Infectious Diseases Flashcards
(125 cards)
1
Q
WHAT ARE THE CAUSATIVE ORGANISMS OF EACH OF THESE DISEASE?
Roseloa
Hand, foot, and mouth
Scarlet Fever
Slapped check/Fifth Disease
A
Roseloa = HHV6
Hand, foot, and mouth = Coxackie A16
Scarlet Fever = Group A strep
Slapped check/Fifth Disease = Parvovirus A19
2
Q
What is Kawazaki disease?
A
Kawasaki disease is a type of vasculitis which is predominately seen in children
3
Q
What is the cause of Kawazaki disease?
Who is most at risk?
A
Unknown
Under 5 most at risk
Boys more than girls
Japanese or Korean more at risk
4
Q
What are the symptoms of Kawazaki disease?
A
3 stages
1st stage >5 days
Fever > 39 degrees
Red eyes
Swollen lymph nodes
2nd stage
Strawberry tongue
Peeling of skin on hands
Joint pain
Vomiting
3rd stage
Reduction of symptoms, can be as long as 8 weeks
5
Q
How do you diagnose Kawazaki disease?
A
Diagnosis of exlcusion
Can test for complications
Blood tests
BNP released when the heart is under stress
ECG
Echocardiogram
Coronary artery aneurysm
6
Q
What is the treatment of Kawazaki disease?
A
High dose aspirin
High doses can treat inflammation
Gamma globulin
Reduce the risk of conorary artery problems
7
Q
What ar the complications of Kawazaki disease?
A
Coronary arteries anneurysm
Inflammation of the heart muscle
Heart valve problems
8
Q
What is measles?
A
Measles, or rubeola, is a viral infection that starts in the respiratory system
9
Q
What is the cause of measles?
How is measles spread?
A
Paramyxovirus family
Respiratory droplets
10
Q
What are the symptoms of measles?
What classic spots are seen?
A
Prodrome
- Irritable
- Conjunctivitis
- Fever
FEVER FOR 3 - 5 DAYS THEN
**Koplik spots (before rash)**
White spots ('grain of salt') on buccal mucosa
Rash
Starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
diarrhoea occurs in around 10% of patients
11
Q
How do you diagnose measles?
A
- IgM antibodies
- Throat swab to identify the virus
12
Q
What is the treatment for measles?
A
Mainly supportive
Admission may be considered in immunosuppressed or pregnant patients
Notifiable disease → inform public health
13
Q
What are the complications of measles?
A
- Otitis media: the most common complication
- Pneumonia: the most common cause of death
- Encephalitis: typically occurs 1-2 weeks following the onset of the illness)
14
Q
How should management of contacts who have not been vaccinated with measles be treated?
A
Vaccine given within 72 hours
15
Q
What is chickenpox?
A
Chickenpox is an infection caused by the varicella-zoster virus
16
Q
What are the symptoms of chickenpox?
A
Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild
17
Q
What stages does the rash go through in chickenpox?
A
Raised pink or red bumps (papules), which break out over several days
Small fluid-filled blisters (vesicles), which form in about one day and then break and leak
Crusts and scabs, which cover the broken blisters and take several more days to heal
18
Q
How do you diagnose chickenpox?
A
History
Examination
Can do blood tests and a culture of lesion samples
19
Q
What is the treatment for chickenpox?
A
No treatment necessary
Antihistamines for the itching
20
Q
What is the prevention for chicken pox in a pregnant woman <20 weeks and >20 weeks?
A
<20 weeks
Varicella-zoster immunoglobulin (VZIG) within 10 days
>20 weeks
Varicella-zoster immunoglobulin (VZIG) or acyclovir between 7-14 days
21
Q
What are the complications of chicken pox?
A
Pneumonia
Encephalitis (cerebellar involvement may be seen)
Disseminated haemorrhagic chickenpox
Arthritis, nephritis and pancreatitis may very rarely be seen
22
Q
What is Rubella?
