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PathY5 > Neonatal and Childhood Diseases > Flashcards

Neonatal and Childhood Diseases Flashcards

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1
Q

What is a congenital infection?

A

An infection with which a baby is born with.

The mother may be infected any time during pregnancy.

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2
Q

What is the current screening of the mother during pregnancy?

A

Hep B
HIV
Rubella
Syphilis

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3
Q

What is currently not screened in the mother during pregnancy but may still undergo vertical transmission?

A

CMV
Toxoplasmosis
Hep C
Group B Streptococcus

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4
Q

What is the (outdated) torch screen?

A

Toxoplasmosis
Other – syphiliss; HIV; hepatitis B/C
Rubella
Cytomegalovirus (CMV)
Herpes simplex virus (HSV)

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5
Q

What are the common clinical features of congenital infections?

A

Mild/no apparent maternal infection

Wide range of severity in the baby

Similar clinical presentation
Low platelets, rash
Cerebral abnormalities
Hepatosplenomegaly/hepatitis/jaundice

Serological diagnosis

Long term sequelae if untreated

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6
Q

What is the life cycle of toxoplasmosis?

A
  1. Unsporulated oocysts are shed in cats faeces
  2. Oocysts shed for 1-2 weeks
  3. Intermediate hosts infected
  4. Oocysts transform into tachyzoites and move to neural/ muslce in hosts
  5. Oocysts may infect human meat consumption
  6. Humans infected (definitive host) via undercooked food, contaminated water, blood transfusion, transplacentally
  7. Stay in human skeletal muscle, heart, brain and eyes
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7
Q

How do you diagnose toxoplasmosis?

A

Serology
Stained biopsy

Amniotic fluid PCR - T gondii

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8
Q

How does congenital toxoplasmosis present?

A

May be asymptomatic at birth – 60% but may still go on to suffer long term sequelae
Deafness, low IQ, microcephaly

40% symptomatic at birth
Choroidoretinitis
Microcephaly/hydrocephalus
Intracranial calcifications
Seizures
Hepatosplenomegaly/jaundice

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9
Q

How does congenital rubella present?

A

Effect on foetus – dependent on time of infection
Mechanism – mitotic arrest of cells; angiopathy; growth inhibitor effect

Eyes: cataracts; microphthalmia; glaucoma; reintopathy

Cardiovascular syndrome; PDA; ASD/VSD

Ears; deafness

Brain: microcephaly; meningoencephalitis; developmental delay

Other: growth retardation; bone disease; hepatosplenomegaly; thrombocytopenia; rash

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10
Q

What does a HSV rash look like?

A

Red, blistering and pustulated

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11
Q

Other than toxoplasmosis and HSV what other congenital infections may occur?

A

Hepatitis B and C
HIV
Listeria monocytogenes
Group B Streptococcus
Syphilis
Chlamydia trachomatis
Mycoplasma species (Mycoplasma hominis and Ureaplasma urealyticum)
Parvovirus

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12
Q

What happens in neonatal Chlamydia?

A

Infection transmitted during delivery
Mother may be asymptomatic
Causes neonatal conjunctivitis, or rarely pneumonia
Treated with erythromycin

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13
Q

How do you treat neonatal chlamydia?

A

Erythromycin

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14
Q

What does Neonatal mean?

A

Definition varies
First 4-6 weeks of life

If born early (premature)
Neonatal period longer and is adjusted for expected birth date

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15
Q

Why are neonatal infections bad?

A

Higher incidence of infections
Can become ill rapidly and seriously
Unlike adults or older children – need to treat with antibiotics when first suspicion of infection

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16
Q

Why can’t neonates protect against infection?

A

Immature host defences

Increased risk with increased prematurity
Less maternal IgG
NICU care
Exposure to microorganisms; colonisation and infection

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17
Q

What are early onset infections?

A

Early onset – usually within 48 hours of birth
Some definitions 3-5 days

Organisms:
Group B streptococci
E. coli (Vaginal canal bacteria)
Listeria monocytogenes

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18
Q

What are group B Streptococci?

