MI: Neonatal and Childhood Infections Pt.2 Flashcards
Outline the treatment of late-onset sepsis.
- Check local guidelines
- Example antibiotic regimen: 1st line = flucloxacillin + gentamicin; 2nd line = meropenem
- If community acquired = ceftriaxone or cefotaxime with calcium infusion
What are some common non-specific symptoms of infections in childhood?
- Fever
- Abdominal pain
List some investigations for meningitis in children.
- Blood cultures
- LP
- Rapid antigen screen
- Blood PCR
- 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?
S. pneumoniae
What type of organism is Streptococcus pneumoniae?
- Gram-positive diplococcus
- Alpha-haemolytic
Which diseases can S. pneumoniae cause?
- Meningitis
- Pneumonia
- Sepsis
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:
- 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
What is the most common cause of death in:
- Children (1-9 years)
- Neonates
Children (1-9 years)
- Cancer (UK)
- Infections e.g. pneumonia, diarrhoea (worldwide)
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.
Atypical
- Fever
- Dry cough
- Headache
- Myalgia
- Pharyngitis
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)
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?
- Clinically + urine dip
- MCS - pure growth of > 105 CFU/mL
- Pyuria
What are the main organisms responsible for UTI in children?
- E. coli (most common)
- 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 e.g. MCUG for vesico-ureteric reflux in children with recurrent UTI
What might recurrent childhood infections suggest?
Immunodeficiency
