Paediatric Infectious Diseases 1, 2 & 3 Flashcards
What is the definition of paediatric sepsis?
- Systemic inflammatory response syndrome
- Suspected/proven infection
What is severe paediatric sepsis?
-Sepsis + 2 or more of: resp failure, renal failure, neurological failure, haematological failure and liver failure
Which patient groups are more at risk of developing sepsis?
- Boys > girls
- New borns are most at risk
Which pathogens are responsible for sepsis in neonates?
- Group B strep
- E coli
- Listeria monocytogenes
Which pathogens are responsible for sepsis in children?
- Strep pneumoniae
- Meningococci
- Group A strep
- Staph aureus
How does sepsis present in children?
- 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
How is sepsis treated in children?
- Supportive: ABCD (intubation/NIV, IV access etc.)
- Antibiotics: broad spectrum and good CSF penetration (3rd generation cephalosporins + amoxicillin if a neonate)
Name the features of the paediatric sepsis 6
- High flow oxygen
- IV/IO access and obtain bloods
- Give antibiotics
- Fluid resus
- Early inotropic support (adrenaline)
- Involve senior/specialist early
What investigations can be done for sepsis in children?
- 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
Which organisms are responsible for meningitiis in neonates?
- Group B strep
- E coli
- Listeria monocytogenes
Which organisms are responsible for meningitis in children?
- Strep pneumoniae
- Meningococci (neisseria meningitidis)
- H influenzae
How does meningitis present in children?
- Nuchal rigidity
- Headaches, photophobia
- Diminished consciousness
- Focal neurological abnormalities
- Seizures
- Rash
How does meningitis present in neonates?
- Lethargy
- Irritability
- Bulging fontanelle
- Seizures
- Rash
How is meningitis treated?
- Same antibiotics as for sepsis
- Chemoprophylaxis for family members
- Steroids (to reduce the long term outcomes e.g. hearing loss)
What are the features of strep pneumoniae?
- Gram positive diplo-cocci
- Transmitted by droplets
- Colonises upper airways
- Viral infections are a predisposing factor for invasive disease
What are the complications for pneumococcal meningitis?
- Brain damage
- Hearing loss
- Hydrocephalus
What are the features of h influenzae B?
- 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
Why is meningococcal disease so virulent?
It produces an endotoxin
What are the features of streptococci?
- Gram positive cocci
- Treated with penicillin
- No resistance issues
What are the features of staphylococci?
- Gram positive cocci
- Treated with fluclox (resistant to beta-lactamases)
- Major resistane issues e.g. MRSA
What are the features of scarlet fever?
- Group A strep
- Malaise, fever, pharyngitis
- Rash
- Strawberry tongue
- Squamation (peeling of skin) of the hands and feet
- Toddler and school age children
How can group A strep be treated?
10 days of penicillin
What are the potential complications of Group A strep infection?
- Impetigo
- Erysipelas
- Necrotising fascitis
- Rheumatic fever
- Glomerulonephritis
Name some infections that staph aureus can cause
- Impetigo
- Cellulitis
- Infected eczema
- Ulceration
- Staph scalded skin syndrome
- Toxic shock syndrome
How does staph scalded skin syndrome present?
- Fever
- Widespread redness
- Fluid filled blisters which rupture easily (esp. in the skin folds)
How does toxic shock syndrome present?
- Systemically unwell
- Widespread redness
- Desquamation
- Multi-organ involvement
- Can be rapidly fatal
What is Kawasaki disease?
Self limiting vasculitis of medium sized arteries
What are the presenting features of Kawasaki disease?
Fever for 5 days plus:
- Bilateral conjunctival injection
- Cracked lips/strawberry tongue
- Cervical lymphadenopathy
- Polymorphous rash
- Changes of the extremities
How can Kawasaki disease be treated?
- Aim is to prevent complications
- Immunogloobulins
- Aspirin
- High dose steroids
- ?Biologics
- Cardiology assessment (ECHO, cardiology follow up)
What are the potential complications of varicella zoster (chicken pox) infection?
- Secondary strep/staph infections
- Meningoencephalitis
- Cerebillitis
- Arthritis
When should chicken pox be treated and with what?
- Immunosuppressed or severely unwell
- Aciclovir
What are the warning signs that a varicella zoster infection is more serious?
- High fever
- New lesions > day 10
- Inflammed lesions
- General malaise
What are the potential complications of herpes simplex infections?
- Keratoconjunctivitis
- Encephalitis
- Systemic neonatal infections
- Immunocompromised children
How can herpes simplex be treated?
Aciclovir
What can happen to neonates who are infected with herpes simplex ?
- 70-80% have disseminated/CNS infections: sepsis, meningoencephalitis and hepatitis
- 20-30% skin/eye/mouth disease
What are primary immunodeficiencies?
- 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
What are secondary immunodeficiencies?
- 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
Which features would suggest an immunodeficiency?
- Serious
- Persistent
- Unusual
- Recurrent
- Family history
Which investigations can be done in a patient with suspected immunodeficiency?
- FBC (WBCs)
- Immunoglobulins
- HIV test
- Functional antibodies (vaccine responses)
- Lymphocyte subsets (CD4 and CD8 counts)
- NBT (specific for chronic granulomatuous)
- Complement
How do antibody deficiencies present?
- Defective B cell function (Igs)
- Recurrent bacterial infections
How do cellular immunodeficiencies present?
- Impaired or absent T cell function
- Unusual/opportunistic infections
- Recurrent/severe viral infections
How do innate immune disorders present?
- Defects in phagocyte function or complement
- Sepsis, abscess and fungal infections
How are pregnant women who are HIV positive and their babies managed
- They receive ART
- Some have C section
- Advised not to breastfeed
- Babies receive prophylaxis postnatally until further testing
