Sepsis & Meningitis

Question 1

Define Sepsis?

Answer 1

Bacteraemi + SIRS:

• Tachypnoea
• Tachycardia
• Fever/Hypothermia
• Leucocytosis/Leucocytopenia

Question 2

What organisms cause sepsis?

Answer 2

Neonates:
- Group B Strep, E. Coli & Listeria Monocytogenes

Children:
- Pneumococcus, Meningococcus, Group A strep & Staph Aureus

Question 3

At what age is sepsis most common?

Answer 3

In neonates, gets progressively less from there

Question 4

How might sepsis look in a kid?

Answer 4

Fever/hypothermia
Chills & rigors

Cold hands/feet + Slow cap refill

Muscle weakness & muscle/joint ache

Rash

Low UO, vomiting & diarrhoea

Question 5

Sepsis 6 in kids is a bit different, what criteria do we use to spot it?

Answer 5

• Hypotension
• Fever/Hypothermia
• Tachycardia
• Tachypnoea
• Alt Mental Status
• Slow cap refill / poor perfusion / mottled peripheries

Question 6

Sepsis 6 is a bit different in kids, what are the 6 actions?

Answer 6

• Take Blood cultures
• Give IV resus
• Give IV Abx
• Give Inotropes
• Give O2

Get Senior Help

Question 7

Meningitis in kids often comes secondary to sepsis, what organisms cause it?

Answer 7

0-6 months: (Same as sepsis)

• Group B Strep
• E. Coli
• Listeria Monocytogenes

6 months - 6 years:

• Meningococcus
• Pneumococcus
• H. Influenzae

6 -60:

• Meningococcus
• Pneumococcus

Question 8

How would meningitis present in a kid?

Answer 8

Older kids will show classic signs such as depressed consciousness, seizures,. focal neuro signs, headaches & photophobia

Neonates will be lethargic, irritable have a bulging fontanelle & “Nappy Pain”

Question 9

What blood tests would you do in a septic/meningeal child?

Answer 9

FBC
CRP
Coagulation study
Blood gas
Glc
U&Es + Creatinine

Question 10

What non-blood tests would you do for septicaemia/meningitis?

Answer 10

LP with antigen testing & PCR

Culture blood, CSF, Urine & skin

Urinalysis

Head CT

Question 11

What would you expect to see after testing a septic/meningeal child?

Answer 11

FBC - Leucocytosis & thrombocytopenia
CRP - Elevated
Coag Study - Low due to DIC
Blood Gas - Metabolic Acidosis
Glc - Hypoglycaemia

CSF - Pleocytosis, high protein & low Glc

Question 12

How do you treat a child with meningitis?

Answer 12

ABCD & G (glc)

Broad spec Abx - Specifically:

• < 3 months = IV cefotaxime* & amoxicillin
• > 3 months = IV cefotaxime*

+/- CCS (dexamethasone)

(*ceftriaxone alternative to cefotaxime)

Question 13

How can we prevent Meningitis?

Answer 13

With vaccines for:

• Pneumococcus
• Meningococcus
• H. Influenzae

Question 14

List 3 major complications of pneumococcal meningitis?

Answer 14

Brain damage hearing loss & hydrocephalus

Question 15

Where can pneumococcal infections occur in the body and what is likely to precede them?

Answer 15

Viral inf tends to predispose to invasive pneumococcal disease.

Can be found:

• Pneumonia
• Meningitis
• Septicaemia
• Otitis Media
• Sinusitis
• Arthritis
• OM
• Peritonitis

Question 16

Are pneumococcus & H influenzae Gram -ve or +ve?

Answer 16

Pneumoccous is gram +ve

Haemophilus is Gram -ve

Question 17

Other than the brain where might you find H influenzae infection?

Answer 17

Septicaemia
Pneumonia
Epiglottitis

Question 18

What’s special about meningococcal infection?

Answer 18

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

Question 19

List 5 major complications of meningococcal infection?

Answer 19

Skin Scarring
Amputation

Cognitive impairment
Epilepsy
Hearing Loss