Paediatric Infectious Diseases Flashcards by Sophie Pitcairn

What is sepsis?

SIRS and suspected or proven infection
Severe sepsis - sepsis plus organ dysfunction
Septic shock - sepsis and CVS dysfunction

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Describe systemic inflammatory response syndrome

SIRS
2 or more of - temp > 38 degrees/ <36, WCC >15x10^9 or <5, tachycardia >2SD and tachypnoea >2SD for normal age

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What is used for plotting paediatric values?

PEWS charts

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What are signs for red flags in sepsis?

Sleeping more, needing stimulation for waking, not doing as much activity, if they are just lying there, can’t wake up and high pitched cry
Evidence of difficulty with breathing
Capillary refill time (over sternum) and how the child looks
Rigors (bacterial infection), non-blanching rashes and bulging fontanelles

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What is the SEPSIS 6 for paediatric diagnosing sepsis?

Temperature, inappropriate tachycardia, proper peripheral perfusion, neuro changes (altered mental state), tachypnoeic and hypotension

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What are the children to think about when diagnosing sepsis?

Under 3 months, immunosuppressed, chemotherapy, on long-term steroids, recent surgery, neuro disabilities and lines/ catheters

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Why do we worry about infants under 3 months?

Increased risk of bacterial infection, sepsis and meningitis
Minimal signs and symptoms
May not mount to a febrile response - 50%
Can deteriorate quickly

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What are some risk factors for infants under 3 months for sepsis?

Prematurity, PROM, maternal pyrexia/ chorioamnionitis, maternal GBS (this and previous pregnancy) and maternal STIs

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What is the management for sepsis in children?

Give high flow O2
ABC
Fluid bolus based on weight
DEFG - 2ml/kg 10% dextrose if hypoglycaemia
Antibiotics - 3rd generation cephalosporin (cefotaxime/ ceftriaxone) and add IV amoxicillin if under 1 month

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What investigations are done if suspected sepsis?

Bloods - FBC, CRP, coagulation screen, blood gas, glucose and blood culture
Cultures - blood, urine and CSF (possible stool)
Imaging - CXR

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What are the responsible organisms in sepsis for neonates?

Group B streptococcus, E. coli and Listeria monocytogenes

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What are the responsible organisms for sepsis in older infants and children?

Streptococcus pneumoniae, Neisseria meningitidis, group A streptococcus and staphylococcus aureus

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What is the definition of meningitis?

A disease caused by inflammation of the meninges
Meningism is the clinical signs and symptoms suggestive of meningeal infection

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What are the signs and symptoms of meningitis in older children?

Fever, headache, photophobia, neck stiffness, N/V, reduced GCS, seizures and focal neurological signs

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What are the signs and symptoms seen in young infants for meningitis?

Fever or hypothermia, poor feeding, vomiting, vomiting, lethargy, irritability, respiratory distress and apnoea

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What are some clinical signs of meningitis?

Nuchal rigidity (neck stiffness) - palpable resistance to neck flexion
Brudzinski’s sign - hips and knees flex on passive flexion of the neck
Kernig’s sign - pain on passive extension of the knee

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What are the causes of childhood meningitis?

Bacteria
Mainly viral - enterovirus
Fungal - neonates and immunocompromised
Unknown and aseptic

What are the responsible organisms for bacterial meningitis in noenates?

Group B streptococcus, E. coli and Listeria monocytogenes

What are the responsible organisms for older infants and children for meningitis?

Streptococcus pneumoniae, Neisseria meningitidis and haemophilus influenza type B

Describe haemophilus influenza

Small, non-motile, gram-negative coccobacillus
Nasopharyngeal carriage
Encapsulated H. influenza - resists phagocytosis and complement mediated lysis
Hib main cause of invasive H. influenza

Describe Neisseria meningitidis

Gram negative diplococcus
Humans only natural hosts
Nasopharyngeal carriage
Infection follows viral URTI
Polysaccharide capsule - determines serogroup
Endotoxin (LPS)

What are the risk factors for invasive meningococcal disease?

