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Infectious Diseases Flashcards

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1
Q

Examples of inactivated vaccines

Killed version of vaccine

A

Polio
Flu vaccine
HepA
Rabies

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2
Q

Subunit and conjugate vaccines
Contain parts of organism
Safer for immunocompromised patients
Examples:

A 
Pneumococcus 
Meningococcus
HepB
Pertussis 
Haemophilus influenza TYB
HPV
Shingles
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3
Q

Live attenuated vaccines
Contain a weakened version of the pathogen
Still capable of causing infection

A 
MMR
BCG: TB
Chickenpox: weakened varicella zoster
Nasal influenza 
Rotavirus
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4
Q

Toxin vaccines

A

Contain toxin produced by vaccine
Diphtheria
Tetanus

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5
Q

Vaccines given at birth

A

BCG if risk factors

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6
Q

Vaccines given at 2 months/ 8 weeks

A

6in1
Oral rotavirus vaccine
MenB

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7
Q

Vaccines given at 12 weeks/ 3 months

A

6 in 1
Pneumococcal (PCV)
Rotavirus

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8
Q

Vacccines given at 4 months/ 16weeks

A

6in1

MenB

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9
Q

Vaccines given at 1 year

A

Hib/MenC (2in1)
Pneumococcal
MMR
MenB

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10
Q

Vaccines given at 2-8

A

Flu vaccine

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11
Q

Vaccine given at 3-4years

A

4in1 pre-school booster

MMR

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12
Q

Vaccines given at 12-13year

A

HPV vaccination

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13
Q

Vaccines given at 13-18years

A

3in1 teenage booster

MenACWY

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14
Q

6in1 vaccine

A 
Diphtheria
Tetanus
Polio
HepB
Hib
Pertussis
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15
Q

4in1 preschool booster

A

Diphtheria
Tetanus
Whooping cough
Polio

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16
Q

3in1 teenage booster

A

Tetanus
Diphtheria
Polio

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17
Q

HPV vaccine and strains

A

Protects against 6, 11, 16 and 18
Strains 6 and 11 cause genital warts
Strains 16 and 18 cause cervical cancer

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18
Q

Cytokines in paediatric sepsis

A

Interleukins and TNF
Immune system activation, NO released, vasodilation
Increased vessel permeability, oedema, increased diffusion distance, decreased oxygenation
Anaerobic respiration, lactic acidosis
Coagulation system activation, DIC, thrombocytopenia, haemorrhages

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19
Q

Septic shock

A

Sepsis has lead to cardiovascular dysfunction
Organ hypoperfusion, decreased BP
Rise in lactate, anaerobic resp

Circulatory collapse and hypoperfusion of organs

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20
Q

Management of septic shock

A

IV fluids to improve blood pressure and tissue perfusion
Escalate children to HDICU
Inotropes stimulate CVS and improve blood pressure and tissue perfusion

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21
Q

Signs of sepsis

A 
Deranged physical observations
Prolonged CRT
Fever or hypothermia
Deranged behaviour 
Poor feeding
Inconsolable or high-pitched crying
Weak cry
Reduced consciousness 
Reduced body tone
Skin colour changes (cyanosis, mottled pale, ashen)
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22
Q

Neonatal sepsis

A

Infection within 28 days of life

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23
Q

Causes of neonatal sepsis

A

Group B streptococcus,early-onset
E.coli
Late-onset: staphylococcal epidermidis, pseudomonas aeruginosa, klebsiella, enterobacter, fungal species

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24
Q

Risk factors for neonatal sepsis

A

Mother who has had a previous baby with GBS infection
Premature <37weeks
Low birth weight
Evidence of maternal chorioamnionitis

