infections Flashcards
(138 cards)
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
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
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
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
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)
6
Q
what vaccines are given at 12 weeks?
A
- 6 in 1 vaccine (again)
- Pneumococcal (13 different serotypes)
- Rotavirus (again)
7
Q
what vaccines are given at 16 weeks?
A
- 6 in 1 vaccine (again)
- Meningococcal type B (again)
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)
9
Q
what vaccine is given yearly ages 2-8?
A
- Influenza vaccine (nasal vaccine)
10
Q
what vaccines is given at 3 years and 4 months?
A
- 4 in 1 (diphtheria, tetanus, pertussis and polio)
- MMR vaccine (again)
11
Q
what vaccine is given as 12-13 years?
A
Human papillomavirus (HPV) vaccine (2 doses given 6 to 24 months apart)
12
Q
what vaccine is given at 14 years?
A
- 3 in 1 (tetanus, diphtheria and polio)
- Meningococcal groups A, C, W and Y
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)
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
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.
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
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
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)
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).
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
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.
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
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.
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
25
what is meningococcal septicaemia?
Meningococcus bacterial infection in the bloodstream - causes non-blanching rash
rash indicates the infection has causes DIC and subcutaneous haemorrhages
26
what are the most common organisms causing bacterial meningitis in children and adults? and neonates?
children and adults = ***Neisseria meningitidis*** (***meningococcus***) and ***Streptococcus pneumoniae*** (***pneumococcus***)
neonates - **group B strep (GBS)**
27
how does meningitis present?
in neonates?
* 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
28
when does NICE recommend a lumbar puncture
* 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???
29
what are the 2 special tests you can perform to look for meningeal irritation?
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
30
how is bacterial meningitis managed in the community?
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)
31
how is bacterial meningitis managed in hospital?
* 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
32
what is post exposure prophylaxis?
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
33
what are some causes of viral meningitis and how is it diagnosed?
***herpes simplex virus*** (***HSV***)
***enterovirus***
***varicella zoster virus*** (***VZV***).
sample of the CSF from the lumbar puncture should be sent for ***viral PCR*** testing.
34
how is viral meningitis treated?
**Aciclovir** in suspected/confirmed HSV or VZV infection
supportive management
35
what is a lumbar puncture?
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
36
what are LP samples sent for?
bacterial culture
viral pcr
cell count
protein
glucose
also send blood glucose so can be compared to CSF
send sample immediately
37
what are LP results for bacterial and viral meningitis?
38
what are some complications of meningitis?
* ***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
39
what is encephalitis in children?
inflammation of the brain
can be result of infective or non-infective causes (autoimmune)
40
what is the most common cause of encephalitis?
viral
herpes simplex virus - HSV 1 in children, HSV 2 in neonates (from genital herpes)
other causes - varicella zoster virus
41
how does encephalitis present?
* Altered consciousness
* Altered cognition
* Unusual behaviour
* Acute onset of focal neurological symptoms
* Acute onset of focal seizures
* Fever
42
how is encephalitis diagnosed?
* ***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
43
what are some contraindications for lumbar puncture?
GCS below
haemodynamically unstable
active seizures or post-ictal
44
how is encephalitis managed?
iv anti viral medications
* aciclovir - HSV, VZV
* ganciclovir - cytomegalovirus
* Repeat
45
how is encephalitis managed?
iv anti viral medications
* aciclovir - HSV, VZV
* ganciclovir - cytomegalovirus
* Repeat
46
how is encephalitis managed?
* 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
47
what are some complications of encephalitis?
* 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
48
what is infections mononucleosis?
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
49
what are some features of infectious mononucleosis
* Fever
* Sore throat
* Fatigue
* ***Lymphadenopathy*** (swollen lymph nodes)
* Tonsillar enlargement
* ***Splenomegaly*** and in rare cases ***splenic rupture***
50
what are heterophile antibodies in infectious mononucleosis?
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
51
what specific antibodies can be tested for in infectious mononucleosis?
specific ***EBV antibodies***
***target viral capsid antigen***
**IgM antibody** - rises early and suggests acute infection
**IgG antibody** - persists after condition and suggests immunity
52
what is the management of infectious mononucleosis?
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
53
what are some complications of infectious mononucleosis?
* Splenic rupture
* Glomerulonephritis
* Haemolytic anaemia
* Thrombocytopenia
* Chronic fatigue
EBV infection is associated with certain cancers, notable ***Burkitt’s lymphoma***.
