Microbiology of neonatal and childhood infections

Microbiology of neonatal and childhood infections

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  • Microbiology of neonatal and childhood infections
    • Congenital infections
      • transmitted vertically from mother to child
      • can occur any time during pregnancy
        • varied presentation, non specific signs, wide range of severity, serological diagnosis,
          • examples of clinical features, rash, thrombocytopaenia, cerebral abnormalities, microcephaly, hepatosplenomegaly, hepatitis, jaundice
      • Toxoplasmosis, Rubella, HIV, Hepatitis B, syphilis, Torch, Toxo, other, rubella, cytomegalovirus, HSV, HIV
        • Toxoplasmosis 60% asymtomatic at birth, long term sequealae, deafness, low iq, microcephaly, 40% symptomatic choroidenitis, microcephaly, hydrocephalus, intracranial calcification, seizure, jaundice, hepatosplenomegaly
        • Congenital rubella syndrome, mitotic arrest of cells, angiopathy, growth inhibitor effect
          • eyes, cataracts, microphtalmia, glaucoma, retinopathy, cardiovascular disease, pda, pas, asd, vsd
          • ears, deafness, brain, microcephaly, developmental delay , bone disease, growth retardation, hepatosplenomegaly, thrombocytopenia, rash
        • cmv, hsv, rash
    • Neonatal infections
      • 1st 6 weeks of life, if born early, adjusted to for expected birth date, can become ill rapidly, treat at first site of infection,
        • immature host defence, less maternal IgG there is early and late onset,
          • Early onset, within 48 hours of birth
            • Group B strept
              • gram + catalase negative, beta haemolytic, lancefield group b, bacteraemia, meningitis, joint infection
            • e. coli
              • gram negative, meningitis, uti
            • Listeria monocytogenes
            • investigations
              • fbc, crp, blood culture, deep ear swab, csf, surface swabs, cxr
              • Ventilation ? Circulation ? Nutrition ? Antibiotics: e.g. benzylpenicillin & gentamicin
            • early onset sepsis risk factor
              • mternal
                • preterm labour
                • fever
                • foetal distress
                • meconium staining
                • previous history
              • baby
                • aphyxia
                • resp distress
          • Late onset
            • group b strept
            • listeria monocytogenes
            • s, ureus
            • enterococci
            • gram negatve
            • Untitled
            • fbc, crp, blood culture, urine, et secretions if ventilated,
            • Review and stop antibiotics if cultures negative and clinically stable  ? NICU-Example of antibiotics for late onset sepsis: ? 1st line: Flucloxacillin & gentamicin ? 2nd line: Pipericillin/tazobactam & vancomycin ? Community acquired late onset neonatal infections: cefotaxime, amoxicillin +/-gentamicin
          • Untitled
    • Infections during childhood
    • recurrent infections
    • Infections during childhood
      • Viral infections are very common e.g. Chickenpox (VZV); Herpes simplex – cold sores/stomatitis; HHV6; HHV8; EBV; CMV; RSV; enteroviruses etc
      • Common non-specific symptoms: ? Fever ? Abdominal pain
      • Investigations: ? FBC ? CRP ? Blood cultures ? Urine ? +/- Sputum; throat swabs etc
      • MEningitis
        • 1. clinical features
          • rash occurs
        • Blood cultures ? Throat swab ? LP for CSF if possible ? Rapid antigen screen ? EDTA blood for PCR ? Clotted serum for serology if needed later#
          • Raised WCC – mainly polymorphs? Gram stain – may see organisms e.g. meningococci; pneumococci etc. ? High protein and low glucose ? Rapid Antigen test on CSF may be positive. ? Culture may grow the organism – yields sensitivity data ? If it doesn't grow, PCR may be positive
      • Streptococcus pneumniae
        • gram + pneumonia, bacterameia meningtitis
        • vacinnation programme in 2000


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