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CP reviewer 1 > Childhood and Pregnancy Infections > Flashcards

Childhood and Pregnancy Infections Flashcards

1
Q

Why should all women be offered routine screening for asymptomatic bacteriuria by midstream urine culture early in pregnancy?

A

Identification and treatment of asymptomatic bacteriuria reduces the risk of pyelonephritis.

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2
Q

How is passive immunity acquired in the foetus?

A

Maternal immunoglobulin G (IgG) is transported across the placenta to offer short term passive immunity

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3
Q

What 3 infectious diseases are screened for during pregnancy?

A
  1. HIV
  2. Syphilis
  3. Hep B

These can all be passed from mother to baby during pregnancy and birth

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4
Q

Why is screening for rubella during pregnancy no longer offered?

A

MMR vaccine

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5
Q

What is TORCH an acronym for?

A

A group of diseases that cause congenital (present at birth) conditions if a foetus is exposed to them in the uterus.

T: Toxoplasmosis

O: Others (syphilis, HIV, Coxsackie virus, Hep B, Varicella-Zoster)

R: Rubella

C: Cytomegalovirus

H: Herpes simplex disease

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6
Q

What diseases come under ‘Other’ of the TORCH acronym?

A

syphilis, HIV, Coxsackie virus, Hep B, Varicella-Zoster

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7
Q

What is considered to be the newest member of TORCH infections?

A

Zika virus

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8
Q

How is the zika virus transmitted?

A

Mosquito bite –> travel history is key

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9
Q

How can Zika virus infection during pregnancy affect the foetus?

A

microcephaly and other severe foetal brain defects

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10
Q

How is toxoplasmosis transmitted?

A

Ingestion of oocysts

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11
Q

How can the TORCH infections affect babies?

A

Most of the TORCH infections cause mild maternal morbidity, but have serious feotal consequences: abortion, stillbirth, prematurity, IUGR, congenital malformations (microcephaly, intracranial calcifications).

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12
Q

What are the potential effects of infection with influenza during pregnancy?

A

o No teratogenesis confirmed
o Premature delivery may occur, as in any febrile maternal illness, increasing the perinatal morbidity and mortality.
o The clinical syndrome in the mother is self-limited unless pneumonia supervenes and in the newborns manifests as any form of sepsis

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13
Q

How can HIV and HBV pass from mother to baby?

A

can be passed in utero & postnatal via breast milk

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14
Q

Is screening for Group B Streptococci (GBS) routinely offered during pregnancy?

A

No; not until it is clear that antenatal screening for GBS carriage does more good than harm and that the benefits are cost-effective

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15
Q

If a woman in a previous pregnancy has had GBS carriage, what is the likelihood of maternal GBS in the next pregnancy?

A

50%

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16
Q

The women who have had a previous GBS carriage, they have 3 choices during their next pregnancy.

What are these?

A
  1. To not have intra-partum antibiotics
  2. To have intra-partum antibiotics
  3. Screening at 35-37 weeks and offer antibiotics to those who have GBS colonisation
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17
Q

What is chorioamnionitis?

A

Inflammation of umbilical cord, amniotic membranes/fluid, placenta

This is a common precursor to preterm labour

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18
Q

Symptoms of chorioamnionitis?

A

Maternal fever, uterine tenderness, tachycardia, purulent/foul amniotic fluid

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19
Q

Pathogenesis of chorioamnionitis?

A

Bacteria ascend from the female genital tract, through the cervix to the amniotic fluid to cause infection

Haematogenous (via blood) infection is rare e.g. Listeria monocytogenes

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20
Q

Risk factors of chorioamnionitis?

A

o Prolonged rupture of membranes –> most common
o Other risk factors include amniocentesis, cordocentesis, cervical cerclage, multiple vaginal examinations, bacterial vaginosis

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21
Q

Causative organisms of chorioamnionitis?

A

o Group B Streptococcus
o Escherichia coli
o Genital Mycoplasma (Mycoplasma hominis & Ureaplasma urealyticum)

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22
Q

Effects of chorioamnionitis on foetus?

A

Adverse outcome for the neonate; sepsis, pneumonia and long-term neurodevelopment disability

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23
Q

Treatment for chorioamnionitis?

