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🍉paeds > infections > Flashcards

infections Flashcards

1
Q

leading cause of death in children?

A

Sepsis

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2
Q

what is Sepsis?

A

SIRS + suspected or proven infection

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3
Q

what is sever sepsis?

A

Sepsis + organ dysfunction

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4
Q

what is septic shock?

A

Sepsis + CVS dysfunction

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5
Q

criteria to have SIRS?

A

Temperature
>38°C or <36°C

WCC
>15 x 109/L or <5 x 109/L

Tachycardia
>2SD above normal for age

Tachypnoea
>2SD above normal for age

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6
Q

How might sepsis look in a kid?

A

Fever/hypothermia
Chills & rigors

Cold hands/feet + Slow cap refill

Muscle weakness & muscle/joint ache

Rash

Low UO, vomiting & diarrhoea
--
5
Sepsis 6 in kids is a bit different, what criteria do we use to spot it?
- Hypotension
- Fever/Hypothermia
- Tachycardia 
- Tachypnoea 
- Alt Mental Status 
- Slow cap refill / poor perfusion / mottled peripheries
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7
Q

Sepsis 6 in kids is a bit different, what criteria do we use to spot it?

A

Hypotension

  • Fever/Hypothermia
  • Tachycardia
  • Tachypnoea
  • Alt Mental Status
  • Slow cap refill / poor perfusion / mottled peripheries
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8
Q

Sepsis 6 is a bit different in kids, what are the 6 actions?

A

Take Blood cultures

  • Give IV resus
  • Give IV Abx
  • Give Inotropes
  • Give O2

Get Senior Help

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9
Q

What organisms cause sepsis?

A

Neonates: (BEL)

  • Group B Strep,
  • E. Coli
  • Listeria Monocytogenes
Children: (PANS)
- Pneumococcus, 
-Neisseria meningitidis
(meningoccoccal)
 -Group A strep 
 -Staph Aureus
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10
Q

what are infants under 3 months more at risk

A

Increased risk bacterial infection

Increased risk sepsis

Increased risk meningitis

May have minimal signs & symptoms

Presentation often non-specific

May not mount a febrile response (~50%)

Deteriorate quickly

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11
Q

RF for sepsis in infants <3months (I think this is the slide?)

A 
Prematurity (< 37/40)
PROM
Maternal pyrexia/chorioamnionitis
Maternal GBS (this pregnancy)
Previous child with GBS
Maternal STI (Chlamydia, Gonorrhoea, Syphilis, HSV)
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12
Q

how many mls per kg do u give for sepsis?

A

20ml/kg fluid bolus

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13
Q

how much glucose to give in sepsis?

A

don’t ever forget glucose’

2ml/kg 10% dextrose

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14
Q

what abs to give in sepsis?

A

3rd generation cephalosporin (eg Cefotaxime/Ceftriaxone)!!

add IV Amoxicillin if <1m old

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15
Q

investigations to do in sepsis?

A 
Bloods
FBC (leukocytosis, thrombocytopaenia)
CRP
Coagulation screen (DIC)
Blood gas (metabolic acidosis, raised lactate)
Glucose
Blood culture
Cultures
Blood
Urine
CSF (including send to virology)
\+/- stool (micro + virology)

Imaging
CXR

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16
Q

Pathogenesis of Sepsis

A

Secretion of pro and anti-inflammatory cytokines
Activation of complement
Activation and mobilisation of leukocytes
Activation of coagulation and inhibition of fibrinolysis
Increased apoptosis

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17
Q

what is meningitis?

A

A disease caused by inflammation of the meninges

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18
Q

what is meningism?

A

The clinical signs and symptoms suggestive of meningeal irritation

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19
Q

Meningitis signs and symptoms in older children

A

classic symptoms

Fever
Headache
Photophobia
Neck stiffness (nuchal rigidity)
Nausea & vomiting
Reduced GCS
Seizures
Focal neurological deficits
20
Q

Meningitis signs and symptoms in young infants

A

lethargic, irritable
bulging fontanelle & “Nappy Pain”

Fever or hypothermia
Poor feeding
Vomiting
Lethargy
Irritability
Respiratory distress
Apnoea
Bulging fontanelle
21
Q

3 clinical signs of meningitis

A

-Nuchal Rigidity (Neck Stiffness)
Palpable resistance to neck flexion

-Brudzinski’s sign
Hips and knees flex on passive flexion of the neck

-Kernig’s sign
Pain on passive extension of the knee

22
Q

Meningitis in kids often comes secondary to sepsis, what organisms cause it?

A

Neonates: (Same as sepsis)

  • Group B Strep
  • E. Coli
  • Listeria Monocytogenes
Children 
- Pneumococcus 
- Neisseria meningitidis
(meningoccoccal)
- H. Influenzae
23
Q

Haemophilus influenzae- what type of bacteria?

where is it found?

A

Small, non-motile, gram-negative coccobacillus

Nasopharyngeal carriage

24
Q

what are the 2 types of Haemophilus influenzae

A

Encapsulated

Non-encapsulated

25
Q

encapsulated H.influenza cause which disease?

