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PAEDS INFECTION Flashcards

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1
Q

FEBRILE CHILD
What system is used to assess a febrile child?
What are the main components?

A
  • NICE traffic light system for <5
  • Colour (skin, lips, tongue)
  • Activity
  • Respiratory
  • Circulation + hydration
  • Other
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2
Q

FEBRILE CHILD
In terms of the NICE traffic light system, what is considered amber for…

i) colour?
ii) activity?
iii) respiratory?
iv) circulation and hydration?
v) other?

A

i) Pallor
ii) No smile, decreased activity, not responding to social cues, wakes when roused
iii) Nasal flaring, SpO2 ≤95%, crackles in chest RR>50 (6-12m) or >40 (>12m)
iv) Tachy (>160 if <1y, >150 if 1–2y, >140 if 2–5y), CRT ≥3s, dry mucous membranes, reduced urine output
v) 3-6m temp ≥39, fever ≥5d, rigors, joint swelling, non-weight bearing

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3
Q

FEBRILE CHILD
In terms of the NICE traffic light system, what is considered red for…

i) colour?
ii) activity?
iii) respiratory?
iv) circulation and hydration?
v) other?

A

i) Mottled skin
ii) No response to cues, doesn’t wake if roused, weak, high-pitched or constant cry
iii) Grunting, RR>60, mod-severe chest indrawing
iv) Reduced skin turgor, no urine output
v) <3m temp ≥38, non-blanching rash, bulging fontanelle, neck stiffness, status, focal seizures/neuro

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4
Q

FEBRILE CHILD
What are some common and uncommon causes of fever?

A
  • Common = URTI, tonsillitis, otitis media, UTI
  • Uncommon = Meningitis, epiglottitis, kawasaki disease, TB
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5
Q

FEBRILE CHILD
What is the management of a green score?

A
  • Manage at home with safety netting
  • Regular fluids, monitor child, contact if concerned
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6
Q

FEBRILE CHILD
What is safety netting?

A
  • Clear verbal ± written advice about warning signs with plan of action
  • Follow up if required
  • Liaise with other HCPs so direct access if child needs
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7
Q

FEBRILE CHILD
What is the management of an amber score?

A
  • F2F assessment with paeds or specialist for further investigation
  • ?Home with safety net
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8
Q

FEBRILE CHILD
What is the management of a red score?

A
  • Urgent referral to hospital for specialist assessment (?999)
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9
Q

CHICKEN POX
What is chicken pox?

A
  • Primary infection by Varicella zoster virus (human herpes virus 3)
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10
Q

CHICKEN POX
What are some risk factors for chicken pox?

A
  • Immunocompromised
  • Older age
  • Steroids
  • Malignancy
  • Neonates
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11
Q

CHICKEN POX
What is the clinical presentation of chicken pox?

A
  • Prodromal high fever 38-39 often ceases when rash appears, malaise
  • Very itchy, vesicular rash starts on head + trunk > peripheries
  • Not infective once vesicles have crusted over (5d usually)
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12
Q

CHICKEN POX
What are some complications of chicken pox?

A
  • Secondary bacterial infection
  • Shingles (older children)
  • Ramsay Hunt syndrome (older children)
  • Risk to immunocompromised, neonates + pregnant women
  • Rarer = pneumonia, encephalitis
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13
Q

CHICKEN POX
How does secondary bacterial infection present in chicken pox?
How is it managed?

A
  • Small area of cellulitis or erythema, persistent fever
  • Small risk staph/group A strep infection > necrotising fasciitis
  • NSAIDs may increase risk, Rx with Abx (IV if severe or dehydrated)
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14
Q

CHICKEN POX
What is shingles?

A
  • Reactivation of dormant virus > herpes zoster virus (shingles) in dorsal root ganglia
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15
Q

CHICKEN POX
What is Ramsay Hunt syndrome?

A
  • Herpes zoster oticus > reactivation of varicella zoster virus in geniculate ganglion of CN7
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16
Q

CHICKEN POX
What is the risk of chicken pox to…

i) immunocompromised?
ii) neonates?
iii) pregnant?

A

i) Disseminated disease, DIC, pneumonitis (VZIG if exposed to case)
ii) Mother develops shortly before/after delivery infant > VZIG + aciclovir
iii) Risk of foetal varicella syndrome if <20w

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17
Q

CHICKEN POX
What is the management of chicken pox?

A
  • Camomile lotion to stop itching
  • Avoid high risk groups
  • Trim nails
  • School exclusion until all lesions crusted over (usually 5d after rash)
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18
Q

MENINGITIS
What is meningitis?

A
  • Inflammation of the meninges which line the brain + spinal cord
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19
Q

MENINGITIS
What are the most common causes of bacterial meningitis?

