Infectious diseases Flashcards
(82 cards)
1
Q
What are the different types of vaccinations?
A
Inactivated - dead version of pathogen, can’t cause infection and safe in immunocompromised pt
Subunit and conjugate vaccines - only contain parts of the organism, can’t cause infection and safe in immunocompromised pt
Live attenuated - weakened version of pathogen, can cause infection esp in immunocompromised pt
Toxin vaccines - toxin produced by a pathogen, produce immunity to the toxin not the pathogen
2
Q
What is the vaccine schedule before 1 year?
A
BCG at birth for babies at risk.
8 weeks - 6in1, meningococcal type B, rotavirus (2m and 3m)
12 weeks - 6in1, pneumococcal, rotavirus
16 weeks - 6in1, meningococcal type B
3
Q
What are the vaccinations you receive pre school?
A
1 year - 2in1, pneumococcal, MMR vaccine, meningococcal type B
3 years 4 months - 4in1, MMR vaccine
4
Q
What are the vaccines you receive in secondary school?
A
12-13 - HPB
14 years - 3in1, meningococcal A,C,W,Y
5
Q
Where can children have a candidiasis infection?
A
- Oral
- Nappy rash - most common
- Vagina/penis
- Skin folds/navel
- Corners of mouth
- Nail beds
6
Q
What children are at risk of candidiasis?
A
- Living in hot humid weather
- Too much time between nappy changes
- Poor hygiene
- Taking abx or corticosteroids
- Immunocompromised
7
Q
What are the features of candidal nappy rash?
A
Well defined red patches or plaques, papules and pustules spread into skin folds.
8
Q
What is the management of candidiasis?
A
Skin - topical clotrimazole
Oral - miconazole gel for at least 7 days or until 2 days after sx clear
9
Q
What is the management of cellulitis?
A
- If <1 year = hospital admission
- Class I cellulitis - fluclox orally or clarithromycin
- Close to eyes or nose - co amoxiclav
10
Q
What is the management of conjunctivitis?
A
Bacterial conjunctivitis clears on its own w/i 5-7 days without treatment so abx not recommended
Chloramphenicol drops if severe
Advise there is no recommended exclusion period from school or nursery but some might have a policy.
11
Q
What are the CF of epiglottitis?
A
- Sore throat
- Stridor
- Drooling
- Tripod position
- High fever
- Difficulty or painful swallowing
- Muffled voice
- Scared, quiet, unwell child
12
Q
What is epiglottitis?
A
Swelling of the epiglottis, most commonly caused by haemophilus influenza type B.
Is life threatening as it can completely obstruct the airway w/i hours of sx developing.
13
Q
What is the management of epiglotitis?
A
- Don’t distress the patient = can increase closure of airway, don’t examine
- Need anaesthetist and senior paediatrician
- Secure airway - need to be prepped to intubate, tracheostomy may be needed if can’t intubate
- IV abx = ceftriaxone, steroids
14
Q
What is Kawasaki disease?
A
Mucocutaneous lymph node syndrome - is a type of vasculitis affecting children <5 years.
More common in boys and Asian children.
15
Q
What are the CF of Kawasaki disease?
A
Persistent high fever >39 degrees for >5 days
Sick unhappy children
Widespread erythematous maculopapular rash and desquamation of palms and soles
Strawberry tongue
Cracked lips
Cervical lymphadenopathy
Bilat conjunctivitis
16
Q
What are the ix into Kawasaki disease?
A
Bloods - FBC, LFT, ESR
Urine dip - neutrophils
Echo = coronary artery aneurysm
17
Q
What are the phases of Kawasaki disease?
A
Acute phase - most unwell, ~2w, fever, rash, lymphadenopathy
Subacute - desquamation and arthralgia, risk of coronary artery aneurysm, 2-4 w
Convalescent stage - sx settle, blood tests to normal and coronary aneurysm regress
18
Q
What is the management of Kawasaki disease?
A
- High dose aspirin to reduce risk of thrombosis
- IV immunoglobulins to reduce risk of coronary artery aneurysms
19
Q
What are differentials for child with fever?
A
- Meningitis
- Meningococcal disease
- Otitis media, mastoiditis
- Pneumonia, sinusitis
- UTI
- Septic arthritis, osteomyelitis
- Kawasaki disease
- Sepsis
- Viral illness
- Skin and soft tissue infection
- Head and neck abscess - retropharyngeal, tonsillar
20
Q
What are the differentials for a child w fever and a rash?
