34. Paediatric Infection – Cases

Question 1

What is a sign of raised ICP in neonates?

Answer 1

Full fontanelle

Question 2

Bacterial LP results:

Answer 2

Cloudy, neutrophils +++, raised protein, <60% of blood glucose

Question 3

Viral LP results:

Answer 3

Clear, lymphocytes++, raised protein, normal glucose

Question 4

TB LP results:

Answer 4

Opalescent, lymphocytes++, raised protein, <60% of blood glucose

Question 5

What infection would have normal glucose on LP?

Answer 5

Viral

Question 6

If lymphocytes present in LP what could the infection be?

Answer 6

Viral, TB

Question 7

If <60% of blood glucose present in LP what could the infection be?

Answer 7

Bacterial or TB

Question 8

Septic screen:

Answer 8

• IV cannula and abx (ceftriaxone, cefotaxime + amoxicillin <3month old)
• Bloods
• Urine (clean catch, MCS)
• Lumbar puncture (MCS, protein, glucose, virology)
• CXR

Question 9

Top 3 organisms causing meningitis:

Answer 9

• Group B strep
• E. Coli
• Listeria

Question 10

Follow up in meningitis:

Answer 10

• Hydrocephalus (head circumference)
• Hearing
• Developmental delay?

Question 11

Meningococcal sepsis:

Answer 11

• Neisseria meningitidis – gram negative diplococci
• Disseminated intravascular coagulation (tissue ischaemia)
• Rapidly overwhelming sepsis and death

Question 12

Management of meningococcal sepsis:

Answer 12

• Broad spectrum Abx: Ceftriaxone, Cefotaxime

- Primary care: IM benzylpenicillin

Question 13

Disease caused by Group A step?

Answer 13

Scarlet fever

Question 14

Disease caused by staph aureus?

Answer 14

Toxic shock, staphylococcal scalded skin syndrome

Question 15

Disease caused by Epstein-Barr Virus?

Answer 15

Glandular fever

Question 16

Kawasaki disease:

Answer 16

Inflammatory condition of unknown aetiology in children <5yo
5 days of fever + 4/5 signs (rash, bilateral conjunctivitis, unilateral lymphadenopathy, oral mucositis, peripheral oedema)

Question 17

Kawasaki disease increases risk of cardiac abnormalities:

Answer 17

Cardiac artery aneurysm

Question 18

Management of Kawasaki disease:

Answer 18

• Anti-inflammatory (IVIG 2g/kg/12h, Aspirin 30-50mg/kg/day, Corticosteroids)
• ECG (at the time of diagnosis and at 2 weeks and at 6 weeks)
• Anti-platelet (low dose aspirin 2-5mg/kg, risk of acute MI)

Question 19

Fever with vesicles:

Answer 19

• Varicella (chicken pox)
• Herpes simplex virus
• Hand foot and mouth (coxsackie virus)

Question 20

Management of chicken pox/ varicella zoster:

Answer 20

• Supportive, conservative
• Fluids and antipyretics
• Calamine lotion

Question 21

Complications of chicken pox:

Answer 21

• 2nd infection (group A strep) – 2nd wave of fever; also encephalitis or pneumonitis
• Can be severe in immunodeficiency and malignancy
• Also warn in on steroids >7d, avoid varicella contact and take VZ IG (immunoglobulins) to protect

Question 22

Kocher score:

Answer 22

• Septic arthritis score:

Non weight bearing, Temperature >38.5*, ESR>40mm/hr, WBC>12

Question 23

Septic arthritis causes:

Answer 23

Common (staph aureus, kingella kingae)

Rare (Strep pneumonia, group A strep)

Question 24

Treatment for septic arthritis:

Answer 24

Surgical washout as per orthopaedics

Question 25

Abx for septic arthritis:

Answer 25

- Co-amoxiclav - IV until improving clinically and inflammatory markers low (CRP <20) - 3-4 weeks for septic arthritis - 4-6 weeks for osteoarthritis

Question 26

Septic arthritis due to staph aureus treatment:

Answer 26

- High dose IV flucloxacillin | - If heart murmur present -> potential endocarditis (ECHO, ECG, blood tests)

Question 27

Initial treatment for malaria:

Answer 27

- Fluid bolus 10ml/kg 0.9% saline - IV ceftriaxone 80mk/kg - IV artesunate (preferred treatment than quinine) - Artemisinin-based combination therapy for uncomplicated malaria (2 drugs in 1)

Question 28

Artemisinin-based drug examples:

Answer 28

Artesunate, artemether

Question 29

2nd class combination therapy for malaria:

Answer 29

Lumefantrine, mefloquine

Question 30

What parasite causes malaria?

Answer 30

Plasmodium falciparum

Question 31

7 Features in severe malaria:

Answer 31

1. Cerebral malaria 2. Respiratory distress/metabolic acidosis 3. Severe anaemia 4. Prostration (child unable to sit normally or unable to drink water) 5. Hypoglycaemia 6. Electrolyte disturbance 7. Circulatory shock