Infectious Diseases Flashcards

1
Q

How do infectious diseases differ between children and adults?

A
  • Most characterised by fever and rash
  • Range of disease severity
  • Developing immune system so different clinical presentation
  • Can be presenting symptom of primary immunodeficiency
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2
Q

Define paediatric sepsis

A

Systemic inflammatory response syndrome with suspected/ proven infection

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3
Q

How doe sepsis present?

A
  • Fever or hypothermia
  • Tachycardia
  • Tachypnoea
  • Leucocytosis or leucocytopaenia
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4
Q

What is bacteraemia?

A

Bacteria multiplying in the blood

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5
Q

What are the normal vital signs for <1 year?

A

RR
30-40

HR
110-160

SBP
70-90

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6
Q

What are the normal vital signs for 1-2 years?

A

RR
25-35

HR
100-150

SBP
80-95

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7
Q

What are the normal vital signs for 2-5 years?

A

RR
25-30

HR
95-140

SBP
80-100

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8
Q

What are the normal vital signs for 5-12 years?

A

RR
20-25

HR
80-120

SBP
90-110

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9
Q

What are the normal vital signs for >12 years?

A

RR
15-20

HR
60-100

SBP
100-120

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10
Q

What is severe sepsis?

A

SIRS + multi organ failure

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11
Q

How is severe sepsis defined?

A

SIRS +2 or more

  • Respiratory failure
  • Renal failure
  • Neurologic failure
  • Haematological Failure
  • Liver failure
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12
Q

What is ARDS?

A

Acute respiratory response syndrome

-Inflammatory response of the lungs

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13
Q

What is the incidence of sepsis?

A
  • Children 1:2,000
  • M>F
  • Incidence decreases with age
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14
Q

What pathogens are implicated in sepsis in neonates (<1 month)?

A
  • Group B streptococci
  • E.coli
  • Listeria monocytogenes
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15
Q

What pathogens are implicated in sepsis in children?

A
  • Strep. pneumoniae
  • Meningococci
  • group A streptococci
  • Staph aureus
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16
Q

What is the pathophysiology of sepsis?

A
  • LPS and bacterial components act on endothelium, neutrophils and monocytes
  • Release of oxygen radicals, cytokines and lipid mediators
  • Activation of complement leading to chemotaxis and lysosomal enzymes
  • Increased TF and PAI1 have a procoagulant effect
  • Microvascular occlusion, vascular instability
  • Sepsis and multi-organ failure
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17
Q

What are the symptoms of sepsis in children?

A
  • Fever or hypothermia
  • Cold hands/feet, mottled
  • Prolonged capillary refill time
  • Chills/rigors
  • Limb pain
  • Vomiting and/or diarrhoea
  • Muscles weakness
  • Muscle/joint aches
  • Skin rash
  • Diminished urine output
18
Q

What pathogens are implicated in meningitis in neonates (<1 month)?

A
  • Group B streptococci
  • E coli
  • Listeria monocytogenes
19
Q

What pathogens are implicated in meningitis in children?

A
  • Strep pneumoniae
  • Meningococci
  • Haemophilus inflaeunzae
20
Q

What are the symptoms of meningitis in children?

A
  • Nuchal rigidity
  • Headaches, Photophobia
  • Diminished consciousness
  • Focal neurological abnormalities
  • Seizures
21
Q

What are the symptoms of meningitis in neonates?

A
  • Lethargy, Irritability
  • Bulging fontanelle
  • Nappy pain’
22
Q

How is meningitis +/- sepsis treated?

A
  • ABCD approach
  • Antibiotics with good penetration in CSF and broad-spectrum (3rd generation cephalosporin’s and amoxicillin if neonate
  • Chemoprophylaxis for close household contacts (particularly meningococcus B and strep A)
23
Q

What will be seen on bloods of meningitis?

A
  • FBC (leucocytosis, thrombocytopenia)
  • Elevated CRP
  • Low coagulation factors (DIC)
  • Hypoglycaemia
24
Q

How is meningitis investigated?

A
  • Bloods
  • Blood and CSF cultures (PCR)
  • CSF (pleocytosis, increased protein level, low glucose)
  • Urine culture, skin biopsy
  • Imaging including T cerebrum
25
How is strep pneumoniae transmitted?
By droplets
26
Where does strep pneumoniae colonise?
Colonizes upper airways - 5-10% adults - 20-40% children
27
What is strep pneumoniae?
- Gram-positive Duplo-cocci (Diplococcus pneumoniae) | - 90 serotypes identified
28
What is a predisposing factor for invasive disease by strep pneumoniae?
Viral infection
29
What can pneumococcal disease cause in the alveoli?
Pneumonia
30
What are the possible complications of pneumococcal meningitis?
- Brain damage - Hearing loss - Hydrocephalus
31
What is haemophilus influenza type B?
- Gram-negative bacterium - Encapsulated H. influenza (resists phagocytosis and complement mediated lysis) - 6 serotypes
32
What conditions is haemophilus influenza type B associated with?
- Bacteraemia - Meningitis - Pneumonia - Epiglottitis
33
How can meningococcal disease lead to meningitis?
- Meningococcus in nasopharynx - Passage through epithelia - Meningococcus in the bloodstream - < 12 hours signs of septic shock - < 18-36 hours signs of meningitis
34
What morbidity is associated with meningococcal disease?
- Amputation (14%) - Skin scarring (48%) - Cognitive impairment/ epilepsy/ hearing loss
35
What is the case fatality associated with meningococcal disease?
- Case-fatality rate 5-15% | - 50% of deaths in first 12 hrs, 80% within 48 hrs
36
What is meningococcal disease virulence dependent on?
Endotoxin levels | -Lipooligosaccharide
37
What can pneumococcal disease cause in the pleura and pericardium?
Empyema
38
What can pneumococcal disease cause in the peritoneum?
Peritonitis
39
What can pneumococcal disease cause in the joints?
- Arthritis | - Osteomyelitis
40
What can pneumococcal disease cause in the blood?
Septicaemia
41
What can pneumococcal disease cause in the meninges?
Meningitis
42
What can pneumococcal disease cause in the nasopharynx?
- Otitits media | - Sinusitis