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Paediatrics > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What is sepsis?

A

SIRS +suspected or proven infection

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2
Q

What is severe sepsis and what is septic shock?

A

Severe sepsis=sepsis + organ dysfunction

Septic shock=sepsis + CVS dysfunction

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3
Q

What >2 of categories is needed for SIRS to be present?

A
  • Temp
  • WCC
  • Tachycardia
  • Tachypnoea
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4
Q

Why should you not focus too much on looking for hypotension in paediatrics when it comes to sepsis?

A

Incredibly late sign in children and only drop BP when in decompensated shock

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5
Q

Why do we worry specifically about infants <3 months in age?

A
  • Increased risk of bacterial infection, sepsis, meningitis
  • May have minimal signs and symptoms
  • Presentation often non-specific
  • May not mount a febrile response
  • Deteriorate quickly
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6
Q

What risk factors would make you think of infection in an infant <3 months?

A
  • Prematurity (<37/40)
  • PROM
  • Maternal pyrexia/chorioamnionitis
  • Maternal GBS or previous child with GBS
  • Maternal STI
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7
Q

What is the management of sepsis?

A

ABC (C=fluid bolus (20ml/kg 0.9%NaCl)

DEFG (Don’t ever forget Glc)=2ml/kg 10% dextrose

Abx:
- 3rd generation cephalosporin (e.g. Cefotaxime/Ceftriaxone)
- Add IV amoxicillin if <1month old (Listeria not covered - most common cause of sepsis meningitis in this age)

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8
Q

What bloods are done in sepsis?

A

FBC (leukocytosis, thrombocytopaenia)

CRP

Coagulation screen (DIC)

Blood gas (metabolic acidosis, raised lactate)-capillary or venous

Glc

Blood culture

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9
Q

What cultures are taken in sepsis?

A

Blood
Urine
CSF (including send to virology)
+/-stool (micro + virology)

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10
Q

If a child is presenting with sepsis with an unclear source what can a CXR be helpful for excluding?

A

Focal Pneumonia

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11
Q

What different organisms are responsible for sepsis in neonates <1 month compared to older infants & children?

A

Neonates:
- Group B strep
- E.coli
- Listeria monocytogenes

Older infants & children:
- Strep pneumoniae
- Neisseria meningitidis
- Group A strep
- Staph aureus

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12
Q

If any child <3 months with … unless its immediately post immunisation paediatricians want to see them

A

FEVER

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13
Q

What is meningitis and what is meningism?

A

Meningitis=A disease caused by inflam of the meninges

Meningism=The clinical signs & symptoms suggestive of meningeal irritation

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14
Q

Where does CSF lie?

A

Between arachnoid and pia mater

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15
Q

What is apnoea?

A

Pause in breathing lasting for >20 secs-unique to young infants

Sign of significant respiratory distress and reduced resp drive

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16
Q

What are the clinical signs of meningitis?

A
  • Nuchal rigidity (Neck stiffness)=Palpable resistance to neck flexion
  • Brudzinski’s sign=Hips and knees flex on passive flexion of the neck
  • Kernig’s sign=Pain on passive extension of the knee
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17
Q

What are the causes of childhood meningitis?

A
  • Bacterial
  • Viral (mainly enterovirus)
  • Fungal-neonates/immunocompromised
  • Unknown/aseptic
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18
Q

What are the organisms cause bacterial meningitis?

A

Neonates (<1month)
- Group B strep
- E.coli
- Listeria

Older infants and children
- Strep pneumoniae
- Neisseria meningitidis
- Hemophilus influenzae type B (HiB)

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19
Q

How is H. Influenza carried and what is the type should be worried about?

A

Nasopharyngeal carriage

Small, non motile, gram -ve coccobacillus

Encapsulated H. influenza

(Non encapsulated=non typable H.influenzae (NTHI)-otitis media & sinusitis-rare for it to cause invasive infection)

20
Q

Neisseria meningitidis is a gram -ve diplococcus in which humans are its only natural hosts. How is it transmitted?

A

Nasopharyngeal carriage
- Transmission via resp secretions
- Infection often follows viral URTI
- Polysaccharide capsule

Endotoxin (LPS)-big driver of the sepsis response

21
Q

What are the risk factors for invasive meningococcal disease?

A
  • Age <1 year or 15-24 years
  • Unimmunised
  • Crowded living conditions
  • Household or kissing contact
  • Cigarette smoking (active or passive)
  • Recent viral/Mycoplasma infection
  • Complement deficiency
22
Q

Invasive meningococcal disease is rapidly progressive, what are some significant long term sequelae associated with it?

A

Amputation

Scarring

Hearing loss

Cognitive impairment/epilepsy

23
Q

Streptococcus pneumoniae (Pneumococcus)-Gram +ve lancet shaped diplococcus, facultative anaerobe, polysaccharide capsule: where dose it colonise?

