Paediatric infectious diseases Flashcards by Michael Gray

What are 6 signs of sepsis in a child?

Temperature >38 or <36
Inappropriate tachycardia
Poor peripheral perfusion
Altered mental state
Inappropriate tachypnoea
Hypotension

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What are 3 signs of sepsis for a child under 5?

Not feeding
Vomiting repeatedly
Hasn’t had a wee or wet nappy for 12 hours

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What are the SIRS criteria?

2 or more of:
Temperature >38 or <36
WCC >15x10^9 or <5x10^9/l
Tachycardia
Tachypnoea

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What is sepsis?

SIRS + suspected or proven infection

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What is severe sepsis?

Sepsis + organ dysfunction

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What is septic shock?

Sepsis + CVS dysfunction

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How might mental state be altered in paediatric sepsis?

Sleepiness
Irritability
Lethargy
Floppiness

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What are some risk factors for infection in infants <3 months?

Premature
Maternal pyrexia
Maternal Group B Strep (GBS)
Maternal STI
Premature rupture of membranes (PROM)

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How do you manage a septic baby?

Airway
Breathing
Circulation - 20ml/kg fluid bolus
DEFG - Don't ever forget glucose - 2ml/kg 10% dextrose
Antibiotics

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Which antibiotics might be used for a septic baby?

3rd gen cephalosporin like cefotaxime or ceftriaxone

Add IV amoxicillin if <1m old

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What are some blood tests to run for a septic baby?

FBC
CRP
Coagulation screen
Blood gas
Glucose
Blood culture

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How would an FBC come back in sepsis?

Leukocytosis

Thrombocytopenia

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How would a blood gas come back in sepsis?

Metabolic acidosis

Raised lactate

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What could you send for culture in sepsis?

Blood
Urine
CSF
Stool

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Which imaging technique could be used in sepsis?

CXR

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What are the main organisms causing sepsis and meningitis in neonates?

Group B Strep
Escherichia coli
Listeria monocytogenes

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

Strep pneumoniae
Neisseria meningitidis
Group A strep
Staph aureus

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What is the pathogenesis of sepsis?

Secretion of pro and anti-inflammatory cytokines
Activation of complement
Activation and mobilisation of leukocytes
Activation of coagulation and inhibition of fibrinolysis
Increased apoptosis

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

Fever
Headache
Photophobia
Neck stiffness 
Nausea & vomiting
Reduced GCS
Seizures
Focal neurological deficits

What causes neck stiffness in meningitis of older children?

Nuchal rigidity

What are some signs and symptoms of meningitis in young infants?

Fever/hypothermia
Poor feeding
Vomiting
Lethargy
Irritability
Respiratory distress
Apnoea
Bulging fontanelle

How can you test nuchal rigidity (neck stiffness)?

Palpable resistance to neck flexion

What is Brudzinski’s sign?

Hips and knees flex on passive flexion of the neck

What is Kernig’s sign?

Pain on passive extension of the knee

What are some clinical signs of meningitis?

Nuchal rigidity Brudzinski's sign Kernig's sign

What are the main bacteria causing meningitis in older children?

Strep pneumoniae Neisseria meningitidis Haemophilus influenzae b

What is the carriage of Haem influenzae and neisseria meningitidis?

Nasopharyngeal

Which aspects of the immune response can haem influenzae resist?

Phagocytosis | Complement mediated lysis

How is neisseria meningitidis transmitted?

Respiratory secretions

What are some risk factors for invasive meningococcal disease?

``` Age <1 year or 15-24 years Unimmunised Crowded living conditions Household or kissing contact Cigarette smoking (active or passive) Recent viral/Mycoplasma infection Complement deficiency ```

How does invasive meningococcal disease progress?

Rapidly

What are some possible long term complications of invasive meningococcal disease?

Amputation Scarring Hearing loss Cognitive impairment

Which aspects of the immune response can strep pneumoniae resist?

Neutrophil phagocytosis | Complement mediated cell lysis

What are some risk factors for invasive pneumococcal disease?

``` Age <2 years Cigarette smoking (active or passive) Recent viral URTI Attendance at childcare Cochlear implant Sickle cell disease Asplenia HIV infection Nephrotic syndrome Immunodeficiency ```

What are some long term neuro complications of pneumococcal meningitis?

``` Hydrocephalus Neurodisability Seizures Hearing loss Blindness ```

Are tests results for meningitis similar?

Yeah pretty much the same | More signs of raised ICP in meningitis

How does staphylococcal scalded skin syndrome present?

``` Initial bullous lesions Followed by widespread desquamation Nikolsky sign Mild fever Purulent conjunctivitis ```

How do we manage staphylococcal scalded skin syndrome?

IV flucloxacillin | IV fluids

How does scarlet fever present?

``` Fever Malaise Sore throat Strawberry tongue Sandpaper rash Skin peeling (desquamation) ```

How is scarlet fever managed?

Phenoxymethylpenicillin

What are the main causative organisms behind TSS?

Staph aureus | Group A Strep

How does TSS present?

``` Fever Diffuse "sunburn" rash Swollen lips Diarrhoea Rapid progression and multi-organ failure ```

How is TSS managed?

Fluid resuscitation Cultures IV flucloxacillin + clindamycin Avoid NSAIDs