27 - Infectious Diseases 2 Flashcards

Question

What is the most common cause of neonatal encephalitis?

Answer 1

**Herpes Simplex Virus** Can present up to 4 weeks after delivery, give IV aciclovir if mother infected with vulval herpes That is why shouldn't kiss newborns

Answer 2

Temporal changes on CT

Answer 3

* Gums * Lips * Eyes * Genitals

Answer 4

Varicella Zoster Virus * **Prodrome:** Fever is often the first symptom, fatigue and malaise * **Vesicular rash:** starting papular on trunk or face and spreading outwards * **Lesions scab over**

Answer 5

* Encourage fluids and give paracetamol * Trim nails * Calamine lotion * School exclusion until crusted over * **Immunocompromised patients and Newborns need varicella zoster immunoglobulin (VZIG).** If chickenpox develops then give IV aciclovir

Answer 6

* **Bacterial superinfection:** AVOID NSAIDs * **Pneumonia** * **Encephalitis** (cerebellar involvement may be seen) * **Disseminated haemorrhagic chickenpox** * **Arthritis, nephritis and pancreatiti**s

Answer 7

* Irritant/Ammonia dermatitis * Candida * Seborrhoeic dermatitis * Psoriasis * Atopic eczema

Answer 8

**Erythematous rash** which involve the **flexures** and has characteristic **satellite lesions** * Rash extending into skin folds * Larger red macules * Well demarcated scaly border * Circular pattern to the rash spreading outwards, similar to ringworm * Satellite lesions * May have oral thrush, check tongue

Answer 9

* **Clotrimazole +/- Hydrocortisone** depending on severity * Use highly absorbent disposable nappies not towel * Change nappy as soon as possible * Expose napkin area to air when possible * DO NOT use barrier preparation like sudocrem

Answer 10

* **Take a swab** if high risk * **Draw around area of redness** * **Antibacterial** * **Manage any underlying conditio**n that may predispose to cellulitis e.g diabetes, venous insufficiency, eczema, oedema * **Reassess if not improving** in 2-3 days of antibacterial or if spreading/pain out of proportion

Answer 11

* Under 1 * Orbital cellulitis * Osteomyelitis * Septic arthritis * Necrotising fasciitis * Sepsis

Answer 12

* Allergic * Viral * Bacterial

Answer 13

* **Highly infectious** caused by influenza viruses types (A, B, and C) * Influenza A more virulent and occurs more frequently; Influenza B is milder; and influenza C causes mild or asymptomatic disease, similar to common cold * **Symptoms usually appear suddenly:** chills, fever, headache, extreme fatigue, myalgia, dry cough, sore throat and nasal congestion

Answer 14

Self limiting between 2-7 days * Under 6 months * Pregnant and up to 2 weeks post partum * Severe immunosuppression * Long-term conditions such as respiratory, renal, hepatic, neurological or cardiac disease * Diabetes * Morbid obesity (BMI ≥ 40 )

Answer 15

* If simple treat at home supportively * If high risk give **Oseltamivir or Inhaled Zanamivir** within 48 hours of symptom onset

Answer 16

Late September to Late November * Children 6months or over who are high risk * All children aged 2–15 years * Children living in long-stay residential homes * Household contacts of immunocompromised individuals

Answer 17

**Live attenuated nasal spray** Does contain gelatin!!!

Answer 18

* Persistent cough * Weight loss and night sweats * Fever * Persistent oral candida * Persistent UTIs * Widespread lymphadenopathy * Hepatosplenomegaly * Failure to thrive * Developmental delay

Answer 19

**_Screened_** * Mantoux (affected by BCG) * Interferon GRA (not affected by BCG but cannot tell active from latent) **_Diagnosis_** * CXR * 3 x Sputum Smear * Sputum culture (gold standard) * NAAT

Answer 20

Decide whether directly observed or not **Initial Phase (2 months)** * Rifampicin * Isoniazid * Pyrazinamide * Ethambutol **Continuation Phase (4 months, 10 months if CNS involvement)** * Rifampicin * Isoniazid

Answer 21

Oral prednisolone or Dexamethasone slowly withdrawn over 4-8 weeks

Answer 22

* HIV positive * Diabetes * Anti-TNFa treatment * Immunosuppressed

Answer 23

**Neonates:** If contact, give I[soniazid](https://bnfc.nice.org.uk/drug/isoniazid.html) (with [pyridoxine hydrochloride](https://bnfc.nice.org.uk/drug/pyridoxine-hydrochloride.html)) followed by a Mantoux test after 6 weeks of treatment. If positive continue for 6 months, if negative stop and give BCG **4 weeks to 2 years:** Close contact with a person with tuberculosis which has not been treated for at least two weeks, should start treatment for latent tuberculosis and have a Mantoux test. Either [isoniazid](https://bnfc.nice.org.uk/drug/isoniazid.html) (with [pyridoxine hydrochloride](https://bnfc.nice.org.uk/drug/pyridoxine-hydrochloride.html)) alone for 6 months or [rifampicin](https://bnfc.nice.org.uk/drug/rifampicin.html) and [isoniazid](https://bnfc.nice.org.uk/drug/isoniazid.html) (with [pyridoxine hydrochloride](https://bnfc.nice.org.uk/drug/pyridoxine-hydrochloride.html)) for 3 months **\> 2 years:** Mantoux test, and if positive (and active tuberculosis is not present), then treat as above for children aged 4 weeks to 2 years. If the test is negative, then offer an interferon-gamma release assay after 6 weeks and repeat the Mantoux test

