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Paeds > Paed Infection > Flashcards

Paed Infection Flashcards

1
Q

Definition of paed sepsis

A

SIRS + suspected / proven infection

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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
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3
Q

What is bacteraemia?

A

Bacteria multiplying in the blood stream

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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
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5
Q

What does ARDS stand for?

A

Acute respiratory response syndrome

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6
Q

What is ARDS?

A

Inflammatory response of the lungs

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7
Q

Which gender gets sepsis more?

A

B > G

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8
Q

Responsible pathogens for paed meningitis in neonates < 1 month

A

Group B streptococci
E coli
Listeria monocytogenes

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9
Q

Responsible pathogens for paeds meningitis in children

A

Streptococcus pneumoniae
Meningococci
Haemophilus influenzae

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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'
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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
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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
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13
Q

What is streptococcus pneumoniae?

A

Gram +ve duplo-cocci

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14
Q

Where does strep pneumoniae colonise?

A

upper airways

  • 5-10% adults
  • 20-40% children
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15
Q

How is strep pneumoniae transmitted?

A

Droplets

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16
Q

What are predisposing factors for invasive disease in step pneumoniae?

A

Viral infections

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17
Q

Complications of pneumococcal meningitis

A

Brain damage
Hearing loss
Hydrocephalus

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18
Q

Where can pneumococcal disease colonised / invade and cause?

A 
Otitis media
Sinusitis
Meningitis 
Septicaemia 
Arthritis / osteomyelitis 
Peritonitis
Empyema 
Pneumonia
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19
Q

What is haemophilus influenzae B?

A

Gram - ve bacterium

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20
Q

What can haem influenza B cause?

A

Bacteraemia
Meningitis (as severe as pneumococcal meningitis)
Pneumonia
Epiglottitis

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21
Q

What are predisposing factors for disease in haemophilus influenzae type B?

A

Viral infections

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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
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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
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24
Q

Virulence factor of meningococcal disease

A

Endotoxin = lipooligosaccharide

Associated endotoxin levels and mortality

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25
Q

Features of streptococci

A

Gram +ve cocci
Penicillin
No resistance issues

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26
Q

Features of staphylococci

A 
Gram +ve cocci 
Flucloxacillin (= synthetic penicillin resistant to B-lactamases)
Resistance big issue 
MRSA
carriers
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27
Q

Causative organisms of scarlatina (scarlet fever)

A

Reaction to toxins produced by Group A B-haemolytic streptococci
exclusively STREP PYOGENES

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28
Q

Presentation of scarlet fever

A 
Malaise
Fever 
Tonsilitis 
then start exanthema 
STRAWBERRY RED TONGUE 
Squamation (hands and feet)
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29
Q

Incubation of scarlet fever

A

2-4 days

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30
Q

Who is protected from scarlet fever?

A

< 2 y/o relatively protected

> 10 y / o natural protection in 80%

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31
Q

Virulence factors of scarlet fever

A

M protein

Exotoxins

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32
Q

Complications of scarlet fever

A 
Erysipelas 
Cellulitis 
Impetigo 
Streptococcal toxic shock 
Rheumatic fever 0.3-3%
Glomerulonephritis
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33
Q

Treatment of scarlet fever

A

Penicillin 10 days

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34
Q

Causative organisms of impetigo

A

S pyogenes

S aureus

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35
Q

Presentation of impetigo

A

highly contagious
sores and blisters
no systemic symptoms
yellow brown crustae

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36
Q

Causative organisms of SSSS

A

Exotoxins of S aureus

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37
Q

Who does SSSS usually affect?

A

< 5 y/o

particularly in newborns

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38
Q

Presentation of SSSS

A 
Fever
widespread
redness
fluid filled blisters
rupture easily, especially the skin folds
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39
Q

Presentation of Kawasaki disease

A 
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
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40
Q

What is Kawasaki disease?

A

Self limited vasculitis of medium sized arteries

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41
Q

Who gets Kawasaki disease?

A

All racial and ethnic groups
highest prevalence in japan and Hawaii
increased risk in siblings and twins

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42
Q

Treatment of Kawasaki disease

A

To prevent complications like vasculitis coronary arteries

  • immunoglobulins
  • aspirin
  • other immunosuppressive agents
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43
Q

What conditions are a persistent fever and rash associated with?

