CP6-3 clinical infections in childhood and pregnancy Flashcards
What are potential consequences of infection in pregnancy?
miscarriage
Congenital abnormalities
Fetal death
Preterm delivery
Preterm rupture of the membranes
How do babies get passive immunity?
By maternal antibodies crossing the placenta to the foetus encouraging vaccination
What is an infection dangerous in pregnancy especially in 3rd trimester?
Chicken pox aka VSV
When is vertical transmission of HIV from mother to baby most likely to occur?
During birth
Breastfeeding
How is transmission of hepatitis B from mother to baby prevented?
Immunoglobulins for passive immunisation are given to the baby after birth
What is torch screening?
Screening mother’s blood for infections that can be vertically transmitted
T = toxoplasmosis
O = others - HIV, syphilis, hep B, VSV, coxsackie virus
R = rubella
C = cytomegalovirus disease
H = herpes simplex complex
How are the TORCH infections transmitted from mother to baby?
Haematogenously
What are common perinatal infections not screened for by TORCH screening?
Group B strep
Listeriosis
Gonorrhoea
Chlamydia
Influenza
What can group B strep infection in the genital tract lead to?
Neonatal sepsis
Why is group B strep not widely screened for in pregnancy in the UK?
As risk of false positives/negatives and often infection cleared before giving birth so causes more worry than benefit
What treatment is offered if a pregnant women is diagnosed with having group B strep?
Intra-partum antibiotics if wanted +/- screening at 35-37 weeks and offer antibiotics again at this time
What is chorioamnionitis?
Inflammation of umbilical cord, amniotic membranes/fluid and placenta
What are risk factors for chorioamnionitis?
rupture of membranes (e.g. water breaks early)
Amniocentesis (a test for genetic and chromosomal conditions using a sample of amniotic fluid)
Cordocentesis (a test which uses a sample of blood from the umbilical cord to detect abnormalities)
Cervical cell age
Multiple vaginal exam
What is the pathogenesis of intra-amniotic infections?
bacteria present in the vagina cause infection by ascending through the cervix
or rarely haematogenously e.g. listeria moncytogenes
What are the main organisms that can a cause intra-amniotic infection?
strep B
E. coli
genital mycoplasma species
How are intra-amniotic infections treated?
intra-partum antimicrobials and delivery to the foetus at the time of diagnosis - not after delivery
What is puerperal endometritis and its risk factors ?
Infection of the uterus lining during puerperium (postpartum period) which can lead to puerperal sepsis.
Risk factors include:
C-section
prolonged labour
prolonged rupture of membranes
multiple vaginal examinations
What are clinical features of peurperal endometritis?
fever after delivery (>/= 38.5 in first 24 hours, >/=38 for 4+ hours, 24+ hours after delivery)
uterine tenderness
abdo pain
purulent, foul-smelling lochia (discharge after birth)
general malaise
What organisms commonly causes puerperal endometritis?
E. coli
Group A and B strep aka beta-haemolytic strep
anaerobes
How is puerperal endometritis treated?
broad spectrum IV antimicrobials until patient is apyrexial (normal temp) for 48 hours
What is early onset neonatal sepsis?
sepsis in newborn babies within 72 hours of birth
What is the most common cause of early onset neonatal sepsis?
Group B strep
E. coli
What babies are most at risk of early onset neonatal sepsis?
premature and low birth weight babies
What is late onset neonatal sepsis?
sepsis in neonates >72 hours after birth
What is the most common type of illness in children?
Respiratory illness
What children are most at risk of infection?
Young infants
Children with special health needs
Children with impaired immune systems
Children with long standing prosthetic devices
How does the incidence of childhood illness change over the first 5 years?
Incidence reduces from 12 per year to 4 per year by 5 years old
What are common respiratory infections in children?
Common cold
Acute tonsillitis
Pharyngitis
Croup (viral laryngotracheitis)
Acute otitis media
What is a sore throat?
Inflammation of tonsils, pharynx, larynx or pain during swallowing
What are the causes of sore throat in children?
Virus (70-80% of time)
Group A strep (20-30% of time)
What is croup?
