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Paediatrics 4MB > Infection and Immunity > Flashcards

Infection and Immunity Flashcards

1
Q

Name the most common cause of fever in children

A

Self-limiting viral infection

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2
Q

What is the definition of fever?

A

Temperature >37.5C

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3
Q

What should be done in a child <3mths if there is no clear cause for fever?

A

Urgent septic screen

Broad spectrum IV antibiotics

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4
Q

List the risk factors for infection

A
  1. Sick contacts
  2. Lack of immunisations
  3. Recent travel
  4. Contact with animals
  5. Immune deficiency
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5
Q

List the red flag features when presenting with fever

A
  1. Fever >38C (if <3mths) or >39C (if 3-6mths)
  2. Pale, mottled or cyanosed (COLOUR)
  3. Decreased level of consciousness
  4. Neck stiffness
  5. Bulging fontanelles
  6. Status epilepticus
  7. Focal neurological signs
  8. Seizures
  9. Significant RDS
  10. Bile stained vomit
  11. Severe dehydration or shock
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6
Q

How can we manage fever?

A
  1. Not seriously ill - manage at home; give parents instructions about signs to look out for
  2. Significantly unwell - admit; investigate and observe; SEPTIC SCREEN
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7
Q

List the important features present in the history of a child with sepsis

A
  1. Fever
  2. Poor feeding
  3. Miserable, irritable, lethargy
  4. History of focal infection
  5. Predisposing conditions
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8
Q

List the important signs present on examination of a child with sepsis

A
  1. Fever
  2. Tachycardia, tachypnoea, low BP
  3. Purpuric rash (meningococcal septicaemia)
  4. Shock
  5. Multi-organ failure
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9
Q

How do we manage sepsis?

A
  1. ANTIBIOTICS - start without delay; broad spectrum
  2. FLUIDS
  3. CIRCULATORY SUPPORT - may require inotropic support
  4. RESPIRATORY SUPPORT - give oxygen
  5. DIC - if bleeding occurs correct clotting derangement with FFP, cryoprecipitate and platelet transfusions
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10
Q

List the causes of meningitis

A
  1. Viral (most common)
  2. Bacterial (SEVERE)
  3. Fungal
  4. Parasitic
  5. Malignancy
  6. Autoimmune
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11
Q

What are the likely organisms to cause bacterial meningitis in the neonate - 3mths age group?

A

Group B Strep
E. Coli
Listeria monocytogenes

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12
Q

What are the likely organisms to cause bacterial meningitis in the 1mth - 6mth age group?

A

Neisseria meningitidis
Haemophilus influenza
Streptococcus pneumoniae

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13
Q

How can meningitis present?

A
  1. Non-specific signs (early)
  2. Photophobia
  3. Hypotonia
  4. Drowsiness
  5. Loss of consciousness
  6. Seizures
  7. Purpuric rash
  8. Neck stiffness
  9. Bulging fontanelle (infant)
  10. Opisthotonus (arching of back)
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14
Q

What investigations should be performed if meningitis is suspected?

A
  1. Lumbar puncture
  2. Septic screen
  3. Cultures - blood, throat, urine, stool
  4. Rapid antigen test for meningitis organisms
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15
Q

List the contraindications to lumbar puncture

A
  1. Cardiorespiratory instability
  2. Focal neurological signs
  3. Signs of raised ICP
  4. Coagulopathy
  5. Thrombocytopenia
  6. Local infection at site
  7. Causes undue delay in starting antibiotics
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16
Q

How is bacterial meningitis managed?

A
  1. IMMEDIATE ANTIBIOTICS - Ceftriaxone +/- Vancomycin
  2. Supportive therapy
  3. Rifampicin prophylaxis to close contacts (meningococcal or Hib meningitis)
17
Q

List the possible complications of meningitis

A
  1. Hearing impairment
  2. Cranial nerve palsies and other focal neurological lesions
  3. Seizures
  4. Subdural effusion
  5. Hydrocephalus
  6. Cerebral abscess
18
Q

List the common causes of viral meningitis

A
  1. Enteroviruses
  2. EBV
  3. Adenoviruses
  4. Mumps
19
Q

What is the CSF composition in viral meningitis?

A

Clear
Increased lymphocytes
Normal/increased protein
Normal/decreased glucose

20
Q

What is the CSF composition in bacterial meningitis?

A

Turbid
Very increased polymorphs
Very increased protein
Very decreased glucose

21
Q

Define encephalitis

A

Inflammation of brain parenchyma

22
Q

List the causes of encephalitis

A
  1. Direct invasion of brain by neurotoxic virus
  2. Post-infectious
  3. Slow virus infection
23
Q

What are the clinical features of encephalitis?

A

Similar to meningitis

Most common - fever, altered consciousness, seizures

24
Q

What organisms can cause encephalitis?

A
  1. Enteroviruses
  2. Influenza viruses
  3. Herpes viruses
  4. Mycoplasma
  5. B. burgdorferi
  6. Bartonella henselae
  7. Rickettsial infections
  8. Arboviruses
25
Q

What are the clinical indicators for HSV encephalitis?

A
  1. EEG +/- CT/MRI = focal changes

2. HSV antibody production in CSF

26
Q

How do we treat HSV encephalitis?

A

IV acyclovir for 3wks

27
Q

What organisms cause toxic shock syndrome?

A
  1. Toxin producing Staphylococcus aureus

2. Group A Streptococcus

28
Q

List the clinical features of toxic shock syndrome?

A
  1. Fever >39C
  2. Hypotension
  3. Diffuse, erythematous macular rash
  4. Mucositis
  5. GI dysfunction
  6. Renal impairment
  7. Liver impairment
  8. Clotting abnormalities and thrombocytopaenia
  9. CNS signs
  10. Desquamation of palms, soles, fingers and toes 1-2wks after onset
29
Q

How can toxic shock syndrome be managed?

A
  1. ICU support required
  2. Areas of infection surgically debrided
  3. ANTIBIOTICS - 3rd generation cephalosporin + clindamycin
  4. IV immunoglobulins

Paediatrics 4MB (22 decks)

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