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Paediatrics > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

How is paediatric sepsis defined?

A

Systemic inflammatory response syndrome (SIRS) with the presence of a suspected or proven infection

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2
Q

How is systemic inflammatory response syndrome characterised?

A

Fever or hypothermia
Tachycardia
Tachypnoea
Leucocytosis or leukocytopenia

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3
Q

What additional features can be present in paediatric sepsis?

A

Shock and organ dysfunction

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4
Q

How is sepsis + multi-organ failure characterised?

A 
At least two of the following:
•	Respiratory failure
•	Renal failure
•	Neurological failure
•	Haematological failure
•	Liver failure
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5
Q

What does septic shock refer to?

A

Cardiovascular failure

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6
Q

What are the risk factors for paediatric sepsis?

A

Boys are more commonly affected by sepsis than girls and incidence decreases with age, with neonates being the most at risk. Being a preterm baby is a risk factor for neonatal sepsis

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7
Q

What are the causative organisms of sepsis in neonates?

A

Group B streptococci
E. coli
Listeria monocytogenes

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8
Q

What are the causative organisms of sepsis in children?

A

Streptococcus pneumoniae
Meingococci
Group A streptococci
Staphylococcus aureus

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9
Q

What are the symptoms of paediatric sepsis?

A 
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
Diminished urine output
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10
Q

How is sepsis treated in children?

A

Supportive treatment- airways, breathing, circulation, glucose
Causative treatment- broad spectrum Abx, cephalosporins

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11
Q

What is included on the sepsis six in children?

A 
Give high flow O2
Obtain IV access and take bloods
Give IV antibiotics
Consider fluid resuscitation
Consider inotropic support- adrenaline
Involve senior help early
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12
Q

What investigations can be done for paediatric sepsis?

A

Bloods- FBC, CRP, coagulation factors, Us&Es, LFTs, blood gases, glucose, culture
CSF- cell count and culture, protein and glucose
Urine culture
Skin biopsy culture
Imaging- CT/MRI head

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13
Q

What are the causative organisms of meningitis in neonates?

A

Group B streptococci
E coli
Listeria monocytogenes

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14
Q

What are the causative organisms of meningitis in children?

A

Streptococci pneumoniae
Meningococci (Neisseria meningitidis)
Haemophilus influenzae

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15
Q

What are the symptoms of meningitis +/- sepsis in children?

A 
Nuchal rigidity
Headache
Photophobia
Diminished consciousness
Focal neurological abnormalities
Seizures
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16
Q

What are the symptoms of meningitis +/- sepsis in neonates?

A

Lethargy
Irritability
Bulging fontanelle
Seizures

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17
Q

What additional treatment can be given for paediatric meningitis?

A

Steroids

Chemoprophylaxis for close household contacts

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18
Q

What is streptococcus pneumoniae?

A

A gram-positive diplo-cocci that colonises the upper airways

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19
Q

How is streptococcus pneumoniae transmitted?

A

It is transmitted by droplets, with viral infections acting as a predisposing factor for invasive disease

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20
Q

What are the possible complications of pneumococcal meningitis?

A

Brain damage
Hearing loss
Hydrocephalus

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21
Q

What kind of bacteria are streptococci and staphylococci?

A

Gram positive cocci

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22
Q

What is the causative organism in Scarlet fever?

A

Group A strep

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23
Q

What is the timeline for scarlet fever?

A
  1. Contact
  2. Incubation for 2-4 days
  3. Malaise, fever and pharyngitis
  4. Rash
  5. Squamation
  6. Strawberry tongue
24
Q

What age is most commonly affected by scarlet fever?

A

<10

Mean age = 4

25
Q

How is group A streptococci treated?

A

10 days of penicillin

26
Q

What are the complications of group A strep?

A

Erythematous rash
Urticaria
Haematuria
Impetigo

27
Q

Where is staph A carried in the general population?

A

Widespread carriage

Common in nasal passages, perineum and axillae

28
Q

What infections are caused by staph A?

A 
Impetigo
Cellulitis
Infected eczema
Ulceration
Staphylococcal scalded skin syndrome
Toxic shock syndrome
29
Q

What is Kawasaki disease?

A

A self-limiting vasculitis of medium sized arteries

30
Q

What are the symptoms of Kawasaki disease?

