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MICRO - Abbie > 8. Neonatal and Childhood Infections > Flashcards

8. Neonatal and Childhood Infections Flashcards

1
Q

What infections are currently screened for during pregnancy?

A

Hep B, HIV, rubella, syphilis

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2
Q

What is currently NOT screened but possible?

A

CMV (most common cause of congenital deafness in the UK), toxoplasmosis, Hep C, Group B Streptococcus

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3
Q

What is the old mnemonic used to consider infections?

A

TORCH screen - toxoplasmosis, other (e.g. syphilis, HIV, hepatitis), rubella, CMV, HSV

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4
Q

What are common clinical features of congenital infections?

A

Mild/no apparent maternal infection; wide range of severity in the baby; similar clinical presentation; serological diagnosis; long-term sequelae if untreated.

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5
Q

What are examples of common clinical features?

A

Thrombocytopaenia; rash; cerebral abnormalities; hepatosplenomegaly/ hepatitis/ jaundice

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6
Q

How does toxoplasmosis start and end up in humans?

A

The acute infection will start off in a cat. It produces faeces containing oocysts. Mice and birds eat the faeces. Cats eat birds and mice. This ends up becoming a cycle. Having cats as pets can mean that the oocysts get ingested by humans.

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7
Q

What percentage of those with congenital toxoplasmosis are asymptomatic at birth and what long term effects might they have?

A

May be asymptomatic (60%) at birth but may still go on to have long-term sequelae such as: deafness, low IQ, microcephaly.

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8
Q

What percentage of those with congenital toxoplasmosis are symptomatic at birth and what long term effects might they have?

A

40%? Choroidoretinitis, microcephaly/hydrocephalus, intracranial calcificiations, seizures, hepatosplenomegaly/jaundice.

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9
Q

What is the mechanism of congenital rubella syndrome?

A

Mitotic arrest of cells, angiopathy, growth inhibitor effect

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10
Q

What is the classical triad of congenital rubella syndrome?

A

Cataracts, congenital heart disease (PDA is not common), deafness

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11
Q

What are other features of congenital rubella syndrome?

A

Microphthalmia, glaucoma, retinopathy, ASD/VSD, microcephaly, meningoencephalopathy, developmental delay, growth retardation, bone disease, hepatosplenomegaly, thrombocytopaenia, rash

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12
Q

How does HSV present?

A

Can spread to the neonate through the genital tract, can cause blistering and rash, disseminated infection with liver dysfunction and meningoencephalitis. (Infection control is particularly important)

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13
Q

How is Chlamydia trachomitis transmitted?

A

During delivery, mother may be asymptomatic.

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14
Q

What does Chlamydia trachomitis cause?

A

Causes neonatal conjunctivitis or pneumonia (RARE)

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15
Q

How is Chlamydia trachomatis treated?

A

Erythromycin

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16
Q

What mycoplasma species may cause a congenital disease?

A

Mycoplasma hominis and Ureaplasma urealyticum

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17
Q

What is the neonatal period?

A

Generally the first 4-6 weeks of life. If born premature, the neonatal period is longer and is adjusted for the expected birth date

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18
Q

Why are premature neonates at an increased risk of infection?

A

Less maternal IgG, NICU care, exposure to micro-organisms, colonisation and infection

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19
Q

What organisms cause early-onset infection (within 48 hours of birth)

A

(*Some definitions say 3-5 days). Organisms: Group B Streptococcus, Escherichia coli, Listeria monocytogenes

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20
Q

What organism is Gram-positive coccus, catalase-negative and beta-haemolytic?

A

Group B Streptococcus (it is Lancefield Group B)

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21
Q

What proportion of women are colonised by GBS in their vagina?

A

1/3

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22
Q

What can Group B Streptococcus cause in neonates?

A

Bacteraemia, meningitis, disseminated infection

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23
Q

What is gram-negative rods? (NOTE: K1 antigen is particularly problematic)

A

Escherichia coli

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24
Q

What organism is gram-positive rods, can cause sepsis in both mother and baby and is catastrophic?

A

Listeria monocytogenes

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25
Q

What are maternal risk factors for early-onset sepsis?

A

PROM/premature labour, fever, foetal distress, meconium staining, previous history

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26
Q

What are signs of early-onset sepsis?

A

Birth asphyxia, resp. distress, low BP, acidosis, hypoglycaemia, neutropenia, rash, hepatosplenomegaly, jaundice

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27
Q

What are investigations for early-onset sepsis?