A

Gram positive coccus
Catalase negative
Beta-haemolytic
Lancefield Group B

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19
Q

What can group B streptococci cause?

A

Bacteraemia
Meningitis
Disseminated infection e.g. joint infections

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20
Q

What does E.coli cause in neonates?

A

Bacteraemia
Meningitis
UTI

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21
Q

What is Listeria Monocytogenes?

A

L. monocytogenes is a Gram-positive, non-spore-forming, motile, facultatively anaerobic, rod-shaped bacterium.

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22
Q

What are the maternal RFs for early onset sepsis?

A

PROM/prem. Labour
Fever
Foetal distress
Meconium staining
Previous history

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23
Q

What are the baby RFs for early onset sepsis?

A

Resp: Birth asphyxia, Resp. distress

Metabolic: Acidosis, Hypoglycaemia

Signs: Neutropenia, Rash, Hepatosplenomegaly, Jaundice, Low BP

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24
Q

What investigations would you do for early onset sepsis?

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A

Bloods: FBC, CRP, Blood culture

Samples: Deep ear swab, Lumbar puncture (CSF), Surface swabs

Imaging: Chest X-ray (full body)

25
What is the treatment for early onset sepsis?
Supportive management: Ventilation, Circulation, Nutrition Antibiotics: e.g. benzylpenicillin & gentamicin
26
What causes late onset sepsis?
Coagulase negative Staphylococci (CoNS) Group B streptococci E. coli Listeria monocytogenes S. aureus Enterococcus sp. Gram negatives – Klebsiella spp. /Enterobacter spp. /Pseudomonas aeruginosa/Citrobacter koseri Candida species
27
What does late onset mean?
after 48-72 hours
28
What are the clinical features of late onset sepis?
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.
29
What investigations do you do for late onset sepsis?
Bloods: FBC, CRP, Blood culture(s) Source identification: Urine, ET secretions if ventilated, Swabs from any infected sites
30
What is the treatment for late onset sepsis?
Treat early – lower threshold for starting therapy Review and stop antibiotics if cultures negative and clinically stable NICU-Example of antibiotics for late onset sepsis: 1st line: cefotaxime & vancomycin 2nd line: meropenem Community acquired late onset neonatal infections: cefotaxime, amoxicillin +/-gentamicin
31
What infections are common in childhood?
Viral infections are very common e.g. Chickenpox (VZV); Herpes simplex – cold sores/stomatitis; HHV6; HHV8; EBV; CMV; RSV; enteroviruses etc Bacterial infections are important and may cause secondary infection after viral illness e.g. iGAS disease post VZV infection May be difficult to ascertain site of infection from history/examination depending on age of child
32
What are common non specific symptoms?
Fever Abdominal pain
33
What investigations can you do in ill children?
FBC CRP Blood cultures Urine +/- Sputum; throat swabs etc
34
What do you do if you suspect a child has meningitis?
Most important bacterial cause of paediatric morbidity and mortality Clinical features Lab tests: Blood cultures Throat swab LP for CSF if possible Rapid antigen screen EDTA blood for PCR Clotted serum for serology if needed later
35
What causes bacterial meningitis?
N. meningitidis - meningococcal septicaemia causes a non blanching erythmatous rash
36
How has the Men B vaccine helped?
50% incidence rate ratio (IRR) reduction in MenB cases (37 cases Vs average 74 cases; IRR 0.50 [95% CI 0.36-0.71; p=0.0001)
37
What does S. pneumoniae cause?
Meningitis, bacteraemia, pneumonia
38
Why is S.pneumoniae bad?
Leading cause of morbidity and mortality esp. in \< 2y.o. \>90 capsular serotypes Increasing penicillin resistance
39
What type of bacteria is S. pneumoniae?
Gram positive diplococcus – alpha haemolytic streptococcus
40
How do we vaccinate against pneumococcus?
