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infectious diseases Flashcards

1
Q

how do infectious diseases present in children

A

majority due to viruses (in developed world)

majority are self limiting

median duration is 8 - 14 days, 3 - 5 months/year

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2
Q

what is sepsis

A

systemic inflammatory response syndrome with suspected/proven infection

severe sepsis: sepsis + organ dysfunction

septic shock: sepsis + CVS dysfunction

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3
Q

how does systemic inflammatory response syndrome present?

A
  • fever or hypothermia
  • white cells
  • tachycardia
  • tachypnoea
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4
Q

what is the epidemiology of sepsis

A

peak incidence in early childhood
< 1 year: 1 in 200
1 - 4 years: 1 in 2000
5 - 15 years: 1 in 5000

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5
Q

what is used to identify fever in under 5s

A

colour (skin, lips, tongue)
activity
respiratory
circulation & hydration

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6
Q

what is the septic 6 score

A 
temperature: <36°, >38°
peripheral fusion: capillary refill time
mental state: sleepiness, irritability, lethargy, floppiness
tachycardia: refer to pews 8
tachypnoea: refer to pews 8
hypotension: refer to pews 8
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7
Q

why do we worry about infants <3 months

A

increased risk of

  • bacterial infection
  • sepsis
  • meningitis

minimal signs and symptoms
- non specific presentation

may not mount a febrile response

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8
Q

what are risk factors for infections in infants <3 months

A

prematurity (<37/40)

prolonged rupture of membranes (PROM)

maternal

  • pyrexia/chorioamnionitis
  • GBS
  • STI (chlamydia, gonorrhoea, syphilis, HSV)
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9
Q

what is the management of sepsis

A

airway
breathing
circulation - 20ml/kg fluid bolus
defg (don’t ever forget glucose - 2ml/kg 10% dextrose)

antibiotics

  • cephalosporin (cefotaxime/ceftriaxone)
  • IV Amoxicillin if <1m old
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10
Q

what are the investigations for sepsis

A

bloods

  • FBC (leukocytosis, thrombocytopaenia)
  • CRP
  • coagulation screen (DIC)
  • blood gas (metabolic acidosis, raised lactate)
  • glucose
cultures
- blood
- urine
- CSF (including send to virology)
\+/- stool (micro + virology)

imaging
- CXR

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11
Q

what are responsible organisms for sepsis

A

neonates (<1 month)

  • group B streptococci
  • e.coli
  • listeria monocytogenes

older infants & children

  • group A streptococcus
  • streptococcus pneumoniae
  • staphylococcus aureus
  • neisseria meningitidis
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12
Q

what is the pathophysiology of sepsis?

A

overwhelming response to infection

  • LPS/bacterial components act on endothelium, neutrophils and monocytes
  • secretion of pro and anti-inflammatory cytokines
  • activation of complement
  • activation and mobilisation of leukocytes
  • activation of coagulation and inhibition of fibrinolysis
  • increased apoptosis
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13
Q

what is meningitis

A

disease caused by inflammation of the meninges

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14
Q

what is meningism

A

clinical signs and symptoms suggestive of meningeal irritation

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15
Q

what are the signs and symptoms of meningitis

A
  • fever
  • headache
  • photophobia
  • neck stiffness
  • nausea & vomiting
  • reduced gcs
  • seizures
  • focal neurological deficits
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16
Q

what are the clinical signs of meningitis

A

nuchal rigidity: palpable resistance to neck flexion
bruduzinski’s sign: hips and knees flex on passive flexion of the neck
kernig’s sign: pain on passive extension of the knee

17
Q

what are the causes of meningitis

A
  • viral
  • bacterial
  • fungal
  • unknown/aseptic
18
Q

what are the responsible organisms for bacterial meningitis

A

neonates (<1 month)

  • group B streptococcus
  • e.coli
  • listeria monocytogenes

older infants & children

  • streptococcus pneumoniae
  • neisseria meningitidis
  • haemophilus influenzae
19
Q

what is haemophilus influenza type B?

