Neonatal and childhood infections

Question 1

list possible vertically acquired/congenital infections?

Answer 1

Hep B
HIV
Syphilis

CMV
Toxoplasmosis
Hep C
Group B Streptococcus
Rubella

Question 2

which congenital infections do we screen for in uk?

Answer 2

Hep B
HIV
Syphilis

Question 3

mmemonic for screen done in an ill neonate?

what does it stand for?

Answer 3

TORCH’ screen :

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

Question 4

what are the 2 outcomes of congenital toxoplasmosis?

Answer 4

60% Asymptomatic at birth -
may still go on to suffer long term sequelae

40% symptomatic at birth -
mainly CNS symptoms

Question 5

what is the classic triad of symptoms present in symptomatic congenital toxoplasmosis?

Answer 5

Choroidoretinitis
Intracranial calcifications
Hydrocephalus

Question 6

list the long term sequelae possible in asymptomatic congenital syphilis?

Answer 6

Deafness, low IQ, microcephaly

Question 7

there are many symptoms in Congenital rubella syndrome but what is the classic triad?

Answer 7

Cardiac anomalies - Patent ductus arteriosus (PDA)
Cataracts
Deafness

Question 8

characterise the rash present in Congenital rubella syndrome?

Answer 8

+- blueberry muffin rash ; purpura

-> they have a specific look to them - see pix

Question 9

seizures are present in which congenital infection?

Answer 9

congenital toxoplasmosis

Question 10

when is Chlamydia trachomatis Infection transmitted ?

Answer 10

during delivery

Question 11

which congenital infection causes neonatal conjunctivitis, or rarely pneumonia?

Answer 11

chlamydia

Question 12

what is the neonate period?

Answer 12

First 4-6 weeks of life: after birth

Question 13

why are premature babies at increased risk of infection?

Answer 13

Less maternal IgG
Exposure to microorganisms; colonisation and infection

• Need NICU care

Question 14

define early onset infection ini neonates and list some causative organisms?

Answer 14

Early onset – usually within 48 hours of birth

Organisms:
Group B streptococci
E. coli
Listeria monocytogenes

Question 15

what Is the catalase Test?

meaning of results?

Answer 15

The catalase test is used to differentiate staphylococci (catalase-positive) from streptococci (catalase-negative).

Question 16

what is the Most common cause of neonatal sepsis?

what organism is 2nd?

Answer 16

1. GBS

2. e.coli

Question 17

LIST 3 consequences of GBS infection in neonates?

Answer 17

Bacteraemia
Meningitis
Disseminated infection e.g. joint infections

Question 18

LIST 3 consequences of E.coli infection in neonates?

Answer 18

Bacteraemia
Meningitis
UTI

Question 19

List Maternal risk factors for Early onset sepsis-risk ?

Answer 19

PROM/prem. Labour
Fever
Foetal distress
Meconium staining - fetal stool in amniotic fluids
Previous history

Question 20

List neonatal risk factors for Early onset sepsis-risk ?

Answer 20

Resp. distress
Low BP
Acidosis
Hypoglycaemia
Neutropenia

Question 21

some ivx for Early onset sepsis in babies?

Answer 21

Full blood count
C-reactive protein (CRP)
Blood culture

Deep ear swab
Lumbar puncture (CSF)

Question 22

how to Early onset manage sepsis in neonate?

Answer 22

give abc at slightest sign of infection

Ventilation
Circulation
Nutrition
Antibiotics: e.g. benzylpenicillin & gentamicin

Question 23

define Late onset sepsis ?

Answer 23

after 48-72 hours

Question 24

Late onset sepsis is most commonly caused by which organism?

Answer 24

Coagulase negative Staphylococci (CoNS) e.g:

staph saprophyticus

Question 25

list some features of late onset sepsis ?

Answer 25

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.s

Question 26

which abx to use in early onset sepsis?

Answer 26

depends but i.e.: benzylpenicillin & gentamicin

Question 27

which abx to use in Late onset sepsis?

1st and 2nd line?

Answer 27

example:

1st line: cefotaxime & vancomycin
2nd line: meropenem

Question 28

which infection is common after VZV infection in kids?

Answer 28

iGAS disease - invasive group A strep

can lead to toxic shock syndrome

Question 29

what is the Most important bacterial cause of paediatric morbidity and mortality?

Answer 29

meningitis

Question 30

what is the diagnostic work up for meningitis?

Answer 30

1. Clinical features

2.Lab tests:
Blood cultures
Throat swab
LP for CSF if possible

Rapid antigen screen
EDTA blood for PCR

Question 31

what is next line if there is no growth on csf in meningitis?

Answer 31

If no growth PCR may be positive

Question 32

which capsular groups cause most disease in meningococcal disease?

Answer 32

B - (MenB)

then W

Question 33

LIST 3 consequences of strep pneumonia infection in neonates?

Answer 33

Meningitis, bacteraemia, pneumonia

Question 34

what happened with the prevent pneumococcal vaccine in uk?

Answer 34

Prevenar responsible for approx 80% of IPD in the UK in 2006

invasive pneumococcal disease

Question 35

which vaccine has replaced prevent?

Answer 35

PCV7:

Pneumococcal conjugative vaccines

Question 36

after 3months of age, which organisms are kids at LESS risk of obtaining meningitis from unlike the first 3 months?

Answer 36

H. influenzae (Hib) if unvaccinated);
GBS;
E. coli;
Listeria sp.

Question 37

leading cause of Respiratory tract infections in:

1. under 4s?
2. over 4s?

Answer 37

under 4: S. pneumoniae (pneumococcus)
- penicillins for treatment

over 4s: mycoplasma pneumonia

Question 38

Fever
Headache
Myalgia
Pharyngitis
Dry cough

this is the classic presentation of?

Answer 38

mycoplasma pneumonia

• similar to Fever in RT apart from the cough

Question 39

list some Extrapulmonary manifestations of mycoplasma pneumonia?

Answer 39

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

Neurological (1% cases) - Encephalitis most common

Cardiac
Polyarthralgia, myalgia, arthritis
Otitis media and bullous myringitis

Question 40

criteria for diagnosis of uti in kiddos?

Answer 40

Symptoms – if child old enough to give clear history
Pure growth >105cfu/ml
Pyuria – pus cells on urine microscopy