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Year 3 - Paediatrics > Paediatric Infectious Diseases > Flashcards

Paediatric Infectious Diseases Flashcards

1
Q

Part 1

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2
Q

what is the epidemiology of infectious diseases in children?

A
  • Infection in children is common!!
  • Average pre-school child will have 8-12 respiratory tract infections per year
  • Majority (in the developed world) due to viruses
  • Majority self-limiting (do not need treatment)
  • Median duration 8-14 days
  • Likely to spend 3-5 months per year with a viral infection
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3
Q

________ in children is a major source of healthcare-seeking behaviour

Large increase in number of admissions and most of the increase is _________ diseases

Signs of infection in children are often very ___________ and can progress quickly and this brings a lot of anxiety to parents

A

Infection

infectious

non-specific

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4
Q

how has child mortality changed?

A

it has redued

Primarily through improvements in public health through the provision of clean water, sanitation and hygiene, reducing overcrowding and improving nutrition. But also advances in modern medicine such as antibiotics and immunisations.

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5
Q

why worry about infections?

A
  • Mortality outcomes for C&YP in the UK are considerably worse than comparable high income countries
  • The UK ranks in the bottom 3 countries in the EU15+ for mortality from common infections in both sexes and across all age groups
  • Mortality from treatable infection in the UK is almost 2x that of our best performing European neighbours
  • Infections account for: 16.2% deaths in 1-4 year olds, 8% deaths in 5-9 year olds

•Failure to recognise serious illness at the point of 1st healthcare contact is an important avoidable factor in child death

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6
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Part 2

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7
Q

•Severe sepsis is one of the leading causes of death in children

what is the epidemiology in children?

A
  • >½ of all sepsis cases worldwide occurred in children
  • Peak incidence in early childhood
  • Infants <1y: 1 in 200
  • Children 1-4y: 1 in 2000
  • Children 5-15y: 1 in 5000
  • Case fatality rate ≈10%
  • In the UK only 38% compliance with recommended treatment guidelines
  • Early recognition and appropriate treatment of sepsis improves survival
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8
Q

what is sepsis?

A

•Sepsis = SIRS + suspected or proven infection

Overwhelming, life-threatening response to infection which, untreated, can lead to tissue damage organ failure and death

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9
Q

what is severe sepsis?

A

•Severe Sepsis = Sepsis + organ dysfunction

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10
Q

what is septic shock?

A

•Septic Shock = Sepsis + CVS dysfunction

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11
Q

Hard to recognise sepsis in children as no set criteria

This chart helps to identify children you should be worried about

Children HR do go up with temperature and that is normal

traffic light table

A
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12
Q

what is the recognition tool for sepsis?

A

Sepsis 6 in middle

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13
Q

Infants <3 months - what are they more at risk of? Why do we worry about infants <3 months of age?

A
  • Increased risk bacterial infection
  • Increased risk sepsis
  • Increased risk meningitis
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14
Q

Infants <3 months - how do they present?

A
  • May have minimal signs & symptoms
  • Presentation often non-specific
  • May not mount a febrile response (~50%)
  • Deteriorate quickly
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15
Q

what increases the risk of infection in Infants <3 months?

A
  • Prematurity (< 37/40)
  • PROM
  • Maternal pyrexia/chorioamnionitis
  • Maternal GBS (this pregnancy)
  • Previous child with GBS
  • Maternal STI (Chlamydia, Gonorrhoea, Syphilis, HSV)
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16
Q

what is the management of sepsis?

A
  • Airway
  • Breathing
  • Circulation – 20ml/kg fluid bolus
  • DEFG – ‘don’t ever forget glucose’ – 2ml/kg 10% dextrose
  • Antibiotics
  • 3rd generation cephalosporin (eg Cefotaxime/Ceftriaxone)
  • add IV Amoxicillin if <1m old

Paediatric sepsis 6 also has a management tool

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17
Q

what investigations could be carried out for sepsis?

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18
Q

what are the responsible oranisms for sepsis?

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19
Q

what is the Pathogenesis of Sepsis?

A

Secretion of pro and anti-inflammatory cytokines

Activation of complement

Activation and mobilisation of leukocytes

Activation of coagulation and inhibition of fibrinolysis

Increased apoptosis

Sepsis is generally an overwhelming response to infection

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20
Q

take home messages:

  • Sepsis is a major cause of _____ in children
  • Early _________ improves survival
  • Important to think ‘could this be sepsis?’
  • Respond appropriately
  • If you’re not sure ask!
  • Follow guidelines!

