Meningitis

5 year old presents with non-blanching rash, fever, headache, photophobia and neck stiffness.

Aetiology

• Up to three months of age
  • Group B streptococcus
  • E-coli
  • Listeria
• Three to 12 years of age
  • Streptococcus pneumonia
  • N. meningitidis

Clinical presentation

• Fever
• Lethargy
• Irritability
• Anorexia
• Nausea/vomiting
• Photophobia
• Neck and back pain/rigidity
• Kernig sign
• Brudzinski sign

Investigations

• FBC
• EUC
• CRP
• Lumbar puncture
• Bloods cultures

Treatment

• Resuscitation
• IV dexamethasone
• IV empirical antibiotics – vancomycin and ceftriaxone
  • Once organism is identified switch to targeted antibiotic therapy

Complications

• Increase intracranial pressure
• Seizures
• Hearing loss (pneumococcus associated)
• Developmental delay

Pertussis

8 month old presents with paroxysmal cough and fever. Parents states the baby coughs all night and has episodes of post-tussive emesis (vomiting). The baby is not up to date with their vaccination.

Aetiology

• Bordetella pertussis

Clinical presentation

• Whooping cough
• Three phases
  • Catarrhal phase – coryzal symptoms
  • Paroxysmal phase  – worsening coughing paroxysms. Inspiratory whoop and facial petechiae with posttusive emesis
  • Convalescent phase – resolution of cough

Differential Diagnosis

• Croup

Investigations

• PCR  of nasopharynx swab

Treatment

• Prevent with immunisation
• Supportive care
• Antibiotics – macrolide
• Treat other people who lives at home

Scarlet Fever

Overview 

Caused by certain strains of group A beta-hemolytic streptococci that release a streptococcal pyrogenic exotoxin.

Clinical Finding

• Fever and sore throat few days before rash
• Strawberry tongue
• Rash
  • Erythematous, blanching, fine macules, resembling a sunburn
  • Sandpaper-like papules
  • Spares the palms
• Sore throat (pharyngitis)

Treatment

• Penicillin (Gold-standards)
  • Cephalosporins
• Macrolides

Impetigo

Overview

Contagious local superficial bacterial infection involving the epidermis.

Aetiology

• Staphylococcus aureus
• Group A streptococcus
• Pseudomonas aeruginosa

Risk Factors

• Contaminant skin disease
• Children
• Poor hygiene
• Overcrowding

Classification and features

• Non Bullous Impetigo
  • Honey comb crusts
  • No blisters (bullous)
  • Not Painful
• Bullous Impetigo
  • Vesicles
  • Bullae
  • Irritating

Treatment

• Hand hygiene
• Stay home (not school)
• Usually self-resolving if not (or concerned) pharmacological treatment
  • Mupirocin
  • Penicillin

Complications

• Cellulitis
• Sepsis
• Glomerulonephritis
• Osteomyelitis

Cellulitis

Cellulitis is an acute local inflammatory condition of deep skin layers involving the dermis and subcutaneous fat.

Causative agents – normal skin flora or other bacteria niche to a area.

• S. Pyogenes
• S. Aureus
• Pseudomonas Aeruginosa
  • Penetrating injury cellulitis

Classic Clinical feature

• Localised pain
• Erythema
• Swelling
• Heat

Diagnosis

• Wound swab of portal of entry, wound

Management

• Oral Antibiotics
• IV Antibiotics – for severe and at risk patients such as diabetes and immunocompromised