Temp >38 or 15 x10 to 9 or <5 x 10 to 9) Tachycardia Tachypnoea

Infectious Disease Flashcards by Lucy Jefford

Sepsis is a lot more common in children. What age is it most common in childhood?

<1, the younger, the more susceptible

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Sepsis?

SIRS (systemic inflammatory response syndrome) = proven infection

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Severe sepsis?

Sepsis + organ failure

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Septic shock?

Sepsis + CVS dysfunction

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SIRS criteria?

Temp >38 or <36

WCC >15 x10 to 9 or <5 x 10 to 9)

Tachycardia

Tachypnoea

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Where to you assess capillary refill in children?

Sternum

->press for five seconds and count how long colour returns, normal is 2-3secs

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What are assessed in screening of a child to rule out sepsis?

Temperature (>38 or >36)

Inappropriate tachycardia

Poor peripheral perfusion

Altered mental state

Inappropriate tachypnoea

Hypotension

->don’t think too much about hypotension in a child, this is a very late stage and is a worrying sign. Don’t wait for hypotension before you suspect sepsis!!

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List some of the risk factors for infection in children <3 months.

Prematurity
PROM (prolonged rupture of membranes)
Maternal pyrexia/chorioamnionitis
Maternal group B strep infection, in this or previous pregnancy
Maternal STI

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Management of sepsis in children?

ABCDEFG- including fluid bolus and dextrose
Antibiotics- cephalosporin e.g. cefotaxime, ceftriaxone
and add IV amoxicillin if <1m old

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What bloods would you want to take if you suspected a child had sepsis?

FBC
CRP
Coagulation screen
Blood gas
Glucose
Blood culture

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What would be seen on a blood gas of a child with sepsis?

Metabolic acidosis
Raised lactate

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In children with suspected septic infection, many cultures are taken to try and find out where the infection is coming from.

What would you want to test?

Blood
Urine
CSF
Stool

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In neonates (<1m), what are the usual causative microorganisms of sepsis?

Group B streptococcus
E.Coli
Listeria monocytogenes

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In older infants and children, what are the usual causative microorganisms of sepsis?

Streptococcus pneumoniae
Neisseria meningitidis
Group A streptococcus
Staph. aureus

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Meningitis?

Infection caused by inflammation of the meninges

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Menignism?

Clinical signs and symptoms suggestive of meningeal irritation

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Between which two layers of dura is CSF?

Between arachnoid and pia mater

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List the signs and symptoms of meningitis in older children.

Fever
Headache
Neck stiffness
Photophobia
Nausea and vomiting
Reduced GCS
Seizures
Focal neurological deficits

->reminder, in adults classic triad is neck stiffness, fever and headache

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Meningitis can have non-specific signs and symptoms in young infants.

List some please :)

Fever or hypothermia
Poor feeding
Vomiting
Lethargy
Irritability
Respiratory distress
Apnoea
Bulging fontanelle

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Nuchal regidity?

Neck stiffness

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Which two signs are positive in meningitis?

Brudzinski’s sign
Kernig’s sign

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What is Brudzinski’s sign?

Hips and knees flex on passive movement of the neck

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What is Kernig’s sign?

Pain on passive extension of the knee

->knee only = K

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What tends to cause childhood meningitis?

Usually viral- mainly enterovirus

Common causative microorganisms of bacterial meningitis in neonates (<1m)?

Same as sepsis :) Group B streptococcus E.Coli Listeria monocytogenes

Common causative microorganisms of bacterial meningitis in older infants and children?

Streptococcus pneumoniae Neisseria meningitidis Hib - haem influenzae type b ->hib a lot less common now because of vaccinations

What kind of bacteria is Haemophilus influenzae?

Gram-negative coccobacillus ->found in nasopharyngeal carriage

Which vaccines are given which reduce risks of meningitis?

Hib MenACWY

Risk factors for menignitis?

Age <1 or 15-24 Unimmunised Crowded living conditions Household or kissing contact Cigarette smoking- passive or active Recent viral/mycoplasma infection Complement deficiency

Invasive meningococcal disease can have symptoms of meningitis and septicaemia. What is the one specific symptom of invasive meningococcal disease?

Petechial/purpuric non-blanching rash

What are some of the long-term sequalae which follow invasive meningococcal disease?

