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4 - Y5 a Path lectures 2021/22 > Microbiology 9S: Neonatal and Childhood Infections > Flashcards

Microbiology 9S: Neonatal and Childhood Infections Flashcards

(73 cards)

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1
Q

Which neonatal imfections are screened for routinely during pregnancy?

A
  • Hep B
  • HIV
  • Rubella status (NOT THE INFECTION ITSELF)
  • Syphilis
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2
Q

Which neonatal infections are currently not screened for, but can be?

A
  • CMV (most common cause of congenital deafness in the UK)
  • Toxoplasmosis
  • Hep C
  • Group B Streptococcus (mother is screened only if asymptomatic bacteriuria)
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3
Q

What are some common clinical features of neonatal infection?

A
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4
Q

What is the lifecycle of toxoplasmocosis?

A
  1. Acute infection will start off in a cat
  2. It produces faeces containing oocysts
  3. Mice and birds eat the faeces
  4. Cats eat birds and mice
  • This ends up becoming a cycle
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5
Q

Is congenital toxoplasmocosis symptomsatic at birth?

A

may be asymptomatic (60%) at birth

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6
Q

What are the long term sequale of congential toxoplasmocosis?

A
  • Deafness
  • Low IQ
  • Microcephaly
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7
Q

If the baby shows symptoms of congential toxoplasmocosis at birth, what are they?

A
  • 40% of babies are symptomatic at birth (4 C’s)
    • Choroidoretinitis
    • Microc**ephaly/hydro**cephalus
    • Intracranial calcifications
    • Seizures / convulsions
    • Hepatosplenomegaly/jaundice
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8
Q

Which is the main factor affecting Congenital Rubella Syndrome’s effect on the foetus?

A

time of infeciton (during pregnancy)

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9
Q

What is the mechanism of Congenital Rubella Syndrome?

A
  • Mechanism: mitotic arrest of cells, angiopathy, growth inhibitor effect
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10
Q

What is the classic triad of features of Congenital Rubella Syndrome?

A
  • Cataracts
  • Congenital heart disease (PDA; ASD/VSD)
  • Deafness/SNHL
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11
Q

What are some other features of Congenital Rubella Syndrome?

A
  • Microphthalmia
  • Glaucoma
  • Retinopathy
  • ASD/VSD
  • Microcephaly
  • Meningoencephalopathy
  • Developmental delay
  • Growth retardation
  • Bone disease
  • Hepatosplenomegaly
  • Thrombocytopaenia
  • Rash
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12
Q

What are the features on the child of congenital Herpes Simplex Virus?

A
  • This can spread to the neonate through the genital tract –> blistering rash
  • It can cause disseminated infection with liver dysfunction and meningoencephalitis
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13
Q

When is Chlamydia trachomatis transmitted to the child?

A

during delivery

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14
Q

If the mother has Chlamydia trachomatis, is she always symptomatic?

A

no can be asymptomatic

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15
Q

What can Chlamydia trachomatis cause in the neonate?

A

neonatal conjunctivitis or pneumonia (RARE)

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16
Q

What is the Tx for Chlamydia trachomatis?

A

erthryomycin

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17
Q

Name some other congenital infections

A
  • Hep B and C
  • HIV
  • Listeria monocytogenes
  • GBS
  • Syphilis
  • Mycoplasma species
  • Parvovirus
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18
Q

When is the neonatal period?

A

first 4 weeks of life

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19
Q

How does the neontal period timings differ for a premature child?

A
  • If born premature, the neonatal period is longer and is adjusted for the expected birth date
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20
Q

Why are premature children at greater risk of infection?

A
  • Premature neonates are at INCREASED risk because:
    • Less maternal IgG
    • NICU care
    • Exposure to micro-organisms, colonisation and infection
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21
Q

What is the first, immediate step of Tx for a suspected infection in a neonate?

A

treat with ABx as soon as infection is suspected!

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22
Q

What is the timing for the term ‘early onset’ neonatal infection?

