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Paediatrics > Paediatric Infectious Diseases 1, 2 & 3 > Flashcards

Paediatric Infectious Diseases 1, 2 & 3 Flashcards

1
Q

What is the definition of paediatric sepsis?

A
  • Systemic inflammatory response syndrome

- Suspected/proven infection

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2
Q

What is severe paediatric sepsis?

A

-Sepsis + 2 or more of: resp failure, renal failure, neurological failure, haematological failure and liver failure

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3
Q

Which patient groups are more at risk of developing sepsis?

A
  • Boys > girls

- New borns are most at risk

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4
Q

Which pathogens are responsible for sepsis in neonates?

A
  • Group B strep
  • E coli
  • Listeria monocytogenes
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5
Q

Which pathogens are responsible for sepsis in children?

A
  • Strep pneumoniae
  • Meningococci
  • Group A strep
  • Staph aureus
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6
Q

How does sepsis present in children?

A
  • Fever or hypothermia
  • Cold/mottled hands/feet
  • Prolonged capillary refill
  • Chills/rigors
  • Limb pain
  • Vomiting and/or diarrhoea
  • Muscle weakness
  • Muscle/joint aches
  • Skin rash
  • Diminished urine output
  • Tachycardia and tachypnoea
  • Bulging fontanelle
  • Neck stiffness
  • Status epilepticus
  • Focal neurological signs and seizures
  • Leucocytosis or leucocytopenia
  • Altered mental state
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7
Q

How is sepsis treated in children?

A
  • Supportive: ABCD (intubation/NIV, IV access etc.)

- Antibiotics: broad spectrum and good CSF penetration (3rd generation cephalosporins + amoxicillin if a neonate)

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8
Q

Name the features of the paediatric sepsis 6

A
  • High flow oxygen
  • IV/IO access and obtain bloods
  • Give antibiotics
  • Fluid resus
  • Early inotropic support (adrenaline)
  • Involve senior/specialist early
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9
Q

What investigations can be done for sepsis in children?

A
  • Blood: FBC, CRP, coagulation, U&Es, LFTs, blood gas (metabolic acidosis and raised lactate), glucose (hypoglycaemia) and culture
  • CSF: cell count, culture, protein (low) and glucose (low)
  • Urine culture
  • Skin biopsy
  • Imaging: CT/MRI head
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10
Q

Which organisms are responsible for meningitiis in neonates?

A
  • Group B strep
  • E coli
  • Listeria monocytogenes
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11
Q

Which organisms are responsible for meningitis in children?

A
  • Strep pneumoniae
  • Meningococci (neisseria meningitidis)
  • H influenzae
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12
Q

How does meningitis present in children?

A
  • Nuchal rigidity
  • Headaches, photophobia
  • Diminished consciousness
  • Focal neurological abnormalities
  • Seizures
  • Rash
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13
Q

How does meningitis present in neonates?

A
  • Lethargy
  • Irritability
  • Bulging fontanelle
  • Seizures
  • Rash
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14
Q

How is meningitis treated?

A
  • Same antibiotics as for sepsis
  • Chemoprophylaxis for family members
  • Steroids (to reduce the long term outcomes e.g. hearing loss)
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15
Q

What are the features of strep pneumoniae?

A
  • Gram positive diplo-cocci
  • Transmitted by droplets
  • Colonises upper airways
  • Viral infections are a predisposing factor for invasive disease
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16
Q

What are the complications for pneumococcal meningitis?

A
  • Brain damage
  • Hearing loss
  • Hydrocephalus
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17
Q

What are the features of h influenzae B?

A
  • Gram negative bacterium
  • Encapsulated: resists phagocytosis and complement mediated lysis
  • Uncapsulates is non typeable
  • Causes bacteraemia, meningitis, pneumonia and epiglottitis
  • Viral infections predispose for invasive disease
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18
Q

Why is meningococcal disease so virulent?

A

It produces an endotoxin

19
Q

What are the features of streptococci?

A
  • Gram positive cocci
  • Treated with penicillin
  • No resistance issues
20
Q

What are the features of staphylococci?

A
  • Gram positive cocci
  • Treated with fluclox (resistant to beta-lactamases)
  • Major resistane issues e.g. MRSA
21
Q

What are the features of scarlet fever?