A
  • Neonates = GBS or listeria monocytogenes
  • 1m–6y = N. meningitidis (gram -ve diplococci), S. pneumoniae (gram + ve cocci chain), H. influenzae
  • > 6y = meningococcus + pneumococcus, rarely TB
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20
Q

MENINGITIS
What are some other causes of meningitis?

A
  • Herpes simplex virus (HSV), enteroviruses, EBV + varicella zoster virus
  • Aseptic/sterile by malignancy or autoimmune diseases
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21
Q

MENINGITIS
What are the symptoms of meningitis?

A
  • Fever, headache, vomiting, drowsiness, poor feeding, irritable/lethargic
  • Later may have seizures, focal neurology, decreased GCS/coma
  • Neonates may have hypothermia, lethargy + hypotonia
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22
Q

MENINGITIS
What are some signs of meningitis?

A
  • Meningism = neck stiffness (not always present), photophobia
  • Bulging fontanelle, opisthotonos, signs of shock
  • +ve Kernig’s + Brudzinski
  • Non-blanching petechial/purpuric rash = later sign in meningococcal septicaemia (endotoxin causes DIC + subcut haemorrhages)
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23
Q

MENINGITIS
What is the difference between Kernig’s and Brudzinski signs?

A
  • Kernig = pain/unable to extend leg at knee when it’s bent
  • Brudzinski = involuntary flexion of hips/knees when neck flexed
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24
Q

MENINGITIS
What investigations would you do for meningitis?