A

Resist phagocytosis & complement mediated lysis
6 serotypes (a-f)
Hib main cause of invasive H. influenzae infection
Bacteraemia, Meningitis, Epiglottitis, Pneumonia
RF – asplenia, sickle cell disease, antibody deficiency

26
Q

Non-encapsulate H.influenza cuase which disease?

A

otitis media & sinusitis

invasive infection rare

27
Q 
neisseria meningitides (meningococcal)
type of bacteria?
transmission?
A

Gram negative diplococcus

Humans only natural hosts
Nasopharyngeal carriage

Transmission via respiratory secretions
Infection often follows viral URTI

28
Q

what is the capsule in meningococcus?

A

Polysaccharide capsule
capsule composition determines serogroup (eg. A, B, C, W, Y)

Endotoxin (LPS)

29
Q

Invasive Meningococcal DiseaseRisk Factors

A

Age <1 year or 15-24 years

Unimmunised

Crowded living conditions

Household or kissing contact

Cigarette smoking (active or passive)

Recent viral/Mycoplasma infection

Complement deficiency

30
Q

meningitis and septicaemia- same symptoms?

A

Petechial/Purpuric Rash

31
Q

septicaemia symtoms?

A 
Fever
Headache
Myalgia
Vomiting
Abdominal pain
Limb pain
Reduced GCS
Signs of shock
32
Q

Other than the brain where might you find H influenzae infection?

A

Septicaemia
Pneumonia
Epiglottitis

33
Q

characteristic of invasive meningococcal disease?

A

the rash

34
Q

Invasive Meningococcal Disease complications?

A

Significant long term sequelae

Amputation (14%)
Scarring (48%)
Hearing Loss
Cognitive impairment/epilepsy

35
Q

Are pneumococcus & H influenzae Gram -ve or +ve?

A

Pneumoccous is gram +ve

Haemophilus is Gram -ve

36
Q

pneumococcus

  • gram pos or neg
  • type of polysaccharide?
  • transmission
A

Pneumo: Positive, Polysach, nasoPharynx, resP

Gram positive, lancet-shaped, diplococcus

Facultative anaerobe

Polysaccharide capsule:

  • inhibits neutrophil phagocytosis
  • inhibits complement mediated cell lysis

> 90 known serotypes
All serotypes can cause invasive disease

Colonises nasopharynx (11-93%!)

Preceeding URTI RF for invasive infection
Respiratory droplet transmission

37
Q

Where can pneumococcal infections occur in the body and what is likely to precede them?

A

Viral inf tends to predispose to invasive pneumococcal disease.

Can be found:

  • Pneumonia
  • Meningitis
  • Septicaemia
  • Otitis Media
  • Sinusitis
  • Arthritis
  • OM
  • Peritonitis
38
Q

Invasive Pneumococcal DiseaseRisk Factors

A 
Age <2 years
Cigarette smoking (active or passive)
Recent viral URTI
Attendance at childcare
Cochlear implant
Sickle cell disease
Asplenia
HIV infection
Nephrotic syndrome
Immunodeficiency/Immunosuppression
39
Q

Pneumococcal Meningitis

complications?

A 
Neurological sequelae common
Hydrocephalus
Neurodisability
Seizures
Hearing loss
Blindness

Case fatality in children 8%

40
Q

Management of Meningitis The basics (the same as sepsis)

A

Airway

Breathing

Circulation – 20ml/kg fluid bolus, inotropes

DEFG – ‘don’t ever forget glucose’
2ml/kg 10% dextrose

Antibiotics

  • 3rd generation cephalosporin
    (e. g. Cefotaxime/Ceftriaxone)
  • add IV Amoxicillin if <1m old
41
Q

Meningitis investigations?

A 
Bloods
FBC (leukocytosis, thrombocytopaenia)
U&Es, LFTs
CRP
Coagulation screen (DIC)
Blood gas (metabolic acidosis, raised lactate)
Glucose
!!!!Blood culture!!!!
Meningococcal/Pneumococcal PCR
42
Q

signs of meningitis?

A 
Signs of raised ICP
	GCS <9
Abnormal tone or posture
HTN & Bradycardia
Pupillary defects
Papilloedema
Focal neurological signs
Recent seizure
Cardiovascularly unstable
Coagulopathy
Thrombocytopenia
Extensive or extending purpura
43
Q

what to request on LP in meningitis

A 
Microscopy
Gram Stain
Culture
Protein 
Glucose 
Viral PCR
44
Q

what findings in LP show bacterial meningitis

A 
Turbid or purulent
High opening pressure
HIGH WCC (polymorphs)
HIGH Protein
LOWGlucose (<50% serum)
45
Q

What’s special about meningococcal infection?

A

Its very very fast. Once it hits the blood stream you get:

  • septic shock within 12hrs
  • Meningitis within 18-36hrs

Also can cause meningococcal rash

46
Q

1st line sepsis treatment? in kids

A

3rd gen cephalosporin!!!

47
Q

invasive menigoccal disease is caused by…

A

Neisseria meningitidis

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