MI: Neonatal and Childhood Infections Flashcards by Misan K

Which infections are screened for in pregnancy?

HIVE
Hepatitis B
Syphilis

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

CMV
HSV
Toxoplasmosis
Group B Streptococcus
Hepatitis C

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What does ‘TORCH’ stand for?

Toxoplasmosis
Rubella
CMV
HSV

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What is the source of toxoplasmosis?

Cat faeces

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What are the possible outcomes for neonates with congenital toxoplasmosis?

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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What is the triad of features in congenital rubella syndrome?

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

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How is herpes simplex virus transmitted to the neonate?

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

During delivery
Causes neonatal conjunctivitis or pneumonia

NOTE: it is treated with erythromycin

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Which mycoplasma species can cause neonatal infection?

Mycoplasma hominis*
Ureaplasma urealyticum*

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Why are premature infants at increased risk of infection?

Less maternal IgG
NICU care (exposure to microorganisms)

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

Infection that occurs within 48 hours of birth

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

Group B Streptococcus
E. coli
Listeria monocytogenes

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What type of bacterium is Group B Streptococcus?

Gram-positive coccus
Catalase negative
Beta-haemolytic

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What can GBS cause in neonates?

Bacteraemia
Meningitis
Disseminated infection

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

Gram-negative rods
Can cause bacteraemia, meningitis and UTI

NOTE: the K1 antigen is particularly problematic

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

Gram-positive rods
Causes sepsis in the mother and the newborn

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List some maternal risk factors for early-onset sepsis.

Premature rupture of membranes
Preterm labour
Foetal distress
Fever
Meconium staining
Previous history

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

Birth asphyxia
Respiratory distress
Low blood pressure
Acidosis
Hypoglycaemia
Neutropaenia
Rash
Hepatosplenomegaly
Jaundice

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

FBC
CRP
Blood culture
Deep ear swab
LP
Surface swabs
CXR

Outline the treatment of early-onset sepsis.

ABCDE
Nutrition
Antibiotics

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

Benzylpenicillin and gentamicin
Benzylpenicillin covers Group B Streptococcus whilst gentamicin covers E. coli

What is late-onset sepsis?

Sepsis that occurs more than 48-72 hours after birth

What are the main causes of late-onset sepsis?

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

List some clinical features of late-onset sepsis.

Bradycardia
Apnoea
Poor feeding
Irritability
Convulsions
Jaundice
Respiratory distress

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

* FBC * CRP * Blood cultures * MSU * Swabs from an infected site * ET secretions if ventilated

Outline the treatment of late-onset sepsis.

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

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

* Fever * Abdominal pain

List some investigations for meningitis in children.

* Blood cultures * Throat swab * LP * Rapid antigen screen * EDTA for blood PCR * Clotted serum for serology

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

They may be coagulopathic

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

* Meningitis C * Haemophilus influenzae type B * Pneumococcus

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

Meningitis B

What type of organism is *Streptococcus pneumoniae*?

* Gram-positive diplococcus * Alpha-haemolytic

Which diseases can *S. pneumoniae* cause?

* Meningitis * Pneumonia * Bacteraemia

What type of vaccine is the *S. pneumoniae* vaccine?

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

What type of organism is *Haemophilus influenzae*?

* Gram-negative cocco-bacilli

What are the typical causes of meningitis for the following age groups: * Under 3 months * 3 months to 5 years * Over 6 years

**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*

What is the most common cause of death in: * Postnatal children (1-59 months) * Neonates

**Postnatal children (1-59 months):** * Pneuomnia * Followed by congenital anomalies **Neonates:** * Prematurity * Followed by intra-partum complications

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

*Streptococcus pneumoniae*

Which children are mainly affected by *Mycoplasma pneumoniae*?

Older children (\> 4 years)

Which group of antibiotics are used to treat *Mycoplasma pneumoniae*?

Macrolides

Describe the classical presentation of *Mycoplasma pneumoniae.*

* Fever * Headache * Myalgia * Pharyngitis * Dry cough

List some extra-pulmonary manisfestations of *Mycoplasma pneumoniae*.

* 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*)

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

* Whooping cough * TB

How is UTI diagnosed in children?

* Symptoms * Pure growth of \> 10⁵ CFU/mL * Pyuria

What are the main organisms responsible for UTI in children?

* *E. coli* * Other coliforms (*Proteus, Klebsiella, Enterococcus*) * Coagulase-negative *Staphylococcus* (*S. saprophyticus*)

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

To check for congenital anomalies

What might recurrent childhood infections suggest?

Immunodeficiency