Infectious Diseases Flashcards

Question

State some common causes of viral meningitis

Answer 1

* Herpes simplex virus * Enterovirus * Varicella zoster virus (VZV)

Answer 2

GBS usually contracted during birth from GBS that harmlessly live in mother's vagina

Answer 3

_Neonates & babies can present with non-specific signs:_ * Poor feeding * Lethargy * Hypothermia * Fever * Hypotonia/floppy * Bulging fontanelle _May present with more specific signs & symptoms:_ * Fever * Neck stiffness * Headache * Vomiting * Photophobia * Altered consciousness * Seizures * If meningococcal septicaemia may have non-blanching rash

Answer 4

* **Kernig's test:** *lie pt flat on back, flex one hip and knee to 90 degrees then slowly straighten/extend knee whilst keeping hip flexed at 90 degrees. If produces pain or there is resistance to movement this indicates meningitis (as this position slightly stretches the meninges)* * **Brudzinski's test:** *lie pt flat on back and gently life their head & neck off the bed and flex their chin to their chest. If this causes the pt to involuntarily flex their hip and knees it's positive and indicates meningitis*

Answer 5

* \<1 month presenting with fever * 1-3 months with fever and are unwell * \<1yr with unexplained fever and other features of serious illness

Answer 6

* Blood glucose * Capillary blood gas * Bloods (FBC, U&Es, LFTs, CRP, coagulation screen, blood culture, meningococcal PCR if suspect meningococcal disease) * Lumbar puncture

Answer 7

* Signs suggesting **raised intracranial pressure** * Reduced or fluctuating consciousness * Relative bradycardia & hypertension * Unequal, dilated or unresponsive pupils * Papilloedema * Dolls eye movements * Focal neurological signs * Abnormal posture * **Shock** * **Coagulation abnormalities** * **Local superficial infection at lumbar puncture site** * **After convulsions until stabilised** * **Extensive or spreading purpura** * **Respiratory insufficiency** (lumbar puncture is considered to have a high risk of precipitating respiratory failure in the presence of respiratory insufficiency) * **Concerns about meningococcal septicaemia**

Answer 8

* Can give results quicker than blood culture (depending on local services) * Will still be positive after bacteria treated with abx

Answer 9

* Insert needle into L3-L4/L4-L5 intervertebral space * Go through skin, supraspinatus ligament, intraspinous ligament, ligamentum flavum, epidural space, dura, arachnoid * Send sample for bacterial culture, viral PCR, WCC, protein & glucose

Answer 10

_Rather than rote learning, think about if the bacteria or virus was living there_ * \*Bacteria release proteins and use up glucose* * \*Viruses release small amount of protein but not as much as bacteria and don't use glucose* * \*Immune system release neutrophils in response to bacteria and lymphocytes in response to viruses*

Answer 11

* If suspect meningitis and there is not a non-blanching rash, blue light to hospital * If have **suspected meningitis with a non-blanching rash or suspect meningococcal septicaemia** give urgent/stat i**njection of IM or IV benzylpenicillin prior to transfer to hospital** *(HOWEVER, giving abx should not delay transfter to hospital and if there is true penicillin allergy then transfer takes priority over finding other abx)*

Answer 12

Early escalation as with sepsis. * IV antibiotics * \<3 months: cefotaxime + amoxicillin *(amoxicillin to cover Listeria)* + gentamicin * 1-3 months: ceftriaxone + amoxcillin * \>3 months: ceftriazone * Add vancomycin if risk of penicillin resistant pneumococcal infection *(e.g. recent foreign travel or prolonged abx exposure)* * Dexamethasone QDS for 4/7 if \>3 months & lumbar puncture suggests bacterial meningitis * Supportive e.g. fluids, NG feeds * Notify public health

Answer 13

Idea that cannot distinguish between bacterial and viral clinically therefore would start bacterial management until have results. Once know it is viral: * Supportive e.g. fluids, NG feeds * Acyclovir in suspected or confirmed HSV or VZV infection

