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Year 2 HD > 20. Bacterial, fungal and protozoal infections in childhood > Flashcards

20. Bacterial, fungal and protozoal infections in childhood Flashcards

1
Q

Why do infections result in morbidity and mortality?

A

This is the result of the infective organism - toxins or as a result of the immunopathology of the host

The bacteria is generally not attempting to kill the host

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2
Q

What are exotoxins?

A

Toxin secreted by the loving bacterial cell into it’s surrounding

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3
Q

Give examples of exotoxins and the typical symptoms

A

Cholera diarrhoea - diarrhoea and abdominal pain

Diphteria - sore throat, fever

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4
Q

What are endotoxins?

A

AKA. Lipopolyacharide - A toxin present within the bacterial cell which is released when the bacterial cell disintegrates

Part of the outer membrane of the gram negative bacteria

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5
Q

When are endotoxins released and what do they result in?

A

Released during lysis of the organism
Leads to macrophage activation and a huge innate immune reaction and inflammatory cascade via release of IL-6 and TNF-alpha

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6
Q

What are the adverse effects of the inflammatory cascade?

A

Myocardial depression
Endothelial dysfunction - capillary leak and shock
Coagulopathy

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7
Q

Why do infections develop differently in children compared to adults?

A

Immune dysfunction - lack of memory, immature
Anatomical e.g. preterm baby- thinner skin, shorter airways, anatomy of Eustachian tube (more horizontal than angular like in adults) - from nasopharynx into the tube to cause ear infection
Increased exposure - hygiene, nursery/daycare

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8
Q

What is the common global presentation of infections?

A

Fever

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9
Q

Define ‘fever’

A

Abnormally high body temperature > 37.8 degrees celsius

NB. dependent on how you measure the temp - rectal temp is the most accurate for core temp
Mouth - will be 0.5 lower than core temp
Axilla - will be 1 lower than core temp

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10
Q

What are the four major groups of infections?

A

Bacterial
Viral
Parasitic
Fungal

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11
Q

Name some severe bacterial infections

A

a

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12
Q

Name some common bacterial infections

A

a

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13
Q

What organisms are responsible for septicaemia and meningitis?

A

Stretococcus pneumoniae
Neisseria meningitidis - mostly group B
haemophilus influenzae B

(All now vaccinated against in imm. schedule)

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14
Q

What are the presentations of septicaemia?

What is the cause of these presentations?

A 
Tachycardia
Tachypnoea
Prolonged capillary refill
Low BP - late sign 
Rash 
Fever

These are essentially signs of shock - the body’s way of responding to this e.g. shock due to myocardial depression

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15
Q

What are the three layers of the meninges?

Where does the inflammation occur in meningitis?

A

Dura mater
Arachnoid
Pia mater

Between the arachnoid and the pia

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16
Q

What are the clinical presentations of meningitis?

A 
High temperature 
Headache
Vomiting
Cannot tolerate bright lights
Drowsy 
Stiff neck
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17
Q

How is meningitis diagnosed?

A

Lumbar puncture

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18
Q

What are the changes in the CSF in meningitis?

A

Bacterial - cloudy CSF, low blood glucose, some neutrophils, high protein
Viral - clear CSF, high lymphocytes, normal protein and normal glucose - fewer clues
TB (extreme) - lymphocytes present, very high protein, very low glucose

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19
Q

What is the problem with meningitis in infants?

A

The younger the child, the more non-specific it will present - easier to be missed

Should therefore have a high index of suspicion in an unwell baby

Also that young babies are not fully vaccinated (apart from BCG)

20
Q

What are the most common infections in neonates?

A

Group B streptococcus
E. Coli
Listeria

21
Q

Why are the common infections different in neonates to infants?

A

They are likely to have been exposed to these during the brith process e.g. maternal colonisation of the pathogens in the vaginal canal (most commonly group B strep - third of women)

22
Q

What are the most common antibiotics to administer to older children and then to neonates?

Why are these administered before you know the exact diagnosis?

A

Older children - Cefriaxone

Young infants (<3 months) - Combination of cefotaxime and amoxicillin (to cover listeria in the top three)

Because time taken for blood culture to return from the lab will allow disease progression

23
Q

What is the difference between early onset and late onset sepsis?

