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Paediatric infections Flashcards

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1
Q

What is a UTI?

A

Infection anywhere from kidney to urethra

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2
Q

What are the clinical features of a UTI in babies < 3 months?

A

1) Fever
2) Vomiting
3) Lethargy
4) Irritability
5) Poor feeding (& fewer wet nappies)
6) Failure to thrive
7) Offensive and dark urine

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3
Q

What are the clinical features of a UTI in babies 3-12 months?

A

1) Fever
2) Vomiting
3) Poor feeding
4) Abdo pain

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4
Q

What are the clinical features of a UTI in children > 1 year old?

A

1) Urinary frequency
2) Dysuria
3) Abdominal pain

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5
Q

When does fever become less common in paediatric UTI?

A

Once > 1 year old

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6
Q

What two investigations are done to diagnose paediatric UTI?

A

1) Urine dip
2) Urine culture

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7
Q

What results diagnose paediatric UTI?

A

1) Positive leukocytes and nitrites on urine dip
2) Positive urine culture with appropriately collected urine (clean catch, non-contaminated collection pad/catheter sample/suprapubic aspirate)

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8
Q

What is first-line management for paediatric UTI?

A

Oral antibiotics (usually enough in most cases unless urosepsis is suspected)

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9
Q

How is antibiotic choice guided in paediatric UTI?

A

1) Latest urine culture sensitivities (if available)
2) Local guidelines
3) Patient’s allergy status
4) Pregnancy test result in girls of reproductive age to avoid teratogenic antibiotics

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10
Q

Which antibiotic are lower paediatric UTIs usually treated with?

A

Nitrofurantoin

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11
Q

Which antibiotic are upper paediatric UTIs usually treated with?

A

A cephalosporin e.g. cefalexin

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12
Q

What follow-up imaging can be done in paediatric UTI?

A

1) US scan - to identify structural abnormalities (does not need to be done acutely unless atypical UTI)
2) Dimercaptosuccinic acid (DMSA) scintigraphy scan - checks for scarring, should not be done until at least 4 months after UTI
3) Micturating cystourethrogram (MCUG) - assess abnormal bladder function

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13
Q

What are the features of an atypical UTI?

A

1) Poor urine flow
2) Abdominal or bladder mass
3) Raised creatinine
4) Septicaemia
5) Failure to respond to treatment with suitable antibiotics within 48h
6) Infection with non-E coli organisms

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14
Q

When do children with UTIs need follow-up?

A

If they need follow-up imaging - if not they do not need routine GP or paediatric follow-up

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15
Q

When should children with UTIs be referred to secondary care for further investigation?

A

Recurrent UTIs esp. babies with faltering growth (may be given prophylactic abx)

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16
Q

What are the potential complications of paediatric UTI?

A

1) Renal scarring and CKD
2) Sepsis

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17
Q

How should an infant < 3 months with a suspected UTI be managed?

A

Admission to hospital for IV abx and further investigations esp. if red flags for sepsis e.g. temp > 38, fewer wet nappies

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18
Q

What are the three classic symptoms of measles?

A

1) Fever > 40 degrees
2) Coryzal symptoms e.g. nonproductive cough, sneezing, irritable
3) Conjunctivitis (red eyes)
4) Followed by a erythematous maculopapular bumpy rash ~ 2-5 days after symptom onset - starts on face and behind ears before moving down the body to the trunk and limbs

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19
Q

What sign is pathognomonic for measles infection?

A

Koplik spots (white spots on buccal mucosa) - small grey discolourations of the mucosal membranes in the mouth (appear 1-3 days after symptoms begin during prodrome phase of infection)/small red spots with white centres

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20
Q

How soon after exposure to an infection individual do measles symptoms tend to develop?

A

10-14 days

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21
Q

How long do measles symptoms lasts?

A

7-10 days

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22
Q

What investigations are done in suspected measles infection?

A

1) Measles specific IgM and IgG serology (ELISA) - most sensitive 3-14 days after rash onset
2) Measles RNA detection by PCR - best for swabs taken 1-3 days after rash onset

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23
Q

What are three complications of measles?

A

1) Acute otitis media
2) Bronchopneumonia
3) Encephalitis

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24
Q

How is measles managed?