Answer 14

_Acute_ * Seizures * Sepsis * Intracerebral abscess * Raised ICP leading to brain herniation * Septic arthritis _Chronic_ * Sensorineural hearing loss * Cognitive impairment & learning disability * Cerebral palsy *(with focal neurological deficits e.g. limb weakness)* * Epilepsy

Answer 15

* Highest risk for those who had **prolonged contact within 7 days of onset of illness**. Risk decreases 7 days after exposure therefore if **no symptoms developed 7 days after exposure they are unlikely to get ill** * **Single dose of ciprofloxacin is given to those at risk ASAP** *(ideally within 24hrs of diagnosis)*

Answer 16

_Infective_ * **Viral is most common cause** * **HSV is most common viral cause** ( type 1 in children, type 2 in neonates as contracted during birth) * Varicella zoster virus * Epstein-Barr virus (associated with infectious mononucleosis) * Cytomegalovirus (associated with immune deficiency) * Enterovirus * Adenovirus * Influenza virus * Others: polio, mumps, rubella, measles * Bacterial (rare in UK) * Fungal (rare in UK) _Non-infective_ * Autoimmune

Answer 17

* Fever * Headache * Altered consciousness * Altered cognition * Acute onset of focal neurological symptoms e.g. aphasia * Acute onset of focal seizures * Unusual behaviour

Answer 18

* **Swabs e.g. throat, vesicle**: *help to establish causative organism* * **Lumbar puncture**: *send CSF for viral PCR* * **EEG:** *not routinely required* * **CT scan:** *if lumbar puncture contraindicated* * **MRI:** *after lumbar puncture to visualise brain in better detail*

Answer 19

* **IV antivirals**. **Aciclovir is started empirically in suspected encephalitis** until organism confirmed. Following treatments for specific viruses; other viruses have no effective treatment and management is supportive * **Aciclovir:** HSV & VZV * **Ganciclovir:** cytomegalovirus * Follow up, support & rehabilitation to help manage with complications Repeat lumbar puncture usually done to confirm successful treatment prior to stopping abx.

Answer 20

* Chronic fatigue * Change in personality * Change in mood * Memory loss * Cognitive impairment (concentration, planning, problem solving) * Epilepsy * Headaches * Learning disability * Movement disorders * Difficulty with swallowing and speech

Answer 21

* Viral infection caused by Mumps virus (an RNA paramyxovirus) * Respiratory droplets * Incubation: 14-25 days * Usually self-limiting, lasts ~1 week *\*\*NOTE: MMR vaccine provides 80% protection against mumps*

Answer 22

Prodrome of flu-like symptoms: * Fever * Muscle aches * Lethargy * Reduced appetite * Headache * Dry mouth Followed by **parotid swelling (may be uni- or bilateral) with associated pain.** May also present with symptoms of complications: * Testicular pain & swelling (orchitis) * Abdominal pain (pancreatitis) * Neck stiffness, headache (meningitis) * Confusion, headache (encephalitis)

Answer 23

* Saliva swab for PCR testing * Saliva swab or blood test for mumps antibodies Must notify public health.

Answer 24

Usually self-limiting condition therefore management is supportive: * Encourage rests * Fluids * Analgesia * To apply warm or cold packs to the parotid gland as it may ease discomfort. * To stay off school or work for 5 days after the initial development of parotitis. Complications are also managed with supportive treatment.

