EXAM 3 Pediatric Infections Flashcards
describe sepsis
- severe infection
- systemic inflammatory response
- multiple organ dysfunction
- vasodilation
- leukocyte accumulation
- increased microvascular permeability
what is the relationship between infection, SIRS, sepsis, severe sepsis, and septic shock?
what is the definition of SIRS in kids?
- core temp >38.5 or <36*C
- tachycardia (>2 SD above normal for age) or bradycardia (<10th percentile for age)
- mean respiratory rate >2 SD above normal for age
- high or low WBC, or >10% immature neutrophils
- *you do not measure BP in children to diagnose SIRS*
which f the following makes neonates more susceptible to infections?
A) less IgG production
B) declining maternal IgG
C) less cytokine production
D) decreased function of neutrophils
all of these
in infants, there is a lot of change in their immune system during the first ___ months of life
3
T and B cells are present in utero, but they have to co-exist with ___
manternal immune system
the number of T lymphocytes are similar/increased in infants, but the ___ is different
function
describe how the function of lymphocytes in infants is different than in adults
- anti-inflammatory cytokine production (T cells) diminished
- immunoglobulin synthesis (B cells) is less
- neutrophils differ from adult functional capacity
what is an important consideration regarding pediatric HIV infection in infants?
CD4 T cell counts will have different meanings in children than in adults, so they will actually use percentages instead of numbers
during the first ___ months of life, there is an increased risk of serious ___ infection
- 0-3
- bacterial
what is considered a neonatal fever?
- rectal temp >/= 38
- may be only sign of infection
what is an SBI?
- serious bacterial infection
- meningitis, bacteremia, UTI
- pneumonia, osteomyelitis/septic arthritis, SSTI, bacterial gastroenteritis
globally, neonatal SBIs are responsible for what fraction of neonatal deaths?
1/3-1/4
___% of infants (<90 days old) with fever have an SBI
8.5%
what accounts for most of the SBIs in infants <90 days old? what percent of infants are affected?
- UTIs
- 73% of infants with SBI
describe the incidence of bacteremia and meningitis in infants
decreases with age
- 0-30 days = 3% with bacteremia, 1.1% with meningitis
- 1-2 months = 1.4% with bacteremia, 0.4% with meningitis
- 2-3 months = 0.7% with bacteremia, 0% with meningitis
what are the most common causes of neonatal SBI?
A) GBS, salmonella sp., e. coli
B) GBS, staph aureus, e.coli
C) GBS, listeria, e. coli
D) staph aureus, e. coli, listeria
E) GBS, listeria, strep pneumoniae
C) GBS, listeria, e. coli
what are the most common bacterial pathogens of neonatal SBI?
- group B strep (s. agalactiae)
- e. coli (and other gram neg enteric bugs)
- listeria monocytogenes
what are the major viral causes of neonatal sepsis?
- HSV 1 and 2
- VZN
- enteroviruses
- influenza
- adenoviruses
- RSV
describe group B strep
- gram positive cocci
- beta-hemolytic
- lancefield group B
- important virulence factor
what is the GBS colonization rate of pregnant women?
- 15-40%
- constant and/or intermittent
- with improved cx techniques → 30-50% colonization
- test pregnant women at >/= 35 weeks gestation
describe neonatal acquisition of GBS
- in utero by ascending route or at time of delivery
- 50% transmission rate prior to prophylaxis
- after birth: mucous membranes
___ are common colonizers of GI and GU tracts; less commonly the pharynx
GBS
what are the clinical manifestations of GBS infection?
- early-onset (<7 days; median age at onset 1 hour)
- late-onset (7-89 days)
- late, late-onset (90+ days)
early onset GBS infection is commonly associated with ___
maternal OB complications
___ onset GBS disease has the highest mortality rate at ___%
- early
- 5-10%
