Infectious Diseases Flashcards by Martin Beattie

What are the components of SIRS?

Fever or hypothermia

Tachycardia

Tachypnoea

Leucocytosis or leucocytopeania

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What is the definition of severe sepsis?

Sepsis + multi-organ failure

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Which organs are commonly affected by severe sepsis?

Lungs

Kidneys

Brain

Blood

Liver

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What is septic shock?

Sepsis + hypotension or hyperlactatemia

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In which group of children is sepsis more common?

Preterm

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What is the most likely organism causing sepsis in neonates (<1 month)?

Group B streptococci

E.coli

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What is the most likely organism causing sepsis in children?

Strep pneumoniae

Meningococci

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What are the pathophysiological processes that occur in sepsis?

1 - Microvascular occlusion

2 - Vascular instability

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What are the symptoms of sepsis in paediatric patients?

Fever or hypothermia
Cold hands/feet
Prolonged cap refill time
Chills & rigors
Vomiting

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What are the pathogens that are most likely to cause meningitis in neonates (<1 month)?

Group B strep

E.coli

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What are the pathogens that are most likely to cause meningitis in children?

Strep pneumoniae
Meningococci
Haemophilius Influenzae B

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What are the symptoms of meningitis in children?

Nuchal rigidity (unable to flex neck forwards)

Headaches

Photophobia

Reduced consciousness

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What are the symptoms of meningitis in neonates?

Lethargy
Irritability
Bulging fontanelle

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What are the 6 components of the sepsis 6 recognition tool?

1 - Temperature (<36 or >38)

2 - Tachycardia

3 - Tachypnoea

4 - Poor peripheral perfusion & cap refill time > 2 secs

5 - Altered mental status (sleepy, irritable, lethargy, floppy)

6 - Hypotension

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How should meningitis +- sepsis patients initially be supported?

A - Airway

B - Breathing

C - Circulation

DEFG - Don’t ever forget glucose

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How should meningitis +- sepsis patients be treated?

Antibiotics
Cephalosporins

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How can meningitis and sepsis be diagnosed?

FBC

CRP (high)

Coagulation factors (low)

Blood gas (metabolic acidosis)

Blood glucose (hypoglycaemic)

CSF (raised protein levels)

Urine culture

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How is strep pneumoniae transmitted?

Droplets

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Where in the body can pneumococcal disease spread to and what diseases does it occur when in these locations?

Lungs - Pneumonia

Middle ear - Otitis media

Blood - Septicaemia

Sinuses - Sinusitis

Meninges - Meningitis

Joints - Osteomyelitis

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What are some of the complications that can arise from meningitis?

Brain damage

Hearing loss

Hydrocephalus

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In what age group is meningococcal disease most likely to occur?

< 1 years old

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What is the endotoxin associated with meningococcal disease?

Lipooligosaccharie

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For which meningitis bacterias are there vaccines available?

Haemophilus Influenzae B

Pneuomococcal infections

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What type of bacteria are streptococci and staphylococci?

Gram + ve cocci

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Out of staphylococci and streptococci, which one is resistant to penicillin?

Staphylococci

With which antibiotic should stahpylococci bacteria be treated with?

Flucloxacilin

With which antibiotic can streptococci bacterias be treated with?

Penicillin

What is one of the commonest Streptococcal A infections in children and what bacteria causes it?

Scarlet fever - Strep pyogenes

What is the characteristic feature of scarlet fever?

Strwaberry tongue Skin like sand paper

How is scarlet fever treated?

Penicillin for 10 days

Who gets scarlet fever?

Mean age is 4 years old

What are the common skin infections from staphylococcal and streptococcal infections?

Impetigo SSSS - Staphylococcus scalded skin syndrome

Which bacteria cause impetigo?

Staph aureus Strep pyogenes

Which bacteria causes SSSS?

Exotoxins of staph aureus

What is the classical sign of impetigo?

Golden crusted on top lip

What are the clinical symptoms of Kawasaki disease?

Fever for at least 5 days AND 4 out of these 5: 1 - Bilateral conjunctival injection 2 - Changes in mucous membranes 3 - Cervical lymphadenopathy 4 - Polymorphous rash 5 - Changes of the extremities

What is Kawasaki disease?

Vasculitis of medium-sized arteries

How is Kawasaki disease treated?

The main purpose of kawasaki diseas treatment is to prevent coronary artery vasculitis This is achieved by using: - Immunoglobulins - Aspirin

What is Henoch-Schonlein purpura and how does it differ from a meningococcal rash?

Vasculitis where the child **not** systemically unwell

What viruses are associated with maculopapular rashes?

Measles Rubella Enterovirus CMV

What viruses are characterised by vesicles and bullae?

Varicella-zoster Herpes simplex Enterovirus

What viruses can cause petechiae and purpura?

Rubella Enterovirus CMV

Vesicles on the palm of the hand and foot are characteristic of which virus?

Enterovirus

Vesicles on tongue are found in which virus?

Herpes simplex virus

Which virus causes chickenpox and shingles?

Varicella-zoster

What is a key feature of chicken pox?

They are systemically well

Which antiviral drug can be used to treat chickenpox and shingles?

Aciclovir

What are the characteristic features of HSV in children?

Stomatitis Recurrent cold sores

What are some of the complications of HSV in neonates?

Sepsis Meningoencephalitis Jaundice

What is the difference between primary and secondary immunodeficiencis?

Primary - parts of the immune system are missing or not working properly Secondary - all of the immune system is present and working correctly but they have acquired a disease which affects the working of the immune system

What are common examples of secondary immunodeficiencies?

HIV Immunodeficiencies caused by cancer treatment

Which cells are defective in antibody deficiencies?

B-cells

Which cells are defective in cellular immunodeficiencies?

T cells

Which cells are defective in innate immune disorders?

Phagocytes

What are signs that an infection in a child may be caused by an immunodeficiency?

Severe (requires IV antibiotics and hospitalization) Persistent Unusual Recurrent Runs in the family

What blood test measurements should be made to diagnose an immunodeficiency?

IgG, IgA, IgM blood measurements

What type of inheritance is chronic granulomatous disease?

X-linked autosomal recessive

What are the characteristics of chronic granulomatous disease?

Recurrent life-threatening bacterial and fungal infections

How is chronic granulomatous disease diagnosed?

DHR test

What is the clinical presentation of neonatal candidaemia?

1 - Sepsis syndrome 2 - Occurs in 2nd/3rd week of life 3 - Thrombocytopaenia 4 - Hyperglycaemia

What are the risk factors for contracting neonatal candidaemia?

Extreme prematurity Extremely low birth weight Immature immune system