Infections in children Flashcards
(37 cards)
How large is the share of under-five deaths caused by infection globally?
2/3
What are some general causes of fever?
Infection, cancer, immunological diseases, intracranial bleeding and medications.
What are risk factors for serious infection in children?
Newborn.
Immunodeficiency (e.g. cancer or hematological diseases).
Indwelling medical devices (such as urinary catheters or vascular access devices).
Chronic illness.
How do you measure capillary refill time (CRT)? What is considered abnormal CRT?
Press on the skin of the sternum or a digit at the level of the heart. Apply blanching pressure for 5 seconds. Measure the time it takes for blush to return. Prolonged CRT (> 2-3 seconds) is considered abnormal.
What should be assessed in a child with fever?
Vital signs (BP, pulse, RR, CRF, saturation).
General condition.
Dehydration status.
Neurological deficits.
Local signs (GI-tract, respiratory tract, lymph glands etc.).
What are the four main features to assess when first meeting a sick child? (To determine if the child i critically ill.)
Responsiveness (or consciousness)
Facial expression
Color
Position
What is the association between high fever and risk of severe infection in children younger than 3-6 months? Can severe infection be excluded in children of this age group if the child is afebrile?
High fever gives high risk of severe infection. Threshold for hospital admission should be low. However, the absence of fever does not exclude severe infection.
What are factors indicative of illness severity in children?
Low age VS High age.
Systemically ill or not.
High (or prolonged fever) VS Low fever.
Presence of features associated with potentially severe infections such as osteomyelitis or septic arthritis.
No localized features VS Localized minor illness such as acute otitis media or upper respiratory tract infection.
Predisposition to infection (e.g. immunodeficiency) VS Normal, otherwise healthy, child.
What lab tests should/can be taken when examining a febrile child?
Complete blood count (CBC). (Erythrocytes, hemoglobin, hematocrit, leukocytes, thrombocytes.)
CRP and procalcitonin.
Blood culture.
Urine sample (dipstick test and culture).
Lumbar puncture.
What are the most common infectious agents in sepsis for children under 3 months of age and over 3 months of age?
< 3 months: Group B streptococci B (GBS) and E. coli.
> 3 months: Streptococcus pneumoniae and group A streptococci (GAS).
What are symptoms of meningococcal sepsis?
Rash. At first pale skin, than later skin bleeding.
Poor general appearance.
Irritability.
Reduced level of consciousness (GCS < 15).
Influenza like body pain.
What are the main differences between symptoms of meningitis in children under and over the age of 18 months?
Children < 18 months: High fever, irritability/fatigue, vomiting, seizures, rash and bulging fontanelle, but often no signs of neck-stiffness.
Children > 18 months: Classical symptoms. Neck-stiffness, headache, irritability, high fever, photophobia and reduced level of consciousness.
What is the “rule of thumb” for symptoms of meningitis if the agent is meningococci. What if the agent is pneumococci?
Meningitis with petechia is generally due to meningococcal infection.
Meningitis without petechia is generaly due to pneumococcal infection.
How should meningitis in children generally be managed?
Lumbar puncture to confirm the diagnosis.
Intravenous antibiotics. (3rd generation cephalosporine.)
Treatment of symptoms (as for sepsis), but be careful with fluids.
True of false: 1/3 of all infections in children are respiratory tract infection.
False. 2/3 of all infections in children are respiratory tract infections.
What are examples of common upper and lower respiratory tract infections (RTI) in children?
Upper RTI: Common cold, otitis media, pharyngitis, tonsillitis, and laryngitis.
Lower RTI: Bronchitis, bronchiolitis, and pneumonia.
What are the most common agents in children with respiratory tract infections?
Viral agents, such as rhinovirus, influenza virus and RS-virus, are the most common.
What is the first choice of antibiotics when treating children with pneumonia (and other RTI) and why? What is the second choice?
Penicillin is the first choice because it has a narrow spectrum and covers both pneumococci and streptococci.
The second choice is a macrolides, which cover both chlamydia and mycoplasma.
What is the most common bacterial agent in children with tonsillitis?
Group A streptococci.
What are important aspects of a child’s breathing to assess in suspected cases of RTI?
Respiratory rate. Retraction. Nasal flaring. Respiratory sounds, e.g. grunting. Auscultation sounds, e.g. crackles, stridor, wheezing.
What are chest retractions?
Collapse of soft tissue due to muscular effort in breathing. (Mainly the diaphragm.)
Why do grunting occur in children with respiratory distress?
It is a mechanism in which the child tries to maintain lunge volume through closure of the glottis. Breathing against the closed glottis provides PEEP (positive end-expiratory pressure).
Define tachypnea for neonates, infants, toddlers and older children.
Neonates: RR > 60.
Infants: RR > 50.
Toddlers: RR > 40.
Older children: RR > 30.
What are the diagnostics when dealing with a pediatric throat infection? How should it be treated?
Diagnostic: Strep A test. (CRP and blood count.)
Treatment: If positive strep A test, treat with penicillin.