Amputation Scarring Hearing loss Cognitive impairment/epilepsy

Risk factors for invasive pneumococcal disease?

Age <2yrs Cigarette smoking- active or passive Recent viral URTI Attendance at childcare Cochlear implant Sickle cell disease Asplenia HIV Nephrotic syndrome Immunodeficiency/immunosuppression

List some of the neurological sequalae which can follow pneumococcal menigitis.

Hydrocephalus Neurodisability Seizures Hearing loss Blindness

Management of menigitis?

Same as sepsis :) ABCDEFG- including fluid bolus and dextrose Antibiotics- cephalsporin e.g. cefotaxime/cefriaone and IV amoxicillin if <1m

Which bloods would you want to check if you were suspicious a child had meningitis?

FBC U&Es LFTs CRP Coagulation screening time Blood gas Glucose

What would be seen on a blood gas in a child with meningitis?

Metabolic acidosis Raised lactate

What other investigation are important in the diagnosis of meningitis?

Blood cultures- meningococcal or pneumococcal Lumbar puncture- essential ->LP ideally before antibiotics but do not delay antibiotics if LP cannot be performed

Signs of raised ICP?

GCS <9 Abnormal tone or posture Hypertension and bradycardia Pupillary defects Papilledema Focal neurological signs Recent seizure CVS unstable Thrombocytopenia Extensive or extending purpura

When do you NOT do a LP?

If signs of raised intracranial pressure ->see previous flashcard

When you have a CSF sample to send to the lab, what are you asking them to assess?

Microscopy Gram stain Culture Protein Glucose Viral PCR

Findings of bacterial meningitis CSF?

Turbid or purulent Very increased WCC Very high protein Low glucose

Which staphylococcus infection causes many skin infections?

Staph.aureus

Which steptococcus infection causes many skin infections?

Strep.pyogenes ->both can also cause bacteraemia, toxin-mediated diseases and TSS

What type of bacteria is straph.aureus?

Gram positive cocci

Where does staph.aureus colonise?

Skin and mucosa

Staph.aurues being resistant to antibiotics is an issue (MSRA). However, which antibiotic are strep.pyogenes universally sensitive to?

Penicillin's

What is staphylococcal scalded skin syndrome?

Skin infection, usually in infants, where they look like they've been scaled. Is a staphylococcal infection. Initial bullous lesions, followed by widespread desquamation

Treatment for staphylococcal scalded skin syndrome?

IV Flucloxacillin IV Fluids ->doesn't tend to cause systemic upset or fever but best treated with antibiotics.

Which microorganism causes Scarlet fever?

Group A strep

What is the typical pattern of infection in scarlet fever?

Contact 2-5 day incubation period Development of fever, malaise and sore throat Strawberry tongue 1-2 days after symptoms, sandpaper rash- usually after symptoms but can precede. Desquamation occurs after rash has disappeared. ->very classic pattern, need to know. Scarlet fever requires pubic health to be informed.

Treatment of scarlet fever?

Phenoxymethylpenicillin for 10 days ->reduces course of illness by one day, but more importantly, reduces incidence of complications

What are some of the potential complications of scarlet fever?

Quincy Acute rheumatic fever Post-streptococcal glomerulonephritis

What is the most common cause of acquired heart disease in children worldwide?

Rheumatic fever

What is toxic shock syndrome?

Acute febrile illness caused by gram positive bacteria (so can be strep or staph) rapidly progressing to shock and multiorgan failure

Clinical features of toxic shock syndrome?

Fever Diffuse, maculopapular 'sunburn' rash Mucosal changes- non-purulent conjunctivitis, swollen lips, strawberry tongue Profuse diarrhoea (s.aureus) Shock symptoms (next flashcard)

Generic symptoms of shock, also seen in toxic shock syndrome?

Tachycardia Hypotension Renal impairment Transaminitis Reduced GCS Prolonged capillary refill time ->always beware of the child with tachycardia and prolonged CRT

Management of toxic shock syndrome?

ABC Fluids Cultures- bloods, swabs, wounds, to find causative microorganism IV antibiotics- flucloxacillin + clindamycin IVIG Surgical debridement ->very good to give clindamycin as well as good at shutting down toxin production but never given on it's own.

Which medications need to be avoided in patients with toxic shock syndrome?

NSAIDs ->increases risk of necrotising fasciitis