Infectious Dse in Children

Question 1

Chickenpox has a complication of only____,

Answer 1

1%

Question 2

Chickenpox is a highly contagious infection
caused by the varicella zoster virus, a DNA virus
within the________________

Answer 2

herpes virus family.

Question 3

Severe neonatal varicella

infection can result from perinatal varicella (especially if___________

Answer 3

contracted from 5 days before

the birth to 2 days after

Question 4

rash of varicella

_________, including oral mucosa

‘_____________: vesicles, papules, crusting
lesions present together

Pruritic

Answer 4

Centripetal distribution

Cropping’ phenomenon

Question 5

Varicella

Death rare except in the _______ and _____

Answer 5

immunocompromised and

neonates with congenital varicella

Question 6

Varicella

Give paracetamol for the fever (avoid ___________in
children due to the possibility of Reye
syndrome).

Answer 6

aspirin

Question 7

Varicella

___________ or similar agents can be life-saving in
the immunocompromised host

Answer 7

Aciclovir

Question 8

Varicella

Exclusion is recommended until the ________

Answer 8

blisters have
dried, usually at least 5 days in unimmunised children
but possibly shorter in those immunised

Question 9

Prevention in contacts who are immunocompromised
or at high risk (e.g. neonates) and in contact with
varicella, is possible with _____

Answer 9

zoster immune globulin

ZIG

Question 10

Measles (rubeola) is a highly contagious disease

caused by an _____

Answer 10

RNA paramyxovirus

Question 11

acute febrile exanthematous illness with characteristic

lesions on the buccal mucosa

Answer 11

measles

Question 12

tiny

white spots like grains of salt, opposite the molars).

Answer 12

Koplik spots

Question 13

If an
acute exanthematous illness is not accompanied by a
______, it is unlikely to be measles

Answer 13

dry cough and red eyes

Question 14

Measles

Laboratory diagnosis is by serology, with IgM rising
_____after the onset of the rash.

Answer 14

3–5 days

Question 15

Transmission of measles

Answer 15

Measles is transmitted by patient-to-patient contact
through oropharyngeal and nasopharyngeal droplets
expelled during coughing and sneezing

Question 16

Measles

The incubation period is 10–14 days and the
patient is infectious until about _____

Answer 16

4 days after the onset

of the rash

Question 17

Stages of meales

Answer 17

Prodromal stage
Exanthema (rash) stage
Convalescent stage

Question 18

What stage of measles

This usually lasts 3–4 days. It is marked by fever, malaise, anorexia, diarrhoea and ‘the three Cs’: cough, coryza and conjunctivitis

Sometimes a non-specific rash appears a day before the Koplik spots

Answer 18

Prodromal stage.

Question 19

Identified by a typically
blotchy, bright red maculopapular eruption; this
stage lasts 4–5 days

Answer 19

Exanthema (rash) stage

Question 20

rash of measles

Answer 20

The rash begins behind the ears; on the first day it spreads to the face the next day to the trunk and
later to the limbs.

Question 21

The rash fades, leaving a
temporary brownish ‘staining’. The patient’s
cough may persist for days, but usually good
health and appetite return quickly

Answer 21

Convalescent stage

Question 22

Cx of measles

Answer 22

otitis media (9%),
pneumonia (6%) and diarrhoea (8%).

Question 23

cx of measles

________ late complication, occurring on average
7 years after infection in 0.5–1/100 000 cases, and
is manifested by universally fatal progressive brain
damage.

Answer 23

Subacute sclerosing panencephalitis

(SSPE) is a

Question 24

Vaccines for measles

Answer 24

Live
attenuated measles virus vaccinations combined with
mumps and rubella (MMR) are recommended at the
age of 12 months and then MMRV (with varicella) at 18
months.

Question 25

Multiple features of ______are usually evident, which include intellectual disabilities, cataracts, deafness, cardiac abnormalities, intrauterine growth disorders (IUGR) and inflammatory lesions of the brain, liver, lungs and bone marrow

Answer 25

Congenital Rubella syndrome

Question 26

All women of child-bearing age should have________ and if not their immune status should be assessed serologically.

Answer 26

2 | documented doses of rubella-containing vaccines

Question 27

Rubella-containing vaccinations are contraindicated | ________ and ________

Answer 27

in pregnant woman and pregnancy should be avoided | for 28 days after vaccination

Question 28

Only | ______ of women of child-bearing age are seronegative, though the risk is higher in women born overseas.

Answer 28

2.5%

Question 29

Rubella T or F Approximately one-third of infections are asymptomatic (subclinical). Infection usually confers temporary immunity

Answer 29

f lifelong

Question 30

Rubella A _______ rash, sometimes pruritic, may be the only evidence of infection. Other symptoms are usually mild and short-lived. There is often a reddened pharynx but sore throats are unusual. An exudate may be seen as well as______

Answer 30

generalised, maculopapular palatal exanthem.