A

Colonises nasopharynx

Preceding URTI RF for invasive infection

Resp droplet transmission

24
Q

What are the risk factors for invasive pneumococcal disease?

A

Age <2 years

Cigarette 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 are the common neurological sequelae of pneumococcal meningitis?

A
  • Hydrocephalus
  • Neurodisability
  • Seizures
  • Hearing loss
  • Blindness
26
Q

What is the treatment of meningitis?

A

SAME TX AS SEPSIS!!!!

ABC

DEFG

Abx

27
Q

What bloods should be done for meningitis?

A

FBC (leukocytosis, thrombocytopaenia)
U&Es, LFTs
CRP
Coagulation screen (DIC)
Blood gas (metabolic acidosis, raised lactate)
Glucose
Blood culture
Meningococcal/Pneumococcal PCR

28
Q

LP is essential in meningitis when should it ideally be done?

A

Ideally prior to Abx but do not delay Abx if LP cannot be performed

29
Q

When should you definitely not do a LP?

A

When there are signs of raised ICP

30
Q

What should you request on an LP?

A

Microscopy
Gram Stain
Culture
Protein
Glucose
Viral PCR

31
Q

What are the findings on LP of a bacterial meningitis?

A
  • Turbid or purulent
  • High opening pressure
  • WCC increased (polymorphs)
  • High protein
  • Reduced Glc (<50% serum)-should do a blood sugar at the same time as doing LP
32
Q

Are different organisms that cause bacterial meningitis treated for different durations?

A

They are indeedy

33
Q

Majority of skin & soft tissue conditions are caused by what and what can both these organisms cause?

A

Staph (mainly S. aureus) or Strep (S. pyogenes)

Both organisms cause osteoarticular infection, bacteraemia, toxin-mediated diseases (Staphylococcal & Streptococcal Toxic Shock Syndrome (TSS))

Can be difficult to distinguish clinically

34
Q

Is resistance a problem in Strep pyogenes?

A

Strep is universally S to penicillin

35
Q

Strep is B haemolytic and has oropharyngeal carriage whereas staph aureus is?

A

Coagulase +ve and colonises skin and mucosa

36
Q

How does staphylococcal scalded skin syndrome present?

A
  • Usually <5yo
  • Toxin mediated (exfoliatoxin)
  • Initial bullous lesions
  • Followed by widespread desquamation
  • Mild fever
  • Purulent conjunctivitis
37
Q

What sign is indicated in staphylococcal scalded skin syndrome and how is the condition managed?

A

Nikolsky sign (rub over skin-sloughs off, desquamates under minimal pressure)

Mx=IV Flucloxacillin + IV fluids

38
Q

What are the characteristics of scarlet fever (scarlatina)?

A
  • 2-5 day incubation period
  • Fever, malaise, sore throat
  • STRAWBERRY TONGUE
  • SANDPAPER RASH
  • Skin peeling (desquamation)
39
Q

How is scarlet fever managed?

A

Notifiable disease- inform public health

Phenoxymethylpenicillin (Penicillin V) 10 days
- Reduces duration and severity illness by ~1 day
- Reduces incidence of complications (quincy/acute rheumatic fever/post-streptococcal glomerulonephritis)
- Reduces transmission

40
Q

What are the potential complications of scarlet fever?

A

Abscess formation -
retropharyngeal or peritonsillar (quincy)

Acute Rheumatic Fever
- most common cause acquired heart disease in children worldwide
- 2-3/52 after pharyngitis
- arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules

Post-streptococcal glomerulonephritis

41
Q

What is toxic shock syndrome (TSS) and what can it result in?

A

Acute febrile illness caused by Gram +ve bacteria (S. aureus & GAS) rapidly progressing to shock and multiorgan failure

Superantigen causes intense T cell stimulation
excessive immune activation
pro-inflammatory cytokine release (TNF-α, IL-1, IL-2, IFN-γ)

Case fatality
30-60% GAS
3-6% S. aureus

42
Q

What are the clinical features of TSS?

A

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

43
Q

How is TSS managed?

A

ABC

Fluid resuscitation +/- inotropes

Cultures
- Blood
- Throat swabs
- Wounds

IV Antibiotics
Flucloxacillin + Clindamycin

IVIG

Avoid NSAIDs (increases risk of necrotising fasciitis)

Surgical debridement

44
Q

Staph and strep cause very similar patterns of infection except in what?

A

Except Scarlet Fever (exclusively GAS) & SSSS

45
Q

Toxins are major … factors of staph and strep

A

VIRULENCE

46
Q

What organism is scarlet fever unique to?

A

GROUP A STREP (GAS)

47
Q

What are the predominant causes of skin & soft tissue infection?

A

Staph & strep infections

Paediatrics (17 decks)

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