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Year 4 PAEDS > Infections and Immunity > Flashcards

Infections and Immunity Flashcards

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1
Q

What immunisations are given <1yr? (8)

A

8 weeks (2 months):

1) 6-in-1 vaccine
2) Pneumococcal (PCV) vaccine
3) Rotavirus vaccine
4) MenB

12 weeks (3 months):

5) 6-in-1 vaccine - 2nd dose
6) Rotavirus vaccine - 2nd dose

16 weeks (4 months):

7) 6-in-1 vaccine - 3rd dose
8) PCV - 2nd dose
9) MenB - 2nd dose

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2
Q

What immunisations are given aged 1-15yr? (10)

A

1 year:

1) Hib/MenC - 1st dose
2) MMR - 1st dose
3) PCV - 3rd dose
4) MenB - 3rd dose

2-10yrs:
5) Flu vaccine - every year

3yrs and 4 months:

6) MMR - 2nd dose
7) 4-in-1 pre-school booster

12-13yr:
8) HPV vaccine

14yr:

9) 3-in-1 teenage booster
10) MenACWY

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3
Q

What immunisations are given to adults? (3)

A

65yr:

1) Pneumococcal (PPV) vaccine
2) Flu vaccine (and every year after)

70yr:
3) Shingles vaccine

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4
Q

What immunisations are offered to pregnant women? (2)

A 
Flu vaccine - during flu season
Whooping cough (pertussis) vaccine - from 16 wks
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5
Q

What is in the 6-in-1 vaccine?

A

DHHPTW

1) Diptheria
2) Hep B
3) Hib - Haemophilus influenza type b
4) Polio
5) Tetanus
6) Whooping cough - pertussis

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6
Q

What is in the 4-in-1 pre-school booster?

A

DTPP

1) Diphtheria
2) Tetanus
3) Whooping cough - pertussis
4) Polio

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7
Q

What is in the 3-in-1 teenage booster?

A

DTP

1) Diphtheria
2) Tetanus
3) Polio

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8
Q

Which vaccines are live? (3)

A

1) Influenza
2) MMR
3) Rotavirus (oral)

+ BCG

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9
Q

When does meningitis mostly occur in children?

A

Mostly in first 5 years of life

75% of cases are <15yrs

Younger children are at greater risk of brain damage and are more difficult to diagnose

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10
Q

How does bacterial infection of the meninges occur, and why is this more likely to occur in children?

A

Colonisation of nasopharyngeal epithelium

Invasion of blood then meninges - BBB is less developed in children so these bugs are more likely to reach the meninges and cause infection

Cerebral oedema caused by inflammation + leaky vessels

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11
Q

What is the pathophysiology of viral meningitis?

A

Infection of a mucus membrane followed by lymph node involvement

Primary viraemia = causes viral illness

Secondary viraemia = involved organs such as liver

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12
Q

What are some risk factors for neonatal meningitis? (6)

A

1) Low birth weight (<2500g)
2) Prematurity
3) Premature rupture of membranes
4) Traumatic delivery
5) Fetal hypoxia
6) Maternal peripartum infection

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13
Q

What are the most common bacterial causative organisms of meningitis in neonates? (3)

A

1) Group B strep
2) E coli
3) Listeria monocytogenes

+ other coliforms

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14
Q

What are the most common bacterial causative organisms of meningitis in infants (1 month to 2 years) (4)

A

Streptococcus pneumoniae
Neisseria meningitides
Haemophilus Influenza B
Meningococcus C

**The last 2 are both now vaccinated against and so their incidence has dropped

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15
Q

What are the most common causative organisms of meningitis in adolescents / adults? (3)

A

1) Neisseria meningitidis
2) Streptococcus pneumoniae
3) Listeria monocytogenes

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16
Q

What symptoms may meningitis present with? (13)

A

Photophobia, neck stiffness and headache are the classical distinguishing symptoms but the young child (infant) might not have these making diagnosis more difficult

Infants may have non-specific signs of infection

  • High-pitched cry
  • Bulging fontanelle
  • Poor feeding
  • Respiratory distress

Other meningitic signs

  • Irritable
  • Vomitting
  • Drowsiness
  • Seizures
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17
Q

What are some signs of raised ICP? (6)

A

1) Papilloedema
2) Altered / LOC
3) Bulging fontanelle in neonates
4) Increased BP
5) Decreased HR
6) Irregular respirations
7) Focal neurological signs

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18
Q

What is meningitis vs meningococcal septicaemia?