Answer 24

**Rotavirus (**also noro and adenovirus) Risk of dehydration Starts with vomiting then diarrhoea

Answer 25

**_Differentials_** * Systemic infection (UTI, pneumonia, meningitis, sepsis). * Appendicitis, intussusception, bowel obstruction, Hirschsprung’s * HUS

Answer 26

* Onset, frequency and duration of symptoms * Number of times child has urinated in past 24 hours * Any other family/contacts unwell? * Recent foreign travel? * Consumption of possible unsafe foods (takeaway, BBQ)? * Recent medication use (especially antibiotics)

Answer 27

* BM * If IV fluids being given check U+Es, VBG and glucose

Answer 28

**REHYDRATION** **_No dehydration_** * **Consider giving 5 ml/kg of ORS (Dioralyte)** or Apple juice after each large watery stool if at increased risk of dehydration * **Ondansetron** - effective at dramatically reducing vomiting * Encourage breastfeeding, other milk feeds and fluid intake * Give full strength milk straight away. * Reintroduce child’s usual solid food * Avoid fizzy drinks and fruit juices until diarrhoea has stopped

Answer 29

Stool culture for MC and S - Microscopy, culture and sensitivity

Answer 30

* Dehydration * Hypoglycaemia * Malnutrition * Lactose intolerance

Answer 31

* Cows' milk intolerance * Toddler diarrhoea * Coeliac disease * post-gastroenteritis lactose intolerance

Answer 32

**_Avoid breastfeeding_** **_At birth_** **Mode of delivery**: * ***Normal vaginal delivery if*** viral load \< 50 copies / ml * ***C section if*** \> 50 copies copies / ml and in all women with \> 400 * ***IV zidovudine*** during caesarean if viral load unknown or \> 10000 **Prophylaxis treatment to baby:** * **Low risk babies (mums viral load is \< 50):** zidovudine for 4 weeks * **High risk babies (mums viral load is \> 50 copies):** zidovudine, lamivudine and nevirapine for 4 weeks

Answer 33

**HIV PCR/Viral Load:** birth, 3 months, 6 months **HIV Antibodies:** done at 18-24 months as before mother's antibodies still present If both negative and mum is not breastfeeding then baby is HIV -ve

Answer 34

GAIN INFORMED CONSENT * PUO * Lymphadenopathy * Hepatosplenomegaly * Persistent diarrhoea * Parotid enlargement * Shingles * Recurrent slow-to-clear infections * Failure to thrive * TB; pneumocystosis; toxoplasmosis; cryptococcosis; histoplasmosis;

Answer 35

**_MDT Approach_** * ***Antiretroviral therapy*** (***ART***): aim for normal CD4 and undetectable viral load * ***Normal childhood vaccines***, avoiding or delaying live vaccines * ***Prophylactic*** ***co-trimoxazole*** (***Septrin***) for children with low CD4 counts, to protect against pneumocystis jirovecii pneumonia (PCP) * ***Treatment of opportunistic infections*** * ***Safe sex talk***

Answer 36

* **Majority clear within 2 months** * **Chronic Hep B:** 5% will develop cirrhosis and 0.05% will develop hepatocellular carcinoma before adulthood

Answer 37

* ***Surface antigen*** (***HBsAg***) – active infection * ***E antigen*** (***HBeAg***) – implies high infectivity * ***Core antibodies*** (***HBcAb***) – past or current infection * ***Surface antibody*** (***HBsAb***) – vaccination, past or current infection * ***Hepatitis B virus DNA*** (***HBV DNA***) – direct count of the viral load

Answer 38

* HBcAb (past infection if IgG, current it IgM) * HBsAg (current infection) If above are positive then test for HBeAg and HBDNA

Answer 39

**Given both of the following in first 24 hours of life:** * Hepatitis B vaccine * Hepatitis B immunoglobulin infusion * **Additional hep B vaccine at 1 and 12 months of age**, in addition to normal 2, 3, 4 months 6 in 1 * **Tested for HBsAg at 1 year**

Answer 40

Yes if baby had all vaccinations

Answer 41

Injection of HBsAg at 8, 12, 16 weeks as part of 6 in 1

Answer 42

Regular specialist follow up to assess monitor **serum ALT, HbeAg, HBV DNA, physical examination** and **Liver US**

Answer 43

* 5 – 15% of the time * Hep C antivirals and precautions not recommended in pregnancy * Very unlikely that children will pass on hep C to others as they do not engage in sexual activity or IV drug use

Answer 44

Yes as long as nipples are not cracked and bleeding

Answer 45

Hep C antibody test at 18 months

Answer 46

* Regular specialist follow up to monitor LFTs and hepatitis C viral load * Treatment is typically ***delayed until adulthood*** unless child is significantly affected, because children are usually asymptomatic * ***Pegylated interferon*** and ***ribavirin if aged over 3 and symptomatic***

Answer 47

Associated with COVID Mimics Kawasaki and Toxic shock syndrome. **KAWASHOCKI**

Answer 48

Do echocardiogram * **Myocarditis**: raised troponin and pro-BNP Coronary artery aneurysms in Kawasaki

Answer 49

To cover Group A strep

Answer 50

* IV methylprednisolone * Aspirin for thrombosis prevention * IV immunoglobulins * Clindamycin cover ALWAYS BE DOING ECHOCARDIOGRAMS

27 - Infectious Diseases 2 Flashcards

(80 cards)