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Clinical Pathology > Lecture 37 - Clinical infections - childhood and pregnancy > Flashcards

Lecture 37 - Clinical infections - childhood and pregnancy Flashcards

1
Q

Infections during pregnancy may cause

A 
miscarriage
congenital anomalies
Fetal hydrops 
Fetal death
preterm delivery
preterm rupture of the membranes

-Maternal antibodies cross the placenta and give passive immunity to the foetus

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2
Q

Route of acquisition of cytomegalovirus

A

respiratory droplet. secretions

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3
Q

Route of acquisition of Parvovirus B19

A

respiratory droplet. secretions

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4
Q

Route of acquisition of Toxoplasmosis

A

Ingestion of oocytes

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5
Q

Route of acquisition of Syphilis (blood)

A

Sexual

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6
Q

Route of acquisition of Varicella Zoster Virus

A

respiratory droplet/secretions

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7
Q

Route of acquisition of rubella

A

Nasopharyngeal secretions

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8
Q

Route of acquisition of Zika virus

A

Mosquito bite

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9
Q

Neonatal infections acquired during passage through birth canal

A 
Group B Streptococcus 
Herpes simplex virus (HSV)
Gonorrhoea
Chlamydia
HIV
Hep B
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10
Q

NICE CG62

Antenatal care for uncomplicated pregnancies

A

Women should be offered routine screening for asymptomatic bacteriuria by midstream urine culture early in pregnancy.

Identification and treatment of asymptomatic bacteriuria reduces the risk of pyelonephritis.

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11
Q

Asymptomatic bacteriuria in pregnancy

A

Symptomatic UTI in pregnancy is frequently preceded by asymptomatic bacteriuria

Prevalence is around 5%

Untreated, at least 30% of women with ASB will develop acute pyelonephritis

Screening for ASB is considered to be a cost effective approach to preventing pyelonephritis

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12
Q

Why is Screening for Group B Streptococci not recommended in UK

A

Until it is clear that antenatal screening for GBS carriage does more good than harm and that the benefits are cost-effective, the National Screening Committee does not recommend routine screening in the UK

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13
Q

Prevention of Early-onset Neonatal Group B Streptococcal Disease

A

Intrapartum antibiotic prophylaxis (IAP) offered to:

Women with a previous baby with neonatal GBS disease
Women with GBS in current pregnancy
Women who are pyrexial in labour should be offered broad-spectrum antibiotics including an antibiotic for prevention of neonatal EOGBS disease

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14
Q

UTI during pregnancy

A

Screening for bacteriuria is indicated in pregnancy
Asymptomatic bacteriuria - no symptoms of UTI and 2 samples containing > 105 same organisms

Bacteriuria can develop into symptomatic UTI if untreated
Continuing bacteriuria is associated with premature delivery and increased perinatal mortality

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15
Q

Antimicrobial prescribing in pregnancy and puerperium

A

The potential to cause harm to the embryo/foetus/neonate must be considered
All antimicrobials cross the placenta to some extent
Virtually all antimicrobials appear in breast milk if given in therapeutic amounts to breast feeding women

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16
Q

Safe antimicrobials in pregnancy

A

Penicillins Cephalosporins

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17
Q

Some antimicrobials considered unsafe in pregnancy

A 
Chloramphenicol
Tetracycline Fluoroquinolones (e.g. ciprofloxacin) Trimethoprim-sulphamethoxazole
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18
Q

Intra-amniotic infections

A

Affects 1-2% term pregnancies
Affects 20-25% pregnancies with pre-term labour
major cause of perinatal morbidity and mortality
“chorioamnionitis” refers to inflammation of umbilical cord, amniotic membranes, placenta

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19
Q

Risk factors for intra-amniotic infections

A

Most common after prolonged rupture of membranes

Other risk factors include:amniocentesis, cordocentesis, cervical cerclage multiple vaginal examinations, ?BV

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20
Q

Pathogenesis of intra-amniotic infections

A

Bacteria present in the vagina cause infection by ascending through the cervix

Haematogenous (via blood ) infection is rare e.g. Listeria monocytogenes

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21
Q

Causative organisms of intra-amniotic infections

A

Group B Streptococcus
enterococci
Escherichia coli

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22
Q

Management of intra-amniotic infections

A

antimicrobials and delivery of the foetus

antimicrobials should be administered at the time of diagnosis (not after delivery)

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23
Q

Puerperal endometritis

A

infection of the womb during puerperium affects ~5% of pregnancies
puerperal sepsis remains a major cause of maternal death

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24
Q

Risk factors for puerperal endometritis

A

caesarean section, prolonged labour, prolonged rupture of membranes, multiple vaginal examinations

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25
Q

Clinical features of puerperal endometritis

A 
fever (38.5oC  in first 24 h post delivery or >38.0o for 4 hours, 24 h+ after delivery)
uterine tenderness
purulent, foul-smelling lochia
increased white cell count
general malaise, abdominal pain
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26
Q

puerperal endometritis causative organisms

A

Escherichia coli
Beta-haemolytic streptococci
Anaerobes

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27
Q

Diagnosis of puerperal endometritis

A

the role of transvaginal endometrial swabs is controversial

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28
Q

Treatment for puerperal endometritis

A

Broad-spectrum intravenous antimicrobials - continued until the patient has been apyrexial for 48 hours.

