Paediatric Infections

Front 1

What aspects of a infection should make you suspicious of a more serious underlying causes e.g an underlying immunodeficiency?

Back 1

Severe - i.e Requires hospitalisation and IV antibiotics

Persistant - wont clear up completely or clears up v slowly

Unusual - caused by an uncommon organism

Recurrent - keeps coming back

Runs in the family - i.e older siblings also have recurrent infections

*basically if they are having recurrent and persistant infections then think immunodeficiency*

Front 2

If a child has a primary antibody immunodeficiency, what type of infections does this put them at higher risk of?

Back 2

Puts them most at risk of respiratory tract bacterial infections:

ie. S. Pneumoniea and H.Influenza

Front 3

Case:

Adam, 4 year old boy

Recurrent respiratory tract infections (6/yr) since age 2

1x pneumonia > hospital admission & i.v. antibiotics

Normal growth and development

4 antibiotic course on average each year

What does this history tell you about the likely hood of Adam having an immunodeficiency disorder?

Think about the signs of immunodeficiency

Back 3

He has Recurrence of infection

He has severity of infection - pneumonia and IV antibiotics.

He has persistance - 4 courses of antibiotics a year.

All these things point towards Adam having an immunodeficiency disorder.

Front 4

With the persistence of respiratory tract infections and the type of them (pneumonia), what part Adam's immune system is likely to be faulty?

Back 4

Weakened respiratory tract immunity suggests it is an Antibody deficiency.

Making Adam vulnerable to H.Influenza and S.Pneumoniae

Front 5

What investigations would you run to confirm Adam has an antibody deficiency?

Back 5

Do serum levels checks for his level of anti-bodies.

ie. Serum IgG, IgA, IgM

You could also check there immune response to H.influenza and S.Pneuomoniae vaccines

Front 6

If a child has Primary immune deficiency of their innate immune system (e.g Phagoyctes and complement system), what type of infections does this make them vulnerable to?

*vulnerable to different infections depending on if they are deficient in Phagocytes or Complement system*

Back 6

If deficient in their innate immune system then vulnerable to:

Phagocyte deficiency - S.Aureus (e.g sepsis, skin lesions), Aspergillus infections (lung,bones,brain)

Complement system deficiency - N.meningitidis

Front 7

Case:

Joseph, a 13-month old boy

Sudden onset of fever and petechial rash

Admitted to PICU

CRP 119 mg/L,

leucocytes 10.9 x 109/L

Meningococcal sepsis diagnosed (blood culture positive)

Critically ill with septic shock during first 18 hr

Complete recovery

Older sibling died 2 years age from meningococcal meningitis at the age of 9 months

What aspects of this history suggest that Joseph may have an immunodeficiency?

Back 7

Aspects suggestive of immunodeficiency:

The severity - required hospitalisation, critically ill

The family history - brother died of meningitis

Front 8

With the onset of meningitis, what part of the immune system does this suggest Joseph is deficient in?

Back 8

Menigiococcal meningitis suggests there is a deficiency in the Complement system

(part of the innate immunity)

Front 9

What are the presenting symptoms of HIV/AIDS in paediatrics?

Back 9

Recurrent RTI’s

Persistent oral trush

Erythematous papular rash

Generalized lymphadenopathy

Recurrent/disseminated VZV/HSVinfections

Failure to thrive

Developmental delay’

Opportunistic infections: CMVpneumonia/retinitis, PCP

*i.e they have recurring infections/viruses, thrush, rash, enlarged lymph nodes, and developmental delay*

Front 10

A baby presents with history of recurrent RTIs, Pnuemonia, persistant thrush, a Erythematous papular rash, enlarged lymph nodes all over and isn't well developed for her age.

What are you thinking could be the underlying condition causing all these symptoms?

Back 10

HIV

Front 11

If a child is low in nuetrophils (e.g Nuetropenia due to Leaukemia) then what type of infection does this make them extra vulnerable to getting?

Back 11

Nuetropenia - Puts child at increased risk of Fungal infections (e.g Thrush)

Front 12

What are the symptoms of SIRS (systemic inflamatory response syndrome) that suggest a child may have sepsis?

Back 12

Fever/Hypothermia

Tachycardia

Tachyponea

Leucocytosis or leucocytopaenia

*ie. if you see a child who has high HR, high BR, abnormal temperature and recent bacterial infection, consider sepsis*

Front 13

What type of organism causes sepsis?

Back 13

Sepsis can only be caused by bacteria in the blood stream.

Front 14

What is the sepsis 6 (which tells you the 4 diagnostics the 2 immediate treatments)?

Back 14

Take 02 - make sure sats are above 94%

Take blood cultures

Measure lactate (lactic acid)

Give IV antibiotics

Give fluid

Measure urine output

Front 15

What condition can occur in the lungs in children with sepsis?

Back 15

ARDS (acute respiratory response syndrome)

=

Inflammatory response of the lungs

Front 16

What organ failure signifies the child has gone into septic shock?

Back 16

Cardiovascular failure

Front 17

What is the most common bacteria causing sepsis in neonates?

Back 17

Group B Streptococci

Front 18

What is the most common bacteria causing sepsis in children?

Back 18

Sreptococcus Pneumoniae

Front 19

Name 6 symptoms of Sepsis in children?

