Paed Infection Flashcards
1
Q
Definition of paed sepsis
A
SIRS + suspected / proven infection
2
Q
Symptoms of paed sepsis
A
Fever or hypothermia Cold hands / feet mottled Prolonged cap refill time Chills / rigors Limb pain Vomiting Diarrhoea Muscle weakness Muscle / joint aches Skin rash Diminished urine output Tachycardia Tachypnoea Leucocytosis or leukocytopenia
3
Q
What is bacteraemia?
A
Bacteria multiplying in the blood stream
4
Q
Definition of paed severe sepsis
A
SEPSIS + multi organ failure + 2 of the following - resp failure - renal failure - neurological failure - haematological failure - liver failure ARDS Septic shock
5
Q
What does ARDS stand for?
A
Acute respiratory response syndrome
6
Q
What is ARDS?
A
Inflammatory response of the lungs
7
Q
Which gender gets sepsis more?
A
B > G
8
Q
Responsible pathogens for paed meningitis in neonates < 1 month
A
Group B streptococci
E coli
Listeria monocytogenes
9
Q
Responsible pathogens for paeds meningitis in children
A
Streptococcus pneumoniae
Meningococci
Haemophilus influenzae
10
Q
Meningitis +/- sepsis symptoms in children / neonates
A
nuchal rigidity headaches photophobia diminished consciousness focal neurological abnormalities Seizures In neonates - lethargy - irritability - bulging fontanelle - 'nappy pain'
11
Q
Treatment for paeds meningitis +/- sepsis
A
Supportive ABCD Causative treatment - Ax with good penetration in CSF and broad spec - 3rd gen cefalosporins (amoxicilline if neonates) Chemoprophylaxis - close household contacts - meningococcus B and strep B
12
Q
Investigations of paed meningitis + / - sepsis
A
Bloods - FBC, leucocytosis, thrombocytopenia - CPR ; elevated - blood gas; metabolic acidosis - glucose; hypoglycaemia CSF - pleocytosis, increased protein level, low glucose Blood and CSF cultures (antigen testing, PCR) Urine culture, skin biopsy culture Imaging - CT cerebellum
13
Q
What is streptococcus pneumoniae?
A
Gram +ve duplo-cocci
14
Q
Where does strep pneumoniae colonise?
A
upper airways
- 5-10% adults
- 20-40% children
15
Q
How is strep pneumoniae transmitted?
A
Droplets
16
Q
What are predisposing factors for invasive disease in step pneumoniae?
A
Viral infections
17
Q
Complications of pneumococcal meningitis
A
Brain damage
Hearing loss
Hydrocephalus
18
Q
Where can pneumococcal disease colonised / invade and cause?
A
Otitis media Sinusitis Meningitis Septicaemia Arthritis / osteomyelitis Peritonitis Empyema Pneumonia
19
Q
What is haemophilus influenzae B?
A
Gram - ve bacterium
20
Q
What can haem influenza B cause?
A
Bacteraemia
Meningitis (as severe as pneumococcal meningitis)
Pneumonia
Epiglottitis
21
Q
What are predisposing factors for disease in haemophilus influenzae type B?
A
Viral infections
22
Q
How does meningococcal disease spread through the body?
A
meningococcus in nasopharynx passage through the epithelia Meningococcus in blood stream - < 12 hours signs of septic shock - < 18-36 hours signs on meningitis
23
Q
Prognosis of meningococcal disease
A
Case fatality rate 5-15% 50% of deaths in first 12 hours, 80% within 48 hours Long term morbidity in the significant proportion of survivors - amputation (14%) - skin scarring (48%) - cognitive impairment - epilepsy - hearing loss
24
Q
Virulence factor of meningococcal disease
A
Endotoxin = lipooligosaccharide
Associated endotoxin levels and mortality
25
Features of streptococci
Gram +ve cocci
Penicillin
No resistance issues
26
Features of staphylococci
```
Gram +ve cocci
Flucloxacillin (= synthetic penicillin resistant to B-lactamases)
Resistance big issue
MRSA
carriers
```
27
Causative organisms of scarlatina (scarlet fever)
Reaction to toxins produced by Group A B-haemolytic streptococci
exclusively STREP PYOGENES
28
Presentation of scarlet fever
```
Malaise
Fever
Tonsilitis
then start exanthema
STRAWBERRY RED TONGUE
Squamation (hands and feet)
```
29
Incubation of scarlet fever
2-4 days
30
Who is protected from scarlet fever?
