Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Child health > Infection - meningococcaemia/septicaemia > Flashcards

Infection - meningococcaemia/septicaemia Flashcards

1
Q

Incidence and demographics of meningococcaemia

A

0.7-1.4 per 100,000

2 out of 3 CNS infections are viral

> 80%of bacterial meningitis is in <16 year olds

More commonly in males

Peak incidence:
6-24 months
Most cases under 4 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Invasive meningococcal disease leads to only meningitis in …

A

30-50% of cases

7-10% only havr septicaemia.
40% have both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why is it important to differentiate between meningococcaemia and septicaemia?

A

Patients preseting with shock are treated differently than the ones presenting primarily with increased ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which Neisseria meningitied serotypes cause meningococaemia?

A

A, B, C are the most significant

B and C predominate in Europe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is neisseria meningitidis transmitted

A

humans are the only reservoir

aerosol or nasopharyngeal secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pathophysiology of meningitis

A

Infection is preceded by nasopharyngeal colonisation

Meningococci enter bloodstream and spread to specific sites (meninges, joints, disseminate - 5% carriers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 3 important virulence factors of Meningococci?

A

Polysaccharide capsule
Lipo-oligosaccharide endotoxin (the body responds to this)
Immunoglobulin A1 protease (cleaves membranes and helps the organism to survive)

Much of the damange cause by meningitis is due to host response (cerebral oedema and raised ICP from release of inflammatory mediators and activated leucocytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

At what ages is the Meningitis C vaccine given?

A

3 months
4 months
1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causative organisms of meningococcaemia (at different ages)

A

Neonates (<3 months): Group B strep, E.coli, Listeria

1 month - 6 years: N. meningitis
Strep pneumonia
H. influenza

> 6 years:
N. meningitis
Strep pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does meningococcaemia present

A

The younger, the less likely to have classic symptoms of fever, headache, meningism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Meningitis presentation in neonates (<3 months)

A

Associated with maternal infection or pyrexia on delivery

Hyperthermia or hypothermia
Change in sleeping or eating habits
Irritability
Lethargy

Vomiting
High-pitched cry
SEIZURES

A child who is quiet at rest, but cries when moved.
Bulging fontanel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Presentation of meningococcaemia in >3 months old children?

A 
Fever
Vomiting
Irritability
Lethargy
Change in behavior

After 2-3 years:
Headache
Stiff neck
photophobia

Clinical course may be fulminant or gradual onset with several days of URTI and severe symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the rash pattern in meningococcaemia

A

Petechial (N. meningitidis)

50-80% of patients

Axillae
Flanks
Wrists
Ankles

Usually located in the centre of light coloured macules (non-blanching) - a sign of vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Signs in meningoccocaemia

A

Opisthotonus - arching of back with increased ICP

Brudzinski - flexion of the neck with the child supine causing flexion of the knees and hips

Kernigs - with the child lying supine and the hips and knees flexed, there is back pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Classical clinical presentation of meningococcaemia

A 
Headache
Fever
Vomiting
Photophobia
Lethargy
Neck stiffness
Rash - 50%
Seizures - 20%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Definition of purpura

A

> 2mm in diameter

no exact definition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Differentials for meningococcaemia

A 
Sepsis
Febrile seizures
Measles
Mumps
HSP
ITP
Reye's syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the pathophysiology of septicaemia

A

From activation and continued stimulation of the immune system by proinflammatory cytokines (caused by endotoxin)

4 elements:
Capillary leak.
Coagulopathy.
Metabolic derangement.
Myocardial failure.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Presentation of septicaemia

A 
Fever
Rash - erythematous and later petechia and purpura
Vomiting
Headache
Myalgia
Abdo pain
Tachycardia/tachypnoea
Hypotension
Cool extremities
Initially normal conscious level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Investigations for fulminant meningococal sepsis

A 
FBC
Blood glucose and gas for acidosis
Coagulation screen
CRP
U and Es
LFTs

Culture - blood, throat swab, urine, stool

Lumbar puncture, unless contraindicated

PCR for possible organisms (blood and CSF)

Consider CT/MRI head and EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Management of meningitis

A

NO delay in antibiotics and supportive therapy
3rd generation cephalosporin (cefotaxime or ceftriaxone) cover most

Length of course depends on causative organism and clinical response

If child is beyond neonatal period, give dexamethasone to reduce chance of longterm complications such as DEAFNESS

22
Q

Management of meningococcal septicaemia

A

Rapid stabilisation and possibly ICU
Broad spectrum antibiotics initially

CVP and urinary catheterisation for fluid balance

Mechanical ventilation of resp failure from pulmonary oedema

Ionotropic support may be needed for myocardial contractility

FFP and platelets if DIC occurs

Finally….. household contacts should be immunised if type C.
Treatment with rifampicin eradicates nasopharyngeal carriage

23
Q

Is meningitis a notifiable disease? (is this a trick question?? Double bluff???)

A

IT IS A NOTIFIABLE DISEASE

Local public health department must know about this

24
Q

What is the commonest cause of sepsis in children?

