Paeds infection and immunity 2

Question 1

In meningococcal sepsis the bacterial component activate pro-inflammatory cytokines. What are 4 consequences of this?

Answer 1

Capillary leak - leads to reduced intravascular volume and venous return to heart, ‘hypovolaemic’ shock resistant to volume expansion

Coagulopathy - endothelial injury produces platelet plugs, and DIC can cause consumption of coag factors. Also downregulation of coag inhibitors.

Myocardial depression - hypovolaemia, acidosis, proinflammatory response, hypoglycaemia.

Metabolic derangement (everything low )

Question 2

Which organism to consider as a cause of meningoencephalitis?

Answer 2

HSV

Question 3

In neonates, the aetiology of meningitis is different to that in older children. Discuss 3 common causes and their mechanism of infection in neonate meningitis.

Answer 3

GBS - colonisation of birth canal

Listeria monocytogenes - unpasteurised milk during pregnancy

E.coli

Question 4

Prior to the introduction of the vaccination in 1992, HiB was the leading cause of meningitis in children. What are the leading bacterial causes now, and their % incidence?

Answer 4

Neisseria meningitidis B 60-70%

Strep pneumoniae 30%

Rest is a combination of HiB, TB and GBS

Question 5

Most common viral cause of meningitis:

Answer 5

Enterovirus

Question 6

Treatment of pertussis:

Answer 6

Supportive
Low threshold for neonatal admission for feeding support

Antibiotics can be given but this is mainly to reduce infectivity and risk of complications.

Question 7

Which 3 infections have an incubation period of 7-14 days?

Answer 7

Measles (virus)
Roseola infantum (virus)

Pertussis (bacteria)

Question 8

Pertussis has a catarrhal phase with low grade fever, coryza and conjunctivitis for 1-2 weeks. How is it investigated, and what are some complications?

Answer 8

Nasal swab for PCR and culture.
Lymphocytosis on bloods.

Feeding problems and post-tussive vomiting leading to weight loss.

Bronchiectasis
Otitis media
Subconjunctival, subarach or IV haemorrhage
Umbilical / inguinal hernia

Question 9

Infectivity period for chickenpox?

Answer 9

2-4 days prior to rash to 5 days post rash starting OR until all lesions have crusted over

Question 10

Features of chickenpox rash:

Answer 10

Itchy
Starts on trunk and spreads to limbs
Crusting as resolves

Question 11

2 most common bacteria to cause secondary infection from chickenpox:

Answer 11

GAS
Staph aureus

Question 12

Which babies are at more risk of developing bronchiolitis, and how can this risk be reduced?

Answer 12

Pre-term
Chronic lung disease
Immunocompromised
Cardiopulmonary disease

Targeted passive immunity via IV or subcut immunoglobulin

Question 13

Tests to confirm throat infection, both bacterial and viral:

Answer 13

Charcoal swab for microscopy, sensitivity and culture

Charcoal swab but send in viral medium sample for PCR

Question 14

4 complications of not treating a bacterial throat infection:

Answer 14

Quinsy
Rheumatic fever
Glomerulonephritis strep associated
Sepsis/ Septic arthritis

Question 15

Definition of sepsis:

Answer 15

Life threatening organ dysfunction due to dysregulated response to an infection

Question 16

The MenB vaccination was introduced in 2015 and protects against meningococcal type B . When is it routinely given?

Answer 16

8w, 16w, 1 year

Question 17

First line antibiotic prophylaxis for contact of meningococcal disease is:

Answer 17

Ciprofloxacin single dose with 24 hours of diagnosis of index case

Question 18

Give an unusual presentation of IDA:

Answer 18

Pica