Due to large health burden and emergence of antibiotic resistance - vaccination programme introduced in the USA in 2000 Previously available pneumococcal polysaccharide vaccine – 23 capsular types of pneumococcus Children\< 2years poor response – antibody response improved by conjugating the polysaccharide to proteins such as CRM This conjugated vaccine – immunogenic in children from 2 months
41
What does the pneumococcal vaccine do?
Prevenar introduced in U.K. in 2006 (7 serotypes, individually conjugated to a carrier, then mixed These 7 serotypes in Prevenar responsible for approx 80% of IPD in the UK in 2006 Vaccine serotypes were almost eradicated since introduction of PCV7 BUT still seeing much IPD in children ? Due to replacement phenomenon i.e. serotype replacement ?Could this lead to change in disease phenotype e.g. HUS (serotype 19a), empyema (serotype 1) Introduction of Prevenar 13 in UK in 2010 (serotypes 4, 6B, 9V, 14, 18C, 19F, 23 and additional serotypes 1, 3, 5, 6A, 7F and 19)
42
What ages do the different bacteria cause meningitis?
\<3/12: N. meningitidis; S. pneumoniae; (H. influenzae (Hib) if unvaccinated); GBS; E. coli; Listeria sp. 3/12 - 5 years:N. meningitidis; S. pneumoniae; (Hib if unvaccinated) \>6 years: N. meningitidis; S. pneumoniae
43
What is the background of RTIs?
Account for 1/3 of all childhood illnesses Mostly upper respiratory tract infections Mostly viral Age is important Sputum is often difficult to obtain Often need to give empiric treatment
44
What bacteria causes pneumonia?
S. pneumoniae (pneumococcus) is the most important bacterial cause Most UK strains remain sensitive to penicillin or amoxicillin Mycoplasma pneumoniae tends to affect older children (\>4 years) – Macrolides are treatment of choice e.g. Azithromycin
45
How does mycoplasma pneumoniae cause problems?
Acquired by droplet transmission person to person. Epidemics occur every 3-4 years. Occurs in school age children and young adults. Incubation period 2-3 weeks
46
What are the symptoms of mycoplasma pneumoniae infection?
Many asymptomatic Classically presents: Fever Headache Myalgia Pharyngitis Dry cough
47
What are the extrapulmonary manifestations of mycoplasma pneumoniae?
Haemolysis IgM antibodies to the I antigen on erythrocyte Cold agglutinins in 60% patients Neurological (1% cases) Encephalitis most common Aseptic meningitis, peripheral neuropathy, transverse myelitis, cerebellar ataxia Aetiology unknown ?antibodies cross react with galactocerebroside Cardiac Polyarthralgia, myalgia, arthritis Otitis media and bullous myringitis
48
If meningitis fails to respond to accurate treatment what else could you consider?
Whooping cough – Bordetella pertussis especially if unvaccinated TB including MDRTB and XDRTB
49
How common are UTIs in children?
Common Up to 3% girls and 1% boys by age 11
50
How do you diagnose UTIs?
Diagnosis: Symptoms – if child old enough to give clear history Pure growth \>105cfu/ml Pyuria – pus cells on urine microscopy N.B. Get sample before starting treatment
51
What organisms cause UTIs?
E. coli Other coliforms e.g. Proteus species, Klebsiella Enterococcus sp. Coagulase negative Staphylococcus Staph saprophyticus
52
What is the management of a suspected uti in a child?
See notes.
53
What is important to do in UTIs?
Early diagnosis and antibiotic treatment important Renal tract imaging Antibiotic prophylaxis after treatment of the infection (NICE guidance)
54
How do you manage recurrent or persistent infections?
May be a sign of immunodeficiency – either congenital or acquired – e.g. HIV, SCID Warrants investigation by Paediatric Infectious Diseases doctors
55
What is the current vaccination schedule?
56
What is the commonest cause of neonatal sepsis?
Gp B strep
57
What is the most common type of meningococcal disease in the UK?
Men B
58
What is the commonest cause of death worldwide in children under 5yrs?
Pneumonia

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