A

FBC, CRP, blood culture, deep ear swab, LP, surface swabs, CXR

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28
Q

What is treatment for early-onset sepsis?

A

Supportive: ventilation, circulation, nutrition, antibiotics e.g. benzylpenicillin and gentamicin (this choice of antibiotics tends to be used because GBS is treated by benzylpencillin and E.coli is treated by gentamicin)

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29
Q

When does late-onset sepsis occur?

A

After 48-72 hours

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30
Q

What organisms are causes of late-onset sepsis?

A

Coagulase-negative Staphylococci (CoNS), Group B Streptococcus, Escherichia coli, Listeria monocytogenes, Staphylococcus aureus, Enterococcus sp., Gram-ngeatives - Klebsiella, Enterobacter, Pseudomonas aeruginosa, Citrobacter koseri, Candida Species

31
Q

What are clinical features of late-onset sepsis?

A

Bradycardia, apnoea, poor feeding/biliary aspirates/abdominal distension, irritability, convulsions, jaundice, respiratory distress, increased CRP, sudden changes in WCC and platelets, focal inflammation (e.g. umbilibus, drip sites)

32
Q

What is treatment for late-onset sepsis?

A

Treat early - low threshold for starting therapy, review and stop antibiotics if cultures are negative and clinically stable, guidelines for antibiotics differ.

33
Q

What are examples of antibiotics for late-onset sepsis?

A

1st line: cefotaxime and vancomycin, 2nd line: meropenem. For community-acquired late-onset neonatal infection: cefotaxime, amoxicillin with or without gentamicin

34
Q

Bacterial infections are important and may cause secondary infection after viral illness. What is an example of this?

A

Invasive Group A Streptococcus infection after VZV

35
Q

Typical investigations for infections in childhood?

A

FBC, CRP, blood cultures, urine, sputum, throat swabs

36
Q

What investigations for the diagnosis of meningitis?

A

Clinical features, blood cultures, throat swab, LP if possible (NOTE: in meningococcal disease the patient may be coagulopathic in which case doing a lumbar puncture is dangerous), rapid antigen screen, EDTA for blood PCR, clotted serum for serology if needed later

37
Q

When should you not do a LP (to collect CSF) in a patient with meningitis?

A

In meningococcal disease the patient may coagulopathic in which case doing a lumbar puncture is dangerous. High ICP?

38
Q

What will be the pressure of CSF in normal, bacterial, viral and fungal/TB?

A

Normal: 5-20; bacterial: >30; viral: normal or mildly increased; fungal/TB …

39
Q

What will be the appearance of CSF in normal, bacterial, viral and fungal/TB?

A

Normal: normal; bacterial: turbid; viral: clear; fungal/TB: fibrin web

40
Q

What will be protein level in CSF in normal, bacterial, viral and fungal/TB?

A

Normal: 0.18-0.45 g/L; bacterial: > 1 g/L; viral: <1 g/L; fungal/TB: 0.1-0.5 g/L. Bacterial meningitis has high protein in CSF

41
Q

What will be the glucose level in CSF in normal, bacterial, viral and fungal/TB?

A

Normal: 2.5-3.5 mmol/L; bacterial: <2.2 mmol/L; viral: normal; fungal/TB: 1.6-2.5. Bacteria uses up glucose, and fungal/TB meningitis also use up a bit of glucose

42
Q

What will be the Gram stain of CSF in normal, bacterial, viral and fungal/TB?

A

Normal: normal; bacterial: 60-90% positive; viral: normal

43
Q

What will be the glucose - CSF: serum ratio in normal, bacterial, viral and fungal/TB?

A

Normal: 0.6; bacterial: < 0.4; viral > 0.6; fungal/TB < 0.4

44
Q

What will be the WCC in CSF in normal, bacterial, viral and fungal/TB?

A

Normal: < 3; bacterial: > 500; viral: < 1000; fungal/TB: 100-500

45
Q

What types of cells are seen in CSF in normal, bacterial, viral and fungal/TB?

A

Bacterial: 90% PMN; viral: monocytes, 10% have > 90% PMN and 30% have > 50% PMN; fungal/TB: monocytes

46
Q

What to do if there is no growth in a meningitis sample?

A

If there is no growth, a PCR may be positive. Rapid antigen tests may be useful.

47
Q

Which vaccination programmes have helped decrease the cases of meningitis?

A

Hib, Men C, and pneumococcus

48
Q

What is the main cause of meningitis at the moment?

