16.1. Paediatric Infectious Diseases - Pneumococcal Infection / Meningitis +/- Sepsis

Question 1

What is Paediatric Sepsis?

Answer 1

Systemic Inflammatory Response Syndrome + Suspected / Proven Infection (Bacteraemia)

Question 2

What are the Features of the Systemic Inflammatory Response Syndrome?

Answer 2

1. Fever / Hypothermia
2. Tachycardia
3. Tachypnoea
4. Lecuocytosis / Leucocytopenia

Question 3

What are the Normal Vital Signs (Respiratory Rate / Heart Rate / Systolic Blood Pressure) for:

1. < 1 Year Old?
2. 1-2 Year Old?
3. 2-5 Year Old?
4. 5-12 Year Old?
5. > 12 Year Old?

Answer 3

Age / Resp. Rate / Heart / Rate / Systolic B.P.

1. <1 / 30-40 / 110-160 / 70-90
2. 1-2 / 25-35 / 100-150 / 80-95
3. 2-5 / 25-30 / 95-140 / 80-100
4. 5-12 / 20-25 / 80-120 / 90-110
5. > 12 / 15-20 / 60-100 / 100-120

Question 4

What is Paediatric Severe Sepsis?

Answer 4

Sepsis + Multi-Organ Failure - 2+ of:
1. Respiratory Failure (ARDS)
2. Renal Failure
3. Neurologic Failure
4. Haematological Failure
5. Liver Failre
Note - Can lead to Septic Shock (Cardiovascular Failure)

Question 5

What are the Most Common Pathogens, responsible for Sepsis, in:

1. Neonates?
2. Children?

Answer 5

1. a) Group B Streptococci
2. b) Eschericha Coli
3. c) Listeria Monocytogenes
4. a) Streptococcus Pneumoniae
5. b) Meningococci
6. c) Group A Streptococci
7. d) Staphylococcus Aureus

Question 6

What are the Symptoms of Paediatric Sepsis?

Answer 6

1. Fever / Hypothermia - Chills / Rigors
2. Cold Hands / Feet - Prolonged Capillary Refil Time
3. Limb / Muscle / Joint Pain or Weakness
4. Vomiting +/- Diarrhoea
5. Skin Rash
6. Decreased Urine Output

Question 7

What are the Features of Paediatric Meningitis +/- Sepsis?

Answer 7

1. Nuchal Rigidity - Impaired Neck Flexion
2. Headaches / Photophobia
3. Diminished Consciousness
4. Focal Neurological Abnormalities
5. Seizures in Neonates
6. Lethargy / Irritability
7. Bulging Fontanelle
8. “Nappy Pain”

Question 8

What is the Treatment of Meningitis +/- Sepsis?

Answer 8

1. Supportive - ABC
2. Antibiotics - 3rd Generation Cefalosporins
3. Chemoprophylaxis
   Note - Antibiotics need to have good penetration into the Cerebro-Spinal Fluid and be Broad Spectrum

Question 9

What are the Investigations for Meningitis +/- Sepsis?

Answer 9

1. Bloods - FBC / CRP / Coag. Factors / Gas / Glucose
2. CSF - Lumbar Puncture
3. Blood and CSF Culture
4. Urine Culture
5. Skin Biopsy Cultrue
6. CT-Cerebrum

Question 10

What will the Findings be for the Blood Tests in Meningitis +/- Sepsis?

Answer 10

1. Full Blood Count - Leucocytosis / Thrombocytopenia
2. C-Reactive Protein - Elevated
3. Coagulation Factors - Low due to Disseminated Intravascular Coagulation
4. Blood Gas - Metabolic Acidosis
5. Glucose - Hypoglycaemia

Question 11

What will the Findings be for the CSF Tests in Meningitis +/- Sepsis?

Answer 11

1. Pleocytosis
2. Increased Protein Level
3. Low Glucose

Question 12

What is the Pathology of Streptococcus Pneumoniae Infection?

Answer 12

1. Airborne Droplets - Nasopharyngeal Carriage
2. a) Local Spread - SINUSITIS / OTITIS MEDIA
3. b) Aspiration - PNEUMONIA
4. b) i) Pleura / Pericardium EMPYEMA
5. SEPTICAEMIA
6. a) PERITONITIS
7. b) ARTHRITIS / OSTEOMYELITIS
8. c) MENINGITIS
   Note - Otitis Media is the most common

Question 13

What are the Complications of Pneumococcal Meningitis?

Answer 13

1. Brain Damage
2. Hearing Loss
3. Hydrocephalus