Serious pediatrics infection .pdf

SERIOUS Infection Jumanah Alqurashi Objectives: 1. List the primary organisms associated with sepsis and meningitis during the neonatal and the post neonatal period. 2. Recognize the clinical presentation and management of sepsis and meningitis. 3. Recognize the signs and sym...

SERIOUS Infection Jumanah Alqurashi Objectives: 1. List the primary organisms associated with sepsis and meningitis during the neonatal and the post neonatal period. 2. Recognize the clinical presentation and management of sepsis and meningitis. 3. Recognize the signs and symptoms of other severe infections during childhood including Septic arthritis, ostomylitis, encephalitis, orbital cellulites and SJS. 4. Outline the proper management and prevention of these infections. Blue: Main Category Orange: Subcategory. Black: Original slides content. Red: Important information. Green: Doctor notes. Blue highlight: Info that came in previous batches questions.  Infection Organism Investigations Management Clinical feature Important points Most commom GBS = IV Ampicillin/ IV gentamicin high fever, lethargy , do full septic work up > same as blood work up but + lumbar puncture or (CSFS/S). Meningitis Group B streptococcus full septic work up CBC ,DIFF CRP PT,PTT,INR Blodd C/S Urine C/S CSFC/S Chest headache, seizures, poor x ray. feeding, vomiting , bulging -complications: Hearing impairment, Neurological lesions , Hydrocephalus, local Gram (-) enteric bacilli -audiological assessment IV Ampicillin/ IV Cefotaxime of fontanelle, irritability, cerebral infarction leads to epilepsy. Nasal discharge. Listeria (less common in In bacterial: CSF is Turbid “milk like”, High protein, low Glucose, -Kering’s sign. older than 3 months) WBC poly- morphs and High. In viral: CSF is clear, mild increase to normal protein, mild -Brudzinski’s neck sign. increase to normal Glucose, High lymphocytes poly- morphs. Encephalitis Viruses: Enteroviruses, - CSF: Cell count and protein value are frequently -CSF HSV PCR is positive , Fever, headache and respiratory viruses (influenza normal or slightly elevated, Glucose often normal , Acyclovir I.V for 21 days lethargy , Seizures are -Herpes simplex PCR should be performed on all CSF specimens viruses), and herpesviruses inflammatory process of High lymphocyte. common in children, In [e.g. HSV, varicella zoster virus the brain in association (VZV), and human herpesvirus - ( PCR) of body fluids and CSF severe encephalitis, lethargy -High dose Acyclovir should be initiated in all patients with suspected with clinical evidence of neurologic dysfunction. 6 (HHV-6)] and arboviruses. - Neuroimaging rapidly progresses to coma encephalitis, pending results of diagnostic studies. and, in some cases, death Bacteria: Mycoplasma ,Mycobacterium Osteomyelitis in general is CBC , Diff CRP ESR Blood c/s Synovial fluid Empiric treatment in this pt Fever Staphylococcus aureus usually effects long bones. Staphylococcus aureus. PLAIN X-RAY Bone scan should cover for Salmonella as Pain at the site of infection, MRI well as S. aureus. Reluctance to use an sickle cell disease affected extremity. (SCD), Salmonella is the IV vancomycin / IV Cefotaxime = Less common complaints most common neonate are anorexia, malaise, and vomiting. IV Clindamycin / IV Cefotaxime = Sickle cell anemia + all age group gram-positive cocci Synovial fluid WBC counts >50,000 cells/ microL, appropriate empiric antimicrobial fever, joint pain, swelling of Drain then clean then treat with antibiotic Septic with a predominance (>90%) of neutrophils suggest therapy, and formal irrigation and the affected joint, and pain arthritis bacterial arthritis debridement (if necessary) can with active and passive be instituted. range of motion. Orbital and streptococci CT IV antibiotic therapy should be fever, proptosis, decreased Orbital > associated with preexisting sinusitis. (Pneumococcus), initiated immediately. extraocular muscle periorbital staphylococci (including movement, ocular pain, and CT used to determine the degree of orbital involvement. cellulitis MRSA), and H. influenzae. Periorbital > Cefuroxime or augmentin decreased visual acuity. In orbital cellulitis URGENT ophthalmological consultation is required to preserve the Orbital > Ceftriaxone + Clinamycin eye and prevent the complications ( Intracranial extension , sinus venous thrombosis) Patient should evaluated by an ophthalmologist and an ENT. Treatment of erysipelas consists It is a superficial skin infection affecting the upper dermis and the lymphatic system. Erysipelas Most common GAS is causative, but group B, C, and of oral anti-streptococcal agent G streptococci occasionally for 10-14 days cause the infection streptococci and It is an acute infection of the skin involving the dermis and subcutaneous tissues that Cellulitis staphylococci. Uncomplicated cellulitis in treated with antimicrobial therapy targeting manifests as edema, warmth, erythema, and tenderness of the skin. streptococci and staphylococci. S. pyogenes Systemic antibiotic therapy with A rare, deep ulcerative infection of the skin that penetrates down to the dermis Ecthyma an agent effective against streptococci is recommended gram- negative Effective treatment requires It is serious and characteristic skin lesion Ecthyma organisms, especially prompt initiation of an antibiotic gangrenos Pseudomonas effective against P. aeruginosa or aeruginosa. other likely causative organisms. um Best of luck doctors ‫وال تنسونا من دعائكم‬