A
  • Blood cultures + serology (before LP + Abx unless undesirable delay)
  • FBC, U+E, LFTs, CRP, blood glucose
  • LP for MC&S with protein, cell count, glucose + viral PCR
  • ?CT head if other signs like papilloedema
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25
MENINGITIS When would you not perform a lumbar puncture? Why?
- Signs of increased ICP, focal neurology, local infection, unduly delay starting Abx or coagulopathies - Coning of cerebellar tonsils via foramen magnum
26
MENINGITIS You suspect a diagnosis of bacterial meningitis. How would a lumbar puncture confirm the diagnosis for... i) appearance? ii) protein? iii) glucose? iv) white cell count? v) other?
i) Cloudy/turbid ii) ++ (make protein) iii) –– (eat glucose) iv) ++ neutrophil polymorphs v) Gram stain
27
MENINGITIS You suspect a diagnosis of viral meningitis. How would a lumbar puncture confirm the diagnosis for... i) appearance? ii) protein? iii) glucose? iv) white cell count? v) other?
i) Clear ii) Normal/+ iii) Normal/- iv) + lymphocytes v) PCR
28
MENINGITIS You suspect a diagnosis of TB meningitis. How would a lumbar puncture confirm the diagnosis for... i) appearance? ii) protein? iii) glucose? iv) white cell count? v) other?
i) Turbid/viscous ii) +++ iii) ––– iv) + lymphocytes v) Acid fast bacilli
29
MENINGITIS What are some complications of meningitis?
- Hearing (sensorineural) loss is key complication - Seizures + epilepsy, cerebral abscess, encephalitis + hydrocephalus - Cognitive impairment, cerebral palsy + LD
30
MENINGITIS What is the management of bacterial meningitis?
- Supportive = correct shock with fluids, oxygen if needed - <3m = IV cefotaxime + amoxicillin (cover listeria from ?pregnancy) - >3m = IV ceftriaxone + IV dexamethasone to reduce frequency + severity of hearing loss + neuro damage (NOT before 3m)
31
MENINGITIS What is the management of viral meningitis?
- Milder so supportive + aciclovir if HSV or VSZ
32
MENINGITIS You see a child with a non-blanching petechial rash in GP and are concerned about meningococcal septicaemia so call for an ambulance. What immediate treatment should you give if possible?
- IM benzylpenicillin
33
MENINGITIS What shoudl be given to close contacts?
- Single dose ciprofloxacin or rifampicin - Ciprofloxacin is prefered as can use for any age, pregnant ladies + does not interfere with OCP
34
MENINGITIS What are the drawbacks with giving ciprofloxacin to a close contact?
- Do not give in myasthenia gravis or previous sensitivity, - can cause tendinitis - can trigger seizures
35
MENINGITIS What Public Health aspects are important in terms of meningitis?
- Meningitis B vaccine at 8w, 16w + 1y (men C at 1y too) and ACWY offered to teenagers + uni students - Bacterial meningitis + meningococcal = notifiable diseases
36
ENCEPHALITIS What is encephalitis?
- Inflammation of the brain parenchyma
37
ENCEPHALITIS What is the clinical presentation of encephalitis?
- Similar to meningitis = fever, headache, photophobia, neck stiffness - KEY difference = altered mental state (behavioural change, confusion) - Acute onset focal neurology (hemiparesis, dysphasia, focal seizures)
38
ENCEPHALITIS What are the investigations for encephalitis?
- FBC, U+Es, blood cultures + serology for viral PCR - LP for MC&S with protein, cell count, glucose + viral PCR - CT/MRI head to visualise brain as ?focal changes, particularly temporal lobes
39
ENCEPHALITIS What would the CSF analysis show in encephalitis for... i) appearance? ii) protein? iii) glucose? iv) white cell count?
i) Clear ii) Normal/+ iii) Normal/– iv) + lymphocytes
40
ENCEPHALITIS What is the management of encephalitis?
- IV aciclovir to cover HSV, Abx in case bacterial meningitis - Supportive therapy in HDU/ICU if needed
41
KAWASAKI DISEASE What is Kawasaki disease? What is the epidemiology?
- Idiopathic medium-sized vessel systemic vasculitis, mainly affects 6m–5y - More common in children of Japanese or Afro-Caribbean ethnicity
42
KAWASAKI DISEASE what are the clinical features?
SYMPTOMS - irritability - pain in >1 joint - swelling in hands and feet - redness in palms and soles (may peel) SIGNS - persistently high fever >5 days (refractory to antipyrexics) - conjunctival injection (red eye without exudate) - strawberry tongue (red, swollen + covered in small bumps) - cervical lymphadenopathy - red cracked lips - polymorphous rash (morbilliform, maculopapular or scarlatiniform)
43
KAWASAKI DISEASE What is the diagnostic criteria for Kawasaki disease?
Fever + 4 (MyHEART) – - Mucosal involvement (red/dry cracked lips, strawberry tongue) - Hands + feet (erythema then desquamation) - Eyes (bilateral conjunctival injection, non-purulent) - lymphAdenopathy (unilateral cervical >1.5cm) - Rash (polymorphic involving extremities, trunk + perineal regions - Temp >39 for >5d
44
KAWASAKI DISEASE What are the 3 phases of Kawasaki disease?
- Acute (1–2w) = child most unwell, fever, rash, lymphadenopathy - Subacute (2–4w) = acute Sx settle, desquamation + Risk of coronary artery aneurysms - Convalescent (2–4w) = remaining Sx settle, blood markers normalise slowly
45
KAWASAKI DISEASE What is a key complication of Kawasaki disease?
- Coronary artery aneurysm + sudden death
46
KAWASAKI DISEASE What is the management of Kawasaki disease?
1ST LINE - IV immunoglobulin (IVIg) - aspirin - follow-up echocardiogram 2ND LINE - corticosteroids
47
KAWASAKI DISEASE Why is the management of Kawasaki disease unique? Prognosis?
- Aspirin normally contraindicated in children due to risk of Reye's syndrome (swelling of the liver + brain) - 50% evidence of cardiac impairment + mild MR, long-term follow up
48
