Infectious Disease Flashcards
Sepsis is a lot more common in children. What age is it most common in childhood?
<1, the younger, the more susceptible
Sepsis?
SIRS (systemic inflammatory response syndrome) = proven infection
Severe sepsis?
Sepsis + organ failure
Septic shock?
Sepsis + CVS dysfunction
SIRS criteria?
Temp >38 or <36
WCC >15 x10 to 9 or <5 x 10 to 9)
Tachycardia
Tachypnoea
Where to you assess capillary refill in children?
Sternum
->press for five seconds and count how long colour returns, normal is 2-3secs
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!!
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
Management of sepsis in children?
ABCDEFG- including fluid bolus and dextrose
Antibiotics- cephalosporin e.g. cefotaxime, ceftriaxone
and add IV amoxicillin if <1m old
What bloods would you want to take if you suspected a child had sepsis?
FBC
CRP
Coagulation screen
Blood gas
Glucose
Blood culture
What would be seen on a blood gas of a child with sepsis?
Metabolic acidosis
Raised lactate
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
In neonates (<1m), what are the usual causative microorganisms of sepsis?
Group B streptococcus
E.Coli
Listeria monocytogenes
In older infants and children, what are the usual causative microorganisms of sepsis?
Streptococcus pneumoniae
Neisseria meningitidis
Group A streptococcus
Staph. aureus
Meningitis?
Infection caused by inflammation of the meninges
Menignism?
Clinical signs and symptoms suggestive of meningeal irritation
Between which two layers of dura is CSF?
Between arachnoid and pia mater
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
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
Nuchal regidity?
Neck stiffness
Which two signs are positive in meningitis?
Brudzinski’s sign
Kernig’s sign
What is Brudzinski’s sign?
Hips and knees flex on passive movement of the neck
What is Kernig’s sign?
Pain on passive extension of the knee
->knee only = K
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