•Paediatricians want to know about any child

A

death

recognition

3

fever

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21
Q

Part 3

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22
Q

what is meningitis?

A

• A disease caused by inflammation of the meninges

Meningitis is inflammation of the lining around your brain and spinal cord. It can be very serious if not treated quickly.

3 layers – dura, arachnoid and pia with CSF between your arachnoid and pia mater

Inflammation of underlying brain parenchyma = meningeal encephalitis

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23
Q

what is meningism?

A

The clinical signs and symptoms suggestive of meningeal irritation

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24
Q

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

A
  • Fever (In older children may see classical triad of fever, headache and neck stiffness)
  • Headache
  • Photophobia
  • Neck stiffness (nuchal rigidity)
  • Nausea & vomiting
  • Reduced GCS
  • Seizures
  • Focal neurological deficits
25
what are the signs and symptoms of meningitis in young infants? (Infants present with non-specific features)
* Fever or hypothermia * Poor feeding * Vomiting * Lethargy * Irritability * Respiratory distress * Apnoea (pause in breathing lasting at least 20 seconds) * Bulging fontanelle (signifies raised ICP)
26
Clinical Signs of Meningitis - what are they?
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
27
what are the Causes of Childhood Meningitis (in the post-vaccine era)?
* Bacterial (4-18%) * Viral – Mainly Enterovirus (54-88%) * Fungal – Neonates/Immunocompromised * Unknown/aseptic (40-76%)
28
Bacterial Meningitis - what are the responsible organisms for bacterial meningitis in neonates (\<1 month) and older infants & children?
29
H. influenzae meningitis - how have the cases changed?
6.72/100,000 (1992) -\> 0.28/100,000 (2008) decreased top graph
30
what is Haemophilus influenzae?
* Small, non-motile, gram-negative coccobacillus * Nasopharyngeal carriage * Encapsulated H. influenzae and Non-encapsulated = Non-typeable H. influenzae (NTHI)
31
Haemophilus influenzae - what do encapsulated and non-encapsulated H. influenzae cause?
•Encapsulated H. influenzae: - Resist phagocytosis & complement mediated lysis - 6 serotypes (a-f) - Hib main cause of invasive H. influenzae infection - Bacteraemia, Meningitis, Epiglottitis, Pneumonia - RF – asplenia, sickle cell disease, antibody deficiency •Non-encapsulated = Non-typeable H. influenzae (NTHI): - otitis media & sinusitis - invasive infection rare
32
what is Neisseria meningitidis?
* Gram negative diplococcus * Humans only natural hosts * Nasopharyngeal carriage * Transmission via respiratory secretions * Infection often follows viral URTI * Polysaccharide capsule - capsule composition determines serogroup (eg. A, B, C, W, Y) * Endotoxin (LPS) Neisseria meningitidis, often referred to as meningococcus
33
what ar ethe risk factors for Invasive Meningococcal Disease? Meningococcal disease is a serious infection caused by the bacteria Neisseria meningitidis. In rare instances, it can become invasive and cause meningitis (an infection of the lining of the brain and spinal cord)
* 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
34
Invasive Meningococcal Disease - what does it cause?
Huge overlap, features of both Petechial – small non blanching spots Purpura – bigger bruise like lesions
35
Invasive Meningococcal Disease - is it dangerous?
* Rapidly progressive * Case fatality rate 5-15% - 50% of deaths in 1st 12h - 80% of deaths in 1st 48h •Significant long term sequelae - Amputation (14%) - Scarring (48%) - Hearing Loss - Cognitive impairment/epilepsy
36
Going on to look at the third big cause of bacterial meningitis in children: what is Streptococcus pnuemoniae (Pneumococcus)?
* Gram positive, lancet-shaped, diplococcus * Facultative anaerobe * Polysaccharide capsule - inhibits neutrophil phagocytosis, inhibits complement mediated cell lysis * \>90 known serotypes - All serotypes can cause invasive disease * Colonises nasopharynx (11-93%!) * Preceeding URTI RF for invasive infection * Respiratory droplet transmission Can cause lots of different infections
37
what are the 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/Immunosuppression
38
Pneumococcal Meningitis - what can it result in?
* Case fatality in children 8% * Neurological sequelae common: Hydrocephalus, Neurodisability, Seizures, Hearing loss, Blindness
39
what is the management of meningitis? | (same as sepsis)
