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CP reviewer 1 > Childhood and Pregnancy Infections > Flashcards

Childhood and Pregnancy Infections Flashcards

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1
Q

Why should all women be offered routine screening for asymptomatic bacteriuria by midstream urine culture early in pregnancy?

A

Identification and treatment of asymptomatic bacteriuria reduces the risk of pyelonephritis.

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2
Q

How is passive immunity acquired in the foetus?

A

Maternal immunoglobulin G (IgG) is transported across the placenta to offer short term passive immunity

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3
Q

What 3 infectious diseases are screened for during pregnancy?

A
  1. HIV
  2. Syphilis
  3. Hep B

These can all be passed from mother to baby during pregnancy and birth

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4
Q

Why is screening for rubella during pregnancy no longer offered?

A

MMR vaccine

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5
Q

What is TORCH an acronym for?

A

A group of diseases that cause congenital (present at birth) conditions if a foetus is exposed to them in the uterus.

T: Toxoplasmosis

O: Others (syphilis, HIV, Coxsackie virus, Hep B, Varicella-Zoster)

R: Rubella

C: Cytomegalovirus

H: Herpes simplex disease

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6
Q

What diseases come under ‘Other’ of the TORCH acronym?

A

syphilis, HIV, Coxsackie virus, Hep B, Varicella-Zoster

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7
Q

What is considered to be the newest member of TORCH infections?

A

Zika virus

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8
Q

How is the zika virus transmitted?

A

Mosquito bite –> travel history is key

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9
Q

How can Zika virus infection during pregnancy affect the foetus?

A

microcephaly and other severe foetal brain defects

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10
Q

How is toxoplasmosis transmitted?

A

Ingestion of oocysts

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11
Q

How can the TORCH infections affect babies?

A

Most of the TORCH infections cause mild maternal morbidity, but have serious feotal consequences: abortion, stillbirth, prematurity, IUGR, congenital malformations (microcephaly, intracranial calcifications).

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12
Q

What are the potential effects of infection with influenza during pregnancy?

A

o No teratogenesis confirmed
o Premature delivery may occur, as in any febrile maternal illness, increasing the perinatal morbidity and mortality.
o The clinical syndrome in the mother is self-limited unless pneumonia supervenes and in the newborns manifests as any form of sepsis

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13
Q

How can HIV and HBV pass from mother to baby?

A

can be passed in utero & postnatal via breast milk

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14
Q

Is screening for Group B Streptococci (GBS) routinely offered during pregnancy?

A

No; not until it is clear that antenatal screening for GBS carriage does more good than harm and that the benefits are cost-effective

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15
Q

If a woman in a previous pregnancy has had GBS carriage, what is the likelihood of maternal GBS in the next pregnancy?

A

50%

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16
Q

The women who have had a previous GBS carriage, they have 3 choices during their next pregnancy.

What are these?

A
  1. To not have intra-partum antibiotics
  2. To have intra-partum antibiotics
  3. Screening at 35-37 weeks and offer antibiotics to those who have GBS colonisation
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17
Q

What is chorioamnionitis?

A

Inflammation of umbilical cord, amniotic membranes/fluid, placenta

This is a common precursor to preterm labour

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18
Q

Symptoms of chorioamnionitis?

A

Maternal fever, uterine tenderness, tachycardia, purulent/foul amniotic fluid

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19
Q

Pathogenesis of chorioamnionitis?

A

Bacteria ascend from the female genital tract, through the cervix to the amniotic fluid to cause infection

Haematogenous (via blood) infection is rare e.g. Listeria monocytogenes

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20
Q

Risk factors of chorioamnionitis?

A

o Prolonged rupture of membranes –> most common
o Other risk factors include amniocentesis, cordocentesis, cervical cerclage, multiple vaginal examinations, bacterial vaginosis

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21
Q

Causative organisms of chorioamnionitis?

A

o Group B Streptococcus
o Escherichia coli
o Genital Mycoplasma (Mycoplasma hominis & Ureaplasma urealyticum)

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22
Q

Effects of chorioamnionitis on foetus?

