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Paediatrics > Infectious diseases in paediatrics > Flashcards

Infectious diseases in paediatrics Flashcards

1
Q

Learning outcomes

A
  • Understand the presentation, diagnosis and management of bacterial meningitis and septicaemia.
  • Recognise common patterns of streptococcal and staphylococcal infection and their treatments.
  • Recognise herpes simplex, varicella zoster and enterovirus infection and their treatments.
  • Recognise the presentation of Kawasaki Disease.
  • Be aware of the presenting features of an underlying immunodeficiency including HIV and the initial approach to assessing these children.
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2
Q

Sepsis in children

A
  • Leading cause of death in children
  • ½ of all sepsis worldwide occur in children
  • Earlier recognition and treatment → better survival
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3
Q

Definitions of sepsis

A
  • Sepsis = systemic inflammatory response syndrome + suspected/ proven infection
  • Severe sepsis = sepsis and organ dysfunction
  • Septic shock = sepsis and CVS dysfunction
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4
Q

Criteria for Systemic Inflammatory Response Syndrome (SIRS)

A
  • Temperature → >38c or > 36 C
  • Leucocytosis or leucopenia
  • Tachycardia
  • Tachypnoea
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5
Q

Infants <3 months of age

A
  • Increased risk of bacterial infection
  • Increased risk of sepsis
  • Increased risk of meningitis
  • may show minimal signs and symptoms
  • Often presents with non-specific signs and symptoms
  • May not present with a febrile response (50%)
  • Deteriorate very quickly
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6
Q

Risk factors in infants <3 months

A
  • Premature (<37/40)
  • Premature rupture of membranes
  • Maternal pyrexia/ chrorioamnionitis
  • Maternal Guillain-barre syndrome
  • Previous child with Guillain-barre syndrome
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7
Q

Management of sepsis in children

A
  • Airways
  • Breathing
  • Circulation → fluid bolus (20ml/kg 0.9% NaCl)
  • DEFG → don’t every forget glucose
  • Antibiotics
    • 3rd generation cephalosporin
    • Add IV amoxicillin if <1 m old
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8
Q

Investigations

A
  • Bloods
    • FBC (leucocytosis, thrombocytopenia)
    • CRP
    • Coagulation screen (DIC)
    • Blood gas (metabolic acidosis, raised lactate)
    • Glucose
    • Blood culture → give antibiotics anyway
  • Culture
    • Blood
    • Urine
    • CSF → including virology
    • +/- stool (micro and virology
  • Imaging → Chest x-ray
    *
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9
Q

Responsible organisms

A
  • Neonates
    • Group B streptococcus
    • Escherichia coli
    • Listeria monocytogenes
  • Older infants and children
    • Streptococcus pneumonia
    • Neisseria meningitides
    • Group A streptococcus
    • Stapylococcus aurea
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10
Q

Definition of meningitis

A
  • Disease causing inflammation of the meninges
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11
Q

Definition of meningism

A
  • Clinical presentation indicating an inflammation of the meninges
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12
Q

Presentation of meningitis in

A
  • Older children
    • Fever
    • Headache
    • Photophobia
    • Neck stiff neck (nuchal rigidity)
    • Nausea/ vomiting
    • Reduced GCS
    • Seizures
    • Focal neurological deficits
  • Young infants → non-specific
    • Fever/ hypothermia
    • Poor feeding
    • Vomiting
    • Lethargy
    • Irritability
    • Respiratory distress
    • Apnoea
    • Bulging fontanelle (raised ICP)
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13
Q

Examination of meningitis

A
  • Nuchal rigidity
    • Neck stiffness
    • Palpable resistance to neck flexion
  • Brudzinki’s sign → Hips and knees flex on passive flexion of the neck
  • Kernig’s sign → Pain on passive extension of knee
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14
Q

Aetiology of childhood meningitis (post-vaccination era)

