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Flashcards in Infectious Dse in Children Deck (85):
1

Chickenpox has a complication of only____,

1%

2

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

herpes virus family.

3

Severe neonatal varicella
infection can result from perinatal varicella (especially if___________

contracted from 5 days before
the birth to 2 days after

4

rash of varicella

_________, including oral mucosa

‘_____________: vesicles, papules, crusting
lesions present together

Pruritic

Centripetal distribution




Cropping’ phenomenon

5

Varicella

Death rare except in the _______ and _____

immunocompromised and
neonates with congenital varicella

6

Varicella

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

aspirin

7

Varicella


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

Aciclovir

8

Varicella

Exclusion is recommended until the ________

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

9

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

zoster immune globulin
(ZIG).

10

Measles (rubeola) is a highly contagious disease
caused by an _____

RNA paramyxovirus

11

acute febrile exanthematous illness with characteristic
lesions on the buccal mucosa

measles

12

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

Koplik spots

13

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

dry cough and red eyes

14

Measles

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

3–5 days

15

Transmission of measles

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

16

Measles

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

4 days after the onset
of the rash

17

Stages of meales

Prodromal stage
Exanthema (rash) stage
Convalescent stage

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

Prodromal stage.

19

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

Exanthema (rash) stage

20

rash of measles

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.

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

Convalescent stage

22

Cx of measles

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

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.

Subacute sclerosing panencephalitis
(SSPE) is a

24

Vaccines for measles

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.

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

Congenital Rubella syndrome

26

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

2
documented doses of rubella-containing vaccines

27

Rubella-containing vaccinations are contraindicated
________ and ________

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

28

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

2.5%

29

Rubella

T or F

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

f

lifelong

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______

generalised, maculopapular






palatal
exanthem.

31

Rubella

The patient is infectious for_________

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

32

Rash of measles vs rubella

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

33

School exclusion in pts with rubella

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

34

CX of rubella

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

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

Viral exanthema (fourth syndrome

36

4th syndrome vs rubella rash

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

37

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

parvovirus strain
B19.

38

Rash of Parvovirus

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

39

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

Erythema infectiosum

40

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

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

41

parvovirus IgM and IgG

• IgG alone detected—______
• IgM detected—_______

immune

false positive or early infection

42

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

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

43

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

Roseola

44

SSx of Roseola

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

high fever (up to 40 ° C)


3 days (or so) then

Red macular or maculopapular

45

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

Hand, foot and mouth (HFM) disease

46

Other name for HFM

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

47

Rash of HFM

• 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

48

Scarlet fever results when a _______ organism produces erythrogenic toxin

Group A Streptococcus
pyogenes

49

Rash of scarlet fever

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

50

Where is the rash of scarlet predominant?

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

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

Phenoxymethylpenicillin

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

Kawasaki disease

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)

conjunctival infection


mucous membrane changes


peripheral changes


cervical lymphadenopathy

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

coronary
aneurysms and ectasia

55

Tx of KD

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

immunoglobulin and aspirin

56

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

Mumps

57

Transmission of mumps

It is usually transmitted by
respiratory secretions or saliva

58

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

classic parotitis

59

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

spontaneous abortion

60

How to differentiate parotitis vs CLAD

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

61

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

Bacterial (suppurative) parotitis

62

Common Cx of mumps

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

63

Rare Cx of mumps

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

64

Children with mumps should be excluded until ____

9 days
after the onset of the parotitis

65

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

Bordetella pertussis

66

Other organisms that can cause Pertussis

Bordetella parapertussis,
Mycoplasma pneumoniae, Chlamydia pneumoniae

67

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

classical
paroxysmal cough followed by an inspiratory whoop

68

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

8 per 1000
cases.

69

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

pneumonia,

seizures and
hypoxic encephalopathy

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.

100 day cough’.

71

Phases of Pertussis

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

catarrhal



(paroxysmal phase).

72

Cx of pertussis

Complications

• Neurological:_____
• Pulmonary: _______

asphyxia, hypoxia, seizures, cerebral haemorrhages


atelectasis, pneumonia, pneumothorax, bronchiectasis

73

Abx for Pertussis

• 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

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

T

75

Prevention strategies for pertussis:

a________’ strategy of vaccinating any adults
who are or will be in close contact with an
infant

‘cocoon

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 ________

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

77

HSV

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

25–30%

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

eczema herpeticum



neonates

79

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

Streptococcus
pyogenes or Staphylococcus aureus

80

2 forms of impetigo

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

81

Abx for impetigo

If extensive and causing systemic symptoms:

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

82

Head lice is an infestation caused by the louse

Pediculus
humanus capitis

83

Spread of head lice

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

84

Insecticides used to treat head lice include:
1
2
3

• malathion
• permethrin
• phenothrin

85

Caution for head lice insecticides

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