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Paed:Infective Flashcards

1
Q

Risk factors for febrile child

A

Illness of other family members
Unimmunised
recent travel abroad
contact with animals

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2
Q

Red flag signs for febrile child

A

Fever >38 if below 3 months or Fever >39 if 3-6months
Colour: Pale/Mottled blue
Decreased LoC, neck stiffness, bulging fontanelle, seizures
Significant resp distress
Bile stained vomit
Severe dehydration/Shock

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3
Q

What is in a Septic Screen?

A
  • Urine Sample
  • Blood tests
  • Lumbar Puncture
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4
Q

What blood tests would you do in a septic screen?

A

Blood cultures, FBC (+WCC), CRP, Blood gas, U+E’s, Creatinine, Clotting screen

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5
Q

What other tests can be done in addition to septic screen?

A

CXR, other cultures (resp, wound, catheter ports)
Rapid antigen screen on blood/csf/ruine
PCR

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6
Q

Red flag sepsis criteria

A 
Hypotension
Resp rate >60
High blood lactate
CRT >5seconds
Oxygen req to maintain sats >92
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7
Q

What is septicaemia?

A

Bacteria proliferating in the bloodstream leading to septicaemia. The host response involves the release of infmallatory cytoines and activation of the endothelial cells, which may lead to septic shock.

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8
Q

Commonest cause of Septicaemia?

A

Neonates: Group B Strep, or G-ve organisms from BC
Children: Meningococcal infection
Pneumococcus is the commonest cause of bacteraemia.

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9
Q

Treatment of septicaemia

A
  • Antibiotics (?IV)
  • Fluids
  • Inotropic support
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10
Q

What is a complication of septicaemia?

A

Disseminated Intravascular Coagulation - Treat with FFP and platelet transfusions

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11
Q

What is meningitis?

A

Inflammation of the meninges. Confirmed by presence of inflammatory cells in the CSF

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12
Q

What type of Meningitis is more common?

A

Viral - although it is usually self limiting. Bacterial is more severe

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13
Q

Causative organisms of bacterial meningitis?

A

Neonatal: Group B Strep, E.Coli, Listeria Monocytogenes
1month-6years: Neisseria Meningitidis, Strep Pneumoniae, Haemophilus Influenzae
>6years: Neisseria meningitidis, Strep Pneumoniae

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14
Q

Presentation of meningitis

A

Non specific infection sx if under 18months.
Other: Fever, headache, purpuric rash, neck stiffness, bulging fontanelle, Opisthotonos, +Ve brudzinski/kernigs, reduced conscious level

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15
Q

What is brudzinskis sign?

A

Flexion of neck w/ child supine causes flexion of knees and hips

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16
Q

What is kernigs sign?

A

Child supine with knees and hips flexed, pain in back on extension of legs.

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17
Q

Diagnosis confirming investiagtion in meningitis?

A

LP

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18
Q

Investigations in meningitis

A

FBC, CRP, Coag Screen, U+E’s, LFTS, blood glucose
Cultures: blood, throat, urine, stool
Rapid antigen test

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19
Q

Lumbar puncture site

A

L3-L5

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20
Q

Contraindications to LP

A
  • Raised ICP (signs: papilloedema, fluctuating consciousness, high BP, reduced HR)
  • Infection over site of LP
  • DIC
  • Cardiorespiratory instability
  • Focal neurological signs
  • If it causes a delay in abx treatment
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21
Q

Risks of LP

A

Infection
Bleeding
Unsuccessful

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22
Q

CSF changes in bacterial meningitis

A

Appearance: Turbid
WBC: Increased polymorphs
Protein: Increased
Glucose: Decreased

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23
Q

CSF changes in viral menigitis

A

Appearance: Clear
WBC: Increased lymphocytes
Protein: Normal/increased
Glucose:Normal/decreased

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24
Q

CSF changes in TB meningitis

A

Appearance: Turbid/Clear/Viscous
WBC: Increased lymphocytes
Protein: Increased (more than bacterial)
Glucose: Decreased (less than bacterial)