54
what is mumps?
viral infections spread by respiratory droplets
incubation period = 14-25 days
self limiting - lasts around 1 week
55
what must you ask when suspecting mumps?
vacine hx
MMR 80% protection against mumps
56
how does mumps present?
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
how is mumps managed?
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
what are some complications of mumps?
* Pancreatitis
* Orchitis
* Meningitis
* Sensorineural hearing loss
59
what is otitis media?
infection of the middle ear (between the TM and the inner ear)
60
what usually precedes otitis media?
viral URTI
Bacteria can very easily enter from the back of the throat through the ET tube
61
what is the most common cause and some other causes of otitis media?
**streptococcus pneumoniae**
others - Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus
62
how does otitis media usually present?
* **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**
## Footnote
**NOTE - MAY BE COMPLETELY NON-SPECIFIC SO ALWAYS EXAMINE EARS OF YOUNG CHILDREN**
63
what is done and seen on examination of otitis media?
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
how is otitis media managed?
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
when should abx be given immediately for otitis media?
* 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
when should a delayed prescription be given for otitis media?
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
what is the first line abx for otitis media?
***amoxicillin*** for 5 days
Alternatives are ***erythromycin*** and ***clarithromycin***.
68
what are some complications of otitis media?
* Otitis medial with effusion
* Hearing loss (usually temporary)
* Perforated eardrum
* Recurrent infection
* Mastoiditis (rare)
* Abscess (rare)
69
what is tonsillitis? what is the most common cause?
inflammation of the tonsils
viral cause most common - do not need abx
70
what is the most common cause of bacterial tonsillitis and how is it treated?
group A strep - strep pyogenes
penicillin V - phenoxymethylpenicillin
71
aside from ***group A streptococcus*** (***Streptococcus pyogenes***) what else can cause tonsillitis?
* ***Streptococcus pneumoniae.***
* ***Haemophilus influenzae***
* ***Morazella catarrhalis***
* ***Staphylococcus aureus***
72
what is waldeyer's tonsillar ring?
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
what are some features of tonsillitis?
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
what may be seen on the throat, what else is important to examine in tonsillitis?
ed, inflamed and enlarged tonsils, with or without ***exudates***. Exudates are small white patches of pus on the tonsils.
ears
cervical lymphadenopathy
75
what is the centor criteria?
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
what is the feverPAIN score?
alternative to centor criteria
* **Fever** during previous 24 hours
* **P** – **P**urulence (pus on tonsils)
* **A** – **A**ttended within 3 days of the onset of symptoms
* **I** – **I**nflamed tonsils (severely inflamed)
* **N** – **N**o cough or coryza
abx when score or 4 or more
77
how is tonsillitis managed?
* 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
when should admission be considered for a patient with tonsillitis?
immunocompromised
systemically unwell
dehydrated
stridor
respiratory distress
peritonsillar abscess
cellulitis
79
what is the antibiotic of choice for tonsillitis?
***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
what are some complications of tonsillitis?
* 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
what is conjunctivitis?
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
how does conjunctivitis present?
* 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
what is specific to bacterial conjunctivitis?
presents with purulent discharge
worse in mornings and eyelids stuck together
starts in 1 eye and spreads to other
++ contagious
84
what is specific to viral conjunctivitis?
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
what are some differentials for painless red eye?
* Conjunctivitis
* Episcleritis
* Subconjunctival Haemorrhage
86
what are some differentials for painful red eye?
* Glaucoma
* Anterior uveitis
* Scleritis
* Corneal abrasions or ulceration
* Keratitis
* Foreign body
* Traumatic or chemical injury
87
how is conjunctivitis managed?
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
what is allergic conjunctivitis and how is it managed?
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
what is orbital cellulitis?
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
what is periorbital cellulitis?
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
what investigation can be used to differentiate between periorbital and orbital cellulitis?
CT
92
what is candidiasis?
infection with yeast called candida albicans
can infect skin folds or navel area, vagina, penis, mouth, corners of mouth, nail beds
93
what are some risk factors for vaginal thrush?
increased oestrogen, poorly controlled diabetes, immunosuppression, Broad-spectrum abx
94
how does vaginal thrush present?