Age under 1 year and 15-24 years
Unimmunised, crowded living conditions, household/ kissing contact, cigarette smoking, recent viral/ Mycoplasma infection and complement deficiency

What can be seen in invasive meningococcal disease?

25% septicaemia
15% meningitis
60% petechiae/ purpura rash

Describe invasive meningococcal disease

Rapidly progressive
Case fatality rate is 5-15%
Significant long term sequelae - amputation, scarring, hearing loss and cognitive impairment/ epilepsy

Describe streptococcus pneumoniae (pneumococcus)

Gram positive, lancet-shaped diplococcus Facultative anaerobe Polysaccharide capsule More than 90 known serotypes and all can cause invasive disease Colonised nasopharynx Proceeding URTI and resp droplet transmission

What are the risk factors for invasive pneumococcal disease?

Age under 2 years, cigarette smoking, recent viral URTI, attendance at childcare, cochlear implant, sickle cell disease, asplenia, HIV infection, nephrotic syndrome and immunodeficiency

Describe pneumococcal meningitis

Case fatality of 8% in children Neurological sequelae common - hydrocephalus, neuro-disability, seizures, hearing loss and blindness

What is the basic management of meningitis?

ABC 20ml/kg fluid bolus 2ml/kg 10% dextrose Antibiotics - 3rd generation cephalosporin (cefotaxime/ ceftriaxone) Add amoxicillin if under 1 month

What are the investigations for meningitis?

Bloods - FBC, U+Es, LFTs, CRP, coagulation screen, blood gas, glucose, blood culture and PCR Lumbar puncture - essential and ideally before antibiotics but don't delay

What should be requested for lumbar puncture and seen on LP for meningitis?

Request - microscopy, gram stain, culture, protein, glucose and viral PCR Findings - turbid/ purulent, high opening pressure, increased WCC, protein and decreased glucose

What are the contraindications for doing a lumbar puncture?

Signs of raised ICP - GCS under 9, abnormal tone/ posture, pupillary defects, bradycardia + HTN, papilledema Focal neurological signs, recent seizures, CV unstable, coagulopathy, thrombocytopenia and extensive purpura

Describe the microbiology of staphylococcus aureus

Gram positive cocci, coagulase positive, produce exotoxins and form super-antigens, colonises skin + mucosa and resistance is a problem

Describe the microbiology of streptococcus pyogenes

Gram positive cocci, B-haemolytic, produce exotoxins and forms super-antigens, oropharyngeal carriage and resistance is not a problem

What are some skin and soft tissue infections caused by staph and strep infections?

Cellulitis, boils/ furuncles, impetigo, infected eczema and lymphadenitis

Describe staphylococcal scalded skin syndrome

Usually under 5 years Toxin mediated Initial bullous lesions followed by widespread desquamation Nikolsky sign, purulent conjunctivitis and mild fever

What is the treatment for staphylococcal scalded skin syndrome?

IV flucloxacillin and IV fluids

Describe the pattern of infection of scarlet fever

Group A strept infection 2-5 day incubation period Fever, malaise and sore throat with strawberry tongue Sandpaper rash Then skin peeling Lasts 7 days

What is the management of scarlet fever?

Notifiable disease Phenoxymethylpenicillin (penicillin V) for 10 days Reduces transmissions and incidence of complications

What are some of the complications of scarlet fever?

Abscess formation - retropharyngeal or peritonsillar Acute rheumatic fever - arthritis, carditis, chorea, erythema marginatum and subcutaneous nodules Post-streptococcal glomerulonephritis

What is toxic shock syndrome?

Acute febrile illness caused by gram positive bacteria which rapidly progresses to shock and multiorgan failure Super-antigen causes intense T cell stimulation - excessive immune activation and pro-inflammatory cytokine release High case fatality

What are the clinical features of toxic shock syndrome?

Fever, diffuse maculopapular sunburn rash, mucosal changes (swollen lips, strawberry tongue + non-purulent conjunctivitis), profuse diarrhoea in S. aureus and rapid progression to shock + multiorgan failure

What is the management of TSS?

ABC Fluid restriction and inotropes Cultures IV antibiotics - flucloxacillin and clindamycin IVIG Avoid NSAIDs Surgical debridement