A
  • Group A strep
  • Malaise, fever, pharyngitis
  • Rash
  • Strawberry tongue
  • Squamation (peeling of skin) of the hands and feet
  • Toddler and school age children
22
Q

How can group A strep be treated?

A

10 days of penicillin

23
Q

What are the potential complications of Group A strep infection?

A
  • Impetigo
  • Erysipelas
  • Necrotising fascitis
  • Rheumatic fever
  • Glomerulonephritis
24
Q

Name some infections that staph aureus can cause

A
  • Impetigo
  • Cellulitis
  • Infected eczema
  • Ulceration
  • Staph scalded skin syndrome
  • Toxic shock syndrome
25
Q

How does staph scalded skin syndrome present?

A
  • Fever
  • Widespread redness
  • Fluid filled blisters which rupture easily (esp. in the skin folds)
26
Q

How does toxic shock syndrome present?

A
  • Systemically unwell
  • Widespread redness
  • Desquamation
  • Multi-organ involvement
  • Can be rapidly fatal
27
Q

What is Kawasaki disease?

A

Self limiting vasculitis of medium sized arteries

28
Q

What are the presenting features of Kawasaki disease?

A

Fever for 5 days plus:

  • Bilateral conjunctival injection
  • Cracked lips/strawberry tongue
  • Cervical lymphadenopathy
  • Polymorphous rash
  • Changes of the extremities
29
Q

How can Kawasaki disease be treated?

A
  • Aim is to prevent complications
  • Immunogloobulins
  • Aspirin
  • High dose steroids
  • ?Biologics
  • Cardiology assessment (ECHO, cardiology follow up)
30
Q

What are the potential complications of varicella zoster (chicken pox) infection?

A
  • Secondary strep/staph infections
  • Meningoencephalitis
  • Cerebillitis
  • Arthritis
31
Q

When should chicken pox be treated and with what?

A
  • Immunosuppressed or severely unwell

- Aciclovir

32
Q

What are the warning signs that a varicella zoster infection is more serious?

A
  • High fever
  • New lesions > day 10
  • Inflammed lesions
  • General malaise
33
Q

What are the potential complications of herpes simplex infections?

A
  • Keratoconjunctivitis
  • Encephalitis
  • Systemic neonatal infections
  • Immunocompromised children
34
Q

How can herpes simplex be treated?

A

Aciclovir

35
Q

What can happen to neonates who are infected with herpes simplex ?

A
  • 70-80% have disseminated/CNS infections: sepsis, meningoencephalitis and hepatitis
  • 20-30% skin/eye/mouth disease
36
Q

What are primary immunodeficiencies?

A
  • Missing or improper function of body’s immune system
  • Usually caused by a single genetic defect
  • Can affect a single or multiple components of the immune system
37
Q

What are secondary immunodeficiencies?

A
  • Acquired diseases or effects of treatment affecting the immune system
  • Components of the immune system are all present and functional
  • E.g. HIV infection, prolonged steroid use and patients being treated for malignancies
38
Q

Which features would suggest an immunodeficiency?

A
  • Serious
  • Persistent
  • Unusual
  • Recurrent
  • Family history
39
Q

Which investigations can be done in a patient with suspected immunodeficiency?

A
  • FBC (WBCs)
  • Immunoglobulins
  • HIV test
  • Functional antibodies (vaccine responses)
  • Lymphocyte subsets (CD4 and CD8 counts)
  • NBT (specific for chronic granulomatuous)
  • Complement
40
Q

How do antibody deficiencies present?

A
  • Defective B cell function (Igs)

- Recurrent bacterial infections

41
Q

How do cellular immunodeficiencies present?

A
  • Impaired or absent T cell function
  • Unusual/opportunistic infections
  • Recurrent/severe viral infections
42
Q

How do innate immune disorders present?

A
  • Defects in phagocyte function or complement

- Sepsis, abscess and fungal infections

43
Q

How are pregnant women who are HIV positive and their babies managed

A
  • They receive ART
  • Some have C section
  • Advised not to breastfeed
  • Babies receive prophylaxis postnatally until further testing

Paediatrics (17 decks)

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