A
Rubella is a contagious viral infection best known by its distinctive red rash.
It’s also called German measles or three-day measles.
23
Q
What are the symptoms of rubella?
A
- Prodrome, e.g. low-grade fever
- Rash: maculopapular, initially on the face before spreading to the whole body, usually fades by the 3-5 day
- Lymphadenopathy: suboccipital and postauricular
24
Q
What are the complications of rubella?
A
- Arthritis
- Encephalitis
- Myocarditis
25
How is rubella spread?
Droplet
26
How do you diganose rubella?
1. **Saliva Sample**
* Serologically
* Rubella specific IgM
27
What is the treatment for rubella?
Viral so nothing
Bed rest
Fluids
28
What is diphtheria?
Diphtheria is a serious bacterial infection that affects the mucous membranes of the throat and nose
29
What is the cause of diphtheria?
How is it spread?
1. **Corynebacterium diphtheriae**
2. The condition is typically spread through person-to-person contact or through contact with objects that have the bacteria on them, such as a cup or used tissue.
3. You may also get diphtheria if you’re around an infected person when they sneeze, cough, or blow their nose.
30
What are the symptoms of diphtheria?
1. A thick, gray membrane covering your throat and tonsils
2. A sore throat and hoarseness
3. Swollen glands (enlarged lymph nodes) in your neck
4. Difficulty breathing or rapid breathing
5. Nasal discharge
6. Fever and chills
7. Malaise
31
What are the complications of diphtheria?
Breathing problems
Heart damage
Nerve damage
32
How is diphtheria diagnosed?
1. Culture of throat swab
* Uses tellurite agar or Loeffler's media
33
What is the treatment of diphtheria?
**Antibiotics**
Penicillin OR erythromycin
**Antitoxin**
34
What is scalded skin syndrome?
Staph scalded skin syndrome (SSSS) is an illness characterised by red blistering skin that looks like a burn or scald, hence its name staphylococcal scalded skin syndrome.
35
What causes scalded skin syndrome?
Staphylococcus aureus
Two exotoxins (epidermolytic toxins A and B) from toxigenic strains of the bacteria
Desmosomes are the part of the skin cell responsible for adhering to the adjacent skin cell.
The toxins bind to a molecule within the desmosome called Desmoglein 1 and break it up so the skin cells become unstuck.
36
What are the symptoms of scalded skin syndrome?
**SSSS usually starts with fever, irritability and widespread redness of the skin.**
**Within 24-48 hours fluid-filled blisters form.**
**These rupture easily, leaving an area that looks like a burn**
**Rash characteristics include:**
Tissue paper-like wrinkling of the skin is followed by the appearance of large fluid-filled blisters (bullae) in the armpits, groin and body orifices such as the nose and ears.
Rash spreads to other parts of the body including the arms, legs and trunk. In newborns, lesions are often found in the diaper area or around the umbilical cord.
Top layer of skin begins peeling off in sheets, leaving exposed a moist, red and tender area. **Nikolsky sign is positive** (ie gentle strokes result in exfoliation)
37
How do you diagnose scalded skin syndrome?
1. Tzanck smear (skin scraping)
2. Skin biopsy, which shows intraepidermal cleavage at the granular layer
3. Bacterial culture from skin, blood, urine or umblical cord sample (in a newborn baby)
38
What is the treatment for scalded skin syndrome?
Hospitalisation
**IV Flucloxacillin**
Nafcillin, oxacillin, cephalosporin and clindamycin.
**Vancomycin** is used in infections suspected with **methicillin resistance (MRSA)**
39
What is whooping cough?
Whooping cough is an infection caused by a germ (bacterium) called Bordetella pertussis.
Whooping cough is also known as 'pertussis'
40
What are the symptoms of whooping cough?
**Early stage (catarrhal stage)**
Sore throat, runny nose, mild cough
**Main coughing stage (paroxymal phase)**
Cough becoems paroxysmal, bouts of intense coughing
Whooping noise is on the inspiration (not always present)
**Easing stage (convalescent phase)**
The bouts of coughing then ease gradually over a period which can last up to three months or more
41
When are you vaccinated against pertusis?
