Paediatric Infectious Diseases Pt. 1 Flashcards
Septicaemia
is a bacterial infection that spreads into the bloodstream
Sepsis
body’s response to infection, during which the immune system will trigger extreme and potentially dangerous, whole-body inflammation.
SIRS =
Systemic inflammatory response syndrome
Fever or Hypothermia
Tachycardia
Tachypnoea
Leucocytosis or Leucocytopaenia
Sepsis = SIRS + ….
suspected/ proven infection
What is the natural progression from infection to Shock?
Infection
- > Infection + SIRS
- > Sepsis (when organ dysfunction occurs) + SIRS
- > Septic Shock + SIRS
How can Sepsis and Shock be picked up early?
PEWS
SEVERE Sepsis =
SEPSIS + multi-organ failure
SEPSIS + multi-organ failure
≥ 2 of the following:
Respiratory failure - most common Renal failure - most common Neurologic failure Haematological failure Liver failure
ARDS =
Acute respiratory distress syndrome
- inflammatory response of the lungs
Septic shock = ….. failure
cardiovascular failure
Incidence of sepsis …. with age
decreases
Paediatric Sepsis
Responsible Pathogens
Neonates
Group B Streptococci
Eschericha Coli
Listeria monocytogenes
Paediatric Sepsis
Responsible Pathogens
Children
Meningococci
Group A streptococci
- see a lot - fairly serious
typically
Streptococcus pneumoniae
Staphylococcus aureus
If Sepsis symptoms overlap with with flu or cold symptoms what might these include?
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
In paeds what is a better indication of how sick a child is?
Tachycardia or hypotension?
Tachycardia as dont drop blood pressure until much later
Treatment for Sepsis involves
Supportive and Causative
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)
Sepsis Investigations
Blood CSF Urine Culture Skin biopsy culture imagine - CT/MRI head
Sepsis investigations (blood)
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
Sepsis investigations (CSF)
Cell count & Culture – increased WCC, antigent testing, PCR
Protein & Glucose - increased protein level, low glucose
Paediatric meningitis Responsible Pathogens
Neonates
Group B streptococci
E. coli
Listeria monocytogenes
Paediatric meningitis Responsible Pathogens
Children
Streptococci pneumoniae
Meningococci (Neisseria Meningitidis)
Haemophilius influenza
Meningitis +/- Sepsis
Children Symptoms
Nuchal rigidity - neck stiffness Headaches, photophobia Diminished consciousness Focal neurological abnormalities Seizures
May just present as sepsis
Meningitis +/- Sepsis
Neonates Symptoms
Lethargy, Irritability
Bulging fontanelle
Seizures
Signs - Meningitis
Meningococcal Rash
Tumbler Test - spots or rashes do not fade with pressure
How do you treat Meningitis?
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
Streptococcus pneumoniae
is a normal flora where?
causes what?
Normal flora in upper resp. tract.
Pneumonia, meningitis, septicaemia.
Vaccine available
in strep pneumoniae and maemophilus influenza type B what is a predisposing factor for invasive disease?
viral infection
complications of pneumococcal meningitis
Brain damage
hearing loss
hydrocephalus
Haemophilus influenza type B
Causes respiratory tract infections. Capsulated form tybe b used to cause menigitis in children (vaccine now available)
