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13.03.12 Paediatric infections

Measles
  • 3-5 day prodrome
  • Spreads downwards from the ears
  • Desquamates in 2nd week
  • Cough, runny nose, Koplik spots
  • Infective from 1-2 days before to 6 days after rash
  • Complications
    • Subacute sclerosing panencephalitis (SSPE)
      • Severe late complication
      • History of primary measles infection usually before the age of 2 years, followed by several asymptomatic years (6–15 on average)
      • Gradual, progressive psychoneurological deterioration: Personality change, seizures, myoclonus, ataxia, photosensitivity, ocular abnormalities, spasticity, coma
    • Otitis media
    • Pneumonia
    • Encephalopathy
  • Treatment is supportive


Meningitis
  • Organisms:
    • Neonates: GBS, E. coli, Listeria
    • Children: Neisseria meningitides, Streptococcus pneumoniae, Haemophilus influenzae type B
  • Treatment:
    • IV ceftriaxone
    • BenPen + Gent in neonates
    • Ampicillin if Listeria suspected


Chicken pox

  • 10-21 day incubation
  • 5% get secondary infection
  • IV aciclovir
    • Older children
    • Immunocompromised
  • VZIG


Kawasaki

  • Peak age 9-11 months
    • But may affect from 6 months to 5 years
  • Winger/spring peak
  • Diagnosis:
    • Fever of ≥5 days' duration plus 4 of:
      • Bilateral nonsuppurative conjunctivitis
      • One or more changes of the mucous membranes of the upper respiratory tract
        • Pharyngeal injection, dry fissured lips, injected lips, "strawberry" tongue
      • One or more changes of the extremities
        • Peripheral erythema, peripheral edema, periungual desquamation, generalized desquamation
      • Polymorphous rash
        • Pimarily truncal
      • Cervical lymphadenopathy
        • >1.5 cm in diameter
  • Can cause fatal coronary artery aneurysms


Bronchiolitis

  • 90% are <1 year
  • RSV most common cause
  • Coryza, breathless, reduced feeding, apnoea
  • Treatment:
    • Oxygen
    • NG feeds
    • IV fluids
    • Check capillary CO2 => ?NIV
  • No need for antibiotics, CXR, bronchodilators


GBS

  • 15-30% of women are carriers
  • Infection may be:
    • Early => Pneumonia, septicaemia, meningitis
    • Late (3 days - 3 months) => Meningitis
  • Risk factors: PROM, Fever in labour
  • Admit straight to NICU
  • BenPen + Gent


UTI management

  • < 3 months
    • Refer to paediatric specialist care and send a urine sample for urgent microscopy and culture
  • 3 months - 3 years
    • Urgent microscopy and culture + antibiotics if specific urinary symptoms
    • If non-specific symptoms, send urine for microscopy and culture and start antibiotics if microscopy or culture is positive
    • Consider paediatric specialist review
  • > 3 years: Do urine dip:
    • Both leucocyte esterase and nitrite positive:
      • Regard as having UTI and start antibiotic treatment should be started
      • Send for culture if high or intermediate risk of serious illness and/or a history of previous UTI
    • Leucocyte esterase negative, nitrite positive:
      • Start antibiotics if the urine test was carried out on a fresh sample of urine
      • Send urine sample for culture to determine further management
    • Leucocyte esterase positive, nitrite negative:
      • Send urine sample for microscopy and culture
      • May be indicative of an infection outside the urinary tract
      • Do not start antibiotics without strong clinical suspicion
    • Both leucocyte esterase and nitrite negative:
      • Regard as not having UTI
      • Investigate other causes


Infectious mononucleosis (EBV)
  • => Rash with penicillin
  • Atypical lymphocytes
  • Splenohepatomegaly
  • Jaundice


Epiglottitis

  • HIB
  • Acute emergency
  • DON'T EXAMINE
  • Urgent senior help + intubation


Croup (laryngotracheobronchitis)

  • Triggered by an acute viral infection of the upper airway; Usually parainfluenza virus
  • Classical symptoms: "barking" cough, stridor, and hoarseness
  • Often worse at night
  • Teated with a single dose of oral steroids; occasionally adrenaline in more severe cases
  • Affects about 15% of children at some point, most commonly between 6 months and 5–6 years of age

Notes

  • AVPU
    • P or below: Call anaesthetist
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