< 2 y/o relatively protected
| > 10 y / o natural protection in 80%
31
Virulence factors of scarlet fever
M protein
| Exotoxins
32
Complications of scarlet fever
```
Erysipelas
Cellulitis
Impetigo
Streptococcal toxic shock
Rheumatic fever 0.3-3%
Glomerulonephritis
```
33
Treatment of scarlet fever
Penicillin 10 days
34
Causative organisms of impetigo
S pyogenes
| S aureus
35
Presentation of impetigo
highly contagious
sores and blisters
no systemic symptoms
yellow brown crustae
36
Causative organisms of SSSS
Exotoxins of S aureus
37
Who does SSSS usually affect?
< 5 y/o
| particularly in newborns
38
Presentation of SSSS
```
Fever
widespread
redness
fluid filled blisters
rupture easily, especially the skin folds
```
39
Presentation of Kawasaki disease
```
Fever for at least 5 days
4 / 5 of....
- bilateral conjunctival injection
- changes of the mucous membranes
- cervical lymphadenopathy
- polymorphous rash
- changes of the extremities
Peripheral oedema
Peripheral erythema
Periungual desquamation
```
40
What is Kawasaki disease?
Self limited vasculitis of medium sized arteries
41
Who gets Kawasaki disease?
All racial and ethnic groups
highest prevalence in japan and Hawaii
increased risk in siblings and twins
42
Treatment of Kawasaki disease
To prevent complications like vasculitis coronary arteries
- immunoglobulins
- aspirin
- other immunosuppressive agents
43
What conditions are a persistent fever and rash associated with?
Infection
Henoch-shonlein purpura
Vasculitis (skin, kidneys, more rare GI tract)
Assosiated with previous aspecific viral illness
44
What causes erythematous and maculopapulous vesicular rashes and fever?
```
Measles
Rubella
Enterovirus
Cytomegalovirus
Human Herpes virus 6 + 7
Parovirus B19
EBV
```
45
What causes a vesiculobullous vesicular rash and fever?
VZV
HSV
Enteroviruses
46
What causes petechial and purpuric vesicular rashes and fever?
Rubella (congenital)
enterovirus
CMV (congenital)
47
Types of varicella zoster virus infections
```
Primary infection
- varicella
- chickenpox
Recurrent infection
- zoster
```
48
Incubation period of VZV
14 (10-21) days
49
Presentation of VZV
```
Mild malaise and fever initially
Kids are NOT sick
Exanthema
- papules -> vesicles -> pustules -> crustae -> scarring -> new lesions during 5-7 days
Rash starts on trunk and scalp
itching
```
50
Complications of VZV
secondary strep/staph infections skin (10-15%) (NSAIDs increase risk)
Meningoencephalitis
Cerebellitis
Arthritis
51
Treatment of VZV
Aciclovir
| - indications
52
Prevention of VZV
Vaccination (active/passive)
Varicella zoster immunoglobulin for
- newborns peripartum exposure
- immunocompromised patients
53
Severe complications of VZV
Death
| T cell deficiencies
54
Warning signs of severe VZV
high fever
new lesions > day 10
inflamed lesions
general malaise
55
What is HSV caused by?
HS1 - oral
| HS2 - genital
56
Presentation of HSV
Stomatitis (primary infection)
| Recurrent cold sores
57
Complications of HSV
Kerato conjunctivitis
Encephalitis
Systemic neonatal infections
immunocompromised children
58
treatment of HSV
Self limiting acyclovir
59
How do neonates catch HSV?