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25
Neonatal sepsis presentation
``` Respiratory distress Tachycardia Apnoea Change in mental status/ lethargy Jaundice Seizures Poor/reduced feeding Abdominal distension Vomiting Temperature, pre term hypothermia, term febrile ```
26
Neonatal sepsis investigations
``` Blood culture FBC CRP Blood gases Urine microscopy, culture and sensitivity Lumbar puncture ```
27
Management of neonatal sepsis
``` IV benzylpenicillin with gentamicin CRP measured 18-24hours after presentation Oxygenation Fluid ad elctoyltres Vasporessor support Hypoglycaemia mx Metabolic acidosis mx ```
28
Sepsis risk assessment
Colour: cyanosis, mottled pale or ashen Activity Respiratory Circulation and hydration All infants <3months with a temperature of >38 need to be treated urgently for sepsis
29
Immediate management of sepsis
Give oxygen: if evidence of shock or saturations <94% IV access FBC, UE, CRP, clotting screen (INR), blood gas (lactate and acidosis) Blood cultures Urine dipstick Antibiotics within 1 hr of presentation, continue for 5-7days IV fluids: 20ml/kg IV if lactate >2mmol/L or if there is shock
30
When do you stop ax in sepsis
Low suspicion of bacterial infection Patient is well Blood cultures and 2 CRP results are negative at 48hours
31
Chickenpox features
Fever initially Itchy rash starting on head/trunk before spreading Macular, papular then vesicular Systemic upset usually mild
32
Measles
Prodromal: irritable, conjunctivitis, fever Koplik spots Rash behind ears then to whole body Discrete maculopapular rash, then blotchy and confluent
33
Mumps
Fever, malaise, muscular pain | Parotitis, unilateral then bilateral
34
Rubella
Pink maculopapular rash, initially on face before spreading to whole body Usually fades by 3-5 days Subocciptal and post auricular lymphadenopathy
35
Erythema infectiosum
``` Fifth disease Slapped cheek syndrome Parvovirus B19 Lethargy, fever, headache Slapped cheek rash spreading to proximal arms and extensor surfaces ```
36
Scarlet fever
Reaction to erythrogenic toxins produced by GroupA haemolytic streptococci Fever, malaise, tonsilitis Strawberry tongue Circumoral pallor
37
Hand, foot and mouth disease
Coxsackie A16 virus Mild systemic upset: sore throat, fever Vesicles in mouth and on the palms and soles of feet
38
Meningitis organisms | Neonatal to 3 months
Group B streptococcus: from mum E,coli Listeria monocytogenes
39
Meningitis organisms | 1month-6years
Neisseria meningitidis Streptococcus pneumoniae Haemophilius influenza
40
Meningitis organisms >6months
Neisseria meningitidis | Streptococcus pneumoniae
41
Presentation of meningitis
``` Fever Neck stiffness Vomiting Headache Photophobia Altered consciousness Seizures Hypotonia, poor feeding, lethargy, hypothermia, bulging fontanelle ```
42
Lumbar puncture indications in meningitis
<1 month and fever 1-3months with fever and unwell <1 year with unexplained fever
43
Contraindications to lumbar puncture
``` RICP signs Focal neurological signs Significant bulging of fontanelle Papilloedema DIC Signs of cerebral herniation ``` Take blood cultures and PCR instead
44
Special tests for meningeal irritation
Kernigs test | Brudzinskis test
45
Kernigs test
``` For meningeal irritation Lie patient on back Flex hip and knee to 90 Straighten knee Spinal pain/resistant to movement ```
46
Brudzinski’s test
Lie patient on back Use hands to lift their hand and neck off bed Flex chin to their chest Positive test: flex hip and knees
47
Management of meningitis
``` Lumbar puncture for CSF Blood culture Meningococcal PCR Fluids to treat shock Cerebral monitoring Notifiable disease, antibiotic prophylaxis of contacts, ciprofloxacin ```
48
Antibiotics in meningitis
<3 months: IV amoxicillin + IV cefotaxime >3 months: IV ceftriaxone Add vancomycin if risk of penicillin resistant pneumococcal infection
49
Steroids in meningitis
No corticosteroids if <3 months | Dexamethasone if lumbar puncture suggests bacterial meningitis, 4x daily for 4 days
50
Causes of viral meningitis
Herpes simplex virus Enterovirus Varicella zoster virus
51
Management of viral meningitis
Aciclovir
52
Meningitis CSF appearance
Cloudy in bacterial | Clear in viral
53
Meningitis CSF protein
0.2-0.4g/l: normal >1.5g/L: bacterial Mildly raised or normal: viral
54
Meningitis CSF glucose
Normal: 0.6-0.8 Viral: 0.6-0.8 Bacterial: <0.5
55
Meningitis CSF WCC
