[PEDII] P.04 Bacterial Infections (Summary Tables).pdf

STAPHYLOCOCCAL INFECTIONS  STAPHYLOCOCCAL SCALDED SKIN SYNDROME STAPHYLOCOCCAL FOOD POISONING STAPHYLOCOCCAL TOXIC SHOCK SYNDROME (TSS) (S...

STAPHYLOCOCCAL INFECTIONS  STAPHYLOCOCCAL SCALDED SKIN SYNDROME STAPHYLOCOCCAL FOOD POISONING STAPHYLOCOCCAL TOXIC SHOCK SYNDROME (TSS) (SSSS, RITTER’ S DISEASE)  STAPHYLOCOCCAL SCALDED SKIN SYNDROME STAPHYLOCOCCAL FOOD POISONING STAPHYLOCOCCAL TOXIC SHOCK SYNDROME (TSS) (SSSS, RITTER’ S DISEASE) STREPTOCOCCUS PNEUMONIA STREPTOCOCCUS PYOGENES STREPTOCOCCUS AGALACTIAE PNEUMOCOCCAL INFECTION GROUP A STREPTOCOCCUS (GAS) INFECTIONS GROUP B STREPTOCOCCAL (GBS) INFECTION STREPTOCOCCUS PNEUMONIA STREPTOCOCCUS PYOGENES STREPTOCOCCUS AGALACTIAE PNEUMOCOCCAL INFECTION GROUP A STREPTOCOCCUS (GAS) INFECTIONS GROUP B STREPTOCOCCAL (GBS) INFECTION STREPTOCOCCUS PNEUMONIA STREPTOCOCCUS PYOGENES STREPTOCOCCUS AGALACTIAE PNEUMOCOCCAL INFECTION GROUP A STREPTOCOCCUS (GAS) INFECTIONS GROUP B STREPTOCOCCAL (GBS) INFECTION DIPHTHERIA INFECTION ENTEROCOCCUS LISTERIA MONOCYTOGENES ACTINOMYCES NOCARDIA ENTEROCOCCUS LISTERIA MONOCYTOGENES ACTINOMYCES NOCARDIA ENTEROCOCCUS LISTERIA MONOCYTOGENES ACTINOMYCES NOCARDIA  ANAEROBIC BACTERIAL INFECTION CLINICAL MANIFESTATIONS BOTULISM TETANUS PSEUDOMEMBRANOUS COLITIS Table 4. Botulism Clinical Manifestation Table 11. Tetanus Clinical Manifestation The smallest disturbance by sight, sound, or touch may Illness varies from a mild self-limited diarrhea without Generalized More common trigger a tetanic spasm. FOOD-BORNE BOTULISM Incubation period: 2–14 days Dysuria and urinary retention result from bladder sphincter pseudomembranes to explosive watery diarrhea with o ⅓ of cases: Nausea, vomiting, or diarrhea Trismus (masseter o Headache, restlessness, and spasm; forced defecation may occur occult blood muscle spasm, or irritability are early symptoms, often Fever: as high as 40°C* o Constipation lockjaw) followed by stiffness, difficulty o common because of the substantial metabolic energy Bacteremia and abscess formation o Begins 12-36 hours after ingestion of the chewing, dysphagia, and neck consumed by spastic muscles Symptoms muscle spasm Tachycardia, dysrhythmias, labile hypertension, diaphoresis, contaminated food Table 18. Clostridium difficile asymptomatic vs symptomatic Risus sardonicus o Results from intractable spasms of and cutaneous vasoconstriction o But can range from as little as 2 hours to as facial and buccal muscles o Common in infants and young Table 12. Tetanus types and Clinical Manifestation ASYMPTOMATIC long as 8 days o When the paralysis extends to o infantile form of generalized tetanus children abdominal, lumbar, hip, and thigh Incubation o 4–14 days muscles, the patient may assume an o 3–12 days of birth as progressive o Serve as potential reservoir for the difficulty in feeding (sucking and contamination of hospital Severity o Mild to severe arched posture of extreme swallowing), associated hunger, and hyperextension of the body o But death can occur within 24 hours crying environment NEONATAL INFANT BOTULISM TETANUS/ o Paralysis or diminished movement, SYMPTOMATIC o As carriers, they facilitate the spread stiffness and rigidity to the touch, and o 1st indication of illness TETANUS spasms, with or without opisthotonos, are of the spores in 25-30% of all cases of Decreased NEONATORUM o Constipation almost always occurs and characteristic antibiotic-associated diarrhea caused frequency or Board-like abdomen usually precedes characteristic signs of o Umbilical stump* by C. difficile even absence neuromuscular paralysis by a few days or may hold remnants of dirt, dung, of defecation Figure 3. Risus sardonicus