A

1) Supportive care incl. antipyrexial
2) Vitamin A in all children < 2

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25
Which medication can reduce the duration of symptoms of measles but its use is not routinely recommended?
Ribavarin
26
Which age children do you give vitamin A to in measles?
< 2 years
27
Describe the rash in measles
Erythematous maculopapular (red and blotchy) e.g. on head, torso and limbs - rash involves limbs
28
What type of antibodies are tested for to diagnose rubella?
IgM (saliva)
29
What test can be useful for investigation bacterial meningitis?
Meningococcal PCR of CSF sample
30
Which pathogen causes whooping cough?
Bordetella pertussis
31
Describe the cough in whooping cough
Cough with characteristic whoop sound on inspiration
32
What conditions should be considered in an unvaccinated child?
MMR, diphtheria, whooping cough
33
What are three symptoms of diphtheria?
1) High fever 2) Sore throat 3) Respiratory distress
34
What is a characteristic sign of diphtheria?
Greyish exudate on the throat
35
How do you test for whooping cough?
Bortadella pernasal swab
36
How do you test for diphtheria?
Diphtheria throat swab
37
How is diagnosis of measles confirmed?
Measles IgM antibodies (blood or saliva)
38
What condition presents with a high fever and red rash with a rough texture?
Scarlet fever
39
What is the causative organism in scarlet fever?
Group A beta-haemolytic Streptococcus, most commonly Streptococcus pyogenes.
40
Which pathogens cause impetigo (skin infection)?
Staphylococcal and streptococcal bacteria
41
How does impetigo present?
1) Pruritic rash with discrete patches that have a golden crusting e.g. on face, red and slightly weepy lesions - golden crusted skin lesions around mouth and nose (pustules and vesicles around mouth - lesions have crusted and appear golden) 2) Fever 3) Can occur as a primary infection or as a complication of an existing skin condition e.g. eczema 4) Patient can be otherwise well
42
In which age group does impetigo present?
Infants and school-age children
43
How is impetigo managed?
Primary care 1) Hydrogen peroxide 1% cream/topical fusidic acid if localised disease 2) Oral flucloxacillin (second line = macrolides e.g. clarithromycin) 3) Highly infectious - patients should not share towels and should not attend school or work until 48h of abx
44
What is the most common cause of impetigo?
Staph aureus
45
What is used for eradicative therapies for MRSA skin infection?
Chlorhexidine with neomycin
46
What is the most common cause of fever and rash in children?
Non-specific viral infection which is never specifically identified
47
How would septicaemia present in a child?
1) Fever 2) Rapidly-developing non-blanching purpuric skin rash 3) Lethargy 4) Headache 5) Rigors 6) Vomiting
48
How should septicaemia be managed in A&E?
1) Take blood cultures 2) Broad-spectrum IV abx commenced asap 3) Notify senior paediatrician and review the patient asap
49
How should you manage a patient presenting in the community with suspected meningococcal septicaemia?
Give immediate IM benzylpenicillin and send to hospital
50
What are differential diagnoses of a purpuric rash?
1) Septicaemia 2) Trauma 3) Liver disease 4) Drugs e.g. anticoagulants 5) Vasculitis 6) Thrombocytopenia 7) Coagulopathy 8) Malignancy 9) Disseminated intravascular coagulation (DIC)
51
Which disease does parvovirus B19 cause?
Slapped cheeky syndrome/fifth disease/erythema infectiosum
52
How does parvovirus B19 present?
1) Bright red rash on both cheeks - may extend to the body with diffuse lace like rash (maculopapular rash and reticular erythema on the torso and the limbs) 2) Fever 3) Symptoms of URTI (coryza) 4) ± diarrhoea
53
How do you manage parvovirus B19?
1) Self-limiting and usually resolves within one week - supportive 2) Once the rash appears, children are no longer infectious
54
How does hand, foot and mouth disease present?
1) Blisters on the hands and feet 2) Grey ulcerations in the buccal cavity (lesions around the mouth) 3) Preceded by one day history of fever and lethargy
55
How do you manage hand, foot and mouth disease?
1) Self-limiting, usually resolves in one week 2) Children do not need to be isolated
56
Which pathogen causes hand, foot and mouth disease?
Coxsackie virus A16
57
How does scarlet fever present?
1) Coarse red maculopapular rash on the chest, abdo, face, limbs - characteristic 'sandpaper' rough texture (starts on abdo then spreads to back/neck and limbs) - appears 12-48h after fever, malaise, sore throat 2) Bright red 'strawberry' tongue ± white coating 3) Sore throat (redness and swelling) 4) Headache 5) Fever 6) Nausea 7) Swollen lymph nodes 8) Malaise 9) Rash is worse in the skinfolds e.g. groin, axilla, neck folds (Pastia's lines) NO COUGH or buccal lesions