A

Meningitis = inflammation of the leptomeninges that surround the brain and spinal cord

  • Various causative organisms
  • May have neck stiffness / photophobia
  • Unlikely to have a rash

Meningococcal septicaemia = systemic infection

  • CAUSED BY NEISSERIA MENINGITIDIS
  • Rapidly spreading purpuric rash
  • May or may not also have meningitis
  • Often fatal
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19
Q

What signs of meningism can be found on examination

A

1) Kernig’s sign - unable to extend knee when thigh flexed to 90 degrees
2) Brudunski’s sign - involuntary lifting of leg when lying supine and head is raised

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20
Q

What investigations are done in meningitis? (6)

A

Do not delay abx by more than 30 mins

1) Bloods - FBC, U&Es, CRP, glucose, blood cultures, gases
2) CT head
3) LP unless contraindicated
4) Urine for MC+S
5) Nasal / throat swabs
6) CXR - lung abscess

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21
Q

What would the LP results be in bacterial vs viral meningitis?

A

Viral:

  • Clear / hazy appearance
  • Lymphocytes +
  • Protein +
  • Glucose = Normal

Bacterial:

  • Cloudy / purprulent
  • Neutrophils ++
  • Protein ++
  • Glucose = Low
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22
Q

List some contraindications to LP (7)

A

1) Raised ICP = stabilise first
2) Shock = stabilise first
3) After convulsions = stabilise first
4) Respiratory insufficiency = stabilise frist

5) Abnormal clotting
6) Infection at LP site
7) Extensive purpura

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23
Q

What is a pyrexia?

What is a red flag?

What is an amber flag?

A

Temp of 38 degrees celsius or more

Infants <3 months, fever of more than 38 = red flag

Infants 3-6 months, fever of over 39 = amber flag

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24
Q

What is the treatment of suspected meningococcal meningitis in the community?