clotted blood, or serum, or it may Table 19. Clostridium difficile clinical manifestation weeks Opisthotonos o an equilibrium position that results appear relatively benign from unrelenting total contraction of o Painful spasms of the muscles adjacent o Abdominal pain opposing muscles, all of which COLITIS WITHOUT Inability to Mild weakness, lethargy, and reduced to the wound site and may precede o Nausea display the typical board like rigidity generalized tetanus PSEUDOMEMBRANE feed, lethargy, feeding which may not require of tetanus LOCALIZED o Associated with chronic otitis media o Anorexia o Laryngeal and respiratory muscle FORMATION weak cry, hospitalization spasm can lead to airway TETANUS o Characterized by retracted eyelids, o Watery, sometimes bloody diarrhea deviated gaze, trismus, risus sardonicus, diminished Severe weakened sucking, swallowing, obstruction and asphyxiation. and spastic paralysis of the tongue and o Refers to the swelling or spontaneous and cry pharyngeal musculature inflammation of the large intestines o Rare form of localized tetanus movement CEPHALIC o Involves the bulbar musculature due to an overgrowth of C. difficile TETANUS (wounds or foreign bodies in the head, bacteria. nostrils, or face) o Secretions/drooling from the mouth o Classic picture: o Generalized muscle weakness and PSEUDO- Bloody diarrhea Dysphagia Figure 4. Opisthotonos diminished gag reflex resulting to pooling of Patient o Tetanus toxin does not affect MEMBRANOUS Fever oral secretions unfortunately sensory nerves or cortical COLITIS Cramps remains conscious function, the patient unfortunately Oculomotor o Pupillary light reflex may be unaffected until remains conscious, in extreme Abdominal pain palsies the child is severely paralyzed, or it may be pain, and in fearful anticipation of Nausea the next tetanic seizure initially sluggish Vomiting Loss of head o Occurs after the infant is curled into position o Other signs and symptoms: control is for lumbar puncture dehydration and presence of pus and typically a mucous in the stool prominent sign Gag, suck, and corneal reflexes diminish as the paralysis advances Respiratory arrest Figure 5. Patient with tetanus Seizures: sudden, severe tonic contractions of the muscles Figure 2. Hypotonia (FLOPPY) weak muscle tone  GRAM NEGATIVE BACTERIAL INFECTION CLINICAL MANIFESTATIONS HAEMOPHILUS INFLUENZA INFECTIONS MENINGOCOCCAL INFECTIONS PERTUSSIS NON-INVASIVE DISEASES INVASIVE DISEASES Cellulitis of tissues comprising the laryngeal inlet 1. OTITIS MEDIA 1. MENINGITIS (epiglottis, aryepiglottic folds, arytenoid cartilage) 2. CONJUNCTIVITIS 2. ACUTE EPIGLOTTITIS/ Usually seen in children 2 – 7 years of age 3. SINUSITIS SUPRAGLOTTITIS Peak incidence is in 5-10 years of age 3. ACUTE PNEUMONIA Life threatening medical emergency with risks of 4. SEPTIC ARTHRITIS sudden, unpredictable airway obstruction that interferes 5. CELLULITIS with air flow 6. Others: pericarditis, o Intubation and sometimes emergency bacteremia without an tracheotomy may be required to prevent airway associated focus, UTI, obstruction and mortality. osteomyelitis Patients present acutely ill with a short history of high- grade fever, tachypnea, inspiratory stridor and 1. HiB MENINGITIS excessive drooling POSITIVE “THUMB” SIGN With signs and symptoms indistinguishable from other o Hypopharyngeal dilatation causes of bacterial meningitis which include: o Manifestation of edematous and enlarged o Fever, headache, photophobia, stiff neck, vomiting epiglottis which is seen in lateral soft tissue and altered mental status radiograph of the neck, suggestive of the diagnosis o Clinically, meningitis caused by H. influenzae type b of acute infectious