Paediatric Infectious Diseases Flashcards
Part 1
what is the epidemiology of infectious diseases in children?
- 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
________ 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
Infection
infectious
non-specific
how has child mortality changed?
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.
why worry about infections?
- 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
Part 2
•Severe sepsis is one of the leading causes of death in children
what is the epidemiology in children?
- >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
what is sepsis?
•Sepsis = SIRS + suspected or proven infection
Overwhelming, life-threatening response to infection which, untreated, can lead to tissue damage organ failure and death
what is severe sepsis?
•Severe Sepsis = Sepsis + organ dysfunction
what is septic shock?
•Septic Shock = Sepsis + CVS dysfunction
traffic light table
what is the recognition tool for sepsis?
Infants <3 months - what are they more at risk of?
- Increased risk bacterial infection
- Increased risk sepsis
- Increased risk meningitis
Infants <3 months - how do they present?
- May have minimal signs & symptoms
- Presentation often non-specific
- May not mount a febrile response (~50%)
- Deteriorate quickly
what increases the risk of infection in Infants <3 months?
- Prematurity (< 37/40)
- PROM
- Maternal pyrexia/chorioamnionitis
- Maternal GBS (this pregnancy)
- Previous child with GBS
- Maternal STI (Chlamydia, Gonorrhoea, Syphilis, HSV)
what is the management of infection?
- 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
what investigations oculd be carried out?
what are the responsible oranisms for infection?
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
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
death
recognition
3
fever
Part 3
what is meningitis?
• 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
what is meningism?
The clinical signs and symptoms suggestive of meningeal irritation