A

o Intra-partum antimicrobials and delivery of the foetus

o Antimicrobials should be administered at the time of diagnosis (not after delivery)

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24
Q

What is puerperal endometritis?

A

Uterine infection (lining of womb) during puerperium from vaginal bacteria.

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25
Q

What is puerperium?

A

The period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition.

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26
Q

Morbidity of puerperal endometritis?

A

Puerperal sepsis is a major cause of maternal death

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27
Q

Risk factors of puerperal endometritis?

A
  • Caesarean section, prolonged labour
  • Prolonged rupture of membranes
  • Multiple vaginal examinations
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28
Q

Clinical features of puerperal endometritis?

A 
o Fever (38.5C in first 24h post-delivery or >38.0 for 4 hours, 24h+ after delivery)
o uterine tenderness
o purulent, foul-smelling lochia
o increased white cell count
o general malaise, abdominal pain
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29
Q

What is lochia?

A

Vaginal postpartum bleeding; the heavy flow of blood and mucus that starts after delivery.

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30
Q

Causative organisms of puerperal endometritis?

A

o Escherichia coli
o Beta-haemolytic Streptococci (Group B)
o Anaerobes

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31
Q

Treatment of puerperal endometritis?

A

Broad-spectrum intravenous antimicrobials (Clindamycin + Gentamicin) – continued until the patient has been apyrexial for 48h

32
Q

What is early onset sepsis (EOS)?

A
  • Sepsis usually within 72 hours (85% present within 24hours of birth)
  • A major cause mortality and morbidity in new-born babies.
33
Q

How is early onset sepsis typically acquired?

A

Organisms from maternal genital tract

34
Q

Mortality rate of early onset sepsis?

A

1 in 4 babies who develop it, even when they are given antibiotics.

35
Q

Major causative organisms of early onset sepsis?

A 
o	Coagulase-negative staphylococci 
o	Staphylococcus aureus 
o	E. coli
o	Klebsiella 
o	Enterobacter
o	Pseudomonas 
o	Candida
36
Q

What bacteria is Group A Strep?

A

Streptococcus pyogenes

37
Q

What bacteria is Group B Strep?

A

Streptococcus agalactiae

38
Q

What is ‘Croup’?

A
  • Childhood infection of URT
  • Inflammation and narrowing of the subglottic region of the larynx
  • It is most often caused by a viral infection.
39
Q

Clinical features of ‘Croup’? What is the characteristic symptom?

A
  • Characteristic barking cough
  • Hoarseness
  • Respiratory distress +/- fever +/- coryza
  • Stridor
40
Q

What is stridor?

A

a high-pitched, wheezing sound caused by disrupted airflow

41
Q

What is otitis media?

A

Infection of the middle ear (common in children)

42
Q

Clinical features of otitis media?

A
  • Unusual irritability
  • Difficulty sleeping
  • Tugging or pulling at one or both ears
  • Fever
  • Fluid draining from the ear
  • Loss of balance
  • Unresponsiveness to quiet sounds or other signs of hearing difficulty
43
Q

What is the leading cause of death in children under 5 years?

A

Respiratory viruses

44
Q

What is the major causative organism behind lower RTIs in childhood?

A

RSV (63%)

45
Q

What are the 3 major causative organisms behind lower RTIs in childhood?

A
  1. RSV (63%)
  2. Mycoplasma pneumoniae (9%)
  3. Streptococcus pneumoniae (8%)
46
Q

What is bronchiolitis?

A

Inflammation of the smallest airways (bronchioles), typically in children younger than 2.

47
Q

Clinical features of bronchiolitis?

A
  • A seasonal viral illness characterised by fever, nasal discharge, and dry, wheezy cough.
  • On examination there are fine inspiratory crackles and/or high-pitched expiratory wheeze
48
Q

Causative organisms of bronchiolitis?

A 
o Respiratory Syncytial Virus (RSV) 
o Metapneumovirus 
o Adenovirus
o Para-influenza virus 
o Influenza 
o Rhinovirus
49
Q

Is bronchiolitis an upper or lower RTI?

A

Lower

50
Q

How does pneumonia typically present in infants and children?

A

Acute febrile illness, possibly preceded by typical viral URTI.

o Breathlessness (poor feeding)
o Irritability
o Sleeplessness
o Cough, chest or abdominal pain in older patients
o Audible wheezing is rare in LRTI, but can occur

51
Q

What is ‘pertussis’?