Question 31

Rubella The patient is infectious for_________

Answer 31

a week before and at least 4 days after the onset of the rash

Question 32

Rash of measles vs rubella

Answer 32

A discrete pale pink maculopapular rash (not confluent as | in measles

Question 33

School exclusion in pts with rubella

Answer 33

The child is usually excluded until fully recovered or | for at least 4 days from the onset of the rash

Question 34

CX of rubella

Answer 34

``` Encephalitis (rare) Polyarthritis, especially in adult women (this complication abates spontaneously) Thrombocytopenia (rare) Congenital rubella syndrome ```

Question 35

This mild childhood infection may be caused by a number of viruses, especially the enteroviruses, and produces a rubella-like rash that may be misdiagnosed as rubella

Answer 35

Viral exanthema (fourth syndrome

Question 36

4th syndrome vs rubella rash

Answer 36

In 4th syndrome: The rash, which is usually non-pruritic and mainly confined to the trunk, does not desquamate and often fades within 48 hours

Question 37

Parvovirus, also known as ‘slapped cheek’ syndrome, | is a childhood exanthem caused by______

Answer 37

parvovirus strain | B19.

Question 38

Rash of Parvovirus

Answer 38

The bright macular rash erupts on the face first then, after a day or so, a maculopapular rash appears on the limbs

Question 39

_________is a mild illness but, if the parvovirus infection occurs during pregnancy, fetal complications including miscarriage can occur

Answer 39

Erythema infectiosum

Question 40

``` Pregnant women should be tested for parvovirus IgM and IgG if: 1 2 3 ```

Answer 40

• in the same room as the infected person for >15 minutes • face-to-face contact • household contact

Question 41

parvovirus IgM and IgG * IgG alone detected—______ * IgM detected—_______

Answer 41

immune false positive or early infection

Question 42

If Parvo infection occurs in the first half of pregnancy, the fetus may become 1 2

Answer 42

anaemic (the virus replicates in erythroid progenitor cells) and hydrops fetalis and miscarriage can occur

Question 43

_______ is a viral infection (human herpes virus 6) of infancy, affecting children at the age of 6 months and 2 years;

Answer 43

Roseola

Question 44

SSx of Roseola 1. Sudden ______ 2. Runny nose 3. Temperature falls after _____ 4. ________ rash appears

Answer 44

high fever (up to 40 ° C) 3 days (or so) then Red macular or maculopapular

Question 45

This is a mild vesicular eruption caused by enteroviruses, the most common being Coxsackie A-16, with EV-71 being less common

Answer 45

Hand, foot and mouth (HFM) disease

Question 46

Other name for HFM

Answer 46

Sometimes referred to as ‘crèche disease’, it often occurs among groups of children in child care centres

Question 47

Rash of HFM

Answer 47

• Starts as a red macule, then progresses to vesicles • Vesicles lead to shallow ulcers on buccal mucosa, gums and tongue • Greyish vesicle with surrounding erythema

Question 48

Scarlet fever results when a _______ organism produces erythrogenic toxin

Answer 48

Group A Streptococcus | pyogenes

Question 49

Rash of scarlet fever

Answer 49

• First appears on neck • Rapidly generalised • Punctate and red, a ‘boiled lobster’ or sunburnt appearance

Question 50

Where is the rash of scarlet predominant?

Answer 50

Prominent on neck, in axillae, cubital fossa | (Pastia lines), groin, skinfolds

Question 51

Tx of scalet __________(dose according to age) for 10 days with rapid resolution of symptoms. Children can return to school 24 hours after taking antibiotics and feeling well

Answer 51

Phenoxymethylpenicillin

Question 52

This is an uncommon but important systemic vasculitis, usually in children under 5 years of age, likely caused by an infection, though the presumed agent remains unknown

Answer 52

Kawasaki disease

Question 53

Features of KD • polymorphous rash • bilateral (non-purulent) _______ • ___________, e.g. reddened or dry cracked lips, strawberry tongue, diffuse redness of oral or pharyngeal mucosa • __________, e.g. erythema of the palms or soles, oedema of the hands or feet (and in convalescence desquamation) •_________(>15 mm diameter, usually unilateral, single, non-purulent and painful)

Answer 53

conjunctival infection mucous membrane changes peripheral changes cervical lymphadenopathy

Question 54

Cx of KD The majorcomplication is vasculitis, which causes _______________ in 15–25% of untreated cases, and which can lead to ischaemic heart disease and sudden death either at the time or years later

Answer 54

coronary | aneurysms and ectasia

Question 55

Tx of KD Early treatment with_____ and ____ has been shown to be effective in reducing the prevalence of coronary artery abnormalities

Answer 55

immunoglobulin and aspirin

Question 56

_______ is an acute infectious disease caused by a paramyxovirus with an affinity for the salivary glands and meninges

Answer 56

Mumps

Question 57

Transmission of mumps

Answer 57

It is usually transmitted by | respiratory secretions or saliva

Question 58

The ______ occurs in only two-thirds of clinical cases of mumps and is usually bilateral