2 Months (8 weeks)
3 Months (12 weeks)
4 Months (16 weeks)
4 Months - 3 Years (4-in-1 preschool booster)
42
What is the diagnostic criteria for whooping cough?
**Acute cough that has lasted for 14 days or more without another apparent cause + 1 or more of the following:**
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
43
How do you diagnose whooping cough?
1. **A nasal swab culture and test**
Make take days or weeks to come back
2. **A chest X-ray**
Complication of pneumonia in whooping cough
44
How do you treat whooping cough?
1. **Antibiotics (Marcolides) to kill the baceria**
* Erythromycin
* Clarythromycin
* Azithromycin
45
What is polio?
Polio is a contagious viral illness that in its most severe form causes nerve injury leading to paralysis, difficulty breathing and sometimes death.
46
What is the cause of polio?
Poliovirus can be transmitted through direct contact with someone infected with the virus or, less commonly, through contaminated food and water
47
When is the polio vaccine administered?
1. 2 months old - 6 in 1
2. 3 months old - 6 in 1
3. 4 months old - 6 in 1
4. 3 years and 4 months of age – as part of the 4-in-1 (DTaP/IPV) pre-school booster
5. 14 years of age – as part of the 3-in-1 (Td/IPV) teenage booster
48
What are the symptoms of polio?
A small number of people will experience a flu-like illness 3 to 21 days after they're infected.
**Symptoms can include:**
A high temperature (fever) of 38C (100.4F) or above
A sore throat
A headache
Abdominal (tummy) pain
Aching muscles
Feeling and being sick
49
How do you diagnose polio?
**Medical history**
Neck and back stiffness, abnormal relfexes, and difficulty swallowing and breathing
**CSF**
Test of polio virus
50
What is the treatment for polio?
No cure for polio
Supportive treatments
51
What is tuberculosis (TB)?
Tuberculosis (TB) is an ongoing (chronic) infection caused by bacteria. It usually infects the lungs.
52
What are the stages of TB?
Exposure
Latent TB infection
TB disease
53
What cause TB in a child?
TB is caused by bacteria.
It’s most often caused by Mycobacterium tuberculosis (M. tuberculosis).
Many children infected with M. tuberculosis never develop active TB and remain in the latent TB stage.
54
What are the symptoms of TB?
Coughing that lasts three or more weeks
Coughing up blood
Chest pain, or pain with breathing or coughing
Unintentional weight loss
Fatigue
Fever
Night sweats
Chills
Loss of appetite
55
What is the vaccination for TB?
Bacillus Calmette-Guerin (BCG)
56
How do you diagnose TB?
**Latent TB**
1. Mantoux test
**Active TB**
1. **Sputum culutre - GOLD STANDARD**
2. **Sputum smear**
Stained for the presence of acid-fast bacilli (Ziehl-Neelsen stain)
3. **Chest x-ray**
Upper love cavitation
Bilteral hilar lymphadenopathy
4. **NAAT testing**
57
What is the treatment for TB?
Rifampicin - 6 months
Isoniazid - 6 months
Pyrazinamide - 2 months
Ethambutol - 2 months
58
What is HIV?
The human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS)
59
How is HIV transmitted?
HIV can be transmitted during sexual intercourse, pregnancy (i.e., from mother to fetus), childbirth, breastfeeding, and other forms of exposure to bodily fluids that carry the virus
60
How is HIV transmitted to children?
More than 90 percent of HIV infections in children result from mother-to-child-transmission
Where the virus is passed from a mother living with HIV to her baby during pregnancy, childbirth, or breastfeeding
61
What are the symptoms of HIV?
1. Lack of energy
2. Delayed growth and development
3. Persistent fever, sweating
4. Frequent diarrhea
5. Enlarged lymph nodes
6. Repeated or prolonged infections that don’t respond well to treatment
7. Weight loss
8. Failure to thrive
62
What infections are HIV infected indiviuals more likely to develop?
