Paeds infection (ILA 1) Flashcards
What is meningitis?
inflammation of the meninges
Name the most common causative organisms causing bacterial meningitis if <3 months old
Group B streptococcus
E.coli
Listeria monocytogenes
Name the most common causative organisms causing bacterial meningitis in 1 month - 6 years old
SPREAD VIA RESP SECRETION
Neisseria meningitidis = gram - ve diplococci
Streptococcus pneumoniae
Haemophilus influenzae
Name the most common causative organisms causing bacterial meningitis if >6 years old
Neisseria meningitidis
Streptococcus pneumoniae
Name the causative organisms of viral meningitis
viral meningitis is the most common cause
enterovirus
Epstein Barr virus
adenovirus
mumps
List the symptoms of meningitis
fever headache photophobia neck stiffness lethargy / irritable poor feeding vomiting drowsiness seizures
List the signs of meningitis
fever purpuric rash neck stiffness bulging fontanelle positive brudzinski / kernels sign signs of shock focal neurological signs
What are the best diagnostic tests for meningitis?
- lumbar puncture and CSF changes
- blood culture
- PCR - take EDTA blood sample
- septic screen!
When should a lumbar puncture not be performed if suspect meningitis?
if suspect meningococcus
if raised ICP or focal neurological signs - this is because at risk of coning the cerebellum through the foramen magnum
Outline the typical changes in the CSF in meningitis for bacterial or viral causes
BACTERIAL turbid appearance increased polymorphs increased protein decreased glucose
VIRAL clear appearance increased lymphocytes normal / slightly increased protein normal/ slightly decreased glucose
how is meningitis managed in a child >3 months old in both the hospital and community?
hospital = IV cefotaxime community = IM benzylpenicillin
+ fluids, cerebral monitorting, mechanical ventilation
How is meningitis managed in a child <3 months old?
IV cefotaxime + Iv amoxicillin
covers for listeria
What should be given in addition to the antibiotics if suspect the cause to be Haemophilus influenzae in meningitis
dexamethasone
What is given as prophylaxis to immediate family members/ close contact of a child with meningitis?
ciprofloxacin* or rifampicin
close contact = if live with child
What are the most common causes of encephalitis?
enterovirus
respiratory viruses e.g. influenza
herpes virus
How does encephalitis present?
presents similar to meningitis …
fever
altered consciousness
seizures
How is encephalitis diagnosed?
- PCR
- EEG
- CT/MRI
How is encephalitis treated?
high dose acyclovir
What are the most common causative organisms of toxic shock syndrome?
staphylococcus aureus
group A streptococcus
What is the diagnostic criteria for toxic shock syndrome?
- fever >39
- hypotension <90 systolic
- diffuse erythematous rash and desquamation of rash on palms and soles
- > 3 organ systems involved e.g. mucositis, diarrhoea, renal or lover impairment, clotting abnormalities
How is toxic shock managed?
- manage shock - intensive care
- antibiotics e.g. ceftriaxone + clindamycin
- IV immunoglobulin
- surgical debridement of infected areas
What is necrotising fasciitis?
severe subcutaneous infection, involving tissue planes from skin down to fascia and muscle
Name the common causes of necrotising fasciitis?
Type 1= mixed anaerobes e.g. post surgery in a diabetic
Type 2= streptococcus progenies, staph. aureus
How does necrotising fasciitis present?
severe painful erythematous lesion
systemic illness
acute onset
MEDICAL EMERGENCY
How is necrotising fasciitis managed?
IV antibiotics
surgical debridement of the necrosis tissue
What is kawasaki disease?
systemic vasculitis affecting children 6 months - 4 years old and most common in children of Japanese or Afro caribbean descent
How is a clinical diagnosis of kawasaki disease made?
CRASH AND BURN (>5 days fever difficult to control) C- conjunctivitis R- rash (erythematous and desquamation) A- adenopathy (cervical lymphadenopathy) S- strawberry tongue and cracked lips H- hands and feet red and oedematous
+/- irritable, inflammation of BCG site
Which investigation is necessary to screen for complications of kawasaki disease?
ECHOCARDIOGRAM to screen for coronary artery aneurysm
children may require long term warfarin therapy if have coronary artery aneurysm
How is kawasaki disease managed?
- high dose aspirin
SE: REYES SYNDROME (encephalopathy), tarry stool, Abdominal pain - IV immunoglobulin
SE: anaphylaxis, AKI, haemolytic anaemia
how does TB spread?
spreads by respiratory route and increasing transmission includes…
- close proximity
- infectious load
- underlying immunodeficiency
- crowding
What is the causative organism of TB?
mycobacterium tuberculosis
How does active TB present?
prolonged fever
malaise
weight loss
focal signs of infection e.g. lymph node swelling
resp = cough, sputum production, night sweats
extra pulmonary disease = genitourinary, meningitis, osteoarticular
Which test is used to screen for latent TB?
Mantoux test / tuberculin skin test
inject purified protein derived from tuberculin into forearm and read after 48-72 hours
>5/6mm = positive
How is TB diagnosed?
