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Year 4 PAEDS > Infections and Immunity 2 > Flashcards

Infections and Immunity 2 Flashcards

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1
Q

What is conjunctivitis?

A

Inflammation the conjunctiva (thin membrane which covers the sclera of the eyes and the inside of the eyelids)

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2
Q

What are some causes of bacterial conjunctivitis?

A 
Staph aureus
Strep pneumoniae
H influenzae
Morazella catarrhalis
Pseudomonas aeruginosa
Gonococcal
Chlamydial
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3
Q

What does neonatal conjunctivitis within the first 48hrs, with purulent discharge and swelling of the eyelids suggest?

A

Gonococcal conjunctivitis

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4
Q

How is gonococcal conjunctivitis managed?

A

IV cephalosporin

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5
Q

How is chlamydial conjunctivitis in a newborn diagnosed and treated?

A

Specific monoclonal antibody test performed on conjunctival secretions

PO erythromycin / topical tetracycline

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6
Q

What are some causes of viral conjunctivitis?

A

Adenovirus (most common)

HSV
HZV
Molluscum contagiosum

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7
Q

How is allergic conjunctivitis managed?

A

Topical mast cell stabilisers

Antihistamines

Topical steroids (specialist)

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8
Q

How does viral conjunctivitis present?

A

Red eye, usually generalised, often bilateral

Irritation, grittiness and discomfort typical (not significant pain)

Clear, watery discharge with mucoid component

NO PHOTOPHOBIA
NO CHANGE IN VISUAL ACUITY

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9
Q

What does marked pain, photophobia and possibly decreased visual acuity suggest?

A

Uveitis

These symptoms suggest deeper inflammatory conditions of eye

Esp in those with ‘conjunctivitis’ not responding to conventional treatment and those with previous episodes

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10
Q

How do scleritis and episcleritis present?

A

Unilateral with localised injection and aching (episcleritis) or intense boring pain (scleritis)

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11
Q

What is the management of bacterial conjunctivas?

A

Chloramphenicol or fusidic acid drops

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12
Q

What is the management of viral conjunctivitis?

A

Symptomatic

Self-limiting

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13
Q

What is the discharge like in conjunctivitis that is:

1) Viral
2) Bacterial
3) Allergic

A

1) Viral - watery / sticky
2) Bacterial - thick yellow / green
3) Allergic - watery / clear / no discharge

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14
Q

What are some advantages of breastfeeding for:

a) Baby
b) Mother

A

Advantages to baby
• Antibodies - especially from rich colostrum in first few days
• Attachment with mum
• As baby grows, the composition of the milk changes to suit the baby
• Reduces risk of allergies, infections, eczema
• Reduce risk of obesity, CVD, diabetes, certain cancers
• In short term, reduces risk of neurodevelopmental problems

Advantages to mother
• Faster uterine involution (oxytocin stimulates uterine contractions) - reduces risk of PPH
• Earlier return to pre-pregnancy weight - burns 500kcal/day
• Lactational amenorrhoea providing natural contraception - 98% effective if fully breastfeeding for up to 6 months post-partum
• Improved bonding with infant
• Reduced risk of ovarian, breast, endometrial cancer and cardiovascular disease and osteoporosis
• Reduced costs and reduced time - more convenient

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15
Q

What is colostrum?

A

Colostrum (thick, yellow fluid) = the first milk produced during late pregnancy until 3-4 days post-partum, which is rich in proteins and immunoglobulins that play important part in gut maturation and immunity for infant

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16
Q

What are some CI to breastfeeding?

A
  • Galactosemia in infant - autosomal recessive defects in enzymes that metabolise galactose
  • HIV infection
  • Cocaine use
  • Active TB or varicella infection - but can give expressed breast milk instead
  • Herpes simplex breast lesions (but if no lesions, encourage breastfeeding)
  • Drugs - tetracyclines (teeth staining), chemotherapy, cytotoxics, lithium, methotrexate, amiodarone
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17
Q

What is the time frame of the weaning process?

A

0-6 months - breast or formula milk only

6 months - Introduce solid foods such as pureed and finger feeds

7-9 months - give more soft feeds before milk feeds. Encourage finger feeding. Give fruit juices in a cup

9-12 months - mash food with a fork. 3 meals / day, at least one with family

1 year and over - undiluted cow’s milk in a cup

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18
Q

What is the difference between food allergy and food intolerance?

A

Food allergy = immunologically mediated reaction to food allerges

  • Acute, rapid onset usually IgE
  • Delayed and non-acute usually non-IgE

Food intolerance = vague term requiring specific explanation

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19
Q

What investigations are done for food allergy?