58
What causes scarlet fever?
Group A streptococcus - strep pyogenes
59
How do you manage scarlet fever?
1) 10 days phenoxymethylpenicillin 2) Children remain infectious until 24h after first dose of abx
60
Which condition has sandpaper rash and strawberry tongue?
Scarlet fever (Group A strep/strep pyogenes)
61
How does roseola infantum present?
1) Lace-like red maculopapular rash across the whole body 2) Prodromal high fever for 3-5 days - child usually well by the time the fever presents
62
What condition does human herpes virus 6 (HHV-6) cause?
Roseola infantum/exanthem subitum
63
How do you manage roseola infantum?
Self limiting - supportive management
64
How does measles present?
1) Erythematous, blanching maculopapular rash all over the body Preceded by: 2) Fever 3) Cough 4) Runny nose 5) Conjunctivitis 6) Koplik spots (white sports inside the buccal cavity/mucosa)
65
What sign is pathognomonic for measles?
Koplik spots (white sports inside the buccal cavity)
66
What pathogen causes measles?
Measles virus
67
How do you manage measles?
1) Self-limiting 2) Children are infectious from 4 days before the rash to around 4 days after - highly infectious
68
Why is immunisation for measles encouraged?
Because of the potential for serious complications
69
What are potential serious complications of measles?
1) Pneumonia 2) Encephalitis 3) Immunosuppression 4) Subacute sclerosing panencephalitis
70
How does chickenpox present?
1) Maculopapular vesicular rash that crust over and form blisters, which can be itchy - rash starts as macular before coming papular and then vesicular (lesions not usually golden) - starts on face or chest then spread to rest or body (raised red spot to small fluid filled blisters which then crust over in next few days) 2) Preceded by fever ± irritability
71
What pathogen causes chickenpox?
Varicella zoster virus (VZV) - human herpes virus 3 (HHV3)
72
How is chickenpox managed?
1) Supportive - unless patient is in one of the categories that require antiviral treatment ± hospital admission following discussion with a specialist 2) Children are infectious from 1-2 days before the rash until every single lesion has crusted over - they should be kept from school until the lesions have crusted over
73
Which patients with chickenpox is antiviral treatment ± hospital admission required?
1) Neonate 2) Immunocompromised 3) An adolescent presenting within the first 24h of treatment 4) Pregnant
74
What are potential complications of chickenpox?
1) Encephalitis (serious complication in children) - occurs 2-6 days after onset of rash, presents with headache and fever, may go on to cause seizures and nuchal rigidity 2) Varicella pneumonitis/pneumonia (breathlessness, pleuritic chest pain and cough) - presents 1-6 days after onset of rash, serious complication but does not commonly occur in children, more commonly seen in adolescents and adults with immunosuppression being a significant risk factor
75
How does rubella present?
1) Postauricular lymphadenopathy 2) Maculopapular rash that starts on the head and spreads down to the trunk NO FEVER, no buccal lesions
76
Why is immunisation against rubella recommended?
Bc of the risk of in-utero complications that occur as a result of pregnant women being infected
77
How does mumps present?
1) Fever 2) Parotid swelling (unilateral or bilateral) with associated pain 3) Reduced appetite 4) Dry mouth 5) Headache 6) Lethargy
78
How can you manage sinusitis?
Nasal decongestant to reduce nasal oedema and improve drainage
79
How does sinusitis present?
Three cardinal symptoms: 1) Purulent nasal discharge 2) Facial pressure - facial swelling and redness with tenderness over cheeks can be noted 3) Nasal + 4) Sinus headaches Neck stiffness is uncommon
80
What is sinusitis?
Inflammation of the paranasal sinuses and nasal cavity
81
Describe sinus headaches
Often follow a pattern similar to migraine but can be differentiated by the absence of nausea or vomiting or aggravation by noise or bright light
82
What is acute epiglottitis?
A rapidly progressive infection causing inflammation of the epiglottis that may lead to abrupt blockage of the upper airway and death
83
Which pathogen causes acute epiglottitis?
Haemophilus influenza B (Hib)
84
Why is acute epiglottitis now rare in the UK?
1) Epiglottitis is preventable by the Haemophilus influenza B (Hib) vaccine which is routinely given to children as part of the UK immunisation schedule 2) Children can still present with this if they have missed the immunisation (e.g. if they were born overseas with poor immunisation coverage or are refugees who did not have reliable access to healthcare)
85
In which age group is epiglottitis most common?
Aged 1-6 years
86
How does acute epiglottitis present?