A
  • Viral → mainly enterovirus
  • Bacterial (4-18%)
  • Fungal → neonates and immunocompromised
  • Unknown/ aseptic (40-76%)
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15
Q

Bacterial causes of meningitis

A
  • Neonates (less than 1 month)
    • Group B streptococcus
    • E.coli
    • Listeria monocytogenes
  • Older infants and children
    • Strep. pneumniae
    • Neisseria meningitides
    • Haemophilus influenza
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16
Q

Neisseria meningitides

A
  • Gram negative diplococcus
  • Only affects humans
  • Nasopharyngeal carriage
  • Transmission via respiratory secretions
  • Infection following viral URTI
  • Polysaccharide capsule
  • Endotoxin on LPS
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17
Q

Riks factors for invasive meningococcal disease

A
  • Less than 1 years or 15-24
  • Unimmunised
  • Crowded living conditions
  • Household or kissing contacts
  • Cigarette smoking
  • Recent viral/ mycoplasma infection
  • Complement deficiency
18
Q

Presentation of meningitis vs septicaemia

A
  • Meningitis (15%)
    • Neck stiffness
    • Bulging fontanelle
    • Seizures
  • Both (65%)
    • Fever
    • Headache
    • Vomiting
    • Reduced GCS
    • Petechial/ purpuric rash → non-blanching
  • Septicaemia (25%)
    • Myalgia
    • Abdominal pain
    • Limb pain
    • Signs of shock
19
Q

Complications of invasive meningococcal disease

A
  • Amputation
  • Scarring
  • Hearing loss
  • Cognitive impairment/ epilepsy
20
Q

Streptococcus pneumonia

A
  • Gram positive
  • Facultative anaerobe
  • Polysaccharide capsule
    • Inhibits neutrophil phagocytosis
    • Inhibits complement mediated cell lysis
  • All serotypes cause invasive illness
  • Colonises nasopharynx
  • Precedes URTI
  • Respiratory triplet transmission
21
Q

Diseases caused by pneumococcal infection

A
  • Pneumonia
  • Pleural and pericardial empyema
  • Otitis media
  • Sinusitis
  • Septicaemia
  • Peritonitis
  • Arthritis/ osteomyelitis
  • Meningitis
22
Q

Risk factors for pneumococcal disease

A
  • Age <2 years
  • Cigarette smoking
  • Recent URTI
  • Attendance to childcare
  • Cochlear implant
  • Sickle cell disease
  • Asplenia
  • HIV infection
  • Nephrotic syndrome
  • Immunodeficiency/ immunosuppression
23
Q

Complications of pneumococcal meningitis

A
  • Hydrocephalus
  • Neurodisability
  • Seizures
  • Hearing loss
  • Blindness
24
Q

Management of meningitis

A
  • Airways
  • Breathing
  • DEFG → don’t forget glucose
  • Antibiotics
    • 3rd generation cephalosporin
    • Add amoxicillin
25
Q

Investigations for meningitis

A
  • Bloods
    • FBC (leukocytosis, thrombocytopenia
    • U and E, LFT
    • CRP
    • Coagulation screening
    • Blood gas → raised lactate
    • Glucose
    • Blood culture
    • Meningococcal/ pneumococcal PCR
  • Lumbar puncture
    • Microscopy
    • Gram stain
    • Culture
    • Protein
    • Glucose
    • Viral PCR
26
Q

Contraindications for lumbar puncture

A
  • Signs of raised ICP
    • GCS less 9
    • Abnormal tone and posture
    • HTN or bradycardia
    • Pupillary defect
    • Papillodema
  • Focal neurological deficits
  • Within 30 minutes of seizure s
  • Haemodynamically unstable
  • Coagulopathy
  • Thrombocytopenia
  • Extensive/ extending purport
27
Q

CSF findings in bacterial meningitis

A
  • Turbid or purulent
  • High opening pressure
  • Increased WCC (polymorphs)
  • Increased protein
  • Decreased glucose
28
Q