Sinus infections
Sepsis
Pneumonias
Tuberculosis
Urinary tract infections
Intestinal illness
Skin disease
Meningitis
63
How do you diagnose HIV?
1. Serology looking for antibodies
2. Look for antigens
64
What is the treatment for HIV?
ART therapy
65
What is meningitis?
Meningitis is an inflammation of the membranes that surround the brain and the spinal cord
66
What causes meningitis?
Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid (CSF).
67
What bacteria and viruses cause meningitis?
**Neonatal to 3 months**
1. Listeria monocytogenes
2. Group B Streptococcus
3. E. coli and other Gram -ve organisms
**1 month and above**
1. Neisseria meningitidis (meningococcus)
2. Streptococcus pneumoniae (pneumococcus)
3. Haemophilus influenzae
**1 month to 6 years**
H. influenzae
68
What are the symptoms of meningitis?
1. Neck and/or back pain
2. Headache
3. Sleepiness
4. Confusion
5. Irritability
6. Fever
7. Refusing to eat
8. Decreased level of consciousness
9. Seizures
10. Photophobia (sensitivity to light)
11. Nausea and vomiting
12. Neck stiffness
69
What is the diagnosis for meningitis?
1. **Lumbar puncture - CT to check if at risk patient**
Gram stain, culute and sensitivity
Cell count
Biochemistry - glucose, protein, lactate
2. **Blood cultures**
3. **Blood testing**
FBC, U&Es, LFTs
4. **Glucose**
70
What is the treatment for meningitis?
**IM benzylpenicillin**
**\<3 months**
Cefotaxime + Amoxocillin
**\>3 months**
Ceftriaxone
Sometimes dexamethosome added to help inflammatory response
71
What do you give to contacts of meningitis for prophylaxis?
Rifampicin OR Ciprofloxacin
72
What is encephalitis?
Encephalitis is inflammation of the brain
73
What are some causes of encephalitis?
1. HSV - Number 1 cuase in UK
2. HIV
3. Measles
4. Mumps
5. Poliomyelitis
6. Coxsackie virus
7. Herpes zoster
74
What are the symptoms of encephalitis?
Encephalitis presents in a similar manner to an abscess:
**A short history of:**
1. Headache, pyrexia, confusion, vomiting
2. An important negative is the absence of neck stiffness
**Developing into:**
1. Epilepsy
2. Focal neurological signs
3. Cognitive impairment
75
What are the investigations for encephalitis?
1. CSF: lymphocytosis, elevated protein
2. PCR for HSV
3. CT: medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients
4. MRI is better
5. EEG pattern: lateralised periodic discharges at 2 Hz
76
What is the treatment for encephalitis?
1. IV acyclovir
77
What are the complications of encephalitis?
1. SIADH
2. DIC
3. Cardiac and respiratory arrest
78
What is slapped cheek syndrome?
What other name does it go by?
Condition caused by parvovirus
It's sometimes called slapped-cheek disease because of the distinctive face rash that develops.
Parvovirus infection has also been known as fifth disease because, historically, it was fifth in a list of common childhood illnesses characterized by a rash
79
What is the cause of slapped cheek syndrome?
Human parvovirus B19
80
What are the symptoms of slapped cheek syndrome?
**RASH**
Several days after the appearance of early symptoms, a distinctive bright red rash may appear on your child's face — usually on both cheeks. Eventually it may spread to the arms, trunk, thighs and buttocks, where the rash has a pink, lacy, slightly raised appearance. The rash may be itchy, especially on the soles of the feet.
Fever
Upset stomach
Headache
Runny nose
81
What is the treatment for slapped cheek syndrome?
For an uncomplicated parvovirus infection, self-care treatment at home is generally sufficient.
People with severe anemia may need to stay in the hospital and receive blood transfusions.
