Sepsis & Meningitis Flashcards
Define Sepsis
life-threatening organ dysfunction caused by a dysregulated host response to infection
What organisms cause sepsis?
State 3 each for neonates and children
Neonates:
- Group B Strep, E. Coli & Listeria Monocytogenes
Children:
- Streptococcus pneumoniae
- Neisseria meningitides
- haemophilus influenza type B
At what age is sepsis most common?
In neonates, gets progressively less from there
Sepsis in children
Symptoms [4]
Signs [4]
Fever/hypothermia
Chills & rigors
Muscle weakness, aches, limb pain
D + V
Cold and mottled hands/feet
Slow cap refill
Reduced urine output
Hypotension, tachycardia, tachypnoea
Sepsis 6 in kids is a bit different, what criteria do we use to spot it? [6]
- Hypotension
- Fever/Hypothermia
- Tachycardia
- Tachypnoea
- Alt Mental Status
- Slow cap refill / poor perfusion / mottled peripheries
SEPSIS 7 in children
High flow oxygen
IV/IO fluid resus
IV/IO ceftriaxone 50mg/kg
Give inotropes
Blood cultures
Monitor urine output
Blood lactate
Describe the classic appearance of meningococcal rash
Non-blanching purpuric or petechial rash
How would meningitis present in a kid?
Children [6]
Neonates [3]
Children:
- Nuchal rigidity
- Headache
- Photophobia
- Reduced GCS
- Seizures
- Focal neurological signs
Neonates:
- Lethargy, irritability
- Bulging fontanelle
- Nappy pain
What blood tests would you do in a septic/meningeal child? [7]
FBC (leucocytosis, thrombocytopenia) CRP Coagulation factors (DIC) PCR (meningococcus) Blood gas (metabolic acidosis) Glc (hypo) U&Es + Creatinine (renal failure)
What non-blood tests would you do for septicaemia/meningitis? [4]
LP with antigen testing & PCR
Culture blood, CSF, Urine & skin
Urinalysis
Head CT
Investigations for:
- Meningitis
- Meningococcal septicemia
Meningitis: LP
Meningococcal septicemia: no LP, only cultures and meningococcal PCR
Subsequent management [4]
What antibiotics to use for listeria?
- IV dexamethasone (in suspected/confirmed bacterial meningitis in children >3m)
- Ceftriaxone for 7-14d
- Public health notification
- Prophylaxis of contacts: ciprofloxacin within 24h dx for close contacts over 7d
Listeria: amoxicillin + gentamicin
Immediate management of: (in the community)
- Suspected bacterial meningitis without non-blanching rash
- Meningococcal rash [2]
o Suspected bacterial meningitis without non-blanching rash: ambulance to hospital
o Meningococcal rash: IV or IM BENZYLPENICILLIN then ambulance to hospital
List 3 major complications of pneumococcal meningitis?
Brain damage hearing loss & hydrocephalus
Where can pneumococcal infections occur in the body and what is likely to precede them?
Viral inf tends to predispose to invasive pneumococcal disease.
Can be found:
- Pneumonia
- Meningitis
- Septicaemia
- Otitis Media
- Sinusitis
- Arthritis
- OM
- Peritonitis
Are pneumococcus & H influenzae Gram -ve or +ve?
Pneumoccous is gram +ve
Haemophilus is Gram -ve
Other than the brain where might you find H influenzae infection?
Septicaemia
Pneumonia
Epiglottitis
What’s special about meningococcal infection?
Its very very fast. Once it hits the blood stream you get:
- Septic shock within 12hrs
- Meningitis within 18-36hrs
Also can cause meningococcal rash
Pre-hospital treatment is IM benzylpenicillin before transfer to secondary care and NO LP just do blood cultures and PCR
List 5 major complications of meningococcal infection?
Skin Scarring
Amputation
Cognitive impairment
Epilepsy
Hearing Loss
What LP results would you expect from meningitis?
CSF - Pleocytosis, high protein & low Glc
Initial empirical antibiotic treatment for neonatal meningitis <3m and >50 yo (while awaiting investigations and culture & sensitivities)
Cefotaxime + amoxicillin
Kernig’s sign vs Brudzinskis sign
Kernig’s sign, which is positive when there is pain and resistance on passive knee extension when hips are flexed
Brudzinski’s sign, which is positive if the hips flex when the neck is bent forward
Difference in presentation between viral and bacterial meningitis
Viral infections (with enteroviruses, EBV, adenoviruses e.t.c.) are more common and usually have a less severe presentation than bacterial meningitis.
