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Kat's Pathology > Neonatal and Childhood Infections > Flashcards

Neonatal and Childhood Infections Flashcards

1
Q

What are congenital infections

A

Babies are born with congenital infections i.e. transmitted vertically from mother to baby

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2
Q

When during pregnancy can congenital infections occur

A

At any time during pregnancy - between the first trimester and birth

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3
Q

What infections are pregnant mothers screened for (6)

A 
Rubella 
Syphilis
Hepatitis B (+/- Hepatitis C) 
HIV
\+/- toxoplasmosis 
\+/- varicella zoster virus (VZV)
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4
Q

What must always be considered in a sick neonate

A

Congenital infection

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5
Q

What are the TORCH infections that are important to screen for (5)

A 
Toxoplasmosis 
Other - syphilis, HIV, hepatitis B/C, etc....
Rubella
CMV (cytomegalovirus) 
HSV (herpes simplex virus)
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6
Q

What are some common features of congenital infections (5)

A 
Mild/no apparent maternal infection
Wide range of severity in the baby
Similar clinical presentation
Serological diagnosis
Long term sequelae if untreated
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7
Q

What are some general clinical features of congenital infections (5)

A 
Thrombocytopenia
Other:ears/ eyes
Rash
Cerebral abnormalities/ microcephaly / meningoencephalitis 
Hepatosplenomegaly/ hepatitis/ jaundice
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8
Q

What are the two presentations of toxoplasmosis

A

Asymptomatic at birth - 60% but may still go on to suffer long-term sequelae (deafness, low IQ, microcephaly)
Symptomatic at birth - 40% choroidoretinitis, microcephaly/hydrocephalus, intracranial calcification, seizures, jaundice, hepatosplenomegaly

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9
Q

How is toxoplasmosis transmitted to humans

A

Cats

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10
Q

What effects does congenital rubella syndrome have on the foetus

A

Depends on the time of the infection

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11
Q

What is the mechanism of action of congenital rubella syndrome (3)

A

Mitotic arrest of cells
Angiopathy
Growth inhibitor effect

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12
Q

What effect does congenital rubella syndrome have on the eyes (4)

A

Cararacts
Microphthalmia
Glaucoma
Retonopathy

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13
Q

What are the cardiovascular effects of congenital rubella syndrome (3)

A

PDA
PAS
ASD/VSD

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14
Q

What are the effects of congenital rubella syndrome of the ears

A

Deafness

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15
Q

What are the effects of congenital rubella syndrome on the brain (3)

A

Microcephaly
Meningoencephalitis
Developmental Delay

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16
Q

What misc effects can congenital rubella syndrome have (5)

A 
Growth retardation 
Bone disease
Hepatosplenomegaly 
Thrombocytopenia 
Rash
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17
Q

What are some important congenital infections to be aware of (8)

A 
Hepatitis B/C
HIV
Syphilis
Listeria monocytogenes
GBS
Chlamydia trachomatis 
Mycoplasma 
Parvovirus
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18
Q

When is chlamydia transmitter to the newborn

A

During delivery

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19
Q

What does neonatal chlamydia cause (2)

A

Neonatal conjunctivitis

Pneumonia

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20
Q

How is neonatal chlamydia treated

A

Erythromycin

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21
Q

Is the mother always symptomatic with chlamydia infections

A

Mother may be asymptomatic

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22
Q

When is the neonatal period

A

1st 6 weeks of life

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23
Q

In a preterm baby, what is the neonatal period

A

If born early (premature infant) the neonatal period is longer and is adjusted for expected birth date

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24
Q

What differs from adults in neonatal infections (3)

A

Higher incidence of infections
Can become ill very quickly and seriously
Unlike adults - need to treat with antibiotics at first suspicion of infection

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25
Q

Why are neonates at risk of infections (2)

A

Immature host defences

Increased risk with prematurity

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26
Q

Why does prematurity increase susceptibility to infections (3)

A

Less maternal IgG
NICU care
Exposure to microorganisms - colonisation and infection

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27
Q

What is early onset neonatal infection

A

Usually within 48hours of birth

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28
Q

What organisms are associated with early onset neonatal infection (4)

A

Group B Streptococci
E.coli
Listeria
Others: other streptococci, haemophilus species, anaerobes