A

If in doubt - treat as bacterial

IM benzylpenicillin single dose

<10yr = 1g
1-9yr = 600mg
<1yr = 300mg
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25
What is the treatment of suspected bacterial meningitis in hospital?
<3 months = IV cefotaxime + amoxicillin/ampicillin to cover listeria >3 months = IV ceftriaxone + dexamethasone to reduce neurological sequelae Symptomatic treatment - antipyretics, analgesics, IV fluids Inform PHE - they offer ciprofloxacin to all close contacts
26
Which bacterium and which virus cause the highest morbidity/mortality in meningitis?
Streptococcus pneumoniae HSV
27
What are some complications of meningitis?
Immediate: - Septic shock - Seizures - DIC - Cerebral oedema - Hydrocephalus (blockage of ventricular outlet) Delayed: - Hearing loss (follow up includes hearing test) - Epilepsy - Cerebral palsy (if <2yr)
28
What vaccinations are given as prevention for meningitis and when are they given?
Men B vaccine is given at 2, 4 and 12-13 months Meningitis ACWY given at 13-18 years old
29
What type of bacteria is Neisseria meningitides?
Gram -ve diplococci
30
What groups are there of Neisseria meningitides?
A, B, C, W, Y
31
What are the early signs of meningococcal septicaemia? (6)
1) Fever 2) Mottling 3) Leg pain 4) Cold peripheries 5) Breathing difficulties 6) Non-blanching rash >12hrs
32
What are some early complications of meningococcal septicaemia? (4)
1) DIC 2) AKI 3) Adrenal haemorrhage 4) Circulatory collapse
33
How should non-blanching rash lesions be referred to depending on their size?
``` <3mm = petechial 3-10mm = purpura >10mm = ecchymosis ```
34
What is the classic surgical sieve pneumonic
VITAMIN CDE ``` Vascular Infective / Inflammatory Trauma Autoimmune Metabolic Iatrogenic Neoplastic Congenital / Coagulopathy Developmental / Digestive Endocrine / Environment ```
35
What is a vascular condition causing purpura?
Henoch-Schonlein purpura
36
What is the distribution of purpura in Henoch-Schonlein purpura? What is the platelet count?
Pupura distributed across extensor surfaces, buttocks and ankles Normal platelet count
37
What is an infective / inflammatory cause of purpura?
Meningococcal disease
38
What is the distribution of purpura in meningococcal disease?
Diffuse macular rash - appear before your eyes Give immediate IM Benzylpenicillin !!!!
39
What coagulopathies can cause purpura?
Thrombocytopenia DIC Scurvy (vit C deficiency causes weak capillary walls)
40
What is the course of purpura in thrombocytopenia?
Petechial rash followed by a purpuric rash Usually acute onset in the weeks following a URTI
41
What is Henoch-Schonlein purpura? What are it's main features?
IgA-mediated, autoimmune hypersensitivity vasculitis of childhood Main features: - Purpura - Arthritis - Abdominal pain - GI bleeding - Glomerulonephritis
42
# Define: 1) Sepsis 2) Septicaemia 3) Septic shock
Sepsis = systemic inflammatory response + source of infection Septicaemia = blood borne infection which causes sepsis Septic shock = severe sepsis causing hypotension and compromised tissue perfusion
43
Describe the process of septic shock
Bacterial toxins cause systemic inflammatory response: 1) Vasodilation 2) Increased microvascular permeability 3) Tissue hypoxia 4) Myocardial depression 5) DIC
44
How may early signs of compensated shock present?
``` Tachycardia Cool peripheries Tachypnoea Decreased urine output Inc cap refill time O2 sats <95% Confusion / LOC Hypotension (later) ``` NB high fever can also cause tachycardia and peripheral vasoconstriction which may present similarly to early compensated shock If septicaemia is meningococcal = look for signs of meningitis and non-blanching petechial/purpuric rash as an early sign (not always present) - in 30% rash is blanching and maculopapular
45
What is involved in a septic screen in children?
Septic screen = CRAP blood Cultures - blood, urine, stool, CSF (if no raised ICP), indwelling catheters Radiography - CXR, AXR ABG - metabolic acidosis Pee (urinalysis) Bloods - FCB (raised WCC), U&Es, LFTs, CRP, ESR, glucose, calcium, phosphate, clotting
46
Which vaccine commonly gives a fever in the days following its administration?
MMR Parents often bring children to A&E but advise them this is a self-limiting reaction
47
List some ddx for a child presenting with a fever and a rash (7)
1) Measles 2) Rubella 3) Roseola 4) Scarlett fever 5) Fifth disease 6) Hand food and mouth disease 7) Chicken pox 8) Meningococcaemia
48
List some ddx for a febrile child with a swelling in the neck (5)
1) Cervical adenitis 2) Infectious mononucleosis (EBV) 3) Mumps 4) Thyroiditis (often no fever) 5) Mastoiditis
49
List some ddx of a child with pyrexia of unknown origin (6)
1) Infective endocarditis 2) Osteomyelitis 3) Collagen vascular disease 4) IBD 5) Neoplastic disease 6) Factitious fever
50
List some ddx of a febrile child with recurrent infections (2)
1) HIV / AIDS | 2) Hyposplenism / splenectomy
51
What virus causes chickenpox?
Varicella-Zoster virus (HHV-3)
52
What does reactivation of VZV lead to?
Shingles
53
What is the incubation period of chicken pox?
10-21 days
54
What is the usual duration of the rash in chickenpox?
6-10 days
55
What is the recommended isolation period for chicken pox?
Until all the lesions are crusted over (usually 5-6 days)
56
Describe the type of rash and distribution in chickenpox
Vesicular rash Occurs in crops starting on trunk and spreading to face and extremities Erythematous macules -> papules -> vesicles filled with clear fluid on erythematous base -> eruption of vesicles -> crusted papules -> hypopigmentation of healed lesions Can have multiple stages on body at once
57
What is the first feature of chickenpox? How long does this last?
Pyrexia and malaise for 1-2 days prior to onset of lesions
58
How else does chickenpox present?
``` Headache Malaise Abdo Pain Itchy rash Shallow ulcers of the mucous membranes Coryzal ```
59
What may occur when immunocompromised get chickenpox?
Pneumonia Large and bleeding vesicles DIC
60
What investigations are done for chickenpox?
Diagnosis clinical PCR of vesicle fluid - confirms diagnosis
61
What is the management of chickenpox in an otherwise healthy individual?
* Advise re fluid intake, avoid scratching and keep nails short, avoid contact with pregnant women/neonates/immunocompromised * Use paracetamol for analgesia and pyrexia * Antihistamines and emollients for pruritis
62
Why are NSAIDs not advised for chickenpox?
Possible association with necrotising soft tissue infections
63
What populations require antiviral treatment for chickenpox?
IV aciclovir: - Immunocompromised - Systemic disease - Pt on high dose steroids - New lesions appearing after 8 days PO aciclovir: - >12yr
64
What are some complications of chickenpox?
1) Secondary infection of skin lesions (e.g. Group A strep (step pyogenes) can produce necrotising fasciitis and toxic shock syndrome) 2) Viral pneumonia 3) Encephalitis 4) CNS complications e.g. benign cerebellar ataxia
65
Why is chickenpox late in pregnancy concerning?
It can cause premature delivery If rash appears within a week of delivery or 2 days after, there is a risk of neonatal chickenpox
66
Why is neonatal chickenpox concerning?
There is transplacental transmission of virus but not antibody, and there is no time for IgG to develop and the baby is at 30% risk of death from severe pneumonia or fulminant hepatitis NB IgG can cross the placenta (initial IgM cannot) - so if at least a week passes between rash and delivery is fine as IgG will have developed
67
Why is chickenpox within first 2 weeks of pregnancy concerning?
Risk of congenital varicella syndrome - IUGR - Microcephaly - Cortical atrophy - Limb hypoplasia
68
What is the treatment of neonatal chickenpox?
Immunoglobulin and aciclovir
69
How is chickenpox transmitted?
Respiratory droplets or direct contact with vesicular fluid
70
When should parents be advised they can reenter their children to school with chickenpox?
6 days after the last spots appear
71
Why is ceftriaxone contraindicated in babies < 3 months?
It displaces bilirubin from albumin binding sites, resulting in higher levels of bilirubin that accumulate in the tissues

Year 4 PAEDS (23 decks)

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