MI: Neonatal and Childhood Infections Pt.2

Question 1

Outline the treatment of late-onset sepsis.

Answer 1

• Check local guidelines
• Example antibiotic regimen: 1st line = flucloxacillin + gentamicin; 2nd line = meropenem
• If community acquired = ceftriaxone or cefotaxime with calcium infusion

Question 2

What are some common non-specific symptoms of infections in childhood?

Answer 2

• Fever
• Abdominal pain

Question 3

List some investigations for meningitis in children.

Answer 3

• Blood cultures
• LP
• Rapid antigen screen
• Blood PCR
• Serology

Question 4

Why is it dangerous to perform an LP in meningococcal septicaemia?

Answer 4

They may be coagulopathic

Question 5

The incidence of meningitis caused by which three agents has decreased in incidence since the introduction of vaccination programmes?

Answer 5

• Meningitis C
• Haemophilus influenzae type B
• Pneumococcus

Question 6

What is the main bacterial cause of meningitis at the moment?

Answer 6

S. pneumoniae

Question 7

What type of organism is Streptococcus pneumoniae?

Answer 7

• Gram-positive diplococcus
• Alpha-haemolytic

Question 8

Which diseases can S. pneumoniae cause?

Answer 8

• Meningitis
• Pneumonia
• Sepsis

Question 9

What type of vaccine is the S. pneumoniae vaccine?

Answer 9

• Conjugate vaccine
• Old version was called Prevenar 7 (7 serotypes), but a new version has been created call Prevenar 13

Question 10

What type of organism is Haemophilus influenzae?

Answer 10

• Gram-negative cocco-bacilli

Question 11

What are the typical causes of meningitis for the following age groups:

• Under 3 months
• 3 months to 5 years
• Over 6 years

Answer 11

Under 3 months:

• Group B Streptococcus
• Escherichia coli
• Listeria monocytogenes
• Neisseria meningitidis
• Streptococcus pneumoniae
• Haemophilus influenzae

3 months to 5 years:

• Neisseria meningitis
• Streptococcus pneumoniae
• Haemophilus influenzae

Over 6 years:

• Neisseria meningitis
• Streptococcus pneumoniae

Question 12

What is the most common cause of death in:

• Children (1-9 years)
• Neonates

Answer 12

Children (1-9 years)

• Cancer (UK)
• Infections e.g. pneumonia, diarrhoea (worldwide)

Neonates:

• Prematurity
• Followed by intra-partum complications

Question 13

What is the most important bacterial cause of respiratory tract infection in children?

Answer 13

Streptococcus pneumoniae

Question 14

Which children are mainly affected by Mycoplasma pneumoniae?

Answer 14

Older children (> 4 years)

Question 15

Which group of antibiotics are used to treat Mycoplasma pneumoniae?

Answer 15

Macrolides

Question 16

Describe the classical presentation of Mycoplasma pneumoniae.

Answer 16

Atypical

• Fever
• Dry cough
• Headache
• Myalgia
• Pharyngitis

Question 17

List some extra-pulmonary manisfestations of Mycoplasma pneumoniae.

Answer 17

• Haemolysis - IgM antibodies to I antigen on erythrocytes, cold agglutinins
• Neurological - encephalitis, aseptic meningitis, peripheral neuropathy, transverse myelitis
• Polyarthralgia
• Cardiac
• Otitis media
• Bullous myringitis (vesicles on the tympanic membrane)

Question 18

If a respiratory tract infection fails to respond to conventional treatment, which diagnoses should be considered?

Answer 18

• Whooping cough
• TB

Question 19

How is UTI diagnosed in children?

Answer 19

• Clinically + urine dip
• MCS - pure growth of > 10⁵ CFU/mL
• Pyuria

Question 20

What are the main organisms responsible for UTI in children?

Answer 20

• E. coli (most common)
• Other coliforms (Proteus, Klebsiella, Enterococcus)
• Coagulase-negative Staphylococcus (S. saprophyticus)

Question 21

Why might renal tract imaging be useful in children who experience UTIs?

Answer 21

To check for congenital anomalies e.g. MCUG for vesico-ureteric reflux in children with recurrent UTI

Question 22

What might recurrent childhood infections suggest?

Answer 22

Immunodeficiency