Answer 25

* Orchitis *(uncommon in pre-pubertal, occurs in 35-35% pubertal. Typically 1-5 days after parotitis)* * Pancreatitis * Meningitis * Encephalitis * Sensorineural hearing loss *(usually unilateral and transient)*

Answer 26

* Contagious * Potential serious complications * Potential serious complications in pregnant women

Answer 27

* Glandular fever, kissing disease, mono * **90% caused Epstein Barr virus** (EBV) (also known as HHV-4). Other causes include cytomegalovirus and HHV-6 * **Infects B cells in oropharynx hence spread via saliva** of infected individuals therefore spread by kissing, sharing cups or toothbrushes or other things that transmit saliva

Answer 28

Can be infectious few weeks before illness begins and intermittently for rest of pts life

Answer 29

FALSE Most people are infected with EBV as children, when it causes very few symptoms. When infection occurs in teenagers or young adults, it causes more severe symptoms.

Answer 30

Classic triad highlighted. Symptoms typically resolve after 2-4 weeks: * **Fever** * **Sore throat** * Fatigue * **Lymphadenopathy** * Tonsillar enlargement * Splenomegaly *(rare cases splenic rupture)* * Hepatitis *(transient rise in ALT)* * Haemolytic anaemia secondary to cold agglutin's (IgM) **!!!! Development of an itchy maculopapular rash in response to amoxicillin or cephalosporins**

Answer 31

* **Heterophile antibodies** *(multipurpose antibodies not specific to EBV antigens. Tests are 100% specific but not everyone develops them and can take up to 6 weeks to develop so sensitivity is 70-80%). Two tests:* * _Monospot test:_ mix pts blood with RBCs from horses; heterophile antibodies will react to produce positive result * _Paul-Bunnell test:_ mix pts blood with RBCs from sheep; heterophile antibodies will react * **Specific antibody tests** *(target viral capsid antigen):* * _IgM_ antibody for early infection * _IgG_ antibody suggests immunity

Answer 32

Usually **self limiting** lasting **2-4 weeks** however f**atigue can last for months**

Answer 33

Management is supportive: * Rest * Drink plenty of fluids * Avoid alcohol *(EBV impairs liver's ability to process the alcohol)* * Avoid contact sports, during and up to 8 weeks after illness, due to risk of splenic rupture * Simple analgesia

Answer 34

* Chronic fatigue * Splenic rupture * Haemolytic anaemia * Thrombocytopenia * Glomerulonephritis * Cancers e.g. Nasopharyngeal carcinoma, Burkitt's lymphoma, Hodgkin's lymphoma

Answer 35

* Measles virus (an RNA paramyxovirus) * Droplet spread * 10-14 days * Infective from prodrome until 4 days after rash

Answer 36

**Prodrome of fever, irritability & conjunctivitis** followed by: * **Koplik spots** *(white spots on buccal mucosa)* * Then develop a **rash** *(starts behind ears then moves to whole body. Maculopapular rash becoming blotchy & confluent)* * Diarrhoea in 10%

Answer 37

Test for IgM antibodies (detectable within few days of onset of rash)

Answer 38

* Consider admission if immunosuppressed or pregnant * Inform public health Supportive as usually **self-limiting resolving in 7-10 days:** * Rest * Fluids * Simple analgesia for pain & fever * Use cotton wool soaked in water to clean eyes if conjunctivitis

Answer 39

_Common_ * Otitis media * Diarrhoea & vomiting * Pneumonia * Febrile seizures _Uncommon_ * Encephalitis * Hepatitis * Squint _Rare_ * Myocarditis * Subacute sclerosing panencephalitis *(can occur years later, fatal)*

Answer 40

Offer MMR vaccine as vaccine induced antibodies develop more rapidly- ideally within 72hrs of exposure

Answer 41

* Candida albicans (yeast-like fungus usually found in GI tract) * Common in infants due to immune system being weaker * Risk factors: DM, inhaled or oral corticosteroids, recent abx, poor dental hygiene, severe anaemia, immunosuppression * Symptoms & signs: yellow or white plaques anywhere in mouth, easily removed, underlying mucosa is red and not painful * Management in children: * Exclude risk factors * Advice: dental hygiene, rinsing mouth after ICS, * Miconazole oral gel for 7 days * Alternative is oral nystatin

