Acutely Unwell Child Flashcards
What is Kawasaki diseaseand how does this present in children
consider this if there is fever that has lasted >5 days
Kawasaki disease causes the blood vessels to become inflamed and swollen, which can lead to complications in the blood vessels that supply blood to the heart
Children with Kawasaki disease might have high fever, swollen hands and feet with skin peeling, and red eyes and tongue.
What are consequences of Meningitis
septicaemia
permanent damage to the brain or nerves
What are Common bacteria that cause meningitis in children
Neisseria meningitis
Streptoccus Pnenumoniae- most common in adults
Haemophilus influenzae
group B streptococcus-most common in children
Symptoms and signs of meningitis and meningococcal disease
Fever
vomiting/nausea
headache
non-blanching rash
altered mental state
Non-blanching rashes are rashes which do not disappear with pressure, particularly using the ‘glass test’
What is Kerning´s sign and Brudzinki´s sign?
Kerning´s sign
if the patient flex leg at knee, lifts a leg at hip 90º, then straightens
if this causes intense back pain, it is called Kernig´s sign
Kernig begins at the Knee
Brudzinki’s sign
flexing their head causes them to flex their knees
Is a CT scan needed for Meningitis
not necessary if the child does not show signs of ICP
Checks for ICP before doing Lumbar Puncture
What do you do in Primary Care with suspected bacterial meningitis or suspected meningococcal septicaemia (with non blanching rash)
give IM/IV benzylpenicillin 500mg asap
urgent hospital transfer
What do you do in Primary Care with Suspected bacterial meningitis without non-blanching rash
no need for parenteral antibiotics
call 999
What are normal Lumber Puncture Findings
Clear appearance
Lymphocytes < 4
no polymorphs
glucose >2.2
protein <0.4
What are Bacterial Lumber Puncture Findings
Turgid appearance
cells per mm2: 5-2000 (more cells than viral)
neutrophils> lymphocytes
glucose very low (due to consumption by bacteria)
protein >1 (high due to protein synthesis by WBCs eg TNF)
other tests: gram staining
What are Viral Lumber Puncture Findings
Clear appearance
cells per mm2: 5-500
Lymphocytes, no neutrophils
glucose normal
protein 0.5-0.9
Other tests: PCR
Name how bacteria can evade the immune response
bacteria can lack polysaccharide capsule, so evade opsonisation
IgA protease
What is Reverse Vaccinology
Reverse vaccinology = making vaccine by starting with genome sequence of pathogen strain
1 - Genome sequence to find Open Reading Frames (gene that codes regions inducing Ab response)
2 - Synthesise recombinant proteins
3 - Inject proteins into mouse
4 - Take serum from injected mice
5 - ELISA and FACS of mouse serum to identify which ABs
6 - Whichever ORF proteins activated humoral Ab response -> include in vaccine
How does S. pyogenes (Group A Streptococcus) strain H292 evade the immune system?
H292 produces a molecule that interferes with neutrophil recruitment.
What enzyme do Invasive strains of Group A Streptococcus Meningitis produce?
SpyCEP
