Paediatric Infectious Diseases Pt. 1

Question 1

Septicaemia

Answer 1

is a bacterial infection that spreads into the bloodstream

Question 2

Sepsis

Answer 2

body’s response to infection, during which the immune system will trigger extreme and potentially dangerous, whole-body inflammation.

Question 3

SIRS =

Answer 3

Systemic inflammatory response syndrome

Fever or Hypothermia
Tachycardia
Tachypnoea
Leucocytosis or Leucocytopaenia

Question 4

Sepsis = SIRS + ….

Answer 4

suspected/ proven infection

Question 5

What is the natural progression from infection to Shock?

Answer 5

Infection

• > Infection + SIRS
• > Sepsis (when organ dysfunction occurs) + SIRS
• > Septic Shock + SIRS

Question 6

How can Sepsis and Shock be picked up early?

Answer 6

PEWS

Question 7

SEVERE Sepsis =

Answer 7

SEPSIS + multi-organ failure

Question 8

SEPSIS + multi-organ failure

≥ 2 of the following:

Answer 8

Respiratory failure - most common
Renal failure - most common
Neurologic failure
Haematological failure
Liver failure

Question 9

ARDS =

Answer 9

Acute respiratory distress syndrome

- inflammatory response of the lungs

Question 10

Septic shock = ….. failure

Answer 10

cardiovascular failure

Question 11

Incidence of sepsis …. with age

Answer 11

decreases

Question 12

Paediatric Sepsis
Responsible Pathogens
Neonates

Answer 12

Group B Streptococci

Eschericha Coli
Listeria monocytogenes

Question 13

Paediatric Sepsis
Responsible Pathogens
Children

Answer 13

Meningococci
Group A streptococci
- see a lot - fairly serious
typically

Streptococcus pneumoniae
Staphylococcus aureus

Question 14

If Sepsis symptoms overlap with with flu or cold symptoms what might these include?

Answer 14

Fever or hypothermia
Cold hands/feet, mottled
prolonged cap refill time >2secs
Chills/ rigours
Limb pain
Vomiting and or diarrhoea
muscle weakness
muscle/koint aches
skin rash
diminished urine ouput

Question 15

In paeds what is a better indication of how sick a child is?

Tachycardia or hypotension?

Answer 15

Tachycardia as dont drop blood pressure until much later

Question 16

Treatment for Sepsis involves

Supportive and Causative

Answer 16

Supportive treatment;
A - airway 
B - breathing
C - circulation
DEFG = dont ever forget glucose

Causative treatment:
Antibiotics with broad-spectrum and good CSF penetration
3rd generation cephalosporins (+ amoxicillin if neonate)

Question 17

Sepsis Investigations

Answer 17

Blood
CSF
Urine Culture 
Skin biopsy culture
imagine - CT/MRI head

Question 18

Sepsis investigations (blood)

Answer 18

FBC - leucocytosis, thrombocytopenia
CRP - elevated
Coagulations factors - deranged clotting due to DIC
U+Es, LFTs - Renal and hepatic dysfunction
Blood gas - metabolic acidosis, raised lactate
Glucose – hypoglycaemia
Culture

Question 19

Sepsis investigations (CSF)

Answer 19

Cell count & Culture – increased WCC, antigent testing, PCR
Protein & Glucose - increased protein level, low glucose

Question 20

Paediatric meningitis Responsible Pathogens

Neonates

Answer 20

Group B streptococci

E. coli
Listeria monocytogenes

Question 21

Paediatric meningitis Responsible Pathogens

Children

Answer 21

Streptococci pneumoniae
Meningococci (Neisseria Meningitidis)

Haemophilius influenza

Question 22

Meningitis +/- Sepsis

Children Symptoms

Answer 22

Nuchal rigidity - neck stiffness
Headaches, photophobia
Diminished consciousness
Focal neurological abnormalities
Seizures 

May just present as sepsis

Question 23

Meningitis +/- Sepsis

Neonates Symptoms

Answer 23

Lethargy, Irritability
Bulging fontanelle
Seizures

Question 24

Signs - Meningitis

Answer 24

Meningococcal Rash

Tumbler Test - spots or rashes do not fade with pressure

Question 25

How do you treat Meningitis?

Answer 25

As per sepsis

(Supportive treatment;
A - airway 
B - breathing
C - circulation
DEFG = dont ever forget glucose

Causative treatment:
Antibiotics with broad-spectrum and good CSF penetration
3rd generation cephalosporins (+ amoxicillin if neonate)

PLUS:
Chemoprophylaxis
-for close household contacts of patient
- Steroids

Question 26

Streptococcus pneumoniae
is a normal flora where?
causes what?

Answer 26

Normal flora in upper resp. tract.
Pneumonia, meningitis, septicaemia.
Vaccine available

Question 27

in strep pneumoniae and maemophilus influenza type B what is a predisposing factor for invasive disease?

Answer 27

viral infection

Question 28

complications of pneumococcal meningitis

Answer 28

Brain damage
hearing loss
hydrocephalus

Question 29

Haemophilus influenza type B

Answer 29

Causes respiratory tract infections. Capsulated form tybe b used to cause menigitis in children (vaccine now available)