avoid contact sports due to risk of splenic rupture

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53
Q

what are some complications of infectious mononucleosis?

A
  • Splenic rupture
  • Glomerulonephritis
  • Haemolytic anaemia
  • Thrombocytopenia
  • Chronic fatigue

EBV infection is associated with certain cancers, notable Burkitt’s lymphoma.

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54
Q

what is mumps?

A

viral infections spread by respiratory droplets

incubation period = 14-25 days

self limiting - lasts around 1 week

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55
Q

what must you ask when suspecting mumps?

A

vacine hx

MMR 80% protection against mumps

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56
Q

how does mumps present?

A

prodrome of flu like symptoms occurring few days before parotid swelling

  • fever
  • muscle aches
  • lethargy
  • reduced appetite
  • headache
  • dry mouth

parotid swelling - uni or bi lat, associated pain

can present with abdo pain (pancreatitis), testicular pain (orchitis), confusion, neck stiffness, headache (meningitis/encephalitis)

57
Q

how is mumps managed?

A

diagnosis can be confirmed using PCR testing on a saliva swab

blood or saliva can also be tested for antibodies to mumps virus

notifiable disease

supportive management - rest, fluids, analgesia

management of complications is also mostly supportive

58
Q

what are some complications of mumps?

A
  • Pancreatitis
  • Orchitis
  • Meningitis
  • Sensorineural hearing loss
59
Q

what is otitis media?

A

infection of the middle ear (between the TM and the inner ear)

60
Q

what usually precedes otitis media?

A

viral URTI

Bacteria can very easily enter from the back of the throat through the ET tube

61
Q

what is the most common cause and some other causes of otitis media?

A

streptococcus pneumoniae

others - Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus

62
Q

how does otitis media usually present?

A
  • ear pain
  • reduced hearing
  • general symptoms of URTI - fever, cough, coryzal symptoms, sore throat, generally unwell
  • may be balance issues and vertigo when infection affects the vestibular system
  • TM perforation = discharge

NOTE - MAY BE COMPLETELY NON-SPECIFIC SO ALWAYS EXAMINE EARS OF YOUNG CHILDREN

63
Q

what is done and seen on examination of otitis media?

A

both ears with otoscope

normal TM will be pearly-grey, transluscent and slightly shiny should be able to visualise the malleus through membrane and cone of light reflecting the light of the otoscope

otitis media will give bulging, red, inflamed looking membrane - perforation = discharge and hole in TM

64
Q

how is otitis media managed?

A

ref to paeds if symptoms severe or diagnostic doubt

always refer in <3 month old with temp >38 or 3-6 month with temp >39

most resolve within 3 days WITHOUT abx - can last up to a week

simple analgesia

abx - immediate, delayed prescription or no abx

always safety net

65
Q

when should abx be given immediately for otitis media?

A
  • Symptoms lasting >4 days or not improving
  • Systemically unwell but not requiring admission
  • Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
  • < 2 years with bilateral otitis media
  • Otitis media with perforation and/or discharge in the canal
66
Q

when should a delayed prescription be given for otitis media?

A

can be collected after 3 days if symptoms have not improved - given to pt v keen on abx or where you suspect they may get worse

67
Q

what is the first line abx for otitis media?

A

amoxicillin for 5 days

Alternatives are erythromycin and clarithromycin.

68
Q

what are some complications of otitis media?

A
  • Otitis medial with effusion
  • Hearing loss (usually temporary)
  • Perforated eardrum
  • Recurrent infection
  • Mastoiditis (rare)
  • Abscess (rare)
69
Q

what is tonsillitis? what is the most common cause?

A

inflammation of the tonsils

viral cause most common - do not need abx

70
Q

what is the most common cause of bacterial tonsillitis and how is it treated?

A

group A strep - strep pyogenes

penicillin V - phenoxymethylpenicillin

71
Q

aside from group A streptococcus (Streptococcus pyogenes) what else can cause tonsillitis?

A
  • Streptococcus pneumoniae.
  • Haemophilus influenzae
  • Morazella catarrhalis
  • Staphylococcus aureus
72
Q

what is waldeyer’s tonsillar ring?

A

in pharynx at back of throat - ring of lymphoid tissue

6 areas

adenoid, tubal tonsils, palatine tonsils, lingual tonsils

palatine tonsils infected in tonsilitis

73
Q

what are some features of tonsillitis?

A

child with fever, sore throat and painful swallowing

5-10 most commonly affected, also 15-20

can be v non-specific in younger children - fever, poor oral intake, headache, vomiting, abdo pain

74
Q

what may be seen on the throat, what else is important to examine in tonsillitis?

