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Infectious Disease Flashcards

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1
Q

What is Kawasaki Disease

A

A febrile vasculitic syndrome causing coronary aneurysm

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2
Q

How does Kawasaki present

A

3 phases:

Acute Febrile: 1-2 weeks
Fever for 5 days or more + 4 of following:
- Bilateral non-exudative conjunctivitis
- Cervical lymphadenopathy
- Pharyngeal Injection, dry fissured lips and strawberry tongue
- polymorphous rash
- change in extremities e.g arthralgia, palmer erythema or later swelling of hands/feet

Subacute: lasts until remission of fever (weeks 4-6)
- Development of coronary artery aneurysms
and risk of MI/sudden death
- desquamation of digits, thrombocytosis, irritability and conjunctival injection

Convalescent: (weeks 6-12)

  • Resolution of clinical signs
  • normalisation of inflammatory markers
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3
Q

What would be found on Ix of Kawasaki Disease

A 
ESR & CRP raised
Bilirubin raised 
Platelets raised 
Echocardiogram 
MRA accurately defines aneurysms
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4
Q

What is the Rx for Kawasaki Disease

A

IV Ig (immunoglobulin) - decreases new coronary aneurysms
if unresponsive - IVIG + prednisolone
Aspirin

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5
Q

What should do if someone has measles

A

Report to you local health protect team as it is notifiable disease

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6
Q

How does measles present in the prodome and when is it infective from

A

Infective from prodome: Fever with CCCK:

  • Cough
  • Coryza
  • Conjunctivitis
  • Koplik Spots on palate
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7
Q

When does the rash develop in measles

What are the complications of measles

A

A maculopapular rash 5d starting e.g behind ears and spreading down body

Complications:

Acute:
Most common: Otitis Media 
Croup and Tracheitis 
Pneumonia - most common cause of death!!!
Encephalitis - older patients

Chronic:
Subacute sclerosing parencephalitis - progressive change in behaviour, myoclonus, dystonia, dementia, coma, death

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8
Q

What is the Rx of measles

A

Isolate in hospital

  • Paracetamol/ antipyretics for fever
  • Adequate nutrition and fluids
  • Vit A
  • Treat secondary bacterial infection with Abx
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9
Q

What is Chicken Pox caused by

A

Varicella - Zoster Virus

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10
Q

What are the signs of chicken pox

A

Fever followed by rash 2 days later:
- Macules - Papules - Vesicles with red surrounding - Ulcers - Crusting
Starts on face, scalp or trunk and is more concentrated to torso than the extremities

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11
Q

What are complications of chicken pox

when is chicken pox dangerous

A

Spots blackish - purpura fulminans
Bluish - necrotising fasciitis - ITU!!!!!

Immunosuppression, CF, Severe eczema and neonates

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12
Q

What is the treatment of chicken pox

A
  • Keeping cool may reduce number of lesions
  • Calamine lotion soothes
  • Daily antiseptic for spots
  • Flucloxicillin if bacterial superinfection
  • Antivaricella-zoster immunoglobulin + aciclovir in immunocomprimised/suppressed
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13
Q

When is Rubella infective and how does it present

A

Infective 5 days before to 5 days after rash

  • Macular rash
  • Suborbital Lympadenopathy
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14
Q

How is rubella prevented and what complications can it cause

A

MMR vaccine

Small joint arthritis
Malformations in utero e.g eye anomaly, cardiac abnormalities, deafness

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15
Q

How does mumps caused by and how does it present

A

Paramyoxovirus
Presents with:
prodromal malaise, fever, and painful parotid swelling

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16
Q

What causes hand, foot and mouth disease

A

Coxsackies

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17
Q

How does hand, foot and mouth present

A
  • child mildly unwell with fever
  • Sore throat
  • Vesicles develop in mouth, hands and feet
  • May also be ulcers in the mouth
    (May also have Abdo pain and nausea)
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18
Q

What is scalded skin syndrome

A

A small number of Staph Aureus produces a toxin which is toxic to the skin
presents with skin blistering and peeling

Presents in the usual places:

  • infections of cuts/grazes
  • boils/abcesses
  • impetigo
  • nappy rash
  • conjunctivitis
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19
Q

What is Diphtheria caused by

A

The toxin of Corynebacterium Diphtheriae

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20
Q

How does Diphtheria present

A

tonsillitis + Pseudomembrane - A thick/grey white coating over back of throat
High Fever
Shock from myocarditis, cardiac conducting system involvement
Dysphagia
Muffled voice
Airway obstruction