Normal <5 Bacterial >1000 and neutrophils Viral >1000 and lymphocytes
56
Complications of meningits
Hearing loss Seizures and epilepsy Cognitive impairment and learning disability Memory loss Cerebral palsy: limb weakness or spasticity
57
Causes of encephalitis
HSV-1 cold sores in children | HSV-2 genital warts in neonates (from birth)
58
Encephalitis presentation
``` Altered consciousness Altered cognition Unusual behaviour Acute onset of focal neurological symptoms Acute onset of focal seizures Fever ```
59
Diagnosis of encephalitis
``` Lumbar puncture CT scan MRI scan EEG recording Swabs: throat and vesicle HIV testing ```
60
Management of encephalitis
IV aciclovir: herpes simplex virus, varicella zoster virus IV gancliclovir: cytomegalovirus Repeat lumbar puncture
61
Complications of encephalitis
``` Lasting fatigue, prolonged recovery Change to personality or mood Changes to memory and cognition Learning disability Headaches Chronic pain Movement disorders Sensory disturbance Seizures Hormonal imbalance ```
62
Infectious mononucleosis
Glandular fever EBD, human herpesvirus 4 Rash after amoxicillin
63
Features of infectious mononucleosis
Sore throat Lymphadenopathy: anterior and posterior triangles Pyrexia ``` Fatigue Tonsillar enlargement, snoring Splenomegaly: splenic ruptures Malaise, anorexia, headache Palatal petechiae Hepatitis, transient rise in ALT Lymphocytosis Haemolytic anaemia ``` Symptoms resolve after 2-4sweek
64
Diagnosis of infectious mononucleosis
Heterophil antibody test: Monospot (horses) or Paul-Bunnell test (sheep) In 2nd week Viral capsid antigen for EBV antibodies
65
Monospot test infectious mononucleosis
Introduces patients blood to RBC from horses | Heterophile antibodies will give a positive result
66
Management and prognosis infectious mononucleosis
Acute illness lasts 2-3weeks, fatigue for several months once infection is disabled Avoid alcohol Rest during early stages Avoid playing contact sports for 8 weeks after having glandular fever to reduce risk of splenic rupture
67
Complications of infectious mononucleosis
``` Splenic rupture Glomerulonephritis Haemolytic anaemia Thrombocytopenia Chronic fatigue Gillian-Barre syndrome Encephalitis ``` Associated with Burkitts lymphoma
68
Mumps
``` RNA paramyxovirus Respiratory droplets Incubation 14-21days Self-limiting, lasts 1 week Supportive management ```
69
Presentation of mumps
``` Fever Malaise, muscular pain Parotitis: unilateral then bilateral, with associated pain Lethargy Dry mouth Reduced appetite Headache ```
70
Complications of mumps
Abdominal pain: pancreatitis Testicular pain and swelling: orchitis Confusion, neck stiffness and headache (meningitis or encephalitis) Sensorineural hearing loss: unilateral and transient
71
Management of mumps
PCR test on saliva swab to diagnose Test saliva for antibodies Supportive management Notifiable disease
72
Epiglottitis
Inflammation and swelling of epiglottitis Caused by infection Haemophilus influenza TYB Streptococcus pneumoniae
73
Pathophysiology of epiglottitis
Haemophilus influenza and streptococcus pneumoniae infection Can also be due to non-infectious cases: trauma, thermal/chemical damage Inflammation starts on lingual surface Spreads to aryepiglottic folds, arytenoids, supraglottic larynx Vocal cords swelling restricted by epithelium, increased pressure in small area, airway obstruction
74
Epiglottitis in children airway obstruction more likely
Epiglottis is more floppy, broader, longer and angled more obliquely to trachea Larger tones and anteriorly-angled vocal cords mean children find it more difficult to move air past partial obstruction
75
Risk factors for epiglottitis
Not receiving HiB vaccine Male gender Immunosuppression
76
4Ds of epiglottitis
Dyspnea Dysphagia Drooling Dysphonia
77
Clinical features epiglottitis
``` Sore throat and stridor Drooling Tripod position High fever Difficulty or painful swallowing Muffled voice Scared and quiet child Septic and unwell appearance ``` Symptom duration<12hours No cough typically
78
DD epiglottitis
``` Croup Inhaled foreign body Retropharyngeal abscess Tonsilitis Peritonsillar abscess Diphtheria ```
79
Investigations epiglottitis
``` Secure airways Intubation equipment ready Throaty swabs Blood tests: FBC, cultures, CRP Lateral neck XRAY: thumb print signs, thickened aryepiglottic folds, increased opacity of larynx and vocal cord ```
