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CHDA > Infections > Flashcards

Infections Flashcards

1
Q

typical presnetation with bronchiolitis

A

Presentation:

• Infants (generally

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2
Q

DDx for acute respiratory failure

A

1) Bacterial laryngo-tracheo-bronchitis
2) H. influenzae epiglottitis
3) Anginose form of EB virus infection
4) Diphtheria
5) Quinsy
6) Rabies with secondary pneumonia

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3
Q

Mx of acute resp failure

A

1) Oxygen
2) Call resuscitation team
3) Notify ENT-Theatre-PICU
4) Ceftriaxone
5) IV fluids

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4
Q 
Croup:
aetiology
age
onset/fever
course
Sx
A 
Parainfluenza virus
4mo-2yrs
subacute/low-grade fever
usually mild, stridor may worsen at night
barky cogh, stridor
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5
Q 
epiglottits
aetiology
age
onset/fever
course
Sx
A 
Haemophilus influenzae
2-5 yrs
acute/high fever
rapid progress of Sx
Dysphagia, sore throat, dysphonia, resp distress
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6
Q

Symptoms of shock

A 
 HR
	Other measures of shock:
	Capillary re-filling time; pallor
	Core:peripheral temperature difference
	Decreased Urine output
	[ Rising respiratory rate ]
	[ Anxiety, restlessness ]
	[ Falling blood pressure ]
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7
Q

Nisseria meningitidis
Type of fever, Onset of rash, type of rash
other features

A

Type of fever
39-41C, then sub-normal late (shock)
Onset of rash
Within 1-3 days of infection usually, occ >10
Type of rash
Purpuric, face/limbs/trunk; extensive, scanty
Other features
Purpura fulminans, meningitis, deafness, adrenal haemorrhage, endocarditis, septic arthritis, chronic meningococcal septicaemia

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8
Q

DDx for fever + associated other Sx

A

Bacterial diarrhoea
High fever
Dysentery

Appendicitis
Tenderness in RIF area and on PR

Pyelonephritis
Tenderness in the renal angle (loin)

Meningitis
Headache
Meningism (care - RUL pneumonia )
Signs of  ICP (‘fighting’); seizures

Pneumonia
Typical grunting tachypnoea
Pleuritic pain
Dullness;  movements; VF; BB; fine crackles

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9
Q

Meningitis signs in infant and older child

A 
Infant:
	Bulging fontanelle
	Meningism minimal
	Systemic symptoms
	more rapid progression
	Older Child:
	[ No fontanelle ]
	Meningism more marked
	More localised symptoms
		eg headache
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10
Q

MEASLES typical presentation

Type of fever, Onset of rash, type of rash
other features

A

Classic form of early measles exanthematous phase, conjunctivitis, coryza, discrete maculopapular rash beginning on the face aspreadin to the trunk and extremities.
Koplik spots in the mouth.

Type of fever
Low-grade during prodrome, then:
39ºC – 41ºC with rash, remittent (cave 2º infection)
Onset of rash
Prodrome after 10-12 days
14 days after infection (Köplick’s first)
Type of rash
Maculo-papular/confluent, occ. haemorrhagic, behind ears, then facetrunklimbs
Other features
Coryza & conjunctivitis misery, immunosuppression etc

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11
Q

measles epidemiology and importance UK/world

A
  • Important cause of morbidity and mortality in developing world
  • Periodic outbreaks occur in the UK associated with vaccine failure (~5%) and non-uptake
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12
Q

re vaccination against measles

A
  • Vaccine may be ineffective if given before 1 year because of maternal antibody
  • Vaccine part of MMR at 12-15 months with preschool booster
  • Vitamin A may be of benefit in malnutrition or immunodeficiency
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13
Q

short and long term complications from measles

A

• Pneumonia, croup, bronchiolitis and otitis media
• Still several deaths each year in UK
• 880 000 deaths worldwide each year
• Post infectious encephalitis. 1 in 1000-5000 - Presents 7-14 days (May be earlier). Mortality 10%. Neurological sequelae 15%.
Long term:
• Rare -SSPE (5-10 years from 1° infection)

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14
Q

rubella typical presentation

Type of fever, Onset of rash, type of rash
other features

A

The rash of acquired rubella is usually maculopapular, which may eventually coalesce.

