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