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Paediatrics > Paediatric Infectious Disease > Flashcards

Paediatric Infectious Disease Flashcards

1
Q

At what age are children most at risk of sepsis?

A

The younger they are the more at risk of sepsis

  • 1 in 200 children under 1yr get sepsis

Fatality rate is around 10% for children who get sepsis

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2
Q

What is sepsis?

A

it’s a systemic inflammatory response syndrome + suspected or proven infection

Sepsis = SIRS + infection

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3
Q

What are the requirements for a child to be classified as having a systemic inflammatory response syndrome (SIRS)?

A

Need to have 2 or more of:

  • Temperature: >38 or <36
  • WCC: >15x10^9/L or <5x10^9/L
  • Tachycardia > 2SD above normal for age
  • Tachpnoea > 2SD above normal for age
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4
Q

What is severe sepsis? What is septic shock?

A

Severe sepsis = sepsis + organ dysfunction

Septic shock = sepsis + CVS dysfunction

(Sepsis = SIRS + infection)

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5
Q

What are some particularly worrying signs that point towards sepsis in children?

A
  • Change in skin colour (pale / blue)
  • Low activity, not responding to social cues, crying
  • Grunting, tachypnoea, laboured breathing
  • Tachycardia, reduced cap refill, reduced skin turgor
  • High temperature, neurological signs, neck stiffness
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6
Q

What is the paediatric SEPSIS 6?

A
  • Temperature: >38 or <36
  • Inappropriate tachycardia
  • Poor peripheral perfusion
  • Altered mental state
  • Inappropriate tachypnoea
  • Hypotension
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7
Q

What are some factors that predispose infants < 3 months to infection (sepsis)?

A 
Prematurity 
Prolonged rupture of membranes 
Maternal pyrexia / chorioamnionitis 
Maternal group B strep 
Previous pregnancy / child with group B strep
Maternal STI
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8
Q

How do you treat a child with sepsis?

A
  1. Give high flow oxygen
  2. Take bloods
  3. Give IV antibiotics
  4. Consider fluid resuscitation
  5. Consider inotropic (heart contraction) support
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9
Q

What fluids do you give to a child experiencing sepsis?

A

20mL/kg of 0.9% NaCl

2mL/kg of 10% dextrose (don’t ever forget glucose)

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10
Q

What antibiotics are used to treat a child with sepsis?

A

3rd generation cephalosporin (cefotaxime)

Add IV amoxycillin if <1 month old

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11
Q

Which bloods do you want to take for a child with sepsis?

A 
FBC 
CRP
Coagulation screen (DIC)
Blood gas (metabolic acidosis, raised lactate)
Glucose 
Blood culture
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12
Q

What cultures would you do for an infant suffering from sepsis?

A

Blood

Urine

CSF

+/- stool depending on history of diarrhoea?

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13
Q

What are the main organisms causing sepsis in neonates less than one month old?

A

Group B streptococcus

E. Coli

Listeria Monocytogenes

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14
Q

What are the main organisms causing sepsis in infants older than 1 month and older children?

A

Streptococcus pneumoniae

Nisseria Meningitidis

Group A streptococcus

Staphylococcus Aureus

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15
Q

What are some of the characteristics of staphylococcus aureus?

A

Gram positive cocci

Coagulase positive (turns fibrinogen - fibrin)

Colonizes skin and mucosa

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16
Q

What are some of the characteristics of sreptococcus pyogenes?

A

Gram positive cocci

Beta haemolytic

Colonizes the oropharynx

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17
Q

what are the majority of skin and soft tissue infections caused by?

A

Staphylococci and Streptococci

Mostly staph aureus and step pyogenes

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18
Q

What is staphylococcal scalded skin syndrome? Characteristics?

A

Condition characterized by initial bullous lesions followed by widespread desquamation (loss of skin)

  • Severe widespread erythema
  • Nikolsky sign: press on what seems to be intact skin and it desquamatizes on minimal pressure
  • Mild fever
  • Purulent conjunctivitis
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19
Q

How do you treat staphyloccocal scalded skin syndrome?

A

IV antibiotics - Flucloxacillin

IV Fluids

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20
Q

What organism causes scarlet fever? How does scarlet fever tend to present?