Back 19

Fever or hypothermia

Cold hands/feet, mottled

Prolonged capillary refill time

Chills/rigors

Limb pain

Vomiting and/or diarrhoea

Muscles weakness

Muscle/joint aches

Skin rash

Diminished urine output

*ie. it is a multisystem disease and has multisytem effects - lack of temp control, lack of HR and RR control, muscle pain, dehydration, GI symptoms and rashes*

Front 20

Think of the meningitis baby watch poster, what are the signs and symptoms that may suggest a baby has meningitis?

Back 20

Is the baby getting worse and fast?

High temperature

Bulging soft head

Headaches/Photophobia

Seizures

Very sleepy/tired looking

Vomiting/refusing to feed

Irritable/high pitched moaning cry

Difficulty feeding

Blotchy skin/ pale/ blue

Fast breathing

Extreme shivering

Stiff body with jerky movementss

Purple pin prick bruises

Cold hands and feet

Front 21

What is definative sign of menigiococcal menigits in a child?

Back 21

Menigiococcal Rash!

Key sign

Press a glass against the rash, usually the rash should disapear - if it doesnt this is called a non-blanching rash.

Front 22

A child is brought in with meningitis + sepsis, what is the immediate management?

Back 22

Support ABC:

Airway

Breathing

Circulation

Check glucose

High flow oxygen

IV antibiotics - preferably ceflasporins

IV fluids

Front 23

If a child presents with the symptoms of menigitis/speticemia, what investigations do you run?

What are the results which would indicate meningitis +/- Septicaemia

Back 23

*start with the 4 of the septic 6*

O2 sats

Urine output

Serum lactate

Blood cultures

Bloods:

FBC - looking for luecocytosis

CRP - should be elevated

Blood gas - metabolic acidosis

Glucose - hypoglycemia

CSF measurement:

Pleocytosis - large number of lymphocytes in CSF

increased protein level

low glucose

Imaging:

CT of cerebrum

Front 24

What condition does Pneumococcal disease (disease caused by Pneumococcal bacteria) usually present with and then what can it eventually progress onto?

Back 24

Pneumococcal infection typically presents with Ottitis media.

Then can progress onto...

Pneumonia >>> Bacteraemia >>> Meningitis

Front 25

What are the long term complications of Pneumococcal Menigitis if not treated quickly enough?

Back 25

Long term complications of Pneumococcal Meningitis:

Brain dammage

Hearing loss

Hydrocephalous

Front 26

What is the most dangerous/acute form of meningitis?

Back 26

Menigococcal Menigitis

Front 27

What is the difference between viral meningitis and bacterial meningitis?

Back 27

Viral meningitis is rarely life threatening not as severe (far more common)

Bacterial meningitis is severe and requires immediate treatment

Front 28

What are the two most common causing bacteria of bacterial meningitis?

Back 28

Pneumococcal

&

Menigococcal

Front 29

What acute condition of the blood is bacterial menigitis closely related to?

Back 29

Septicaemia - only caused by bacteria in the blood stream

*viral meningitis is not related)

Front 30

What age group is bacterial meningitis most common in?

Back 30

Significantly more common in <1 year olds

Front 31

What is the main antibiotic treatment for Streptococcal & Staphylococci infections?

Back 31

They are both gram positive bacteria - so therefore treated with Penicillin

Front 32

List the 5 main diseases caused by Streptococcal and Staphylococci infections

Back 32

Impetigo

Streptococcal toxic shock syndrome

Bacteremia

Cellulitis

Septic arthritis

Front 33

What bacteria causes septic arthritis?

Back 33

Septic arthritis caused by Streptococcal or Staphylococcal gram positive Bacteria

Therefore can be treated with Penicillin

Front 34

What is the causative organism for Necrotosing fascititis and cellulitis?

Back 34

Both caused by Streptococcal or Staphylococcal gram positive bacteria

Therefore can be treated with Penicillin

Front 35

What is the causative organism of Scarlet fever in children?

*classic sign is strawberry tongue*

Back 35

S. Pyogens

Gram posotive so treat with Penicillin

Front 36

What is the main two symptoms that indicates the child has a bacterial Steptococci or Staphylococci infection?

Back 36

Fever and Rash

Front 37

Fever and rash does not always indicate bacterial infeciton, what is the most common non-infective cause of a fever and rash in children?

Back 37

Kawasakis Disease

Most common non-infective of fever and rash in kids

Cause is idopathic

Front 38

What is Kawasakis disease?

Back 38

Kawasaki disease is a disease in which blood vessels throughout the body become inflamed.

The most common symptoms include a fever that lasts for more than five days

Front 39

What are the symptoms of Kawasakis disease?

Back 39

Main symptom = Fever that lasts more than 5 days

+++

Bilateral conjunctival injection

Changes of the mucous membranes
Cervical lymphadenopathy
Polymorphous rash

Changes of the extremities

Front 40

A child presents with cervical lumphadenopahty, a 5 day fever, peripheral oedema, peripheral erythema.

What condition is likely to cause these fever, rash and oedema symptoms?

Back 40

Kawasaki's Disease

Front 41

What is the 1st line treatment for kawasakis disease?

Back 41

Immunoglobumins

&
Aspirin

Front 42

A child presents with mild malaise and fever and crusty, itchy pustules - what are you thinking they have?

Back 42

Chicken pox - Vircella Zoster Virus

*the key feature is the MILD malaise and fever, chicken pox they are not physically that unwell just itchy*

Front 43

What is the therapy for Vircella Zoster Virus?

Back 43

Normally just let it run its course

if not give Aciclovir

Front 44

What is the two main clinical defining features of Herpes simplex virus in a child?

Back 44

Stomatitis - general term for an inflamed and sore mouth

+++

Recurrent cold sores