Infectious disease Flashcards
What are the components of the traffic light system for assessing if children have sepsis?
Colour - cyanosis/mottled etc.
Activity - drowsy, inconsolable etc.
Resp - resp distress
Circulation and hydration - tachy, dry membranes, poor skin turgor
Other - fever more than 5 days, non balnching rash, seizures
How should a child under 3 months with a temp over 38 be treated?
Urgently for sepsis
What bacteria most commonly cause bacterial meningitis?
Niseria menigitidis (meningococcal) Streptococcus pneumoniae (pneumococcal) In neonates it is most commonly group B strep from the mothers vagina
What is the presentation of meningitis?
Fever Neck stiffness Photophobia Vomiting headache Altered consciousness Non blanching rash is specific to meningococcal septicaemia
When is a lumbar puncture indicated in children?
All children:
- Under 1 month with a fever
- 1 to 3 months with fever and are unwell
- Under 1 year with unexplained fever and other features of serious illness
What are the two special tests on examination for meningeal irritation?
Kernig’s test - straightening leg with hip flexed produces spinal pain as it stretches meninges
Brudzinski’s test - Passive neck flexion causes them to bend their legs
What is the management of bacterial meningitis?
In the community IV benpen is given and they are transferred to hospital
LP should ideally be done before starting antibiotics but should not delay management
Blood is sent for meningococcal PCR which gives you a result before cultures
Cefotaxime is often used under 3 months
Ceftriaxone is often used over 3 months
Steroids reduce hearing loss and neuro damage so dexamethasone is given 4 times a day for 4 days
What is the post exposure prophylaxis for bacterial menigitis?
Any close contacts are given a single dose of ciprofloxacin
What are the most common causes of viral meningitis and how should it be investigated?
Usually herpes simplex virus, enterovirus, varicella zoster virus
Investigated with viral PCR on LP
At what level is a lumbar puncture done?
The needle is inserted at L3/4 as the cord ends at L1/2
What are the findins in a bacterial and viral CSF samples?
Bacteria will use up glucose and release proteins
Therefore there will be low glucose, high protein, will appear cloudy and there will be a high white cell count with lots of neutrophils
Viruses will not use up glucose
Therefore the glucose will be normal, protein normal, clear appearance and high white cells with lots of lymphocytes
What are the complications of meningitis?
Hearing loss is a key complication
Seizures and epilepsy
Cognitive impairment and learning disability
Cerebral palsy
What are the causes of paediatric encephalitis?
It is caused by infections by viruses most commonly
HSV1 in children and HSV2 in neonates from the mothers vagina
It can also be caused by other viruses e.g. chickenpox (varicella zoster) and CMV
What is the presentation of encephalitis in children?
Altered level of consiousness Altered cognition Unusual behaviour Acute onset focal neurology Acute onset focal seizures
What are the investigations for encephalitis?
LP to do PCR for viruses CT scan if LP contraindicated MRI head to visualise brian in detail Swabs for causative organisms HIV test