Birth canal
| Direct contact
60
When does HSV appear in neonates?
Day 4 - 21 of life
61
Presentation of HSV in neonates
```
70-80% disseminated/ CNS infections
- sepsis
- meningoencephalitis
- hepatitis (jaundice, bleeding)
20-30% skin / eye / mouth (SEM disease)
High mortality
```
62
Causative organisms of hand-foot-mouth disease
Enterovirus 71
| Coxsackie A16
63
Incubation of hand foot mouth disease
3 - 6 days
64
Who gets hand foot mouth disease?
< 10 y/o
65
When do you get hand foot and mouth disease?
Summer and early autumn
66
Presentation of hand-foot-mouth disease
```
Mild systemic upset
- sore throat
- fever
Exanthema and enanthema
Painful lesions
Vesicles in mouth and on palms of soles and feet
```
67
How long does recovery take in hand foot mouth disease?
5 - 10 days
68
Presentation of mild enteroviral disease
```
Fever +/- rash
Hand, foot and mouth disease
Herpangina
Pleurodynia
Pharyngitis
Conjunctivis
Croup
```
69
Presentation of potentially severe enteroviral diseases
```
Meningitis
Encephalitis
Acute paralysis
Neonatal sepsis
Myocarditis/pericarditis
Hepatitis
Chronic infection in immunocompromised patients
```
70
Investigations of vesicular rashes
```
Clinical
Smear of vesicle (ulcer base)
- Tznack test; no differentiation HSV/VZV
PCR (fluids, CSF, blood)
Serology (past infections only)
```
71
What infections cause vesicular rashes?
Varicella zoster
Herpes simplex
Enterovirusess
72
What does Kawasaki disease need to be differentiated from?
S pygoenes infections
73
What are primary immunodeficiencies?
Rare, chronic disorders in which part of the bodys immune system is missing or functions improperly
74
What are primary immunodeficiencies caused by?
Single gene defects
75
What are secondary immunodeficiencies?
Components of the immune system are all present and functional, but acquired diseases affecting the immune system and/or treatment negatively influencing the immune system
76
Examples of causes of secondary immunodeficiencies
HIV infection
| Patients treated for malignancies
77
Types of primary immunodeficiencies
Antibody deficiencies
Cellular immunodeficiencies
Innate Immune disorders
78
What are antibody deficiencies characterised by?
Deficiency of one or more (sub)classes of antibodies (e.g. IgA, IgG, IgM) due to defective B-function
Absence of mature B cells
Recurrent bacterial infections of the upper and/or lower resp tract
S pneumoniae, H influenzae
79
What are cellular immunodeficiencies characterised by?
Impaired T cell function or the absence of normal T cells
Unusual or opportunistic infections often combined with failure to thrive
Pneumocytic jirovecci
80
Features of innate immune disorders
```
Defects in phagocyte function
Complement deficiencies
Absence or polymorphisms in pathogen recognition receptors
Defects in phagocyte function
- s aureus
- aspergillus
Complement deficiencies
- n meningitidis
```
81
Signs of primary immunodeficiencies vs just an infection
Severe - requires hospitalisation or IV Ax
Persistent - wont completely clear up or clears up very slowly
Unusual - caused by an uncommon organism
Runs in the family
- similar susceptibility to infection
82
Investigations of a membrane attack complex
Measurement of complement activation and/or individual factors
83
Presenting Symptoms of paediatric HIV/AIDs
```
recurrent common childhood RTIs
Persistent oral thrush
Erythematous popular rash
Generalised lymphadenopathy
Recurrent / disseminated VZV/HSV infections
Failure to thrive
Developmental delays
Oppertunistic infections ; CMV, pneumonia / retinitis
```
84
Genetics of chronic granulomatous disease
65% X linked
| 35% autosomal recessive
85
Presentation of chronic granulomatous disease
Life threatening recurrent severe bacterial and fungal infections
Life time incidence of invasive aspergillosis 25-40% and main cause of death 35%
86
Curative option of chronic granulomatous disease
HSCT
87
Investigation of chronic granulomatous disease
DHR test
88
What is the presenting symptom of primary immunodeficiency?