A

Adverse outcome for the neonate; sepsis, pneumonia and long-term neurodevelopment disability

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23
Q

Treatment for chorioamnionitis?

A

o Intra-partum antimicrobials and delivery of the foetus

o Antimicrobials should be administered at the time of diagnosis (not after delivery)

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24
Q

What is puerperal endometritis?

A

Uterine infection (lining of womb) during puerperium from vaginal bacteria.

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25
What is puerperium?
The period of about six weeks after childbirth during which the mother's reproductive organs return to their original non-pregnant condition.
26
Morbidity of puerperal endometritis?
Puerperal sepsis is a major cause of maternal death
27
Risk factors of puerperal endometritis?
- Caesarean section, prolonged labour - Prolonged rupture of membranes - Multiple vaginal examinations
28
Clinical features of puerperal endometritis?
``` o Fever (38.5C in first 24h post-delivery or >38.0 for 4 hours, 24h+ after delivery) o uterine tenderness o purulent, foul-smelling lochia o increased white cell count o general malaise, abdominal pain ```
29
What is lochia?
Vaginal postpartum bleeding; the heavy flow of blood and mucus that starts after delivery.
30
Causative organisms of puerperal endometritis?
o Escherichia coli o Beta-haemolytic Streptococci (Group B) o Anaerobes
31
Treatment of puerperal endometritis?
Broad-spectrum intravenous antimicrobials (Clindamycin + Gentamicin) – continued until the patient has been apyrexial for 48h
32
What is early onset sepsis (EOS)?
- Sepsis usually within 72 hours (85% present within 24hours of birth) - A major cause mortality and morbidity in new-born babies.
33
How is early onset sepsis typically acquired?
Organisms from maternal genital tract
34
Mortality rate of early onset sepsis?
1 in 4 babies who develop it, even when they are given antibiotics.
35
Major causative organisms of early onset sepsis?
``` o Coagulase-negative staphylococci o Staphylococcus aureus o E. coli o Klebsiella o Enterobacter o Pseudomonas o Candida ```
36
What bacteria is Group A Strep?
Streptococcus pyogenes
37
What bacteria is Group B Strep?
Streptococcus agalactiae
38
What is 'Croup'?
- Childhood infection of URT - Inflammation and narrowing of the subglottic region of the larynx - It is most often caused by a viral infection.
39
Clinical features of 'Croup'? What is the characteristic symptom?
* Characteristic barking cough * Hoarseness * Respiratory distress +/- fever +/- coryza * Stridor
40
What is stridor?
a high-pitched, wheezing sound caused by disrupted airflow
41
What is otitis media?
Infection of the middle ear (common in children)
42
Clinical features of otitis media?
* Unusual irritability * Difficulty sleeping * 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
43
What is the leading cause of death in children under 5 years?
Respiratory viruses
44
What is the major causative organism behind lower RTIs in childhood?
RSV (63%)
45
What are the 3 major causative organisms behind lower RTIs in childhood?
1. RSV (63%) 2. Mycoplasma pneumoniae (9%) 3. Streptococcus pneumoniae (8%)
46
What is bronchiolitis?
Inflammation of the smallest airways (bronchioles), typically in children younger than 2.
47
Clinical features of bronchiolitis?
* A seasonal viral illness characterised by fever, nasal discharge, and dry, wheezy cough. * On examination there are fine inspiratory crackles and/or high-pitched expiratory wheeze
48
Causative organisms of bronchiolitis?
``` o Respiratory Syncytial Virus (RSV) o Metapneumovirus o Adenovirus o Para-influenza virus o Influenza o Rhinovirus ```
49
Is bronchiolitis an upper or lower RTI?
Lower
50
How does pneumonia typically present in infants and children?
