Infection Flashcards
What are the risk factors for group B strep?
Prematurity
PPROM
Sibling with previous GBS
Maternal pyrexia
How is group B strep infection prevented?
Intrapartum IV benzylpenicillin
What are the indications for intrapartum GBS treatment?
Preterm
+ swab during pregnancy
Previous sibling with GBS
Pyrexia in labour
What is sepsis?
Life threatening organ dysfunction caused by dysregulated host response to infection
What are the common causes of sepsis in neonates?
GBS= most common
E. coli
Listeria monocytogenes
What are the common causes of sepsis in kids?
Strep. pneumoniae
Meningococci
Group A strep
Staph aureus
What is the presentation of sepsis?
Fever or hypothermia Mottled skin, cyanosis Prolonged cap refill Chills/rigors Reduced LOC Reduced tone Diminished urine output Poor feeding, change in behaviour, inconsolable
What is an urgent indication for sepsis treatment in <3 months?
Fever >38
What is the management of sepsis?
ABC
Sepsis 6
What is the sepsis 6?
Take 3, give 3
Blood cultures, urine output, serum lactate
Oxygen, IV fluids, IV antibiotics
What is a complication of sepsis?
Septic shock
What is septic shock?
Sepsis leading to CV dysfunction, resulting in hypotension and hypo perfusion
What is the management of septic shock?
Sepsis 6
Bolus fluids
What bacteria cause meningitis in neonates?
GBS
Listeria monocytogenes
What bacteria cause meningitis in children?
N. meningitides
Strep. pneumonia
What viruses cause meningitis?
HSV
VZV
ENterovirus
What is the presentation of meningitis in babies?
Bulging fontanelles
Non specific- poor feeding, hypotonia, hypothermia
What is the presentation of meningitis?
Classic triad- fever, neck stiffness, altered consciousness
Headache, photophobia
Vomiting
Non blanching rash
What is non blanching rash a sign of?
Meningococcal septicaemia
What are the indications for LP where meningitis is suspected?
<1 month with fever
1-3 months with fever and unwell
<1 year with unexplained fever and very unwell
What is looked at in an LP?
Bacterial culture Viral PCR Cell count Protein Glucose
What investigations are done for suspected meningitis?
LP
Kernig’s and Brudzinski’s test
Blood cultures
Meningococcal PCR- if meningococcal disease suspected
What are Kernig’s and Brudzinski’s?
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
What is the management of suspected bacterial meningitis presenting in the community?
Stat IM/IV benzylpenicillin and transfer to hospital
What is the management of bacterial meningitis in hospital in neonates?
Ampicillin and cefotaxime
Dexamethasone
What is the management of bacterial meningitis in hospital > 1 month?
ceftriaxone/cefotaxime +/- vancomycin
Dexamethasone
Why is dexamethasone given in bacterial meningitis?
Reduce frequency and severity of hearing loss and neurological damage
What is the management of viral meningitis?
Supportive
Confirmed HSV or VZV= aciclovir
What is the prognosis of bacterial vs viral meningitis?
Viral= generally less severe Bacterial= associated strongly with hearing loss
What are some longterm complications of meningitis?
Hearing loss- bacterial
Cerebral palsy
Seizures and epilepsy
Cognitive impairment and disability
What are some causes of encephalitis?
Infection- viral, bacterial, fungal
Autoimmune
What is the most common cause of encephalitis?
Viral
What viruses commonly cause encephalitis?
HSV 2= neonates
HSV 1= children
VZV, CMV
Measles, mumps and rubella in unvaccinated
What is the presentation of encephalitis?
Altered consciousness and cognition
Unusual behaviour
Acute onset focal neurological symptoms and seizures
Fever
What investigations are done for encephalitis?
LP
MRI
Swabs
HIV test
What are the contraindications for an LP in encephalitis?
GCS <9
HAemodynamically unstable
Active seizures
What is the management of encephalitis?
IV acyclovir (ganciclovir for CMV)
Supportive
Repeat LP before stopping antivirals
What are some long term complications of encephalitis?
Learning disability
Headaches
Seizures
What is mumps?
Self limiting viral infection
What is the presentation of mumps?
Flu like prodrome
Parotid swelling with associated pain
What investigations are done for mumps?
PCR saliva and swab
Antiboddy test of blood or saliva
What is the management of mumps?
Rest, fluids and analgesia
Notifibable disease
What causes mono?
EBV
What is the pathophysiology of mono?
Most people infected as children and have few symptoms
Recurs and causes more symptoms
What is the presentation of mono/glandular fever?
Classic triad= lymphadenopathy, sore throat, fever
Fatigue
Intensely itchy maculopapular rash in response to amoxicillin
Rare= splenomegaly and splenic rupture
What investigations are done for mono?
Monospot test in 2nd week of illness
What is the management of mono?
Supportive
Avoid alcohol
Avoid contact sports for 8 weeks due to risk of splenic rupture
What are the complications of mono?
Associations with certain cancers and MS
Splenic rupture
Chronic fatigue
How is vertical HIV transmission prevented?
NEVER breastfeed if mother HIV+
Antiretrovira to babies for first 4 weeks
Delivery- normal vaginal if viral load <50, section if >400
What are the indications for HIV testing of children?
HIV + parents
Immunodeficiency
Risk factors- e.g. needle stick injury, sexual abuse
Concerning/recurrent infections e.g. encephalitis
What HIV tests can be done?
Antibody screen
Viral load
What is the management of HIV?
Antiretroviral therapy
Normal vaccination- avoid/delay live vaccines if severely immunosuppressed
Prophylactic co-trimoxazole if low CD4- prevent pneumocystis pneumonia