A

Men B

49
Q

The meningococcal disease can be fulminant to the point …

A

… where limb amputation is necessary

50
Q

The Men B vaccine because available in 2015 and it showed to reduce the incidence of meningococcal disease in the cohort that they were studying. What is an issue with this vaccine?

A

This vaccine is very immunogenic and is usually given with paracetamol because it can make the child ill

51
Q

What organism is the leading cause of morbidity and mortality especially in < 2 years?

A

Strep pneumoniae

52
Q

What is a gram-positive diplococcus, alpha-haemolytic, has more than 90 capsular serotypes and is increasing in penicillin resistance?

A

Streptococcus pneumoniae

53
Q

Why was the pneumococcal conjugate vaccine found?

A
  • Previously there was a polysaccharide vaccine with 23 capsular types of pneumococcus.
  • Children < 2 showed a poor response.
  • Antibody response was improved by conjugating the polysaccharide with proteins such as CRM
  • The conjugate vaccine is immunogenic in children from 2 months
  • This conjugate vaccine was called Prevenar 7 which targeted 7 serotypes
  • These serotypes were almost eradicated
  • However, we are still seeing a lot of cases of invasive pneumococcal disease
  • More serotypes were added to create Prevenar 13
54
Q

What can Strep Pneumonia lead to?

A

Meningitis, bacteraemia and pneumonia

55
Q

What is a Gram-negative rod, grows glossy colonies on blood agar and causes meningitis at all ages?

A

Haemophilus influenzae

56
Q

Typical causes of meningitis in under 3 months:

A
  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Group B Streptococcus
  • Escherichia coli
  • Listeria monocytogenes
57
Q

Typical causes of meningitis in 3 months to 5 years:

A
  • Neisseria meningitis
  • Streptococcus pneumoniae
  • Haemophilus influenzae
58
Q

Typical causes of meningitis in over 6 years:

A
  • Neisseria meningitis

* Streptococcus pneumoniae

59
Q

What constitutes 1/3 of all childhood illnesses?

A

Respiratory tract infections

60
Q

What are respiratory tract infections mostly?

A

Mostly URTI, mostly viral

61
Q

What is the most important bacterial cause and why?

A

Streptococcus pneumonia because most UK strains of pneumococcus remain sensitive to amoxicillin or penicillin

62
Q

Who does mycoplasma pneumoniae tend to affect?

A

Older children (>4 years)

63
Q

How is mycoplasma pneumoniae treated?

A

Macrolides (azithromycin)

64
Q

How does mycoplasma pneumonia spread?

A

Person-to-person droplet infection

65
Q

What is the incubation period of mycoplasma pneumoniae?

A

2-3 weeks. (Epidemics occur every 3-4 weeks)

66
Q

What is the clinical presentation of mycoplasma pneumonia?

A

Mainly asymptomatic. Fever, headache, myalgia, pharyngitis, dry cough

67
Q

What extrapulmonary manifestations may mycoplasma pneumoniae have?

A

Haemolysis, neurological, cardiac, musculoskeletal, otitis media, bullous myringitis

68
Q

What neurological extrapulmonary manifestations does mycoplasma pneumoniae have?

A

Encephalitis, aseptic meningitis, peripheral neuropathy, transverse myelitis, cerebellar ataxia

69
Q

What musculoskeletal manifestations may mycoplasma pneumoniae have?

A

polyarthralgia, myalgia, arthritis

70
Q

What is bullous myringitis?

A

Vesicles on the tympanic membrane - pathognomonic of mycoplasma disease

71
Q

If a respiratory tract infection fails to respond to treatment, what else should we consider?

A

Whooping cough (Bordatella pertussis) and TB

72
Q

How is a UTI diagnosed in a child?

A

Symptoms - if child can give a history; pure growth of > 10^5 CFU/mL; pyuria - pus cells on urine microscopy. Obtain sample before starting treatment. Renal tract imaging may be required to check for congenital anomalies

73
Q

What organisms can cause UTIs?

A

Escherichia coli - MAIN ORGANISM, other coliforms (Proteus, Klebsiella, Enterococcus sp.), coagulase-negative Staphylococcus (Staphylococcus saprophyticus)

74
Q

What may recurrent or persistent infections in a child be a feature of?

A

Immunodeficiency - either congenital (e.g. SCID) or acquired (e.g. HIV). Warrants investigation by paediatric ID specialist

MICRO - Abbie (19 decks)

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