* Airway * Breathing * Circulation – 20ml/kg fluid bolus, inotropes * DEFG – ‘don’t ever forget glucose’ - 2ml/kg 10% dextrose * Antibiotics - 3rd generation cephalosporin (e.g. Cefotaxime/Ceftriaxone) - add IV Amoxicillin if \<1m old
40
what investigations can be done for meningitis?
Blood culture ideally before antibiotics but if not possible then dont delay antibiotics Lumbar puncture gives you the diagnosis
41
what are the contraindicaitons of a lumbar puncture?
42
what do you want to request on a lumbar pucture and what wold your findings be in meningitis?
viral PCR because Viral causes are the most common in children
43
Bacterial Meningitis - what is the Treatment Duration?
44
Summary: * Meningitis remains a serious cause of morbidity and ________ in children * Bacterial meningitis is a devastating infection with serious long term \_\_\_\_\_\_\_ * Meningitis and sepsis can progress \_\_\_\_\_\_ * Early recognition and treatment are \_\_\_\_\_\_\_ * \_\_\_\_\_\_\_ provides effective prevention against many childhood causes of meningitis
mortality sequelae rapidly imperative Vaccination
45
Part 4
46
Majority skin & soft tissue infections caused by what?
by Staph (mainly S. aureus) or Strep (S. pyogenes) * Both organisms cause osteoarticular infection * Both organisms cause bacteraemia * Both cause toxin-mediated diseases - Staphylococcal & Streptococcal Toxic Shock Syndrome (TSS)
47
what are the micorobiological features of Staphylococcus aureus?
Gram +ve cocci Coagulase +ve Produce exotoxins & form superantigens Colonise skin & mucosa Resistance is a problem (MRSA) Staph forms clusters
48
what are the micorobiological features of Streptococcus pyogenes (GAS)?
Gram +ve cocci β-haemolytic Produce exotoxins & form superantigens Oro-pharyngeal carriage Resistance is not a problem (universally S to penicillin)
49
Staph and strep cause a similar picture of infection, all these pictures could be either whata re some skin and soft tissue infecitons that they can cause?
50
what is Staphylococcal Scalded Skin Syndrome?
* Usually \<5y * Toxin mediated (exfoliatoxin) * Initial bullous lesions * Followed by widespread desquamation * Nikolsky sign * Mild fever * Purulent conjunctivitis
51
how is Staphylococcal Scalded Skin Syndrome managed?
Mx – IV Flucloxacillin + IV Fluids
52
what happens in scalret fever?
Unique to group A strep Scarlet fever is a toxin mediated disease, you have the acute infection but it is the toxin that produces the rash and things associated with it
53
how do you manage scarlet fever?
* Notifiable disease - inform public health * Phenoxymethylpenicillin (Penicillin V) 10 days - Reduces duration and severity illness by ~1 day - Reduces incidence of complications (quincy/acute rheumatic fever/post-streptococcal glomerulonephritis) - Reduces transmission
54
what are the complications of scarlet fever?
* Abscess formation - retropharyngeal or peritonsillar (quincy) * Acute Rheumatic Fever - most common cause acquired heart disease in children worldwide, 2-3/52 after pharyngitis, Presents with: arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules * Post-streptococcal glomerulonephritis
55
what is Toxic Shock Syndrome (TSS)? This is the other significant toxin mediated disease
* Acute febrile illness caused by Gram +ve bacteria (S. aureus & GAS) rapidly progressing to shock and multiorgan failure * Superantigen causes intense T cell stimulation - cessive immune activation, pro-inflammatory cytokine release (TNF-α, IL-1, IL-2, IFN-γ) * Case fatality - 30-60% GAS, 3-6% S. aureus
56
what are the clinical features of TSS?
* Fever * Diffuse, maculopapular, ‘sunburn’ rash * Mucosal changes - non-purulent conjunctivitis, swollen lips, strawberry tongue * Profuse diarrhoea (S. aureus) * Rapid progression to shock & multi-organ failure - tachycardia, prolonged CRT, hypotension, renal impairment, transaminitis, reduced GCS
57
how is TSS managed?
* ABC * Fluid resuscitation +/- inotropes * Cultures - Blood, Throat swabs, Wounds * IV Antibiotics - Flucloxacillin + Clindamycin * IVIG * Avoid NSAIDs * Surgical debridement
58
Staphylococcal & Streptococcal Infection Recap: * Predominant cause of skin & ____ \_\_\_\_\_\_\_ infection in children * Cause very similar patterns of _______ - except Scarlet Fever (exclusively GAS) & SSSS * \_\_\_\_\_\_ are major virulence factors * Can cause significant morbidity and \_\_\_\_\_\_\_
soft tissue infection Toxins mortality

Year 3 - Paediatrics (40 decks)

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