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Microbiology - Path > Neonatal infections > Flashcards

Neonatal infections Flashcards

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1
Q

Define congenital infection

A

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

Congenital infections can occur anytime during pregnancy and birth

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2
Q

What congenital infections are mothers screened for at the moment?

A

–Hep B

–HIV

–Rubella

–Syphilis

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3
Q

What is the TORCH screen?

A

–Toxoplasmosis

–Other – syphilis; HIV; hepatitis B/C

–Rubella

–Cytomegalovirus (CMV)

–Herpes simplex virus (HSV)

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4
Q

What are some common clinical features of congenital infections?

A

•Common clinical features

–Mild/no apparent maternal infection

–Wide range of severity in the baby

–Similar clinical presentation

–Serological diagnosis

–Long term sequelae if untreated

•Examples

–Low platelets, rash

–Cerebral abnormalities

–Hepatosplenomegaly/hepatitis/jaundice

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5
Q

Describe congenital toxoplasmosis

  1. Symptoms at birth
  2. Long term side effects
A
  1. May be asymptomatic at birth

40% symptomatic at birth:

  • Choroidoretinitis
  • Microcephaly/hydrocephalus
  • Intracranial calcifications
  • Seizures
  • Hepatosplenomegaly/jaundice
  1. Long term side effects:
  • Deafness
  • Low IQ
  • Microcephaly
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6
Q

Describe the effects of congenital rubella syndrome on the following organs:

  • Fetus
  • Eyes
  • CV system
  • Ears
  • Brain
  • Other
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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7
Q

What does this baby have?

A

Herpes simplex virus (HSV)

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8
Q

Name some congenital infections

A
  • Hepatitis B and C
  • HIV
  • Listeria monocytogenes
  • Group B Streptococcus
  • Syphilis
  • Chlamydia trachomatis

–Infection transmitted during delivery

–Mother may be asymptomatic

–Causes neonatal conjunctivitis, or rarely pneumonia

–Treated with erythromycin

•Mycoplasma species

–Mycoplasma hominis and Ureaplasma urealyticum

•Parvovirus

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9
Q

Define the neonatal period

A
  • Definition when born at FGA is the first 4-6 weeks of life
  • If born early (premature) neonatal period longer and is adjusted for expected birth date
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10
Q

Describe neonatal infections

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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11
Q
  • Why are neonates at higher risk of infections?
  • Why are premature infants at higher risk of infections?
A
  • Immature host defences
  • Increased risk with increased prematurity
  • Less maternal IgG
  • NICU care
  • Exposure to microorganisms; colonisation and infection
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12
Q

What are some common neonatal infections?

A
  • Early and late onset infection
  • Early onset – usually within 48 hours of birth

–Some definitions 3-5 days

•Organisms

  • Group B streptococci
  • E. coli
  • Listeria monocytogenes
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13
Q
  1. Describe group B streptococci
  2. What does it cause in neonates?
A

1.

  • Gram positive coccus
  • Catalase negative
  • Beta-haemolytic
  • Lancefield Group B
  1. In neonates:
  • Bacteraemia
  • Meningitis
  • Disseminated infection e.g. joint infections
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14
Q
  1. Describe E.coli
  2. What does it cause in neonates?
A
  1. Gram negative rod
  2. In neonates:
  • Bacteraemia
  • Meningitis
  • UTI
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15
Q

What are some early onset sepsis risk factors for

  1. Maternal?
  2. Baby?
A

1.Maternal

  • PROM/prem. Labour
  • Fever
  • Foetal distress
  • Meconium staining
  • Previous history
  1. Baby
  • Birth asphyxia
  • Resp. distress
  • Low BP
  • Acidosis
  • Hypoglycaemia
  • Neutropenia
  • Rash
  • Hepatosplenomegaly
  • Jaundice
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16
Q

What investigations can be done to check for early onset sepsis?

A
  • Full blood count
  • C-reactive protein (CRP)
  • Blood culture
  • Deep ear swab
  • Lumbar puncture (CSF)
  • Surface swabs
  • Chest X-ray (full body)
17
Q

What is the management for early onset neonatal sepsis?