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29
Q

Early onset sepsis

A

Early-onset neonatal sepsis (usually within 72 hours) is a major cause of mortality and morbidity in newborn babies.

High mortality, particularly in premature and low birth weight babies.

Death: 1 in 4 babies who develop it, even when they are given antibiotics.

Typical to have multisystem involvement/pneumonia

Higher mortality, particularly those infections evident within first 24 hours

30
Q

Cause of Early onset sepsis

A

organisms from the maternal genital tract

31
Q

Cause of late onset sepsis

A 
Coagulase-negative staphylococci
Staphylococcus aureus
Escherichia coli
Klebsiella spp.
Enterobacter spp
Pseudomonas spp.
Candida spp.
32
Q

Why are children more susceptible to infections

A

Young infants
Children with special health care needs
Children with impaired immune systems
Children with long standing prosthetic devices

As children age, the incidence of illness decreases from 12 per year to 4 per year by the time the child is 5 years old

90% of infections are mild, self-limited, and require no treatment

33
Q

What are the upper respiratory tract infections in children

A

Common cold
Acute tonsillitis
Acute otitis media

34
Q

What is a sore throat

A

any of various inflammations of the tonsils, pharynx, or larynx characterized by pain in swallowing

70-80% of the time is viral

Group A beta-haemolytic Streptococcus (20-30%)

35
Q

Symptoms of otitis media

A 
Unusual Irritability 
Difficulty Sleeping 
Tugging or Pulling At One Or Both Ears 
Fever 
Fluid Draining From The Ear 
Loss Of Balance 
Unresponsiveness To Quiet Sounds or Other Signs Of Hearing difficulty
36
Q

Prevalence of LRTI’s in children

A

30–40 cases per 1000 children per year in the UK;
(a GP will see, on average, 1-2 cases per year)

Every year, pneumonia contributes to 750,000 – 1.2 million neonatal deaths worldwide

Includes pneumonia, acute bronchitis & bronchiolitis

Respiratory viruses remain the leading cause in children under 5years

37
Q

What is the major cause of acute respiratory infections in children?

A

Respiratory synctial virus (63%)
Streptococcus pneumoniae (8%)
Adenovirus (7%)

38
Q

Bronchiolitis

A

a seasonal viral illness characterized by fever, nasal discharge, and dry, wheezy cough. On examination there are fine inspiratory crackles and/or high-pitched expiratory wheeze”

39
Q

Causes of bronchiolitis

A 
Respiratory Syncytial Virus (RSV) 
Metapneumovirus 
Adenovirus
Para-influenza virus 
Influenza 
Rhinovirus
40
Q

Common pathogens causing pneumonia in Newborn

A 
Group B Strep
Gram -ve bacilli
Listeria monocytogenes
Herpes simplex
Cytomegalovirus
Rubella
41
Q

Common pathogens causing pneumonia in 1-3 month year olds

A

Chlamydia trachomatis
Respiratory Synctial virus
other respiratory viruses

42
Q

Common pathogens causing pneumonia in 3-12 month year olds

A 
Respiratory Synctial virus
Other respiratory viruses
Strep pneumoniae
Haemophilius influenzae
Chlamydia trachomatis
Mycoplasma pneumoniae
43
Q

Common pathogens causing pneumonia in 2-5 year olds

A 
Respiratory viruses
Strep pneumoniae
Haemophilius influenzae
Mycoplasms pneumoniae
Chlamydia pneumoniae
44
Q

Common pathogens causing pneumonia in 5-18 year olds

A 
Mycoplasma pneumoniae
strep pneumoniae
Chlamydia pneumoniae
Haemophilius influenzae
Influenza viruses A and B
Adenoviruses
Other respiratory viruses
45
Q

Presentation of pneumonia

A

Acute febrile illness, possibly preceded by typical viral URTI.

46
Q

Symptoms of pneumonia

A

Breathlessness (poor feeding)
Irritability
Sleeplessness
Cough, chest or abdominal pain in older patients
Audible wheezing is rare in LRTI but can occur

47
Q

Pertussis

A

Usually affect children before vaccine available, recent resurgence noted
Clinical illness in 3 stages
Catarrhal phase, Paroxysmal phase, Convalescent phase

48
Q

Catarrhal phase of Pertussis

A

Cold-like (coryza, conjunctival irritation, occasionally a slight cough)
7-10 days

49
Q

Paroxysmal phase of pertussis

A

Long duration (2-6 weeks); No fever
a series of rapid, forced expirations, followed by gasping inhalation the typical whooping sound
Post-tussive vomiting common
Very young infants may present with apnea or cyanosis in the absence of cough

50
Q

Convalescent phase of pertussis

A

Characterized by:
Gradual recovery
Less persistent, paroxysmal coughs that disappear in 2-3 weeks
Paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis.