A

within 48 hours (or 3 to 5 days; definitions vary) of birth

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23
Q

Name some possible early onset neonatal infections

A
  • Group B Streptococcus
  • Escherichia coli
  • Listeria monocytogenes
  • Early-Onset Sepsis
    *
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24
Q

Name some features of Group B Streptococcus

A
  • Lancefield Group B
  • Gram +ve coccus
  • Catalase -ve
  • Beta haemolytic
  • 33% of women have GBS commensal (gut, urinary tract, etc)
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25
What is the function of a catalase test?
The catalase test is primarily used to distinguish among Gram-positive cocci: * members of the genus Staphylococcus are catalase-positive * members of the genera Streptococcus and Enterococcus are catalase-negative.
26
What is the clinical significance of beta haemolytic bacteria?
can completely lyse RBCs vs non-beta haeemolytic bacteria
27
What does Group B Streptococcus infection cause in neonates?
* Bacteraemia * Meningitis * Disseminated infection (i.e. joint infection)
28
What are some features of E Coli?
* **Gram -ve** rod * The K1 antigen is particularly problematic
29
What does E coli cause in neonates?
* Bacteraemia * Meningitis * UTI
30
What are some features of Listeria monocytogenes?
* **Gram +ve** rod
31
What does Listeria monocytogenes infection cause in the neonate?
* Sepsis in both the mother and baby
32
Name some neonatal risk factors for early onset sepsis
* Birth asphyxia * Resp. distress * Low BP * Acidosis * Hypoglycaemia * Neutropenia * Rash * Hepatosplenomegaly * Jaundice
33
Name some maternal risk factors for early onset sepsis
* PROM/PPROM * Fever * Foetal distress * Meconium staining * Previous history GBS
34
Name some investigations for ?early onset sepsis
bloods: * FBC * CRP * Blood culture other: * Deep ear swab * LP * Surface swabs imaging: * CXR (full body)
35
What is the treatment for early onset neonatal sepsis?
* **Supportive** – ventilation, circulation, nutrition * **Antibiotics** (e.g. benzylpenicillin & gentamicin  used in combination because… * GBS is treated by benzylpenicillin * E. coli is treated by gentamicin
36
What is the timing for the term 'late onset' neonatal infection?
* after 48-72 hours of birth:
37
Name some possible late onset neonatal infections
* Coagulase-negative Staphylococci (CoNS) * GBS * Escherichia coli * Listeria monocytogenes * Staphylococcus aureus * Enterococcus sp. * Candida species * Gram-negatives - Klebsiella, Enterobacter, Pseudomonas aeruginosa, Citrobacter koseri
38
What are some clinical features of late onset neonatal infection?
* Bradycardia * Apnoea * Poor feeding/abdominal distension * Irritability * Convulsions * Jaundice * Respiratory distress * Increased CRP * Sudden changes in WCC & platelets * Focal inflammation (e.g. umbilicus/drip sites)
39
What are the investigations for ?late onset neonatal infection?
bloods: * FBC * CRP * Blood cultures other: * Urine * ET (endothelin?) secretions if ventilated * Swabs from any infected site
40
What is the Tx for late onset neonatal infection?
* Treat early – low threshold for starting therapy * Review and stop antibiotics if cultures are negative and clinically stable * Antibiotics (guidelines do vary): * 1st line: cefotaxime + vancomycin * 2nd line: meropenem * Community-acquired: cefotaxime, amoxicillin ± gentamicin
41
Is the site of infection easy to ascertain from Hx and examination?
may be difficult
42
Name some viral infections in childhood
Very common * chickenpox, * HHV6, * EBV, * RSV
43
What is the relationship betweeen bacterial and viral infections?
* bacteria may cause secondary infection after viral illness * e.g. invasive Group A Streptococcus (iGAS) infection after VZV
44
What are the symptoms of childhood infections?
Common, non-specific symptoms --\> **fever** and **abdominal pain**
45
What are the investigatios for ?childhood infections?
bloods: * FBC * CRP * Blood cultures other: * Urine * Sputum, throat swabs
46
Which infection is the *most important cause of paediatric morbidity and mortality?*
Meningitis
47
Name the pathogens that can cause childhood meninigtis
* **Men B / Neisseria meningitidis** * Streptococcus pneumoniae (Pneumococcus) * Haemophilus influenzae
48
How is meningitis diagnosed?
* Clinical features bloods: * Blood cultures * EDTA blood for PCR * Clotted serum for serology other: * Throat swab * LP if possible (may be dangerous) --\> Rapid antigen test using CSF
49
What are the contraindications to LP in ?(childhood) meningitis?
* rasied ICP * bleeding disorder * overlying infection at LP site * spina bifida
50
Which results can be obtained from a CSF analysis?
