infectious disease Flashcards
What is the definition of paediatric sepsis?
- SIRS + suspected/ proven infection
□ SIRS = systemic inflammatory response syndrome
® Fever or hypothermia
® Tachycardia
® Tachypnoea
® Leucocytosis or leukocytopenia
□ Infection = bacteraemia (e.g. bacteria multiplying in the bloodstream)
What is the difinition of severe sepsis in a child?
- SEPSIS + multi-organ failure □ ≥ 2 of the following: ® Respiratory failure ® Renal failure ® Neurologic failure ® Haematological Failure ® Liver failure □ ARDS (acute respiratory distress syndrome) ® Inflammatory response of the lungs □ Septic shock (e.g. cardiovascular failure)
What are the responsable pathogens of sepsis in neonates?
- Group B strptococci
- Escherichia coli
- Listeria monocytogenes
What are the responsable pathogens of sepsis in children?
□ Streptococcus pneumoniae
□ Meningococci
□ Group A streptococci
□ Staphylococcus aureus
What are the symptoms of sepsis in children?
- Fever or hypothermia
- Cold hands/feet, mottled skin
- Prolonged capillary refill time
- Chills/rigors
- Limb pain
- Vomiting and/or diarrhoea
- Muscles weakness
- Muscle/joint aches
- Skin rash
- Diminished urine output
□ Difficult to pick up in children so ask if the dampness of the nappy is reduced or if the urine colour has changed
What is the paediatric sepsis 6?
- If you start treatment within an hour then outcomes are better
- Temperature
- Tachycardia
- Capillary refill
- Altered mental state
- Inappropriate tachypnoea
- Hypotension
How is sepsis treated in a child?
- Supportive treatment □ A- airway □ B- breathing □ C- circulation □ DEFG= don't ever forget glucose - Causative treatment □ Antibiotics with broad-spectrum and good CSF penetration □ 3rd generation cephalosporins (+amoxicillin if neonate)
What investigations should be done if a child has sepsis
□ FBC- leucocytosis, thrombocytopaenia
□ CRP- elevated
□ Coagulation factors deranged clotting due to DIC
□ U and Es, LFTs- renal and hepatic dysfunction
□ Blood gas- metabolic acidosis, raised lactate
□ Glucose- hypoglycaemia
□ Culture
□ CSF
® Cell count and culture- increased WCC, antigen testing, PCR
® Protein and glucose- increased protein level, low glucose
□ Urine culture
□ Skin biopsy
□ Imaging- CT/ MRI head
What pathogens are responable for causing meningitis in neonates?
□ Group B streptococci
□ Escherichia coli
□ Listeria monocytogenes
What pathogens are responable for causing meningitis in children?
□ Streptococcus pneumoniae
□ Meningococci (Neisseria menangitisis)
□ Haemophilus influenza
What are the symptoms of meningitis in children?
□ Nuchal rigidity □ Headaches, Photophobia □ Diminished consciousness □ Focal neurological abnormalities □ Seizures
What are the symptoms of meningitis in neonates?
□ Lethargy, Irritability
□ Bulging fontanelle
□ Seizures
□ ‘nappy pain’
® Stretching of the meninge when lifting the baby up to change the nappy
□ High temperature
□ Tachypnoea
□ Shivering
□ Pin prick rash/ marks or purple bruises anywhere on the body
□ Sometime diarrhoea
□ Vomiting/ refusing to feed
□ Blotchy skin getting paler or turning blue
□ A stiff body with jerky movements or floppy and lifeless
□ Cold hands and feet
Describe the mengococcal rash
- Late sign
- Non-blanching rash e.g. purpura and petechiae - tumbler test
How is meningitis diagnosed in children?
- 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
What is the treatment of menengitis in children?
- Supportive treatment: □ A airway □ B breathing □ C circulation □ DEFG = ‘don’t ever forget glucose’ - Causative treatment: □ Antibiotics with good penetration in CSF & broad-spectrum: □ 3rd generation cephalosporins (+ amoxicillin if neonate) - Chemoprophylaxis □ Close household contacts □ Meningococcus B and Streptococcus group A - Steroids
What are the complications if pneumococcal meningitis?
- Brain damage
- Hearing loss
- Hydrocephalus
What diseases cam be either staph. or strep?
- Impetigo
- Toxic shock syndrome
- Bacteraemia
- Cellulitis
- Septic arthritis
What is streptococci?
- Gram positive cocci
- Penicillin
- No resistance issues
What is saphlococci?
- Gram positive cocci
- Flucloxacillin (=synthetic penicillin resistant to beta-lactamases)
- Resistance big issue
- MRSA
- Carriers
What is the history of a child with scarlet fever?
- Contact
- Intubation for 2-4 days
- Malaise fever, tonsillitis
- Start exanthema
- Strawberry tongue
- Squamation (hands and feet)- seen a week or 2 after the acute infection (caused by the exotoxins from strep A)
What causes scalet fever?
group A beta-haemolytic streptococci
What age do cgildren get scarlet fever?
○ Children under the age of 2 are relatively protected
○ Children over the age of 10 have natural protection (80%)
What are the virulance factors of scarlet fever?
- M-protein
- Exotoxins
What are the complications of scarlet fever?
- Erysipelas, cellulitis, impetigo
- Streptococcal toxic shock
- Rheumatic fever (0.3-3%)
- Glomerulonephritis