A
- Measles
- Viral rash
- Meningococcal sepsis
- Scarlet fever
- Chicken pox
- Hand foot and mouth disease
- Impetigo
- Slapped cheek
21
Q
What are the red flag symptoms in a child with a fever?
A
- Pale, blue, mottled
- Unrousable, sleepy, no response to social cues
- Grunting, RR >60, resp distress
- Reduced skin turgor
- <3m
- Non blanching rash and neck stiffness
- Bulging fontanelle
22
Q
What are the differentials for acute rash? no fever
A
Prickly heat
Eczema
Hives/urticaria
Ringworm
Scabies
Molluscum contagiosum
Baby acne
Cradle cap
23
Q
What are the CFs of measles?
A
- Rash 3-4 days - first on forehead and neck and then to trunk and limbs, fades after 3-4 days and can leave brown discolouration
- Fever + cough, coryza, conjunctivitis
- Koplik’s spots on buccal mucosa
- High fever
24
Q
What are the ix into measles?
A
Salivary swab
25
What is the management of measles?
- Uncomplicated = symptomatic treatment as mainly self limiting
- Notifiable disease - post exposure prophylaxis to contacts
- Vaccination
26
What are the complications of measles?
Resp - otitis media, bronchopneumonia (biggest cause of death)
Acute demyelinating encephalitis
Diarrhoea
27
Meningitis vs meningococcal septicaemia?
Meningitis - inflam of the meninges, usually associated w infection
Meningococcal septicaemia - Neisseria meningitidis in bloodstream, causes non blanching rash, DIC and subcutaneous haemorrhages
28
What are the causative organisms of meningitis?
Neisseria meningitidis
Strep pneumoniae
Neonates - group B strep
29
What are the CF of meningitis?
- Fever
- Headache
- Photophobia
- Alt conc and seizures
- Neck stiffness
- Meningococcal septicaemia - non blanching rash
- Babies - poor feeding, lethargy, bulging fontanelle
30
What are the special tests that are positive in meningeal irritation?
Kernig's - pt on back, flex hip and knee to 90 degrees then slowly straighten knee = spinal pain or resistance to movement
Brudzinski - pt on back, lift head and neck off bed and chin to test = involuntarily flex hips and knees
31
When is a LP indicated in children?
<1m w fever
1-3 m w fever and unwell
<1 year w unexplained fever and features of serious illness
32
What is the management of meningitis?
Found in GP = urgent IM benzylpenicillin prior to transfer to hospital
<3m = cefotaxime and amoxicillin
>3m = ceftriaxone
Add vancomycin in risk of resistance eg. foreign travel or prolonged abx exposure
Steroids in bacterial meningitis to reduce risk of hearing loss and neuro damage eg. dex QDS for 4 days
Notifiable disease
33
What is post exposure prophylaxis of meningitis?
Single dose of ciprofloxacin to those w close prolonged contact w/i 7 days prior to onset of illness
34
What viruses cause meningitis? How can they be managed?
- Herpes simplex virus
- Enterovirus
- Varicella zoster virus
Treat - aciclovir for HSV or VSV
35
Bacterial vs viral CSF in meningitis
Bacterial - cloudy, high protein, low glucose, high neutrophils, +ve culture
Viral - clear, mildly raised/normal protein, normal glucose, high lymphocytes, -ve culture
36
What are some complications of meningitis?
Hearing loss
Seizures and epilepsy
Cog impairment and learning disability
Memory loss
Cerebral palsy
37
What is mumps?
Most infectious from ~1-2 days before onset of sx, transmitted by saliva droplets.
Is caused by paramyxovirus, normally in children and young adults. MMR vaccine gives about 80% protection against mumps.
38
What are the CF of mumps?
Prodome - fever, muscle aches, lethargy, reduced appetite, headache, dry mouth.
Parotid gland swelling w associated pain
Sx of complications:
- Abdo pain = pancreatitis
- Testicular pain = orchitis - can present w/o parotid gland swelling and is often missed
- Confusion, neck stiffness, headache = meningitis or encephalitis
39
What are the ix into mumps and how is it managed?
PCR test w saliva swab. Can also do serology for ab.
Notifiable disease.
Supportive management - rest, fluids, analgesia.
40
What are some signs of sepsis in a child?
- Prolonged CRT
- Fever or hypothermia
- Deranged behaviour and physical obs
- Poor feeding
- High pitched crying, inconsolable, weak cry
- Reduced conc and body tone - floppy
- Skin colour changes - cyanosis, mottled, pale
41
What is septic shock? How is it managed?
