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Paediatrics > 2: Infections - Staphylococcal and Streptococcal Infections > Flashcards

2: Infections - Staphylococcal and Streptococcal Infections Flashcards

1
Q

What organisms are staphylococci

A

Gram positive

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2
Q

What are the main two groups of staphylococcus

A
  1. Staphylococcus aureus

2. Staphylococcus epidermis

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3
Q

Is staph.a coagulase positive or negative

A

Positive

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4
Q

Is staphylococcus epidermis coagulase positive or negative

A

Negative

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5
Q

What are the three methods staphylococcus aureus can cause infection

A
  1. Direct
  2. Indirect toxin-mediated
  3. Direct toxin-mediated
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6
Q

What is direct effect

A

Due to proteases released by bacteria

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7
Q

What is indirect toxic-mediate

A

Toxins activate T-cells which release cytokines

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8
Q

What is a mnemonic to remember conditions staphylococcus can cause due to direct effects

A

BASIC POPES

Boils 
Abscess 
Septic arthritis 
Impetigo 
Cellulitus 
Pneumonia 
Osteomyelitis 
Peri-orbital cellulitus 
Endocarditis 
Septicaemia
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9
Q

What are two conditions that are indirect toxin-mediated

A
  • Toxic shock syndrome

- Food poisoning

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10
Q

What condition is direct toxin-mediated

A

Scaled skin syndrome

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11
Q

What is impetigo

A

Superficial skin infection with Staph.aureus

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12
Q

What are the two types of impetigo

A

Primary

Secondary

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13
Q

What is primary impetigo

A

Infection of previously healthy skin

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14
Q

What age-group does impetigo primarily affect

A

2-6 years

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15
Q

Explain spread of impetigo

A

Spreads rapidly around nurseries due to being highly contagious

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16
Q

What is the most common cause of impetigo

A

Staphylococcus aureus

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17
Q

What can cause non-bulbous impetigo

A

Staphylococcus epidermis

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18
Q

What are 4 RF for impetigo

A
  • Diabetes
  • Immunocompromised
  • Poor personal hygiene
  • Atopic dermatitis
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19
Q

What are the two types of impetigo

A

Non-Bullous

Bullous

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20
Q

What is 70% of impetigo

A

Non-Bulbous

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21
Q

Explain clinical presentation of non-bulbous impetigo

A

Papules and small vesicles surrounded by erythema that rupture to give a honey yellow-coloured crust. Occurs more commonly around mouth and nose.

Regional lymphadenopathy

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22
Q

Explain clinical presentation of bullies impetigo

A

vesicles turn into large bullae that rupture to give brown crusts

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23
Q

What is positive in bullous impetigo

A

Nikolosky sign = on touching the skin it sloughs

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24
Q

Where does bullous impetigo tend to present

A

Trunk and upper extremities

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25
Q

When should impetigo be suspected

A

Child presents with honey colour crusts around lips and nose

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26
Q

What 3 pieces of advice should be offered for someone with impetigo

A
  • Wash face regularly
  • Do not share towels
  • Avoid school 48h after all lesions crusted over
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27
Q

How long should someone with impetigo avoid school for

A

48h after all lesions crusted over

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28
Q

What is first line for mild impetigo

A

Topical fusidic acid

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29
Q

How long is fusidic acid given for

A

TDS for 5d

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30
Q

What antibiotic is given if impetigo is more widespread

A

Flucloxacillin

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31
Q

How long is flucloxacillin given for

A

7d

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32
Q

What is given to manage impetigo

A

Topic fusidic acid

Oral flucloxacillin

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33
Q

What is a complication of streptococcus

A

Post-streptococcal glomerulonephritis (Group A Strep - if caused by streptococcus )

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34
Q

What is cellulitus

A

Skin infection of deep dermis and subcutaneous tissue

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35
Q

What can cause cellulitus

A

Staphylococcus aureus

Group A staphylococcus

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36
Q

How does cellulitus present clinically

A

Poorly demarcated erythematous lesion

Can present with systemic symptoms - fever, chills, confusion

37
Q

How is cellulitus classified

A

Eron Classification

38
Q

What is Eron Class 1

A
  • Systemically well

- No co-morbidities

39
Q

What is Eron Class 2

A
  • Systemically unwell

- Systemically well with co-morbidities

40
Q

What is Eron Class 3

A
  • Significant systemic illness
  • Unstable interfering co-morbidities
  • Limb threatening vascular compromise
41
Q

What is Eron Class 4

A

Sepsis or necrotising fasciitis

42
Q

How is cellulitus managed

A

Flucloxacillin

43
Q

What is staphylococcus scalded skin syndrome

A

Caused by exfoliative toxin of staphylococcus aureus

44
Q

What precede staphylococcal scalded skin syndrome

A

Mucocutaneous staphylococal aureus infection

45
Q

In which age-group does staphylococcal scalded skin syndrome occur

A

Under 6

46
Q

How does staphylococcal scalded skin syndrome present

A

Starts with malaise, fever and peri-oral erythema.

