Neonatal and childhood infections

Question 1

The mnemonic TORCH can be used to remember common congenital infections. What does it stand for?

Answer 1

Toxoplasmosis Other (HIV/HBV) Rubella CMV HSV

Question 2

Describe the aetiology of congenital infection

Answer 2

Transmission from mother

Question 3

TORCH can also stand for the non-specific features of congenital infection presentation. List these presenting features

Answer 3

Thrombocytopaenia Other (ears/eyes - cataracts, choroidoretinitis) Rash Cerebral abnormality (eg microcephaly) Hepatosplenomegaly

Question 4

How are congenital infections diagnosed?

Answer 4

Serology

Question 5

How are congenital infections prevented?

Answer 5

TORCH screen for antibodies in pregnant mothers/women planning a pregnancy NB This screening test is more commonly performed on neonates, but at that point is no longer a preventative measure

Question 6

List 3 organisms responsible for early onset neonatal sepsis

Answer 6

Group B Strep E. coli Listeria

Question 7

List 3 maternal factors that can cause early onset neonatal sepsis

Answer 7

PROM Fever Foetal distress

Question 8

List 3 fetal factors that can cause early onset neonatal sepsis

Answer 8

Respiratory distress Acidosis Asphyxia

Question 9

How does early onset sepsis present?

Answer 9

Fever Generally unwell - similar to neonatal meningitis

Question 10

Neonatal sepsis is diagnosed using a “septic screen” of tests. What does this include?

Answer 10

FBC CRP Blood culture Deep ear swab CSF Surface swab CXR

Question 11

What is the treatment for early onset neonatal sepsis?

Answer 11

ABC Supportive Nutrition Antibiotics: BenPen + Gentamicin OR if listeria suspected, Amoxicillin/Ampicillin

Question 12

In what time frame would neonatal sepsis be diagnosed as late onset?

Answer 12

48 hrs - 6 weeks after birth

Question 13

List 4 organisms responsible for late onset neonatal sepsis

Answer 13

Coag -ve staph (eg epidermis) Group B Strep E. coli Listeria

Question 14

How does late onset neonatal sepsis present?

Answer 14

Bradycardia Apnoea Poor feeding Irritability Convulsions Jaundice Respiratory distress Focal inflammation (examine umbilicus)

Question 15

How is late onset neonatal sepsis diagnosed?

Answer 15

Septic screen + urine culture

Question 16

What is the first line antibiotic treatment for late onset neonatal sepsis?

Answer 16

Flucloxacillin + Gentamicin

Question 17

What is the second line antibiotic treatment for late onset neonatal sepsis (if child v ill)?

Answer 17

Tazocin + Vancomycin

Question 18

What is the antibiotic treatment for late onset neonatal sepsis in the community?

Answer 18

BenPen + Amoxicillin + Cefotaxime (to cover listeria and community meningitis)

Question 19

Which 2 viruses commonly cause childhood infection and how can this be complicated?

Answer 19

VZV HSV Complication: Secondary bacterial infection

Question 20

How does childhood infection usually present?

Answer 20

Non-specific: fever, abdo pain

Question 21

How is childhood infection diagnosed?

Answer 21

FBC CRP Blood/urine/sputum culture

Question 22

Which organism most commonly causes bacterial meningitis in children under 3months

Answer 22

Haemophilus influenzae

Question 23

Which organism most commonly causes bacterial meningitis in children >3 months old?

Answer 23

Neisseria meningitidis

Question 24

Which organism also causes bacterial meningitis in children under 2 years old?

Answer 24

Streptococcus pneumoniae

Question 25

Which organisms also commonly cause bacterial meningitis in children 1-3 months old?

Answer 25

GBS E coli Listeria (Therefore empirical antibiotics at this age should include amoxicillin)

Question 26

In the young, respiratory infections are usually viral. At what age are bacterial resp infections possible, and which should be considered?

Answer 26

>4 years S. pneumoniae and mycoplasma

Question 27

List 4 organisms that cause UTI in children

Answer 27

E. coli (most common) Proteus Klebsiella Enterococcus

Question 28

How are UTIs diagnosed in children?

Answer 28

Culture (>10^5 cfu/ml) Microscopy: pyutia (pus cells) Clinical symptoms