MEASLES What is measles?
- Infection with measles virus (RNA paramyxovirus) via droplets (highly contagious)
49
MEASLES What is the clinical presentation of measles?
- Prodromal Sx for 3–5d (CCCK) – Cough, Coryza, Conjunctivitis, Koplik spots - Maculopapular rash starts on forehead, neck + behind ears > down to limb, trunk - Fever, marked malaise
50
MEASLES What are Koplik spots?
- White spots on buccal mucosa = pathognomonic
51
MEASLES What are some important complications of measles?
- Otitis media (commonest complication) - Pneumonia (commonest cause of death) - Diarrhoea - Febrile convulsions, encephalitis - Subacute sclerosing panencephalitis rare where 5-10y after primary measles > loss of neuro function, dementia + death
52
MEASLES What is the management of measles?
- Notifiable disease - notify health protection team 1st line - conservative management (rest, oral fluids, paracetamol/ibuprofen) - school/work absence for 4 days after initial development of rash + avoid contact with susceptible people
53
RUBELLA What is rubella? How does it spread?
- Mild notifiable disease occurring in winter + spring - Spreads via respiratory route, often from known contact, prevention via vaccine
54
RUBELLA What is the clinical presentation of rubella?
SYMPTOMS - rash - arthralgia - prodromal symptoms (low grade fever, headache, malaise, coryza) SIGNS - maculopapular rash (starts on face before spreading down neck + becoming generalised) - lymphadenopathy (suboccipital, postauricular and cervical)
55
RUBELLA What are the investigations for rubella?
- oral fluid sample to consider - test for alternative infections
56
RUBELLA What are some complications of rubella? How can it be reduced?
- Rare but > encephalitis, arthritis, myocarditis + thrombocytopenia - Congenital rubella syndrome > cataracts, CHD + sensorineural deafness - Avoid pregnant women, school exclusion 4d from rash, ensure vaccinated
57
RUBELLA what is the management?
NON-PREGNANT - conservative (rest, fluids, paracetamol/ibuprofen) - school/work absence for 5 days after initial development of rash + avoid contact with susceptible people PREGNANT - gestation <20 weeks = referred urgently to obstetrics for assessment due to higher risk of congenital rubella syndrome, immunoglobulin may be considered gestation >20 weeks = reassured not at risk of congenital rubella syndrome
58
MUMPS What is mumps? How does it occur?
- RNA paramyxovirus, occurs in winter + spring, spreads via resp droplets where virus replicates in epithelial cells - Virus accesses parotid glands before further dissemination
59
MUMPS What is the clinical presentation of mumps?
SYMPTOMS - parotid gland swelling - earache - difficulty with chewing/pronouncing words - prodromal symptoms (fatigue, headache, fever, malaise, muscle ache) SIGNS - parotid gland swelling and tenderness (often unilateral before becoming bilateral)
60
MUMPS What are some complications of mumps?
- Viral meningitis + encephalitis - Orchitis (usually unilateral, may reduce sperm count + lead to infertility) - Pancreatitis
61
MUMPS what are the investigations?
clinical diagnosis to consider - oral fluid sample
62
MUMPS What is the management of mumps?
- Notifiable disease 1st line - conservative management (rest, fluids + paracetamol/ibuprofen) - school/work absence for 5 day after initial development of parotitis
63
HAND, FOOT + MOUTH What is hand, foot and mouth disease caused by?
- Caused by coxsackie A16 virus
64
HAND, FOOT + MOUTH What is the management of hand, foot and mouth disease?
- Subsides within few days, supportive with fluids, analgesia - Very contagious, avoid sharing towels + bedding, good handwashing - Only exclude from school if unwell
65
SCARLET FEVER What is scarlet fever?
- Reaction to strep pyogenes (group A beta haemolytic) toxin - strep A
66
SCARLET FEVER What is the clinical presentation of scarlet fever?
SYMPTOMS - sore throat - fever (>38.3 degrees) - fatigue - nausea and vomiting - headache SIGNS - petechiae on hand and soft palate - strawberry tongue (erythema, white exudate, enlarged papillae) - rash (widespread, erythematous, blanching, pinpoint 'sandpaper' texture, accentuated in flexure creases, begins on trunk, spares palms and soles) - cervical lymphadenopathy - facial flushing
67
SCARLET FEVER how is the rash described?
widespread rash erythematous blanching pinpoint 'sandpaper' texture accentuated in flexure creases begins on trunk spares palms and soles
68
SCARLET FEVER What is the investigation of choice for scarlet fever?
- Throat swab (but start Abx)
69
SCARLET FEVER What is the management of scarlet fever?
- Notifiable disease - Phenoxymethylpenicillin for 10d to prevent rheumatic fever - Supportive (fluids, pain relief) - School exclusion until 24h after Abx
70
SLAPPED CHEEK What is slapped cheek syndrome, or erythema infectiosum?
- Caused by parvovirus B19, outbreaks common during spring months
71
SLAPPED CHEEK What is the clinical presentation of slapped cheek syndrome?
- Prodromal Sx = fever, malaise, headache, myalgia - Followed by classic rose-red rash on face week later (slapped-cheek) - Progresses to maculopapular, 'lace-like' rash on trunk + limbs
72
SLAPPED CHEEK What are some complications of slapped cheek syndrome?
- Aplastic crisis (most serious) more common in chronic haemolytic anaemias like sickle cell, thalassaemia + in immunocompromised - Vertical transmission can lead to foetal hydrops + death due to severe anaemia
73
STAPH + STREP INFECTION What are the different ways that staph can cause diseases?
- Direct invasion of bacteria = abscess, cellulitis, impetigo - Toxin-mediated (indirect) = toxic shock, food poisoning - Toxin-mediated (direct) = SSS
