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.
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
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
4
Q
Criteria for Systemic Inflammatory Response Syndrome (SIRS)
A
- Temperature → >38c or > 36 C
- Leucocytosis or leucopenia
- Tachycardia
- Tachypnoea
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
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
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
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
*
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
10
Q
Definition of meningitis
A
- Disease causing inflammation of the meninges
11
Q
Definition of meningism
A
- Clinical presentation indicating an inflammation of the meninges
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)
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
14
Q
Aetiology of childhood meningitis (post-vaccination era)
A
- Viral → mainly enterovirus
- Bacterial (4-18%)
- Fungal → neonates and immunocompromised
- Unknown/ aseptic (40-76%)
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
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
