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Paeds AM > Infection > Flashcards

Infection Flashcards

1
Q

What are the risk factors for group B strep?

A

Prematurity
PPROM
Sibling with previous GBS
Maternal pyrexia

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2
Q

How is group B strep infection prevented?

A

Intrapartum IV benzylpenicillin

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3
Q

What are the indications for intrapartum GBS treatment?

A

Preterm
+ swab during pregnancy
Previous sibling with GBS
Pyrexia in labour

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4
Q

What is sepsis?

A

Life threatening organ dysfunction caused by dysregulated host response to infection

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5
Q

What are the common causes of sepsis in neonates?

A

GBS= most common
E. coli
Listeria monocytogenes

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6
Q

What are the common causes of sepsis in kids?

A

Strep. pneumoniae
Meningococci
Group A strep
Staph aureus

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7
Q

What is the presentation of sepsis?

A 
Fever or hypothermia
Mottled skin, cyanosis
Prolonged cap refill 
Chills/rigors 
Reduced LOC 
Reduced tone 
Diminished urine output 
Poor feeding, change in behaviour, inconsolable
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8
Q

What is an urgent indication for sepsis treatment in <3 months?

A

Fever >38

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9
Q

What is the management of sepsis?

A

ABC

Sepsis 6

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10
Q

What is the sepsis 6?

A

Take 3, give 3
Blood cultures, urine output, serum lactate
Oxygen, IV fluids, IV antibiotics

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11
Q

What is a complication of sepsis?

A

Septic shock

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12
Q

What is septic shock?

A

Sepsis leading to CV dysfunction, resulting in hypotension and hypo perfusion

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13
Q

What is the management of septic shock?

A

Sepsis 6

Bolus fluids

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14
Q

What bacteria cause meningitis in neonates?

A

GBS

Listeria monocytogenes

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15
Q

What bacteria cause meningitis in children?

A

N. meningitides

Strep. pneumonia

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16
Q

What viruses cause meningitis?

A

HSV
VZV
ENterovirus

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17
Q

What is the presentation of meningitis in babies?

A

Bulging fontanelles

Non specific- poor feeding, hypotonia, hypothermia

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18
Q

What is the presentation of meningitis?

A

Classic triad- fever, neck stiffness, altered consciousness
Headache, photophobia
Vomiting
Non blanching rash

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19
Q

What is non blanching rash a sign of?

A

Meningococcal septicaemia

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20
Q

What are the indications for LP where meningitis is suspected?

A

<1 month with fever
1-3 months with fever and unwell
<1 year with unexplained fever and very unwell

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21
Q

What is looked at in an LP?

A 
Bacterial culture
Viral PCR 
Cell count
Protein
Glucose
22
Q

What investigations are done for suspected meningitis?

A

LP
Kernig’s and Brudzinski’s test
Blood cultures
Meningococcal PCR- if meningococcal disease suspected

23
Q

What are Kernig’s and Brudzinski’s?

A

tests for meningeal irritation
K= flex hip and knee to 90, straighten knee= pain
B= flex chin to chest, patient will flex hips and knees

24
Q

What is the management of suspected bacterial meningitis presenting in the community?

A

Stat IM/IV benzylpenicillin and transfer to hospital

25
Q

What is the management of bacterial meningitis in hospital in neonates?

A

Ampicillin and cefotaxime

Dexamethasone

26
Q

What is the management of bacterial meningitis in hospital > 1 month?

A

ceftriaxone/cefotaxime +/- vancomycin

Dexamethasone

27
Q

Why is dexamethasone given in bacterial meningitis?

A

Reduce frequency and severity of hearing loss and neurological damage

28
Q

What is the management of viral meningitis?

A

Supportive

Confirmed HSV or VZV= aciclovir

29
Q

What is the prognosis of bacterial vs viral meningitis?

A 
Viral= generally less severe
Bacterial= associated strongly with hearing loss
30
Q

What are some longterm complications of meningitis?

A

Hearing loss- bacterial
Cerebral palsy
Seizures and epilepsy
Cognitive impairment and disability

31
Q

What are some causes of encephalitis?

A

Infection- viral, bacterial, fungal

Autoimmune

32
Q

What is the most common cause of encephalitis?

A

Viral

33
Q

What viruses commonly cause encephalitis?

A

HSV 2= neonates
HSV 1= children
VZV, CMV
Measles, mumps and rubella in unvaccinated

34
Q

What is the presentation of encephalitis?

A

Altered consciousness and cognition
Unusual behaviour
Acute onset focal neurological symptoms and seizures
Fever

35
Q

What investigations are done for encephalitis?

A

LP
MRI
Swabs
HIV test

36
Q

What are the contraindications for an LP in encephalitis?

A

GCS <9
HAemodynamically unstable
Active seizures

37
Q

What is the management of encephalitis?

A

IV acyclovir (ganciclovir for CMV)
Supportive
Repeat LP before stopping antivirals

38
Q

What are some long term complications of encephalitis?

A

Learning disability
Headaches
Seizures

39
Q

What is mumps?

A

Self limiting viral infection

40
Q

What is the presentation of mumps?

A

Flu like prodrome

Parotid swelling with associated pain

41
Q

What investigations are done for mumps?

A

PCR saliva and swab

Antiboddy test of blood or saliva

42
Q

What is the management of mumps?

A

Rest, fluids and analgesia

Notifibable disease

43
Q

What causes mono?

A

EBV

44
Q

What is the pathophysiology of mono?

A

Most people infected as children and have few symptoms

Recurs and causes more symptoms

45
Q

What is the presentation of mono/glandular fever?

A

Classic triad= lymphadenopathy, sore throat, fever
Fatigue
Intensely itchy maculopapular rash in response to amoxicillin
Rare= splenomegaly and splenic rupture

46
Q

What investigations are done for mono?

A

Monospot test in 2nd week of illness

47
Q

What is the management of mono?

A

Supportive
Avoid alcohol
Avoid contact sports for 8 weeks due to risk of splenic rupture

48
Q

What are the complications of mono?

A

Associations with certain cancers and MS
Splenic rupture
Chronic fatigue

49
Q

How is vertical HIV transmission prevented?

A

NEVER breastfeed if mother HIV+
Antiretrovira to babies for first 4 weeks
Delivery- normal vaginal if viral load <50, section if >400

50
Q

What are the indications for HIV testing of children?

A

HIV + parents
Immunodeficiency
Risk factors- e.g. needle stick injury, sexual abuse
Concerning/recurrent infections e.g. encephalitis

51
Q

What HIV tests can be done?

A

Antibody screen

Viral load

52
Q

What is the management of HIV?

A

Antiretroviral therapy
Normal vaccination- avoid/delay live vaccines if severely immunosuppressed
Prophylactic co-trimoxazole if low CD4- prevent pneumocystis pneumonia

Paeds AM (28 decks)

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