Paediatric infectious diseases Flashcards
Meningitis : Definition
- Meningitis is defined as inflammation of the meninges.
- The meninges are the lining of the brain and spinal cord.
- This inflammation is usually due to a bacterial or viral infection.
Bacterial meningitis : Pathophysiology
(common pathogens)
- Inflammation of the meninges caused by a bacterial infection
- Common pathogens are;
* Children > 6 years
i) Neisseria meningitides (meningococcus)
ii) Streptococcus Pneumonia (Pneumococcus)
- Children : 1 month - 6 years
i) Neisseria meningitides (meningococcus)
ii) Streptococcus Pneumonia (Pneumococcus)
iii) Haemophilius influenca - Neonates :
i) Group B strep : contracted from vaginal flora during birth
ii) Ecoli, Listeria
Bacterial meningitis : Clinical features
- Fever,
- Neck stiffness
- Vomiting
- Headache + photophobia
- Seizures
- In Neonates
* ‘Bulging fontanelle’
* Systemic sx : poor feeding, lethargy
Meningococcal Septicaemia : Clinical features
- Sepsis caused by Neisseria Meningitidis in the blood
-
Clinical feature :
* ‘Non-blanching rash’ - indicates DIC and subcutaneous haemorrhages
Bacterial meningitis : Investigation
- Meningococcal PCR
- NICE recommend a lumbar puncture as part of the investigations for all children:
* Under 1 month presenting with fever
* 1 to 3 months with fever and are unwell
* Under 1 year with unexplained fever and other features of serious illness
Bacterial meningitis : Management
Step 1 : Antibiotics
Primary care
1. Suspected meningitis AND Non-blanching rash
* IM Benzylpenicillin + admit
Secondary care
1. Ix } LP prior to Abx + PCR
* < 3 months : IV Cefotaxime + IV Amoxicillin (covers listeria from vaginal flora)
* >3 months : IV Cefotxime
Step 2 : Steroids
* Reduces risk of complications such as hearing loss
Step 3 : Fluids
Bacterial meningitis : Complications
- Hearing loss : most common
Bacterial meningitis : PEP
Indication : Contact < 7 days
Mx :
1. Refer to public health - notifiable disease
2. Treatment : Single dose of Ciprofloxacin
Infectious Mononucleosis : Definition
- Infectious mononucleosis is a condition caused by infection with the Epstein Barr virus(EBV*)
- Virus transmitted by via saliva
Infectious Mononucleosis :Clinical features
The classic triad of sore throat, pyrexia and lymphadenopathy is seen in around 98% of patients
- Fever
- Sore throat } tonsillar enlargement
- Lymphadenopathy + Splenomegaly
Infectious Mononucleosis : Investigations
-
Bloods;
1. Hepatitis : transient ALT rise
2. Lymphocytosis -
Antibody testing
1. Heterophil antibody test (Monospot test)
Infectious Mononucleosis : Diagnosis
- Heterophil antibody test (Monospot test)
* NICE : FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.
Mumps : definition
Viral infection spread by respiratory droplets
-MMR vaccine protects against mumps
Mumps : Clinical Presentation
- Early symptoms (1-3 days)
* Systemic sx : Fever, lethargic, myalgia - Parotid gland swelling and pain : -Unilateral or bilateral
* ‘Ear ache’ or ‘Pain on eating
Mumps : Complications
- Abdominal pain (pancreatitis)
- Testicular pain and swelling (orchitis)
- Confusion, neck stiffness and headache (meningitis or encephalitis)
- Hearing loss
Mumps : Management
- Conservative Mx : Fluids and analgesia
- Notify public health
School exclusion : No exclusions (8)
Medical conditions which do not require school exclusion
- Fifth disease (slapped cheek)
- Hand, foot and mouth
- Roseola
- Infectious mononucleosis
- Hand, foot and mouth
- Conjunctivitis
- Head lice
- Threadworms
School exclusion : 24 hour after Antibiotics
Scarlet fever
School exclusion : 48 hour after Antibiotics
- Whooping cough } : 21 days after onset of symptoms
- Impetigo : or until lesions crusted or healed
School exclusion : 4 days from onset of rash
Measles
School exclusion : 5 days from onset of rash
Rubella
School exclusion : All lesions crusted over
- Chicken pox
- Impetigo
Infective gastroenteritis : Clinical features
- Sudden onset diarrhoea and vomitting
- Febrile
- Bloody diarrhoea Campylobacter and E.coli
Infective gastroenteritis : Causative organism
-
Viral pathogens (most common cause of gastroenteritis)
1. Rota virus : most common cause of viral gastroenteritis in children - Declining prevalence since rotavirus vaccine
- Norovirus
Most common cause of gastroenteritis in the UK
Bacterial pathogens - associated with bloody diarrhea
1 . Campylobacter Jejuni
* Most common bacterial cause of gastroenteritis
* Common cause of travellers diarrhoea
2 . E coli
Including shiva toxin-producing E.coli
Infective gastroenteritis : Complication
1 . Dehydration , electrolyte imbalance, AKI
1 . Haemorrhage colitis
* Complication from shiva toxin coli
* Associated : acute bloody diarrhoea and severe abdominal pain
1 . Haemolytic uraemia syndrome
* Life threatening complication occurs in mostly in children < 5 year old
* Assoc Ecoli and Campylobacter
1 . Sepsis /Osteomyelitis : infection with salmonella
Infective gastroenteritis : Features of dehydration
- Altered responsiveness : irritable, lethargic
- Decreased urine output
- Sunken eyes
- Dry mucous membrane
- Reduced skin turgor
- Vitals : Tachycardia, Tachypnea
Hypotension
Weak peripheral pulse
Reduced skin turgor
Infective gastroenteritis : Investiagtions
- Stool sample if;
* Suspected food poisoning / Travel abroad
* Systemically unwell/Immunocompromised
* Diarrhoea >7 days
Infective gastroenteritis : Management
Hospital admission if;
1. Severe dehydration : vitals impaired
2. Billous vomitting
3. Painful, bloody diarrhoea
Primary care management;
1. Increase fluid intake - avoid fruit juice or carbonated drink as can worsen diarrhoea
2. Oral dehydration solution
No attendance at school >48 hours after last D+V episode
