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Paeds infection (ILA 1) Flashcards

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1
Q

What is meningitis?

A

inflammation of the meninges

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2
Q

Name the most common causative organisms causing bacterial meningitis if <3 months old

A

Group B streptococcus
E.coli
Listeria monocytogenes

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3
Q

Name the most common causative organisms causing bacterial meningitis in 1 month - 6 years old

A

SPREAD VIA RESP SECRETION
Neisseria meningitidis = gram - ve diplococci
Streptococcus pneumoniae
Haemophilus influenzae

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4
Q

Name the most common causative organisms causing bacterial meningitis if >6 years old

A

Neisseria meningitidis

Streptococcus pneumoniae

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5
Q

Name the causative organisms of viral meningitis

A

viral meningitis is the most common cause

enterovirus
Epstein Barr virus
adenovirus
mumps

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6
Q

List the symptoms of meningitis

A 
fever
headache
photophobia 
neck stiffness 
lethargy / irritable
poor feeding 
vomiting 
drowsiness
seizures
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7
Q

List the signs of meningitis

A 
fever
purpuric rash 
neck stiffness
bulging fontanelle 
positive brudzinski / kernels sign 
signs of shock
focal neurological signs
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8
Q

What are the best diagnostic tests for meningitis?

A
  1. lumbar puncture and CSF changes
  2. blood culture
  3. PCR - take EDTA blood sample
  4. septic screen!
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9
Q

When should a lumbar puncture not be performed if suspect meningitis?

A

if suspect meningococcus

if raised ICP or focal neurological signs - this is because at risk of coning the cerebellum through the foramen magnum

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10
Q

Outline the typical changes in the CSF in meningitis for bacterial or viral causes

A 
BACTERIAL
turbid appearance 
increased polymorphs
increased protein
decreased glucose

VIRAL
clear appearance 
increased lymphocytes
normal / slightly increased protein
normal/ slightly decreased glucose
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11
Q

how is meningitis managed in a child >3 months old in both the hospital and community?

A 
hospital = IV cefotaxime 
community = IM benzylpenicillin

+ fluids, cerebral monitorting, mechanical ventilation

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12
Q

How is meningitis managed in a child <3 months old?

A

IV cefotaxime + Iv amoxicillin

covers for listeria

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13
Q

What should be given in addition to the antibiotics if suspect the cause to be Haemophilus influenzae in meningitis

A

dexamethasone

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14
Q

What is given as prophylaxis to immediate family members/ close contact of a child with meningitis?

A

ciprofloxacin* or rifampicin

close contact = if live with child

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15
Q

What are the most common causes of encephalitis?

A

enterovirus
respiratory viruses e.g. influenza
herpes virus

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16
Q

How does encephalitis present?

A

presents similar to meningitis …

fever
altered consciousness
seizures

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17
Q

How is encephalitis diagnosed?

A
  1. PCR
  2. EEG
  3. CT/MRI
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18
Q

How is encephalitis treated?

A

high dose acyclovir

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19
Q

What are the most common causative organisms of toxic shock syndrome?

A

staphylococcus aureus

group A streptococcus

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20
Q

What is the diagnostic criteria for toxic shock syndrome?

A
  1. fever >39
  2. hypotension <90 systolic
  3. diffuse erythematous rash and desquamation of rash on palms and soles
  4. > 3 organ systems involved e.g. mucositis, diarrhoea, renal or lover impairment, clotting abnormalities
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21
Q

How is toxic shock managed?

A
  1. manage shock - intensive care
  2. antibiotics e.g. ceftriaxone + clindamycin
  3. IV immunoglobulin
  4. surgical debridement of infected areas
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22
Q

What is necrotising fasciitis?

A

severe subcutaneous infection, involving tissue planes from skin down to fascia and muscle

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23
Q

Name the common causes of necrotising fasciitis?

A

Type 1= mixed anaerobes e.g. post surgery in a diabetic

Type 2= streptococcus progenies, staph. aureus

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24
Q

How does necrotising fasciitis present?

A

severe painful erythematous lesion
systemic illness
acute onset
MEDICAL EMERGENCY