A

Infection
Henoch-shonlein purpura
Vasculitis (skin, kidneys, more rare GI tract)
Assosiated with previous aspecific viral illness

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44
Q

What causes erythematous and maculopapulous vesicular rashes and fever?

A 
Measles
Rubella 
Enterovirus 
Cytomegalovirus 
Human Herpes virus 6 + 7 
Parovirus B19
EBV
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45
Q

What causes a vesiculobullous vesicular rash and fever?

A

VZV
HSV
Enteroviruses

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46
Q

What causes petechial and purpuric vesicular rashes and fever?

A

Rubella (congenital)
enterovirus
CMV (congenital)

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47
Q

Types of varicella zoster virus infections

A 
Primary infection 
- varicella
- chickenpox
Recurrent infection 
- zoster
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48
Q

Incubation period of VZV

A

14 (10-21) days

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49
Q

Presentation of VZV

A 
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
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50
Q

Complications of VZV

A

secondary strep/staph infections skin (10-15%) (NSAIDs increase risk)
Meningoencephalitis
Cerebellitis
Arthritis

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51
Q

Treatment of VZV

A

Aciclovir

- indications

52
Q

Prevention of VZV

A

Vaccination (active/passive)
Varicella zoster immunoglobulin for
- newborns peripartum exposure
- immunocompromised patients

53
Q

Severe complications of VZV

A

Death

T cell deficiencies

54
Q

Warning signs of severe VZV

A

high fever
new lesions > day 10
inflamed lesions
general malaise

55
Q

What is HSV caused by?

A

HS1 - oral

HS2 - genital

56
Q

Presentation of HSV

A

Stomatitis (primary infection)

Recurrent cold sores

57
Q

Complications of HSV

A

Kerato conjunctivitis
Encephalitis
Systemic neonatal infections
immunocompromised children

58
Q

treatment of HSV

A

Self limiting acyclovir

59
Q

How do neonates catch HSV?

A

Birth canal

Direct contact

60
Q

When does HSV appear in neonates?

A

Day 4 - 21 of life

61
Q

Presentation of HSV in neonates

A 
70-80% disseminated/ CNS infections
- sepsis
- meningoencephalitis 
- hepatitis (jaundice, bleeding)
20-30% skin / eye / mouth (SEM disease)
High mortality
62
Q

Causative organisms of hand-foot-mouth disease

A

Enterovirus 71

Coxsackie A16

63
Q

Incubation of hand foot mouth disease

A

3 - 6 days

64
Q

Who gets hand foot mouth disease?

A

< 10 y/o

65
Q

When do you get hand foot and mouth disease?

A

Summer and early autumn

66
Q

Presentation of hand-foot-mouth disease

A 
Mild systemic upset
- sore throat 
- fever 
Exanthema and enanthema 
Painful lesions 
Vesicles in mouth and on palms of soles and feet
67
Q

How long does recovery take in hand foot mouth disease?

A

5 - 10 days

68
Q

Presentation of mild enteroviral disease

A 
Fever +/- rash 
Hand, foot and mouth disease
Herpangina
Pleurodynia 
Pharyngitis 
Conjunctivis 
Croup
69
Q

Presentation of potentially severe enteroviral diseases

A 
Meningitis
Encephalitis 
Acute paralysis 
Neonatal sepsis 
Myocarditis/pericarditis 
Hepatitis
Chronic infection in immunocompromised patients
70
Q

Investigations of vesicular rashes

A 
Clinical 
Smear of vesicle (ulcer base) 
- Tznack test; no differentiation HSV/VZV
PCR (fluids, CSF, blood)
Serology (past infections only)
71
Q

What infections cause vesicular rashes?

A

Varicella zoster
Herpes simplex
Enterovirusess

72
Q

What does Kawasaki disease need to be differentiated from?

A

S pygoenes infections

73
Q

What are primary immunodeficiencies?

A

Rare, chronic disorders in which part of the bodys immune system is missing or functions improperly

74
Q

What are primary immunodeficiencies caused by?

A

Single gene defects

75
Q

What are secondary immunodeficiencies?

A

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
Q

Examples of causes of secondary immunodeficiencies

A

HIV infection

Patients treated for malignancies

77
Q

Types of primary immunodeficiencies

A

Antibody deficiencies
Cellular immunodeficiencies
Innate Immune disorders

78
Q

What are antibody deficiencies characterised by?

A

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
Q

What are cellular immunodeficiencies characterised by?