Answer 42

* Acute bacterial infection of the dermis & hypodermis * Staphylococcus aureus & Streptococcus pyogenes * Risk factors: skin trauma (e.g. wounds, bites), chronic skin conditions (e.g. eczema, tinea pedis), chicken pox, obesity * Presentation: swelling, warm to touch, red, painful, fever * Eron Clasification (see image) * Management: * Class I: flucloxacillin 5-7 days * If in danger triangle prescribe co-amoxiclav * Admission if under 1yr, immunocompromised, class III or IV, involves eye (opthalmology)

Answer 43

* **Inflammation of the conjunctiva due to infection** (viral, bacterial, fungal, parasitic) * **Most common cause= viral** (and most common viral cause is **adenovirus**). Most common bacterial causes= S.aureus, S.pneumonia, H.influenza * Presentation: conjuncitival erythema, ‘grittiness’, discharge, watering * Managment: * Advice most cases self-limiting * Self care measures: bathing/cleaning eyelids, cool compress, lubricating drops * Advice about infection control e.g. don't share towels * Safety net e.g. pain, visual disturbance, swelling * Consider delayed prescription of topical chloramphenicol *

Answer 44

* **Any conjunctivitis occurring within first 28 days of life** * Can be **non-infective** cause (due to blocked lacrimal duct or irritant) or due to **infection** with **bacteria** (**most commonly S.aureus** but also chlamydia trachomatis, Neisseria gonorrhoea) or **viral** (e.g. HSV, adenovirus) * **Chlamydial & gonococcal ON are of concern** due to complications which may be sight threatening. Get during birth if mother infected- both present with purulent discharge & oedema. **Gonococcal presents in first few days**. **Chlamydia presents 5-14 days after birth.** * Management: * If mild with no discharge: bathe eyelids with water or saline & cotton pad. * If no improvement after above or discharge evident prescribe topical chloramphenicol * If suspect Gonococcal, IV cefotaxime * If suspect chlamydia, oral erythromycin

Answer 45

* **Infection of soft tissues anterior to the orbital septum** (eyelids, skin, subcutaneous tissue of face) * Common in children (**80% \<10yrs, median age is 21 months**) * Causative organisms: **S.aureus, S.epidermis, Streptococci** * Spread from **breaks in skin, resp tract infections, sinus infections** (particularly ethmoid sinus). *\*More common in winter due to more resp infections* *

Answer 46

_Clinical features_ * Erythema * Oedema * Partial or complete ptosis of eye due to swelling * **Absence of:** pain on movement, restricted eye movement, proptosis, visual disturbance, chemosis, RAPD (shown in image)

Answer 47

* Swabs of any discharge * Bloods: FBC, CRP * Contrast CT of orbit (if there is suspicion of orbital cellulitis)

Answer 48

_Management_ * **Paediatrics requires urgent admission** to hospital to be managed by paediatricians, ophthalmology & ENT and for **IV abx (e.g. cefotaxime) for 2-5 days** **and daily review** as _difficult to differentiate between peri-orbital and orbital_ as children unable to give full history and be examined * **Adults can be managed with oral antibiotics (e.g. co-amoxiclav) & safety net** _Complications_ * Orbital cellulitis

Answer 49

* Infection of the fat & muscles posterior to the orbital septum, within the orbit but not involving the globe. * Mean age: 7-12yrs * Staphylococcus aureus, Streptococci, Haemophilus influenza B

Answer 50

* **Sinus infection** (particularly ethmoid) * Peri-orbital cellulitis * Orbital trauma * Dental infection * Ear infection * Facial cellulitis * Not had Haemophilus influenza B vaccine

Answer 51

* Erythema * Swelling * Ptosis * Severe ocular pain * Visual disturbance * Proptosis * Ophthalmoplegia/pain with eye movements * If meningeal involvement: drowsiness, nausea/vomiting etc…