A

ed, inflamed and enlarged tonsils, with or without exudates. Exudates are small white patches of pus on the tonsils.

ears

cervical lymphadenopathy

75
Q

what is the centor criteria?

A

used to estimate the probability that tonsillitis is due to bacterial infection and will benefit from abx

3 or more = abx

  • Fever over 38ºC
  • Tonsillar exudates
  • Absence of cough
  • Tender anterior cervical lymph nodes (lymphadenopathy)
76
Q

what is the feverPAIN score?

A

alternative to centor criteria

  • Fever during previous 24 hours
  • P – Purulence (pus on tonsils)
  • A – Attended within 3 days of the onset of symptoms
  • I – Inflamed tonsils (severely inflamed)
  • N – No cough or coryza

abx when score or 4 or more

77
Q

how is tonsillitis managed?

A
  • exclude other serious pathology - meningitis, epiglottitis, peritonsillar abscess
  • calculate feverPAIN or centor criteria
  • educate likely viral and safety net
  • simple analgesia, paracetamol, ibuprofen
  • return if pain not settled in 3 days or if fever above 38.3
  • delayed prescription or abx if required
78
Q

when should admission be considered for a patient with tonsillitis?

A

immunocompromised

systemically unwell

dehydrated

stridor

respiratory distress

peritonsillar abscess

cellulitis

79
Q

what is the antibiotic of choice for tonsillitis?

A

Penicillin V (also called phenoxymethylpenicillin) for a 10 day course is typically first line.

penicillin V is it tastes bad - young children requiring syrups are often reluctant to take it.

Amoxicillin has a better taste but is not part of the guidelines.

Clarithromycin is the first line choice in true penicillin allergy.

80
Q

what are some complications of tonsillitis?

A
  • Chronic tonsillitis
  • Peritonsillar abscess, also known as quinsy
  • Otitis media if the infection spreads to the inner ear
  • Scarlet fever
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Post-streptococcal reactive arthritis
81
Q

what is conjunctivitis?

A

inflammation of the conjunctiva - thin layer of tissue that covers the inside of the eyelids and sclera of the eye

3 types - bacterial, viral, allergic

82
Q

how does conjunctivitis present?

A
  • uni or bi lateral
  • red eyes
  • blood shot
  • itchy or gritty sensation
  • discharge from eye
  • no pain, photophobia, reduced visual acuity
  • may be blurry when eye is covered in discharge
83
Q

what is specific to bacterial conjunctivitis?

A

presents with purulent discharge

worse in mornings and eyelids stuck together

starts in 1 eye and spreads to other

++ contagious

84
Q

what is specific to viral conjunctivitis?

A

common and usually presents with clear discharge

associated with viral infections such as dry cough, sore throat and blocked nose

tender preauricular lymph nodes

contagious

85
Q

what are some differentials for painless red eye?

A
  • Conjunctivitis
  • Episcleritis
  • Subconjunctival Haemorrhage
86
Q

what are some differentials for painful red eye?

A
  • Glaucoma
  • Anterior uveitis
  • Scleritis
  • Corneal abrasions or ulceration
  • Keratitis
  • Foreign body
  • Traumatic or chemical injury
87
Q

how is conjunctivitis managed?

A

usually resolves without tx after 1-2 weeks

good hygiene advice

bacterial - antibiotic eye drops can be considered but does resolve w/o tx - chloramphenicol and fuscidic acid both options

<1 month old need urgent ophthal input - can be associated with gonococcal infection

88
Q

what is allergic conjunctivitis and how is it managed?

A

caused by contact with allergens - causes swelling of conjunctival sac and eyelid with ++ watery discharge and itch

antihistamines can be used to reduce symptoms

topical mast-cell stabilisers can be used in pt with chronic seasonal symptoms - prevent mast cells releasing histamine (use for several weeks before benefit)

89
Q

what is orbital cellulitis?

A

infection around eyeball involving tissues behind orbital septum

pain on eye movements, reduced eye movements, changes in vision, abnormal pupil reactions, forward movement of eyeball

medical emergency - admit and iv abx

may require surgical drainage if abscess forms

90
Q

what is periorbital cellulitis?

A

aka preorbital cellulitis

eyelid and skin infection in front of orbital septum

swelling, redness, hot skin around eyelids and eye

systemic abx - oral or iv

can develop into orbital in vulnerable pt ie children

91
Q

what investigation can be used to differentiate between periorbital and orbital cellulitis?

