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Infection 1 Flashcards

1
Q

Why do children present with different presentations in infections?

A

Developing immune system

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2
Q

What is systemic inflammatory response syndrome? (SIRS)

A

Fever or hypothermia
Tachycardia
Tachypnoea
Leucocytosis

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3
Q

What is sepsis?

A

Bacteraemic infection + SIRS

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4
Q

What happens to organs in the body as a result of sepsis?

A

Dysfunction/failure

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5
Q

How is severe sepsis defined?

A 
Sepsis + 2 or more of;
(Respiratory failure
Renal failure
Neurological faliure
Haematological failure
Liver failure)
ARDS
Septic shock - CVS failure
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6
Q

Are boys or girls more likely to get sepsis?

A

Boys

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7
Q

Are younger or older cihldren more likely to get sepsis?

A

Younger

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8
Q

What are common causative organisms of sepsis in neonates?

A

Group B strep
E coli
Listeria monocytogenes

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9
Q

What are common causative organisms in children?

A

Strep pneumoniae
Meningococci
Group A strep
Staph aureus

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10
Q

What is the pathophysiology of sepsis?

A

Lipopolysaccharide and other bacterial toixns activate inate immune cells and endothelium secretion
Mass activation of cytokines and compement
Microvascular occlusion and vascular instability
Leads to fever, coagulopathy, vasodilation, and capillary leak leading to sepsis and multiorgan failure

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11
Q

What are symptoms of sepsis?

A 
Fever or hypothermia
Cold hands/feet, mottled
Prolonged cap refill 
Chills/rigors
Limb pain
Vomiting and/or diarrhoea
Muscle weakness
Muscle/joint aches
Skin rash
Diminished urine output
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12
Q

What are 6 criteria of paediatric sepsis recognition?

A 
Temp <36 or >38
Inappropriate tachycardia
Poor cap refill/mottled
Altered mental state
Inappropriate tacypnoea
Hypotension
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13
Q

What supportive treatment is done for sepsis?

A

A - Airway
B - Breathing/oxygen
C - Circulation - fluids
DEFG - Don’t ever forget glucose

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14
Q

What is causative treatment for sepsis?

A

Antibiotics with broad spectrum and good CSF penetration

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15
Q

What blood investigations are done for sepsis?

A

FBC - leucocytosis, thrombocytopenia
CRP - elevated
Coagulation factors - DIC
U&Es/LFTs - Renal and hepatic dysfunction
Blood gas - Metabolic acidosis, raised lactate
Glucose - hypo
Blood cultures

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16
Q

What non-blood investigations are done for sepsis?

A

CSF cell count and culture - raised WCC and PCR
CSF protein and glucose - raised protein, lowered glucose
Urine culture
Skin biopsy and culture
Imaging

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17
Q

What pathogens cause meningitis in nenonates?

A

Group B strep
E coli
Listeria monocytogenes - same as sepsis

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18
Q

What pathogens cause meningitis in children?

A

Strep pneumoniae
Neisseria meningitidis - meningococcus
Haemophilus influenzae

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19
Q

What are symptoms of meningitis in children?

A 
Niuchal rigidity - neck stiffness
Headaches
Photophobia
Diminished consciousness
Focal neurological abnormalities
Seizures
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20
Q

What are symptoms of meningitis in neonates?

A

Lethargy
Irritability
Bulging fontanelle
Seizures

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21
Q

How do you assess for meningococcal rash?

A

Tumbler test

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22
Q

What is a meningococcal rash called?

A

Petichial rash

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23
Q

What are complications of pneumococcal meningitis?

A

Brian damage
Hearing loss
Hydrocephalus

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24
Q

Where do meningococci come from in meningococcal meningitis?

