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review micro > MI: Neonatal and Childhood Infections > Flashcards

MI: Neonatal and Childhood Infections Flashcards

1
Q

Which infections are screened for in pregnancy?

A
  • HIV
  • Hepatitis B
  • Syphilis
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2
Q

Which other congenital infections are known to cause issues in pregnancy/delivery?

A
  • TORCH
    • Toxoplasmosis
    • Other (varicella, parvovirus)
    • Rubella
    • CMV
    • Herpes
  • Group B Streptococcus
  • Hepatitis C
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3
Q

What is the source of toxoplasmosis?

A

Cat faeces

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4
Q

What are the possible outcomes for neonates with congenital toxoplasmosis?

A

Asymptomatic (60%) at birth but go on to develop long-term sequelae such as deafness, low IQ and microcephaly

Symptomatic (40%) at birth

  • Triad
    • Chorioretinitis
    • Hydrocephalus
    • Intracranial calcifications
  • Other features: seizures, hepatosplenomegaly/jaundice
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5
Q

What is the triad of features in congenital rubella syndrome?

A
  • Cataracts
  • Congenital heart disease (PDA is most common)
  • Sensorineuronal deafness
  • Other features: microphthalmia, glaucoma, retinopathy, ASD/VSD, microcephaly, meningoencephalopathy, developmental delay
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6
Q

How is herpes simplex virus transmitted to the neonate?

A
  • In utero/congenital - rare (5%)
    • Triad of cutaneous, ophthalmic, and CNS manifestations
  • Exposure to virus in the around time of delivery (mainly intrapartum) - most common (95%)
    • Predominantly skin, eye and mouth (SEM) infections - vesicular lesions in these places
    • Can also cause CNS and disseminated disease - meningoencephalitis, liver dysfunction
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7
Q

How is Chlamydia trachomatis transmitted to the neonate and what disease does it cause in the neonate?

A
  • During delivery
  • Causes neonatal conjunctivitis or pneumonia

NOTE: it is treated with erythromycin

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8
Q

Which mycoplasma species can cause neonatal infection?

A
  • Mycoplasma hominis*
  • Ureaplasma urealyticum*
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9
Q

Why are premature infants at increased risk of infection?

A
  • Immune system less developed
  • Less maternal IgG
  • NICU care (exposure to microorganisms)
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10
Q

What is the definition of ‘early-onset’ infection?

A

Infection that occurs within 72 hours of birth

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11
Q

What are the three main organisms that cause early-onset infection?

A
  • Group B Streptococcus
  • E. coli
  • Listeria monocytogenes
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12
Q

What type of bacterium is Group B Streptococcus?

A

Streptococcus agalactiae

  • Gram-positive coccus
  • Catalase negative
  • Beta-haemolytic
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13
Q

What can GBS cause in neonates?

A

Most common causes of neonatal infection

  • Sepsis
  • Meningtits
  • Pneumonia
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14
Q

What type of organism is E. coli and which diseases can it cause in the neonate?

A
  • Gram-negative rods
  • Can cause bacteraemia, meningitis and UTI

NOTE: the K1 antigen is particularly problematic

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15
Q

What type of organism is Listeria monocytogenes and what disease can it cause?

A
  • Gram-positive rods
  • Causes sepsis in the mother and the newborn
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16
Q

List some risk factors for early-onset sepsis.

A
  • Prematurity
  • Prolonged rupture of membranes
  • Maternal pyrexia
  • Previous history of neonatal GBS infection
  • Maternal bacturia
  • Foetal distress
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17
Q

List some investigations that may be useful in early-onset sepsis.

A
  • Bloods
    • Blood culture
    • FBC, CRP
    • Blood gases
  • LP (meningitis)
  • CXR (pneumonia)
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18
Q

Outline the treatment of early-onset sepsis.

A
  • ABCDE
  • Antibiotics - benzylpenicillin and gentamicin
    • Benzylpencillin covers GBS and gentamicin covers E coli
19
Q

What is late-onset sepsis?

A

Sepsis that occurs more than 72 hours after birth

20
Q

What are the main causes of late-onset sepsis?

A
  • Coagulase negative staphylococci (e.g. S. epidermidis)
  • GBS
  • E. coli
  • Listeria monocytogenes
  • S. aureus
  • Enteroccocus sp.
  • Gram-negatives (e.g. Klebsiella, Enterobacter, Pseudomonas)
21
Q

List some clinical features of neonatal sepsis.

