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Paediatrics Jenna To Sort > Paediatric Infectious Diseases > Flashcards

Paediatric Infectious Diseases Flashcards

1
Q

Infections in children - epidemiology

A
  • Mostly due to virus
  • Most are self-limiting
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2
Q

What are the definitions of:

  • sepsis
  • severe sepsis
  • septic shock
A
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3
Q

What does SIRS stand for?

A

Systemic inflammatory response syndrome

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4
Q

What is the criteria for SIRS?

A
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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
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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
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7
Q

How can sepsis risk be investigated?

A
  • Traffic lights
  • Sepsis 6
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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
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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)
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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
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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
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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
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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
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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)
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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
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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
  • 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
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

Paediatrics Jenna To Sort (37 decks)

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