80
Management of epiglottitis
Secure airway: Escalate to anaesthetist and ENT registrar Oxygen Nebulised adrenaline to reduce oedema IV antibiotics: 3rd generation cephalosporin (cefotaxime, ceftriaxone), oral co-amoxicillin once well IV steroids (dexamethasone) IV infusion
81
Complications of epiglottitis
``` Mediastinitis: if spreads to retropharyngeal space Deep neck space infection Pneumonia Meningitis Sepsis/ Bacteraemia ```
82
Glandular fever epidemiology
Age 1-6 | Age 18-22
83
Tonsilitis
``` Inflammation of palatine tonsils Viral infection Concentration of lymphoid tissue within oropharynx Tonsillopharyngitis Adenotonsilitis ```
84
Causes of bacterial tonsilitis
Group A streptococcus (pyogenes) Penicillin V (phenoxymethylpenicillin) Streptococcus pneumoniae Also: H. influenza Morazella catarrhalis Staphylococcus aureus
85
Causes of viral tonsilitis
Adenovirus EBV Group A strep (strep. Pyogenes)
86
Risk factors for tonsilitis
Smoking | Second hand smoke
87
Waldeyer’s tonsillar ring
``` Ring of lymphoid tissue in pharynx Adenoids Tubular Lingual Palatine Infected and enlarged in tonsilitis ```
88
Tonsilitis history
``` Symptoms last 5-7 days, if linger could be glandular fever Odynophagia Fever Reduced oral intake Halitosis New onset snoring Shortness of breath ```
89
Tonsilitis examination
Red inflamed tonsils White exudate spots on tonsils Cervical lymphadenopathy Examine eats to visualise tympanic membranes
90
Centor criteria | Estimate probability that tonsilitis is due to bacterial infection
``` >3 Fever >38 Tonsillar exudates Absence of cough Tender anterior cervical lymph nodes (lymphadenopathy) ```
91
FeverPAIN criteria | Probability of bacterial tonsilitis
``` >4 Fever: during previous 24hours Purulence (pus on tonsils) Attended within 3 days of the onset of symptoms Inflamed tonsils (severely inflamed) No cough or Coryza ```
92
Streptococcal score card Specific to Group A streptococci Tonsilitis
``` 5-15years Season Fever Cervical lymphadenopathy Pharyngeal erythema, oedema or exudate No viral URTI symptoms ```
93
DD tonsilitis
``` Quinsy or peritonsillar abscess Pharyngitis Glandular fever Tonsillar malignancy Epiglottitis ```
94
Investigations tonsilitis
Throat swabs limited value FBC LFT, glandular fever U&E: dehydration/AKI
95
Initial management of tonsilitis
``` Check for respiratory compromise Rehydrate Analgesia Steroids Antibiotics: benzylpenicillin IV, oral penicillin V if able to swallow 7-10days ```
96
Complications of tonsilitis
``` Chronic tonsilitis Peritonsillar abscess, quinsy Otitis media Scarlet fever Rheumatic fever Post-streptococcal glomerulonephritis Post-streptococcal reactive arthritis ```
97
Post-streptococcal glomerulonephritis
Hypertension Haematuria Oedema
98
Rheumatic fever post-streptococcal
Prolonged fever Anaemia Arthritis Pancarditis
99
Peritonsillar abscess
Quinsy Collection of pus in peritonsillar space that surrounds palatine tonsils Deep neck space abscess Complications of tonsilitis
100
Pathophysiology peritonsillar abscess
Tonsil between anterior tonsillar pillar (glossopalatine muscle) and posterior tonsillar pillar (pharyngopalatine muscles) Pus collects in space between tonsillar capsule and superior pharyngeal muscles
101
Causative organisms peritonsillar abscess
30-39years: Group A Streptococcus (Strep pyogenes) | 15-24years: fusobacterium necrophorum
102
Risk factors peritonsillar abscess
Recurrent tonsilitis Partially treated tonsilitis Smokers
103
Peritonsillar abscess presentation
``` Sore throat Painful swallowing/ drooling Trismus: muscle spasms preventing jaw opening to full extent Hot potato voice: pharyngeal swelling Halitosis Fever Neck pain Referred ear pain Swollen tender lymph nodes Fatigue and irritability: dehydration ```
104
Peritonsillar abscess examination
Unilateral tonsillar inflammation Deviation of uvula away from affected side Restricted opening of jaw Fullness/ fluctuant swelling superior to the tonsil/ in posterior soft palpate pushing the tonsil infero-medially
105
Peritonsillar abscess examination
Unilateral tonsillar inflammation Deviation of uvula away from affected side Restricted opening of jaw Fullness/fluctuant swelling superior to tonsil/ in posterior soft palate pushing the tonsil inferomedially
106
DD peritonsillar abscess
Tonsilitis Peritonsillar cellulitis Parapharyngeal/ retropharyngeal abscess Epiglottitis
107