Type of fever
Moderate to low-grade, rarely > 38.4ºC, remittent
Onset of rash
14-21 days after infection, short prodrome
Type of rash
Maculopapular, can be minimal, mild branning
Other features
Retro-aurical, post-cervical & occipital lymph nodes, tender

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15
Q

significance of rubella?`

A

Rubella
• Generally insignificant illness with low complication rate
• Significance of vaccination is in the eradication of congenital rubella
• Complications which are unusual include polyarthritis, encephalitis and thrombocytopenia

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16
Q

rubella in non-immune pregnant women

A

• 50-80% fetus infected if infection

17
Q

congenital rubella syndrome signs at birth

A 
Signs at birth (32%)
• IUGR
• Microcephaly
• Micro-ophthalmia
• Cataracts
• Thrombocytopenia
• CHD
• Linear bone lesions
• Retinitis
• Convulsions
18
Q

congenital rubella syndrome later manifestations

A 
Signs at birth (32%)
• IUGR
• Microcephaly
• Micro-ophthalmia
• Cataracts
• Thrombocytopenia
• CHD
• Linear bone lesions
• Retinitis
• Convulsions
19
Q

mums genral

A
  • Causative organism – mumps virus (RNA myxovirus)
  • Fever – may be up to 40° for up to 1 week
  • Rash – not a feature
  • Salivary gland enlargement 1 – 2 days after malaise, fever
  • Complications aseptic meningitis, orchitis, pancreatitis
20
Q

scarlet fever

presentation, cause

A

Blanching sandpaper rash, strawberry tongue

Type of fever
39.6-40ºC on 2nd day, to normal in 5-7 days
Onset of rash
1-7 days after infection
Type of rash
Red punctate, papular, blanching, desquamating in flakes
Other features
Strawberry tongue, circumoral pallor
Local complications of Streptococcal infection

Scarlet Fever
• Causative organism – Group A streptococcus
• Fever - sudden, high, lasts 4/5 days
• Rash – Erythematous. Starts axilla & groin, spreads to trunk and limbs
• Circumoral pallor
• Strawberry tongue
• Desquamation starts on face, spreads to palms & soles
21
Q

scarlet fever complicaitons

A 
Early
	• Cervical adenitis
	• Otitis media- mastoiditis, meningitis, cerebral abscess
	• Sinusitis
	• Peritonsillar cellulitis/ abscess formation
	• Laryngitis
	Late
	• Rheumatic fever
	• Acute GN
	• Erythema Nodosa
22
Q

chickenpox

A

The early morphology of the vesicles has been likened to a ‘‘dewdrop on a rose petal,’’

• Human herpes virus
• Usually benign illness
• Vaccination is available in special
circumstances
• May be fatal if immunosuppressed

Type of fever
Moderate, 38-39ºC, occ 41ºC
Onset of rash
14-18 days after infection, short prodrome
Type of rash
Papular vesicular cloudy & umbilicated, centripetal, in crops; pharynx, eyes, vagina
Other features
Pneumonia, meningo-encephalitis, ITP, [eczema, immunosuppressed, neonatal]

23
Q

complications of chickenpox

A 
Skin & soft tissue infections
		Necrotising faciitis
	Pneumonia / pneumonitis
	CNS
		Encephalitis
		Cerebellitis
		Vascultitis / stroke

Complications
Short term
• Bacterial complications particularly Group A Streptococcus (pneumonia, necrotising fasciitis)
• Post infectious cerebellitis
• Acute demyelinating encephalomyelitis (ADEM)
Long term
• Reactivation of dormant virus as shingles

24
Q

Varicella Neonatorum

A
  • Neonatal varicella can be severe
  • Maternal rash from 7 days pre-delivery to 2 days post partum, infant at high risk - give ZIG
  • Give aciclovir if any rash develops
  • Consider ZIG if mother is non-immune and baby is exposed
25
Q

congenital varicell syndrome

A
  • Infection first trimester 2% risk
  • Cicatricial scarring of limbs
  • Cortical atrophy
  • Hypoplasia of limbs
  • Digital defects
  • Retinitis
  • Cataracts
26
Q

roseola infantum

A

Type of fever
Sudden high fever 39-41ºC persistent
Onset of rash
3-7 days after infection with HHV-7, lasts 3-4 days
Type of rash
Macular, face  whole body, like roseola
Other features
Febrile seizures common, bulging fontanelle
Often no abnormal physical signs
Chronic pneumonitis in immunocompromised
Temperature settles when rash appears

* Causative organism - HHV6
* Fever - Abrupt, high, falls as rash appears
* Rash - Maculopapular, trunk & neck, sometimes spreads to face & limbs, lasts 3 – 5 days
* Other names - Erythema subitum, sixth disease
* Known cause of febrile convulsions
27
Q

