Paediatric Infectious Diseases Flashcards
1
Q
Infections in children - epidemiology
A
- Mostly due to virus
- Most are self-limiting
2
Q
What are the definitions of:
- sepsis
- severe sepsis
- septic shock
A
3
Q
What does SIRS stand for?
A
Systemic inflammatory response syndrome
4
Q
What is the criteria for SIRS?
A
5
Q
Sepsis - aetiology
A
- Neonates (<1 month)
- Group B strep
- E-coli
- Listeria monocytogenes
- Older infants and children
- Streptococcus pneumoniae
- Neisseria meningitides
- Group A strep
- Staph aureus
6
Q
Sepsis - epidemiology
A
- Severe sepsis one of leading causes of death in children
- Peak incidence in early childhood
- Infants <1 year 1/200
- Children 1-4 year 1/2000
- Children 5-15 years 1/5000
7
Q
How can sepsis risk be investigated?
A
- Traffic lights
- Sepsis 6
8
Q
What are important key points about sepsis in infants < 3 months?
A
- Increased risk bacterial infection, sepsis and meningitis
- May have minimal signs and symptoms, presentation often non-specific
- Deteriorate quickly
9
Q
What are risk factors for sepsis in children <3 months?
A
- Prematurity (<37 weeks)
- PROM
- Maternal pyrexia/chorioamnionitis
- Maternal GBS (this pregnancy)
- Previous child with GBS
- Maternal STI (chlamydia, gonorrhoea, syphilis, HSV)
10
Q
Sepsis - management
A
- Early recognition
- High flow oxygen
- IV access for bloods
- Cultures
- Glucose - replace
- Lactate
- IV antibiotics – broad spectrum
- 3rd generation cephalosporin (such as Cefotaxime/Ceftriaxone)
- Add IV amoxicillin if <1 month old
- Fluid resuscitation
- Ionotropic support – adrenaline
11
Q
Sepsis - investigations
A
- Bloods
- FBC – leucocytosis, thrombocytopaenia
- CRP
- Coagulation screen (DIC)
- Blood gas (metabolic acidosis, raised lactate)
- Glucose
- Blood culture
- Cultures
- Blood
- Urine
- CSF (including send to virology)
- +/- stool (microscopy and virology)
- Imaging
- Chest x-ray
12
Q
What are the definitions of:
- meningitis
- meningism
A
- Meningitis
- Disease caused by inflammation of meninges
- Meningism
- Clinical signs and symptoms suggestive of meningeal irritation
13
Q
Meningitis - aetiology
A
- Bacterial (4-18%)
- Table attached
- Previously H. Influenzae meningitis, not anymore though due to vaccine (encapsulated, serotypes a-f)
- Meningococcal meningitis (usually serotype B), not anymore due to vaccine but more incidence than influenzae
- Neiseria meningitides (polysaccharide capsule, determines serotype A, B, C, W, Y)
- Also called meningococcus
- Pneumococcal meningitis (streptococcus pneumoniae)
- Viral (60-90%)
- Mainly enterovirus
- Unknown/aseptic
14
Q
What bacteria causes some of the worse kinds of meningitis infections?
A
- Previously H. Influenzae meningitis, not anymore though due to vaccine (encapsulated, serotypes a-f)
- Meningococcal meningitis (usually serotype B), not anymore due to vaccine but more incidence than influenzae
- Neiseria meningitides (polysaccharide capsule, determines serotype A, B, C, W, Y)
- Also called meningococcus
- Pneumococcal meningitis (streptococcus pneumoniae)
15
Q
Meningitis - presentation
A
- Older children
- Fever – classic triad in adults
- Headache
- Neck stiffness
- Photophobia
- Nausea and vomiting
- Reduced GCS
- Seizures
- Focal neurological deficits
- Young infants – various and non-specific features
- Fever or hypotheramia
- Poor feeding
- Vomiting
- Lethargy
- Irritability
- Respiratory distress
- Apnoea
- Bulging fontanelle
16
Q
What is the classic triad of meningitis in older children and adults?
A
- Fever
- Headache
- Neck stiffness
17
Q
Meningitis - clinical signs
A
- Nuchal rigidity (neck stiffness)
- Palpable resistance to neck flexion
- Brudzinski’s sign
- Hips and knees flex on passive flexion of neck
- Kernig’s sign
- Pain on passive extension of knee
18
Q
What are the following:
- Nuchal rigidity
- Brudzinski’s sign
- Kernig’s sign
A
- Nuchal rigidity (neck stiffness)
- Palpable resistance to neck flexion
- Brudzinski’s sign
- Hips and knees flex on passive flexion of neck
- Kernig’s sign
- Pain on passive extension of knee
19
Q
Meningitis - investigations
A
- Bloods
- FBC – leucocytosis, thrombocytopaenia
- U&Es, LFT
- CRP
- Coagulation screen (DIC)
- Blood gas (metabolic acidosis, raised lactate)
- Glucose
- Blood culture
- Meningococcal/pneumococcal PCR
- Lumbar puncture
- Essential
- Prior to antibiotics but do not delay antibiotics if LP cannot be performed
- Request - Microscopy, gram stain, culture, protein, glucose, viral PCR
- Findings – turbid or purulent, high opening pressure, increased WCC, increased protein, decreased glucose
20
Q
What should be requested from the lab for a LP for meningitis?
A
- Request - Microscopy, gram stain, culture, protein, glucose, viral PCR
21
Q
What are LP findings for meningitis?
A
- Findings – turbid or purulent, high opening pressure, increased WCC, increased protein, decreased glucose
22
Q
When should an LP not be done?
A
- Signs of raised ICP
- GCS < 9
- Abnormal tone or posture
- HTN and bradycardia
- Pupillary defects
- Papilloedema
- GCS < 9
- Focal neurological signs
- Recent seizure
- Cardiovascular instability
- Coagulopathy
- Thrombocytopenia
- Extensive or extending purpura
23
Q
Meningitis - management
A
- ABCDE
- Circulation – fluid, inotropes
- Glucose – dextrose
- Antibiotics
- 3rd generation cephalosporin
- Cefotaxime/ceftriaxone
- Add IV amoxicillin if <1 month old
- Different organisms are treated for different levels of time
- 3rd generation cephalosporin
24
Q
Invasive meningococcal disease - aetiology
A
- Neisseria meningitides
25
Q
Invasive meningococcal disease - risk factors
A
Risk factors for being invasive:
- Age <1 year or 15-24 years
- Unimmunised
- Crowded living conditions
- Household or kissing contact
- Smoking (active/passive)
- Recent viral infection
- Complementary deficit
26
Q
Invasive meningococcal disease - presentation
A
- Features of both meningitis and septicaemia
- Petechial/purpuric rash
27
Q
Invasive meningococcal disease - prognosis
A
- Rapidly progressive
- Mortality 5-15%
- Long term sequelae
- Amputation 15%
- Scarring 50%
- Hearing loss
- Cognitive impairment/epilepsy
28
Q
Invasive pneumococcal infection - risk factors
A
Risk factors for invasive:
- Age < 2years
- Smoking (active or passive)
- Recent viral URTI
- Attendance at childcare
- Cochlear implant
- Sickle cell disease
- Asplenia
- HIV infection
- Nephrotic syndrome
- Immunodeficiency
29
Q
Invasive pneumococcal infection - prognosis
A
- Mortality 8*
- Neurological sequelae common
- Hydrocephalus
- Neurodisability
- Seizures
- Hearing loss
- Blindness