Those with weakened immune systems may receive antibodies, via immune globulin injections, to treat the infection.
82
WHAT IS SCARLET FEVER?
Scarlet fever results from an infection with Streptococcus pyogenes or group A beta haemolytic streptococci that produces an erythrogenic toxin
Group A beta haemolytic streptococci is commonly found on the skin or in the throat and is responsible for causing bacterial sore throat or “strep throat”
83
What are the symptoms of scarlet fever?
1. **Fever: typically lasts 24 to 48 hours**
**THEN**
1. **Malaise, headache, nausea/vomiting**
2. **Sore throat**
3. **'Strawberry' tongue**
4. **Rash**
- - Fine punctate erythema ('pinhead') which generally appears first on the torso and spares the palms and soles
- - It is often described as having a rough 'sandpaper' texture
- - Desquamination occurs later in the course of the illness, particularly around the fingers and toes
84
How do you diagnose scarlet fever?
1. Throat swab
2. Treatment should be started immediately rather than waiting for the results
85
What is the treatment for scarlet fever?
1. Oral **penicillin V** for 10 days
2. If allergic then **azithromycin**
* Children can return to school 24 hours after commencing antibiotics
* Scarlet fever is a notifiable disease
86
What is hand, foot and mouth disease?
Acute viral illness characterized by vesicular eruptions in the mouth and papulovesicular lesions of the distal limbs
87
What viruses cause hand, foot and mouth disease?
Coxsackie A16 virus, although other group A and B Coxsackie viruses may be causative.
Less commonly, but more seriously, it can be caused by enterovirus 71.
88
What are the symptoms of hand, foot and mouth disease?
1. Mild systemic upset: sore throat, fever
2. Oral ulcers
**Followed later**
1. By vesicles on the palms and soles of the feet
89
What is the diagnosis of hand, foot and mouth disease?
**Diagnosis is usually based on clinical grounds**
**Diagnosing techniques include:**
1. Coxsackie A (generally A16) virus is isolated from lesions and stools
2. Serum testing may reveal a specific antibody
90
What is the management for hand, foot and mouth disease?
**Symptomatic treatment only**
General advice about hydration and analgesia
**Reassurance no link to disease in cattle**
**Children do not need to be excluded from school**
The HPA recommends that children who are unwell should be kept off school until they feel better
They also advise that you contact them if you suspect that there may be a large outbreak.
91
WHAT IS ROSEOLA INFANTUM?
Roseola infantum (also known as exanthem subitum, occasionally sixth disease)
caused by the human herpes virus 6 (HHV6)
92
What is roseola infantum caused by?
Caused by the human herpes virus 6 (HHV6)
93
At what age does roseola occur?
6-18 months
94
What are the symptoms of roseola infantum?
Whats spots are seen and where are they?
1. High fever lasting a few days
**Followed later by a**
1. Maculopapular rash
2. **Nagayama spots:** papular enanthem on the uvula and soft palate
3. Febrile convulsions occur in around 10-15%
4. Diarrhoea and cough are also commonly seen
95
What are the complications of roeola infantum?
1. Febrile convulsions
2. Aseptic meningitis
3. Hepatitis
96
What is the management of roseola infantum?
Supportive
97
What conditions don't require exclusion from school?
1. Fifth disease (slapped cheek)
2. Roseola
3. Head lice
4. Threadworms
5. Hand, foot and mouth
98
What disease require exclusion 24 hours after starting antibiotics?
Scarlet fever
99
What disease requires 2 days exclusion after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics)?
Whooping cough
100
What conditions require 4 days exclsuion from onset of rash?
1. Measles
2. Rubella
101
What requires exclusion 5 days after swollen glands?
Mumps
102
What condition require exclusion after all vesicles have crusted over?
Chicken pox
103
What is impetigo?
Impetigo is a superficial bacterial skin infection usually caused by either **Staphylcoccus aureus or Streptococcus pyogenes.**
It can be a primary infection or a complication of an existing skin condition such as eczema (in this case), scabies or insect bites.
