Infections in Children Flashcards
Most frequent causative organisms of bacterial meningitis in children and young people aged 3 months or older?
How long do each need to be treated with ceftriaxone>
- Neisseria meningitidis - 7 days
- Streptococcus pneumoniae - 14 days
- Haemophilus Influenzae B - 10 days
Most frequent causative organisms of bacterial meningitis in neonates (children younger than 28 days)?
How are they treated?
- Streptococcus agalactiae (group B streptococcus) - IV Cefotaxime for 14 days
- Escherichia coli
- Streptococcus pneumoniae
- Listeria monocytogenes - IV Ampicillin/ Amoxicillin for 21 days with Gentamicin for 1st 7 days
What are the contraindications to performing a lumbar puncture in suspected meningitis or suspected meningococcal disease?
- signs suggesting raised intracranial pressure:
reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 or more), relative bradycardia and hypertension, focal neurological signs, abnormal posture or posturing, unequal, dilated or poorly responsive pupils, papilloedema, abnormal ‘doll’s eye’ movements - shock
- extensive or spreading purpura - this is a sign of DIC
- after convulsions until stabilised
- coagulation abnormalities
coagulation results (if obtained) outside the normal range, platelet count below 100×109/litre, receiving anticoagulant therapy - local superficial infection at the lumbar puncture site
- respiratory insufficiency (lumbar puncture is considered to have a high risk of precipitating respiratory failure in the presence of respiratory insufficiency).
Brudzinski Signs and Kernig Sign
Both signs of bacterial meningitis or meningococal disease
- Brudzinski’s sign is consequence of neck stiffness - when neck is flexed, hips and knees invountarily flex
- Kernig’s sign is consequence of hamstring stiffness - is the elicitation of pain or resistance when leg is flexed past angle
Treatment of suspected bacterial meningitis or meningococcal disease in children <3 months?
Treatment of suspected bacterial meningitis or meningococcal disease in children >3 months?
What do you add if the child has recently travelled/been exposed to multiple antibiotics in the last 3 months?
- IV Cefotaxime + Ampicillin/Amoxicillin
- IV Ceftriaxone
- Vancomycin
When to use corticosteroids in meningitis?
Do not use corticosteroids in children younger than 3 months or meningococcal septicaemia.
Give dexamethasone (0.15 mg/kg to a maximum dose of 10 mg, 4 times daily for 4 days) for suspected or confirmed bacterial meningitis as soon as possible if lumbar puncture reveals any of the following:
- frankly purulent CSF
- CSF white blood cell count greater than 1,000/microlitre
- raised CSF white blood cell count with protein concentration greater than 1 g/litre
- bacteria on gram stain.
Presentation of Scarlet Fever
Scarlet fever has an incubation period of 2-4 days andtypically presents with:
- fever: typically lasts 24 to 48 hours
- malaise, headache, nausea/vomiting
- sore throat
- ‘strawberry’ tongue - tongue is red, swollen and covered with white papillae
- rash
- fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
- children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures
- ‘Pastia’s lines’ (rash in prominent skin creases)
- it is often described as having arough ‘sandpaper’ texture
- desquamination (shedding of skin) occurs later in the course of the illness, particularly around the fingers and toes
Treatment of Scarlet Fever
- oral penicillin V (phenoxymethylpenicillin aka Pen V QDS 10 days) for 10 days
- patients who have apenicillin allergy should be given azithromycin
- children can return to school 24 hours after commencing antibiotics
- scarlet fever is anotifiable disease
Where is scarlet fever rash most prominent?
In flexures, particularly cubital fossas.
Pastia’s lines - Accentuation of the red rash in flexor creases (i.e., under the arm, in the groin
Diagnostic Criteria for Kawasaki Disease
Kawasaki disease is a rare condition mainly seen in children under 5-years-old. It is classified by a fever which is present for 5 days or more along with 4 of the following features:
1) Cervical lymphadenopathy
2) Dry cracked lips, strawberry tongue, or erythema of oral and pharyngeal mucosa
3) Bilateral conjunctivitis without exudate
4) Peeling of skin on toes and fingers/ oedema or erythema of hands or feet
5) Red rash over trunk
Fever typically tends to be resistant to anti-pyretics
Management of Kawasaki Disease
Intravenous immunoglobulin, High dose aspirin, arrange echocardiogram (to look for coronary artery aneurysm)
4Ds of acute epiglottitis
1) Drooling
2) Dysphonia
3) Dysphagia
4) Distress
+ High-grade fever
Clinical features of Whooping Cough
Whooping cough has 3 phases of symptoms: catarrhal, paroxysmal, and convalescent.
CATARRHAL PHASE
- The catarrhal phase typically begins 7–10 days (and ranges from 4–21 days) after exposure and lasts for 1–2 weeks.
- Symptoms are often difficult to distinguish from those of other upper respiratory tract infections and include rhinorrhoea, malaise, mild cough, sore throat, and conjunctivitis.
- Fever is uncommon and low-grade.
- People are most infectious in this stage.
PAROXYSMAL PHASE
- The paroxysmal phase usually lasts 1–6 weeks but can last up to 10 weeks.
- It is characterized by rapid, violent, and uncontrolled coughing fits (paroxysms) due to difficulty expelling thick mucus from the tracheobronchial tree.
- The coughing fits:
1) Typically consist of a short expiratory burst followed by an inspiratory gasp (causing the characteristic ‘whoop’ sound). The ‘whoop’ is less common in adults, and in children younger than 3 months of age (who may present with apnoea alone).
2) Occur frequently at night, with an average of 15 attacks per 24 hours.
3) May be triggered by external stimuli, such as cold or noise.
4) Are frequently associated with post-tussive vomiting and may be severe enough to cause cyanosis in children. 5) Adults may experience sweating attacks with facial flushing, and rarely, cough syncope.
6) Increase in frequency during the first 1–2 weeks, remain at the same frequency for 2–3 weeks, and then gradually decrease.
- Fever is absent or minimal.
- Most diagnoses are made during this stage.
CONVALESCENT PHASE
- The convalescent phase usually lasts 2–3 weeks, during which there is a gradual improvement in cough frequency and severity.
- However, paroxysms can recur with subsequent respiratory infections for many months after the initial infection.
How to confirm diagnosis of whooping cough? i.e. what investigations to request
Investigations to request: Nasopharyngeal aspirate/ nasopharyngeal swab, throat swab or antibody serology or sputum
Laboratory confirmation of clinically suspected cases of whooping cough can be made by
- culture from per nasal swab
- polymerase chain reaction (PCR),
- serological testing, or
- oral fluid testing (OFT) - test for anti-pertussis toxin immunoglobulin G (IgG).
WHOOPING COUGH DIAGNOSIS CONFIRMED BY
Presence of clinical features AND
- B pertussis isolated, or
- PCR positive, or
- high antibody titre in absence of vaccination in the past year