A

CT

92
Q

what is candidiasis?

A

infection with yeast called candida albicans

can infect skin folds or navel area, vagina, penis, mouth, corners of mouth, nail beds

93
Q

what are some risk factors for vaginal thrush?

A

increased oestrogen, poorly controlled diabetes, immunosuppression, Broad-spectrum abx

94
Q

how does vaginal thrush present?

A

Vaginal- Thick white discharge does not typically smell, vulval and vaginal itching, irritation or discomfort

More severe= erythema, fissures, oedema, dyspareunia, dysuria, excoriation

95
Q

what investigations can be done for vaginal thrush?

A

Test vaginal pH using swab and pH paper can be helpful in differentiating between BV and Trichomonas (pH>4.5) and Candidiasis (pH<4.5)

Charcoal swab with microscopy can confirm the diagnosis

96
Q

what are some management options for vaginal thrush?

A
  • Antifungal cream (clotrimazole) inserted into the vaginal with an applicator
  • Antifungal pessary (Clotrimazole)
  • Oral antifungal tablets (fluconazole)

candesten duo OTC - contains single fluconazole tablet and clotrimazole cream

recurrent infections (>4 in a year) can be treated woih an induction and maintenance regime over 6/12 with oral or vaginal antifungal medications (off label use)

creams/pessaries may damage latex condoms and prevent spermicides working

97
Q

what does NICE say about vaginal thrush

A
  • Single dose intravaginal clotrimazole (5g of 10%) at night
  • Single 500mg pessary at night
  • Three 200mg pessaries over 3 nights
  • Single 150mg dose fluconazole
98
Q

how is oral thrush managed?

A

miconazole gel or nystatin

99
Q

what is cellulitis?

A

Infection of the skin and soft tissues underneath. Skin normally acts as a very effective physical barrier between the environment and soft tissues. When presents- look for a breach in skin barrier and a point of entry for the bacteria. May be due to skin trauma, eczematous skin, fungal nail infections or ulcers.

100
Q

how does cellulitis present?

A
  • Erythema
  • Warm or Hot to touch
  • Tense
  • Thickened
  • Oedematous
  • Bullae
  • Golden yellow crust can be present and indicate staphylococcus aureus infection
101
Q

what are some common causes of cellulitis?

A
  • Staph aureus
  • Group A strep (pyogenes)
  • Group C strep (dysgalactiae)

Others= MRSA

102
Q

what is the eron classification for cellulitis?

A

way of classifying a patients cellulitis depending on how they present

  • Class 1- no systemic toxicity or co morbidity
  • Class 2- systemic toxicity or comorbidity
  • Class 3- significant systemic toxicity or significant co morbidity
  • Class 4- Sepsis or Life threatening

Admit the patient for IVABX in class 3 or 4. Also consider admission fir frail, v young or immunocompromised.

103
Q

what antibiotics are used for cellulitis?

A

Flucloxacillin- works well against other gram-positive cocci. Oral or IV.

Alternatives:

  • Clarithromycin
  • Clindamycin
  • Co-amoxiclav
104
Q

what is influenza?

A

RNA virus - 3 types A B C

A has subtypes - H&N=H1N1 which is swine flu and H5N1 is avian flu

typically outbreaks in winter

105
Q

each year the flu vaccine is changed to target multiple strains of influenza that are likely to cause flu - who is offered the flu vaccine free on the NHS?

A
  • Aged 65
  • Young children
  • Pregnant women
  • Chronic health conditions such as asthma, COPD, heart failure and diabetes
  • Healthcare workers and carers
106
Q

how does influenza present?

A
  • Fever
  • Coryzal symptoms
  • Lethargy and fatigue
  • Anorexia (loss of appetite)
  • Muscle and joint aches
  • Headache
  • Dry cough
  • Sore throat
107
Q

how is influenza diagnosed?

A

tx started based on hx, risk factors and clinical presentation

viral nasal and throat swabs can be sent to virology lab for PCR analysis - confirm dx and used to help public health

108
Q

how is influenza managed?

A

PH monitor no. of cases in flu and provide guidance on when there is enough flu in an area to justify treating pt

health pt not at much risk of complications = will self resolve and no anti-virals needed

  • 2 options for tx
    • Oral oseltamivir 75mg twice daily for 5 days
    • Inhaled zanamivir 10mg twice daily for 5 days

Treatment needs to be started within 48H of the onset of symptoms to be effective.

post exposure prophylaxis can be given to higher risk pt within 48h of close contact

  • Oral oseltamivir OD for 10 days
  • Inhaled zanamivir 10mg OD for 10 days
109
Q

what are some complications of flu?