A

Early onest - within 48 hours of life - more likely pneumococcus septicaemia
Late onset - after 48 hours - more likely meningitis

24
Q

What are the gram positive organisms? (Need to know)

A

Cocci:
Staphylococcus
Streptoccus
Enterococcus

Bacilli:
Corynebacterium
Listeria
Bacillus
Clostridium

Anything not on this list is likely to therefore be gram-negative

25
Q

What is the most common streptococcus infection?

A

Streptococcus pneumoniae - can be invasive or non-invasive

26
Q

What are the predisposing factors for a pneumococcal infection?

A

Absent/non-function spleen e.g. hyposplenism in sickle cell
Hypogammaglobulinaemia e.g. low IgG or IgM
HIV infection - T cell immunodeficiency

27
Q

How can these people in the predisposed groups be protected from a pneumococcal infection?

A

Vaccination

Lifelong peniccilin daily

28
Q

What are the clinical features?

A

Acute otitis media
Sinusitis
Conjunctivitis
Pneumonia - lobar

Septicaemia
Meningitis
Peritonitis
Arthritis
Osteomyelitis
29
Q

What are the vaccinations for pneumococcal infections?

A

Two types
PPV - pneumococcal polysaccharide vaccine
PCV - pneumococcal conjugate vaccine - routinely to children at two and four months

30
Q

What is a conjugate vaccine?

A 
The polysaccharide (make immune response against) is conjugated (joined) to a protein
This is then engulfed by a B cell and broken up into many fragments and presents of MCII molecule  
Allows T cells to get engaged and there is antibody production against the polysaccharide

Under the age of two this is underdeveloped

The function of the protein is just to allow the pathogen to enter the B cell

31
Q

What is serotype replacement?

A

Vaccination against certain strains of the pneumococcus means that these certain strains will no longer be present in the nasopharynx
BUT this results in other serotypes coming and settling in the nasopharynx which we do not vaccinate against

32
Q

What is the bacterium responsible for TB infection?

A

Mycobacterium Tuberculosis

33
Q

What is the difference between TB infection and TB disease?

A

Infection - MT is present within the body

Disease - Presents with symptoms

34
Q

What is progressive primary disease?

A

The childhood infection of the TB does not result in a well developed immune response and reactivation of the TB will result in symptomatic TB and this has a high chance of ending in death

35
Q

What is the bacterium responsible for Tetanus?

A

Clostridium Tetani - exotoxin

Gram positive bacilli

36
Q

How can Tetanus present in neonates?

A 
Weak 
Lethargic
Poor such 
Spasms
Fits
37
Q

What are the two different types of Fungi that can cause human disease?

Give an example of each

A

Yeasts e.g. candida

Moulds e.g. Aspergillus

38
Q

What type of organism is Fungi?

A

Eukaryotes

39
Q

What are the two different types of fungal disease?

A

Superficial mycoses - normal, common (nothing wrong with the immune system)
Invasive mycoses - rare - usually some problem with anatomical barriers or the immune system

40
Q

What are common superficial mycoses?

A

Candidiasis - nappy rash

Tinea corporis - ringworm

41
Q

What are the immune defects making you vulnerable to fungal infections?

A

Reduced neutrophil counts
Impaired function of neutrophils e.g. leukocyte adhesion defect (cannot migrate to sites of infection), chronic granulomatous disease

Problem with the T cells, either congenital e.g. SCID or acquired e.g. HIV

42
Q

What are the different types of protozoa?

A

Sporozoa
Amoebae
Flagellates

43
Q

What are the most common types of Protozoa infection in children?

A

Sporozoa - Plasmodium and Toxoplasma

44
Q

What is the pathogen responsible for malaria?

A

P. Falcifarum - most severe

P. Vivax
P. Ovale
P. Malariae

45
Q

What are the clinical presentations of malaria?

A

Non-specific - fever, lethargy, vomiting, diarrhoea

46
Q

What is the most common form of toxoplasma infection?

A

Congenital toxoplasmosis (cat oocytes)

Year 2 HD (29 decks)

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