Acute febrile illness, possibly preceded by typical viral URTI. o Breathlessness (poor feeding) o Irritability o Sleeplessness o Cough, chest or abdominal pain in older patients o Audible wheezing is rare in LRTI, but can occur
51
What is 'pertussis'?
'Whooping cough'; highly contagious respiratory disease
52
What are the 3 clinical stages of pertussis?
1. Catarrhal phase 2. Paroxysmal phase 3. Convalescent (recovering) phase
53
Describe the catarrhal phase of pertussis?
 Cold-like (coryza, conjunctival irritation, occasionally a slight cough)  7-10 days
54
Describe the paroxysmal phase of pertussis?
 Long duration (2-6 weeks); No fever  a series of rapid, forced expirations, followed by gasping inhalation; the typical whooping sound  Post-tussive vomiting common  Very young infants may present with apnoea or cyanosis in the absence of cough
55
What does 'post-tussive' mean?
occurring after a cough
56
What organism causes pertussis?
B. pertussis
57
How does meningitis present in newborns and infants?
Can have non-specific clinical presentation in newborns and infants: o Fever o Irritability o Lethargy o Poor feeding o High pitched cry, bulging AF o Convulsions, opisthotonos (muscle spasm)
58
Causative organisms of bacterial meningitis in neonates? Causative organisms of bacterial meningitis in >1 month-5 year olds?
Neonates: Group B Streptococcus, Escherichia coli, Listeria monocytogenes >1 month-5 year olds: Streptococcus pneumoniae, Neisseria meningitidis
59
Causative organisms of viral meningitis in neonates and infants?
Enteroviruses (commonest, meningitis occurring in 50% of children <3 months), HSV, Influenza, EBV, adenovirus, CMV
60
What is meningococcaemia?
bloodstream infection caused by Neisseria meningitidis
61
What is meningitis B?
Meningitis caused by Neisseria meningitidis
62
What is meningitis C?
Meningococcal C infection is caused by bacteria called meningococcal type C
63
Symptoms of meningococcaemia?
o Fever, non-specific malaise, lethargy, vomiting, meningism, respiratory distress, irritability, seizures o Maculopapular rash common early in disease o Petechial rash seen in 50-60%
64
major causative organisms of UTIs in children?
Most are from ascending bacteria: E. coli (60-80%), Proteus, Klebsiella, Enterococcus, and Staphylococcus saprophyticus
65
Prevalence of UTIs in caucasian children vs African American children?
Caucasian children had a two- to fourfold higher prevalence of UTI as compared to African American children
66
Symptoms of UTI in: a) older children b) infants?
o Classic UTI symptoms in older children; Dysuria, frequency, urgency, small-volume voids, lower abdominal pain. o Infants with UTIs have nonspecific symptoms; Fever, irritability, vomiting, poor appetite
67
Urine sampling options for UTIs in children/infants?
o A clean catch sample should be obtained o If not possible, use non-invasive method i.e. Urine collection pad o Do not use cotton wool balls, gauze or sanitary towels. o If non-invasive method not possible, use catheter sample or suprapubic aspiration
68
What is impetigo?
highly contagious skin infection
69
2 major causative organisms of impetigo?
o Staphylococcus aureus | o Streptococcus pyogenes
70
Symptoms of impetigo?
o Classically ruptured vesicles with honey-coloured crusting o May be bullous o Commonly starts around face/mouth
71
Antibiotic treatment for impetigo?
Topical antibiotics or oral Flucloxacillin
72
What is Scarlet fever?
contagious bacterial infection that causes blotchy rash
73
Major causative organism of scarlet fever?
o Group A beta-haemolytic Streptococcus | o 2-4 days post-Streptococcal pharyngitis
74
Symptoms of scarlet fever?
o Fever, headache, sore throat, unwell o Flushed face with circumoral pallor o Rash appears on chest/abdomen, may extend to whole body o Rough ‘sandpaper’ skin o Desquamation after 5/7, particularly soles and palms o White strawberry tongue
75
Antibiotic treatment for scarlet fever?
Penicillin

CP reviewer 1 (59 decks)

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