Investigations for peritonsillar abscess
FBC, elevated neutrophil U&E CRP Glandular fever CT to see if infection is spread into parapharyngeal or retropharyngeal space
108
Management peritonsillar abscess
``` Aspiration or incision and drainage Antibiotics: co-amoxicillin or benzylpenicillin and metronidazole. IV rehydration Steroid therapy: dexamethasone Needle aspiration ```
109
Tonsillectomy indications
7 or more in 1 year 5 per year for 2 years 3 per year for 3 years Recurrent tonsillar abscesses (2 episodes) Enlarged tonsils causing difficult breathing, swallowing or snoring
110
Complications of tonsillectomy
``` Pain, sore throat Damage to teeth Infection Post-tonsillectomy bleeding Risks of general anaesthetic ```
111
Post-tonsillectomy bleeding management
Call ENT registrar IV access, send bloods including FBC, clotting screen, group and save, crossmatch Keep child calm and give adequate analgesia Sit child up and encourage to spit out blood rather than swallowing IV fluids for maintenance and resuscitation as required Hydrogen peroxide gargle Adrenalin soaked swab applied topically
112
Otitis media
Middle ear infection Bacteria enter through Eustachian tube Viral URTI Short,straight wide Eustachian tube in children
113
Bacteria in otitis media
Streptococcus pneumoniae most common ``` Also: Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus RSV Rhinovirus ```
114
Risk factors for acute otitis media
``` Age Gender Passive smoking Bottle feeding Craniofacial abnormalities ``` Recurrent AOM seen more commonly with use of pacifiers Fed supine, first episode occurred <6months More common in winter season
115
Clinical features of otitis media
Ear pain, reduced hearing Pain, malaise, fever, coryzal symptoms lasting a few days Feeling generally unwell Tug at ears or cradle ear that hurts Vestibular system: balance issues, vertigo, discharge when tympanic membrane perforated Fever, vomiting, irritability, lethargy, poor feeding
116
Examination otitis media
Otoscope: Tympanic membrane erythematous and bulging Tear and discharge Conductive hearing loss Cervical lymphadenopathy Test and document function of facial nerve Intracranial complications
117
DD acute otitis media
Chronic suppurative otitis media Otitis media with effusion Otitis externa
118
Management of otitis media
Assessment and admission in infants <3 months or with a temperature of >38 Or 3-6 months with a temperature >39 Symptoms resolve in <3 days Grommets
119
Indications for antibiotics in otitis media
``` Amoxicillin 5 days Systemically unwell children not requiring admission Known risk factors for complications Unwell for >4days Discharge with ear <2s with bilateral infections ```
120
Complications of otitis media
``` Otitis media with effusion Mastoiditis Perforated eardrum Hearing loss Recurrent infection Abscess ```
121
Mastoiditis from otitis media
``` Boggy, erythematous swelling behind ear Pushes pinna forward IV AX CT head if no improvement High risk of intracranial spread and meningitis ```
122
Otitis media with effusion
Eustachian tube dysfunction Build up of fluid in middle ear Loss of hearing
123
Risk factors glue ear
``` Bottle fed Paternal smoking Atopy Genetic disorders: mucociliary disorders(CF, primary ciliary dyskinesia) Craniofacial disorders (Downs syndrome) ```
124
Glue ear presentation
Reduction of hearing in that ear Sensation of pressure, popping or crackling noises Vertigo ``` Otoscopy: Dull tympanic membrane No light reflex Bubble seen behind TM Visible fluid level ```
125
Investigations glue ear
Pure tone audiometry Tympanometry Conductive hearing loss and reduced membrane compliance
126
Management of glue ear
Resolve within 3 months No resolution after 3 months: Non-surgical: hearing aid insertion Surgical: myringotomy and grommet insertion Persistent disease: Adenoidectomy
127
Peri-orbital cellulitis epidemiology
0-15years More common in males Bi-modal seasonal variation late winter/early spring Sinus related infections
128
Peri-orbital cellulitis pathophysiology
Pre-septal cellulitis Post-septal cellulitis Paranasal sinuses: ethmoidal sinuses most common cause, frontal sinuses, sphenoidal sinuses, maxillary sinuses
129
Why does peri-orbital cellulitis occur more in children
Neonates haven’t yet formed their frontal sinuses Thinner and dehiscent bone surface of lamina papyracea Increased diploic venous supply in comparison with adulthood Incomplete immunologic development in age group Mild periorbital cellulitis-> sight-threatening orbital abscess