A

Nasopharynx

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25
How long after meningococcal infection of the nasopharynx do sepsis and meningitis occur?
Septic shock=<12 hours | Meningitis=18-36 hours
26
What toxin do meningococci produce?
Lipooligosaccharide
27
How are streptococci treated?
Penicillin
28
How are staphylococci treated?
Flucloxacillin
29
Why is flucloxacillin used over penicillin in staphylococci?
It is resistant to beta lactamases
30
What bacteria causes Scarlet fever?
Strep A
31
What is the progression of Scarlet fever?
``` Contact Incubation - 2-4 days Malaise, fever, pharyngitis Rash Squamation of hands and feet Strawberry tongue ```
32
What is the most common age for strep A infection?
2-10 years
33
What are complications of strep A infection?
Scarlet fever Poststreptococcal glomerulonephritis Rheumatic fever Toxic shock syndrome
34
Where is staph aureus carried as a commensal organism?
Nasal passage Perineum Axillae
35
What diseases are caused by staph aureus?
``` Impetigo Cellulitis Infected eczema Ulceration Staph scalded syndrome Toxic shock syndrome ```
36
What are features of impetigo?
Highly contagious | Golden sores and blisters, no systemic symptoms
37
What are features of staph scalded skin syndrome?
Mostly in kids under 5 Fever Widespread redness Fluid filled blisters, especially in skin folds
38
What are features of toxic shock syndrome?
``` Systemically unwell Widespread redness Desquamation Multi-organ involvement Can be rapidly fatal ```
39
What is Kawasaki disease?
Self-limited vasculitis of medium sized arteries
40
What are features of Kawasaki disease?
``` Fever for 5 days plus: Bilateral conjunctival infection Cracked lips/strawberry tongue Cervical lymphadenopathy >1.5cm Polymorphous rash Changes of the extremities ```
41
How is Kawasaki disease diagnosed?
Exclude differentials - no diagnostic test
42
How is kawasaki disease treated?
Immunoglobulins Aspirin Steroids Other immunosuppressive agents
43
What is the goal of Kawasaki disease treatment?
Prevent complications
44
What infections cause erythematosus maculopapulous rash?
``` Measles Rubella Enterovirus Cytomegalovirus EBV ```
45
What infections cause vesiculobullous rash?
Varicella zoster virus Herpes simplex virus Enterovirus
46
What infections cause petechial and purpuric rash?
Rubella (congenital) Cytomegalovirus (congenital) Enterovirus
47
What are features of varicella zoster virus infetion?
Mild malaise and fever Itchy Skin lesions progressive - papules ->vesicles ->Pustules ->crustae for 5-7 days
48
How is varicella zoster virus treated?
Conservatively | If severely unwell or immunosuppressed - aciclovir
49
What are warning signs of fatal varicella?
High fever New lesions for more than 10 days Inflamed lesions General malaise
50
Where do HSV 1 and HSV 2 act?
HSV1 - oral | HSV 2 - genital
51
What are features of HSV infection?
Stomatitis | Recurrent cold sores
52
What are complications of HSV?
Keratoconjunctivitis Encephalitis Systemic neonatal infections Immunocompromised children
53
How is HSV treated?
Aciclovir
54
What infectious agents cause hand-foot-mouth disease?
Enteroviruses
55
What is the most common time of year for hand-foot-mouth disease?
Summer and early autumn
56
What are clinical features of hand-foot-mouth disease?
Exanthema Painful lesions Recovery in 5-10 days
57
What are examples of physical barriers to infection?
``` Skin Mucous membranes Mechanical defences Chemical defences Microbiome ```
58
What are the SPUR F warning signs for immunodeficiencies?
Serious Persitent Unusual Recurrent Family history
59
What investigations are done into suspected immunodeficiency?
``` FBC Immunoglobulins HIV test Functional antibodies Lymphocyte subsets Complement NBT ```
60
How do antibody deficiencies generally present?
Defective B cell function - present with recurrent bacterial infections ie pneumonia
61
How do cellular immunodeficiencies present?
Impaired or absent T cell function - present with unusual or opportunistic infections, recurrent/severe viral infections
62
How do innate immune disorders present?
Defects in phagocyte function - presents with sepsis, abscess, fungal infections
63
How are most paediatric HIV cases transmitted?
Vertically - from mother during utero
64
How is HIV prevented in children at risk?
Mothers antenatally screened Mothers receive retroviral therapy and babies receive prophylaxis postnatally until further testing Mothers advised not to breastfeed

Paediatrics (25 decks)

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