epiglottitis cannot be differentiated from Neisseria meningitidis or o Obliteration of vallecula and aryepiglottic fold Streptococcus pneumoniae. Infants present with less characteristic symptoms such as o Vomiting, refusal to feed and irritability o Severe cases may present with convulsion and coma Single most common cause of bacterial meningitis in children 3 months to 3 years of age o S/s: fever, meningeal signs, seizures,  ICP 6% of patients with HiB meningitis develop hearing impairment due to inflammation of the cochlea and labyrinth Figure 3. Acute epiglottitis Risk of complication is high o About 10 to 15% of survivors: cerebral palsy, 3. PNEUMONIA hydrocephalus, blindness and sensory neural deafness Clinically indistinguishable from other bacterial o A further 15-20%: less severe long term sequalae such pneumonia but usually with insidious onset and history as partial deafness, behavioral and learning difficulties, of fever, cough and purulent sputum production speech and language problems True incidence in children is unknown Major Neurologic sequelae Important cause in unvaccinated children 4 years old or o Behavior problems younger o Language disorders Signs and symptoms cannot be differentiated from those o Delayed development of language of pneumonia caused by other microorganisms o Impaired vision o Mental retardation 4. ORBITAL CELLULITIS o Motor abnormalities Most commonly involves the buccal and periorbital o Ataxia regions usually associated with fever o Seizures Lid edema, proptosis, chemosis, impaired vision, o Hydrocephalus limitation of the extraocular movements pain on movement of the globe Infections of the orbit are infrequent and usually complicate acute ethmoid and sphenoid sinusitis. The distinction between preseptal and orbital cellulitis may be difficult and is best delineated by CT. Figure 2. Major Neurologic Sequelae 2. ACUTE EPIGLOTTITIS Figure 4. Orbital Cellulitis  FOOD AND WATER-BORNE INFECTIONS CLINICAL MANIFESTATIONS SALMONELLA INFECTIONS SHIGELLOSIS ESCHERICHIA COLI INFECTIONS CHOLERA ENTERIC FEVER OR TYPHOID FEVER Acute onset of copious watery diarrhea and vomiting without abdominal cramps or fever Stools are colorless with small flecks of mucus (“rice- water”) and sometime described as having a fishy odor Figure 2. “Rice water” At first, children may be restless or extremely thirsty, but if fluid and electrolyte losses are not replaced, they may become lethargic or unconscious. Complications Severe dehydration, metabolic acidosis and hypokalemia Septicemia can occur in 4-12 hours Febrile seizure o Other signs of dehydration may rapidly manifest, Pneumonia including poor skin turgor, sunken eyes, dry mouth and Hemolytic uremic syndrome (HUS) tongue, no urine output, delayed capillary refill, rapid or o Caused by Shiga toxin mediated endothelial injury weak pulse, and low blood pressure due to S. dysenteriae serotype 1 o The fluid losses may be so rapid that the child quickly o Can also be caused by E. coli O157:H7 develops hypovolemic shock, hypoglycemia, coma, and o Acute renal failure, microangiopathic anemia, seizures and is at risk of dying within a few hours of onset thrombocytopenia Incubation Period: 18 hours to 5 days Figure 3. Clinical picture of cholera NONTYPHOIDAL SALMONELLOSIS ACUTE ENTERITIS: most common clinical presentation o Abrupt onset of nausea, vomiting, abdominal cramps, chills, watery diarrhea, sometimes with blood and mucus o Hyperactive bowel sounds, abdominal tenderness, signs of dehydration o Symptoms subside within 7 days in healthy children o Symptoms persist for several weeks in high-risk groups (debilitated patients, extreme of ages, malignancy, antibiotic or steroid therapy)