A

Supportive management:

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

Neonatal infection (early onset): antibiotics for prevention and treatment

18
Q
  1. Define late onset sepsis
  2. What organisms cause late onset sepsis?
A
  1. Late onset sepsis - after 48-72 hours
  2. Organisms that can cause 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
19
Q

What are the clinical features of late onset sepsis?

A
  • 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.
20
Q

What investigations should be done for late onset sepsis?

A
  • FBC
  • CRP
  • Blood culture(s)
  • Urine
  • ET secretions if ventilated
  • Swabs from any infected sites
21
Q

What is the treatment for late onset sepsis in neonates?

A
  • 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
22
Q

Name some common viral infections in childhood

A
  • 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 (invasive group A streptoccocus) post VSV infection

23
Q

What investigations should be done for a child with a suspected infection?

A
  • FBC
  • CRP
  • Blood cultures
  • Urine
  • +/- Sputum; throat swabs etc
24
Q

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

A

Meningitis

25
Q

What are the clinical features of meningitis in a child?

A
  • Macular papular rash
  • Fever
  • Lethargy
  • Change in level of consciousness
  • headache
26
Q

What lab tests should be done if meningitis is suspected?

A

–Blood cultures

–Throat swab

–LP for CSF if possible

–Rapid antigen screen

–EDTA blood for PCR

–Clotted serum for serology if needed later

27
Q

Describe what happens to the following in CSF when it is normal, and when there is a bacterial, viral and fungal/TB infection

  • Pressure
  • Appearance
  • Protein (g/L)
  • Glucose (mmol/L)
  • Gram stain
  • Glucose-CSF:Serum ratio
  • WCC
  • Other
A
28
Q

What infection an neisseria meningitidis cause?

A

Meningitis or meningococcal septicaemia

29
Q

Describe what streptococcus pneumoniae is, and what it can cause

A
  • Leading cause of morbidity and mortality esp. in < 2y.o.
  • Gram positive diplococcus – alpha haemolytic streptococcus
  • Meningitis, bacteraemia, pneumonia
  • >90 capsular serotypes
  • Increasing penicillin resistance
  • Therefore the pneumoccocal conjugative vaccine have been introduced - Prevnar 13 - against 13 serotypes
30
Q

What bacteria cause meningitis in the following age groups (most likely)

  1. <3 months
  2. 3months-5 years
  3. >6 years
A
  1. <3/12: N. meningitidis; S. pneumoniae; (H. influenzae (Hib) if unvaccinated); GBS; E. coli; Listeria sp.
  2. 3/12 - 5 years:N. meningitidis; S. pneumoniae; (Hib if unvaccinated)
  3. >6 years: N. meningitidis; S. pneumoniae
31
Q

Describe respiratory tract infections in children

A
  • 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
32
Q
  1. Which is the most important cause of a respiratory tract infection?
  2. Which bacteria tends to affect older children? Treatment of choice for this?
A
  • 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
33
Q
  1. How is mycoplasma pneumoniae transmitted?
  2. What is the clinical presentation?
A
  1. 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
  1. Many asymptomatic

Classically presents:

  • Fever
  • Headache
  • Myalgia
  • Pharyngitis
  • Dry cough
34
Q

What are some extrapulmonary manifestations of an infection with mycoplasma pneumoniae?

A

•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
35
Q

Describe the epidemiology, symptoms, signs and investigations for a UTI

A
  • Common
  • Up to 3% girls and 1% boys by age 11
  • 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

36
Q

What is the most common cause of a UTI? What are other causes?

A
  1. E.coli
  2. Other coliforms e.g. Proteus species, Klebsiella enterococcus so. - Coagulase negative staphylococcus - staph saprophyticus
37
Q

What is the best management for UTIs?

A
  • Early diagnosis and antibiotic treatment important
  • Renal tract imaging
  • Antibiotic prophylaxis after treatment of the infection (NICE guidance)
38
Q

If there is a recurrent or persistent infection in a child, what should be considered?

A
  • May be a sign of immunodeficiency – either congenital or acquired – e.g. HIV, SCID
  • Warrants investigation by Paediatric Infectious Diseases doctors
39
Q

Describe the normal routine immunisation schedule for children in the UK

A

Microbiology - Path (12 decks)

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