A
  • Otitis media, sinusitis and bronchitis
  • Viral pneumonia
  • Secondary bacteria pneumonia
  • Worsening chronic health conditions such as COPD and HF
  • Febrile convulsions (young children)
  • Encephalitis
110
Q

what is malaria?

A

Malaria is an infectious disease caused by members of the Plasmodium family of protozoan parasites. Protozoa are single celled organisms.

111
Q

how is malaria spread?

A

by bites from the female anopheles mosquitoes

112
Q

what are the 4 types of malaria?

A
  • Plasmodium falciparum is the most severe and dangerous form
  • Plasmodium vivax
  • Plasmodium ovale
  • Plasmodium malariae
113
Q

what is the life cycle of malaria?

A

Malaria reproduces in the gut of mosquito→

sporozoites→

liver humans from bite→

can lie dormant as hypnozoites (Vivax and Ovale)→

mature in liver as merozoites (reproduce 48H) which enter the blood and causing a haemolytic anaemia. Therefore Malaria pt have temp spikes every 48H.

114
Q

how does malaria present?

A

Suspect when from area, incubation is 1-4 weeks after infection with malaria although it can lie dormant for years.

Non-specific:

  • Fever, sweats and rigors
  • Malaise
  • Myalgia
  • Headache
  • Vomiting

Signs:

  • Pallor due to anaemia
  • Hepatosplenomegaly
  • Jaundice as bilirubin released during RBC rupture
115
Q

how is malaria diagnosed?

A

Malaria blood film. Sent EDTA bottle (red).

3 samples over 3 consecutive days to exclude. Due to 48H cycles.

116
Q

how is malaria managed?

A

Discuss w/ local infectious diseases unit for advice on management. All pt falciparum should be admitted as can deteriorate quickly.

PO:

  • Artemether with lumefantrine (Riamet)
  • Proguanil and atovaquone (Malarone)
  • Quinine sulphate
  • Doxycylcline

IV in severe or complicated:

  • Artenusate- most effective but not licensed
  • Quinine dihydrochlorise
117
Q

what are some complications of falciparum?

A
  • Cerebral Malaria
  • Seizures
  • Reduced consciousness
  • AKI
  • Pulmonary oedema
  • DIC
  • Severe haemolytic anaemia
  • Multi-organ failure and death
118
Q

what can be done for malaria prophylaxis?

A
  • Beware of locations high risk
  • No method 100% effective
  • Use mosquito spray (50% DEET Spray) in mosquito exposed areas
  • Use mosquito nets and barriers in sleeping area
  • Seek medical advice if symptoms develop
  • Take antimalarials as recommended
119
Q

what are 3 antimalarial options?

A

Antimalarial medications are around 90% effective at preventing infections. There are several options.

Proguanil and atovaquone (Malarone)

  • Taken daily 2 days before, during and 1 week after being in endemic area
  • Most expensive (around £1 per tablet)
  • Best side effect profile

Mefloquine

  • Taken once weekly 2 weeks before, during and 4 weeks after being in endemic area
  • Can cause bad dreams and rarely psychotic disorders or seizures

Doxycycline

  • Taken daily 2 days before, during and 4 weeks after being in endemic area
  • Broad-spectrum antibiotic therefore it causes side effects like diarrhoea and thrush
  • Makes patients sensitive to the sun causing a rash and sunburn
120
Q

what is rubella and what is it caused by?

A

Rubella virus

Highly contagious via respiratory droplets

121
Q

what is the incubation period for rubella and when are they infectious?

A

14-21 days.

Individuals are infectious before symptoms appear, to 4 days after the onset of the rash.

122
Q

what is shock?

A

Shock can be defined as the inadequate delivery of glucose or oxygen to peripheral tissues and organs in the body.

It can be attributed to either the inadequate delivery** of substrates (e.g. glucose, oxygen), or the **removal of toxins from peripheral tissues.

Due to the absence of oxygen in the shock state, pyruvate is converted to lactate instead of acetyl-CoA. This is associated with the accumulation of lactate.

The inadequate production of ATP and the production of lactate is associated with impaired cell membrane ion pump function and acidosis. Cellular oedema eventually occurs, followed by cellular death If the shock state is not corrected.

123
Q

name 4 types of shock

A

hypovolaemiac shock

distributive shock

cardiogenic shock

obstructive shock

124
Q

what is hypovolaemic shock, what causes it and how is it managed?