A

‘Whooping cough’; highly contagious respiratory disease

52
Q

What are the 3 clinical stages of pertussis?

A
  1. Catarrhal phase
  2. Paroxysmal phase
  3. Convalescent (recovering) phase
53
Q

Describe the catarrhal phase of pertussis?

A

 Cold-like (coryza, conjunctival irritation, occasionally a slight cough)
 7-10 days

54
Q

Describe the paroxysmal phase of pertussis?

A

 Long duration (2-6 weeks); No fever
 a series of rapid, forced expirations, followed by gasping inhalation; the typical whooping sound
 Post-tussive vomiting common
 Very young infants may present with apnoea or cyanosis in the absence of cough

55
Q

What does ‘post-tussive’ mean?

A

occurring after a cough

56
Q

What organism causes pertussis?

A

B. pertussis

57
Q

How does meningitis present in newborns and infants?

A

Can have non-specific clinical presentation in newborns and infants:
o Fever
o Irritability
o Lethargy
o Poor feeding
o High pitched cry, bulging AF
o Convulsions, opisthotonos (muscle spasm)

58
Q

Causative organisms of bacterial meningitis in neonates?

Causative organisms of bacterial meningitis in >1 month-5 year olds?

A

Neonates: Group B Streptococcus, Escherichia coli, Listeria monocytogenes

> 1 month-5 year olds: Streptococcus pneumoniae, Neisseria meningitidis

59
Q

Causative organisms of viral meningitis in neonates and infants?

A

Enteroviruses (commonest, meningitis occurring in 50% of children <3 months), HSV, Influenza, EBV, adenovirus, CMV

60
Q

What is meningococcaemia?

A

bloodstream infection caused by Neisseria meningitidis

61
Q

What is meningitis B?

A

Meningitis caused by Neisseria meningitidis

62
Q

What is meningitis C?

A

Meningococcal C infection is caused by bacteria called meningococcal type C

63
Q

Symptoms of meningococcaemia?

A

o Fever, non-specific malaise, lethargy, vomiting, meningism, respiratory distress, irritability, seizures
o Maculopapular rash common early in disease
o Petechial rash seen in 50-60%

64
Q

major causative organisms of UTIs in children?

A

Most are from ascending bacteria: E. coli (60-80%), Proteus, Klebsiella, Enterococcus, and Staphylococcus saprophyticus

65
Q

Prevalence of UTIs in caucasian children vs African American children?

A

Caucasian children had a two- to fourfold higher prevalence of UTI as compared to African American children

66
Q

Symptoms of UTI in:

a) older children
b) infants?

A

o Classic UTI symptoms in older children; Dysuria, frequency, urgency, small-volume voids, lower abdominal pain.

o Infants with UTIs have nonspecific symptoms; Fever, irritability, vomiting, poor appetite

67
Q

Urine sampling options for UTIs in children/infants?

A

o A clean catch sample should be obtained
o If not possible, use non-invasive method i.e. Urine collection pad
o Do not use cotton wool balls, gauze or sanitary towels.
o If non-invasive method not possible, use catheter sample or suprapubic aspiration

68
Q

What is impetigo?

A

highly contagious skin infection

69
Q

2 major causative organisms of impetigo?

A

o Staphylococcus aureus

o Streptococcus pyogenes

70
Q

Symptoms of impetigo?

A

o Classically ruptured vesicles with honey-coloured crusting
o May be bullous
o Commonly starts around face/mouth

71
Q

Antibiotic treatment for impetigo?

A

Topical antibiotics or oral Flucloxacillin

72
Q

What is Scarlet fever?

A

contagious bacterial infection that causes blotchy rash

73
Q

Major causative organism of scarlet fever?

A

o Group A beta-haemolytic Streptococcus

o 2-4 days post-Streptococcal pharyngitis

74
Q

Symptoms of scarlet fever?

A

o Fever, headache, sore throat, unwell
o Flushed face with circumoral pallor
o Rash appears on chest/abdomen, may extend to whole body
o Rough ‘sandpaper’ skin
o Desquamation after 5/7, particularly soles and palms
o White strawberry tongue

75
Q

Antibiotic treatment for scarlet fever?

A

Penicillin

CP reviewer 1 (59 decks)

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