Infection Flashcards
What is the definition of sepsis?
SIRS + suspected/proven infection
What is the definition of SIRS?
Systemic inflammatory response syndrome
What is severe sepsis?
Sepsis + multi-organ failure (>2 of the following): Respiratory failure - common Renal failure Neurologic failure Liver failure
What are causes of sepsis in neonates?
(<1 month)
Group B streptococci
Eshericha coli
What are the causes of sepsis in children?
Group A streptococci
Strep pneumoniae
Meningococci
Staph aureus
What are the symptoms of sepsis?
Fever/hypothermia Cold peripheries Prolonged capillary refill time >2 seconds Chills/rigors Limb pain Vomiting and/or diarrhoea Muscle/joint aches Diminished urine output
How is sepsis investigated?
Sepsis 6 recognition tool FBC – decreased WCC, decreased platelets CRP – elevated Metabolic acidosis Raised lactate Hypoglycaemia CSF Urine culture
How is sepsis treated?
Supportive – ABCG – O2
Broad spectrum antibiotics – 3rd generation cephalosporins (Benzylpenicillin + gentamycin
Rifampicin )
What is meningitis?
Inflammation of the meninges
What are the causes of bacterial meningitis in neonates?
Group B streptococci
E. coli
What are the causes of bacterial meningitis in children?
Step pneumonia
Neisseria meningitidis
Haemophilus influenzae
What are the signs of meningitis in neonates?
Lethargy
Irritability
Bulging fontanelle
Seizures
What are the signs of meningitis in children?
Nuchal rigidity (neck stiffness) Headaches Photophobia Diminished consciousness Seizures Rash - late sign
How is meningitis investigated?
Blood culture
Lumbar puncture
Tumbler test if rash (non-blanching)
Kernig’s test - patient lies on back flexing hip and knee, straightens leg (keeping hip flexed) pain down meninges
Brudzinski’s test - touch chin with neck and see involuntary flexion of hips/knees
How is meningitis treated?
<3 months – IV cefotaxime + amoxicillin
>3 months – IV ceftriaxone
Both before tests come back
Dexamethasone – to reduce the chance of long-term outcomes
What are the complications of meningitis?
Hearing loss Cerebral palsy Seizures and epilepsy Cognitive impairment Epilepsy Memory loss
What are the differentials of a fever in a child?
Mild - URTI, mild gastroenteritis, non-specific viral infection
Significant - pneumonia, meningitis, encephalitis, meningococcal sepsis, UTI, septic arthritis, kawasaki’s disease
Infants under 3 months with a temp of 38C need to be treated for sepsis until proven otherwise
What is Kawasaki disease?
Medial vessel vasculitis
Affects young children <5
Increased risk in siblings and twins
What are the symptoms of kawasaki disease?
Fever for 5 days + 4 of: Bilateral conjunctival infection Cracked lips/strawberry tongue Cervical lymphadenopathy >1.5cm Polymorphous rash Change of the extremities
How is kawasaki disease treated?
Aspirin
IV immunoglobulins
Cardiology assessment as it’s the leading cause of heart disease
What are the complications of kawasaki disease?
Coronary artery aneurysms
Varicella zoster
Primary infection - varicella, chickenpox
Recurrent infection - zoster (shingles)
Incubation period - 14 days
What are the symptoms of a varicella zoster infection?
Mild malaise
Fever
Itchy
Exanthema - papule, vesicles, pustules
How is varicella zoster infection treated?
Aciclovir if immunocompromised or severely unwell
Prevented with vaccine
Herpes simplex virus
Reactivation of varicella zoster
HSV1 – oral
HSV2 – genital
What is the presentation of herpes simplex virus?
Stomatitis
Recurrent cold sores
How is herpes simplex treated?
Self-limiting
Aciclovir
What are the complications of herpes simplex virus?
Keratoconjunctivitis
Encephalitis
Systemic neonatal infections
Immunocompromised children
Herpes simplex virus and neonates
Contact in birth canal
Day 4-21 of life
CNS infections common (70%) – sepsis, meningoencephalitis, hepatitis
Skin/eye/mouth disease (20-30%)
Primary immunodeficiency
Rare
Lots of disorders
Missing or improper functions of the body’s immune system
Usually caused by single genetic defects
May affect a single component or multiple components of the immune system
Secondary immunodeficiency
Common
Acquired diseases or effects of treatment affecting the immune system
Components of the immune system all present and are functional
Eg – HIV, prolonged steroid use, patients treated for malignancies
What are the warning signs for immunodeficiency?
SPUR F Serious Persistent Unusual Recurrent Family history