130
Causes of peri-orbital cellulitis
``` Sinuses infection spread Dacrocystitis Dental infecton Endophthalmitis Trauma Foreign bodies Insect bites Skin infections (impetigo) Eyelid lesions (chalazia, hordeola) Eyelid and oral procedures ``` Haemophilus influenza TYB
131
Clinical features of pre-septal cellulitis
``` Eyelid oedema Erythema of upper eyelid Abscence of orbital signs Normal vision Absence of proptosis Full ocular motility without pain on movement ``` Impedance to drainage through ethmoid vessels: Erythema may spread to upper cheek and brow area Hx of acute sinusitis or URTI Hyperaemia of nasal mucosa Occasional purulent discharge from ipsilateral osteomeatal complex and sphenoethmoidal recess
132
Clinical features of orbital cellulitis
``` Proptosis Opthalmoplegia Decreased visual acuity Loss of red colour vision- first sign of optic neuropathy Chemosis Painful diplopia ```
133
Chandler classification
``` TY1: pre-septal cellulitis TY2: post septal, orbital cellulitis TY3: sub periosteal abscess TY4: intra-orbital abscess TY5: cavernous sinus thrombosis ```
134
TY1: pre-septal cellulitis
Cellulitis confined to eyelid | Anterior to superior orbital septum: inflammation does not spread beyond orbital septum
135
TY2: post-septal, orbital cellulitis
Inflammation extends into orbital tissue No abscess formation Cellulitis involving the orbit-a disuse infiltration of orbital tissues with inflammatory cells Eyelids may be swollen and there may be conjunctival chemosis with variable degree of proptosis and visual loss
136
TY3: subperiosteal abscess
Abscess forms deep to periosteum of the orbit Purulent material collects periorbitally and in the bony walls of the orbit Pronounced eyelid oedema, conjunctival chemosis, and tenderness along the affected orbital rim with variable degree of motility, proptosis and visual acuity changes
137
TY4: intra-orbital abscess
Collection of pus inside or outside muscle cone Progressive and untreated orbital cellulitis Proptosis, conjunctival chemosis, decreased ocular motility, and visual loss may be severe
138
TY4: cavernous sinus thrombosis
Bilateral marked eye oedema Involvement of CN3, 5, 6 Associated generalised sepsis, nausea, vomiting and signs of altered mentation Orbital apex syndrome: proptosis, eyelid oedema, optic neuritis, opthalmoplegia, neuralgia of opthalmic division of CN5 Caused by sinus disease aroun optic foramen and superior orbital fissure
139
Examination peri-orbital cellulitis | Investigations
Vitals Dentition Anterior rhinoscopy: appearance of the nasal mucosa in general and middle meatus area Discharge should be swapped and sent for culture Opthalmic assessment Neurological examination Inflammatory markers to check response to treatment CT: extension of disease into orbit
140
DD peri-orbital cellulitis
``` Vesicles of herpes zoster opthalmicus Erythematous irritation of contact dermatitis Hordeolum or stye Chalazion Dacrocystitis Blepharitis Raised, dry plaques of atopic dermatitis ```
141
Management of pre-septal cellulitis
Outpatient | Broad spectrum oral ax
142
Management of orbital cellulitis
``` Hospital admission IV ax Nasal decongestants Steroid nasal drops Nasal douching IV fluids Analgesia Optic nerve monitoring ``` Intracranial complications: urgent drainage
143
Optic complication of peri-orbital cellulitis
Loss of vision: from papilloedema or neuritis, mechanical pressure, compression of arteries, necrosis of optic nerve Asymmetrical eyelid opening Impaired ocular motility Eyelid inflammation
144
Neurological complications of peri-orbital cellulitis
Encephalomeningitis Cavernous sinus thrombosis Sepsis Intracranial abscess formation: fever, altered mental status
145
Staphylococcal toxic shock syndrome
Severe systemic reaction to staphylococcal exotoxins | TSST-1 superantigen txin
146
Staphylococcal toxic shock syndrome | Centres for disease control and prevention diagnosirtc criteria
``` Fever: temperature >38.9 Hypotension: systolic blood pressure <90 Diffuse erythematous rash Desquamation of rash, especially of the palms and soles Involvement of >3 organ systems ```
147
Presentation of staphylocccal toxic shock syndrome
``` GI: D/V Mucous membrane erythema Renal failure Hepatitis Thrombocytopenia CNS involvement ```