Answer 52

* **Swab of conjunctiva & nasopharynx for M,C&S** * **FBC:** elevated WCC * **CRP**: may be elevated * **Blood culture** * **CT orbit with contrast**

Answer 53

**Medical emergency requiring urgent admission, & senior review by paediatrics, ophthalmology & ENT**. * **IV antibiotics for 7-10 days** * If orbital collection/abscess found may need surgical intervention

Answer 54

* Orbital abscess (and others) * Meningitis * Ocular compartment syndrome

Answer 55

Children given **nasal flu** vaccine: * **1st dose at 2-3yrs then annually after that up until 15yrs** * **LIVE** vaccine * More effective than injectable vaccine * Only children aged 2-9 years who have not received an influenza vaccine before need 2 doses

Answer 56

* immunocompromised *(should have injectable as this is not live)* * aged \< 2 years * current febrile illness or blocked nose/rhinorrhoea * current wheeze (e.g. ongoing viral-induced wheeze/asthma) or history of severe asthma (BTS step 4) * egg allergy * pregnancy/breastfeeding * if the child is taking aspirin (e.g. for Kawasaki disease) due to a risk of Reye's syndrome

Answer 57

* Blocked nose * Rhinorrhoea * Headache * Anorexia

Answer 58

Key points: * Don't routinely test (only if very ill or get severe risk factors) * Oseltamivir (PO) is treatment *(should be within 48hrs but if child is very unwell can give after 48hrs)*

Answer 59

* **Toga virus** * Very rare after introduction MMR vaccine (\<5 cases in UK per year) * Incubation time **14-21 days**. Infectious **7 days before rash appears and 4 days after** * Features: * Prodrome e.g. low grade fever * **Maculopapular rash initially on face** * Lymphadenopathy * Complications: * arthritis * thrombocytopaenia * encephalitis * myocarditis

Answer 60

Rare, life-threatening condition caused by bacteria entering body and releasing harmful toxins; caused by either Staphylococcus or Streptococcus bacteria

Answer 61

* Loss of skin integrity (e.g. [cut](https://www.nhs.uk/conditions/cuts-and-grazes/), [burn](https://www.nhs.uk/conditions/burns-and-scalds/), [boil](https://www.nhs.uk/conditions/boils/), [insect bite](https://www.nhs.uk/conditions/insect-bites-and-stings/), wound etc…) * Nasal packing to treat a [nosebleed](https://www.nhs.uk/conditions/nosebleed/) * A S[taphylococcal infection](https://www.nhs.uk/conditions/staphylococcal-infections/) or Streptococcal infection, (e.g. [throat infection](https://www.nhs.uk/conditions/sore-throat/), [impetigo](https://www.nhs.uk/conditions/impetigo/) or [cellulitis](https://www.nhs.uk/conditions/cellulitis/)) *Less relevant in children:* * *Childbirth* * *Tampons* * *Female barrier contraceptives (e.g.* [*contraceptive diaphragm or cap*](https://www.nhs.uk/conditions/contraception/contraceptive-diaphragm-or-cap/)*)* \*NOTE: don't develop immunity so can get it more than once!

Answer 62

* **Fever** * **Hypotension** * **Diffuse erythematous rash and desquamation of rash** (especially of the palms and soles) * Involvement of three or more organ systems (required as part of diagnostic criteria): * Gastrointestinal (diarrhoea and vomiting) * Renal failure * Hepatitis * Thrombocytopenia * CNS involvement (e.g. confusion) * Mucous membrane erythema

Answer 63

* Removal of infection focus (if there is one) * IV fluids * IV antibiotics

Answer 64

Babies who were born prematurely should receive their routine vaccinations according to chronological age; there should be no correcting for gestational age. Babies who were born prior to 28 weeks gestation should receive their first set of immunisations at hospital due to risk of apnoea.

Infectious Diseases Flashcards

(92 cards)