clinical infections childhood and pregnancy Flashcards
Pregnancy does not alter resistance to infection.
What can it cause in fetus?
Miscarriage, congenital abnormalities, fetal death, preterm delivery and preterm rupture of membranes.
Also maternal antibodies cross the placenta and give passive immunity.
Asymptomatic bacteruria in pregnancy
Symptomatic UTI in pregnancy frequently preceeded by asymptomatic bacteriuria. If untreated, 30% develop acute pyelonephritis. screening for this is cost effective.
= no symptoms of UTI and 2 samples containing the >105 of same organism,
UTI during pregnancy
Can develop from asymptomatic bacteruria. Associated with premature delivery and increased perinatal mortality.
Intra amniotic infections
Common cause: Group B strep, enterococco, E.coli
Epidemiology: 1-2% term pregnancies affected.
Major cause of perinatal morbidity and mortality.
“Chorioamnionitis” = inflammation of umbilical cord, amniotic membranes and placenta.
Risk factor: multiple vaginal examinations, amniocentesis. The bacteria present in vagina cause infection by ascending through cervix or by blood.
Management: Antimicrobials and delivery of fetus.
Puerperal endometritis
Cause: E.coli, Group B syrep, anaerobes (often mixed)
Infection of the womb during pregnacy affects 5%. Puerperal sepsis remains major cause of maternal death.
Diagnosis: Transvaginal endometrial swabs
Risk factors: C-section, prolonged labour, multiple vaginal exams.
Treatment: broad spec IV antimicrobials til patient has been apyrexial for 48 hours. Also penicillin to baby for 10 days after.
Microbial prescribing in pregnancy.
All anti-microbials cross the placenta to some extent and appear in breast milk.
Ones considered safe: penicillins, cephalosporins.
Unsafe: chloraphenicol
Infections in children:
Neonatal sepsis
Cause: Group B strep, staph aures
15% of all neonatal mortality.
Early onset: GBS (within 72 hours). Major cause of death in babies with low birth weight. Death in 1/4 babies who develop it even when given antibiotics.
Late onset:after 7 days. commonest cause is staph aureus.
Cause: organisms from maternal genital tract. Children are susceptible due to frequent hand to mouth behaviours and not fully immunized.
Common childhood infections
90% are mild and self limiting therefore require no treatment
More severe ones: Meningitis, Otis media, Pneuomnia, Sepsis
Common symptoms: Respiratory, fever, gastroenteritis, earcahe
Respiratory tract infections
UPPER: common cold, acute tonsillitis, acute otis media
-soar throat: 75% of the time viral, rest bacterial.
-Otis media: irritability, difficulty sleeping, fever.
LOWER: e.g pneumonia, bronchiectasis
Cause: RSV, strep pneumonia, neisseria meningitides.
Rashes associated with systemic diseases
Meningococcemia
mortality and morbidity 10% (including deafness, neurological problems) peak incidence under 4 years. immunisation program includes men C/
Symptoms: fever, malaise, vomiting, respiratory distress, irritability, seizurfes.
MAculopapular rash common and petechial rash seen in 60%.
Impetigo
Staph aureus/strep pyogenes causes.
Classically ruptured besicles with honey coloured crusting. more common in pre existing skin disease
Treatment: topical antibiotics/oral flucloxacillin.
Scarlet fever (slapped cheek)
Group A beta haemolytic strep. 2-4 days post strep pharyngitis.
Symptoms: fever, headache, sore throat, flushed face. sandpaper skin.
School aged children. White strawberry tongue.
Diagnosed: throat swab.
Treatment: Penicillin
Measles
Symptoms: Fever, conjunctivitis, maculopapular rash,koplik spots. Rash starts at hairline. lasts 6 days.
Communicable 4 days either side of rash onset.
public health emergency.
Chicken pox
Member of herpes family.
Harmless childhood disease.
Symptoms: fever, runny nose, sore throat, itchy skin rash.
Rubella
Mild febrile viral illness (feve)
Rash is maculopapular. starts on face and spreads downwards. lasts 2-5 days. German measles.