A

Food diary
Psysician-supervised oral food challenged
Skin-prick testing
Food-specific serum IgE testing

Concordance between results of skin prick testing and serum IgE levels is not always good and thus both need to be carried out

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20
Q

How are serum-allergen specific IgE measured?

A

Enzyme-linked immunosorbent assay (ELISA) and fluorescent enzyme immunoassay (FEIA) tests

Only available for a some foods and v expensive

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21
Q

What are some classic foods involved in allergy?

A 
Milk
Eggs
Fish and seafood
Peanuts
Sesame
Tree nuts
Soy beans
Wheat
Kiwi fruit
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22
Q

What are some examples of non-IgE mediated food allergy?

A

1) Food protein induced enterocolitis
2) Eosinophilic oesophagitis and gastroenteritis
3) Coeliac disease (not strictly an allergy)

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23
Q

How does food protein induced enterocolitis present?

A

Projectile committing, diarrhoea and FTT in first few months of life

Cows milk and soy protein formulas are usually responsible

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24
Q

How does eosinophilic oesophagitis and gastroenteritis present?

A

Nausea, abdo pain, reflux and FTT

No response to antacids

Eosinophilia may be found on FBC or at GI biopsy

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25
What is the management of food allergy and intolerance?
Food avoidance (inc breastfeeding mothers) Dietician referral Drug therapy: Antihisatmine for mild symtoms Oral sodium cromoglicate Corticosteroids Medical emergency identification bracelet EpiPen (IM) in severe respiratory symptoms or anaphylaxis Injection immunotherapy (desensitisation) successfully sued for pollen and insect venom allergies (but risky for food)
26
What is the prognosis of food allergy?
Most children grow out of allergies 1/3rd adults and children lose their clinical reactivity to food allergens after 1-2 years of food elimination diets
27
Which foods is sensitivity rarely lost?
Peanuts Seafood Fish and tree nuts
28
What are some examples of GI enzyme deficiency leading to food intolerances? (2)
1) Lactose intolerance | 2) Congenital sucrose-isomaltase deficiency
29
What are some common food additives and chemicals in food that can cause pharmacological food intolerance reactions?
1) Artificial food colours / preservatives 2) Glutamates including monosodium glutamate 3) Salicylates 4) Caffeine
30
What causes infectious mononucleosis?
aka glandular fever Epstein-barr virus (90%) Rarely CMV
31
How does infectious mononucleosis present?
Prodrome of flu-like illness for 3 days 1) Low-grade fever 2) Malaise 3) Pharyngitis 4) Cervical lymphadenopahty Occasionally: 5) Hepatotosplenomegally 6) Jaundice
32
What investigations are done for infectious mononucleosis?
Triad: 1) FBC - WCC shows lymphocytosis (lymphocytes account for 80-90% WBC) 2) Blood films - more than 10% lymphocytes atypical 3) Serology - positive agglutination test (monospot test) for EBV (or CMV)
33
How long do symptoms last of infectious mononucleosis?
Self-limiting but can last months
34
What is contraindicated in infectious mononucleosis?
Amoxicillin as will cause a maculopapular rash in EBV infection
35
Does the monospot test have high or low sensitivity?
Low sensitivitiy False positives in lymphoma and hepatitis
36
What else may be found when investigating infectious mononucleosis?
Raised LFTs Mild thromobocytopenia Raised IgM and IgG early in disease
37
What is the management of infectious mononucleosis?
Supportive Pt with splenomegaly should avoid contact sports for 1 months and avoid alcohol
38
What are some complications of infectious mononucleosis?
GI / abdo: - Hepatitis - Splenomegaly - Splenic rupture CNS: - Aseptic meningitis - Encephalitis - Guillan-Barre syndrome Post-viral tiredness Also: - Lymphoma - Orchitis - Myocarditis - Pneumonia
39
What is the pathophysiology of infectious mononucleosis?
Virus infects B lymphocytes in pharyngeal lymphoid tissue then spreads to the rest of the lymphoid system
40
What is the incubation period of infectious mononucleosis?
4-8 weeks
41
What is EBV also associated with?
Burkitt's lymphoma B-cell lymphoma MS
42
What is Kawasaki disease?
Idiopathic self-limiting systemic vasculitis
43
What age group does Kawasaki disease most commonly affect?
6 months - 5 years M>F
44
Children of which origin are most commonly affected by Kawasaki disease?
