Infectious disease 1.0 Flashcards Preview

Paediatrics > Infectious disease 1.0 > Flashcards

Flashcards in Infectious disease 1.0 Deck (15):
1

What is unique about childhood infectious disease? 

  • Common infections can become life threatening infections: fever and rash
  • Immune system is developing so will present differently 
  • Presenting symptom of primary immunodeficiencies (inborn error in specific immune component) or HIV 

2

What is paediatric sepsis

SIRS + suspected/proven infection

3

SSx of paediatric sepsis

  • Fever or hypothermia
    • Tachycardia
    • Tachypnoea
    • Leucocytosis or leucocytopaenia
  • Chills/rigors
  • Limb pain
  • Vomiting/diarrhoea
  • Muscle weakness
  • Joint pain
  • Skin rash
  • Infection = bacteraemia (e.g. bacteria multiplying in the bloodstream) 
  • More common in boys
  • Most common in newborn 1/300

4

What is paediatric severe sepsis

SEPSIS + multi-organ failure

≥2 of the following:

  • Respiratory failure
  • Renal failure
  • Neurologic failure
  • Haematological Failure • Liver failure 

5

What is ARDS?

  • (acute respiratory response syndrome)
    • Inflammatory response of the lungs 

6

Sepsis

What are the responsible pathogens in neonates? (<1month)

What are the responsible pathogens in children?  

Neonates:

  • Group B streptococci
  • E coli
  • Listereria monocytogenes

Children

  • Strep pneumoniae
  • Meningococci
  • Group A streptococci
  • Staph aureus

7

Paediatric meningitis

Possible pathogens: neonates?

Children?

Neonates

  • Group B strep
  • E. coli
  • Listeria monocytogenes

Children

  • Strep pneumoniae
  • meningococci
  • H influenzae

8

Meningitis 

SSx? 

in Neonates? 

  • Nuchal rigidity
  • Headaches, photophobia
  • Diminished consciousness
  • Focal neurological abnormalities
  • Seizures

In neonates:

  • Lethargy, irratability
  • Bulging fontanelle
  • nappy pain 

9

Meningits +/- Sepsis

What is the management? 

Supportive

  • A - airway
  • B - breathing
  • C - circulation
  • D - Don't ever forget glucose

Causative treatment:

  • Antibiotics with good penetration in CSF & broad-spectrum:
    • 3rd generation cefalosporins (cefotaxime) (+ amoxicilline if neonate)

Chemoprophylaxis:

  • Close household contacts

  • Meningococcus B and Streptococcus group A 

10

What test do we need to do to make a diagnosis of meningitis +/- sepsis? 

  • Blood:
    • FBC; leucocytosis, thrombocytopaenia
    • CRP; elevated
    • coagulation factors; low levels due to DIC
    • blood gas; metabolic acidosis
    • glucose; hypoglycaemia
  • CSF: pleocytosis, increased protein level, low glucose
  • Blood and CSF cultures (antigen testing, PCR)
  • Urine culture, skin biopsy culture
  • Imaging: CT-cerebrum 

11

Give me some deets on strep pneumoniae: 

  • Gram-positive Duplo-cocci (Diplococcus pneumoniae)
  • 90 serotypes identified
  • Colonizes upper airways
    • 5-10% adults
    • 20-40% children
  • Transmission by droplets
  • Viral infections predisposing factor for invasive disease 

12

Complications of pneumococcal meningitis? 

  • Brain damage
  • Hearing loss
  • Hydrocephalus 

13

Tell me about haemophilus influenza type b: 

  • Gram-negative bacterium
  • Encapsulated H. influenzae, 6 serotypes
    • Resist phagocytosis and complement-mediated lysis
  • Unencapsulated H. influenzae = non-typeable H. influenzae (NTHI)
  • Bacteraemia, meningitis (as severe as pneumococcal meningitis), pneumonia, epiglottitis
  • Viral infections predisposing factor for invasive disease 

14

What is the clinical epidemeology of meningococcal disease? 

  • Meningococcus in nasopharynx
  • Passage through epithelia
  • Meningococcus in the bloodstream
    • < 12 hours signs of septic shock
    • < 18-36 hours signs of meningitis
  • Case-fatality rate 5-15%
    • 50% of deaths in first 12 hrs, 80% within 48 hrs
    • Long-term morbidity in significant proportion of survivors
  • Amputation (14%), skin scarring (48%)
  • Cognitive impairment/epilepsy/hearing loss 

15

What are the vaccine preventable diseases? 

  • Haemophillus influenza B
  • Pneumococcal disease

These are major causative organisms that can be protected against.