Infectious Diseases Flashcards
What are the symptoms of paediatric sepsis?
Fever or hypothermia Cold hands/feet, mottled Prolonged capillary refill time >2secs Chills/rigors Limb pain Vomiting and/or diarrhoea Muscles weakness Muscle/joint aches Skin rash (meningococcal) Diminished urine output Nuchal rigidity Headaches, photophobia Diminished consciousness Focal neurological abnormalities Seizures Lethargy, Irritability Bulging fontanelle
What antibiotics should be used in paeds sepsis?
3rd generation cephalosporins
Plus amoxicillin if neonate
Can add in steroids
What investigations should be done in sepsis and what will they show?
FBC - leucocytosis, thrombocytopaenia
CRP - elevated
Coagulation factors - deranged clotting due to DIC
U&Es, LFTs – Renal and hepatic dysfunction
Blood gas - metabolic acidosis, raised lactate
Glucose – hypoglycaemia
Culture
Cell count & Culture – increased WCC, antigent testing, PCR
Protein & Glucose - increased protein level, low glucose
Urine culture
Skin biopsy culture
Imaging – CT/MRI head
What are the organisms responsible for neonatal and child sepsis?
Neonatal- Group B strep, E. Coli, Listeria Monocytogenes
Children- Strep Pneumoniae, HIB, Neisseria Meningitidis
What are the three complications of pneumococcal meningitis?
Brain damage
Hearing loss
Hydrocephalus
What is the antibiotic treatment for Staphylococcal and Streptococcal infections?
Strep-penicillin
Staph- flucloxacillin
What is Scarlet fever?
An infection of Strep Pyogenes which causes malaise, fever, sandpaper rash (spares peri-oral region), strawberry tongue, desquamation of hands and feet and pharyngitis
More common in children 2-10 years old
Treated with oral penicillin
What are the complications of a Strep A infection?
Impetigo Erysipelas Necrotising fasciitis Rheumatic fever Glomerulonephritis
What is Kawasaki disease?
Self-limited vasculitis of medium-sized arteries
Potential viral trigger
Causes myocarditis and coronary artery aneurysms
Fever for 5 days plus:
-bilateral conjunctival injection
-Cracked lips/strawberry tongue
-cervical lymphadenopathy >1.5cm
-polymorphous rash
-changes of the extremities
No diagnostic test so need to exclude differentials and make clinical diagnosis
Treatment is with Immunoglobulins, aspirin, steroids and other immunosuppressive agents
What is chickenpox?
Infection with varicella zoster virus at usually a young age. Presents with mild malaise and fever, generally not unwell, itchy and exanthema: papules → vesicles → pustules → crustae → (scarring) ‘cropping’ for 5-7 days
Complications include secondary strep/staph infections skin, meningoencephalitis, cerebellitis, arthritis.
Treatment is with acyclovir if immunosuppressed or very unwell
Secondary infection can occur as shingles in adults which is treated with acyclovir
What can be the complications of a Herpes 1 infection?
Keratoconjunctivitis Encephalitis Systemic neonatal infections In neonates can get by direct contact through the birth canal if mother has active virus and complications include disseminated/CNS infections (Sepsis, Meningoencephalitis, hepatitis) and skin/eye/mouth (SEM) disease Manage with acyclovir
What is hand, foot and mouth disease?
Cause: enteroviruses; Coxsackie A16 and enterovirus 71 Children <10 year Summer and early autumn Incubation period: 3-6 days Clinical: Exanthema Painful lesions Recovery in 5 to 10 days May cause complicated illness in neonates
What are the ten warning signs of primary immunodeficiency?
Ear infections more than four a year Two sinus infections in a year Two or more months of antibiotics Two or more pneumonias a year Falter in growth Deep skin infection or organ abscess Persistent skin thrush or fungal infections that can't be explained Need for IV antibiotics to clear infections FH Septicaemia
What investigations should be done to look for a primary immunodeficiency?
FBC Immunoglobulins HIV test Functional antibodies Lymphocyte subsets NBT Complement
What would Antibody Deficiencies present with?
Recurrent bacterial infections like LRTI
What would Cellular Immunodeficiencies present with?
Present with unusual or opportunistic infections, recurrent/severe viral infections or failure to thrive
What would Innate Immune Disorders present with?
Defects in phagocyte function present with sepsis, abscess, fungal infections
Complement deficiencies present with sepsis