1) High fevers 2) Toxic looking child - flushed and irritable, abnormal behaviours 3) Intensely painful throat preventing child from speaking or swallowing - saliva drools down the chin 4) Soft inspiratory stridor and rapidly increasing respiratory difficulty over hours 5) Child sits immobile, upright with open mouth to optimise airway 6) Cough minimal or absent
87
How do you manage acute epiglottitis?
1) Emergency - senior ENT, anaesthetic and paediatric support + notifying PICU is required asap 2) Secure airway = first priority - endotracheal intubation may be necessary 3) Once airway is secure - take cultures + examine throat 4) Treat with IV abx - cefuroxime
88
What must you not do in acute epiglottitis?
Examine the airway or upset the child in the absence of senior support/before the airway is secure (child may obtund their airway and enter respiratory arrest)
89
What is first line treatment for acute epiglottitis?
IV cefuroxime
90
How do you manage mumps?
1) Supportive - usually self-limiting and lasts around 1 week 2) Treat complications if they occur
91
What is the incubation period of mumps?
14-25 days (viral infection spread by respiratory droplets)
92
How does eczema herpeticum present?
1) Rapidly progressing painful rash - itchy, painful monomorphic blisters on the face/neck, old blisters crust over and form sores (erosions/punched out lesions) 2) Patients with eczema are susceptible 3) Primary skin infection
93
Which pathogen causes eczema herpeticum?
Herpes simplex virus (HSV1/2 disseminated viral infection)
94
How is parvovirus B19 diagnosed?
Clinical diagnosis
95
What are complications of parvovirus B19?
1) Red cell aplasia 2) Infection in the first half of pregnancy can also cause severe foetal anaemia that can precipitate hydrops foetalis and subsequent miscarriage 3) Cardiomyopathy
96
What is the risk of parvovirus B19 in pregnancy?
Infection in the first half of pregnancy can also cause severe foetal anaemia that can precipitate hydrops foetalis and subsequent miscarriage
97
What are the features of parvovirus B19 associated red cell aplasia?
1) Parvovirus infection reduces erythropoiesis. 2) This is not significant for most patients however, in vulnerable groups like those with conditions like sickle cell anaemia and hereditary spherocytosis that rely on erythropoiesis, infection can precipitate a severe anaemia, causing an aplastic crisis - can sometimes be severe enough to require transfusion
98
What is tonsillitis?
A form of pharyngitis where there is intense acute inflammation of the tonsils, often with a purulent exudate in bacterial tonsillitis (infection affecting pharynx and tonsils) - typical features include fever, tonsillar inflammation and fatigue
99
What is the most common cause of tonsillitis esp. in recurrent tonsillitis in children?
Strep pneumoniae
100
What is a common viral cause of tonsillitis?
EBV
101
What are key features in bacterial tonsillitis?
1) Tender cervical lymphadenopathy 2) Tonsillar exudate 3) Fever > 38 4) Absence of cough
102
What are key features in viral tonsillitis?
1) Headache 2) Apathy 3) Abdominal pain
103
Which criteria are used to determine the likelihood of tonsillitis/sore throat being due to bacterial infection?
CENTOR criteria
104
What are the CENTOR criteria?
1) Tender cervical lymphadenopathy 2) Tonsillar exudate (white) - back of throat 3) Fever > 38 4) Absence of cough
105
How do you interpret the CENTOR criteria?
1) Each of the Centor criteria score 1 point (maximum score of 4) 2) A score of 0, 1 or 2 is thought to be associated with a 3 to 17% likelihood of isolating streptococcus 3) A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of isolating streptococcus
106
What would indicate prescribing antibiotics in tonsillitis?
1) Centor criteria score of 3 or 4 2) Evidence of systemic upset/immunosuppression
107
What is the first line treatment of bacterial tonsillitis?
Penicillin V (phenoxymethylpenicillin) 500mg PO QDS for 5-10 days
108
How do you treat bacterial tonsillitis in penicillin allergy?
Clarithromycin/Erythromycin (erythromycin in pregnancy) 250-500mg PO BD for 5 days
109
What is a quinsy?
A peritonsillar abscess that can occur as a complication of acute tonsillitis - serious complication
110
How is quinsy managed?
Immediate IV abx + aspiration of the inflamed tonsil
111
How does quinsy present?
Severe, unilateral pain with deviation of the uvula and trismus
112
When do you refer recurrent tonsillitis to specialist services for assessment via ENT referral?
NICE recommends referral if there are more than: 1) Seven episodes in 1 year 2) Five per year over 2 years OR 3) Three per year for 3 years Patients with recurrent tonsillitis may require tonsillectomy

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