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Infectious disease Flashcards

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1
Q

Cervical lymphadenopathy definition

A

Enlargement of cervical lymph nodes

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2
Q

Causes cervical lymphadenopathy

A

ALL
Napkin dermatitis
Acute bacterial adenitis nodes >10mm, warm and fluctuant. Usually Staph aureus/ group A strep
Kawasaki disease (unilat, >15mm, painful nodes + other ass features)
Atopic eczema (nodes >2wks, usually bilat)
Measles
JIA
Chickenpox
HIV
Mononucleosis/ Epstein Barr Virus infection (generalised lymphadenopathy, hepatosplenomegaly)
Mycobacterium avium (usually unilat, child

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3
Q

Mx acute adenitis

A

Incision and drainage (but NOT if ?TB)
Oral abx for 10 days (fluclox)
IV abx if neonates/ unwell/ failed oral rx

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4
Q

EBV illnesses

A

Most infections sub-clinical
Infectious mononucleosis
Burkett lymphoma
Lymphoproliferative disease in immunocomp hosts

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5
Q

EBV transmission

A

Usually oral contact

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6
Q

EBV syndrome

A

Older kids (and sometimes young):

  • fever
  • malaise
  • tonsillopharyngitis (often severe, limiting oral fluid + food ingestion. Sometimes can compromise breathing)
  • lymphadenopathy, esp cervical nodes
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7
Q

Other sx EBV infection

A 
petechiae soft palate
splenomegaly
hepatomegaly
maculopapular rash
jaundice
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8
Q

Dx EBV

A

Dx supported by:
atypical lymphocytes (numerous large T cells on blood film)
positive Monspot test (but this often -ve in young children with the disease)
seroconversion with production of IgM and IgG to EBV
Sx can persist for 1-3 months but ultimately resolve

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9
Q

Tx EBV

A

Tx symptomatic
When airway severely comp, can consider steroids
In 5%, group A strep grown from tonsils - can be tx with penicillin (AVOID ampicillin/ amoxicillin in children w ?EBV - can cause florid maculopapular rash)

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10
Q

CMV transmission

A

Usually transmitted via saliva, genital secretions, breast milk
More rarely: blood products, organ transplants, transplacentally

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11
Q

CBV infection syndromes

A

Mild/ subclinical infection in normal hosts
(Developed countries: ~1/2 adults show ev of past infection)
Mononucleosis syndrome; gen less pronounced pharyngitis and lymphadenopathy vs EBV

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12
Q

RFs CMV infection

A

Immunocompromised people:
- retinitis, pneumonitis, BM failure, enceph, hepatitis, colitis, oesophagitis
MUST watch out for CMV activation post-organ transplant: PCR of bloods
Foetus (congenital infection)

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13
Q

CMV Ix

A

Atypical lymphocytes on blood film BUT

heterophile antibody negative

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14
Q

CMV Tx

A

Ganciclovir or foscarnet BUT both have serious SEs

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15
Q

Epidemiology pneumonia

A

Peak incidence in infants + elderly
Relatively high in childhood however
Viruses most common cause in younger children, bacteria commoner in older children

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16
Q

Pathogens causing pneumonia in newborn

A

Organisms from mothers genital tract, esp group B strep

also TB

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17
Q

Pathogens causing pneumonia in infants + young children

A

Resp viruses, esp RSV, most common
Bacteria: strep pneumoniae, H. influenzae
(also TB)

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18
Q

Pathogens causing pneumonia in children >5

A

Mycoplasma pneumonia
Strep pneumoniae
Chlamydia pneumoniae
(also TB)

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19
Q

Clin features pneumonia

A

Fever + breathing difficulty = main sx (usually preceded by URTI)
Other sx: lethargy, cough, poor feeding
Localised chest/ back/ abdo pain suggests pleural irritation + bacterial infection

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20
Q

O/E pneumonia

A

Tachypnoea
Nasal flaring
Chest indrawing
End-inspiratory coarse crackles
BEST CLIN FEATURE = INCREASED RESP RATE (can miss pneumonia if RR not measured)
(Consolidation w dullness to percussion, decreased breath sounds and bronchial breathing often absent in young kids)
O2 sats may be low = IX FOR ADMISSION

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21
Q

Pneumonia Ix

A

CXR (But cant differentiate btwn viral + bacterial, except classic lobar pneumonia = Staph aureus)
Bloods (^ ESR, CRP)
Younger kids: nasopharyngeal aspirate can differentiate btwn bacterial + viral causes

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22
Q

Indications for admission pneumonia

A

O2 sats

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23
Q

General principles mx pneumonia

A

Gen supportive care: O2 if hypoxia, analgesics if pain
IV fluids if needed
Physiotherapy no role

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24
Q

Abx pneumonia

A

Newborns: IV broad spectrum
Older infants: oral amoxicillin
Reserve broad-spectrum abx, e.g. co-amox for complicated/ unresponsive patients)
Children >5: amoxicillin or oral macrolide, e.g. erythromycin