A

Group A Strep (strep pyogenes) (toxin mediated)

At first - fever, malaise, sore throat 
Then:
- Very red "strawberry" tongue 
- Sandpaper erythematous rash 
- Rash isn't on: palms, soles of feet, around mouth
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21
Q

How is scarlet fever managed?

A

Notifiable disease - inform public health

10 day course of antibiotics: phenoxymethylpenicillin (penicillin V)

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22
Q

What are some of the complications of scarlet fever? (incidence reduced by antibiotic use)

A
  • Retropharyngeal or peritonsillar abscesses (quincy)
  • Acute rheumatic fever (most common cause of acquired heart disease in children)
  • Post-streptococcal glomerulonephritis
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23
Q

How does acute rheumatic fever present?

A
  • Occurs 2/3 weeks after pharyngitis
  • Arthritis
  • Carditis
  • Chorea (involuntary, unpredictable movements)
  • Erythema marginatum
  • Subcutaneous nodules
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24
Q

What is the causative organism for toxic shock syndrome? How severe is this condition? What is the mechanism of the condition?

A

Caused by gram positive bacteria (S aureus and group A strep)(fatality much higher with GAS)

Very severe - can rapidly progress to shock and multiorgan failure

Superantigen causes intense T cell stimulation: excessive immune activation and pro-inflammatory cytokine release

25
Q

What is group A strep?

A

Streptococcus pyogenes

26
Q

What is the initial presentation of toxic shock syndrome?

A
  • Non-purulent conjunctivitis
  • Swollen lips
  • Strawberry tongue
  • Diffuse, maculopapular “sunburn” rash
  • If S. Aureus: severe diarrhoea
27
Q

What are some signs that toxic shock syndrome is progressing?

A
  • Tachycardia
  • Prolonged Capillary refill
  • Hypotension (more rapid onset than usual)
  • Reduced GCS
  • Renal impairment
  • Transaminitis (high liver enzymes)
28
Q

Investigations for toxic shock syndrome?

A

Cultures:

  • Bloods
  • Throat swabs
  • Wounds
29
Q

Management of toxic shock syndrome (TSS)?

A
  • Give oxygen and take bloods
  • Fluid resuscitation (.9% NaCl & 10% dextrose)
  • IV antibiotics: flucloxacillin and clindamycin
  • IV immunoglobulins (IVIG)

Avoid NSAIDS (can cause necrotizing fasciitis)

30
Q

What is one very important step in the management of toxic shock syndrome?

A

Surgical debridement: if there are any areas of pus remaining there is still ongoing toxin production and inflammatory response

31
Q

What is meningitis? What is meningism?

A

Meningitis - A disease caused by the inflammation of the meninges

Meningism - the clinical signs and symptoms suggestive of meningeal irritation

32
Q

How do older children with meningitis tend to present?

A
  • Fever
  • Headache
  • Photophobia
  • Neck stiffness

Nausea and vomiting
Reduced GCS
Seizures
Focal neurological deficits

33
Q

How do young infants tend to present with meningitis?

A
  • Fever or hypothermia
  • Poor feeding & vomiting
  • Lethargy, irritability
  • Respiratory distress
  • Apnoea
  • Bulging fontanelles
34
Q

What is apnoea?

A

Temporary cessations in breathing

35
Q

What are some clinical signs of meningitis?

A
  • Neck stiffness: palpable resistance to neck flexion
  • Brudzinski’s sign: hips and knees flex on passive flexion of the neck
  • Kernig’s sign: pain on passive extension of the knee
36
Q

What is the most common cause of childhood meningitis?

A

Viral - mainly enterovirus

37
Q

What causes childhood meningitis?

A

Bacterial 4 - 18%
Viral 54 - 88%
Unknown / aseptic 40 - 76%
Fungal neonates / immunocompromised

38
Q

What organisms are responsible for causing bacterial meningitis in young infants?

A

Group B Strep (strep agalactiae)

E. Coli

Listeria monocytogenes

39
Q

What organisms are responsible for causing bacterial meningitis in older children?

A

Strep pneumoniae

Nisseria meningitidis

Haemophilus influenzae type B (Hib)

40
Q

What condition does non-encapsulated haemophilus influenzae cause commonly?

A

Otitis media

& sinusitis

41
Q

What are some characteristics of nisseria meningitidis?

