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Paediatrics > Infection 1 > Flashcards

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
Q

How long after meningococcal infection of the nasopharynx do sepsis and meningitis occur?

A

Septic shock=<12 hours

Meningitis=18-36 hours

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26
Q

What toxin do meningococci produce?

A

Lipooligosaccharide

27
Q

How are streptococci treated?

A

Penicillin

28
Q

How are staphylococci treated?

A

Flucloxacillin

29
Q

Why is flucloxacillin used over penicillin in staphylococci?

A

It is resistant to beta lactamases

30
Q

What bacteria causes Scarlet fever?

A

Strep A

31
Q

What is the progression of Scarlet fever?

A 
Contact
Incubation - 2-4 days
Malaise, fever, pharyngitis
Rash
Squamation of hands and feet
Strawberry tongue
32
Q

What is the most common age for strep A infection?

A

2-10 years

33
Q

What are complications of strep A infection?

A

Scarlet fever
Poststreptococcal glomerulonephritis
Rheumatic fever
Toxic shock syndrome

34
Q

Where is staph aureus carried as a commensal organism?

A

Nasal passage
Perineum
Axillae

35
Q

What diseases are caused by staph aureus?

A 
Impetigo
Cellulitis
Infected eczema
Ulceration
Staph scalded syndrome
Toxic shock syndrome
36
Q

What are features of impetigo?

A

Highly contagious

Golden sores and blisters, no systemic symptoms

37
Q

What are features of staph scalded skin syndrome?

A

Mostly in kids under 5
Fever
Widespread redness
Fluid filled blisters, especially in skin folds

38
Q

What are features of toxic shock syndrome?

A 
Systemically unwell
Widespread redness
Desquamation
Multi-organ involvement
Can be rapidly fatal
39
Q

What is Kawasaki disease?

A

Self-limited vasculitis of medium sized arteries

40
Q

What are features of Kawasaki disease?

A 
Fever for 5 days plus:
Bilateral conjunctival infection
Cracked lips/strawberry tongue
Cervical lymphadenopathy >1.5cm
Polymorphous rash
Changes of the extremities
41
Q

How is Kawasaki disease diagnosed?

A

Exclude differentials - no diagnostic test

42
Q

How is kawasaki disease treated?

A

Immunoglobulins
Aspirin
Steroids
Other immunosuppressive agents

43
Q

What is the goal of Kawasaki disease treatment?

A

Prevent complications

44
Q

What infections cause erythematosus maculopapulous rash?

A 
Measles
Rubella
Enterovirus
Cytomegalovirus
EBV
45
Q

What infections cause vesiculobullous rash?

A

Varicella zoster virus
Herpes simplex virus
Enterovirus

46
Q

What infections cause petechial and purpuric rash?

A

Rubella (congenital)
Cytomegalovirus (congenital)
Enterovirus

47
Q

What are features of varicella zoster virus infetion?

A

Mild malaise and fever
Itchy
Skin lesions progressive - papules ->vesicles ->Pustules ->crustae for 5-7 days

48
Q

How is varicella zoster virus treated?

A

Conservatively

If severely unwell or immunosuppressed - aciclovir

49
Q

What are warning signs of fatal varicella?

A

High fever
New lesions for more than 10 days
Inflamed lesions
General malaise

50
Q

Where do HSV 1 and HSV 2 act?

A

HSV1 - oral

HSV 2 - genital

51
Q

What are features of HSV infection?

A

Stomatitis

Recurrent cold sores

52
Q

What are complications of HSV?

A

Keratoconjunctivitis
Encephalitis
Systemic neonatal infections
Immunocompromised children

53
Q

How is HSV treated?

A

Aciclovir

54
Q

What infectious agents cause hand-foot-mouth disease?

A

Enteroviruses

55
Q

What is the most common time of year for hand-foot-mouth disease?

A

Summer and early autumn

56
Q

What are clinical features of hand-foot-mouth disease?

A

Exanthema
Painful lesions
Recovery in 5-10 days

57
Q

What are examples of physical barriers to infection?

A 
Skin
Mucous membranes
Mechanical defences
Chemical defences
Microbiome
58
Q

What are the SPUR F warning signs for immunodeficiencies?

A

Serious
Persitent
Unusual Recurrent

Family history

59
Q

What investigations are done into suspected immunodeficiency?

A 
FBC
Immunoglobulins
HIV test
Functional antibodies
Lymphocyte subsets
Complement
NBT
60
Q

How do antibody deficiencies generally present?

A

Defective B cell function - present with recurrent bacterial infections ie pneumonia

61
Q

How do cellular immunodeficiencies present?

A

Impaired or absent T cell function - present with unusual or opportunistic infections, recurrent/severe viral infections

62
Q

How do innate immune disorders present?

A

Defects in phagocyte function - presents with sepsis, abscess, fungal infections

63
Q

How are most paediatric HIV cases transmitted?

A

Vertically - from mother during utero

64
Q

How is HIV prevented in children at risk?

A

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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