148
Management of staphylococcal toxic shock syndrome
Removal of infection focus, tampon IV fluids IV ax
149
Candidiasis
Balanitis Oral thrush Vaginal discharge: cottage cheese discharge, vulvitis, itch Onychomycosis Black hairy tongue Candida dermatitis (napkin rash), satellite lesions, involves flexure
150
Features of bacterial conjunctivitis
Purulent discharge | Eyes stuck together in morning
151
Features of viral conjunctivitis
Serous discharge Recent URTI Preauricular lymph nodes
152
Management of infective conjunctivitis
Self-limiting in 1-2sweeks Topical Ax therapy, chloramphenicol drops Topical fusidic acid for pregnant women
153
Kawasaki disease
``` Mucocutaneous lymph node syndrome Medium sized vasculitis <5s affected More common in boys and Asian children Complication: coronary artery aneurysm ```
154
Features of Kawasaki disease
``` High-grade fever >5 days Conjunctival injection Bright red, cracked lips Strawberry tongue Cervical lymphadenopathy Red palms of hand and soles of feet, desquamation Fever resistant to antipyretic Widespread erythematous maculopapular rash ```
155
Investigations Kawasaki disease
FBC: anaemia, leukocytosis, thrombocytosis LFT: hypoalbuminaemia, elevated liver enzymes Inflammatory markers raised Urinalysis: raised WCC without infection ECHO: coronary artery pathology
156
Disease course Kawasaki disease
Acute phase: fever, rash, lymphadenopathy 1-2weeks Subacute phrase: desquamation and arthralgia, risk of coronary artery aneurysms forming, 2-4weeks Convalescent stage: settle, 2-4weeks
157
Management of Kawasaki disease
High dose aspirin to reduce thrombosis risk IVIG to reduce risk of coronary artery aneurysm Follow up with ECHO
158
Congenital rubella syndrome
8-10 weeks risk of damage to fetus is high Caused by togavirus If contracted during pregnancy Incubation 14-21days
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Features of congenital rubella syndrome
``` Sensorineural deafness Congenital cataracts Congenital heart disease Growth retardation Hepatosplenomegaly Purpurin skin lesions Salt and pepper chorioretinitis Micropthalmia Cerebral palsy ```
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Diagnosis of congenital rubella syndrome
Health protection unit | IgM antibodies raised n women recently exposed to virus
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Management of congenital rubella syndrome
Discuss with local health protection unit | Offer non-immune mom MMR vaccine post-natally
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Rubella features
Milder erythematous macular rash Starts on face and spreads to body Rash lasts 3 days Associated with mild fever, joint pain, sore throat Lymphadenopathy behind ear and at back of neck
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Management of rubella
Supportive Notifiable disease Stay off school 5 days after rash first appearance Children should avoid pregnant women
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Complications of rubella
``` Thrombocytopenia Encephalitis Arthritis Myocarditis Congenital rubella syndrome: deafness, blindness, congenital heart disease ```
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Measles
RNA paramyxovirus Spread by droplets Infective from prodromal until 4 days after rash starts Incubation 10-14datys
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Features of measles
Prodrome: irritable, conjunctivitis, fever Koplik spots Rash behind ears then to whole body, discrete maculopapular rash becoming blotchy and confluent Diarrhoea in 10% of patients
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Investigations for measles
IGM antibodies few days after rash appears
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Management of measles
Mainly supportive, self resolves after 7-10 days of symptoms Admission may be considered in immunosuppressed or pregnant patients Notifiable disease-> inform public health
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Complications of measles
``` Pneumonia Otitis media Encephalitis Subacute sclerosing pan encephalitis, may present 5-10years following illness Febrile convulsions Keratoconjunctivitis, corneal ulceration Diarrhoea Increased incidence of appendicitis Myocarditis Dehydration Meningitis Vision loss Death ```

Child Health (20 decks)

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