Inflammation and narrowing of the subglottic region of the larynx usually as a result of viral infection
How do children with croup present?
Stridor
Barking cough
Hoarseness
Respiratory distress +/- fever +/- coryza
How are children with croup treated?
Steroids to help open up the airway
How do children with otitis media present?
Usually irritable
Difficulty sleeping
Tugging/pulling at one or both ears
Fever
Fluid draining from the ear
Loss of balance
Unresponsive to quiet sounds/signs of hearing difficulty
What pathogens tend to cause otitis media?
Bacteria including
Strep pneumoniae
H. Influenzae
M. Catarrhalis
Strep pyogenes
Staph aureus
What is the epidemiology of lower respiratory tract infections in children?
30-40 cases per 1000 in UK
What are common lower tract infections in children?
Pneumonia
Acute bronchitis
Bronchiolitis
What pathogen is responsible for a majority of lower respiratory tract infections in children?
Respiratory syncytial virus
What is bronchioloitis?
a seasonal viral infection causing inflammation of the bronchioles presenting with fever, nasal discharge and a dry wheezy cough. On examination there are fine inspiratory crackles +/- high-pitched expiratory wheeze
How do children with pneumonia present?
Acute febrile illness (possibly preceded by a viral upper respiratory tract infection) with breathlessness, irritability, sleeplessness, cough, heat or abdominal pain and sometimes an audible wheeze
What are the phases of pertussis (whooping cough)?
Catarrhal - cold like phase with coryza, conjunctival irritability + occasionally a slight cough - 7-10 days
Paroxysmal - no fever, a series of rapid, forced expirations followed by gasping inhalation +/- post-tussive/post-cough vomitting - 2-6 weeks
Convalescent phase - beginning of slow recovery where coughing becomes less frequent and less severe.
What is pertussis?
Whooping cough
How is pertussis diagnosed?
culture and PCR in early stages
How will a child with meningitis present?
fever
irritability
lethargy
poor feeding
high pitched cry
convulsions and opisthotonus (complete arching position of the body as in a state of hyperextension)
What are the common causes of bacterial meningitis in children up to 5?
neonates = strep B, E. coli and listeria monocytogenes
> 1 month - 5 years = strep pneumoniae and neisseria meningites
What are the common causes of viral meningitis in children up to 5?
enteroviruses (most common), HSV, influenza, EBV, adenovirus, CMV
How will a child with meningococcaemia present?
fever
non-specific malaise
vomiting
lethargy
meningism
respiratory distress
irritability
seizures
maculopapular rash and petechial rash
What are long term consequences of meningococcaemia?
Mortality in 5-10% of cases
Morbidity of deafness, neurological problems and amputations in 10% of patients
What percentage of girls vs boys experience a symptomatic, culture proven UTI before 6 yrs old?
7% of girls : 2% of boys
How do children with UTIs present?
infants = nonspecific like fever, irritability, vomiting, poor appetite
older children = dysuria, frequency and urgency of urination, small volume voids, lower abdo pain
What commonly causes UTIs in children?
ascending bacteria like e.coli (60-80% of the time), proteus, klebsiella, enterococcus and staph saprophyticus
How are UTIs diagnosed in children?
by testing urine from a clean catch sample if possible.
When do children with UTIs require a follow up?
if have recurrent UTI or abnormal imaging results
What should not be routinely recommended for children following a first time UTI?
antibiotics
What is impetigo? How do patients with this present?
A very contagious, rapid spread rash as a result of staph aureus or staph pyogenes infection. Children present with:
ruptured vesicles with honey-coloured crusting
can be bullous (blister)
What is scarlet fever? How do children with this present?
throat infection caused by group A strep causing pharyngitis and patients present with:
fever
headache
sore throat
feeling generally unwell
flushed face with circumoral pallor (paleness in area around the mouth)
rash on chest and abdomen that can extend to whole body
rough sandpaper like skin
white strawberry tongue
desquamation (skin peeling) after 5 days
How is scarlet fever treated?
penicillin for 10 days
What is chicken pox? How do children present with this?
primary VZV infection causing an intensely itchy rash formed of lesions on the trunk which spread to the limbs/face/mucosa.