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29
Q

What do group B streptococci look like

A

Gram positive cocci

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30
Q

What are the features of group B steptococci (4)

A

Gram positive cocci
Catalase negative
Beta-haemolytic
Lacefield group B

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31
Q

What does group B streptococci cause in neonates (3)

A

Bacteraemia
Meningitis
Disseminated infection (e.g. joint infections)

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32
Q

What does e.coli look like

A

Gram negative rod

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33
Q

What does E.coli cause in neonates (3)

A

Bacteraemia
Meningitis
UTI

34
Q

What are some maternal risk factors for early onset sepsis of the neonate (5)

A 
PROM/pre-term labour 
Fever
Foetal distress
meconium staining 
Previous history
35
Q

What are some baby risk factors for neonatal sepsis (9)

A 
Birth asphyxia 
Respiratory distress
Low BP
Acidosis 
Hypoglycaemia 
neutropenia 
Rash 
Hepatosplenomegaly 
Jaundice
36
Q

What are the first-line investigations for early onset neonatal sepsis (7)

A 
FBC
CRP
Blood cultures 
Deep ear swab 
CSF
Surface swabs 
CXR
37
Q

What is the treatment for early onset neonatal sepsis

A

Supportive management

38
Q

What is involved in the supportive management for early onset neonatal sepsis (4)

A

Ventilation
Circulation
Nutrition
Antibiotics (e.g. benzylpenicillin and gentamicin)

39
Q

What organisms are likely in early onset neonatal sepsis (3)

A

Group B streptococci
E.coli
Listeria monocytogenes

40
Q

What organisms are likely in late onset neonatal sepsis (4)

A 
CNS involvement!!!!
S.aureus 
Enterococci
Gram negatives - Klebsiella, enterobacter, pseudomonas aeruginosa
Candida species
41
Q

What are the clinical features of late onset neonatal sepsis (10)

A

Bradycardia
Apnoea
Poor feeding/biliois aspirates/abdominal distension
Irritability
Convulsions
Jaundice
Respiratory distress
Increased CRP, sudden changes in WCC/platelets
Focal inflammation - umbilicus, drip sites, etc…

42
Q

What investigations are carried out in late onset neonatal sepsis (6)

A 
FBC
CRP
Blood cultures 
Urine
ET secretions if ventilated 
Swabs from any infected sites
43
Q

What is the treatment for late onset neonatal sepsis (3)

A

Treat early - lower threshold for starting therapy
Review and stop antibiotics if cultures negative and clinically stable
NICU treatment

44
Q

What are the first-line antibiotics used for neonatal sepsis (2)

A

Flucloxacillin and gentamicin

45
Q

What are the second line antibiotics for late onset neonatal sepsis (2)

A

Pipericillin/tazobactam and vancomycin

46
Q

What are the antibiotics used to treat community acquired late onset neonatal infections (3)

A

Cefotaxime, amoxicillin +/- gentamicin

47
Q

What are the most common causative organisms in childhood

A

Viral infections (e.g. chickenpox (VZV), herpes simplex (cold sores/stomatitis), HHV6, EBV, CMV, RSV, enteroviruses,

48
Q

What may viral infections in childhood predispose to

A

Secondary infection with bacteria

49
Q

What are the most common symptoms of infection in childhood (2)

A

Non-specific symptoms (fever, abdominal pain)

50
Q

What investigations are useful in childhood infections (5)

A 
FBC
CRP
Blood cultures 
Urine 
\+/- sputum, throat swabs, etc...
51
Q

What is the most important bacterial cause of paediatric morbidity and mortality

A

Meningitis

52
Q

How is bacterial meningitis diagnosed in childhood (2)

A

Clinical features

Lab tests

53
Q

What lab tests are used to diagnose bacterial meningitis (6)

A 
Blood cultures
Throat swab 
LP for CSF if possible 
Rapid antigen screen 
EDTA blood for PCR
Clotted serum for serology if needed alter
54
Q

What are the CSF features of bacterial meningitis (7)

A

Raised WCC (mainly polymorphs)
Raised protein
Low glucose
Gram stain - may see organisms (e.g. meningococci, pneumococci)
Rapid antigen test on CSF may be positive
Culture may grow the organism - yields sensitivity data
If it doesn’t grow, PCR may be positive