Answer 58

classic parotitis

Question 59

Mumps can result in________ | if contracted in the first trimester of pregnancy

Answer 59

spontaneous abortion

Question 60

How to differentiate parotitis vs CLAD

Answer 60

Lymph nodes are posteroinferior to the ear lobe; the parotid gland is anterior and, when enlarged, obscures the angle of the mandible

Question 61

________ is associated with | toxaemia and results in a high leucocyte count

Answer 61

Bacterial (suppurative) parotitis

Question 62

Common Cx of mumps

Answer 62

``` Orchitis Meningeal symptoms (10%) Abdominal pain (transient) ```

Question 63

Rare Cx of mumps

Answer 63

``` Oophoritis Encephalitis Arthritis (one or several joints) Deafness (usually transient) Pancreatitis ```

Question 64

Children with mumps should be excluded until ____

Answer 64

9 days | after the onset of the parotitis

Question 65

Pertussis (whooping cough) is a respiratory infection (a bronchitis) caused by________and occurs worldwide

Answer 65

Bordetella pertussis

Question 66

Other organisms that can cause Pertussis

Answer 66

Bordetella parapertussis, | Mycoplasma pneumoniae, Chlamydia pneumoniae

Question 67

The _______ followed by ________ is less common in older children and adults, or children who have partial immunity from vaccination

Answer 67

classical | paroxysmal cough followed by an inspiratory whoop

Question 68

The fatality rate of pts with pertussis in | unvaccinated infants less than 6 months is______

Answer 68

8 per 1000 | cases.

Question 69

The most common cause of death is pertussis | _______ sometimes complicated by _____ and ______

Answer 69

pneumonia, seizures and hypoxic encephalopathy

Question 70

Pertussis is also referred to as the ‘________ This can lead to issues with sleep disturbance, work performance (especially when dealing with machinery or driving) and rarely rib fractures.

Answer 70

100 day cough’.

Question 71

Phases of Pertussis Classic whooping cough is characterised by cough and coryza for 1 week (_______) followed by paroxysms of a more pronounced cough _____

Answer 71

catarrhal (paroxysmal phase).

Question 72

Cx of pertussis Complications * Neurological:_____ * Pulmonary: _______

Answer 72

asphyxia, hypoxia, seizures, cerebral haemorrhages atelectasis, pneumonia, pneumothorax, bronchiectasis

Question 73

Abx for Pertussis

Answer 73

``` • azithromycin — <6 months: 10 mg/kg daily for 5 days — >6 months: 10 mg/kg on day 1 (up to 500 mg) then 5 mg/kg (up to 250 mg) for a further 4 days ``` • clarithromycin — >1 month: 7.5 mg/kg (up to 500 mg) bd for 7 days • erythromycin — >1 month: 10 mg/kg (up to 250 mg, or 400 mg if ethyl succinate) qid for 7 days

Question 74

T or F High-risk contacts of a pertussis case (those with close/household contact and who may be vulnerable to complications, or transmit to others who are vulnerable) should be treated with the same medications

Answer 74

T

Question 75

Prevention strategies for pertussis: a________’ strategy of vaccinating any adults who are or will be in close contact with an infant

Answer 75

‘cocoon

Question 76

Prevention strategies for pertussis: mothers should be vaccinated in pre-pregnancy planning or straight after delivery. Alternatively, if more than 5 years has elapsed since their last previous dose, a pertussis vaccine should be given in their ________

Answer 76

third trimester (which will boost maternal antibodies that are transmitted in utero to the about-to-be-newborn)

Question 77

HSV The specific gingivostomatitis occurs in ______of cases and can be severe and acute

Answer 77

25–30%

Question 78

Cx of HSV ``` • encephalitis can develop in otherwise healthy children • _______—children can get widespread severe herpetic lesions • disseminated HSV infection in _____ (avoid contact until recovered) • HSV can be a serious issue in the immunocompromised patient ```

Answer 78

eczema herpeticum neonates

Question 79

Impetigo (school sores) is a contagious superficial bacterial skin infection caused by______ or ________ or a combination of these two virulent organisms

Answer 79

Streptococcus | pyogenes or Staphylococcus aureus

Question 80

2 forms of impetigo

Answer 80

1 vesiculopustular with honey-coloured crusts (either strep or staph) 2 bullous type, usually S. aureus

Question 81

Abx for impetigo If extensive and causing systemic symptoms:

Answer 81

flucloxacillin/dicloxacillin 12.5 mg/kg up to 500 mg) 6 hourly for 10 days or cephalexin 25 mg/kg up to 1 g 12 hourly for 10 days

Question 82

Head lice is an infestation caused by the louse

Answer 82

Pediculus | humanus capitis

Question 83

Spread of head lice

Answer 83

Head lice spread from person to person by direct contact, such as sitting and working very close to one another

Question 84

Insecticides used to treat head lice include: 1 2 3

Answer 84

* malathion * permethrin * phenothrin

Question 85

Caution for head lice insecticides

Answer 85

These applications can be irritating to the scalp, | so use caution in children prone to atopic dermatiti