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Paediatric Microbiology. Dr Amy Chue ID/Microbiology Registrar Dr Peter Munthali Consultant Microbiologist. Objectives. By the end of this session you should be able to: Distinguish between the common causes of infections in the neonate and older children - PowerPoint PPT Presentation
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Paediatric Microbiology
Dr Amy ChueID/Microbiology Registrar
Dr Peter MunthaliConsultant Microbiologist
Objectives
• By the end of this session you should be able to:– Distinguish between the common causes of
infections in the neonate and older children– Relate maternal infections to neonates– Interpret CSF findings in relation to clinical
presentation in neonates– Demonstrate rational use of antibiotics in
neonatal sepsis with regard to possible causative organisms
Case One
• 3 week old baby born at 39/40• Normal vaginal delivery• Healthy and feeding well initially• Upset and crying• Bulging fontanelle noted by parents• Taken to ED• Hx – admitted a week earlier with bronchiolitis
and discharged with no antibiotic treatment
Results
• CSF– Clear and colourless– RBC 84x10^6/L– WCC 236x10^6/L– Gram stain: organisms not seen– Glucose 3.1 mmol/L– Protein 1.4 g/L (0.15 – 0.45)
• FBC– Hb 101g/L (111 – 141g/L)– WCC 24.85 x 10^9/L (6 – 18.0 x 10^9/L)– CRP 46mg/L (<11mg/L)
Questions
• What is the possible microbiological diagnosis?
• What antibiotics would you consider commencing and why?
Microbiology
Management
• Amoxicillin based regime for 14 days
• Vaccination (2/12, 4/12, 12/12)
Case Two
• 1 day old baby born at 36+5
• Floppy at birth
• Mother had fever during labour and received some antibiotics
• Baby started on Cefotaxime and Amoxicillin
Investigations• LP
– Gram• Turbid CSF• RBC 6x10^6/L• WCC 1046x10^6/L 90% Poly• Glucose 1.9mmol/L• Protein 1.30g/L (0.15 – 0.45g/L)• No organism seen
• CRP 164• FBC
– HB 93g/l– WCC 13.09x10^9/L (6.0 – 18.0)
• Blood culture – Gram positive cocci ?type
Questions
• What is the diagnosis?– What is the possible microbiological
diagnosis?
• Is this infection preventable?
• Should antibiotics regime be changed?– If so, how?
Organisms
• Group B Streptococcus– Streptococcus agalactiae
Management
• Penicillin based regime (Benzylpenicillin Vs Amoxicillin)
• Prophylactic antibiotics given during labour
• Cefotaxime as blind treatment for neonate
Case Three
• 7 day old baby born at term
• Normal vaginal delivery
• Presents with fever, irritability and poor feeding
Investigations
• FBC– Hb 115g/l– WCC 24.85x10^9/L
• CRP 12
• Blood cultures: Gram positive bacilli
Questions
• What is your microbiological diagnosis?
• How would you manage the case:– Antibiotics– Infection control
Diagnosis
• Listeria monocytogenes
Listeria monocytogenes
• Gram positive bacillus
• Pregnant women particularly at risk
• Certain at risk foods
• Inherently resistant to cephalosporins
Management
• Amoxicillin for 14 - 21 days
• Infection control – isolation
Case Four
• Baby born at 38 wks, 2.6Kg
• Mother had episiotomy
• Baby discharged well on day 2
• Readmitted on day 7 with:– Wt loss– Poor feeding– Abnormal limb movements– EEG – no seizure activity
Investigations• CRP 158• CSF:
– Cell count normal– Glucose normal– Protein 0.85g/L (0.15-0.45g/L)
• Clotting deranged• Low platelets• LFTs deranged• CT: extensive bleeding on brain and evidence of
hypoxic injuries
Treatment
• Initial treatment: Benzylpenicillin and Gentamicin
• Modified treatment: Meropenem and Vancomycin
Further investigations and treatment
• What further investigations should be done– On CSF– On Blood
• What is the possible diagnosis?
• Is the current antibiotic regime adequate?
Further Results
• CSF PCR – HSV 1 positive
• Blood PCR – HSV 1 positive
HSV infection in neonates
• Usually peri natal and post natal– 45% skin, eyes and mouth infections– 20% CNS infection– 25% disseminated HSV
• Symptoms• Irritability• Seizures• Respiratory distress• Jaundice• Coagulopathy• Pneumonitis
HSV in neonates
• Rx high dose aciclovir
• Rx women with lesions– Suppressive therapy
• Consideration of C-section
• BASHH guidelines
Key points
• Possible organisms causing neonatal sepsis– Group B Streptococcus– Group A Streptococcus– E.coli– Listeria monocytogenes
• Antibiotic treatment– If Listeria is suspected, must consider penicillin based
regime
• Important to consider maternal infection