Vaginal- Thick white discharge does not typically smell, vulval and vaginal itching, irritation or discomfort
More severe= erythema, fissures, oedema, dyspareunia, dysuria, excoriation
95
what investigations can be done for vaginal thrush?
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
what are some management options for vaginal thrush?
* 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
what does NICE say about vaginal thrush
* 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
how is oral thrush managed?
miconazole gel or nystatin
99
what is cellulitis?
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
how does cellulitis present?
* Erythema
* Warm or Hot to touch
* Tense
* Thickened
* Oedematous
* Bullae
* Golden yellow crust can be present and indicate staphylococcus aureus infection
101
what are some common causes of cellulitis?
* Staph aureus
* Group A strep (pyogenes)
* Group C strep (dysgalactiae)
Others= MRSA
102
what is the eron classification for cellulitis?
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
what antibiotics are used for cellulitis?
**Flucloxacillin**- works well against other gram-positive cocci. Oral or IV.
Alternatives:
* Clarithromycin
* Clindamycin
* Co-amoxiclav
104
what is influenza?
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
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?
* Aged 65
* Young children
* Pregnant women
* Chronic health conditions such as asthma, COPD, heart failure and diabetes
* Healthcare workers and carers
106
how does influenza present?
* Fever
* Coryzal symptoms
* Lethargy and fatigue
* Anorexia (loss of appetite)
* Muscle and joint aches
* Headache
* Dry cough
* Sore throat
107
how is influenza diagnosed?
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
how is influenza managed?
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
what are some complications of flu?
* 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
what is malaria?
Malaria is an infectious disease caused by members of the Plasmodium family of protozoan parasites. Protozoa are single celled organisms.
111
how is malaria spread?
by bites from the **female anopheles** mosquitoes
112
what are the 4 types of malaria?
* Plasmodium falciparum is the most severe and dangerous form
* Plasmodium vivax
* Plasmodium ovale
* Plasmodium malariae
113
what is the life cycle of malaria?
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
how does malaria present?
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
how is malaria diagnosed?
Malaria blood film. Sent EDTA bottle (red).
3 samples over 3 consecutive days to exclude. Due to 48H cycles.
116
how is malaria managed?
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
what are some complications of falciparum?
* Cerebral Malaria
* Seizures
* Reduced consciousness
* AKI
* Pulmonary oedema
* DIC
* Severe haemolytic anaemia
* Multi-organ failure and death
118
what can be done for malaria prophylaxis?
* 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
what are 3 antimalarial options?
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
what is rubella and what is it caused by?
Rubella virus
Highly contagious via respiratory droplets
121
what is the incubation period for rubella and when are they infectious?
14-21 days.
Individuals are infectious before symptoms appear, to 4 days after the onset of the rash.
122
what is shock?
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
name 4 types of shock
hypovolaemiac shock
distributive shock
cardiogenic shock
obstructive shock
124
what is hypovolaemic shock, what causes it and how is it managed?
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
what is distributive shock, what causes it and how is it managed?
**_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
what is cardiogenic shock, what causes it and how is it managed?
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
what is obstructive shock and what are some causes?
**_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
what is toxic shock syndrome?
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
what are some risk factors for toxic shock symdrome?
* S. aureus cellulitis
* Tampons
* Wounds (incl. burns)
* Sinusitis
* Pharyngitis
* Varicella infection
* Influenza virus infection
130
what are some clinical features of toxic shock syndrome?
* High fever
* Diarrhoea
* Vomiting
* Rapid progression and circulatory failure, with profound hypotension and tachycardia
* Myalgia and muscle weakness
* Generalised erythematous rash
* Conjunctival reddening
131
what are some differentials for toxic shock syndrome?
Cellulitis, Meningococcal disease, Infectious mononucleosis, Kawasaki disease, Dengue fever
132
what are some investigations for toxic shock syndrome?
* 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
what is the management of toxic shock syndrome?
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
what are some complications of toxic shock syndrome?
* Cardiomyopathy
* Rhabdomyolysis
* AKI
* DIC
135
what is measles?
RNA Paramyxovirus.
Spreaded by droplets.
Infective from prodrome until 4 days after rash starts. Incubation period=10-14days
136
how does measles present?
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
how is measles managed?
Supportive
Admission considered in immunosuppressed or pregnant patients
PHE notice
**Contacts**
If child not immunised against= MMR vaccine w/in 72H
138
what are some complications of measles?
* 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