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25
Hospital management for bacterial meningitis
Ceftriaxone or Cefotaxime
26
What can be given as immediate management for bacterial meningitis?
IM Benzylpenicillin
27
Cerebral complications of meningitis
- Hearing loss - Local vasculitis - Local cerebral infarction - subdural effusion - hydrocephalus - cerebral abcess
28
What is the cause of purpura?
Blood leaking and skin being necrotic.
29
How is meningitis spread?
Droplet spread
30
First line tx to reduce risk of disease in close contacts of meningitis
Ciprofloxacin: Single dose, no interaction with OC, readily available
31
Who shouldnt have Rifampicin?
- People on OC pill - Renal/Hepatic impairment - Pregnant women
32
How is a close contact defined?
Has had prolonged close contact with the case in a household type setting during the 7 days before onset of illness. OR People who have had transient close contact with the case only if they have been directly exposed to large particle droplets from resp tract of case around time of admission
33
Common causes of viral meningitis
Enteroviruses, EBV, adenoviruses, mumps
34
Viral mengitis confirmed by?
Culture/PCR of CSF, stool culture, serology
35
3 main symptoms of encephalitis?
Fever, altered consciousness, seizures
36
Commonest causes of encephalitis
Enterovirus, respiratoryviruses, HSV, VZV,
37
Treatment of encephalitis
Aciclovir
38
What causes Toxic Shock Syndrome?
Toxin producing Staph Aureus and Group A Strep
39
3 main symptoms of TSS
Fever >39 Hypotension Diffuse erythematous macular rash
40
Treatment of TSS
Abx: Clindamycin + Flucloxacillin Also: IV Immunoglobulin
41
What is Necrotising fasciitis/cellulitis?
Severe subcutaneous infection involving tissue from the skin down to the fascia and muscle. Leaves necrotic tissue at centre
42
Organism causing Necrotising Fasc?
Group A strep or S. Aureus
43
Treatment of Necrotising Fasciitis
Antibiotics (Benzypenicllin) and IV Ig and Surgical Debridement
44
What causes Scalded Skin Syndrome?
Exfoliative staphylococcal toxin
45
Symptoms of SSS?
Fever, malaise Purulent, crusting, localised infection around eyes/noes/mouth widespread erythema and skin tenderness
46
What is Nikolsky's sign?
Areas of the epidermis separate on gentle pressure. Seen in SSS
47
Treatment of SSS
IV flucloxacillin
48
Treatment of Herpes Simplex infections
Aciclovir
49
Primary varicella zoster infection is better known as:
Chickenpox
50
Clinical features of Chickenpox:
Vesicular rash, starting on head and trunk, 200-500 lesions and then moves to peripheries. Papules>Vesicles>Pustules>Crusts.
51
Complications of chickenpox
Secondary bacterial infection Encephalitis Purpura Fulminans
52
Treatment of chickenpox
Normally self limiting. If immunocompromised give IV Aciclovir. If adolescent/adult give IV Valaciclovir. Human varicella zoster IG may be given to at risk immunocompromised.
53
What is shingles?
Reactivation of latent VZV causing a vesicular eruption in the dermatomal distribution of sensory nerves. Commonly thoracic.
54
Symptoms of EBV infection
Fever, malaise, tonsillopharyngitis, lymphadenopathy. | On exam: petechiae on soft palate, splenomegaly, hepatomegaly, maculopapular rash, jaundice.
55
Diagnosis of EBV
- Atypical lymphocytes (large T cells on film) - positive monospot test (presence of heterophile antibodies) - Seroconverion with production of IgM and IgG to EBV antigens
56
Treatment of EBV infection
Symptomatic or steroids if airway compromised.
57
How is CMV transmitted?
Saliva, genital secretions, breastmilk, blood products
58
Treatment of CMV
Ganciclovir of Foscarnet
59
What can CMV cause in compromised pts
Retinitis, colitis, pneumonitis, enchephalitis, hepatitis, oesphagitis, bm failure
60
What is Parvovirus b19 infection called?
Slapped cheek syndrome/ fitfth disease / eyrthema infectiosum
61
How is Parvovirus B19 transmitted?
Resp secretions or MTCT
62
What are clinical syndromes of Parvovirus B19?
- Aysmptomatic - Erythema infectiosum - aplastic crisis - fetal disease
63
How are enteroviruses transmitted?
Faeco-oral route
64
How is measles spread?
Droplet spread. Caused by Rubeola virus
65
Clinical features of measles?
- Fever - rash - spreads downards from behind ears to whole of body - Kopliks spots - white spots on buccal mucosa, seen against bright red background - conjunctivitis and coryza - cough
66
How to prevent measles?
IMMUNISATION U FOOLS (DR HR isnt happy)
67
Complications of measles
Otitis media, croup, tracheits, pneumonia, encephalitis, convulsions diarrhoea