74
STAPH + STREP INFECTION What is a boil? How are they managed?
- Infections of hair follicles or sweat glands by s. aureus - Systemic Abx + occasionally surgery
75
STAPH SCALDED SKIN What is staphylococcal scalded skin syndrome (SSSS)?
- Caused by type of S. aureus that produces epidermolytic toxins that breakdown proteins that hold skin together
76
STAPH SCALDED SKIN what is the epidemiology?
usually affects children <5yrs older children and adults usually have developed immunity to epidermolytic toxins
77
STAPH SCALDED SKIN What is the clinical presentation of SSSS?
- Starts as generalised patches of erythema on the skin, skin looks thin + wrinkled - Bullae formation which burst + leave very sore, erythematous skin below (like a burn/scald) - Nikolsky sign = gentle rubbing causes peeling - Systemic Sx = fever, lethargy, dehydration > sepsis
78
STAPH SCALDED SKIN What is the management of SSSS?
- Most need admission for IV flucloxacillin, fluid balance + analgesia
79
HERPES SIMPLEX What are the two types of herpes simplex virus?
- HSV1 = lip + skin lesion, - HSV2 = genital lesions
80
HERPES SIMPLEX What are the various manifestations of herpes simplex infection?
- Gingivostomatitis - Cold sores on lip - Eczema herpeticum - Herpetic whitlows - Eyes = blepharitis or conjunctivitis - CNS = aseptic meningitis, encephalitis
81
HERPES SIMPLEX What is gingivostomatitis? How may it present?
- Vesicular lesions on lips, gums, tongue which can lead to painful ulceration + bleeding - High fever, miserable child, oral intake may hurt
82
HERPES SIMPLEX What is eczema herpeticum? How does it present?
- Widespread vesicular lesions with pus developing on eczematous skin - Fever, lethargy, lymphadenopathy
83
HERPES SIMPLEX What are herpetic whitlows? How can they occur?
- Painful pustules on site of broken skin on fingers - Infected adult kissing a child's finger
84
VACCINATIONS What is the process of vaccinations?
- Induce T + B cell (antibody) immunity - Induce immunological memory - Herd immunity to protect those who haven't been immunised
85
VACCINATIONS How should vaccinations be given in those who are premature?
- Not adjusted for prematurity, give chronologically - Babies born <28w should receive first set in hospital due to risk of apnoea
86
VACCINATIONS What are the two types of immunity?
- Active = give part of pathogen either non-living or attenuated (live but weak) - Passive = give them antibodies to pathogen (natural = cross-placental transfer, artificial = treated with human IgG)
87
VACCINATIONS What vaccines are attenuated?
- MMR, BCG, nasal flu, rotavirus + Men B
88
VACCINATIONS What vaccines are given at... i) 2m? ii) 3m? iii) 4m?
i) 6-in-one, rotavirus + men B ii) 6-in-one, rotavirus + PCV iii) 6-in-one, men B
89
VACCINATIONS What vaccines are given at... i) 1y? ii) 3y + 4m? iii) 12-13y? iv) 14y?
i) Men B, PCV, Hib/Men C + MMR ii) MMR, 4-in-one preschool booster = DTaP + IPV iii) HPV iv) 3-in-1 teenage booster = tetanus, diphtheria + IPV, men ACWY
90
VACCINATIONS What extra vaccines may be considered?
- Babies born to mothers with hepatitis B = hep B - Neonates at TB risk = BCG - Children 6m-17y with chronic health conditions get yearly flu vaccine (nasal yearly flu normally 2–10y)
91
VACCINATIONS When in the vaccination schedule would at risk individuals get... i) hep B vaccine? ii) BCG?
i) Neonate, 1m and 1y (as well as 2m, 3m, 4m as normal schedule) ii) Neonate
92
ALLERGY What is an allergy? Give examples
- Hypersensitivity reaction initiated by specific immunoglobulins - Food allergy, eczema, allergic rhinitis, asthma, urticaria, insect sting, drugs, latex + anaphylaxis
93
ALLERGY Define hypersensitivity
Objectively reproducible symptoms/signs following a defined stimulus at a dose tolerated by a normal person
94
ALLERGY What are two theories of allergy and briefly explain them?
- Hygiene hypothesis = high microbial exposure means less allergy - Skin sensitisation theory = regular exposure via food + preventing exposure via breaks in skin before food means less allergies
95
ALLERGY What are 2 broad categories of allergens?
- Inhalant = house-dust mite, plant pollens, moulds in asthma - Ingestant = nuts, cow's milk, eggs, seafood
96
ALLERGY What are the 2 broad types of allergy?
- IgE mediated (some food allergies, allergic asthma) - Non-IgE mediated (coeliac disease, some food allergies)
97
ALLERGY How does IgE mediated allergies present?
- Early phase within minutes where release of histamines from mast cells > urticaria, angioedema, sneezing + bronchospasm with a late response 4-6h later with nasal congestion, cough + bronchospasm of lower airway - Urticaria can be trigger if in sun or if child gets hot/cold
98
ALLERGY How does non-IgE mediated allergies present?
- Typically, delayed onset of Sx + a more varied clinical course
99
ALLERGY What is the Gell and Coombs hypersensitivity classification?
- Type 1 = IgE trigger mast cells + basophils to release histamines + cytokines - Type 2 = IgG/M bind to cell-surface antigens which is a host cell but activates immune system as considers foreign > cytotoxic - Type 3 = immune complex mediated with activation of complement/IgG - Type 4 = T-cell mediated delayed type hypersensitivity
100
ALLERGY Give an example of a type 1hypersensitivity reaction
- acute anaphylaxis, - hayfever
101
ALLERGY What are some investigations that can be done in allergy?
- Skin prick test = test a patch + compare the size of wheals with controls - Patch test = useful in allergic contact dermatitis where place a patch of allergens + assess the skins' reaction - RAST test = measures total + allergen specific IgE in blood - Food challenge test = slowly increase exposure to allergen + measure response