Asian esp Japanese and Chinese
45
Kawasaki disease is the most common cause of what in the developing world?
Acquired childhood heart disease It has taken over from rheumatic fever
46
What are the characteristic features of Kawasaki disease? (6)
CRASH and burn Conjunctivitis - bilateral and dry Rash - widespread non-vesicular Adenopathy - cervical LN >1.5cm Strawberry tongue - inflammation of mucous membranes of mouth, lips, tongue Hand - erythema, swelling and desquamation Burn = prolonged fever of 39 degrees or more (5 or more days) (or echocardiographic evidence of coronary artery aneurysms) May not all be present at the same time
47
What are some other features of Kawasaki disease? (7)
1) Lethargy 2) Urethritis and sterile pyuria 3) d&v 4) Abdo pain 5) Myalgia 6) Arthralgia 7) Arthritis
48
Describe the type of rash and its course in Kawasaki disease
Polymorphic exanthema Comes on within 3-5 days of onset of fever
49
What investigations are performed for Kawasaki?
No diagnostic test for condition - diagnosis made clinically FBC - leukocytosis, neutrophilia, raised ESR and CRP (in acute phase) Platelets elevated and marked thrombocytopenia in 2-3rd weeks LFTS - elevated transaminases and bilirubin Urinalysis - sterile pyuria Abdo US - gallbladder distension ECG - conduction abnormalities
50
How is Kawasaki managed?
Hospital admission Aspirin - One of the few cases in which aspirin is indicated in a child due danger of Reye's syndrome - 30-50mg/kg/day divided QDS - For at least 6 weeks - Reduces risk of thrombus IV immunoglobulin - 2g/kg as a single infusion over 12 hours - Give in first 10 days (or much less effective)
51
What is the follow up management of Kawasaki disease?
Children who receive IvIg should have live vaccines (eg MMR) delayed for 3-11 months Follow up echocardioloogy to determine if there have been any coronary artery complications
52
List some ddx of Kawasaki disease
``` Bacterial = strep / staph infection Viral = adenovirus / enterovirus / measles infection Others = drug reaction / SJS ```
53
What are some complications of Kawasaki disease? What is the mortality?
Coronary artery aneurysms (20-30%) Coronary thrombosis MI Dysrhythmias 4% mortality
54
What causes measles?
Paramyxovirus Leading cause of vaccine-preventable childhood mortality in the world
55
Is measles contagious?
One of the most contagious infectious diseases NB is a notifiable disease
56
How is measles transmitted?
Airborne via respiratory droplets These can spread to surfaces and the virus can remain transmissible for up to 2 hours
57
What is the incubation period of measles?
10-12 days Infectivity lasts from 4 days before until 4 days after the rash appears
58
How does measles present?
Rash + 3 x C's (cough, coryza and conjunctivitis) 1) Rash for at least 3 days 2) Fever for at least 1 day plus at least one of: - Cough - Coryza - Conjunctivitis 3) Prodrome: 2-4 days with fever, cough, runny nose, mild conjunctivitis and diarrhoea 4) Koplik spots 5) Rash = morbilliform +/- high fever and nonproductive cough +/- swelling around the eyes and photophobia Child ill and irritable (miserable disease) unlike other infectious diseases
59
What are Koplik spots?
Pathognomonic On buccal mucosa Small, red spots each with a bluish-white speck (like a grain of rice) in centre Present in 60-70% during prodrome and for up to 2-3 days after rash disappears
60
Where does the rash first appear in measles?
Morbilliform = measles-like Maculopapular rash First on forehead and behind ears, then spreads to neck and spreads, involving trunk and finally limbs, over 3-4 days Fades after 3-4 days Leaves behind brown-discolouration (+/- fine desquamation)
61
How is measles confirmed?
Laboratory diagnosis: - Salaviary swab or serum sample for measles-specific IgM within 6 weeks of onset - RNA detection in salivary swabs
62
How is measles managed?
Uncomplicated measles is usually self-limiting and treatment is symptomatic - paracetamol, ibuprofen, fluids Stay at home to limit spread Monitor carefully for complications
63
What are some respiratory complications of measles?
Respiratory: - Bronchopneumonia - Giant cell pneumonitis
64
What are some neurological complications of measles?
Neurological = 3 different encephalitic diseases: - Acute demyelinating encephalitis - Subacute sclerosing panencephalitis (SSPA) occurs 4-10yrs after attack and characterised by slow progressive neurological degeneration - Measles inclusion body encephalitis
65
What are some GI complications of measles?