68
How is mumps spread?
Spread by droplet infection. Attacks parotid gland
69
Clinical features of mumps
Fever Malaise Parotitis Earache
70
What enzyme can be raised in mumps?
Amylase
71
How is rubella spread?
Droplet spread
72
Symptoms of rubella
Low grade fever maculopapular rash lymphadenopathy
73
Complications of rubella
Arthritis encephalitis thrombocytopenia myocarditis
74
What is impetigo?
localised, highly contagious, staphylococcal and/or streptococcal skin infection
75
Main route of transmission of HIV in paeds?
MTCT - Intrauterine - in pregnancy - intrapartum - at delivery - postpartum - breastfeeding
76
Diagnosis of HIV
>18months: HIV detected by antibodies to the virus <18months: - Born to infected mothers --> will have transplacental maternal IgG HIV antibodies - HIV DNA PCR is most sensitive
77
Clinical features of HIV
Mild immunosupression: Lymphadenopathy, parotitis Moderate immunosuppresiion: recurrent bacterial infections, candidiasis, chronic diarrhoea Severe: opportunistic infections eg. Pneumocystis jiroveci pneumonia, severe FtT
78
Treatment of HIV
Antiretroviral therapy | Prophylaxis against Pneumocystis jiroveci pnia --> co-trimaxole
79
How to reduce vertical transmission?
- Use of ART in mother - Birth via C section - Avoid breastfeeding - Avoid prolonged rupture of membranes
80
What causes Scarlet Fever?
Exotoxin released from Strep Pyogenes
81
Signs of scarlet fever?
Red prinprick blanching rash (chest, axilla, behind ears) , facial flushing w/ circumoral pallor, strawberry tongue. Develops after initial sore throat and fever.
82
Treatment of scarlet fever?
Phenoxymethylpenicillin
83
What is Kawasaki disease?
Systemic vasculitis that can lead to coronary artery aneurysms and myocardial infection.
84
Diagnostic criteria for Kawasaki disease?
Fever >38.5 >5days and 4outof5 of: - Non-purulent bilateral conjunctivitis - Red mucous membranes (dry cracked lips, strawberry tognue) - Cervical lymphadenopathy - Polymorphous rash - Extremities changes (red, oedemaotus, peeling palms)
85
What test results would you see in Kawa Disease?
``` Anaemia Increased WCC Increased CRP Increased ESR Icnreased liver enzymes Urine: mononuclear WBC w/o bacteria Increased platelets Note: You would perfrom an echo to check for cardiac changes. ```
86
Management of Kawasaki disease?
High dose IV Ig | Aspirin
87
Complications of treatment of KD with Aspirin?
Reyes Syndrome (hepatic encephalitis)
88
Complications of treament of KD with IV IG
Steven Johnson syndrome
89
What are some predisposing factors for Candida albicans infection?
- moist body folds - treatment with broad-spec abx - immunosuprresion - diabetes mellitus
90
What are the variants of candida?
- cutaneous candidiasis: well demarcated macular erythema, slight scaling and small outline 'satellite' lesions, worse in body folds - chronic paronychia - chronic mucocutaenous granulomatous candidiasis (secondary to congenital immunodeficiency disorder)
91
Ix of candida
Skin scrapings for microscopy and culture
92
Tx of candida
oral or topical anti-candida drugs (e.g. nystatin, fluconazole)
93
What is candida?
Fungal skin infection
94
What is a coxsackie virus?
RNA virus that can cause hand, foot and mouth disease. Usually self-limiting
95
What is Diptheria?
This is an acute upper respiratory tract infection, but sometimes it infects the skin. Caused by Corynebacterium diphtheriae.
96
Polio? Tell me about it
Poliomyelitis (polio) is caused by infection with the poliovirus, an enterovirus. The virus may invade lymphatic tissue and spread into the bloodstream. It can be neurotropic, destroying motor neurons, particularly in the anterior horn of the spinal cord and brain stem. This causes flaccid paralysis which may be spinal or bulbar.
97
What is protected against in the 6in1 vaccine?
Diphtheria, Tetanus, Pertussis, Polio, Hib disease, hepatitis B
98
When is the 6in1 given?
8, 12 and 16 weeks
99
When is pneumococcal (PCV) vaccine given?
8 and 16 weeks
100
WHen is Meningococcal group B vaccine given?
8 weeks, 16 weeks and one year.
101
When is rotavirus vaccine?
8 and 12 weeks
102
When is Hib and Men C vaccine?
1 year old
103
MMR vaccine when?
1 year old | 3years 4 months
104
Preschool/4in1 booster?
Diphteria, tetanis, pertussis, polio. 3years4months.
105
HPV vaccine when?
12-13yr olds
106
Teenage booster?
Tetanus, diphtheria and polio. teenage.
107
When give MenACWY?
4 types of meningococcal disease. teenage

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