51
Q

cause of pertussis

A

Highly communicable acute respiratory infection caused by B. pertussis

52
Q

Transmission of pertussis

A

Person-to-person transmission through aerosolised respiratory droplets
Humans are the sole reservoir

53
Q

Diagnosis of pertussis

A

Culture and PCR in early stages

54
Q

Serology if illness

A

more than 3 weeks

55
Q

Meningitis in children

A

Newborn & Infants: non-specific clinical presentation
Fever
Irritability
Lethargy
Poor feeding
High pitched cry, bulging anterior fontanelle
Convulsions, opisthotonus

56
Q

Aetiology of meningitis in neonates

A

Group B Strep, E Coli, Listeria monosytogenes

57
Q

Aetiology of meningitis in more than 1 - 5 years

A

Streptococcus pneumoniae, Neisseria meningitidis

58
Q

Viral meningitis

A

Most common infection of CNS especially in <1yr

Enteroviruses (commonest, meningitis occurring in 50% of children <3mth ), HSV, Influenza, EBV, adenovirus, CMV
Mononuclear lymphocytes in CSF

Symptomatic treatment CP

59
Q

UTI’s in children

A

Up to 7% of girls and 2% of boys experience a symptomatic culture-proven UTI prior to 6 years of age.
Of febrile neonates, up to 7% have UTIs.
Most UTIs in children are from ascending bacteria
E. coli (60-80%), Proteus, Klebsiella, Enterococcus, and Staphylococcus saprophyticus
The overall prevalence of UTI is approximately 5% in febrile infants but varies widely by race and sex.
Caucasian children had a two- to fourfold higher prevalence of UTI as compared to African-American children
Females have a two- to fourfold higher prevalence of UTI than do circumcised males

60
Q

Symptoms of uti’s in children

A

Classic UTI symptoms in older children
Dysuria, frequency, urgency, small-volume voids, lower abdominal pain.
Infants with UTIs have nonspecific symptoms
Fever, irritability, vomiting, poor appetite

61
Q

Urine sampling

A

A clean catch sample should be obtained
If not possible, use non invasive method i.e. Urine collection pad
Do not use cotton wool balls, gauze or sanitary towels.
If non invasive method not possible
Use catheter sample or suprapubic aspiratio

62
Q

Follow up for UTI’s in children

A

Those who have recurrent UTI or abnormal imaging results should be assessed by paediatric specialist
Those who do not require imaging do not need specialist assessment
Asymptomatic bacteriuria does not require follow up
Antibiotic prophylaxis should not be routinely recommended in infants and children following first-time UTI

63
Q

Meningococcoemia

A

MORTALITY 5-10% (90% if DIC)

MORBIDITY 10% (Deafness, neurological problems, amputations)

Peak incidence < 4yrs

Immunisation programme includes Men C
60% of bacterial meningitis in UK due to Men B

Fever, non-specific malaise, lethargy, vomiting, meningism, resp distress, irritability, seizures
Maculopapular rash common early in disease

Petechial rash seen in 50-60%

64
Q

Meningococcoemia cause

A

Staphylococcus aureus or Strep pyogenes

65
Q

Symptoms of Meningococcoemia

A 
Classically ruptured vesicles with honey-coloured crusting
May be bullous
More common in pre-existing skin disease
Very contagious, rapid spread
Commonly starts around face/mouth
66
Q

Treatment for Meningococcoemia

A

Topical antibiotics or oral Flucloxacillin

Advice re nursery/school

67
Q

Scarlet fever

A 
Gp A beta-haemolytic Streptococcus
2-4 days post-Streptococcal pharyngitis
Fever, headache, sore throat, unwell
Flushed face with circumoral pallor
Rash may extend to whole body
Rough ‘sandpaper’ skin
Desquamation after 5/7, particularly soles and palms
School age children
White strawberry tongue
Dx Throat swab, ASO titres
Rx Penicillin 10/7
68
Q

Cause of scarlet fever

A

Staphylococcus aureus or Strep pyogenes
Classically ruptured vesicles with honey-coloured crusting
May be bullous
More common in pre-existing skin disease
Very contagious, rapid spread
Commonly starts around face/mouth
Rx. Topical antibiotics or oral Flucloxacillin
Advice re nursery/school

69
Q

What is chicken pox and its causes

A

Is a contagious disease caused by a virus
Member of the herpes virus family
Chickenpox is considered by many experts to be a relatively harmless childhood disease.

70
Q

Symptoms of chicken pox

A

Fever
runny nose
sore throat
itchy skin rash
rash and disease usually disappear after one or 2 weeks
disease confers permanent immunity - will not get it again
Complications in adults who did not have chicken pox as a child or in youngsters with already weakened immune systems

Clinical Pathology (16 decks)

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