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21
Q

what is a concern with Diphtheria

A

Toxin induced myocarditis (do frequent ECG)

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22
Q

What is the Diagnosis and Rx of Diphtheria

A

Swab culture of material below pseudomembrane

Rx: Diphtheria Antitoxin and Erythromycin

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23
Q

What causes Whooping Cough

A

Bordetella Pertussis

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24
Q

How does whooping cough present

A 
Infants: 
Apnoea
Bouts of coughing with vomiting worse at night and after feeding 
Whoops caused on inspiration
Co-infection with RSV e.g bronchiolitis
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25
What is the diagnosis and Rx of Whooping Cough
PCR via nasal swab Macroglide - Clarithromycin
26
What is a complication of whooping cough
Prolonged illness can lead to bronchiectasis and death
27
What is TB cause by
Mycobacterium Tuberculosis
28
What is the pathogenesis of TB
Can be latent - asymptomatic, uninfectous or active - symptomatic, mortality high Resists killing by Macrophages Therefore Bacilli and Macrophages form a Granuloma in the lung
29
What is the risk factors for TB
``` HIV +ve Overseas contact IVUD Homeless Crowded living ```
30
What are the features of TB
Pulmonary: Cough, Chest pain, Dyspnoea, Haemoptysis, Pleural Effusion Systemic: Weight loss, Anorexia, Low grade fever, Night Sweats, Failure to thrive, Malaise
31
What is Extrapulmonary TB
haematogenous dissemination - Lymph nodes - swelling - Millary TB - Bone - pain, swelling of joints, Potts - Abdominal TB - ascites, malabsorption - Genito-Urinary TB - CNS TB - meningitis
32
How is TB diagnosed
- Tuberculin Test - skin test - Interferon Gamma release testing - blood test - Culture + Zielhl - Neesen Stain of sputa - CXR: consolidation, cavitation, (small white dots means millary spread)
33
How is TB treated
4 drugs for 6 months in active disease: - Rifampicin - Isoniazid - Pyrazinamide - first 2 months only - Ethambutol - first 2 months only In latent disease 2 drugs for 3 months
34
What is the TB treatment SE
Rifampicin - Hepatitis Isoniazid - Neuropathy Ethamabutol - Optic Neuritis (Monitor LFTs and U&Es) Remember - Drug Resistance major problem therefore compliance is vital
35
What is meningitis and how does it present
Inflammation of the Meninges Infants subtle: Crying, Irritability, Lethargy, Difficulty feeding, Fever, Seizures, Bulging Fontanelle Septic Signs: Fever/raised T, cold hands/feet, limb/joint pain, abnormal skin colour, abnormal behaviour, non blanching purpuric rash, DIC, Raised HR, Low BP Meningeal Signs: Less common in young children!!! - Headache - Neck Stiffness - Photophobia - Nausea/Vomiting - Kernigs Sign - resistance to extending knee when hip flexed
36
What are the main causes of meningitis
Neonates: Step B Pneumococcus Older: nisseria Meningitidis
37
How is meningitis managed pre hospital
Suspected bacterial meningitis without non blanching rash - Urgent transfer to secondary care without giving parenteral Abx Suspected meningococcal disease (meningitis with rash or meningococcal septicaemia) - Give IV/IM benzylpenicillin
38
How is meningitis managed in secondary care
- Examination for signs of meningitis or septicaemia - Give IV Cefotaxime immediately/without delay if any hint of meningococcal disease (meningitis with rash or meningococcal septicaemia) sending bloods and CSF must not delay this!!!!! - Carry out appropriate Ix - Protect Airways, Give high flow O2, set up IVI - Children 3 months or older - IV Ceftriaxone - Children younger than 3 months - IV cefotaxime + Amoxicillin Dexamethasone - can be given to prevent deafness (complication of meningitis) If Viral Meningitis e.g Herpes Simplex give Acyclovir
39
What Ix should be performed in suspected Meningitis
``` FBC CRP Coagulation Screening Blood Culture PCR - for N. Meningitidis Lumbar Puncture - only do if not contraindicated e.g signs of Raised ICP, shock, DIC, purpura, brain herniation near Blood glucose and gas ```
40
How too you distinguish bacterial and viral meningitis
