Infections and Immunity Core Conditions

Question 1

What vaccinations does a child receive at 8 weeks?

Answer 1

1. 6 in 1 (1st) (Dip, Tet, Polio, Pertussis, Hib, Hep B)
2. Meningococcal type B
3. Rotavirus (1st) (Oral vaccine)

Question 2

What vaccinations does a child receive at 12 weeks?

Answer 2

1. 6 in 1 (2nd) (Dip, Tet, Polio, Pertussis, Hib, Hep B)
2. Pneumococccal
3. Rotavirus (2nd) (Oral)

Question 3

What vaccinations does a child receive at 16 weeks?

Answer 3

1. 6 in 1 (3rd) (Dip, Tet, Polio, Pertussis, Hib, Hep B)
2. Meningococcal type B (2nd)

Question 4

What vaccinations does a child receive at 1 year?

Answer 4

1. 2 in 1 (Hib and Men C)
2. Pneumococcal (2nd)
3. MMR (Measles, mumps and Rubella) (1st)
4. MenB (3rd)

Question 5

What vaccinations does a child receive at 3 years and 4 months?

Answer 5

1. 4 in 1 (Dip, Tet, Pertussis, Polio)
2. MMR (2nd)

Question 6

What vaccinations does a child receive at 14 years?

Answer 6

1. 3 in 1 (Tet, Dip and Polio)
2. Men ACWY

Question 7

What are Inactivated vaccines?

Answer 7

When a killed version of the pathogen is given. They cannot cause infections and are safe for immunocompromised.
Inactived vaccines:
-Polio
-Flu vaccine
-Hep A
-Rabies

Question 8

What are subunit/conjugated vaccines?

Answer 8

When only parts of the organism are used to stimulate an immune response. Cannot cause infection and are safe for immunocompromised patients.
-Penumococcus
-Meningococcus
-Hep B
-Pertussis
-HiB
-HPV
-Shingles

Question 9

What are live attenuated vaccines?

Answer 9

Contain weakened versions of the pathogen. Still capable of causing infection particularly in immunocompromised patients.
-MMR
-BCG
-Chickenpox
-Nasal Flu
-Rotavirus

Question 10

What are toxin vaccines?

Answer 10

Contain a toxin that is normally produced by a pathogen. Cause immunity to the toxin and not the pathogen itself.
-Diphtheria
-Tetanus

Question 11

What is meningitis?

Answer 11

Inflammation of the meninges covering the brain. Can be confirmed by the presence of WBC in the CSF.

Question 12

What are the common causative organisms of bacterial meningitis is children <3 months old?

Answer 12

-Group B Streptococcus (usually contracted during birth from the GBS bacteria that live in the mother’s vagina. More common in low birth weight babies and following prolonged rupture of the membranes)
-Escherichia Coli and other coliforms
-Listeria monocytogenes

Question 13

What are the common causative organisms of bacterial meningitis in children >3 months old?

Answer 13

-Neisseria meningitides (meningococcus)
-Steptococcus pneumoniae (pneumococcus)
-Haemophilus influenzae (in children 1 month - 6 years)

Question 14

What are the features of meningitis in children?

Answer 14

-Neck stiffness (brudzinski’s and Kernig’s sign)
-Fever
-Headache
-Lethargy
-Photophobia
-Poor feeding/ vomiting
-Irritability
-Hypotonia
-Drowsiness
-Loss of consciousness
-Seizures
-Bulging fontanelle
-Purpuric rash (meningococcal disease)
-Signs of shock
-Focal neurological signs

Question 15

What is Brudzinski’s sign?

Answer 15

Flexion of the neck with the child supine causes flexion of the knees and hips

Question 16

What is Kernig’s sign?

Answer 16

When the child is lying supine and with the hips and knees flexed, there is back pain on extension of the knee. Creates stretch of the meninges.

Question 17

What investigations are needed in suspected meningitis?

Answer 17

-FBC, Coagulation screen, CRP, U&Es, LFTs.
-Blood glucose and blood gas (for acidosis)
-Blood, throat swab, urine and stool cultures
-Viral PCR
-Lumbar puncture (unless contrandicated)

Question 18

What are the contraindications to lumbar puncture?

Answer 18

-Cardiorespiratory instability
-Focal neurological signs
-Signs of raised ICP (coma, high BP, low heart rate, papilloedema, bulging fontanelle)
-Coagulopathy
-Thrombocytopenia
-Local infection at the site of LP
-Meningococcal septicaemia

Question 19

Where is a lumbar puncture performed?

Answer 19

Into the L3-4 intervertebral space (spinal cord ends at L1-2)

Question 20

What are the CSF changes in bacterial meningitis?

Answer 20

Turbid appearance, raised protein, raised WCC (polymorphs, neutrophils), low glucose.C

Question 21

What are the CSF changes in bacterial meningitis?

Answer 21

Clear appearance, mildly raised or normal protein, normal glucose, high WCC (lymphocytes)

Question 22

What antibiotics are given to treat bacterial meningitis in children <3 months?

Answer 22

IV amoxicillin (or ampicillin) + IV cefotaxime

Question 23

What antibiotics are given to treat bacterial meningitis in children >3 months?

Answer 23

IV ceftriaxone (or cefotaxime)

Question 24

How is bacterial meningitis managed?

Answer 24

1. Antibiotics
2. Steroids (dexamethasone in children >3 months)
3. Fluids - to treat shock
4. Cerebral monitoring
5. Public health notification and antibiotics prophylaxis of contacts (Ciprofloxacin)

Question 25

When are why are steroids given in bacterial meningitis?

Answer 25

Given to reduce the frequency and severity of hearing loss and neurological damage. Dexamethasone is given 4x daily for 4 days to children over 3 months if the LP is suggestive of bacterial meningitis

Question 26

What are the complications of meningitis?

Answer 26

-Hearing loss -Seizures and epilepsy -Cognitive impairment and learning disability -Memory loss -Cerebral palsy, with focal neurological deficits such as limb weakness or spasticity -Focal neurological deficit -Sepsis, intracerebral abscess -Brain herniation, hydrocephalus

Question 27

What are the causes of viral meningitis?

Answer 27

-HSV -Enterovirus -Varicella zoster virus -EBV -Mumps (now rare due to MMR vaccine)

Question 28

How does presentation and management of viral meningitis differ from bacterial?

Answer 28

Much more common however much milder disease than bacterial. Often only requires supportive treatment and will make a full recovery. Can treat with Aciclovir. Treat with abx if any query over if bacterial.

Question 29

How should children seen in primary care with suspected meningitis and a non-blanching rash be treated?

Answer 29

Urgent stat injection (IM or IV) of benzylpenicillin