102
ANAPHYLAXIS What is anaphylaxis?
- Severe T1 hypersensitivity reaction where IgE stimulates mast cells to rapidly release histamine + other pro-inflammatory chemicals (mast cell degranulation)
103
ANAPHYLAXIS What is a consequence of anaphylaxis? What can trigger it?
- Compromise in ABC = life-threatening medical emergency - Foods (peanuts), insect stings, drugs, latex
104
ANAPHYLAXIS What is the clinical presentation of anaphylaxis?
- Rapid onset allergic Sx = urticaria, itching, angioedema with swelling around lips + eyes - Anaphylaxis Sx = SOB, wheeze, stridor (larynx swelling), tachycardia, light-headed + collapse
105
ANAPHYLAXIS What investigation confirms anaphylaxis?
- Serum mast cell tryptase within 6h of event = mast cell degranulation
106
ANAPHYLAXIS What is the acute management of anaphylaxis?
- Airway = secure - Breathing = oxygen, salbutamol to help wheeze, monitor SpO2, RR - Circulation = IV fluid bolus with collapse, monitor BP, ECG - Disability = lie pt flat to improve cerebral perfusion - Exposure = look for flushing, urticaria + angioedema
107
ANAPHYLAXIS What medications can be given in anaphylaxis?
- IM adrenaline (EpiPen if community), repeat after 5m if necessary - Antihistamines like chlorphenamine or cetirizine - Steroids like IV hydrocortisone
108
IMMUNE DEFICIENCY What are the 2 broad types of immune deficiency?
- Primary (uncommon) = intrinsic defect in the immune system - Secondary = due to another disease or treatment (HIV, nephrotic syndrome)
109
IMMUNE DEFICIENCY What are the 6 types of immune deficiency?
- T-cell defects - B-cell defects - Combined B- + T-cell defects - Neutrophil defect - Leucocyte function defect - Complement defects
110
IMMUNE DEFICIENCY What are T-cell defects?
- Severe/unusual viral + fungal infections + failure to thrive in first 2m
111
IMMUNE DEFICIENCY What are B-cell defects? Give some examples
- Present beyond infancy as passively acquired maternal antibodies, severe bacterial infections, esp. (lower) RTIs. - Selective IgA deficiency (#1) - X-linked (Bruton) agammaglobulinaemia - Common variable immune deficiency
112
IMMUNE DEFICIENCY Give some examples of combined B- and T-cell disorders
- Severe combined immunodeficiency = group of inherited disorders of profound defective cellular + humoral immunity - Hyper IgM syndrome = B cells produce IgM but prevented from IgG/A
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IMMUNE DEFICIENCY What do neutrophil defects lead to? Give an example
- Recurrent bacterial infections - Chronic granulomatous disease = X-linked recessive, defect in phagocytosis as fail to produce superoxide after ingestion
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IMMUNE DEFICIENCY What are leucocyte function defects? Give an example
- Delayed separation of umbilical cord, wound healing, chronic skin ulcers - Leucocyte adhesion deficiency = deficiency of neutrophil surface adhesion molecules so inability to migrate to sites of infection
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IMMUNE DEFICIENCY What are complement defects? Examples
- Recurrent bacterial infections (meningococcal, HiB, pneumococcus), SLE-like illness - Hereditary angioedema (measure C4 levels) - Mannose-binding lectin deficiency
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IMMUNE DEFICIENCY What are some investigations for immune deficiency?
- FBC (WCC, lymphocytes, neutrophils) - Blood film - Complement - Immunoglobulins
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IMMUNE DEFICIENCY What prophylaxis should be given in immune deficiency?
- T-cell + neutrophil = co-trimoxazole for PCP, fluconazole for fungal - B-cell = azithromycin for recurrent bacterial infections
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IMMUNE DEFICIENCY What is the management of immune deficiency?
- Prompt, appropriate + longer Abx courses - Screen for end-organ disease (CT scan) - Ig replacement therapy if antibody deficient - Bone marrow transplantation for SCID, chronic granulomatous disease
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WHOOPING COUGH What is it?
- Highly contagious form of bronchitis caused by Bordetella pertussis > gram -ve aerobic coccobacillus
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WHOOPING COUGH what is the incubation period and how long is a person infectious for?
incubation = 7 days infectious for 3 weeks after onset of symptoms
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WHOOPING COUGH what are the different stages of disease progression?
- catarrhal - paroxysmal - convalescent
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WHOOPING COUGH What is the clinical presentation of pertussis?
CATARRHAL STAGE (1-2 weeks) - dry unproductive cough - low grade fever - coryzal symptoms PAROXYSMAL STAGE (1 week after catarrhal, lasts up to 6 weeks) - coughing fits (inspiratory whoop) - vomiting after coughing CONVALESCENT STAGE (lasts up to 6 months) - gradual improvement of symptoms
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WHOOPING COUGH How long does the cough last?
- Can last for months = '100 day cough'
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WHOOPING COUGH What are the investigations?
- Nasopharyngeal swab with bacterial culture or PCR - Marked lymphocytosis on blood film (predom high lymphocytes) - Test for anti-pertussis toxin IgG if cough >2w
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WHOOPING COUGH What are some complications of pertussis?
