Theme 6: Clinical infections in childhood and pregnancy Flashcards
Which 3 conditions do you want to screen early in pregnancy? ideally by 10 weeks
HIV, syphilis and hepB
Which infections can be transmitted from mother to baby during pregnancy?
TORCH Taxoplasmosis Others (syphilis, HIV, coxsackie virus, HepB, varicella-zoster) Rubella Cytomegalovirus disease Herpes simplex disease
How do TORCH infections spread from mother to baby?
haematogenous spread
What are the fetal consequences of TORCH infections?
- abortion
- still birth
- prematurity
- IUGR
- congenital malformations (microcephaly, intracranial calcifications)
What are other perinatal infections (other than TORCH) that can be passed onto the foetus?
- group B streptococcus
- listeriosis
- gonorrhoea
- chlamydia
- HIV
- HepB
Does the UK recommend screening for group B streptococci?
no as it is not clear that screening does more good than harm and is cost effective
What condition can arise in a neonate if their mother is infected with group B streptococci?
neonatal sepsis
If a women has had a previous GBS carriage, what is the likelihood of maternal GBS carriage in current pregnancy?
50%
What 3 options does a previous GBS carrier have in their current pregnancy?
- to not have intra-partum antibiotics
- to have intra-partum antibiotics
- screening at 35-37 weeks and offer antibiotics to those who have GBS colonisation
what is chorioamnionitis?
-inflammation of umbilical cord, amniotic membranes/fluid, placenta -major cause of perinatal morbidity and mortality
What are the symptoms of chorioamnionitis?
- maternal fever
- uterine tenderness
- tachycardia
- purulent/foul amniotic fluid
- neonatal sepsis/pneumonia/neurodevelopment disability
What are the risk factors for intra-amniotic infections?
- most common after prolonged rupture of membranes
- amniocentisis
- cordocentesis
- multiple vaginal examinations
What is the pathogenesis behind intra-amniotic infections?
- bacteria present in the vagina cause infection by ascending through the cervix
- haematogenous infection is is rare
What are the 3 causative organisms of intra-amniotic infections?
- Group B strep
- E. coli
- genital mycoplasma
How do we treat intra-amniotic infections?
- intra-partum antimicrobials and delivery of the foetus
- antimicrobials should be administered at the time of diagnosis (not after delivery)
What is puerperal endometritis?
uterine infection (lining of the wall) during pueperium (6 weeks after childbirth)
What are the risk factors for puerperal endometritis?
- caesarean section
- prolonged labour
- prolonged rupture of membranes
- multiple vaginal examinations
- sepsis, pelvic abscess and peritonitis in moter
What are the clinical features of puerperal endometritis?
- fever
- uterine tenderness
- purulent, foul-smelling lochia (post-partum bleeding)
- increased white cell count
- general malaise, abdominal pain
What are the causative organisms in puerperal endometritis?
- E.coli
- group B strep
- anaerobes
How do we treat puerperal endometritis?
broad spectrum intravenous antimicrobials - continued until the patient has been apyrexial for 48 hr
What is EOS?
- early onset neonatal sepsis
- usually within 72hrs
- major cause of mortality
What are the major causative pathogens in neonatal late-onset sepsis?
- coagulase-negative staphylococci
- staphylococcus aureus
- e.coli
- klebsiella spp
- pseudomonas spp
- candida spp
Who is at risk of childhood infections?
- young infants –> frequent hand-to-mouth behaviours, not fully immunised
- children with special health care needs
- children with impaired immune systems
- children with long standing prosthetic devices
What are 3 main upper respiratory tract infections in children?
- common cold
- acute tonsilitis
- acute otitis media
What is a sore throat?
any of various inflammations of the tonsils, pharynx or larynx characterised by pain in swallowing
- viral (70-80%)
- bacterial - group A beta-haemolytic streptococcus (20-30%)
What is croup?
- inflammation and narrowing of the subglottic region of the larynx
- most often caused by a viral infection
What are the symptoms of croup?
- stridor
- barking cough
- hoarseness
- respiratory distress
- fever
- coryza
What is acute otitis media?
-ear infection
What bacteria can cause acute otitis media?
-strep pneumoniae
-H.influenzae
etc
What are the symptoms of acute otitis media?
- unusual irritability
- difficulty sleeping
- middle ear effusion and inflammation of middle ear
- tugging or pulling at one or both ears
- fever
- fluid draining from the ear
- loss of balance
- unresponsiveness to quiet sounds or other signs of hearing difficulty
Give examples of lower respiratory tract infections in children?
- RSV (most common by far)
- pneumonia
- adenovirus
- influenza
- acute bronchitis
- bronchiolitis
What is bronchiolitis?
- inflammation of the bronchioles/ small airways in children younger than 2 years, usually 3-6 months of life
- a seasonal viral illness characterised by fever, nasal discharge and dry, wheezy cough
- typically caused by RSV
How does pneumonia present?
acute febrile illness, possibly preceded by viral URTI
What are the symptoms of pneumonia?
- breathlessness
- irritability
- sleeplessness
- cough
- chest or abdominal pain in older patients
- audible wheezing
- younger children rarely cough, may present with grunting, tachypnoea and chest retractions
What is pertussis cough?
- highly communicable acute respiratory infection caused by B.pertussis
- humans are sole reservoir –> aerolised respiratory droplets
What are the 3 stages of pertussis?
- catarrhal phase (7-10 days) - cold like
- paroxysmal phase (2-6 weeks)
- convalescent ohase
What is the clinical presentation of meningitis in children?
Non-specific:
- fever
- irritability
- lethargy
- poor feeding
- high pitched cry, bulging AF
- convulsions, opisthotonos
What organisms cause meningitis in neonates?
group B streptococcus
E.coli
listeria monocytogenes
What organisms cause meningitis in young infants?
streptococcus pneumonia
neisseria meningitis
What is the most common infection of the CNS?
Viral meningitis
What are the symptoms of meningococcemia?
fever, non-specific malaise, lethargy, vomiting, meningism, resp distress, irritability, seizures, maculopapular rash
What is the prevalence of UTIs in children and what organisms are they caused by?
- 7% of girls and 2% of boys experience a symptomatic culture proven UTI up to 6 years of age
- organisms: E.coli, proteus, klebsiella, enterococcus
What are the symptoms of UTI?
- dysuria
- frequency
- urgency
- small-volume voids
- lower abdominal pain
- fever
- irritability
- vomiting
- poor appetitie
How do we collect urine samples from infants?
- if possible use non-invasive method i.e urine collection pad
- if not catheter sample or suprapubic aspiration
What is the clinical presentation of impetigo?
- classically ruptured vesicles with honey coloured crusting
- may be bullous
- commonly starts around face and mouth
What organisms is impetigo caused by?
staph aureus or strep pyogenes
very contagious, rapid spread
What is the treatment for impetigo?
topical antibiotics or oral flucloxacillin
What organism is scarlet fever caused by?
group A beta haemolytic streptococcus
What are the symptoms of scarlet fever?
fever
headache
sore throat
flushed face with circumoral pallor
rash appears on chest/abdomen, may extend to whole body
-desquamaton after 5 days, particuarly on soles and palms
-white strawberry tongue
What is the treatment for scarlet fever?
penicillin
