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44 Cards in this Set
- Front
- Back
What aspects of a infection should make you suspicious of a more serious underlying causes e.g an underlying immunodeficiency? |
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* |
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If a child has a primary antibody immunodeficiency, what type of infections does this put them at higher risk of? |
Puts them most at risk of respiratory tract bacterial infections: ie. S. Pneumoniea and H.Influenza |
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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
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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. |
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With the persistence of respiratory tract infections and the type of them (pneumonia), what part Adam's immune system is likely to be faulty? |
Weakened respiratory tract immunity suggests it is an Antibody deficiency. Making Adam vulnerable to H.Influenza and S.Pneumoniae |
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What investigations would you run to confirm Adam has an antibody deficiency? |
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 |
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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* |
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 |
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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
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Aspects suggestive of immunodeficiency: The severity - required hospitalisation, critically ill The family history - brother died of meningitis |
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With the onset of meningitis, what part of the immune system does this suggest Joseph is deficient in? |
Menigiococcal meningitis suggests there is a deficiency in the Complement system (part of the innate immunity) |
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What are the presenting symptoms of HIV/AIDS in paediatrics? |
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* |
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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? |
HIV |
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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? |
Nuetropenia - Puts child at increased risk of Fungal infections (e.g Thrush) |
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What are the symptoms of SIRS (systemic inflamatory response syndrome) that suggest a child may have sepsis? |
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*
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What type of organism causes sepsis? |
Sepsis can only be caused by bacteria in the blood stream. |
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What is the sepsis 6 (which tells you the 4 diagnostics the 2 immediate treatments)? |
Take 02 - make sure sats are above 94% Take blood cultures Measure lactate (lactic acid) Give IV antibiotics Give fluid Measure urine output |
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What condition can occur in the lungs in children with sepsis? |
ARDS (acute respiratory response syndrome) = Inflammatory response of the lungs |
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What organ failure signifies the child has gone into septic shock? |
Cardiovascular failure |
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What is the most common bacteria causing sepsis in neonates? |
Group B Streptococci |
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What is the most common bacteria causing sepsis in children? |
Sreptococcus Pneumoniae |
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Name 6 symptoms of Sepsis in children? |
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* |
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Think of the meningitis baby watch poster, what are the signs and symptoms that may suggest a baby has meningitis? |
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 |
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What is definative sign of menigiococcal menigits in a child? |
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. |
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A child is brought in with meningitis + sepsis, what is the immediate management? |
Support ABC: Airway Breathing Circulation Check glucose High flow oxygen IV antibiotics - preferably ceflasporins IV fluids |
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If a child presents with the symptoms of menigitis/speticemia, what investigations do you run?
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*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 |
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What condition does Pneumococcal disease (disease caused by Pneumococcal bacteria) usually present with and then what can it eventually progress onto? |
Pneumococcal infection typically presents with Ottitis media. Then can progress onto...
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What are the long term complications of Pneumococcal Menigitis if not treated quickly enough? |
Long term complications of Pneumococcal Meningitis: Brain dammage Hearing loss Hydrocephalous |
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What is the most dangerous/acute form of meningitis? |
Menigococcal Menigitis |
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What is the difference between viral meningitis and bacterial meningitis? |
Viral meningitis is rarely life threatening not as severe (far more common) Bacterial meningitis is severe and requires immediate treatment |
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What are the two most common causing bacteria of bacterial meningitis? |
Pneumococcal & Menigococcal |
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What acute condition of the blood is bacterial menigitis closely related to? |
Septicaemia - only caused by bacteria in the blood stream *viral meningitis is not related) |
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What age group is bacterial meningitis most common in? |
Significantly more common in <1 year olds |
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What is the main antibiotic treatment for Streptococcal & Staphylococci infections? |
They are both gram positive bacteria - so therefore treated with Penicillin |
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List the 5 main diseases caused by Streptococcal and Staphylococci infections |
Impetigo Streptococcal toxic shock syndrome Bacteremia Cellulitis Septic arthritis |
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What bacteria causes septic arthritis? |
Septic arthritis caused by Streptococcal or Staphylococcal gram positive Bacteria Therefore can be treated with Penicillin |
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What is the causative organism for Necrotosing fascititis and cellulitis? |
Both caused by Streptococcal or Staphylococcal gram positive bacteria Therefore can be treated with Penicillin |
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What is the causative organism of Scarlet fever in children? *classic sign is strawberry tongue* |
S. Pyogens Gram posotive so treat with Penicillin |
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What is the main two symptoms that indicates the child has a bacterial Steptococci or Staphylococci infection? |
Fever and Rash |
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Fever and rash does not always indicate bacterial infeciton, what is the most common non-infective cause of a fever and rash in children? |
Kawasakis Disease Most common non-infective of fever and rash in kids Cause is idopathic |
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What is Kawasakis disease? |
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 |
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What are the symptoms of Kawasakis disease? |
Main symptom = Fever that lasts more than 5 days +++ Bilateral conjunctival injection Changes of the mucous membranes Changes of the extremities |
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A child presents with cervical lumphadenopahty, a 5 day fever, peripheral oedema, peripheral erythema. |
Kawasaki's Disease |
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What is the 1st line treatment for kawasakis disease? |
Immunoglobumins & |
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A child presents with mild malaise and fever and crusty, itchy pustules - what are you thinking they have? |
Chicken pox - Vircella Zoster Virus *the key feature is the MILD malaise and fever, chicken pox they are not physically that unwell just itchy* |
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What is the therapy for Vircella Zoster Virus? |
Normally just let it run its course if not give Aciclovir |
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What is the two main clinical defining features of Herpes simplex virus in a child? |
Stomatitis - general term for an inflamed and sore mouth +++ Recurrent cold sores |