Infections w/Vaccines

Question 1

What organism causes measles & mumps?

Answer 1

RNA paramyxovirus

HIGHLY infectious

Question 2

What is the pattern of Sx in someone with measles?

Answer 2

1) 2-3d = prodrome
2) 5-7d = Exanthematous stage
3) 14d = rash

Question 3

What is the incubation period for Measles, Mumps, Rubella, Chicken Pox & Whooping cough?

Answer 3

Measles = 10d
Mumps = 14-21d
Rubella = 14-21d
Chicken = 10-20d
Whooping = 7-20d

Question 4

What Sx occur in the prodromal stage of measles?

Answer 4

Fever + Cough + Coryza
Conjunctivitis
Koplick spots

Question 5

What Sx occur in the exanthematous stage of measles?

Answer 5

Maculopapular rash:
Behind ears → face → trunk
Lasts 6-8days

OTHER: Lymphadenopathy, anorexia, diarrhoea

Question 6

How is measles investigated?

Answer 6

Blood Film: Leucopaenia
Bloods: LFTs (↑AST/ALT), IgM↑
Sputum sample + PCR: Measles RNA

Question 7

How is measles treated?

Answer 7

Supportive: Isolation, Fluids, nutrition, paracetamol
2o bacterial infection: Amoxicillin
Severe: Ribavirin

Question 8

What are the complications of measles?

Answer 8

Acute OM
Pneumonia- immediately after infection
Encephalitis- 7d after usually if immunoS
Sub-acute sclerosing panencephalitis- 7-13yrs post

Question 9

What organs does mumps affect?

Answer 9

MAINLY salivary glands
Pancreas
Testis/ovary
Brain

Question 10

How long is mumps contagious for?

Answer 10

7d before swelling

9d after parotid swelling

Question 11

How does mumps present?

Answer 11

Fever + malaise + myalgia

PAROTITIS: painful, earache, pain on eating, dry mouth

Question 12

How is mumps treated?

Answer 12

Symptomatic

Question 13

What are the complications of mumps?

Answer 13

Orchitis = INFERTILITY
Hearing Loss
Acute pancreatitis
Meningitis

Question 14

What are the Sx of orchitis (as a complication of mumps)?

Answer 14

Chills/sweats
Headache
Backache
Swinging fever
Severe local testicular pain & tenderness
Swollen scrotum

Question 15

What organism causes Rubella?

Answer 15

RNA Togavirus

Question 16

When is Rubella infective?

Answer 16

5days before + 5days after rash

Question 17

What are the Sx of Rubella?

Answer 17

Low grade fever
Macular rash: Discrete on face → coalesce whole body
Forcheimer spots: Red spots on palate
Lymphadenopathy: Post-auricular, sub-occipital, cervical
Arthralgia

Question 18

How is Rubella investigated?

Answer 18

Serology +/- Saliva PCR

FBC: ↓WCC

Question 19

How is Rubella managed?

Answer 19

Supportive

ASK about contact w/pregnant women

Question 20

What are the complications or Rubella?

Answer 20

Foetal damage: Teratogenic in 1st trimester = Miscarriage/Stillbirth not thought to be a risk >20w
Encephalopathy
Arthritis + Arthralgia
Thrombocytopenia

Question 21

When is chicken pox infective?

Answer 21

2d before vesicles till last vesicle has crusted over

Question 22

How does Chicken Pox present?

Answer 22

Viral Prodrome: Fever + Coryza 2days before rash
Vesicular rash
Itchy++
Headache, anorexia, URTI

Question 23

How does the Chicken Pox rash progress?

Answer 23

Head + trunk → body

Macules → Papules → Vesicle → Pustule → Crust

Question 24

How is Chicken Pox investigated?

Answer 24

Clinical diagnosis but if unsure:

Serology: VZV IgM

Question 25

How is Chicken Pox treated?

Answer 25

Isolation/off school Supportive: Calpol/Paracetamol, Calamine lotion Severe/immunoS: Aciclovir 2o bacterial: Flucloxacillin

Question 26

What are the indications for a varicella zoster vaccine?

Answer 26

In contact w/people at high risk of severe chicken pox/shingles infection -Non-immune healthcare workers

Question 27

What are the complications of chicken pox?

Answer 27

``` Secondary bacterial infection Necrotising fasciitis & TSS Viral pneumonia/Pneumonitis Encephalitis Shingles ```

Question 28

What should be done if a pregnant women comes into contact with someone with chicken pox?

Answer 28

Prev had chicken pox: No worries | Not prev had chicken pox: Antibody blood test → not immune → varicella zoster immunoglobulins

Question 29

How does shingles occur?

Answer 29

VZV reactivation later in life | Vesicular lesions in nerve distribution

Question 30

How does shingles present?

Answer 30

Burning rash follows dermatome | Tx: Aciclovir 10mg/kg TDS

Question 31

What organism causes whooping cough?

Answer 31

Bordetella Pertussis | Commonly co-infected w/RSV

Question 32

What are the Sx of whooping cough?

Answer 32

``` CATARRHAL PHASE: (1-2w) -Coryza + cough + fever PAROXYSMAL PHASE: (2-6w) -Paroxysmal coughing fit & inspiratory whoop leads to vomiting Rhinorrhoea Subconjunctival haemorrhage Young: Apnoea & NO WHOOPING ```

Question 33

In whooping cough what makes the cough +/- vomiting worse?

Answer 33

Night | Post-feeds

Question 34

How is whooping cough investigated?

Answer 34

PCR via nasal swab = DIAGNOSTIC Culture Bloods: ↑WCC, leucocytosis Serology: If >17yo or <5yo w/2w cough for anti-pertussis toxin IgG

Question 35

How is whooping cough treated?

Answer 35

Self-limiting usually 1m Erythromycin 14d or Clarithromycin 7d Isolation: For 5d after starting Abx Prophylaxis: Immunisation & Erythromycin to close contacts

Question 36

What are the complications of whooping cough?

Answer 36

Encephalitis & seizures Dehydration Weight loss

Question 37

What are the indications for hospital admission w/whooping cough?

Answer 37

``` <6mo Ventilation required Apnoea Cyanosis Severe paroxysms Seizure ```