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PATH FINAL > MI: Neonatal and Childhood Infections > Flashcards

MI: Neonatal and Childhood Infections Flashcards

1
Q

Which infections are screened for in pregnancy?

A
  • HIVE
  • Hepatitis B
  • Syphilis
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2
Q

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

A
  • CMV
  • HSV
  • Toxoplasmosis
  • Group B Streptococcus
  • Hepatitis C
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3
Q

What does ‘TORCH’ stand for?

A
  • Toxoplasmosis
  • Rubella
  • CMV
  • HSV
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4
Q

What is the source of toxoplasmosis?

A

Cat faeces

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5
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

  • Choriodoretinitis
  • Microcephaly/hydrocephalus
  • Intracranial calcifications
  • Seizures
  • Hepatosplenomegaly/jaundice
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6
Q

What is the triad of features in congenital rubella syndrome?

A
  • Cataracts
  • Congenital heart disease (PDA is most common)
  • Deafness
  • Other features: microphthalmia, glaucoma, retinopathy, ASD/VSD, microcephaly, meningoencephalopathy, developmental delay
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7
Q

How is herpes simplex virus transmitted to the neonate?

A
  • Lesions in the genital tract can transmit HSV to the neonate
  • It causes a blistering rash and can cause disseminated infection with liver dysfunction and meningoencephalitis
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8
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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9
Q

Which mycoplasma species can cause neonatal infection?

A
  • Mycoplasma hominis*
  • Ureaplasma urealyticum*
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10
Q

Why are premature infants at increased risk of infection?

A
  • Less maternal IgG
  • NICU care (exposure to microorganisms)
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11
Q

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

A

Infection that occurs within 48 hours of birth

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12
Q

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

A
  • Group B Streptococcus
  • E. coli
  • Listeria monocytogenes
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13
Q

What type of bacterium is Group B Streptococcus?

A
  • Gram-positive coccus
  • Catalase negative
  • Beta-haemolytic
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14
Q

What can GBS cause in neonates?

A
  • Bacteraemia
  • Meningitis
  • Disseminated infection
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15
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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16
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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17
Q

List some maternal risk factors for early-onset sepsis.

A
  • Premature rupture of membranes
  • Preterm labour
  • Foetal distress
  • Fever
  • Meconium staining
  • Previous history
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18
Q

List some baby-related risk factors for early-onset sepsis.

A
  • Birth asphyxia
  • Respiratory distress
  • Low blood pressure
  • Acidosis
  • Hypoglycaemia
  • Neutropaenia
  • Rash
  • Hepatosplenomegaly
  • Jaundice
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19
Q

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

A
  • FBC
  • CRP
  • Blood culture
  • Deep ear swab
  • LP
  • Surface swabs
  • CXR
20
Q

Outline the treatment of early-onset sepsis.

A
  • ABCDE
  • Nutrition
  • Antibiotics
21
Q

Which antibiotic combination is often used in early-onset sepsis and why?

A
  • Benzylpenicillin and gentamicin
  • Benzylpenicillin covers Group B Streptococcus whilst gentamicin covers E. coli
22
Q

What is late-onset sepsis?

A

Sepsis that occurs more than 48-72 hours after birth

23
Q

What are the main causes of late-onset sepsis?

A
  • Coagulase negative staphylococcis (e.g. S. epidermidis)
  • GBS
  • E. coli
  • Listeria monocytogenes
  • S. aureus
  • Enteroccocus sp.
  • Gram-negatives (e.g. Klebsiella, Enterobacter, Pseudomonas)
24
Q

List some clinical features of late-onset sepsis.

A
  • Bradycardia
  • Apnoea
  • Poor feeding
  • Irritability
  • Convulsions
  • Jaundice
  • Respiratory distress
25
Q

List some investigations that may be used in late-onset sepsis.

A
  • FBC
  • CRP
  • Blood cultures
  • MSU
  • Swabs from an infected site
  • ET secretions if ventilated
26
Q

Outline the treatment of late-onset sepsis.

A
  • Treat early with antibiotics
  • Guidelines differ
  • Example antibiotic regimen: 1st line = cefotaxime + vancomycin; 2nd line = meropenem
27
Q

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

A
  • Fever
  • Abdominal pain
28
Q

List some investigations for meningitis in children.

A
  • Blood cultures
  • Throat swab
  • LP
  • Rapid antigen screen
  • EDTA for blood PCR
  • Clotted serum for serology
29
Q

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

A

They may be coagulopathic

30
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
31
Q

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

A

Meningitis B

32
Q

What type of organism is Streptococcus pneumoniae?

A
  • Gram-positive diplococcus
  • Alpha-haemolytic
33
Q

Which diseases can S. pneumoniae cause?

A
  • Meningitis
  • Pneumonia
  • Bacteraemia
34
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
35
Q

What type of organism is Haemophilus influenzae?

A
  • Gram-negative cocco-bacilli
36
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:

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

3 months to 5 years:

  • Neisseria meningitis
  • Streptococcus pneumoniae
  • Haemophilus influenzae

Over 6 years:

  • Neisseria meningitis
  • Streptococcus pneumoniae
37
Q

What is the most common cause of death in:

  • Postnatal children (1-59 months)
  • Neonates
A

Postnatal children (1-59 months):

  • Pneuomnia
  • Followed by congenital anomalies

Neonates:

  • Prematurity
  • Followed by intra-partum complications
38
Q

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

A

Streptococcus pneumoniae

39
Q

Which children are mainly affected by Mycoplasma pneumoniae?

A

Older children (> 4 years)

40
Q

Which group of antibiotics are used to treat Mycoplasma pneumoniae?

A

Macrolides

41
Q

Describe the classical presentation of Mycoplasma pneumoniae.

A
  • Fever
  • Headache
  • Myalgia
  • Pharyngitis
  • Dry cough
42
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 - pathognomonic of Mycoplasma)
43
Q

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

A
  • Whooping cough
  • TB
44
Q

How is UTI diagnosed in children?

A
  • Symptoms
  • Pure growth of > 105 CFU/mL
  • Pyuria
45
Q

What are the main organisms responsible for UTI in children?

A
  • E. coli
  • Other coliforms (Proteus, Klebsiella, Enterococcus)
  • Coagulase-negative Staphylococcus (S. saprophyticus)
46
Q

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

A

To check for congenital anomalies

47
Q

What might recurrent childhood infections suggest?

A

Immunodeficiency

PATH FINAL (36 decks)

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