* pressure * appearance * protein * glucose * gram stain * glucose - CSF:serum ratio * WCC
51
What are the results of a CSF analysis for bacterial vs viral infections?
Main differences between bacterial and viral: * **pressure**: high in bacterial, normal/slightly increased in viral * **appearance**: turbid in bacterial, clear in viral * **protein**: \>1 in bacterial, \<1 in viral * **glucose**: low (\<2.2) in bacterial, normal in viral * **gram stain:** usually +tive in bacterial, normal in viral * **glucose - CSF:Serum ratio** - *see table* * **WCC**: \>500 bacterial, \<1000 viral * **Other**: 90% polymorphonuclear neutrophils in bacterial, less likely such a large % PMN in viral
52
What have vaccination programmes done for the incidence of meningitis infections?
* Number of cases of meningitis from following pathogens have decreased: * HiB (Haemoophilius influenza type B) * Men C * pneumococcus
53
Which pathogens are now the main cause of meningitis?
Men B / Neisseria meningitidis
54
When are Men B vaccines given? What is given along with them?
* **Given**: 2m, 4m and 12m * The vaccine is very immunogenic and is usually _given with paracetamol_ because it can make the child ill
55
Which pathogen is a leading cause of meningitis mortality/morbidity, especially in especially in those \<2 years?
Streptococcus pneumoniae (Pneumococcus)
56
Describe Streptococcus pneumoniae (Pneumococcus)?
* Gram-positive diplococcus, * Alpha-haemolytic, * Optochin-sensitive * More than 90 capsular serotypes (difficult to generate a vaccine) * Increasing penicillin resistance
57
What types of infections can Streptococcus pneumoniae (Pneumococcus) cause?
Meningitis, Bacteraemia, Pneumonia
58
When are Streptococcus pneumoniae (Pneumococcus) vaccinations given?
* Given: **12w, 12m** * called **Prevenar 13** (targets 13 serotypes)
59
Describe *Haemophilus influenzae*:
* **Gram-negative rod**, * grows **glossy colonies** on blood agar * Causes meningitis at all ages
60
Describe childhood respiratory infections
* 1/3 of all childhood illnesses * Mostly URTIs, mostly viral * Age is important * Sputum is difficult to obtain * Often need to give empirical antibiotics
61
Name the main pathogens that cause childhood respiratory infections
* **Streptococcus pneumoniae** * Mycoplasma pneumoniae *
62
Which pathogen is the most important cause of childhood respiratory infections?
Streptococcus pneumoniae
63
Which Abx is Streptococcus pneumoniae sensitive to?
* Sensitive to amoxicillin or penicillin
64
Describe the features of childhood Mycoplasma pneumoniae infection
* Features: * Tends to affect older children (\> 4 years) * Person-to-person droplet transmission * Incubation period 2-3 weeks * Epidemics every 3-4 years * Occurs in school children / young adults * Mainly asymptomatic
65
What are the clinical features of Mycoplasma pneumoniae?
* Clinical features (if not asymptomatic): * Fever * Headache * Myalgia * Pharyngitis * Dry cough
66
What are some extrapulmonary manifestations of Mycoplasma pneumoniae?
* Haemolysis * IgM antibodies to the I antigen on erythrocytes * **_Cold agglutinins_** in 60% * Neurological * Encephalitis * Aseptic meningitis * Peripheral neuropathy * Transverse myelitis * Cerebellar ataxia * *Cardiac* * Polyarthralgia, myalgia, arthritis * Otitis media * Bullous myringitis (vesicles on tympanic membrane – pathognomonic of mycoplasma disease)
67
Which class of ABx is used to treat Mycoplasma pneumoniae?
* Treated with macrolides (azithromycin)
68
69
What should you consider as differentials if a childhood respiratory tract infection fails to respond to ABx?
* Whooping cough (**Bordatella pertussis**) * TB
70
How are UTIs in children diagnosed?
* Symptoms – If child can give a history * Pure growth of \>105 CFU/mL * Pyuria – **pus cells** on urine microscopy
71
Which main organisms are implicated in childhood UTIs?
* **_Escherichia coli_** – MAIN ORGANISM * Other coliforms (Proteus, Klebsiella, Enterococcus sp.) * Coagulase-negative Staphylococcus (Staphylococcus saprophyticus)
72
How are UTIs in children treated?
* Early diagnosis and antibiotic treatment is important * _Obtain sample_ before starting treatment * **Renal tract imaging** may be required to check for congenital anomalies * **Antibiotic prophylaxis** may be given after treatment of the infection
73
What must you consider in the case of **Recurrent or Persistent Infections** in children?
* May be a feature of immunodeficiency – either congenital (e.g. SCID) or acquired (e.g. HIV) * Warrants investigation by paediatric infectious diseases specialist

4 - Y5 a Path lectures 2021/22 (37 decks)

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