Paediatric Infectious Diseases Flashcards
When to stop antibiotics in neonatal sepsis
Abx for 5 - 7 days
Consider stopping if low suspicion of sepsis, patient is well, blood culture is negative and 2 CRP results are negative at 48 hours
Pathophysiology of meningitis
Inflammation of the meninges due to:
- Neisseria meningitidis - gram negative diplococci
- Streptococcus pneumoniae
- Group B streptococcus - neonates
Presentation of meningococcal sepsis
Fever Headache Photophobia Neck stiffness Vomiting and nausea Seizures Altered consiousness Non blanching rash - late sign
Presentation of meningococcal sepsis in neonates
Bulging fontanelles Hypotonia Reduced feeding Lethargy Hypothermia
When should a lumbar puncture be performed
- Under 1 month old presenting with fever
- 1 - 3 months with fever and unwell
- Under 1 year with unexplained fever and red flag features
Special tests for meningeal irritation
Kernigs test - flex hip and knee to 90 degrees then straighten knee
Brudzinski’s test - lying on back and flex neck causes involuntary flexion of the hips and knees q
Community management of meningococcal sepsis
Urgent stat injection of IV/IM benzylpenicillin prior to transfer to hospital
Hospital management of meningococcal sepsis
Sepsis 6 protocol
Lumbar puncture - CSF PCR
Under 3 months - cefotaxime and amoxicillin
Above 3 months - ceftriaxone
Dexamethasone qds for 4 days if > 3 months and positive lumbar puncture
Notify Public Health England
Antibiotic for pneumococcal sepsis
Vancomycin
Why give dexamethasone for treatment of meningitis
Decreases the risk of hearing loss and neurological damage
Post exposure prophylaxis for contacts of meningitis patients
If within 7 days of the patient contracting the disease, one dose of ciprofloxacin should be given to close contacts
Viral causes of meningitis
Herpes simplex virus
Enterovirus
Varicella zoster virus
Management of viral meningitis
IV Acyclovir for HSV or varicella zoster
Bacterial lumbar puncture
Appearance - cloudy Protein - high Glucose - low WCC - high (neutrophilic) Culture - bacteria
Viral lumbar puncture
Appearance - clear Protein - normal Glucose - normal WCC - high (lymphocytic) Culture - negative
Complications of meningitis
Hearing loss Seizures Cognitive impairment Memory loss Cerebral palsy
Pathophysiology of encephalitis
Inflammation of the brain due to infection, autoimmune causes or toxins
Infective causes of encephalitis
Herpes simplex virus - cold sores or genital lumps Varicella zoster - chicken pox CMV - immunodeficiency Epstein Barr virus Enterovirus Adenovirus Influenza virus
Presentation of encephalitis
Altered consciousness and cognition Unusual behaviour Focal neurological symptoms Seizures Fever
Diagnosis of encephalitis
Lumbar puncture - CSF PCR CT scan if LP contraindicated MRI scan EEG Swabs - throat HIV testing
Contraindications for a lumbar puncture
GCS < 9
Haemodynamically unstable
Active seizures
Post ictal
Management of encephalitis
IV acyclovir empirically, before confirming encephalitis
IV acyclovir - HSV, VZV
IV Gancicyclovir - CMV
Repeat lumbar puncture after antiviral course to check success
Complications of encephalitis
Lasting fatigue and prolonged recovery Changes in personality and mood Changes in memory and cognition Learning disability Headaches Chronic pain Movement disorders Sensory disturbance Seizures Hormonal imbalance
Infectious mononucleosis (glandular fever) pathophysiology
Infection with EBV spread by saliva which causes fever, sore throat and fatigue
Presentation of glandular fever
Fever Sore throat Fatigue Lymphadenopathy Tonsillar enlargement Splenomegaly - splenic rupture
Sore throat and itchy rash after taking amoxicillin
Glandular fever
Testing for glandular fever
Monospot test - patient’s RBCs introduced to horses RBCs and causes a reaction
Management of glandular fever
Self limiting, lasts 2 - 3 weeks but can cause fatigue for months
Complications of glandular fever
Splenic rupture Glomerulonephritis Haemolytic anaemia Thrombocytopenia Chronic fatigue
Which cancer is EBV associated with
Burkitts lymphoma
Mumps pathophysiology
Viral infection spread by respiratory droplets causing parotid swelling
Incubation period of mumps
14 -25 days
Management of mumps
Self limiting, lasts 1 week
Supportive - analgesia, rest and fluids
Notify Public Health England
Presentation of mumps
Fever Parotid swelling Muscle aches and lethargy Reduced appetite Headache Dry mouth
Complications of mumps
Abdominal pain - pancreatitis
Testicular pain and swelling - orchitis
Confusion, neck stiffness and headache - meningitis or encephalitis
Sensorineural hearing loss
Diagnosing mumps
PCR of saliva
Preventing HIV in babies
Caesarean if viral load is > 50 copies/ml
IV zidovudine during caesarean if > 10000 copies/ml
Low risk baby - zidovudine for 4 weeks
High risk baby - zidovudine, lamivudine and nevirapine for 4 weeks
Avoid breastfeeding
When to test babies who have HIV postive patients
HIV viral load test at 3 months
HIV antibody test at 24 months
Can be false positive up to 18 months due to maternal antibodies that have crossed the placenta
Management of paediatric HIV
Specialist paediatric HIV doctor and MDT
- antiretroviral therapy
- Childhood vaccines but delay live attenuated vaccines if immunocompromised
- prophylactic co - trimoxazole - prevent pneumocystis jirovecci
Management of babies who have mothers that have hep C
Tested at 18 months using the Hep C antibody test
Can breastfeed unless nipples crack or bleed, then temporarily stop
Tx: Pegylated interferon and ribavirin - delayed until adulthood unless significantly affected
