Infections

Question 1

What is SIRS?

Answer 1

Systemic Inflammatory Response Syndrome

Characterised by:

• fever (or hypothermia)
• tachycardia
• tachypnoea
• leucocytosis/leucocytopenia (high or low WCC)

Question 2

What is ARDS?

Answer 2

Acute Respiratory Distress Syndrome

- exaggerated response of the lungs

Question 3

When does sepsis become severe sepsis (in paeds)?

Answer 3

Sepsis + multi-organ failure

Multi-organ failure = at least 2 of:

• resp failure
• renal failure
• neurological failure
• haematological failure
• liver failure

Question 4

Which age are most at risk of sepsis?

Answer 4

Younger children, particularly preterm babies

Question 5

Which pathogens are responsible for sepsis in neonates?

Answer 5

Group B strep
E. coli
Listeria monocytogenes

Question 6

Which pathogens are responsible for sepsis in children?

Answer 6

Strep pneumoniae
Meningococci
Group A strep (strep pyogenes)
Staph aureus

Question 7

What condition is particularly worrying if it presents with signs of diminished circulation? describe these signs

Answer 7

Paediatric sepsis

Cold hands/feet
Mottled appearance of hands/feet
Prolonged capillary refill
Chills/rigors

Question 8

Which pathogens are responsible for meningitis in neonates?

Answer 8

(the same as sepsis!)
Group B strep
E. coli
Listeria monocytogenes

Question 9

Which pathogens are responsible for meningitis in children?

Answer 9

Strep pneumoniae
Meningococci
Haemophilus influenzae
(not the same as sepsis!)

Question 10

What is the difference in causative organisms between sepsis and meningitis?

Answer 10

No difference in neonates

In children, staph aureus and strep A cause sepsis but not meningitis

Question 11

What are the main signs/symptoms of meningitis in children?

Answer 11

Fever
Headache, photophobia
Nuchal rigidity
Diminished consciousness
Focal neuro abnormalities
Seizures
(Rash)

Question 12

What are the main signs/symptoms of meningitis in neonates?

Answer 12

Lethargy, irritability
Fever
Nappy pain (neonatal version of nuchal rigidity)
Bulging fontanelle
(Rash)

Question 13

What is “toxic shock syndrome”?

Answer 13

Warm septic shock –> septic shock without reduced peripheral circulation
Due to toxins released by the pathogens

Question 14

Which pathogens most commonly cause toxic shock syndrome?

Answer 14

Staph and strep

Question 15

How are paediatric patients triaged/assessed for sepsis?

Answer 15

Traffic light scoring system to assess risk (green, amber, red for low, intermediate and high risk).

Question 16

What is assessed during a traffic light assessment for paediatric sepsis?

Answer 16

Activity of the child
Respiratory function
Circulation and hydration
Other e.g. fever, rigors, swelling, limb pain, rash, bulging fontanelle, neck stiffness

Question 17

What questions are asked by the “paediatric sepsis six” system for recognising sepsis in a child?

Answer 17

Temperature <36 or >38 degrees?
Inappropriate tachycardia?
Poor peripheral perfusion / cap refill > 2 secs / mottled appearance
Altered mental state?
Inappropriate tachypnoea?
Hypotension?

Question 18

What are the signs of altered mental status in a child?

Answer 18

Sleepiness
Irritability
Lethargy
Floppiness

Question 19

Describe the initial treatment of a child with sepsis

Answer 19

1. Immediate supportive treatment:
   - ABC
   - DEFG - don’t ever forget glucose
2. treat causative infection (antibiotics)

Question 20

What antibiotics are used to treat bacterial sepsis in paediatrics?

Answer 20

3rd generation cephalosporin IV e.g. cephtriaxone
Plus amoxicillin if neonate

(also give chemoprophylaxis to close household contacts)

Question 21

What is the reason behind the choice of antibiotics in sepsis in children?

Answer 21

3rd generation cephalosporin

• broad spectrum
• good penetration of CSF in case of associated meningitis

Question 22

What is the reason behind the choices of antibiotics in neonates?

Answer 22

Add amoxicillin to cover listeria (listeria generally only affects the very young and very old)

Listeria is not susceptible to cephalosporins

Question 23

Give five infections which are caused by both staph and strep, and cannot be clinically differentiated between staph and strep infection

Answer 23

Impetigo
Toxic shock syndrome
Bacteraemia
Cellulitis
Septic arthritis

Question 24

Which bug is susceptible to penicillin?

Answer 24

Strep

Question 25

Which antibiotic is used to treat staph?

Answer 25

flucloxacillin

Question 26

What pathogen causes scarlet fever?

Answer 26

strep A e.g. strep pyogenes

Question 27

What are the potential complications of scarlet fever?

Answer 27

o Erysipelas, cellulitis, impetigo
o Strep toxic shock
o Rheumatic fever
o Glomerulonephritis

Question 28

What severe skin infection is caused by staph?

Answer 28

SSSS - staph scalded skin syndrome

Question 29

Which bugs cause hand-foot-mouth disease?

Answer 29

Enteroviruses:

• coxsackie A16
• enterovirus 71

Question 30

What is the main cause of mortality in neonatal severe enteroviral disease?

Answer 30

No effective treatment
Sepsis
Myocarditis

Question 31

What is the main complication of Kawasaki disease?

Answer 31

Vasculitis of the coronary arteries

Question 32

What are the treatment options for Kawasaki disease?

Answer 32

Immunoglobulins
Aspirin
Other immunosuppressive agents

Question 33

Describe the clinical presentation of Kawasaki disease

Answer 33

Fever for at least 5 days, plus four of
o	Bilateral conjunctival injection
o	Changes of the mucous membranes
o	Cervical lymphadenopathy
o	Polymorphous rash
o	Changes of the extremities
Peripheral oedema and erythema
Periungual desquamation