A

This is the most common type of shock seen in children.

Causes include:

  • Dehydration
  • Fluid loss (e.g. diarrhoea, vomiting)
  • Bleeding (e.g. trauma)
  • Third-space losses (e.g. gastroenteritis, burns, diabetes insipidus)

It is characterised by a decreased cardiac filling, decreased EDV, SV and CO.

Management may involve:

  • Fluid resuscitation
  • Blood transfusion
125
Q

what is distributive shock, what causes it and how is it managed?

A

Distributive Shock

This occurs when the patient has a significant increase in peripheral vascular vasodilation, and a decrease in systemic vascular resistance.

Causes include:

  • Sepsis
  • Neurogenic
  • Anaphylaxis

Management may involve:

  • Fluid resuscitation
  • Empirical antibiotic therapy
126
Q

what is cardiogenic shock, what causes it and how is it managed?

A

This can result from congenital heart diseases or cardiomyopathies.

Causes include:

  • Cardiomyopathy
  • Arrhythmia

It is characterised by decreased CO, due to impaired systolic function of the heart (not because of decreased filling).

Management may involve:

  • Fluid resuscitation
  • Inotropic therapy
127
Q

what is obstructive shock and what are some causes?

A

Obstructive Shock

This occurs due to acute obstruction to the pulmonary or systemic blood flow.

Causes include:

  • Cardiac tamponade
  • PE
  • Tension pneumothorax
  • Coarctation of the aorta
  • Severe aortic valve stenosis
128
Q

what is toxic shock syndrome?

A

Rare toxin-mediated life-threatening acute condition caused by toxin-producing bacteria such as Streptococcus pyogenes and Staphylococcus aureus. Superantigenic exotoxins, which trigger a cytokine release and cause endothelial wall damage.

It is most common in young females at the time of menstruation, especially in those who use vaginal tampons.

129
Q

what are some risk factors for toxic shock symdrome?

A
  • S. aureus cellulitis
  • Tampons
  • Wounds (incl. burns)
  • Sinusitis
  • Pharyngitis
  • Varicella infection
  • Influenza virus infection
130
Q

what are some clinical features of toxic shock syndrome?

A
  • High fever
  • Diarrhoea
  • Vomiting
  • Rapid progression and circulatory failure, with profound hypotension and tachycardia
  • Myalgia and muscle weakness
  • Generalised erythematous rash
  • Conjunctival reddening
131
Q

what are some differentials for toxic shock syndrome?

A

Cellulitis, Meningococcal disease, Infectious mononucleosis, Kawasaki disease, Dengue fever

132
Q

what are some investigations for toxic shock syndrome?

A
  • Blood cultures
  • FBC – leucocytosis, low platelets
  • U&Es – raised urea and creatinine, electrolyte disturbances, hypocalcaemia
  • CK – elected
  • LFTs – elevated
  • Urinalysis – may show microscopy haematuria
133
Q

what is the management of toxic shock syndrome?

A

Management involves aggressive haemodynamic resuscitation, with central fluid volume monitoring and regular electrolyte testing. Vasopressor agents may be used to manage shock.

Antibiotics used should include cephalosporin or vancomycin, along with clindamycin.

134
Q

what are some complications of toxic shock syndrome?

A
  • Cardiomyopathy
  • Rhabdomyolysis
  • AKI
  • DIC
135
Q

what is measles?

A

RNA Paramyxovirus.

Spreaded by droplets.

Infective from prodrome until 4 days after rash starts. Incubation period=10-14days

136
Q

how does measles present?

A

Prodromal phase

  • Irritable
  • Conjunctivitis
  • Fever

Koplik spots

  • Typically develop before rash
  • White spots (grain of salt) on the buccal mucosa

Rash

  • Starts behind ears then to the whole body
  • Discrete maculopapular rash (morbilliform rash) blotchy and confluent
  • Desquamation that typically spares the palms and soles may occur after a week

Diarrhoea occurs in around 10% pt

137
Q

how is measles managed?

A

Supportive

Admission considered in immunosuppressed or pregnant patients

PHE notice

Contacts

If child not immunised against= MMR vaccine w/in 72H

138
Q

what are some complications of measles?

A
  • OM
  • Pneumonia
  • Encephalitis- 1-2 weeks after
  • Subacute sclerosing panencephalitis- v rare, may present 5-10yrs following
  • Febrile convulsions
  • Keratoconjunctivitis, corneal ulceration
  • Diarrhoea
  • Increased incidence appendicitis
  • Myocarditis

Paediatrics (6 decks)

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