A

Gram negative diplococcus

Nasopharyngeal carriage

Invasive infection often follows viral URTI

42
Q

What are some risk factors for invasive meningococcal disease?

A 
Age (< 1 year or 15-24 years)
Unimmunised 
Crowded living conditions 
Household or kissing contact 
Cigarette smoking (active or passive)
Recent viral / mycoplasma infection
Complement deficiency
43
Q

What is the cardinal sign of meningococcal meningitis?

A

Petechial and more so purpuric rash

  • Petechiae: small red / purple non-blanching spots on skin
  • purpura: bigger red / purple rashes
44
Q

How severe of a disease is invasive meningococcal disease?

A

Severe:

  • Rapidly progressive
  • Case fatality of 5-15%
  • 50% of deaths in first 12h, 80% in 48h
  • Significant long term complications: amputation (14%), scarring (48%), hearing loss, cognitive impairment / epilepsy
45
Q

What organism causes meningococcal meningitis / meningococcal disease?

A

Nisseria meningitidis

46
Q

What are the characteristics of streptococcus pneumoniae?

A

Gram positive

> 90 serotypes, all can cause invasive disease

colonizes the nasopharynx

Invasive infection commonly preceded by URTI

47
Q

Why is it hard to vaccinate against strep pneumoniae?

A

Because there are so many serotypes and as you vaccinate one a higher proportion of cases becomes composed of other serotypes

48
Q

What are some risk factors for pneumococcal disease?

A 
Age (< 2 years)
Cigarette smoking (active / passive)
Recent viral URTI 
Attendance at childcare 
Cochlear implant 
Sickle cell disease 
Asplenia (bad spleen function)
HIV infection
Nephrotic syndrome 
Immunodeficiency / immunosuppression
49
Q

Main big risk factors for bacterial meningitis?

A

preceding URTI

Age < 1 or 2

Exposure to lots of people

Cigarette smoking

50
Q

What are some common complications of pneumococcal meningitis?

A

Neurological consequences are common:

  • Hydrocephalus
  • Neurodisability
  • Seizures
  • Hearing loss
  • Blindness
51
Q

How do you treat meningitis?

A

Same as sepsis:

  • Give oxygen and take bloods
  • Fluid resuscitation (.9% Nacl & 10% dextrose)
  • Antibiotics: 3rd gen cephalosporins (cefoxatime) as well as IV amoxycillin if <1 month old)
52
Q

What are the two main investigations for meningitis in children?

A

Bloods

Lumbar puncture*** (diagnostic)

53
Q

What bloods are done for children with suspected meningitis?

A 
FBC 
U&E's / LFTs 
CRP
Coagulation screen
Blood gas 
Glucose 
Blood culture **** (ideally before antibiotics but don't delay)
Meningococcal / pneumoccocal PCR
54
Q

What are the main contraindications to lumbar puncture?

A

Signs of raised ICP:
- GCS<9, abnormal tone / posture, high BP & bradycardia, pupillary defects, papilloedema)

  • Focal neurological signs
  • Recent seizure
  • Cardiovascular instability
  • Coagulopathy
  • Thrombocytopenia
  • Extensive or extending purpura
55
Q

What do you send the CSF for once you’ve done your lumbar puncture?

A 
Microscopy
Gram stain
Culture 
Protein
Glucose 
Viral PCR ******* (most common cause of meningitis)
56
Q

What findings are expected from the CSF after a lumbar puncture if bacterial meningitis?

A

Turbid or purulent CSF appearance

High opening pressure when doing LP

High CSF WCC (neutrophils)

High Protein in CSF

Low glucose in CSF

57
Q

What findings are expected from the CSF after a lumbar puncture if viral meningitis?

A

Clear appearance

Protein mildly raised or normal

WCC very high (lymphocytes)

Glucose unchanged

58
Q

What accounts for the differences between viral and bacterial CSF findings?

A
  • Bacteria swimming in the CSF will release proteins and use up the glucose.
  • Viruses don’t use glucose but may release a small
    amount of protein.
  • The immune system releases neutrophils in response to bacteria and lymphocytes in response to viruses
59
Q

Most common causes of viral meningitis?

A

herpes simplex virus (HSV),

enterovirus

varicella zoster virus (VZV)

Paediatrics (33 decks)

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