Paediatric Infectious Diseases 1 & 2 Flashcards

1
Q

How many respiratory infections will the average school child have a year?

A

8-12

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2
Q

What are the signs of sepsis in a child?

A

1) Breathing quickly
2) Fit or convulsion
3) Mottled, bluish or pale
4) Has a rash that does not fade when you press it
5) Is very lethargic or difficult to wake
6) Feels abnormally cold

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3
Q

What are the signs of sepsis in a child under 5?

A

1) Is not feeding
2) Vomiting repeatedly
3) Has not urinated fo 12 hours

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4
Q

What are the signs of meningitis in a baby?

A

Refuse feeds

Be irritable

Have a high-pitched cry

Have a stiff body or be floppy or unresponsive

Have a bulging soft spot on the top of their head

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5
Q

How do mortality rates for children and young people in the UK compare with those of other high income countries?

A

Mortality outcomes for C&YP in the UK are considerably worse than comparable high income countries

The UK ranks in the bottom 3 countries in the EU15+ for mortality from common infections in both sexes and across all age groups

Mortality from treatable infection in the UK is almost 2x that of our best performing European neighbours

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6
Q

What proportion of sepsis cases worldwide occurr in children?

A

>1/2

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7
Q

When is the peak incidence for sepsis?

A

Early childhood (<1y)

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8
Q

What is the fatality rate of child sepsis?

A

10%

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9
Q

What is sepsis?

A

SIRS + suspected or proven infection

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10
Q

What is severe sepsis?

A

SIRS + suspected or proven infection

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11
Q

What is septic shock?

A

Sepsis + CVS dysfunction

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12
Q

What is SIRS?

A

Systemic inflammatory response syndrome

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13
Q

What constitutes SIRS?

A
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14
Q

What are normal NEWS RR and HR for a child 12-23 months?

A

RR - 25-40

HR - 100-150

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15
Q

Describe the traffic light system in assesseing children

A
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16
Q

What is the criteria for commencing sepsis 6 in a child?

A
17
Q

If you suspect sepsis, what must you do? (1)

A
18
Q

If you suspect sepsis, what must you do? (2)

A
19
Q

What makes recognising sepsis in a child <3 months difficult?

A
  • May have minimal signs & symptoms
  • Presentation often non-specific
  • May not mount a febrile response (~50%)
20
Q

What makes recognising sepsis in a child <3 months important?

A
  • Increased risk bacterial infection
  • Increased risk sepsis
  • Increased risk meningitis
  • Deteriorate quickly
21
Q

What are risk factors for sepsis in a child <3 months?

A
  • Prematurity (< 37/40)
  • Premature ruptuer of membranes (PROM)
  • Maternal pyrexia/chorioamnionitis
  • Maternal GBS (this pregnancy) - Group B Streptococcal Septicaemia??
  • Previous child with GBS
  • Maternal STI (Chlamydia, Gonorrhoea, Syphilis, HSV)
22
Q

How must you manage paediatric sepsis?

A
  • Airway
  • Breathing
  • Circulation – 20ml/kg fluid bolus
  • DEFG –‘don’t ever forget glucose’
    • 2ml/kg 10% dextrose
  • Antibiotics
    • 3rdgeneration cephalosporin (e.g. Cefotaxime/Ceftriaxone)
    • Add IV Amoxicillin if <1m old
23
Q

What are the blood tests done in sepsis?

A
  • FBC (leukocytosis, thrombocytopaenia)
  • CRP
  • Coagulation screen (DIC)
  • Blood gas (metabolic acidosis, raised lactate)
  • Glucose
  • Blood culture
24
Q

What are the cultures done in sepsis?

A
  • Blood
  • Urine
  • CSF (including send to virology)
  • +/- stool (micro + virology)
25
Q

What imaging is done in sepsis?

A

CXR

26
Q

What are the organsims liekly to be responsible neonates <1 month?

A
  • Group B Streptococcus
  • E. coli
    • (Escherichia coli)
  • Listeria monocytogenes
27
Q

What are the organsims liekly to be responsible older infants and children?

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Group A Streptococcus
  • Staphylococcus aureus
28
Q

Describe the pathogenesis of sepsis

A
  • Secretion ofpro and anti-inflammatory cytokines
  • Activation of complement
  • Activation and mobilisation of leukocytes
  • Activation of coagulation and inhibition of fibrinolysis
  • Increased apoptosis
29
Q

Summary

A
  • Sepsis is a major cause of death in children
  • Early recognition improves survival
  • Important to think ‘could this be sepsis?’
  • Respond appropriately
    • If you’re not sure ask!
    • Follow guidelines!
  • Paediatricians want to know about any child <3m old with fever