Infectious Disease 1

Question 1

What is different between adult and paediatric infections?

Answer 1

Self-limiting infections right up until life-threatening infections all can present with fever and rash

Question 2

What is SIRS?

Answer 2

Systemic inflammatory response syndrome

Characterised by fever/hypothermia, tachycardia, tachypnoea, leucocytosis or leucocytopaenia

Question 3

What is the paediatric definition of severe sepsis?

Answer 3

SEPSIS + multiorgan failure
2+ of:
Respiratory failure 
Renal failure 
Neurologic failure 
Haematological failure 
Liver failure

Question 4

What is ARDS?

Answer 4

Acute respiratory distress syndrome

Inflammatory response of the lungs

Question 5

What bacteria are responsible for neonatal sepsis?

Answer 5

Group B strep
Escheria coli
Listeria monocytogenes

Question 6

What bacteria are responsible for sepsis in children?

Answer 6

Strep pneumoniae
Meningococci
Group A strep
Staph aureus

Question 7

What are the paediatric symptoms of sepsis?

Answer 7

Fever/hypothermia
Cold hands/feet, mottled 
Prolonged cap refill time 
Chills/rigors
Limb pain 
Vomiting +/- diarrhoea
Muscle weakness
Muscle/joint aches
Skin rash 
Diminished UO

Question 8

What pathogens are responsible for neonatal meningitis?

Answer 8

Group B strep
E. coli
Listeria monocytogenes

Question 9

What pathogens are responsible for meningitis in children?

Answer 9

Strep pneumoniae
Meningococci
H. influenza

Question 10

What are the signs/symptoms on meningitis in children?

Answer 10

Nuchal rigidity
Headaches, photophobia
Diminished consciousness
Focal neurological abnormalities
Seizures

Neonates: lethargy, irritability, bulging fontanelle (pressure around brain) nappy pain (pain from stretching the meninges when lifting the legs up)
Non-blanching rash typical of Neisseria

Question 11

How does toxic shock syndrome differ from other types of shock?

Answer 11

Warm shock
Hands/feet warm and will not see mottled skin n
Feel warm because staph/strep toxins lead to ongoing dilatation

Question 12

What is the traffic light scheme for diagnosing sepsis/meningitis in kids?

Answer 12

Looks at activity of the child, colour of skin, response to stimulation to environment, respiratory, circulation, hydration etc.

Question 13

How do you Rx sepsis +/- meningitis?

Answer 13

Supportive Rx: ABC (inotropes/fluid)
DEF (don’t ever forget glucose)

Antibiotics with good penetration in CSF & broad spectrum (e.g. 3rd generation cefalosporins & amoxicillin if neonate)

Chemoprophylaxis of close household contacts (for Men B and Strep A)

Question 14

What investigations should you do in suspected meningitis/sepsis?

Answer 14

FBC (leucocytosis, thrombocytopaenia)
CRP (elevated)
Coagulation factors (low due to DIC)
Blood gases (metabolic acidosis)
Glucose (hypoglycaemia)
CSF: pleocytosis, increase protein level, low glucose
Blood and CSF cultures (antigen testing, CSF)
Urine culture, skin biopsy culture
Imaging: CT-cerebrum (make sure safe to take LP)

Question 15

When would you be able to do a skin biopsy to help diagnose meningitis?

Answer 15

If there is rash you may find the bacteria in the skin

Question 16

What kind of bacteria is streptococcus pneumoniae?

Answer 16

Gram positive duplo-cocci

It colonises upper airways
Spread by droplets

Question 17

What is the major predisposing factor for invasive disease with strep pneumoniae?

Answer 17

Viral infection

Question 18

What kind of infection can pneumococcal disease lead to?

Answer 18

It has nasopharyngeal carriage and can spread locally to the sinuses/ear or can spread to lungs –> pneumonia/empyema
Can get into blood and cause septicaemia or meninges and cause meningitis

Many other places too

Question 19

What kind of pneumonia is very characteristic of pneumococcal disease?

Answer 19

Lobar pneumonia

Question 20

How can pneumococcal disease be prevented?

Answer 20

Pneumococcal vaccine - 13-valent

Question 21

If pneumococcal meningitis isn’t treat quickly enough what complications can result?

Answer 21

Brain damage
Hearing loss
Hydrocephalus

Question 22

What kind of bacteria is Hib?

Answer 22

Gram -ve
Encapsulated H. influenzae can resist phagocytosis and complete mediated lysis
Unencapsulated Hi is non-typeable

Question 23

What can Hib cause?

Answer 23

Bacteraemia, meningitis, pneumonia, epiglottitis

Question 24

What is the major factor predisposing to Hib infection?

Answer 24

Viral infection

Question 25

How does meningococcus cause disease?

Answer 25

Meningococcus is carried in nasopharynx
Passage through epithelia
Meningococcus can enter BS

Question 26

How long after meningococcus has entered the blood do we get symptoms?

Answer 26

<12h signs of septic shock

<18-36h signs of meningitis

Question 27

What are some of the long term morbidities that survivors of meningococcal meningitis suffer?

Answer 27

Amputation, skin scarring, cognitive impairment/epilepsy/hearing loss

Question 28

Who does meningococcal disease tend to affect?

Answer 28

Young children <1

Question 29

What is the thing that makes meningococcal disease so virulent?

Answer 29

Endotoxin (lipopolysaccharide)

Endotoxin levels assoc. with higher mortality as it stimulates a septic cascade