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25
How is necrotising fasciitis managed?
IV antibiotics surgical debridement of the necrosis tissue
26
What is kawasaki disease?
systemic vasculitis affecting children 6 months - 4 years old and most common in children of Japanese or Afro caribbean descent
27
How is a clinical diagnosis of kawasaki disease made?
``` CRASH AND BURN (>5 days fever difficult to control) C- conjunctivitis R- rash (erythematous and desquamation) A- adenopathy (cervical lymphadenopathy) S- strawberry tongue and cracked lips H- hands and feet red and oedematous ``` +/- irritable, inflammation of BCG site
28
Which investigation is necessary to screen for complications of kawasaki disease?
ECHOCARDIOGRAM to screen for coronary artery aneurysm children may require long term warfarin therapy if have coronary artery aneurysm
29
How is kawasaki disease managed?
1. high dose aspirin SE: REYES SYNDROME (encephalopathy), tarry stool, Abdominal pain 2. IV immunoglobulin SE: anaphylaxis, AKI, haemolytic anaemia
30
how does TB spread?
spreads by respiratory route and increasing transmission includes... - close proximity - infectious load - underlying immunodeficiency - crowding
31
What is the causative organism of TB?
mycobacterium tuberculosis
32
How does active TB present?
prolonged fever malaise weight loss focal signs of infection e.g. lymph node swelling resp = cough, sputum production, night sweats extra pulmonary disease = genitourinary, meningitis, osteoarticular
33
Which test is used to screen for latent TB?
Mantoux test / tuberculin skin test inject purified protein derived from tuberculin into forearm and read after 48-72 hours >5/6mm = positive
34
How is TB diagnosed?
1. Interferon gamma release assays blood test for TB, +ve = TB 2. sputum samples use Ziehl Neelsen statins for acid fast bacilli
35
How is active TB treated?
quadruple therapy of... Rifampicin Isoniazid Pyrazinamide Ethambutol
36
How is latent TB treated? (positive Mantoux test and asymptomatic)
3 months of rifampicin and isoniazid | BCG vaccination
37
How is TB prevented?
BCG vaccination
38
How is HIV transmitted to children?
1. mother to child transmission e.g. during pregnancy, at delivery, breast feeding 2. infected blood products 3. contaminated needles 4. sexual abuse
39
What is the pathology behind HIV?
Human Immunodeficiency Virus causes low levels of CD4 t cells so more susceptible to opportunistic infections
40
How might HIV present in children if mild/ moderate/severe immunocompromised?
1. MILD IMMUNOCOMPROMISED lymphadenopathy, parotid enlargement 2. MODERATE IMMUNOCOMPROMISED recurrent bacterial infections, chronic diarrhoea, lymphocytic interstitial pneumonitis 3. AIDS opportunistic infections e.g. pneumocytisis jirovecii pneumonia, encephalopathy, malignancy
41
How is HIV diagnosed?
HIV DNA PCR if born to infected mothers, will have transplacental maternal IgG HIV antibodies
42
How is HIV managed?
1. anti-retroviral therapy (ART) 2. prophylaxis of cotrimoxazole 3. immunisations up to date 4. MDT management 5. regular follow ups
43
What are the most common causes of sepsis?
E.coli * = early onset in neonates group B streptococcus = early onset in neonates staphylococcus aureus = late onset in neonates Neisseria meningitidis streptococcus pneumonia
44
What is sepsis?
inflammatory response to bacterial infection of the blood causing organ dysfunction
45
How does sepsis present?
``` fever lethargy irritable, miserable poor feeding history of focal infection e.g. meningitis, osteomyelitis, gastroenteritis, cellulitis ```
46
What are the signs of sepsis?
``` fever tachycardia tachypnoea low blood pressure shock multiorgan failure ```
47
List the features of a septic screen?
1. blood cultures 2. FBC 3. U&E 4. urine sample and MC&S 5. Chest X-ray 5. lumbar puncture and CSF 6. CRP and ESR
48
How is sepsis managed?
1. ABCDE - assess for signs of shock 2. IV antibiotics - start without delay 3. IV fluids - catheterise to monitor urine output, central venous pressure monitoring 4. circulatory support
49
What are the 4 most common key infections in children?
1. respiratory infection (pneumonia) 2. UTI 3. sepsis 4. meningitis
50
What is the cause of purpura?
purple red lesions on the skin, non blanching caused by blood vessels damaged by bacteria/ toxins of the infection and leaking blood under the skin
51
What are the contraindications of rifampicin and possible side effects?
do not wear contact lenses pregnancy SE= urine and tears red
52
How is chickenpox caused?
Primary Varicella zoster virus
53
Describe the features of chicken pox
Fever, unwell Vesicular rash on face and trunk Papules -> vesicles -> pustules -> crusts Itchy
54
How is chicken pox managed?
Calamine lotion Human varicella zoster immunoglobulin if immunocompromised or in close contact School exclusion for 5 days after rash
55
How does measles present?
C- cough C- coryza C- conjunctivitis K- koplik spots - white spots on buffalo mucosa + maculopapular rash behind ears to whole of body , fever
56
How is measles confirmed?
PCR- igM antibodies within few days of rash
57
How is measles managed?
1. Supportive 2. Ribavirin if immunocompromised 3. Notify public health 4. If close contacts unvaccinated, have MMR within 72 hrs
58
How is parvovirus caused?
Human parvovirus B19 Transmission via real secretions, vertical transmission, infected blood products
59
How does parvovirus present?
Slapped cheek syndrome - erythema infectiosum | With fever, malaise, headache and myalgia
60
What causes roseola infantum?
Human herpes virus 6
61
How does roseola infantum present?
Hugh fever Maculopapular rash Febrile convulsions Diarrhoea and cough Comp: a sceptic meningitis, hepatitis
62
How does mumps present?
Hugh fever Malaise Parotitis - swelling on one side of face, ear ache, pain on eating or drinking Infertility in boys
63
How is mumps diagnoses?
Plasma amylase elevated
64
How does herpes simplex virus 1 present?
Vesicular lesions on lips and gums and tongue - painful, ulceration, bleeding Eating and drinking painful Hugh fever For 2 weeks
65
How is herpes simplex virus managed?
Aciclovir - viral DNA polymerase inhibitor
66
What causes glandular fever / infectious mononucleosis?
Epstein Barr virus (HHV4)
67
How does glandular fever present?
1. Cervical lymphadenopathy 2. Fever 3. Painful sore throat + malaise, myalgia, fatigue, splenomegaly, Petechie on soft palate, jaundice
68
How is glandular fever diagnosed?
Mono spot test - antibodies test | FBC- lymphocytes
69
How is glandular fever managed?
1. Supportive care - fluids, analgesia, avoid alcohol, rest | 2. No contact sports for 8 weeks
70
How is scarlet fever caused?
Reaction to strep toxin after sore throat
71
How does scarlet fever present?
Strawberry tongue - white coat and red papillae Rash on torso , sandpaper Tonsillitis
72
Describe the rash in meningococcal septicaemia
non blanching purpuric | purpura occurs because toxins form the infection damage the blood vessels causing them to leak under the skin

3a Paediatrics (9 decks)

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