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
Meningococcal Disease
Meningococcus in nasopharynx –> passes through Epithelia to enter the blood stream
<12 hours signs of septic Shock
<18-36 hours signs of meningitis
Long term morbidity:
Amputation
Skin scarring
Cognitive impairment, Hearing loss, epilepsy
meningococcal disease virulence factors
Endotoxin = Lipooligosaccharide
Endotoxin levels and mortality are related
Vaccine preventable diseases
Haemophilus influenza B
Pneumococcal disease
Meningococcal disease
Scarlet Fever - Typical Strep A infection
Contact - 2-4 day incubation
malaise, fever, tonsilitis
Strawberry Tongue
Squamation of hands and feet
Cause of Scarlet Fever (scarlatina)
Group A Beta-Haemolytic Streptococci
Ages between 2 -10
Complications of Scarlatina
Impetigo Erysipelas Cellulitis Streptococcal toxic shock Glomerulonephritis
Treatment of Scarlatina
10 day course penicillin
cause of Impetigo
Strep Pyogenes AND staph A.
Staphylococcal septic shock syndrome (SSSS)
Exotoxin of Staph A. mostly kids <5 Fever Wide spread redness Fluid filled blisters - rupture easily, espescially in skin folds
Clinical Symptoms of Kawasaki Disease
Fever for at least 5 days + 4 out of the following 5 Bilateral conjunctival infection Changes to mucus membranes Cervical Lymphadenopathy Polymorphous rash Changes to extremities Peripheral edema peripheral erythema periungual desquamation
Treatment of Kawasaki disease
To Prevent complications like vasculitis of the coronary arteries
Immunoglobulins - boost immune system
aspirin
other immunosuppressive agents
Henoch-Schonlein Purpura
Vasculitis (Skin Kidneys, More rarely GI tract_
Associated with previous aspecific viral illness