A
  • gram-negative coccobacillus
  • nasopharyngeal carriage
  • encapsulated h influenza: bacteraemia, meningitis, epiglottis, pneumonia
  • capsulated h influenza: otitis media & sinusitis
20
Q

what is neisseria meningitidis

A
  • gram negative diplococcus
  • nasopharyngeal carriage
  • transmission: respiratory secretions
  • often after viral URTI
  • polysaccharide capsule
  • endotoxin LPS
21
Q

what are the risk factors for invasive meningococcal disease

A
  • age: <1 years, 15 - 24 years
  • unimmunised
  • crowded living conditions
  • household or kissing contact
  • cigarette smoking (active/passive)
  • recent viral or mycoplasma infection
  • complement deficiency
22
Q

summarise presentation for invasive meningococcal disease

A
23
Q

what is streptococcus pneumoniae

A
  • gram-positive diplococcus
  • colonises nasopharynx
  • polysaccharide capsule
24
Q

what are the risk factors for invasive pneumococcal disease

A
  • age: <2 years
  • smoking: active or passive
  • recent viral URTI
  • attendance at childcare
  • cochlear implant
  • sickle cell disease, asplenia, HIV infection
  • nephrotic syndrome
  • immunodeficiency/Immunosuppression
25
Q

what is the common neurological sequelae in meningitidis

A
  • hydrocephalus
  • neurodisability
  • seizures
  • hearing loss
  • blindness
26
Q

what is the management of meningitidis

A
  • airway
  • breathing
  • circulation (20ml/kg fluid bolus)
  • defg (don’t ever forget glucose - 2ml/kg 10% dextrose)
  • antibiotics (cefotaxime/ceftriaxone)
    + IV amoxicillin if <1 month
27
Q

what are the investigations for meningitidis

A

bloods

  • FBC (leukocytosis, thrombocytopaenia)
  • U&Es, LFTs
  • CRP
  • coagulation screen (DIC)
  • blood gas (metabolic acidosis, raised lactate)
  • glucose

cultures (PCR)

  • bloods
  • CSF
  • meningococcal/pneumococcal PCR

other

  • focal neurological signs
  • seizure
  • cardiovascularly unstable
  • coagulopathy
  • thrombocytopenia
  • extensive or extending purpura
28
Q

what are signs of raised intracranial pressure

A
  • GCS <9
  • abnormal tone or posture
  • HTN & Bradycardia
  • pupillary defects
  • papilloedema
29
Q

what does lumbar puncture measure

A
  • microscopy
  • gram stain
  • culture
  • protein: increased
  • glucose: decreased
  • viral PCR
30
Q

what is the microbiology of staphylococcus aureus

A
31
Q

what is the microbiology of streptococcus pyogenes (GAS)

A
32
Q

what are skin and soft tissue infection

A
  • cellulitis
  • boils/furuncles
  • impetigo
  • infected eczema
  • lymphadenitis
33
Q

what is staphylococcal scalded skin syndrome

A

age: <5y

presentation:

  • toxin mediated (exfoliatoxin)
  • bullous lesions widespread desquamation
  • nikolsky sign
  • mild fever, purulent conjunctivitis

management:
- IV flucloxacillin + IV Fluids

34
Q

what is scarlet fever

A

presentation:

  • fever
  • malaise
  • sore throat
  • strawberrry tongue
  • sandpaper rash
  • skin peeling (desquamation)

management: phenoxymethylpenicillin (Penicillin V) 10 days
complications: abscess formation, acute rheumatic fever, post-streptococcal glomerulonephritis

35
Q

what is toxic shock syndrome

A
  • gram +ve bacteria S. aureus & GAS
  • superantigen causes intense T cell stimulation

presentation:

  • fever
  • diffuse, maculopapular, ‘sunburn’ rash
  • mucosal changes: non-purulent conjunctivitis, swollen lips, strawberry tongue
  • profuse diarrhoea (S. aureus)

rapid progression to shock & multi-organ failure

  • tachycardia
  • prolonged CRT
  • hypotension
  • renal impairment
  • transaminitis
  • reduced GCS
36
Q

what is the management of toxic shock syndrome?

A
  • ABC
  • fluid resuscitation +/- inotropes
  • cultures: blood, throat swabs, wounds
  • IV Antibiotics: flucloxacillin + clindamycin
  • IVIG
  • avoid NSAIDs
  • surgical debridement

paediatrics (37 decks)

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