A

Impaired T cell function or the absence of normal T cells
Unusual or opportunistic infections often combined with failure to thrive
Pneumocytic jirovecci

80
Q

Features of innate immune disorders

A 
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
Q

Signs of primary immunodeficiencies vs just an infection

A

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
Q

Investigations of a membrane attack complex

A

Measurement of complement activation and/or individual factors

83
Q

Presenting Symptoms of paediatric HIV/AIDs

A 
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
Q

Genetics of chronic granulomatous disease

A

65% X linked

35% autosomal recessive

85
Q

Presentation of chronic granulomatous disease

A

Life threatening recurrent severe bacterial and fungal infections
Life time incidence of invasive aspergillosis 25-40% and main cause of death 35%

86
Q

Curative option of chronic granulomatous disease

A

HSCT

87
Q

Investigation of chronic granulomatous disease

A

DHR test

88
Q

What is the presenting symptom of primary immunodeficiency?

A

Invasive fungal infections

89
Q

Who are invasive fungal infections seen in?

A

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
Q

What type of fungi is candida?

A

Endogenous

91
Q

How do you catch candida?

A

Birth canal

Hands of health care workers

92
Q

What can candida cause?

A

Candidaemia

93
Q

What type of fungi is aspergillus?

A

Exogenous

94
Q

How do you catch aspergillus?

A

Air
Water
Environment

95
Q

Blood cultures candida vs aspergillus

A 
Candida = positive
Aspergillus = negative
96
Q

What birth weight is most common for neonatal candidemia?

A

< 750g

97
Q

Mortality of neonatal candidaemia

A

20-40%

98
Q

Presentation of neonatal candidaemia

A

Sepsis syndrome
2/3rd week of life
Thrombocytopenia
Hyperglycaemia

99
Q

Risk factors for neonatal candidemia

A 
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
Q

Features of the rash in scarlet fever

A

Fine punctuate erythema SPARING AREA AROUND THE MOUTH

101
Q

What Is the rash in scarlet fever which is sparing around the mouth called?

A

Circumoral pallor

102
Q

What is another name for slap cheek?

A

Erythema infectiosum

103
Q

What causes slap cheek?

A

Parovirus B19

104
Q

Presentation of slap cheek

A 
Lethargy 
Fever
Headache
Rash 
- "slapped cheek rash"
- spreading to proximal arms and extensor surfaces
105
Q

Presentation of mumps

A

Fever
Malaise
Muscular pain
Parotitis unilateral then turning bilateral in 70%

106
Q

Presentation of parotitis

A

Earache

Pain on eating

107
Q

Presentation of measles

A 
Prodrome
- irritable
- conjunctivits
- fever
Koplik spots
Rash
108
Q

What are kolpik spots?

A

White spots on buccal mucosa

109
Q

Rash in measles

A

Starts behind ears
Then whole body
Discrete maculopapular rash becoming blotchy and confluent

110
Q

When is GBS a problem in patients?

A

Pregnant women (can spread to baby)
Young babies
Elderly

111
Q

What does GBS stand for?

A

Group B strep

112
Q

Where is GBS found in normal healthy people?

A

Vagina

Rectum

113
Q

If in GP practice and suspect meningitis, what can be given?

A

IM BenPen

114
Q

What can be given in strep pneumoniae meningitis?

A

Dexamethasone

115
Q

What triggers the rash once its gone in slap cheek?

A

Warm bath
Sunlight
Heat
Fever

116
Q

Complication of slap cheek in pregnant women

A

Hydrops fetalis

117
Q

What is scarlet fever characterised by?

A

Sandpaper rash

118
Q

What causes roseola infantum?

A

Herpes virus 6

119
Q

Incubation of roseola infantum

A

5 - 15 days

120
Q

What age of child is affected by roseola infantum?

A

6 months - 2 years

121
Q

Presentation of roseola infantum

A

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
Q

Other possible consequences of roseola infantum

A

Aseptic meningitis

Hepatitis

123
Q

Is school exclusion needed for roseola infantum?

A

No

124
Q

What is the most common cause of anal itching in children?

A

Threadworms

125
Q

Treatment of meningitis in children < 3 months

A

IV cefoxamine
AND
IV amoxicillin to cover listeria

126
Q

What infection has the prodrome of fever, irritability and conjunctivitis?

A

Measles

Paeds (28 decks)

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