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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

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Paediatric Microbiology

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  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

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