KAWASAKI

A

Type of fever
39-41ºC, sustained, for more than 5 days
Onset of rash
At onset of illness, ?incubation
Type of rash
Erythema multiforme, maculo-papular, strawberry tongue, cracked lips, conjuntivitis, enanthem, LN+.
Peeling hands and feet ( late )
Other features
Coronary aneurisms, sometimes larger arteries
gall bladder enlarged
Transient arthritis, iridocyclitis, meatitis etc
VIG & aspirin treatment

* First described in Japan in 1960s
* Behaves like infectious disease but no causative organism found
* Median age of onset 2 years
* Incidence in Japan 15 – 100 per 100 000 children but less in UK
* National epidemics in 2 – 4 yearly cycles
* Pathology: diffuse vasculitis of small and medium sized vessels
* Fever - High, swinging, lasts 5-30 days, responds rapidly to aspirin or IV immunoglobulin
* Rash - Similar to scarlet fever at onset of fever, fades within a week
* Erythema of palms & soles with non pitting oedema of hands & feet. Palms & soles desquamate in 2nd and 3rd week
28
Q

diagnostic criteria for kawasaki and laboratory findings

A 
Five of six features should be present including fever
	• Fever
	• Conjunctivitis
	• Oral changes
	• Changes of extremities
	• Polymorphous rash
	• Cervical lymphadenopathy
		• Mainly non-specific: 
	– Leucocytosis and neutrophilia in the early phase
	– Thrombocytosis later
	– Raised ESR, CRP
	– Sterile pyuria
29
Q

complications of kawasaki

A

Complications
• Thrombocytosis in 2nd and 3rd weeks
• Arthritis
• Transient derangement of liver enzymes
• Myocarditis and pericarditis
• Coronary artery aneurysms (up to 20% without treatment)
• Aneurysms in other arteries (may be silent and especially in infants and may lead to peripheral gangrene or cerebral infarction)

30
Q

glandular fever

A 
Type of fever
		38-40C, remittent and often regular
	Onset of rash
		30-50 days after EBV infection
	Type of rash
		Maculo-papular, often absent
	Other features
		Lymphadenopathy, splenomegaly, sore throat, nausea, fatigue. Anginose form. Epitrochlear node
		Rash with amoxycillin; Paul Bunnell test
31
Q

parvovirus 19 infection

A 
Type of fever
		39-41C, remittent
	Onset of rash
		After 6-12 days incubation
	Type of rash
		Fine macular, limbs, sometimes absent, can wax & wane for 3 weeks, spares palms & soles, lacy reticular appearance when clearing
	Other features
		Fetal effects, arthritis, anaemia in sickle cell anemia
32
Q

Henoch-Schönlein Purpura

A
  • Multisystem disease, usually affects skin, joints, GI tract, & kidneys
    • IgA response following infection
    • Not infectious
    • Check urinalysis and blood pressure
    • Avoid PE if sore joints or lack energy
    • Will need regular OPD
    • Associated nephritis often self limiting but can be serious
33
Q

mucocutaneous lymph node syndrome

A

• Type of fever
– 39-41C, abrupt onset, unremitting, for 1-3 weeks
• Onset of rash
– At onset of illness, ?incubation
• Type of rash
– Erythema multiforme, maculo-papular, strawberry tongue,cracked lips, conjuntivitis, enanthem, LN+.
– Peeling hands and feet ( late )
• Other features
– Coronary aneurisms, sometimes larger arteries
– gall bladder enlarged
– Transient arthritis, iridocyclitis, meatitis etc
– IG & aspirin treatment

34
Q

contraindicaitons to vaccination

A 
• General
	– Acute illness
	– Previous severe local reaction
	– General reactions
	• Live vaccines (BCG,MMR,Polio)
	– Immunosuppressants
	– Impaired cell-mediated immunity
	– Immunoglobulin administration within 3/12
	– HIV
	Contraindicated BCG, yellow fever, oral typhoid
35
Q

common presentaitons of acutely infected children and differnetials

A 
Common presentations:
• Fever
• Rash
• Arthralgia
• Lymphadenopathy

Differential diagnosis groups
• Infection - viral, bacterial, protozoal, fungal, parasitic, rickettsial
• Immunological (eg post-infectious, HSP, SLE)
• Malignancy (eg leukamias, bone tumours)
• Rheumatological (eg JIA)
• Haematologial (Haemophilia)

CHDA (2 decks)

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