55
Q

What is the glass test

A

Tests for a non-blanching rash in bacterial meningitis

56
Q

What is streptococcus pneumoniae a dangerous cause of (3)

A

Bacterial meningitis
Pneumonia
Bacteraemia

57
Q

How does strep pneumoniae appear

A

Gram positive diplococci

Alpha haemolytic streptococci

58
Q

What is the pneumococcal conjugative vaccine

A

Prevenar introduced in UK in 2006.
Vaccine serotypes almost eradicated since introduction.
However, still seeing invasive pneumococcal disease in children

59
Q

What may cause the continuing invasive pneumococcal disease in children despite vaccination

A

Perhaps due to serotype replacement

60
Q

What is haemophilus influenza cultured on

A

Chocolate agar plate

61
Q

What are the most common causes of meningitis in children < 3 months old (6)

A 
N. meningitidis. 
S. pneumoniae. 
(H. influenzae if unvaccinated) 
Group B Strep. 
E. coli. 
Listeria.
62
Q

What are the most common causes of meningitis in children < 3 months old (3)

A

N. meningitidis.
S. pneumoniae.
H. influenza if unvaccinated.

63
Q

What are the most common causes of meningitis in children > 6 years old (2)

A

N. meningitidis.

S. pneumoniae.

64
Q

Accounts for 1/3rd of all childhood illnesses

A

Respiratory tract infections

65
Q

What are the most common causes of respiratory tract infections in children (2)

A

S. pneumoniae 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 the treatment fo choice e.g. azithromycin.

66
Q

What must be considered if treatment for s.pneumonia and mycoplasma ineffective (2)

A

Whooping cough - bordetella pertussis - especially if unvaccinated.
TB, including MDRTB and XDRTB

67
Q

What is the prevalence of UTIs

A

Up to 3% of girls and 1% boys by age 11

68
Q

What is important in UTIs before commencing treatment

A

Get samples before starting treatment

69
Q

What are the most common causes of UTIs in children (3)

A

E.coli
Other coliforms e.g. proteus species, klebsiella
Enterococcus

70
Q

What are the NICE guidelines on UTIs in children

A

Antibiotic prophylaxis after treatment of the infection

71
Q

What may recurrent or persistent infections indicate

A

May be a sign of immunodeficiency (e.g. HIV, SCID)

Warrants investigation by paediatric infectious diseases doctors

72
Q

What is the UK vaccination schedule (8)

A

8 weeks Diphtheria, Tetanus, Acellular Pertussis (whooping cough), Inactivated Polio Vaccine, Hib (DTaP / IPV / Hib) and Pneumococcal Conjugate Vaccine (PCV)
12 weeks DTaP / IPV / Hib and Meningococcal C Vaccine (Men C)
16 weeks DTaP / IPV / Hib, PCV and Men C
12 months Hib/Men C booster
13 months Measles, Mumps and Rubella (MMR) and PCV
3 years 4 months MMR - second dose (may be given earlier)Diphtheria, Tetanus, Pertussis and IPV
13+ years Tetanus, Diphtheria and IPV
13+ years (girls) HPV 16&18

73
Q

Vaccinations at 8 weeks (6)

A

Diphtheria, Tetanus, Acellular Pertussis (whooping cough), Inactivated Polio Vaccine, Hib (DTaP / IPV / Hib)
Pneumococcal Conjugate Vaccine (PCV)

74
Q

Vaccinations at 12 weeks (4)

A

DTaP/IPV / Hib

Meningococcal C Vaccine (Men C)

75
Q

Vaccinations at 16 weeks (5)

A

DTaP / IPV / Hib
PCV
Men C

76
Q

Vaccinations at 12 months (2)

A

Hib/Men C booster

77
Q

Vaccinations at 13 months (4)

A

Measles, Mumps and Rubella (MMR)

PCV

78
Q

Vaccinations at 3 years 4 months (7)

A

MMR second dose
Diphtheria, Tetanus, Pertussis
IPV

79
Q

Vaccinations 13 + years (3)

A

Tetanus, Diphtheria

IPV

80
Q

Vaccinations 13+ years (girls)

A

HPV 6, 11, 16, 18

Kat's Pathology (105 decks)

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