1 / 27

Paediatric Microbiology

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

karan
Download Presentation

Paediatric Microbiology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Paediatric Microbiology Dr Amy Chue ID/Microbiology Registrar Dr Peter Munthali Consultant Microbiologist

  2. 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

  3. 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

  4. 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)

  5. Questions • What is the possible microbiological diagnosis? • What antibiotics would you consider commencing and why?

  6. Microbiology

  7. Management • Amoxicillin based regime for 14 days • Vaccination (2/12, 4/12, 12/12)

  8. 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

  9. 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

  10. Questions • What is the diagnosis? • What is the possible microbiological diagnosis? • Is this infection preventable? • Should antibiotics regime be changed? • If so, how?

  11. Organisms • Group B Streptococcus • Streptococcus agalactiae

  12. Management • Penicillin based regime (Benzylpenicillin Vs Amoxicillin) • Prophylactic antibiotics given during labour • Cefotaxime as blind treatment for neonate

  13. Case Three • 7 day old baby born at term • Normal vaginal delivery • Presents with fever, irritability and poor feeding

  14. Investigations • FBC • Hb 115g/l • WCC 24.85x10^9/L • CRP 12 • Blood cultures: Gram positive bacilli

  15. Questions • What is your microbiological diagnosis? • How would you manage the case: • Antibiotics • Infection control

  16. Diagnosis • Listeria monocytogenes

  17. Listeria monocytogenes • Gram positive bacillus • Pregnant women particularly at risk • Certain at risk foods • Inherently resistant to cephalosporins

  18. Management • Amoxicillin for 14 - 21 days • Infection control – isolation

  19. 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

  20. 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

  21. Treatment • Initial treatment: Benzylpenicillin and Gentamicin • Modified treatment: Meropenem and Vancomycin

  22. 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?

  23. Further Results • CSF PCR – HSV 1 positive • Blood PCR – HSV 1 positive

  24. 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

  25. HSV in neonates • Rx high dose aciclovir • Rx women with lesions • Suppressive therapy • Consideration of C-section • BASHH guidelines

  26. 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

More Related