- Pneumonia - Convulsions - Bronchiectasis
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WHOOPING COUGH What is the management of pertussis?
- Notify PHE - Prophylaxis = vaccine (esp. infants + pregnant women) or if close contact macrolide (erythromycin) - PO macrolides (azithromycin, clarithromycin) 1st line if onset <21d - School exclusion for 48h following Abx or 21d from onset if no Abx
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WHOOPING COUGH When should you admit a child to hospital with pertussis?
- Suffering from cyanotic attacks - <6m and acutely unwell - significant complication e.g. seizure
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POLIO what is the cause?
poliovirus type 1
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POLIO what is the pathophysiology?
- transmitted via faecal-oral route - incubation period is 3-30 days + can be excreted for up to 6 weeks - replicates in nasopharynx + GI tract and can spread to CNS where it can affect anterior horn cells, motor neurons and the brainstem
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POLIO what is the clinical presentation?
90-95% of cases are asymptomatic fatigue fever nausea and vomiting diarrhoea sore throat headache photophobia
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POLIO what are the clinical features of a more serious polio infection?
acute flaccid paralysis (AFP) - initially fatigue, fever N+V - asymmetrical lower limb weakness and flaccidity can progress to life-threatening bulbar paralysis and respiratory compromise
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POLIO what are the investigations?
- virus culture from stool, CSF or pharynx - CSF analysis - serum antibodies to poliovirus - MRI of spinal cord - EMG of affected limb(s)
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POLIO what is the management?
- supportive care with rehydration and neurological monitoring - physiotherapy - intubation and ventilation for respiratory paralysis
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POLIO what are the complications?
post-poliomyelitis syndrome (PPS) - this usually occurs years after the initial infection - demonstrates the same features as polio infection - treated in the same way as polio
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DIPHTHERIA what is the cause?
Corynebacterium diphtheriae
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DIPHTHERIA what is the pathophysiology?
- it infects the epithelium of the skin and the mucosa of the upper resp tract - it forms a grey pseudomembrane on the tonsils
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DIPHTHERIA what is the clinical presentation?
recent visitors to eastern Europe/Russia/Asia - sore throat - low grade fever - dysphagia, dysphonia, dyspnoea and croupy cough can occur in serious illness - bulky cervical lymphadenopathy - neuritis e.g. cranial nerves - heart block
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DIPHTHERIA what are the investigations?
- throat + nose swabs, microscopy and culture (uses tellurite agar or Loeffler's media) - diphtheria antibodies - PCR
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DIPHTHERIA what is the management?
- hospitalisation, isolation - diphtheria anti-toxin - IM penicillin
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DIPHTHERIA what is the management for close-contacts?
prophylactic antibiotics - erythromycin diphtheria toxoid immunisation
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CANDIDIASIS what is the cause?
candida albicans fungus
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CANDIDIASIS what are the predisposing factors?
- moist body folds - treatment with broad spectrum antibiotics - immunosuppression - diabetes mellitus
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CANDIDIASIS where can it occur?
- skin folds - vagina - penis - mouth - corners of mouth - nail beds (paronychia)
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CANDIDIASIS what are the investigations?
skin scrapings for microscopy and culture
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CANDIDIASIS what is the management?
oral or topical anti-candidial drugs e.g. nystatin, fluconazole
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CANDIDIASIS what is the clinical presentation?
- rash/scaling - white/yellow vaginal discharge - white patches on tongue - cracks at the corner of mouth - white/yellow nail that separates from the nail bed
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CHICKEN POX How does it spread?
Droplet via resp route
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CHICKEN POX How long is it contagious for?
Contagious 4d before rash + until lesions crusted (often 5d)
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CHICKEN POX What is the management of shingles?
PO aciclovir
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CHICKEN POX How does shingles present?
Characteristic rash in dermatomal distribution, acute, unilateral, blistering painful rash
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CHICKEN POX What is the management of Ramsay Hunt syndrome?
PO aciclovir + corticosteroids
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CHICKEN POX How does Ramsay Hunt Syndrome present?
- Auricular pain, - facial nerve palsy, - vesicular rash around ear, - ?vertigo + tinnitus
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MENINGITIS How does it occur?
Microorganisms reach meninges by direct extension from ears, nasopharynx or bloodstream spread
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MENINGITIS What are the drawbacks with giving rifampicin to a close contact?