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25
Mx parapneumonic effusions
Most resolve w abx | Small proportion develop empyema that requires drainage (Chest drain or surgical decortication)
26
Prognosis pneumonia
Children w simple consolidation on CXR + who recover clinically generally don't need follow up F/U CXR after 4-6 wks if ev lobar collapse, atelectasis or empyema Virtually all kids make full recovery
27
Definition stomatitis
Inflammation of the mucous membranes of the mouth
28
Causes stomatitis
Many causes Infancy: Candida infection After infancy: 1st infection with Cocksackie A viruses or HSV-1 Stevens-Johnson syndrome
29
Features Stevens-Johnson syndrome
Severe mouth ulceration with conjunctivitis, erythema multiforme, severe systemic illness
30
Mx Candida stomatitis
Deal with RFs (immunodef, poor hygeine, chronic illness, malnutrition) Treat w topical antifungal (nystatin)
31
Mx viral stomatitis
Mostly symptomatic | If severe HSV-1, may need IV fluids and acyclovir
32
Chickenpox incubation period
14-21 days | Spread by respiratory route, then via blood and lymphatics
33
Chickenpox period of infectivity
2 days before rash to | 5 days after rash appears (i.e. when all the lesions crust)
34
Presentation
Fever Itchy, vesicular rash which appears in crops (i.e. appears in clusters of lesions in different areas) over 3-5 days Crops mainly on head, neck and trunk: sparse on limbs
35
Chickenpox virus
Varicella Zoster Virus
36
Mx chickepox
Symptomatic Aciclovir if immunocomp or adolescent (likely to develop more severe disease) If immunocomp and in contact with or maternal chickenpox around delivery or VZVIg
37
Complications chickenpox
2y bacterial infection Encephalitis Purpura fulminans
38
Causes macular/papular/maculopapular rash
Rubella (macular only) Measles Human Herpes Virus 6/7 (Roseola infantum) Enterovirus
39
Causes purpuric/ petechial rash
Meningococcal sepiticaemia Henoch Schonlein purpura Enterovirus Thrombocytopaenia
40
Causes vesicular rash
Herpes simplex Chickenpox Hand, foot and mouth disease Shingles
41
Causes pustular/ bullous rash
Impetigo | Scalded skin syndrome
42
Causes desquamation
Post-scarlet fever | Kawasaki's disease
43
Presentation measles
``` Fever Rash Cough Coryza Conjunctivitis Koplik's spots ```
44
Measles rash
Maculopapular, spreads down from behind ears to whole body. Discrete -> blotchy/ confluent. May desquamate in 2nd week
45
Diagnosis measles
History of fever (2-3 days) One of cough/ coryza/ conjunctivitis/ Koplik's spots Lab = IgM antibody or isolation of viral RNA
46
Management measles
If symptomatic, isolate patient if admitted If immunocomp, consider ribavirin. Give vit A in developing countries Immunisation, usually via MMR
47
Complications measles
MEASLES COMP myocarditis, encephalitis, appendicitis, subacute sclerosing encephalitis, laryngitis, early death, shits (diarrhoea), corneal ulcer, otitis media, mesenteric lymphadenitis, pneumonia (+ related: bronchiolotis, bronchitis, croup)
48
Prognosis measles
Good prognosis, serious complications v rare. | Rare in developed countries (vaccine)
49
Rubella presentation
Generally mild disease in childhood - Low grade fever or none at all - Rash - Prominent lymphadenopathy (esp suboccipital + postauricular nodes)
50
Rubella rash
Maculopapular, appears initially on fever, spreads centrifugally to whole body. Not itchy, fades in 3-5 days
51
Congenital rubella syndrome
Rubber ducky, I'm so blue Rubber: Rubella Ducky: patent Ductus arteriosus, pulmonary artery stenosis I'm: Eyes (cataracts, retinopathy, micropthalmia, glaucoma) Blue: "Blueberry Muffin" rash (extramedullary haematopoesis in skin + purpura)
52
Mx rubella
Symptomatic | Immunisation (MMR)
53
Complications rubella
``` Rare in childhood. TEAM Thrombocytopaenia Enceph Arthritis Myocarditis ```
54
Prognosis rubella
Mild, self-limiting, often asymptomatic in children | Poor prognosis in congenital rubella syndrome
55
Cause scarlet fever
Exotoxin release by Strep pyogenes
56
Presentation scarlet fever
Sore throat Fever Bright red ("strawberry") tongue Characteristic rash
57
Scarlet fever rash
``` Fine, red, rough, blanches 12-48 hrs post-fever Starts on chest, armpits, behind ears Worse on skin folds Fades 3-4 days after onset ```
58
Scarlet fever dx
``` Dx= CLIN Marked leucocytosis with neutrophilia High ESR, CRP Raised antistreptolysin O titre Strep in throat culture ```
59
Mx scarlet fever
Penicillin | if allergic, clindamycin/ erythromycin
60
Complications scarlet fever
Septic: sepsis, ear and sinus infection, strep pneumonia, empyema, meningitis (SEPEM) Immunological: acute glomerulonephiritis, rheumatic fever, erythema nodosum (ARE)
61
Prognosis SF
Rash can last 2-3 weeks, excellent prognosis w abx
62
Kawasaki Disease clin features
FEEL my conjunctivitis F: fever, for 5 days, often high E: Edema of hands and feet, clasically child refuses to walk E: erythematous rash, classically maculopapular + desquamation of fingers and toes but polymorphic!! L: lymphadenopathy, often unilar cervical My: mucositis = dry, cracked lips, red throat + oral mucosa, strawberry tongue Conjunctivitis: Non-purulent, limbic sparing (part of sclera around iris remains white)
63
Dx Kawasaki disease
Fever >5 days AND 4/5 of: - conjunctivitis - red mucous membranes - cervical lymphadenopathy - rash (polymorphic) - extremities: red + oedematous palms, desquamation of fingers and toes
64
Mx Kawasaki's
Prompt IVIg within 1st ten days | Aspirin reduces risk thrombosis
65
Complications Kawasaki
Affects coronary arteries in 1/3 | Can cause coronary artery aneurysm followed by scarring and stenosis, MI and sudden death (1-2% mortality)
66
Kawasaki prognosis
Good with prompt tx, if untreated 2% die of coronary complications

Paediatrics (7 decks)

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