GI: - Diarrhoea - Hepatitis - Hypocalcaemia
66
What are some obstetric complications of measles?
Potentially fatal pneumonitis Greater risk of miscarriage, prematurity an low birth weight (but not congenital malformation)
67
What are some other complications of measles?
Vitamin A deficiency and blindness - Those with boardlerline vitA should be given a high dose vit A Immunodeficiency Acute OM
68
How is measles prevented?
MMR vaccine at 12 months
69
What is periorbital cellulitis?
Aka preseptal cellulitis Infection of eyelid and surrounding skin anterior to the orbital septum Alarming
70
What are the usual causes of periorbital cellulitis?
Staph aureus H influenza type B Staph epidermidis Anaeorbes
71
What may periorbital cellulitis occur secondary to in older children?
Paranasal or dental abscesses URTI and sinusitis
72
How does periorbital cellulitis present?
Often systemically unwell with: - Acute onset of swelling, redness, warmth and tenderness of eyelid - Eyelid oedema in the absence or orbital signs such as gaze restriction or proptosis - Fever, malaise, irritability - Ptosis
73
What features increase suspicion of orbital cellulitis?
``` Decreased visual acuity Proptosis External ophthalmoplegia Temp >37.5 Leuckocytosis ```
74
How is periorbital cellulitis investigated?
Clinical diagnosis FBC may show leukocytosis CT of sinuses and orbit +/- brain MRI can help confirm cavernous sinus thrombosis
75
How is periorbital cellulitis managed?
Emergency referral to hospital - all children with suspected preseptal cellulitis should be considered to have orbital cellulitis until proven otherwise ie repeated exams normal, good response to abx, normal CT PO co-amoxliclav - should show improvement within 24-48hrs Possible IV ceftriaxone until response seen
76
What are some complications of periorbital cellulitis?
Progression of infection to orbital cellulitis Lagophthalmos (inability to completely close eyelids) Lid abcess Cicatricial ectropion Lid necrosis
77
What can orbital cellulitis lead to?
Untreated periorbital cellulitis may develop into orbital cellulitis with: - Evolving ocular proptosis - Limited ocular movement - Decreased visual acuity Rarely: - Intracranial abscess formation - Meningitis - Cavernous sinus thrombosis
78
What is prophylactic management of peri-orbital cellulitis?
Prophylactic abx eg chloramphenicol for surgical and accidental trauma to eyelid - QDS to clean wound for one week Hib vaccine
79
What features do HIV infected infants usually present with?
Immunodeficiency: - FTT - Diarrhoea - Candidiasis - Hepatosplenomegaly - Severe bacterial infections
80
What severe bacterial infections may affect HIV infected infants? (6)
1) Pneumonia 2) Septicaemia 3) Persistent pulmonary infiltrates 4) Pneumocystis jiroveci pneumonia (PCP) 5) TB 6) Systemic candida
81
How is HIV diagnosed in children?
Detection of HIV antibody = very specific and sensitive However, passive maternal transplacental IgG obscures diagnosis in young infants as antibody may still be measurable up to 18 months in uninfected clinically well infants Thus in children <2yrs, detection of HIV antigen is required to confirm diagnosis
82
How is HIV managed in children?
Antiviral drugs Prophylactic abx Viral vaccines Where necessary, immune serum globulin
83
What is the prognosis of babies born to HIV-positive mothers?
20-30% become HIV positive themselves
84
How is vertical HIV transmission prevented?
Administration of combination antiretroviral therapy including zidovudine to HIV-infected pregnant women Delivery by CS At birth infant should receive zidovudine for 4 weeks Avoid breastfeeding
85
List 3 AIDS defining conditions in a HIV +ve child
1) Lymphocytic interstitial pneumonitis 2) PCP 3) Candida oesphagitis
86
What is rubella? When is it concerning?
aka German measles Mild illness and rash may not even be noticed Concerning if it is contracted in first trimester
87
How may a fetus be affected if the mother contracts rubella in the first trimester of pregnancy?
``` Fetal death Congenital heart disease Mental retardation Deafness Cataracts ```
88
How does rubella present? What is the incubation period?
Rash appears in tiny macule on face and trunk and works its way down the body, lasts 2-3 days - Suboccipital LN (+/- generalised lymphadenopathy) Generally well +/- fever Incubation period is 14-21 days
89
What are some complications of rubella?
Thrombocytopenia Encephalitis Arthritis (rare) Devastating effects on fetus

Year 4 PAEDS (23 decks)

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