A

meningococcus

THUS, suspect even when there is no RASH

25
Q

What are the potential sequelae of meningococcaemia (nervous system)

A

15-25% mortality in neonatal period
5% afterwards

Focal neurological sequelae:
Hearing lossLocal vasculitis causing cranial nerve palsies
Local cerebral infarction (focal or multifocal seizures - may lead to epilepsy)

Subdural effusion

Hydrocephalus (from impaired CSF resorption or blockage of ventricular outlets)

Cerebral abscess
-signs of space occupying lesion and deterioration

26
Q

Complications of meningococaemia (non-nervous system)

A 
DIC
Thrombocytopenia
Septic arthritis
Pericarditis
Bacterial endocarditis
Gangrene
27
Q

Which rare underlying deficit may lead to recurrent meningococcaemia

A

Complement deficiency

28
Q

Define sepsis and septicaemia

A

Sepsis: a bacterial infection in the blood stream or body tissues. It is a very broad term covering the presence of many types of microscopic disease causing organisms

Septicaemia  when bacteria cause a focal infection or proliferate in the blood stream  the host response includes the release of inflammatory cytokines and activation of endothelial cells, which may lead to septic shock

29
Q

List the relevant causative organisms of sepsis for neonates

A

Acquired from birth canal or ascended into amniotic fluid:
Group B strep
Gram -ves (E.coli, Hib, Listeria monocytogenes)

In late-onset sepsis, source is often in the environment:
S. epidermidis, E.coli, Klebsiella, Pseudomonas, enterobacter

30
Q

List the relevant causative organisms of sepsis for infants

A

Hib
Strep pneumoniae
N. meningitides
Salmonella

31
Q

List the relevant causative organisms of sepsis for children (older)

A

Hib
Strep pneumoniae
N. meningitides
Salmonella

32
Q

Which is the commonest organism causing bacteraemia, but not usually septic shock

A

Pneumococcus

33
Q

What are the main causative organisms of sepsis in “at-risk” groups (immunocompromised, respiratory illness)

A

Chronic respiratory illness - risk of Pseudomonas

Immunodeficiency - particularly pneumococcus

34
Q

Normal BP, Pulse, RR in neonates, infants, young and old children

A 
RR: tachypnoea is
>60 (neonate)
>50 (infants)
>40 (young child)
>30 (old child)
HR - normal range
110-160 (<1 year)
95-140 (2-5 yrs)
80-120 (5-12yrs)
60-100 (>12 years)

BP upper limit (SBP)
110mmHg (1-5yrs)
120mmHg (6-10 yrs)

35
Q

Presentation of sepsis in children (early and late)

A

Fever

Minimal tachycardia
Widened pulse pressure
Minimal tachypnoea
Minimally delayed cap refill

Later:
Hypotension
Mental state changes
Anuria
Hypothermia
Cool extremities
Petecial/purpuric rash
36
Q

What are red flag sings in sepsis? (NICE)

A

Pale/mottled/blue
No response to social cues
Unable to roused
Weak, high-pitched continuous cry

Grunting
Tachypnoea (>60)
Moderate or severe recessions
Reduced skin turgor

>38°C (0-3months)
>39°C (3-6months)
Non-blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs/seizures
Bile stained vomiting
37
Q

Amber signs in sepsis (NICE)

A

Pallor
Decreased activity
No smile

Nasal flaring
Tachypnoea
Oxygen sats <95% on air
Crackles

Dry mucous membranes
Poor feeding in infants
Cap refill > 3 seconds
Reduced urine output

Swelling of limb or joint (osteomyelitis?)
New lump >2cm

38
Q

What is shock?

A

Circulation is inadequate to meet the demands of the tissue - insufficient perfusion
(eg. sepsis or intestinal obstruction)

39
Q

Early clinical features of shock

A

Manifestations of compensatory physiological mechanisms:

Tachypnoea
Tachycardia
Decreased skin turgor
Sunken eyes and fontanelle
Delayed cap refill (>2s)
Mottled, pale, cold skin
Core-peripheral temerature gap >4°C
Decreased urinary output
40
Q

Late decompensated signs of septic shock

A 
Acidotic (Kussmaul) breathing
Bradycardia
Hypotension
Confusion
No urinary output
Blue peripheries
41
Q

Which antibiotics are most empiric in septicaemia for a Newborn/infant (first 6-8 weeks)

A

Ampicillin and Gentamicin
Ampicillin and Cefotaxime
Ampicillin and ceftriaxone

42
Q

Which antibiotics are most empiric in septicaemia for an older child

A

Third generation cephalosporin alone:

ceftriaxone or cefotaxime

43
Q

Priority in septic shock management

A

Fluid resuscitation:
0.9% saline OR blood (after trauma)(20ml/kg)

TWICE if NECESSARY

PICU if no improvement

44
Q

Management of septicaemia and shock on PICU

A

Tracheal intubation and mechanical ventilation
Invasive monitoring of BP
Inotropic support
Correction of heamatological, biochemical and metabolic derangement

Support for renal or liver failure

45
Q

In the notes, these symptoms in conjunction with fever point towards meningococcal disease

A 
Non-blanching rash
Ill-looking child
Lesion larger than 2 mm (purpura)
Cap refill >3sec
Neck stiffness
46
Q

In the notes, these symptoms in conjunction with fever point towards bacterial meningitis disease

A

Neck stiffness
Bulging fontanelle
Decreased level of consciousness
Convulsive status epilepticus

47
Q

In the notes, these symptoms in conjunction with fever point towards Herpes simplex encephalitis

A

Focal neurological signs
Focal seizures
Decreased level of consciousness

48
Q

In the notes, these symptoms in conjunction with fever point towards pneumonia

A 
Tachypnoea
Crackles in the chest
Nasal flaring
Chest indrawing
Cyanosis
Oxygen sats <95%
49
Q

In the notes, these symptoms in conjunction with fever point towards UTI

A 
Vomiting
Poor feeding
Lethargy
Irritability
Abdo pain or tender
Urinary frequency
Dysuria
50
Q

In the notes, these symptoms in conjunction with fever point towards septic arthritis

A

Swelling of limb or joint
Not using an extremity
Non-weight bearing

Child health (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions