Paediatric Infectious diseases Flashcards
Define Sepsis + Multi organ failure
2 or more of the Following Respiratory failure Renal Failure Neurological failure Haematological failure Liver failure
Define ARDS
Acute respiratory response syndrome
Inflammatory response in the lungs
SIRS + Suspected/Proven infection
SIRS = Systemic inflammatory response syndrome Fever OR Hypothermia Tachycardia Tachypnoea Leucocytosis Or Leucocytopaenia
Responsible Organisms in Paediatric sepsis
Neonates (<1 month)
Group B Streptococci
E. Coli
Listeria Monocytogenes
Children Strep Pneumoniae Meningococcal Group A streptococci Staph A.
Symptoms of Paediatric Sepsis
Fever or Hypothermia cold Hands/feet - Mottled prolonged capillary refill time Chills/Rigors Limb pain Vomiting and or diarrhoea Muscle weakness Muscle/Joint ache Skin Rash Diminished urine output
Organisms responsible for paediatric minigitis
Neonates (<1 month)
Group B strep
E. Coli
Listeria monocytogenes
Children
Strep Pneumoniae
Meningococcal
Haemophilus B
Menigitis Symptoms
Nuchal Rigidity Headaches, Photophobia Diminished consciousness Focal neurological abnormalities Seizures
Specifically in neonates
Lethargy and irratiblity
Bulging fontanelle
‘Nappy pain’
Paediatric Sepsis 6
Temperature <36 or >38
Inappropriate Tachycardia (refer to the PEWS score)
Poor peripheral perfusion / Cap Refill - > 2s / mottled
Altered mental State
Inappropriate tachypnoea - Refer to PEWS
Hypotension - Refer to PEWS
If Yes to 1 - consider sepsis criteria threshold
If Yes to 2 - refer to Senior Dr and Consider sepsis 6
if 3+ yes - immediate senior Dr review and begin Sepsis 6
Meningitis +/- sepsis treatment
Supportive Treatment
A, B, C + DEFG (Don’t EVER forget Glucose)
Causative Treatment
Abx - < 3 months: IV amoxicillin + Ceftriaxone
> 3 months: IV Cefotaxime
Fluids - colloid
Cerebral monitoring
Chemoprophylaxis
Close Household contacts
Meningococcus B and Group A strep
What is the paediatric Sepsis 6
Give High flow O2
Obtain IV access and bloods (Sugar, Culture, Lactate)
Give IV Abx (ceftriaxon + amoxicillin or Cefotaxime)
Consider Fluid Resus
Consider Early Ionotropic support
Involve senior/ Specialist help early
Dx of meningitis + sepsis
Blood FBC, Leucocytosis, Thrombocytopaenia CRP ---> will be elevated Coag screen - Low due to DIC Blood gas looking for metabolic Acidosis Glucose --> Low
CFS: Pleocytosis, increased protein, Low glucose
Blood and CSF cultures (antigen testing and PCR)
Urinary Culture, Skin Bx culture
Imaging: CT-cerebrum
Info on Strep Pneumoniae
Gram +ve Diplococci
Colonizes upper airway of children and adults
Transmission via Droplets
Viral Infections will predispose invasive disease
Spread of Pneumoccocal Infection
From nasopharyngeal Carriage to…
Aspiration -> alveoli where is will spread to Pleura or
pericardium causing empyema OR to the blood
causing septicaemia: meningitis,
Arthritis/osteomyleitis, Peritonitis
Local Spread –> Sinusitis or otitis media OR
septicaemia resulting in the same ending.
Complications of Pneumococcal Meningitis
Brain damage
Hearing loss
Hydrocephalus
Info On Haemophilus influenza type B
Gram -ve
capable of resisting phagocytosis and compliment-mediated lysis
Bacteraemia, meningitis (as severe as pneumococcal), Pneumonia, epiglottitis
Viral infection also predisposes
