Infection, Inflammation and immunity ILA Flashcards
What is a septic screen?
A set of investigations: FBC, U&Es, Blood culture, CRP< Urine sample, Lumber puncture, CXR, stool sample (BUFALO)
What does a septic screen screen for?
FBC - WCC
U&Es - electrolyte imbalance
CRP - whether raised
URine sample - MS+C, ruke out UTI
LP - CSF MC+S, look for signs of meningitis - raised protein, low glucose, WBC
CXR - look for any consolidation, signs of chest infection
Stool sample - any bugs
What is the most common cause of bacterial meningitis in children?
Neisseria Meningitidis
What is the immediate management of sepsis in a child?
ABCDE
Cannulate and treat with IV antibiotics and fluids
- fluid bolus 20mls/kg 0.9% saline
- IV ceftriaxone when bacterial meningitis suspected
- O2 esp if tachycardia and low sats
If after initial management still tachycardic and hypotensive?
Another bolus 200mls 0.9% saline
IF a second bolus of fluids doesn’t help become less tachycardia or hypotensive then what do you do?
keep giving fluid until don’t need it or if not working consider use of ionotropes
What management would be done in intensive care for sepsis?
- intubation
- put to sleep (induced coma)
- central line
- ionotropes
- blood transfusion
What antibiotic is given for bacterial meningitis( N.meningitidis) and what dose would be given?
IV ceftriaxone for 7 days, 100mg/kg once daily
IV cefotaxine plus amoxicillin in under 3 months
What is N.meningitidis sensitive to?
beta-lactas e.g. penicillin
What is the cause of purpura in meningitis?
In meningicoccal sepsis, toxins are produced which break down the wall of blood vessels and cause purpura
How is meningitis carried and passed on?
~1 in 10 people are carriers of N.meningitidis at the back of their nose/throat. It is passed on through coughing, sneezing, kissing or lengthy contact. Spending time in the same house in the same week
What is the first-line treatment recommended for those who are ‘close contacts to reduce the risk of meningitis?
Prophylactic antibiotics - Rifampicin or Ciprofloxacin
should be given ideally within the first 24 hours of diagnosis
What are th contraindications to rifampicin as prophylaxis for meningitis in close contacts?
interacts with OCP
What are the contraindications to ciprofloxacin as prophylaxis for meningitis in close contacts?
Unlicensed in children - as can cause arthropathy of weight bearing joints in immature animals so not recommended in children or growing adolescents
however is more readily available in community pharmacies and can be given as a single dose
What might you warn people about who are receiving prophylaxis for meningitis?
The highest risk is in the first 7 days after the case is diagnosed