- Affect hormonal contraception, - not advised in pregnancy - have to monitor LFTs + renal function
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ENCEPHALITIS What causes it?
- Mostly viral – herpes viruses (HSV 1 if child or 2 if neonate from birth, VZV), enteroviruses, EBV, resp viruses - Non viral = any bacterial meningitis, TB, lyme disease - Non-infective = autoimmune antibodies against brain
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KAWASAKI DISEASE What are some investigations for Kawasaki disease?
ESR/CRP = elevated FBC = leukocytosis, anaemia, thrombocytosis echocardiogram to consider - ECG - lumbar puncture (to rule out meningitis)
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KAWASAKI DISEASE What are the side effects of IVIG in the management of Kawasaki disease?
- anaphylaxis, - aseptic meningitis, - organ dysfunction
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MEASLES What is a risk factor?
close contact with infected person Avoidance of MMR vaccine infants pregancy/immunocompromised
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MEASLES What are the investigations for measles?
Clinical Dx 1st line = oral fluid sample to consider - serum measles IgM/IgG - mouth/throat swabs
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MUMPS What marker may be raised?
Raised amylase
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HAND, FOOT + MOUTH How does it present?
- Mild viral URTI (sore throat, cough, fever) - Painful red vesicular lesions on hands, feet, mouth + tongue (often buttocks too)
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SCARLET FEVER How is it spread?
- Via respiratory droplets
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SCARLET FEVER What are some complications of scarlet fever?
- Otitis media (#1), - quinsy, - post-strep glomerulonephritis, - rheumatic fever
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SLAPPED CHEEK What is important to note in slapped cheek syndrome?
Infects red cell precursors in bone marrow which can cause complications
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SLAPPED CHEEK How is it spread?
- Respiratory secretions, - vertical transmission - transfusions
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STAPH SCALDED SKIN Who is it more common in?
Children <5y as when older they develop immunity to toxins
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STAPH SCALDED SKIN What is an important differential?
Steven-Johnson's syndrome
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HERPES SIMPLEX How is it spread?
- Enters via mucous membranes or skin (kissing, genital contact, vertical transmission at birth)
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HERPES SIMPLEX How is gingivostomatitis managed?
Supportive but PO aciclovir if severe, chlorhexidine mouthwash
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HERPES SIMPLEX What is a complication of eczema herpeticum?
Secondary bacterial infection + septicaemia
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HERPES SIMPLEX How is eczema herpeticum managed?
IV aciclovir as life-threatening, bacterial infection will need Abx
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ALLERGY Define atopy
Personal/familial tendency to produce IgE in response to ordinary exposures to allergens (triad = eczema, asthma + rhinitis)
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ALLERGY Give an example of a type 2 hypersensitivity reaction
- autoimmune disease, - haemolytic disease of newborn, - transfusion reaction
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ALLERGY Give an example of a type 3 hypersensitivity reaction
- SLE, - RA, - HSP, - post-strep glomerulonephritis
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ALLERGY Give an example for of a type 4 hypersensitivity reaction
- TB, - contact dermatitis
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ALLERGY what is the pathophysiology of a type 1 hypersensitivity reaction?
IgE trigger mast cells + basophils to release histamines + cytokines
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ALLERGY what is the pathophysiology of a type 2 hypersensitivity reaction?
IgG/M bind to cell-surface antigens which is a host cell but activates immune system as considers foreign > cytotoxic
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ALLERGY what is the pathophysiology of a type 3 hypersensitivity reaction?
immune complex mediated with activation of complement/IgG
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ALLERGY what is the pathophysiology of a type 4 hypersensitivity reaction?
T-cell mediated delayed type hypersensitivity
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IMMUNE DEFICIENCY When would you suspect immune deficiency?
Severe, prolonged, unusual or recurrent (SPUR) infections
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IMMUNE DEFICIENCY Give some examples of T-cell defects
- DiGeorge syndrome - HIV - Duncan syndrome (X-linked lymphoproliferative disease) - Ataxic telangiectasia - Wiskott-Aldrich
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VACCINATIONS What advise is given for vaccines that are attenuated?
Can give fever, advise normal + administer paracetamol
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VACCINATIONS Which vaccines are included in the 6-in-1 injection?
- diphtheria - tetanus - pertussis DTaP (whooping cough) - polio IPV - Haemophilus influenza B (HiB) - Hepatitis B

MY REVISION - ALL PHASES (36 decks)

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