24-48h later:
- Flaccid easily ruptured bullae form. They rupture to show erythematous moist skin underneath.

47
Q

What sign is positive in staphylococcal skin syndrome

A

Nikolosky sign

48
Q

What is not present in staphylococcal scalded skin syndrome

A

Mucosal involvement

49
Q

Explain pathophysiology of staphylococcal scalded skin syndrome

A

Staphylococcus aureus releases exfoliative toxins which cleave desmoglein 1 causing epidermal detachment

50
Q

Explain how staphylococcal scalded skin syndrome is investigated

A

Blood Culture
Nasopharyngeal aspirate
FBC, CRP

51
Q

How is staphylococcal scalded skin syndrome managed

A

Fluids
Antibiotics
NSAIDs for pain

52
Q

How is streptococcus categorised

A

Depending on its ability to haemolyse blood agar it is categorised into:

  • Group A streptococcus
  • Group B streptococcus
53
Q

What are a-haemolytic streptococci

A

Partially haemolyse blood-agar

54
Q

What are b-haemolytic streptococci

A

Completely haemolyse blood-agar

55
Q

Give two examples of a-haemolytic streptococci

A

S. pneumonia

S. viridians

56
Q

What are 3 conditions streptococcus pneumonia can cause

A
  • Otitis media
  • Pneumonia
  • Meningitis
57
Q

What are the two types of B-haemolytic streptococci

A

Group A streptococcus

Group B streptococcus

58
Q

What is an example of group A streptococcus

A

Streptococcus pyogenes

59
Q

What does group A streptococcus cause

A 
Erysipelas 
Impetigo 
Cellulitus 
Necrotising fasciitis 
Scarlet Fever 
Tonsillitis 
Post-streptococci glomerulonephritis
60
Q

What is an example of Group B streptococcus

A

Streptococcus agalactiae

61
Q

What can streptococcus agalactiae cause

A

Meningitis

62
Q

What can streptococcus pneumonia cause

A

Otits media
Pneumonia
Meningitis

63
Q

What can streptococcus pyogenes cause

A

Tonsillitis

64
Q

What is scarlet fever

A

Infection causes by exotoxin produced by Group A, b-haemolytic streptococci

65
Q

What causes scarlet fever

A

Toxin of streptococcus pyogenes (Group A, b-haemolytic streptococci)

66
Q

When is scarlet fever most common

A

2-6 years

67
Q

What causes transmission group A streptococcus

A

Respiratory droplets

68
Q

Explain how scarlet fever presents

A

Initial phase then 12-48h later is an exanthem phase

69
Q

How does the initial phase of scarlet fever present

A
  • Malaise and Fever
  • Tonsillopharyngitis: strawberry tongue, dysphagia

GI symptoms: abdominal pain and diarrhoea (more common in young children)

70
Q

What is a key feature of the initial phase of scarlet fever

A

Strawberry tongue

71
Q

Explain presentation of the exanthem phase of scarlet fever

A

Sand-paper like rash that starts on the torso and blanches with pressure

72
Q

Where does the rash in scarlet fever spare

A

palms and soles

73
Q

What is a feature of scarlet fever rash

A

pasta line = petechial rash of creases

74
Q

What investigation is often performed in scarlet fever

A

throat swab for streptococcus pyogenes

75
Q

Explain management of scarlet fever

A

Penicillin V

76
Q

Is scarlet fever a notifiable disease

A

Yes

77
Q

When can child return to school in scarlet fever

A

1d after starting antibiotics

78
Q

What is the most common complication of scarlet fever

A

Otitis media

79
Q

What are 4 complications of scarlet fever

A
  • Otitis media
  • Rheumatic fever
  • Meningitis
  • Post-streptococcal glomerulonephritis
80
Q

When may rheumatic fever present after scarlet fever

A

20d

81
Q

When may post-streptococcal glomerulonephritis present after scarlet fever

A

10d

82
Q

What is post-streptococcal glomerulonephritis

A

Inflammation glomerulus following infection Group A streptococcus

83
Q

What usually precedes post-streptococcal glomerulonephritis

A
  • Tonsillarpharyngitis

- Impetigo

84
Q

When does post-streptococcal glomerulonephritis occur

A

2W after infection

85
Q

How will post-streptococcal glomerulonephritis present

A

Nephritic syndrome:

  • Haematuria = Coca Cola urine
  • Proteinuria
  • HTN
  • Oedema
  • Oliguria
86
Q

What is the main differential of post-streptococcal glomerulonephritis

A

IgA Nephropathy (presents 1-2d post infection)

87
Q

How is post-streptococcal glomerulonephritis investigate

A 
Anti-streptolysin O Titre 
Urinalysis 
U+E
RFT 
Complement
88
Q

What is present in anti-streptolysin O titre

A

Raised

89
Q

What is prognosis of post-streptococcal glomerulonephritis

A

6-8W

Paediatrics (61 decks)

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