104
What are the symptoms of impetigo?
Multiple lesions affecting the face or extremities. They may be macules, vesicles, bullae or pustules.
Characteristic honey coloured or golden, gummy crusts in streptococcal infection which leave denuded red areas when removed.
Bullae are more prominent in staphylococcal infection and in infants.
105
How do you diagnose impetigo?
Usually clinical
106
What is the treatment for impetigo?
1. Localised non-bullous impetigo, you can consider prescribing **Hydrogen peroxide 1% cream**
2. Only if this is 'unsuitable', should you consider **topical antibiotics**
* *fusidic acid 2% - first line**
* *Mupirocin 2% - second line if fusidic acid resistance is suspected or confirmed)**
Neither referral nor admission are required for this simple primary care presentation
107
What are the different causative agents for meningitis?
**Neonatal to 3 months**
Group B Streptococcus: usually acquired from the mother
E. coli and other Gram -ve organisms
Listeria monocytogenes
**1 month to 6 years**
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
```
**Greater than 6 years**
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
```
108
What is candidia (nappy rash)?
Candidiasis is commonly superimposed on napkin dermatitis. It causes a bright red rash involving the flexures. Discrete satellite lesions may be present. Oral thrush is common.
109
What are the characteristic lesions in nappy rash candidia?
1. Satelite lesions
110
What is the treatment of candida (nappy rash)?
1. Nystatin cream
2. Imidazole cream - Canesten or Daktarin.
111
What is oral candidia?
Oral candidiasis is a common fungal infection of the oral mucosa
112
What are the risk factors for oral candidia infection?
1. Hematinic deficiency - vitamin B12, ferritin, folic acid
2. Immunosuppressive drugs
3. Endocrine disease – diabetes, hypothyroidism, hypoparathyroidism
4. Blood dyscrasias or advanced malignancy
113
What are the symptoms of oral candida?
1. Often asymptomatic
* *Can present with**
2. Dysphagia
3. Burning and soreness as well as sensitivity to acidic and spicy foods
4. Altered taste sensation
114
What is the treatment of candidiasis in children?
1. Miconazole oral gel - 7 days
2. **If under 4 months**
Nyastatin - 7 days
115
What is staph toxic shock syndrome?
Staphylococcal toxic shock syndrome describes a severe systemic reaction to staphylococcal exotoxins, the TSST-1 superantigen toxin
116
What are the causes of staph toxic shock syndrome?
1. Young females at the time of menstruation - increase in females who use vaginal tampons
117
What are the clinical features of toxic shock syndrome?
**Fever**
Temperature \> 38.9ºC
**Hypotension**
Systolic blood pressure \< 90 mmHg
**Diffuse erythematous rash**
**Desquamation of rash, especially of the palms and soles**
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
118
What is the management for toxic shock syndrome?
1. Removal of infection focus (e.g. retained tampon)
2. IV fluids
3. IV antibiotics - Flucloxacillin
119
What is the mnemonic for day of rash appearing after fever?
120
What are each of these bacteria responsible for causing?
## Footnote
Group A haemolytic Strep
Coxsackie A16
Parovirus B19
Group A haemolytic Strep = Scarlett Fever
Coxsackie A16 = Hand, foot and mouth
Parovirus B19 = Slapped Cheek Syndrome
121
How long does the fever last in these conditions before a rash appears?
Measles
Scarlett Fever
Fifth Disase
Roseola
1. Scarlett Fever - **1**-2 days
2. Measles - **2**-4 days
3. Roseola - **3**-5 days
4. Fifth disease - **4**-14 days
122
How does the rash spread in measles?
Start on head and spreads to trunk and extemities
123
How does the rash present in scarlett fever?
Fine, erythematous papular eruption
124
How does the rash present in fifth disease?
**Pruritic,** **lacy rash** sparing palmes and soles
125
How does the rash present in roseola?
Tiny eryrthematous papules on trunk spreading to neck/extremities