Appearance - Viral usually clear, Bacterial turbid Predominant cell - Viral mononuclear, Bacterial polymorph Glucose - low in bacterial, normal in viral Protein - raised in bacterial, normal in viral
41
What can be given as prophylaxis to prevent meningitis
Ciprofloxacin
42
What are the causes of meningitis
Over 3 months: - Meningococcus/Neisseria Meninigitiis - Streptococcus Pneumoniae - Haemophillus Influenzas (in unvaccinated) Under 3 months: - Group B haemolytic Streptococci!!! - via mothers vagina - E-coli, meningococcus, pneumococcus Viruses: Enterovirus, HSV
43
How does Encephalitis present
``` Flu like prodome Change in consciousness Odd behaviour Vomting Fits Temp Increase Menignism ```
44
What are the causes of Encephalitis
``` HSV Mumps Varicella Zoster Rabies TB Malaria Enetroviruses ```
45
How Is Encephalitis managed
``` CSP Blood Cultures MC&S Test stools Urine ``` If Herpes Simplex give Acyclovir
46
What is slapped cheek syndrome
Caused by Parovirus B19 ``` presents with: High Fever Headache Runny nose & sore throat Bright red rash on both cheeks Maculopapular rash with pruritus on torso, arms and legs ```
47
What is impetigo
Skin infection caused by Staph Aureus Presents with: Blisters that quickly burst and form a golden crust which can be itchy and painful Rx: Topical Abx e.g Fusidic Acid More widespread? - oral Abx - Flucloxicillin
48
What is candida
A fungal Infection Can cause: Nappy Rash
49
How do children often develop HIV
Through Vertical transmission from mother to baby during childbirth - may need C-section OR through breastfeeding - ALL HIV +ve women should bottle-feed
50
How may an undiagnosed HIV +ve Child present
``` Failure to thrive Lympadenopathy Hepatospleomegaly Presisitant diarrhoea Parotid enlargement Shingles Recurrent slow to clear infection TB Low platelets Clubbing ```
51
What are the risks of HIV in children
Immunocomprimised
52
How is HIV managed in children
Full course of vaccination | HAART treatment
53
What is poliomyelitis
A viral infection that can result in temporary or permanent paralysis due to its potential invasion of the grey matter of the spinal cord Spread by faeco-oral spread
54
How does polio present
Most are asymptomatic (90%) Poliomyelitis without CNS involvement (flu symptoms) : - high temp - sore throat - headache - abdo pain - aching muscles - feeling sick Poliomyelitis with CNS involvement: - - Fever, neck stiffness, headache, vomiting - Paralysis, respiratory failure
55
What are the long term complications of polio
Muscle weakness and pain
56
What will be found on Ix
PCR amplification of poliovirus RNA from CSF
57
What is the Rx of Polio
Pain relief mechanical ventilation close monitoring of BP and RR Immunisation - for prevention
58
What is scarlet fever
Caused by Group A bets haemolytic step
59
How does scarlet fever present
Acute tonsillitis - Fever - Tonsillopharyngitis - sore throat, white coating of tongue, pharyngeal erythema and strawberry tongue Scarlet colour maculopapular rash with sandpaper like texture with Pastia's lines Desquamation phase - desquamation of skin in flakes
60
How is it diagnosed and treated
Diagnosis: Throat swab Abx: Oral penicillin
61
What is toxic shock syndrome caused by
``` Staphlyococcus or Streptococcus bacteria which can release harmful toxins Causes: - High Temp - Flu like symptoms - Nausea/Vomitng - Diarrhoea - Wide spread rash - dizziness, fainting and difficulty breathing ```
62
What vaccinations are given at 8 weeks old
``` The 6 in 1 Diphtheria Tetanus Pertussis (DTaP) Polio (IPV) Haemophilus Influenza Type B (HiB) Hepatitis B (HepB) ``` Pneumococcal Meningococcal Group B (MenB) Rotavirus Gastroenteritis
63
What vaccinations are given at twelve weeks old
Diphtheria, Tetanus & Pertussis (DTaP) Polio (IPV) HiB Hepatitis B Rotavirus
64
What vaccinations are given at 16 weeks old
Diphtheria, Tetanus & Pertussis (DTaP) Pneumococcal MenB
65
What vaccinations are given at 1 year
HiB and MenC Pneumococcal MMR MenB
66
What vaccinations are given at 3 years and 4 months
Diphtheria, Tetanus & Pertussis Polio (IPV) MMR

Paediatrics (13 decks)

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