paediatric infections Flashcards
What is sepsis
SIRS + suspected or proven infection
SIRS - systemic inflammatory response syndrome
What is severe sepsis
Sepsis + organ dysfunction
What is septic shock
Sepis + CVS dysfunction
What is required to have a diagnosis of SIRS - systemic inflammatory response syndrome
atleast 2 of the following:
- Temp >38 or <36
- WCC >15x10 to the 9 or <5x10 to the 9
- Tachycardia 2standard deviations above normal for age
- Tachypnoea 2 standard deviations above normal for age
Describe the paediatric sepsis 6
- Temp <36 or >38
- inappropriate tachycardia
- Poor perfusion(capillary refill >2s)
- altered mental state
- inappropriate tachypnoea
- hypotension
What are the risk factors for infections in children
- prematurity
- PROM - premature rupture of membranes
- Maternal group B strep
- Maternal pyrexia or chorioamnionitis during labour
What is the management of paediatric Sepsis
- High flow O2
- IV access and obtain bloods
- Give IV antibiotics: cefotoxamine and add IV amoxicillin if they are less than 1 month
- Fluid resuscitation with a fluid bolus
- DEFG - dont ever forget glucose (2ml/kg 10% dextrose)
What are the responsible organisms for sepsis in neonates under 1 month
- Group B strep
- Ecoli
- Listeria
What are the responsible organisms for sepsis in older infants and children
- Strep pneumoniae
- Neisseria meningitidis
- Group A strep
- Staph aureus
What is meningitis
A disease caused by inflammation of the meninges
What is the presentation of meningitis in older children
- Fever
- headache
- photophobia
- neck stiffness
- nausea and vomiting
- reduced GCS
- seizures
- focal neurological deficits
What is the presentation of meningitis in infants
- fever
- hypothermia
- poor feeding
- vomiting
- lethargy
- irratability
- respiratory distress
- apnoea
- Bulging fontanelle
What type of rash is associated with meningitis
Non blanching purpuric rash
What are the neurological complications which can occur after pneumococcal meningitis
- Hydrocephalus
- Neurodisability
- seizures
- hearing loss
- blindness
What is the management of meningitis
- Airway
- Breathing
- Circulation - 20ml/kg fluid bolus
- DEFG - dont ever forget glucose - 2ml/kg dextrose 10%
- Antibiotics - Ceftoxamine and add IV amoxicillin if less than 1 month old
What is used to diagnose meningitis
Lumbar puncture
When should Lumbar puncture be avoided
- Signs of raised ICP
- Focal neurological signs
- recent seizure
- Cardiovascularly unstable
What is found in lumbar puncture in bacterial meningitis
- Turbid or purulent
- High opening pressure
- Raised WCC especially polymorphs
- Raised protein
- Decreased glucose <50% serum glucose
Describe the microbiology of staphylococcus aureus
- Gram +ve cocci
- clusters
Describe the microbiology of streptococcus pyogenes
- Gram +ve cocci
- long chains
Describe the presentation of staphylococcus scalded skin syndrome
- Usually in under 5 year olds
- Initial bullous lesions followed by widespread desquamation
- Nikolsky sign - rub the skin and it peels off
- Mild fever
What is the treatment of staphyococcus scalded skin syndrome
IV flucloxacillin and IV fluids
What is the management of scarlet fever
- Inform public health
- Phenoxymethylpenicillin (penicllin V) for 10 days
What causes scarlet fever
Group A strep (strep pyogenes)
What is the presentation of scarlet fever
- 2-5 day incubation period till symptoms manifest
- fever, malaise and sore throat
- Plurulent tonsils
- strawberry tongue
- sandpaper rash - starts on head and neck and then goes to trunk and extremities - spares the skin around mouth and palms and soles
- Skin peeling (desquamation)
What is the presentation of Toxic shock syndrome
- Fever
- Diffuse maculopapular (sunburn like) rash
- swollen lips
- strawberry tongue
- profuse diarrhoea if staph aureus cause
- rapid progression to shock and multi-organ failure
What is the management of toxic shock syndrome
- ABC
- Fluid resuscitation
- Cultures
- IV antibiotics: Flucloxacillin and clindamcin
