Sepsis Pedia Flashcards
criteria for sirs
2/4 of:
- core temp >38.5 or <36
- tachycardia (mean hr >2 sd above normal in absence of stimuli or drugs)
- tachypnea (rr >2 sd above normal or acute need for mechanical ventilation)
- leukocyte count elevated or depressed for age or >10% immature neutrophils
criteria for sepsis
fulfillment of criteria for sirs in the presence of suspected or proven infection
criteria for severe sepsis
fulfillment of sepsis plus 1 of:
- cardiovascular organ dysfunction
- ards
- > /= 2 organ dysfunctions
criteria for septic shock
severe sepsis + cardiovascular organ dysfunction depsire fluid resuscitation
criteria for multi-organ dysfunction syndrome
altered organ function such that homeostasis cannot be maintained without medical intervention (late stages of septic shock)
most common pathogens in previously healthy children
s aureus
strep sp
n meningitides
most common pathogens in children with chronic diseases
s aureus
candida
pseudomonas
transmission of s aureus
autoinoculation or direct contact
most significant risk factors for developing s aureus infections
- disruption of intact skin and breaches from wounds
- skin disease (eczema, burns)
- catheters or shunts
different mechanisms for invasion by s aureus
- coagulase that escapes phagocytosis
- antigen masking by protein a
- clumping factors
- toxic shock syndrome toxin 1
- pneumonia: panton valentine leukocidin, protein a, alpha hemolysin
t/f s aureus infections are more common following influenza virus infection in those with cerebral palsy
false, those with cystic fibrosis
most important groups of streptococcus species
s pneumoniae: alpha hemolytic (partial)
gas and gbs: beta (complete)
s pneumoniae or pneumococcus is the most common cause of
bacteremia bacterial pneumonia meningitis osteomyelitis septic arthritis
gas: ___
gbs: ___
gas: streptococcal toxic shock syndrome and necrotizing fascitiis
gbs: early and late onset sepsis
pneumococcus is an important cause of secondary pneumonia in pts with __
influenzae infection
body defenses that limit strep infection
- aspiration of secretions containing strep is hindered by epiglottic reflex
- respiratory epithelial cilia move infected mucus towards the pharynx and away from the lungs
- normal ciliary flow from middle ear to eustachian tube and sinuses to nasopharynx
== interference of these can lead to infection
the spread of infection by streptococus is facilitated by ___
antiphagocytic properties of its capsule (avoids immune clearance)
the pyrogenic toxin of gas is responsible for ___
rash of scarlet fever and streptococcal toxic shock syndrome
clinical syndromes of pneumococcal infections
otitis media sinusitis pneumonia sepsis bacteremia primary peritonitis
clinical syndromes of gas
pharyngitis
pneumonia (CONSOLIDATION)
scarlet fever (pale zone around the mouth, pharynx and tongue beefy red)
rheumatic fever
gas-tss (shock and multi-organ system failure early)
necrotizing fasciitis (extensive local necrosis)
clinical syndromes of gbs
early onset sepsis: within first 6 days of life, associated with maternal ob complications; usually sepsis, pneumonia, and meningitis, GROUND GLASS ON CXR
late onset sepsis: after day 7, bacteremia and meningitis
gas infections can be diagnosed retrospectively on the basis of ____
an elevated streptococcal antibody titer
cxr findings in strep infections
s pneumonia: pneumatoceles
pneumococcal/gas: consolidation
gbs in neonates: ground glass appearance
substances that can increase during inflammatory response to infection
elevated crp
elevated procalcitonin
elevated tnf
elevated il6, il8, il10