- Interferon gamma release assays
blood test for TB, +ve = TB - sputum samples
use Ziehl Neelsen statins for acid fast bacilli
How is active TB treated?
quadruple therapy of…
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
How is latent TB treated? (positive Mantoux test and asymptomatic)
3 months of rifampicin and isoniazid
BCG vaccination
How is TB prevented?
BCG vaccination
How is HIV transmitted to children?
- mother to child transmission e.g. during pregnancy, at delivery, breast feeding
- infected blood products
- contaminated needles
- sexual abuse
What is the pathology behind HIV?
Human Immunodeficiency Virus causes low levels of CD4 t cells so more susceptible to opportunistic infections
How might HIV present in children if mild/ moderate/severe immunocompromised?
- MILD IMMUNOCOMPROMISED
lymphadenopathy, parotid enlargement - MODERATE IMMUNOCOMPROMISED
recurrent bacterial infections, chronic diarrhoea, lymphocytic interstitial pneumonitis - AIDS
opportunistic infections e.g. pneumocytisis jirovecii pneumonia, encephalopathy, malignancy
How is HIV diagnosed?
HIV DNA PCR
if born to infected mothers, will have transplacental maternal IgG HIV antibodies
How is HIV managed?
- anti-retroviral therapy (ART)
- prophylaxis of cotrimoxazole
- immunisations up to date
- MDT management
- regular follow ups
What are the most common causes of sepsis?
E.coli * = early onset in neonates
group B streptococcus = early onset in neonates
staphylococcus aureus = late onset in neonates
Neisseria meningitidis
streptococcus pneumonia
What is sepsis?
inflammatory response to bacterial infection of the blood causing organ dysfunction
How does sepsis present?
fever lethargy irritable, miserable poor feeding history of focal infection e.g. meningitis, osteomyelitis, gastroenteritis, cellulitis
What are the signs of sepsis?
fever tachycardia tachypnoea low blood pressure shock multiorgan failure
List the features of a septic screen?
- blood cultures
- FBC
- U&E
- urine sample and MC&S
- Chest X-ray
- lumbar puncture and CSF
- CRP and ESR
How is sepsis managed?
- ABCDE - assess for signs of shock
- IV antibiotics - start without delay
- IV fluids - catheterise to monitor urine output, central venous pressure monitoring
- circulatory support
What are the 4 most common key infections in children?
- respiratory infection (pneumonia)
- UTI
- sepsis
- meningitis
What is the cause of purpura?
purple red lesions on the skin, non blanching
caused by blood vessels damaged by bacteria/ toxins of the infection and leaking blood under the skin
What are the contraindications of rifampicin and possible side effects?
do not wear contact lenses
pregnancy
SE= urine and tears red
How is chickenpox caused?
Primary Varicella zoster virus
Describe the features of chicken pox
Fever, unwell
Vesicular rash on face and trunk
Papules -> vesicles -> pustules -> crusts
Itchy
How is chicken pox managed?
Calamine lotion
Human varicella zoster immunoglobulin if immunocompromised or in close contact
School exclusion for 5 days after rash
How does measles present?
C- cough
C- coryza
C- conjunctivitis
K- koplik spots - white spots on buffalo mucosa
+ maculopapular rash behind ears to whole of body , fever
How is measles confirmed?
PCR- igM antibodies within few days of rash
How is measles managed?
- Supportive
- Ribavirin if immunocompromised
- Notify public health
- If close contacts unvaccinated, have MMR within 72 hrs
How is parvovirus caused?
Human parvovirus B19
Transmission via real secretions, vertical transmission, infected blood products
How does parvovirus present?
Slapped cheek syndrome - erythema infectiosum
With fever, malaise, headache and myalgia
What causes roseola infantum?
Human herpes virus 6
How does roseola infantum present?
Hugh fever
Maculopapular rash
Febrile convulsions
Diarrhoea and cough
Comp: a sceptic meningitis, hepatitis
How does mumps present?
Hugh fever
Malaise
Parotitis - swelling on one side of face, ear ache, pain on eating or drinking
Infertility in boys
How is mumps diagnoses?
Plasma amylase elevated
How does herpes simplex virus 1 present?
Vesicular lesions on lips and gums and tongue - painful, ulceration, bleeding
Eating and drinking painful
Hugh fever
For 2 weeks
How is herpes simplex virus managed?
Aciclovir - viral DNA polymerase inhibitor
What causes glandular fever / infectious mononucleosis?
Epstein Barr virus (HHV4)
How does glandular fever present?
- Cervical lymphadenopathy
- Fever
- Painful sore throat
+ malaise, myalgia, fatigue, splenomegaly, Petechie on soft palate, jaundice
How is glandular fever diagnosed?
Mono spot test - antibodies test
FBC- lymphocytes
How is glandular fever managed?
- Supportive care - fluids, analgesia, avoid alcohol, rest
2. No contact sports for 8 weeks
How is scarlet fever caused?
Reaction to strep toxin after sore throat
How does scarlet fever present?
Strawberry tongue - white coat and red papillae
Rash on torso , sandpaper
Tonsillitis
Describe the rash in meningococcal septicaemia
non blanching purpuric
purpura occurs because toxins form the infection damage the blood vessels causing them to leak under the skin
