34. Paediatric Infection – Cases Flashcards
What is a sign of raised ICP in neonates?
Full fontanelle
Bacterial LP results:
Cloudy, neutrophils +++, raised protein, <60% of blood glucose
Viral LP results:
Clear, lymphocytes++, raised protein, normal glucose
TB LP results:
Opalescent, lymphocytes++, raised protein, <60% of blood glucose
What infection would have normal glucose on LP?
Viral
If lymphocytes present in LP what could the infection be?
Viral, TB
If <60% of blood glucose present in LP what could the infection be?
Bacterial or TB
Septic screen:
- IV cannula and abx (ceftriaxone, cefotaxime + amoxicillin <3month old)
- Bloods
- Urine (clean catch, MCS)
- Lumbar puncture (MCS, protein, glucose, virology)
- CXR
Top 3 organisms causing meningitis:
- Group B strep
- E. Coli
- Listeria
Follow up in meningitis:
- Hydrocephalus (head circumference)
- Hearing
- Developmental delay?
Meningococcal sepsis:
- Neisseria meningitidis – gram negative diplococci
- Disseminated intravascular coagulation (tissue ischaemia)
- Rapidly overwhelming sepsis and death
Management of meningococcal sepsis:
- Broad spectrum Abx: Ceftriaxone, Cefotaxime
- Primary care: IM benzylpenicillin
Disease caused by Group A step?
Scarlet fever
Disease caused by staph aureus?
Toxic shock, staphylococcal scalded skin syndrome
Disease caused by Epstein-Barr Virus?
Glandular fever
Kawasaki disease:
Inflammatory condition of unknown aetiology in children <5yo
5 days of fever + 4/5 signs (rash, bilateral conjunctivitis, unilateral lymphadenopathy, oral mucositis, peripheral oedema)
Kawasaki disease increases risk of cardiac abnormalities:
Cardiac artery aneurysm
Management of Kawasaki disease:
- 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)
Fever with vesicles:
- Varicella (chicken pox)
- Herpes simplex virus
- Hand foot and mouth (coxsackie virus)
Management of chicken pox/ varicella zoster:
- Supportive, conservative
- Fluids and antipyretics
- Calamine lotion
Complications of chicken pox:
- 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
Kocher score:
- Septic arthritis score:
Non weight bearing, Temperature >38.5*, ESR>40mm/hr, WBC>12
Septic arthritis causes:
Common (staph aureus, kingella kingae)
Rare (Strep pneumonia, group A strep)
Treatment for septic arthritis:
Surgical washout as per orthopaedics
Abx for septic arthritis:
- Co-amoxiclav
- IV until improving clinically and inflammatory markers low (CRP <20)
- 3-4 weeks for septic arthritis
- 4-6 weeks for osteoarthritis
Septic arthritis due to staph aureus treatment:
- High dose IV flucloxacillin
- If heart murmur present -> potential endocarditis (ECHO, ECG, blood tests)
Initial treatment for malaria:
- 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)
Artemisinin-based drug examples:
Artesunate, artemether
2nd class combination therapy for malaria:
Lumefantrine, mefloquine
What parasite causes malaria?
Plasmodium falciparum
7 Features in severe malaria:
- Cerebral malaria
- Respiratory distress/metabolic acidosis
- Severe anaemia
- Prostration (child unable to sit normally or unable to drink water)
- Hypoglycaemia
- Electrolyte disturbance
- Circulatory shock
