Infectious Disease 1 Flashcards

1
Q

What is different between adult and paediatric infections?

A

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

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2
Q

What is SIRS?

A

Systemic inflammatory response syndrome

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

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3
Q

What is the paediatric definition of severe sepsis?

A
SEPSIS + multiorgan failure
2+ of:
Respiratory failure 
Renal failure 
Neurologic failure 
Haematological failure 
Liver failure
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4
Q

What is ARDS?

A

Acute respiratory distress syndrome

Inflammatory response of the lungs

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5
Q

What bacteria are responsible for neonatal sepsis?

A

Group B strep
Escheria coli
Listeria monocytogenes

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6
Q

What bacteria are responsible for sepsis in children?

A

Strep pneumoniae
Meningococci
Group A strep
Staph aureus

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7
Q

What are the paediatric symptoms of sepsis?

A
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
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8
Q

What pathogens are responsible for neonatal meningitis?

A

Group B strep
E. coli
Listeria monocytogenes

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9
Q

What pathogens are responsible for meningitis in children?

A

Strep pneumoniae
Meningococci
H. influenza

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10
Q

What are the signs/symptoms on meningitis in children?

A
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

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11
Q

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

A

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

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12
Q

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

A

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

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13
Q

How do you Rx sepsis +/- meningitis?

A

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)

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14
Q

What investigations should you do in suspected meningitis/sepsis?

A

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)

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15
Q

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

A

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

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16
Q

What kind of bacteria is streptococcus pneumoniae?

A

Gram positive duplo-cocci

It colonises upper airways
Spread by droplets

17
Q

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

A

Viral infection

18
Q

What kind of infection can pneumococcal disease lead to?

A

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

19
Q

What kind of pneumonia is very characteristic of pneumococcal disease?

A

Lobar pneumonia

20
Q

How can pneumococcal disease be prevented?

A

Pneumococcal vaccine - 13-valent

21
Q

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

A

Brain damage
Hearing loss
Hydrocephalus

22
Q

What kind of bacteria is Hib?

A

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

23
Q

What can Hib cause?

A

Bacteraemia, meningitis, pneumonia, epiglottitis

24
Q

What is the major factor predisposing to Hib infection?

A

Viral infection

25
How does meningococcus cause disease?
Meningococcus is carried in nasopharynx Passage through epithelia Meningococcus can enter BS
26
How long after meningococcus has entered the blood do we get symptoms?
<12h signs of septic shock | <18-36h signs of meningitis
27
What are some of the long term morbidities that survivors of meningococcal meningitis suffer?
Amputation, skin scarring, cognitive impairment/epilepsy/hearing loss
28
Who does meningococcal disease tend to affect?
Young children <1
29
What is the thing that makes meningococcal disease so virulent?
Endotoxin (lipopolysaccharide) Endotoxin levels assoc. with higher mortality as it stimulates a septic cascade