Paediatric Infectious diseases Flashcards
Conjunctivitis - state the following:
- Pathophysiology
- Presentation (red flag)
- Management
Pathophysiology:
- Inflammation of the lining of the eyelids and eyeball
- Many causes e.g. bacteria, virus, allergy, immune reaction, physical irritation or medication
Presentation:
- Watery (viral) or purulent (bacterial) discharge / difficulty opening eye in morning
- Itchy eye
- Redness / hyperaemia
- Tender, pre-auricular lymphadenopathy (if bacterial)
Red flag
- Visual changes
- Eye pain / headache / photophobia
- In a neonate
- History of trauma
Management:
Reassure that is self limiting
- Clean eyelids with sterile water and cotton pads
- Cool compresses
- Cleanliness as able to spread to other eye, or others
- Only use antibiotics if severe or immunocompromised
- No advice for staying away from school or nursery
List some symptoms and questions to ask about for a child presenting with a fever
About fever:
- Duration / severity
- Identify source of infection e.g. UTI symptoms, chest infections
- Other unwell contacts
Associated symptoms
- Meningism e.g. neck stiffness, headache, visual disturbance
- Rash
- Febrile seizures
Systemic overview:
- Eating / drinking / feeding
- Lethargy / consciousness
- Sleep
- Recent travel
- Up to date immunisations / recent immunisation
Suggest some differentials for a child presenting with acute fever (use systems approach, head to toe)
Head / CNS:
- Encephalitis / meningitis
- Cerebral abscess
ENT:
- Otitis media
- Sinusitis
- Epiglottitis / quinsy
- URTI
Respiratory:
- Bronchiolitis
- Pneumonia
- Croup
Hepatobiliary:
- Hepatitis
- Pancreatitis
- Cholecystitis
MSK:
- Cellulitis
- Septic arthritis
- Osteomyelitis
Suggest some differentials for a child presenting with chronic fever or ‘pyrexia of unknown origin’ (use systems approach)
Inflammatory:
- Kawasaki disease
- Juvenile idiopathic arthritis
- SLE
- Sarcoidosis
- IBD
Infectious:
- TB
- HIV
- Glandular fever / infectious mononucleosis (Epstein-Barr virus)
- Malaria
- Cat-scratch disease
- Typhoid
Malignancy:
- Leukaemia
- Lymphoma
Endocrine:
- Hyperthyroidism
State some investigations to consider in a child presenting with acute fever
Bloods:
- FBC
- U&Es
- CRP
- Blood cultures
- Blood gas
Others:
- Urine dip
- Lumbar puncture (automatically all children < 3 months)
- Check x-ray if respiratory symptoms
Broadly list some differential diagnoses for a child with lymphadenopathy (use systems approach)
Could be non-specific e.g. URTI
Infectious:
- Glandular fever / infectious mononucleosis (Epstein-Barr virus)
- CMV (cytomegalovirus)
- Strep infection / tonsillitis
- Rubella
- Cat scratch disease
- Parvovirus B19
- Viral exanthems
- Mycoplasma pneumonia / TB
Malignancy:
- Lymphoma
- Leukaemia
Inflammatory:
- Kawasaki disease
- SLE
- Sarcoidosis
State some differentials for bruising in children
Normal!
- Erythema Nodosum
- Infection related e.g. meningococcal meningitis
- Leukaemia / lymphoma / aplastic anemia
- Bleeding disorders
- Drug related e.g. NSAIDs
- Ehlers-Danlos Syndrome
- Vitamin C deficiency
Other:
- Abuse / neglect
State which 3 electrolytes are most commonly deranged in children and some conditions which can cause it
1) Sodium
- Dehydration
- Excessive sweating
- CKD
2) Potassium
- DKA
- Vomiting / diarrhea
- Medications e.g. diuretics or laxatives
3) Calcium
- CKD
- Hyperthyroidism e.g. Graves’ disease
State some differentials for pallor in children (anaemia)
RBC loss:
- Acute blood loss
- Chronic ongoing loss e.g. heavy periods, IBD
Reduced RBC production:
- Iron deficiency
- B12 / folate deficiency
- Bone marrow failure / leukaemia
- Anaemia of chronic disease
Increased RBC destruction:
- Sickle cell
- Thalassaemia
- Autoimmune haemolytic anaemia
Sequestration:
- Hypersplenism / splenomegaly
Herpes simplex virus - state the following:
- Pathophysiology
- Presentation (including any red flags)
- Investigations
- Management
Pathophysiology:
- Herpes simplex virus 1 or 2 (90% cases HSV-1)
- Transmitted via direct contact with infected secretions (through skin or mucous membranes)
- Especially dangerous to babies under 6 months of age (if have cold sores, don’t kiss babies under 6 months)
Presentation:
Usually asymptomatic
- Fever
- Anorexia
- Headache
- Malaise / sleeplessness
- Oral / genital vesicular lesions (can be preceded by pain, burning, tingling or itching)
Red flags (HSV encephalitis)
- Lethargy
- Drowsiness
- Focal neurology
- Altered behaviour
Investigations:
- Not normally needed
Management:
- Analgesia
- Antipyretic
- Generally can be self limiting unless severe infection or immunocompromised = give Aciclovir
State some complications that can occur from Herpes Simplex Virus (HSV) in immunocompromised people
- Eczema herpeticum
- Corneal ulceration and other diseases
- Erythema multiforme
- Pneumonia
- Encephalitis
Meningitis - state the following:
- Pathophysiology
- Most common age
- Presentation
- Investigations
- Management (depending on community vs hospital)
Pathophysiology:
- Infection of the meninges
- Either viral (milder) or bacterial (more serious)
Most common age:
- Bacterial: under 1 and teenagers
- Viral: no particular age but more common in summer
Presentation:
- Fever
- Neck stiffness
- Headache
- Photophobia
- Vomiting
- Non-blanching rash (bacterial)
- Seizures / altered consciousness
Investigations:
Difficult to tell viral from bacterial without testing
- Lumbar puncture (send sample for analysis and viral PCR testing)
- Blood cultures
- Kernig’s test
- Brudzinski’s test
Management:
**NOTIFIABLE DISEASE*
Community
- IM/IV Benzylpenicillin stat dose
- Urgent transfer to hospital
Hospital
- Ceftriaxone (Cefotaxime if under 3 months)
- Dexamethasone QDS for 4 days
- Add Vancomycin if recent travel or prolonged antibiotic exposure
State common bacterial causes of meningitis in children (and neonates)
Generally:
- Neisseria meningitidis
- Steptococcus pneumoniae
Neonates:
- Group B strep
Outline how a baby with meningitis may present
- Bulging fontanelle
Non-specific symptoms:
- Poor feeding
- Hypotonia
- Hypothermia
- Lethargy
State some complications of meningitis
- Hearing loss
- Brain damage (cognitive impairment / learning disability)
- Cerebral palsy and focal neurological deficits
- Seizures / epilepsy
- Memory loss
