Sepsis, Meningitis + Anaphylaxis paeds Flashcards
(34 cards)
Meningitis pathology
Usually in first 5 years of life
Inflammation of leptomeninges surrounding brain tissue
Release of inflammatory mediators + activated leucocytes
Endothelial damage = causes cerebral oedema, raised ICP + decreased cerebral blood flow
Inflammatory response causes vasculopathy - causes cerebral cortical infarction
Fibrin deposits block reabsorption of CSF
Causes hydrocephalus
75% occur before age of 15
Incubation period for bacterial meningitis
2-10 days
Bacteria causing meningitis
Neonates = group B strep, E coli, Listeria
Infants + kids = Neisseria, strep pneumonia, Haemophilus influenza B
Adolescents = neisseria, strep pneumonia
S+S meningitis (+ for ages)
Shock = tachycardia, tachypnoea, prolonged cap refill General = fever, headache, photophobia, irritability, hypotonia, purpuric rash Infants = poor feeding, respiratory distress, coma Infants = lethargy, unsettled, refusing food Adolescents = muscle aches + pains, neck stiffness, N+V
Kernigs + Brudzinskis sign
Kernig = child lies supine, hips + knees flexed, back pain on extension of knee
Brudzinski’s = flexion of neck causes flexion of knees + hips
Complications of menigitis
Hearing loss Vasculitis Cerebral infarction = seizures Subdural effusion = especially H influenza Hydrocephalus Cerebral abscess
Investigations for meningitis
Lumber puncture Septic screen Bloods + glucose, lactate, cultures + gas Urine for M,C +S Nasal + throat swabs Viral/ bacterial PCRs
Management of bacterial meningitis
<3 months cefotaxime + amoxicillin Ceftrixone >3 months IM benpen in community Dexamethasone Rifampicin to family
S+S neonatal meningitis
Bulging fontanelle
Hyperextension of neck (opisthotonus)
Sepsis vs severe sepsis vs septic shock
Sepsis = infection + systemic inflammatory response Severe = sepsis + CV dysfunction/ acute respiratory distress Shock = Severe sepsis + CV dysfunction
Boundaries for tachycardia in children
<12 months = >160
12-24 months = >150
2-5 years = >140
Food allergy cause
IgE mediated
Infants = milk, egg, peanut
Older kids = peanuts, fish
S+S food allergies (IgE mediated vs not)
IgE mediated: facial swelling, anaphylaxis
Non IgE = D+V, abdo pain
Pathology of anaphylaxis
Maldistribution of fluid
Allergen reacts with IgE ab on mast cells + basophils (type 1 hypersensitivity reaction)
Causes capillary leakage, mucosal oedema + shock
Management of anaphylaxis
> 12 years = 500mcg IM adrenaline
6-12 = 300mcg
<6 = 150mcg
Why is periorbital cellulitis a concern in children?
May be secondary to underlying bacterial sinusitis or due to spread from primary infection
What are complications of periorbital cellulitis?
Sub-periosteal abscess, cavernous sinus thrombosis, intracranial abscess
How to diagnose HIV in infants?
<18 mths = HIV DNA PCR
Over 18mths = detecting ab to virus
Contraindications for LP
raised ICP,
thrombocytopaenia,
local infection at site of LP, extensive purpura
shock - stabilise first
after convulsions - stabilise first
respiratory insufficiency - stabilise first
CSF results for bacterial meningitis
Cloudy/ turbid
High protein (>1)
Low glucose
Neutrophils present
CSF results for viral meningitis
Clear fluid
Normal/ high protein
Normal glucose
Lymphocytes present
CSF results for TB meningitis
Clear/ slightly cloudy
High protein >1.5
Low glucose
Lymphocytes + acid-fast bacilli present
What infection is caused by herpes 4?
EBV
What antibodies are involved in HSP?
IgA + IgG interact + deposit in organs