Sepsis = cardiovascular dysfunc = blood pressure falls and there is hypoperfusion = rise in blood lactate.
Manage = IV fluids to increase BP and tissue perfusion. If doesn't work = inotropes used to increase BP eg. noradrenaline.
42
What is the immediate management of sepsis?
- O2 if <94%
- Obtain IV/IO access
- Bloods - FBC U+E CRP INR, ABG, cultures before abx
- Urine dip and cultures and sensitivities
- Abx w/i 1 hour of presentation
- IV fluids
43
What is the additional ix into sepsis in children?
- CXR if suspect pneumonia
- Abdo and pelvic USS
- LP if suspect meningitis
- Meningococcal PCR blood test is suspect meningococcal disease
- Serum cortisol if adrenal crisis suspected
44
What is the additional management of sepsis in children?
- Cont abx for 5-7 days, change abx choice and duration once source and organism found
- Stop abx is unlikely to be bacterial infection, pt well, blood cultures and two CRP results -ve at 48 hours
45
What are the CF of neonatal herpes simplex virus infection and how is it transmitted?
During delivery baby comes into contact w primary vesicles in maternal genital tract. Risk is low w recurrent herpes infection, highest w first presentation.
CF - local features = vesicular lesions on skin, eye or oral mucosa
Disseminated = seizures, encephalitis, hepatitis, sepsis
46
What is the management of neonatal herpes simplex virus?
Parenteral aciclovir and supportive therapy.
Elective c section or intrapartum IV aciclovir if mother has primary herpes lesions at term.
47
What is otitis media? What are the CF?
Inflam of the middle ear. CF:
- Ear pain
- Fever, anorexia, vomiting
- Red, bulging TM
- Usually follows viral URTI
- Aural fullness then discharge if TM perforates
- Impaired hearing
48
Benign chronic otitis media vs chronic suppurative otitis media
Benign chronic otitis media - dry TM perforation w/o chronic infection
Chronic suppurative otitis media - persistent purulent drainage through perforated TM
49
What is the management of otitis media?
- <3m w temp >38 = admit
- Suspected acute complications eg. mastoiditis, meningitis, facial nerve palsy = admit
- Paracetamol and ibuprofen
- Most children don't need abx, can use delayed abx prescribing = only start if sx don't improve w/i 4 days
- Immediate abx for children who are systemically unwell or immunocomp
50
What are some complications of otitis media?
- Facial nerve palsy
- Mastoiditis
- Petrositis - infection to apex of petrous temporal bone = Gradenigo syndrome - otorrhoea, pain deep inside the ear and the eye, ipsilateral abducens palsy
- Labrynthitis
- Meningitis
- Sigmoid sinus thrombosis - sepsis, swinging pyrexia, meningitis
- Brain abscess
51
Preseptal vs orbital cellulitis
Orbital cellulitis - sight and life threatening, infection of structures behind orbital septum
Preseptal cellulitis - infection of tissue ant to orbital septum, much more common than orbital cellulitis and most cases are in children <10, however in children septum isn't fully developed so any periorbital infection has a high risk of progression to orbital cellulitis
52
What are the RF of orbital cellulitis?
- Trauma
- Surgical
- Ethmoidal sinusitiis
- Other facial infections
53
What are the CF of orbital cellulitis?
Sx - periocular pain and swelling, pain on eye movement, fever, malaise
Signs - erythematous, swollen, tender eyelid, chemosis, proptosis, diplopia, restricted eye movements
54
What are the ix into orbital cellulitis? How is it managed?
Bloods - FBC, CRP, swabs to MC+S, CT orbit = gold standard to differentiate between pre and post septal cellulitis
Manage - IV abx
55
What are the CF of preseptal cellulitis?
Erythematous swollen eyelid, mild fever and erythema
-ve findings - no proptosis, normal eye movements, no chemosis, normal optic nerve func
56
What is the management of preseptal cellulitis?
Young or systemically unwell children = IV abx, if not = oral abx and daily outpt review
57
What organisms cause tonsilitis?
Most commonly viral but group A strep - Streptococcus pyogenes is the most common bacterial cause.
Other bacterial causes are the common URTI/LRTI organisms.
58
What makes up the tonsillar ring?
1. Adnoid
2. Tubal tonsils
3. Palatine tonsils - most commonly infected
4. Lingual tonsil
59
What are the CF of tonsilitis?