Treatment duration for meningitis

A
  • Varies depending on the causative organism
  • Longest duration → listeria monocytogenes
29
Q

Summary of meningitis

A
  • Bacterial meningitis has serious long-term consequences
  • Meningitis and sepsis can progress rapidly
  • Early treatment is essential
  • Vaccination can provide effective protect against childhood causes of meningitis
30
Q

Staph and strep infection

A
  • Human pathogen with risk of invasive infection
  • Majority cause skin and soft tissue infection
  • Clinically relevant serotypes → Staph. aureas and strep. pyogenes
  • Both cause osteoarticular infection
  • Both cause bacteraemia
  • Both cause toxin-mediated disease → toxic shock syndromes
  • Difficult to distinguish clinically
31
Q

Strep vs staph

A
  • Staph
    • Coagulae +ve
    • Colonises skin and mucosa
    • Resistance → MRSA
  • Both
    • Gram positive cocci
    • Produces exotoxin and form superantigans
  • Strep
    • Beta-haemolytic
    • Colonises oropharynx
    • Resistance → not a problem
32
Q

Skin and soft tissue infections caused by staph and strep

A
  • Cellulitis
  • Boils and furuncles
  • Impetigo
  • Infected eczema
  • Lymphadenitis
33
Q

Staphylococcal scalded skin syndrome

A
  • Usually <5 years
  • Toxin-mediated (exfoliatoxin)
  • Initial bullies lesions
  • Widespread desquamation
  • Nikolsky’s sign
  • Mild fever
  • Purulent conjunctivitis
  • Management
    • IV flucloxacillin
    • IV fluids
34
Q

Nikolsky sign

A
  • Desquamation of top layer of skin on minimal rubbing
35
Q

Scarlet fever

A
  • Caused by Group A strep
  • 2-5 days incubation
  • Fever, malaise, sore throat
  • Strawberry tongue
  • Sandpaper rash
    • Skin peeling
36
Q

Scarlet fever management

A
  • Notify public health
  • Penicillin (phenoxymethylpenicillin 10 days
37
Q

Function of phenoxymethylpenicillin in scarlet fever

A
  • Reduces duration and severity fo disease
  • Reduces complications
    • Quincy/ acute rheumatic fever
    • Post-streptococcal glomerulonephritis
  • Reduces transmission
38
Q

Complications of scarlet fever

A
  • Abscess formation → retropharyngeal and peritonsillar (Quincy)
  • Acute rheumatic fever
    • Commonest cause of acquired heart disease
    • Arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules
  • Post-streptococcal glomerulonephritis
39
Q

Definition of toxin shock syndrome (TSS)

A
  • Caused by both streptococcus or streptococcus organisms
  • Acute febrile illness
  • Rapidly progressing shock and multi organ failure
  • Cause
    • Superantigen → intense T cell activation
    • Excessive immune activation
    • Cytokine storm
  • Highly fatal
40
Q

Clinical features of TSS

A
  • Fever
  • Diffuse maculopapular rash
  • Mucosal changes
    • Swollen lips
    • Non-purulent conjunctivitis
    • Strawberry tongue
  • Profuse diarrhoea (s.aurea)
  • Shock and multi-organ failure
    • Tachycardia
    • Prolonged cap refill
    • Hypotension
    • Renal impairment
    • Transaminitis → high levels of transaminase
    • Reduced GCS
41
Q

Management of toxic shock syndrome

A
  • ABC
  • Fluid resuscitation +/- inotropes
  • Cultures
    • Blood
    • Throat swab
    • Wound
  • IV antibiotics → flucloxacillin and clindamycin
41
Q

Management of toxic shock syndrome

A
  • ABC
  • Fluid resuscitation +/- inotropes
  • Cultures
    • Blood
    • Throat swab
    • Wound
  • IV antibiotics → flucloxacillin and clindamycin
  • Avoid NSAID’s
  • Surgical debridement

Paediatrics (10 decks)

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