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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
When should impetigo be suspected
Child presents with honey colour crusts around lips and nose
26
What 3 pieces of advice should be offered for someone with impetigo
- Wash face regularly - Do not share towels - Avoid school 48h after all lesions crusted over
27
How long should someone with impetigo avoid school for
48h after all lesions crusted over
28
What is first line for mild impetigo
Topical fusidic acid
29
How long is fusidic acid given for
TDS for 5d
30
What antibiotic is given if impetigo is more widespread
Flucloxacillin
31
How long is flucloxacillin given for
7d
32
What is given to manage impetigo
Topic fusidic acid | Oral flucloxacillin
33
What is a complication of streptococcus
Post-streptococcal glomerulonephritis (Group A Strep - if caused by streptococcus )
34
What is cellulitus
Skin infection of deep dermis and subcutaneous tissue
35
What can cause cellulitus
Staphylococcus aureus | Group A staphylococcus
36
How does cellulitus present clinically
Poorly demarcated erythematous lesion | Can present with systemic symptoms - fever, chills, confusion
37
How is cellulitus classified
Eron Classification
38
What is Eron Class 1
- Systemically well | - No co-morbidities
39
What is Eron Class 2
- Systemically unwell | - Systemically well with co-morbidities
40
What is Eron Class 3
- Significant systemic illness - Unstable interfering co-morbidities - Limb threatening vascular compromise
41
What is Eron Class 4
Sepsis or necrotising fasciitis
42
How is cellulitus managed
Flucloxacillin
43
What is staphylococcus scalded skin syndrome
Caused by exfoliative toxin of staphylococcus aureus
44
What precede staphylococcal scalded skin syndrome
Mucocutaneous staphylococal aureus infection
45
In which age-group does staphylococcal scalded skin syndrome occur
Under 6
46
How does staphylococcal scalded skin syndrome present
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
What sign is positive in staphylococcal skin syndrome
Nikolosky sign
48
What is not present in staphylococcal scalded skin syndrome
Mucosal involvement
49
Explain pathophysiology of staphylococcal scalded skin syndrome
Staphylococcus aureus releases exfoliative toxins which cleave desmoglein 1 causing epidermal detachment
50
Explain how staphylococcal scalded skin syndrome is investigated
Blood Culture Nasopharyngeal aspirate FBC, CRP
51
How is staphylococcal scalded skin syndrome managed
Fluids Antibiotics NSAIDs for pain
52
How is streptococcus categorised
Depending on its ability to haemolyse blood agar it is categorised into: - Group A streptococcus - Group B streptococcus
53
What are a-haemolytic streptococci
Partially haemolyse blood-agar
54
What are b-haemolytic streptococci
Completely haemolyse blood-agar
55
Give two examples of a-haemolytic streptococci
S. pneumonia | S. viridians
56
What are 3 conditions streptococcus pneumonia can cause
- Otitis media - Pneumonia - Meningitis
57
What are the two types of B-haemolytic streptococci
Group A streptococcus | Group B streptococcus
58
What is an example of group A streptococcus
Streptococcus pyogenes
59
What does group A streptococcus cause
``` Erysipelas Impetigo Cellulitus Necrotising fasciitis Scarlet Fever Tonsillitis Post-streptococci glomerulonephritis ```
60
What is an example of Group B streptococcus
Streptococcus agalactiae
61
What can streptococcus agalactiae cause
Meningitis
62
What can streptococcus pneumonia cause
Otits media Pneumonia Meningitis
63
What can streptococcus pyogenes cause
Tonsillitis
64
What is scarlet fever
Infection causes by exotoxin produced by Group A, b-haemolytic streptococci
65
What causes scarlet fever
Toxin of streptococcus pyogenes (Group A, b-haemolytic streptococci)
66
When is scarlet fever most common
2-6 years
67
What causes transmission group A streptococcus
Respiratory droplets
68
Explain how scarlet fever presents
Initial phase then 12-48h later is an exanthem phase
69
How does the initial phase of scarlet fever present
- Malaise and Fever - Tonsillopharyngitis: strawberry tongue, dysphagia GI symptoms: abdominal pain and diarrhoea (more common in young children)
70
What is a key feature of the initial phase of scarlet fever
Strawberry tongue
71
Explain presentation of the exanthem phase of scarlet fever
Sand-paper like rash that starts on the torso and blanches with pressure
72
Where does the rash in scarlet fever spare
palms and soles
73
What is a feature of scarlet fever rash
pasta line = petechial rash of creases
74
What investigation is often performed in scarlet fever
throat swab for streptococcus pyogenes
75
Explain management of scarlet fever
Penicillin V
76
Is scarlet fever a notifiable disease
Yes
77
When can child return to school in scarlet fever
1d after starting antibiotics
78
What is the most common complication of scarlet fever
Otitis media
79
What are 4 complications of scarlet fever
- Otitis media - Rheumatic fever - Meningitis - Post-streptococcal glomerulonephritis
80
When may rheumatic fever present after scarlet fever
20d
81
When may post-streptococcal glomerulonephritis present after scarlet fever
10d
82
What is post-streptococcal glomerulonephritis
Inflammation glomerulus following infection Group A streptococcus
83
What usually precedes post-streptococcal glomerulonephritis
- Tonsillarpharyngitis | - Impetigo
84
When does post-streptococcal glomerulonephritis occur
2W after infection
85
How will post-streptococcal glomerulonephritis present
Nephritic syndrome: - Haematuria = Coca Cola urine - Proteinuria - HTN - Oedema - Oliguria
86
What is the main differential of post-streptococcal glomerulonephritis
IgA Nephropathy (presents 1-2d post infection)
87
How is post-streptococcal glomerulonephritis investigate
``` Anti-streptolysin O Titre Urinalysis U+E RFT Complement ```
88
What is present in anti-streptolysin O titre
Raised
89
What is prognosis of post-streptococcal glomerulonephritis
6-8W

Paediatrics (61 decks)

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