A 
Five days of fever 
PLUS:
-Bilateral conjunctival injection
-Cracker lips/strawberry tongue
-Cervical lymphadenopathy
-Polymorphous rash
-Changes to extremities
31
Q

What is the main aim of treatment of Kawasaki’s disease?

A

Prevention of coronary aneurysms

32
Q

How is Kawasaki’s disease treated?

A 
Immunoglobulins
Aspirin
Steroids
Other immunosuppressive agents
Cardiology assessment
33
Q

What are the causes of a maculopapulous rash?

A 
Measles
Rubella
Enterovirus
Cytomegalovirus
Human herpes virus 6 and 7
Parovirus B19
EBV
34
Q

What are the causes of a vesicobullous rash?

A

Varicella-zoster virus
Herpes simplex virus
Enterovirus

35
Q

What are the causes of a petechial and purpuric rash?

A

Rubella
Cytomegalovirus
Enterovirus

36
Q

What are the presentations of varicella-zoster virus?

A

Primary infection- varicella, chickenpox

Recurrent infection- zoster

37
Q

What is the incubation period for varicella-zoster virus?

A

10-21 (most commonly 14) days

38
Q

What are the clinical features of varicella-zoster virus?

A

Mild malaise and fever
Itch
Generally not unwell
Exanthema

39
Q

What are the possible complications of varicella-zoster virus?

A

Secondary strep/staph skin infections
Meningoencephalitis
Cerebellitis
Arthritis

40
Q

How is varicella-zoster virus treated?

A

Usually conservative

Can give acyclovir if immunosuppressed

41
Q

What are the warning signs of a serious VZV infection?

A

High fever
New lesions after day ten
Inflamed lesions
General malaise

42
Q

What are the different kinds of herpes simplex virus?

A

HSV 1- oral form

HSV 2- genital form

43
Q

What is the clinical presentation of herpes simplex virus?

A

Stomatitis and recurrent cold sores

44
Q

What are the possible complications of herpes simplex virus?

A

Keratoconjunctivitis
Encephalitis
Systemic neonatal infections
Immunocompromised children

45
Q

How is HSV treated?

A

Conservative

Acyclovir

46
Q

What is the mortality rate of neonatal HSV?

A

50% without acyclovir

20-30% with acyclovir

47
Q

When does neonatal HSV onset?

A

DOL 4-21

48
Q

What are the features of disseminated neonatal HSV?

A

Sepsis
Meningoencephalitis
Hepatitis (jaundice, bleeding)

49
Q

What are the causative organisms of hand-foot-mouth disease?

A

Coxsackie A16

Enterovirus 71

50
Q

When is hand-foot-mouth disease most common?

A

Most commonly affects children <10

Most common in the summer and autumn months

51
Q

What is the incubation period of hand-foot-mouth disease?

A

3-6 days

52
Q

What are the clinical features of hand-foot-mouth disease?

A

Exanthema
Painful lesions
Recovery in 5-10 days
Can cause complicated illness in neonates

53
Q

What are the differences between primary and secondary immunodeficiency?

A

Primary immunodeficiencies:
-Rare
- >300 disorders
-Occurs when there is a missing or improper function of the body’s immune system
-Usually caused by single gene defects
-Can affect one or multiple components of the immune system.
Secondary immunodeficiencies:
-More common
-Acquired diseases or affects of treatment damaging the immune system. Common examples include HIV infection, prolonged steroid use and patients being treated for malignancy

54
Q

What are the warning signs of primary immunodeficiency?

A

Four or more new ear infections in one year
Two or more serious sinus infections in one year
Two or more months on antibiotics with little effect
Two or more pneumonias within one year
Failure to thrive
Recurrent, deep skin or organ abscesses
Persistent oral thrush or fungal skin infection
Need for IV Abx to clear infection
Two or more deep seated infections (ie sepsis)
Family history of primary immunodeficiency

55
Q

What is the simplified version of the warning signs of primary immunodeficiency?

A 
Serious
Persistent
Unusual
Recurrent
Family history
56
Q

What investigations can be used for immunodeficiency?

A 
Full blood count
Immunoglobulins
HIV test
Functional antibodies
Lymphocyte subsets
NBT (nitroblue tetrazolium test)
Complement

Paediatrics (22 decks)

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