W14 - Neonatal and childhood infections Flashcards
Congenital infections - what (2) do these include?
- Babies are born with congenital infections (verticlaly from mom to baby)
- Infection can occur at any time DURING pregnancy (between 1st trimester to birth)
What infectious agents (3) are mothers screened for during pregnancy?
What infectious agents (5) could be tested for but not currently screened regularly?
- Hep B
- HIV
- Syphillis
- CMV 2. Toxoplasmosis 3. Hep C 4. Group B streptococcus 5. Rubella
How are the clinical features of congenital infections?
- mom during pregnancy may acquire infection but show no apparent sign
- neonates have varied presentations and non-specific signs (low platelets; rash; cerebral abnormalities; hepatosplenomegaly; hepatitis; jaundice)
- congenital infections need to be considered in ANY sick neonate
What screening should be done in any sick neonate as part of checking for congenital infections?
TORCH screen:
–Toxoplasmosis
–Other – syphilis; HIV; hepatitis B/C
–Rubella
–Cytomegalovirus (CMV)
–Herpes simplex virus (HSV)
Why do we advise pregnancy women to stay away from cat faeces?
Toxoplasmosis in foecal-contaminated litter box - can spread transplacentally to feotus
Congenital toxoplasmosis - describe presentation
40% symptomatic at birth:
- chorioretinitis
- Microcephaly/hydrocephalus
- intracranial calcifications
- seizures
- hepatosplenomegaly/jaundice
60% may be asymptomatic at birth but may still develop long-term sequelae:
- deafness
- low IQ
- microcephaly
What are 3 long-term sequelae of congenital toxoplasmosis?
- deafness
- low IQ
- microcephaly
Congenital rubella syndrome - what are some clinical presentations?
effect on foetus depends on time of infection
Eyes: cataracts, microphthalmia, glaucoma, retinopathy
Ears: deafness
Brain: microcephaly, meningoencephalitis, developmental delay
CVS: PDA, ASD/VSD
Other: growth retardation, bone disease, hepatosplenomegaly, thrombocytopaenia, rash
What is the diagnosis?
Rash + cataracts in neonate = Congenital Rubella Syndrome
What is the recommendation to a mother presenting with genital HSV in 3rd trimester?
High chance of transmission to child in vaginal birth
recommend C section to avoid trnasmission
Neonate presents with rash (picture) and deranged LFTs - diagnosis?
Likely HSV
How can HSV present in neonate?
- Rash (usually blistering)
- Deranged LFTs, jaundice
- Encephalitis (inc. seizures)
Define neonatal period
First 4-6 weeks of life
If born prematurely => neonatal period longer AND is adjusted for expected birth date
If a neonatal infection presents within the first few (max 5 days) from birth, what 3 organisms do you need to think of? Why are these more prevalent?
- Group B streptococci
- E coli
- Listeria monocytogenes
These are usually present within the vaginal tract of the mom
Group B Streptococci neonatal infection:
- Describe their microbiology (G stain, catalase +/-, beta haemolytic +/-)
- The 3 types of infections they cause in neonates
- The abx used to treat this
- G+ cocci, catalase negative, beta-haemolytic +
1. Bactaraemia, 2. Meningitis, 3. Disseminated infection (i.e joint infection) - penicillin sensitive
E coli neonatal infection:
- Describe their microbiology (G stain)
- The 3 types of infections they cause in neonates
- Gram - rods
1. Bactaraemia, 2. meningitis, 3. UTI
Name 5 risk factors for early-onset maternal sepsis
- Preterm rupture of membranes (PROM)/premature labour
- Fever
- Foetal distress
- Meconium staining
- Previous history
Name 10 risk factors for early-onset sepsis in newborn?
- Birth asphyxia
- Meconium staining
- Resp. distress
- Low BP
- Acidosis
- Hypoglycaemia
- Neutropenia
- Rash
- Hepatosplenomegaly
- Jaundice
Describe treatmetn for early onset neonatal sepsis
Supportive management:
- Ventilation
- Circulation
- nutrition
- antibitoics: i.e. benzylpenicillin (for Group B streptococci), gentamicin (for E coli), +/- amoxicillin (if meningitis susepected - to cover listeria)
What are some causative agents for late-onset sepsis (usually presenting within first few weeks of life)
Depends on if baby had gone home
- if baby HAD gone home = big 3 again (Group B streptococci, E coli, Listeria)
- if baby stayed in hospital = coagulase negative staphylococci (CoNS), S. areus, and some G-s associated with UTIs (klebsiella, enterococcia, etc)
Name some clinical features of neonatal late-onset sepsis
- bradycardia
- apnoea!!
- resp distress
- poor feeding/bilious aspirates/abdo distension
- irritability
- convulsions
- jaundice
In terms of causes of death amongst neonates (0-27 days) and post-neonatal children (1-59 months) - what is the commonest cause in each group?
Neonates (0-27 days) => prematurity
Post-neonatal (1-59 months) => pneumonia
Haemophilus influenzae
- Microbiology (G stain, plate for growth)
Gram negative ROD
chocolate plate
What isthe commonest cause of invasive meningococcal infection in the UK?
Men B encapsulated group
Streptococcus pneumonia
- Microbiology (G stain, type of haemolysis, serotypes)
- types of infections typically caused (3)
- Gram + diplococci, ALPHA haemolytic streptococci (green), >90 capsular serotypes
1. pneumonia
2. bacteraemia
3. Meningitis
What are the main causes of meninigitis at <3 months of age, 3m-5years of age, and >6 years of age
<3/12:
- N. meningitidis;
- S. pneumoniae; (H. influenzae (Hib) if unvaccinated);
- GBS; E. coli; Listeria sp.
3/12 - 5 years:
- N. meningitidis;
- S. pneumoniae;
- (Hib if unvaccinated)
>6 years:
- N. meningitidis;
- S. pneumoniae
UTIs in children; up to ___% of girls and ____% of boys by age 11
3% girls and 1% boys by age 11
Top 3 causative agents of UTI in children
- E coli (MAIN)
- Proteus species
- Klebsiella enterococcus species
- Staphylococcus species (i.e. CoNS inc. staph saprophyticus)
What is the commonest cause of early onset neonatal sepsis?
Group B streptococcus
What is the commonest cause of death worldwide in children under 5 years?
Prematurity
(followed by pneumonia 13%)
