Infectious disease 1.0 Flashcards
What is unique about childhood infectious disease?
- Common infections can become life threatening infections: fever and rash
- Immune system is developing so will present differently
- Presenting symptom of primary immunodeficiencies (inborn error in specific immune component) or HIV
What is paediatric sepsis?
SIRS + suspected/proven infection
SSx of paediatric sepsis?
- Fever or hypothermia
- Tachycardia
- Tachypnoea
- Leucocytosis or leucocytopaenia
- Chills/rigors
- Limb pain
- Vomiting/diarrhoea
- Muscle weakness
- Joint pain
- Skin rash
- Infection = bacteraemia (e.g. bacteria multiplying in the bloodstream)
- More common in boys
- Most common in newborn 1/300
What is paediatric severe sepsis?
SEPSIS + multi-organ failure
≥2 of the following:
- Respiratory failure
- Renal failure
- Neurologic failure
- Haematological Failure • Liver failure
What is ARDS?
- (acute respiratory response syndrome)
- Inflammatory response of the lungs
Sepsis
What are the responsible pathogens in neonates? (<1month)
What are the responsible pathogens in children?
Neonates:
- Group B streptococci
- E coli
- Listereria monocytogenes
Children
- Strep pneumoniae
- Meningococci
- Group A streptococci
- Staph aureus
Paediatric meningitis
Possible pathogens: neonates?
Children?
Neonates
- Group B strep
- E. coli
- Listeria monocytogenes
Children
- Strep pneumoniae
- meningococci
- H influenzae
Meningitis
SSx?
in Neonates?
- Nuchal rigidity
- Headaches, photophobia
- Diminished consciousness
- Focal neurological abnormalities
- Seizures
In neonates:
- Lethargy, irratability
- Bulging fontanelle
- nappy pain
Meningits +/- Sepsis
What is the management?
Supportive
- A - airway
- B - breathing
- C - circulation
- D - Don’t ever forget glucose
Causative treatment:
- Antibiotics with good penetration in CSF & broad-spectrum:
- 3rd generation cefalosporins (cefotaxime) (+ amoxicilline if neonate)
Chemoprophylaxis:
- Close household contacts
- Meningococcus B and Streptococcus group A
What test do we need to do to make a diagnosis of meningitis +/- sepsis?
-
Blood:
- FBC; leucocytosis, thrombocytopaenia
- CRP; elevated
- coagulation factors; low levels due to DIC
- blood gas; metabolic acidosis
- glucose; hypoglycaemia
- CSF: pleocytosis, increased protein level, low glucose
- Blood and CSF cultures (antigen testing, PCR)
- Urine culture, skin biopsy culture
- Imaging: CT-cerebrum
Give me some deets on strep pneumoniae:
- Gram-positive Duplo-cocci (Diplococcus pneumoniae)
- 90 serotypes identified
- Colonizes upper airways
- 5-10% adults
- 20-40% children
- Transmission by droplets
- Viral infections predisposing factor for invasive disease
Complications of pneumococcal meningitis?
- Brain damage
- Hearing loss
- Hydrocephalus
Tell me about haemophilus influenza type b:
- Gram-negative bacterium
- Encapsulated H. influenzae, 6 serotypes
- Resist phagocytosis and complement-mediated lysis
- Unencapsulated H. influenzae = non-typeable H. influenzae (NTHI)
- Bacteraemia, meningitis (as severe as pneumococcal meningitis), pneumonia, epiglottitis
- Viral infections predisposing factor for invasive disease
What is the clinical epidemeology of meningococcal disease?
- Meningococcus in nasopharynx
- Passage through epithelia
-
Meningococcus in the bloodstream
- < 12 hours signs of septic shock
- < 18-36 hours signs of meningitis
-
Case-fatality rate 5-15%
- 50% of deaths in first 12 hrs, 80% within 48 hrs
- Long-term morbidity in significant proportion of survivors
- Amputation (14%), skin scarring (48%)
- Cognitive impairment/epilepsy/hearing loss
What are the vaccine preventable diseases?
- Haemophillus influenza B
- Pneumococcal disease
These are major causative organisms that can be protected against.
