paeds - infections Flashcards
Reproductive Number (R0) definition
- Average number of secondary cases arising from a primary case in a wholly susceptible population
- Needs to be > 1 to maintain spread
- Assumes disease confined to humans,
homogenous population & stable immunity
Critical Proportion (Pc)
Proportion of population that needs to be successfully immunised to achieve eradication
modes of transmission
- respiratory (droplets, airborne)
- face-oral
- fomites
- parenteral
occupational exposure
UM SIN
- Needle-stick injuries
- Mucosal exposure
- Intact skin
- Secretions/Excretions
- Universal precautions
immunisations
measles
BCG = Bacille-Calmette-Guerin (TB)
OPV = Oral Polio Vaccine
TDaP/HiB/TIPV/HBV = Diphtheria +Tetanus + acellular Pertussis + Haemophilus influenza B + Trivalent Inactivated Polio Virus + Hepatitis B vaccine - currently Hexaxim©
Rota = Rotavirus (currently Rotarix©)
PCV-13 = 13-valent Conjugate Pneumococcal Vaccine (currently Prevenar-13©)
Td = Tetanus + reduced dose Diphtheria
diarrhoea definition
- ≥3 loose stools/day
- Increase in frequency and ‘wateriness’
causes of diarrhea
Infective
- Viral, bacterial, fungal, protozoal, etc.
Non-infective PIME
- Inflammatory, malabsorption, endocrine, psychiatric, etc.
diarrhoea epidemiology
- 3rd most common cause of death in <5y/o in RSA
- 2nd most common cause of death in <5y/o (after pneumonia) annually
diarrhoea leads to
Really dry HILL
dehydration
Children are more prone to dehydration:
- Larger total body water volume (70% in infants)
- Larger body surface area:weight ratio
- Renal immaturity
- Inability to meet own fluid requirements
- Higher metabolic rates
Older children show signs of dehydration quicker than younger ones – smaller ECF volumes
diarrhoea clinical presentation
U & I WAnt A FEStival
- urine output (little/no)
- stool output (watery)
- emesis
- fever
- appetite
- weight loss
- antibiotic use?
- ingestions
diarrhoea S & S
decreased:
- level of consciousness
- capillary refill
- mucous membranes
- tears
- blood pressure
- pulse
- skin tugor
- sunken fontanel
- sunken eyes
- urine output
increased:
- heart rate
- respiratory rate
IMCI dehydration classification
no dehydration
- not enough signs to classify
some dehydration (2 of the following)
- restless/ irritable
- sunken eyes
- drink eagerly
- skin pinch goes back slow
severe dehydration (2 of the following)
- lethargic/ unconscious
- sunken eyes
- not able to drink/ drink poorly
- skin pinch goes back very slowly
diarrhoea management principles
- fluids = oral rehydration/ IV/ IO
- Zinc = Reduces morbidity & mortality in children with Acute/ Chronic/ Persistent diarrhoea
- probiotics
- Loperamide, opiates, anticholinergics, bismuth subsalicylate, adsorbents
- Ondansetron may reduce the need for IV fluids in vomiting children
diarrhoea diet
- Normal feeds restarted as soon as tolerated
- Diluting milk not recommended
- Encourage intake of complex CHOs (rice, potato, bread, pap), vegetables, lean proteins
- Avoid fatty foods and simple sugars
diarrhoea prevention
- Breastfeeding
- Safe formula preparation
- Vitamin A
Routine supplementation
No benefit during acute diarrheal illness - Immunization
Rotavirus & Measles - Hygiene & Sanitation
Handwashing reduces AGE by 30-35%
Clean water probably most important measure - Probiotics
