Infections Flashcards
What is SIRS?
Systemic Inflammatory Response Syndrome
Characterised by:
- fever (or hypothermia)
- tachycardia
- tachypnoea
- leucocytosis/leucocytopenia (high or low WCC)
What is ARDS?
Acute Respiratory Distress Syndrome
- exaggerated response of the lungs
When does sepsis become severe sepsis (in paeds)?
Sepsis + multi-organ failure
Multi-organ failure = at least 2 of:
- resp failure
- renal failure
- neurological failure
- haematological failure
- liver failure
Which age are most at risk of sepsis?
Younger children, particularly preterm babies
Which pathogens are responsible for sepsis in neonates?
Group B strep
E. coli
Listeria monocytogenes
Which pathogens are responsible for sepsis in children?
Strep pneumoniae
Meningococci
Group A strep (strep pyogenes)
Staph aureus
What condition is particularly worrying if it presents with signs of diminished circulation? describe these signs
Paediatric sepsis
Cold hands/feet
Mottled appearance of hands/feet
Prolonged capillary refill
Chills/rigors
Which pathogens are responsible for meningitis in neonates?
(the same as sepsis!)
Group B strep
E. coli
Listeria monocytogenes
Which pathogens are responsible for meningitis in children?
Strep pneumoniae
Meningococci
Haemophilus influenzae
(not the same as sepsis!)
What is the difference in causative organisms between sepsis and meningitis?
No difference in neonates
In children, staph aureus and strep A cause sepsis but not meningitis
What are the main signs/symptoms of meningitis in children?
Fever Headache, photophobia Nuchal rigidity Diminished consciousness Focal neuro abnormalities Seizures (Rash)
What are the main signs/symptoms of meningitis in neonates?
Lethargy, irritability Fever Nappy pain (neonatal version of nuchal rigidity) Bulging fontanelle (Rash)
What is “toxic shock syndrome”?
Warm septic shock –> septic shock without reduced peripheral circulation
Due to toxins released by the pathogens
Which pathogens most commonly cause toxic shock syndrome?
Staph and strep
How are paediatric patients triaged/assessed for sepsis?
Traffic light scoring system to assess risk (green, amber, red for low, intermediate and high risk).
What is assessed during a traffic light assessment for paediatric sepsis?
Activity of the child
Respiratory function
Circulation and hydration
Other e.g. fever, rigors, swelling, limb pain, rash, bulging fontanelle, neck stiffness
What questions are asked by the “paediatric sepsis six” system for recognising sepsis in a child?
Temperature <36 or >38 degrees? Inappropriate tachycardia? Poor peripheral perfusion / cap refill > 2 secs / mottled appearance Altered mental state? Inappropriate tachypnoea? Hypotension?
What are the signs of altered mental status in a child?
Sleepiness
Irritability
Lethargy
Floppiness
Describe the initial treatment of a child with sepsis
- Immediate supportive treatment:
- ABC
- DEFG - don’t ever forget glucose - treat causative infection (antibiotics)
What antibiotics are used to treat bacterial sepsis in paediatrics?
3rd generation cephalosporin IV e.g. cephtriaxone
Plus amoxicillin if neonate
(also give chemoprophylaxis to close household contacts)
What is the reason behind the choice of antibiotics in sepsis in children?
3rd generation cephalosporin
- broad spectrum
- good penetration of CSF in case of associated meningitis
What is the reason behind the choices of antibiotics in neonates?
Add amoxicillin to cover listeria (listeria generally only affects the very young and very old)
Listeria is not susceptible to cephalosporins
Give five infections which are caused by both staph and strep, and cannot be clinically differentiated between staph and strep infection
Impetigo Toxic shock syndrome Bacteraemia Cellulitis Septic arthritis
Which bug is susceptible to penicillin?
Strep
