Micro 10 - Neonatal and childhood infections

Question 1

Toxoplasmosis long term sequalae

Answer 1

• Deafness
• Microcephaly
• Low IQ

Question 2

Toxoplasmosis presentation at birth

Answer 2

• 40% of babies are symptomatic at birth (4 C’s)

• Microcephaly/hydrocephalus
• Choroidoretinitis
• Intracranial calcifications
• Seizures / convulsions
• Hepatosplenomegaly/jaundice

Question 3

• Congenital Rubella Syndrome triad of sx

Answer 3

Cataracts
Congenital heart defects (PDA, VSD, ASD)
Deafness/ sensorineural hearing loss

Mechanism – mitotic arrest of cells; angiopathy; growth inhibitor effect

Question 4

GBS

lab features
mx

Answer 4

AKA streptococcus agalactiae

Gram +Ve
catalase -ve
beta haemolytic

penicillin

Question 5

E coli

lab features
mx

Answer 5

gram -ve rod

gentamycin

Question 6

Listeria

lab features
mx

Answer 6

gram +ve rod

amoxicillin

Question 7

Define early onset neonatal infection + late onset

Answer 7

neonatal period - first 4-6 weeks of life, need to adjust for prematurity (in premature babies neonatal period is longer)

early onset - within 48h of birth (some definitions mention 3-5 days)

late onset - after 48-72h of birth

Question 8

Early onset sepsis ix

Answer 8

Full blood count
C-reactive protein (CRP)
Blood culture
Surface swabs 
Deep ear swab
Lumbar puncture (CSF)
Chest X-ray (full body)

Question 9

Early onset neonatal sepsis mx

Answer 9

o Benzylpenicillin + gentamicin
 first line for neonatal infection  used in combination
 GBS - benzylpenicillin
 E. coli – gentamicin

o Add in amoxicillin if there is meningitis

Question 10

Most common cause of late onset neonatal infection

Answer 10

Coagulase negative Staphylococci (CoNS)

Question 11

Late onset sepsis clinical features

Answer 11

Bradycardia
Apnoea
Poor feeding/bilious aspirates/ abdominal distension
Irritability
Convulsions
Jaundice
Respiratory distress
Increased CRP; sudden changes in WCC/platelets
Focal inflammation – e.g. Umbilicus; drip sites etc.

Question 12

Late onset sepsis mx

Answer 12

1st line - cefotaxime + vancomycin
2nd line - meropenem

community acquired - cefotaxime + amoxicillin +/- gentamycin

Question 13

Important complication after VZV

Answer 13

Secondary bacterial infection with

Invasive Group A strep (iGAS)

Question 14

Childhood infection ix

Answer 14

FBC, CRP
Blood cultures
Urine
+/- sputum culture, throat swabs

Question 15

gram +ve cocci in chains that are beta haemolytic in neonates

gram +ve cocci in pairs that are alpha haemolytic in a child

Answer 15

gram +ve cocci in chains that are beta haemolytic* in neonates -> GBS

gram +ve cocci in pairs that are alpha haemolytic** in a child -> Pneumococcus (strep pneumoniae)

• beta haemolytic - you can see whiteness around colonies
• • alpha haemolytic - you can see greenness around colonies

Question 16

When is the men b vaccine given in children

Answer 16

8w
16w
1y

or

2m
4m
1y

Question 17

Gram staining of

Neisseria meningitidis
Haemophilus influenza

Answer 17

Neisseria meningitidis
gram -ve coccus

Haemophilus influenza
gram -ve rod

Question 18

When is the pneumococcal vaccine given in children

Answer 18

12w

12m

Question 19

Most important/common bacterial cause of respiratory tract infections in children and mx

Answer 19

Streptococcus pneumoniae

Amoxicillin or penicillin

Question 20

Mycoplasma pneumoniae

Who does it affect
treatment of choice

Answer 20

older children >4, school children, young adults

macrolide e.g. azithromycin

Haemolysis
IgM antibodies to the I antigen on erythrocyte
Cold agglutinins in 60% patients

Question 21

• Causes of death in children <5yo:

Answer 21

o Neonatal (0-27 days)  biggest causes: prematurity, intrapartum-related complications

o Post-neonatal (1-59 months)  biggest causes: pneumonia, congenital anomalies