pead infectious disease Flashcards
SIRS: 2+ of
temp >38 or <36
WCC >15 or <5
tachycardia >2SDs
tachypnoea >2SDs
paed sepsis 6
- give high flow O2
- blood cultures, blood Glc, blood lactate
- IV broad spectrum antib
- fluid resus 20ml/kg isotonic fluid
- consider inotropic support - adrenaline
- involve senior clinicians/specialists early
infants <3mo and sepeis
may have minimal symptoms/signs and non-specific presentation
deteriorate quickly
infant sepsis risk factors
PROM maternal pyrexia maternal GBS maternal STI prematurity
sepsis Rx
airway breathing circulation: 20ml/kg fluid bolus glc: 2ml/kg 10% dextrose antib
sepsis antibiotic
3rd generation cephalosporin - ceftriaxone
add IV amoxicillin if <1mo
sepsis investigations
blood: FBC, CRP, coag screen, blood gas, glucose
culure: blood, urine, CSF, stool
CXR
sepsis organisms <1mo
group b strep
e.coli
listeria monocytogenes
sepsis organisms older infants + kids
strep pneumoniae
neisseria meningitidis
group a strep
staph a
meningitis features older children
headache stiff neck photophobia fever nausea and vomiting reduced GCS seizure focal neurological deficits
meningitis features younger children
fever or hypothermia poor feeding lethargy, irritable respiratory distress apnoea buldging fontanelle vomiting
meningitis clinical signs
nuchal rigidity
brudzinski’s sign
kernig’s sign
brudinski’s sign
hip and knee flex on passive neck flexion
sign meningitis
kernig’s sign
pain on passive knee extension
sign meningitis
causes childhood meningitis
bacterial 4-18%
mostly viral - mainly enterovirus
fungal - neonates, immunocompromosed
unknown, aseptic
bacterial meningitis organisms neonate <1mo
group b strep
e.coli
listeria monocytogenes
bacterial meningitis organisms older infants + children
strep pneumoniae
neisseria meningitisis
Hib
meningitis: Hib
small, non-motile
gram negative
coccobacillus
encapuslated - more serious infections
non-encapsulated - not bad
invasive meningococcal disease long term sequalae
amputation
scarring
hearing loss
cognitive impairment/epilepsy
strep pneumoniae
gram positive lancet-shaped diplococci
preceeding URTI to invasive infection
pneomococcal meningitis neurological sequelae
hydrocephalus neurodisability blindness hearing loss seizures
meningitis Rx
airway breathing circulation: 20ml/kg fluid bolus, inotropes glucose: 2ml/kg 10% dextrose antibiotics
meningitis antibiotics
3rd generation cephalosporin e.g. ceftriaxone
add IV amoxicillin if <1mo
meningitis Ix
FBC, LFT, U+Es, CRP blood gas Glc blood culture meningococcal/pneumococcal PCR
signs of raised ICP
GCS <9 abnormal tone/posture HTN bradycardia pupillary defects papilloedema
meningitis duration of Rx: neisseria meningitidis
7 days
meningitis duration of Rx: Hib
10 days
meningitis duration of Rx: strep pneumoniae
14 days
meningitis duration of Rx: group B strep
14+ days
meningitis duration of Rx: listeria monocytogenes
21 days
what cause the majority of soft tissue and skin infections
staph aureus
strep pyogenes
staph aureus
gram positive cocci coagulase negaitive colonise skin and mucosa produce exotoxins and form superantigens resistance is a problem - MRSA
strep pyogenes
gram positive cocci B-haemolytic oropharyngeal carriage produce exotoxins and form superantigens resistance not usually problem
staphylococcal scalded skin syndrome
usually <5yrs
toxin mediated - exfoliatoxin: damage to linkage proteins in superficial layers of dermis
staphylococcal scalded skin syndrome features
initial bullous lesions then widespread desquemation
nikolsy’s sign
mild fever
purulent conjunctivitis
staphylococcal scalded skin syndrome Rx
IV flucloxacillin
IV fluids
scarlet fever - features
2-5 day incubation period sandpaper rash 1-2 days after symptoms start fever, malaise, sore throat strawberry tongue desquamation
scarlet fever Rx
inform public health - notifiable disease
phenoxymethylpenicillin 10days
scarlet fever complications
abscess: retropharyngeal, peritonsilar
rheumatic fever
post-strep glomerulonephritis
toxic shock syndrome
acute febrile illness caused by group A strep or staph a
rapid progression to shock and multi-organ failure
toxic shock syndrome pathophys
superantigen causes intese T cell stimulation
- pro-inflam cytokine release
- excessive immune activation
TSS features
fever
diffuse maculopapular rash
mucosal changes: non-purulent conjunctivitis, strawberry tongue, swollen lips
diarrhoea
shock + multi-organ failure: tachycardia, hypotension, renal impairment, reduced GSC
TSS Rx
ABC fluid resuscitation +/- inotropes cultures: blood, throat swabs, wounds antib IV Ig avoid NSAIDs surgical debridement
TSS antibiotics
IV flucloxacillin and clindamycin