Fever, sore throat, painful swallowing
Headache, vom, abdo pain - younger children = non specific sx
Red inflam enlarged tonsils +/- exudate
May have otitis media and cervical lymphadenopathy also
60
What is FeverPAIN score?
Fever
Purulence
Attended w/i 3 days onset of sx
Inflam tonsils
No cough
4-5 = likely tonsilitis and give abx
2-3 = delay abx
61
What abx do you use in tonsilitis?
Phenoxymethylpenicillin for 10 days
Clarithromycin in penicillin allergy
62
What are some complications of tonsilitis?
- Chronic
- Quinsy - peritonsilar abscess
- Otitis media
- Scarlet fever, rheumatic fever
- Post streptococcal glomerulonephritis and reactive arthritis
63
What additional sx indiciate peritonsillar abscess?
- Trismus - pt unable to open mouth
- Hot potato voice
- Swelling and erythema in area beside tonsils
64
What is the management of a quinsy?
Incision and drainage under GA by ENT team
Abx before and after surgery, normally broad spectrum eg. co amoxiclav
Can give dexamethasone to reduce inflam
65
What are the indications for a tonsillectomy?
7+ in 1 year
5 per year for 2 years
3 per year for 3 years
x2 tonsillar abscesses
Enlarged tonsils causing difficulty breathing, swallowing, snoring
66
What are some complications of a tonsillectomy?
- Pain and sore throat
- Damage to teeth
- Post tonsillectomy bleeding
- GA risks and infection
67
What is post tonsillectomy bleeding? How do you manage?
Bleeding after tonsillectomy, is notable as it can be severe and even life threatening -> blood aspiration
- ENT called
- IV access - FBC, clot, G+S, crossmatch
- Analgeisa
- Sit child up and spit blood out
- NBM and IV fluids, resus and maintenance
- Hydrogen peroxide gargle and adrenaline soaked swab can stop bleeding
68
What are some causes of viral gastroenteritis?
- Norovirus
- Rotavirus
- Adenovirus but less common
Is common and highly contagious
69
What are the principles of gastroenteritis management?
- Good hygiene
- Barrier nursing and infection control
- Children stay off school for 48 hours after sx completely resolved
- Fluid challenge, if fail = IV fluids
- Rehydration solutions
- Avoid antidiarrhoeal meds
70
What is the presentation of rubella?
Fever
Coryza
Arthralgia
Rash - starts on face and moves down to trunk, spares arms and legs
Lymphadenopathy - classically post auricular
71
What is the management of rubella?
Managed supportively and prognosis is good, mild sx that resolve in 7-10 days. Problem is in pregnancy.
Serology to confirm rubella togavirus.
72
What is toxic shock syndrome?
Exotoxin mediated multisystemic illness usually caused by group A strep, S.aureus and MRSA.
Causes T cell activation and massive cytokine release = shock and multi organ failure.
More common in adults than children. Treat w normal sepsis management.
73
What are the CF of toxic shock syndrome?
Non specific flu and N+V+D at first
Then ... high fever and widespread macular rash >90% body involved, usually becomes erythrodermic and involves mucous membranes
Get multiorgan involvement w hypotension due to cardiac depression and confusion due to encephalopathy.
74
What are the viral exanthems?
Exanthem = widespread rash w systemic sx eg. fever, malaise, headache
- Measles
- Rubella
- Chickenpox - varicella
- Fifth disease - parvovirus
- Roseola
75
How do you treat viral exanthem rash?
Supportive treatment - fluids and rest
Rash - cream to reduce itchiness, paracetamol, NSAIDs
76
How do you treat latent TB in children?
3 months of isoniazid and rifampicin or 6 months isoniazid
77
What children are at risk of TB?
- Children in general are more at risk to catch TB from infectious adult as they have immature immune systems
- Children in same house as someone w TB
- <5
- HIV infection or severely malnourished
78
What are the sx of TB in children?
- Cough that doesn't improve after 3 weeks
- Fever
- Weight loss or difficulty putting weight on
- Night sweats
79
What are the ix into TB?
- CXR
- Mantoux skin test
- Sputum samples but more difficult in children
80
What is the management of TB?
x2 m = isoniazid w pyridoxine, rifampicin, pyrazinamide, ethambutol
x4 m = rifampixin and isoniazid w pyridoxine
DOT or VOT
81
What is the mangement of whooping cough?
- Notify
- If presentation <21 days = azithromycin
- >21 days = normally goes on own
82
What is the school exclusion period of whooping cough?
5 days since abx started or 3 weeks since cough started