Invasive fungal infections
89
Who are invasive fungal infections seen in?
Children with neutropenia due to leukaemia and/or chemotherapy
Invasive candidiasis in prem neonates due to immature (but physiological) immune system
In children admitted to PICU and treated with broad spec Ax and or abdo surgery
90
What type of fungi is candida?
Endogenous
91
How do you catch candida?
Birth canal
| Hands of health care workers
92
What can candida cause?
Candidaemia
93
What type of fungi is aspergillus?
Exogenous
94
How do you catch aspergillus?
Air
Water
Environment
95
Blood cultures candida vs aspergillus
```
Candida = positive
Aspergillus = negative
```
96
What birth weight is most common for neonatal candidemia?
< 750g
97
Mortality of neonatal candidaemia
20-40%
98
Presentation of neonatal candidaemia
Sepsis syndrome
2/3rd week of life
Thrombocytopenia
Hyperglycaemia
99
Risk factors for neonatal candidemia
```
Extreme prem ( < 28 weeks)
ELBW
Immature immune system
impaired barrier function of skin and mucosa
Indwelling catheter
Broad spectrum antibiotics
Parenteral nutrition
H2 blockers
Steriods
Hyperglycaema
Abdo surgery
Multiple site candida colonisation
```
100
Features of the rash in scarlet fever
Fine punctuate erythema SPARING AREA AROUND THE MOUTH
101
What Is the rash in scarlet fever which is sparing around the mouth called?
Circumoral pallor
102
What is another name for slap cheek?
Erythema infectiosum
103
What causes slap cheek?
Parovirus B19
104
Presentation of slap cheek
```
Lethargy
Fever
Headache
Rash
- "slapped cheek rash"
- spreading to proximal arms and extensor surfaces
```
105
Presentation of mumps
Fever
Malaise
Muscular pain
Parotitis unilateral then turning bilateral in 70%
106
Presentation of parotitis
Earache
| Pain on eating
107
Presentation of measles
```
Prodrome
- irritable
- conjunctivits
- fever
Koplik spots
Rash
```
108
What are kolpik spots?
White spots on buccal mucosa
109
Rash in measles
Starts behind ears
Then whole body
Discrete maculopapular rash becoming blotchy and confluent
110
When is GBS a problem in patients?
Pregnant women (can spread to baby)
Young babies
Elderly
111
What does GBS stand for?
Group B strep
112
Where is GBS found in normal healthy people?
Vagina
| Rectum
113
If in GP practice and suspect meningitis, what can be given?
IM BenPen
114
What can be given in strep pneumoniae meningitis?
Dexamethasone
115
What triggers the rash once its gone in slap cheek?
Warm bath
Sunlight
Heat
Fever
116
Complication of slap cheek in pregnant women
Hydrops fetalis
117
What is scarlet fever characterised by?
Sandpaper rash
118
What causes roseola infantum?
Herpes virus 6
119
Incubation of roseola infantum
5 - 15 days
120
What age of child is affected by roseola infantum?
6 months - 2 years
121
Presentation of roseola infantum
High fever lasting a few days. Followed by
Maculopapular rash
Nagayama spots; popular enanthem on the uvula and soft palate
Febrile convulsions in 10 - 15%
Diarrhoea and cough are common
122
Other possible consequences of roseola infantum
Aseptic meningitis
| Hepatitis
123
Is school exclusion needed for roseola infantum?
No
124
What is the most common cause of anal itching in children?
Threadworms
125
Treatment of meningitis in children < 3 months
IV cefoxamine
AND
IV amoxicillin to cover listeria
126
What infection has the prodrome of fever, irritability and conjunctivitis?
Measles