A

Non-specific

  • Respiratory
    • Distress: grunting, nasal flaring, recessions
    • Apnoea
  • Cardiovascular: tachycardia, hypotension, cool peripheries, increased CRT
  • Irritability, poor feeding, lethargy
  • Skin changes: jaundice, blue/mottled
  • Temperature: can be high or low
  • Seizures (meningitis)
22
Q

List some investigations that may be used in late-onset sepsis in addition to the ones used in early-onset sepsis

A
  • Urine MCS
  • Swabs from an infected site
  • ET swabs if ventilated
23
Q

Outline the treatment of late-onset sepsis.

A
  • Check local guidelines
  • Example antibiotic regimen: 1st line = flucloxacillin + gentamicin; 2nd line = meropenem
  • If community acquired = ceftriaxone or cefotaxime with calcium infusion
24
Q

What are some common non-specific symptoms of infections in childhood?

A
  • Fever
  • Abdominal pain
25
Q

List some investigations for meningitis in children.

A
  • Blood cultures
  • LP
  • Rapid antigen screen
  • Blood PCR
  • Serology
26
Q

Why is it dangerous to perform an LP in meningococcal septicaemia?

A

They may be coagulopathic

27
Q

The incidence of meningitis caused by which three agents has decreased in incidence since the introduction of vaccination programmes?

A
  • Meningitis C
  • Haemophilus influenzae type B
  • Pneumococcus
28
Q

What is the main bacterial cause of meningitis at the moment?

A

S. pneumoniae

29
Q

What type of organism is Streptococcus pneumoniae?

A
  • Gram-positive diplococcus
  • Alpha-haemolytic
30
Q

Which diseases can S. pneumoniae cause?

A
  • Meningitis
  • Pneumonia
  • Sepsis
31
Q

What type of vaccine is the S. pneumoniae vaccine?

A
  • Conjugate vaccine
  • Old version was called Prevenar 7 (7 serotypes), but a new version has been created call Prevenar 13
32
Q

What type of organism is Haemophilus influenzae?

A
  • Gram-negative cocco-bacilli
33
Q

What are the typical causes of meningitis for the following age groups:

  • Under 3 months
  • 3 months to 5 years
  • Over 6 years
A

Under 3 months:

  • Group B Streptococcus
  • Escherichia coli
  • Listeria monocytogenes
  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae

3 months to 5 years:

  • Neisseria meningitis
  • Streptococcus pneumoniae
  • Haemophilus influenzae

Over 6 years:

  • Neisseria meningitis
  • Streptococcus pneumoniae
34
Q

What is the most common cause of death in:

  • Children (1-9 years)
  • Neonates
A

Children (1-9 years)

  • Cancer (UK)
  • Infections e.g. pneumonia, diarrhoea (worldwide)

Neonates:

  • Prematurity
  • Followed by intra-partum complications
35
Q

What is the most important bacterial cause of respiratory tract infection in children?

A

Streptococcus pneumoniae

36
Q

Which children are mainly affected by Mycoplasma pneumoniae?

A

Older children (> 4 years)

37
Q

Which group of antibiotics are used to treat Mycoplasma pneumoniae?

A

Macrolides

38
Q

Describe the classical presentation of Mycoplasma pneumoniae.

A

Atypical

  • Fever
  • Dry cough
  • Headache
  • Myalgia
  • Pharyngitis
39
Q

List some extra-pulmonary manisfestations of Mycoplasma pneumoniae.

A
  • Haemolysis - IgM antibodies to I antigen on erythrocytes, cold agglutinins
  • Neurological - encephalitis, aseptic meningitis, peripheral neuropathy, transverse myelitis
  • Polyarthralgia
  • Cardiac
  • Otitis media
  • Bullous myringitis (vesicles on the tympanic membrane)
40
Q

If a respiratory tract infection fails to respond to conventional treatment, which diagnoses should be considered?

A
  • Whooping cough
  • TB
41
Q

How is UTI diagnosed in children?

A
  • Clinically + urine dip
  • MCS - pure growth of > 105 CFU/mL
  • Pyuria
42
Q

What are the main organisms responsible for UTI in children?

A
  • E. coli (most common)
  • Other coliforms (Proteus, Klebsiella, Enterococcus)
  • Coagulase-negative Staphylococcus (S. saprophyticus)
43
Q

Why might renal tract imaging be useful in children who experience UTIs?

A

To check for congenital anomalies e.g. MCUG for vesico-ureteric reflux in children with recurrent UTI

44
Q

What might recurrent childhood infections suggest?

A

Immunodeficiency

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