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The Child with Infectious Disease

The Child with Infectious Disease. Jan Bazner-Chandler RN, MSN, CNS, CPNP. Infants Immune System. No active immune response at birth Passive immunity from mother Potential for immune response is present / active response is lacking. Immune Response.

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The Child with Infectious Disease

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  1. The Child with Infectious Disease Jan Bazner-Chandler RN, MSN, CNS, CPNP

  2. Infants Immune System • No active immune response at birth • Passive immunity from mother • Potential for immune response is present / active response is lacking

  3. Immune Response • IgG is received from mother trans-placental and in breast milk • 6 to 9 months infants start to produce IgG • Immune system starts to assume defensive role • Active immunity begins after exposure to antigens

  4. Test for Evaluating Infection • Complete-blood count with differential • Serum C-Reactive Protein or CRP • Erythrocyte sedimentation rate or ESR • Urine, stool or sputum culture • Blood culture • Lumbar puncture • Enzyme-linked immunosorbent assay or ELISA • Rapid antigen extraction – group A strep or influenza A and B

  5. Sepsis • Sepsis is the presence of systemic inflammatory response with infection. • Systemic inflammatory response is diagnosed in the presence of at least two of the following feature: • Core temperature more than 101F (38.5 C) or less than 96 F or (36 C) • Tachycardia (not caused by external stimuli) or bradycardia (not caused by congenital heart disease) • Mean respiratory rate more than two standard deviations above age norm • Leukocyte count depressed or elevated for age or more than 10% immature neutrophils

  6. Sepsis • Laboratory confirmed blood stream infection

  7. Assessment • Temperature, heart and respiratory rate • Risk factors in any infant ill during the first 90 days of life • Review laboratory values

  8. Neonatal Sepsis • Can be caused by bacterial, fugal, parasitic or viral pathogens. • Etiology: complex interaction of maternal-fetal colonization, transplacental immunity and physical and cellular defenses of the fetus and mother.

  9. Neonatal sepsis • Mortality rate 50% • 1 to 8 cases per 1000 live births • Meningitis occurs in 1/3

  10. Minor Risk Factors • Twin gestation • Premature infant • Low APGAR • Maternal Group B Streptococcus • Foul lochia

  11. Major Risk Factors • Maternal prolonged rupture of membranes > 24 hours • Intra-partum maternal fever > 38C • Prematurity • Sustained fetal tachycardia > 160

  12. Etiology • Group B beta-hemolytic Streptococcus • Escherichia coli • Haemophilus Influenza

  13. Diagnostic Tests • C-Reactive Protein * earliest indicator of infectious / inflammatory process • CBC with differential • WBC • Blood Culture – rule out blood borne bacteria – sepsis (take 3 days for final culture results) • Lumbar Puncture – rule out meningitis • Urine Culture – rule out UTI

  14. Clinical Manifestations • Respiratory distress • Tachypnea / apnea / hypoxia • Temperature instability • > 99.6 (37 C) or < 97 (36 C) • Gastrointestinal symptoms • Vomiting, diarrhea, poor feeding • Decreased activity: lethargic / not eating

  15. Empiric Treatment • Ampicillin • aminoglycoside or • cefotaxime • Vancomycin or ceftazidime for coverage of MRSA • Acyclovir: herpes

  16. Interdisciplinary Interventions • Administer IV antibiotics • Monitor therapeutic levels • Monitor VS, temperature, O2 saturation • Activity level • Sucking • Infant parent bonding

  17. Outcomes • Newborn will achieve normalization of body function • Parents will participate in care • Newborn will demonstrate no signs of CV, neurological or respiratory compromise • Newborn will experience no hearing loss as a result of antibiotic therapy

  18. Streptococcal Infections • Streptococcal pharyngitis • Streptococcal impetigo • Streptococcal cellulitis • Necrotizing fasciitis (invasive GAS disease)

  19. Group A Streptococcal Infections (GAS) • Most common diseases of childhood causing a variety of cutaneous and systemic infections and complications with variable severity and prognosis. • Pharyngitis or throat infection to “flesh eating” bacteria

  20. Scarlet Fever

  21. Scarlet Fever • Caused by group A Streptococcus • Rash is usually seen in children under age 18 years. • Rash appears on chest and abdomen – feels rough like a piece of sandpaper • Redder in the arm pits and groin area. • Rash lasts 2-5 days • After rash disappears fingers and toes begin to peel • Face is flushed with a pale area around the lips.

  22. Management of Scarlet Fever • Respiratory precautions for 24 hours. • Oral antibiotic for 10 days. • Treat sore throat with analgesics, gargles, lozenges, and antiseptic throat spray. • Encourage fluids. • See health care provider if fever persists.

  23. SCIDS • Severe Combined Immunodeficiency Disease • Hereditary disease • Absence of both humoral and cell mediated immunity

  24. Clinical Manifestations • Susceptibility to infection • Frequent infection • Failure of infection to respond to antibiotic treatment

  25. Treatment • Manage infection • Bone marrow transplant

  26. HIV and AIDS • HIV is a retrovirus that attacks the immune system by destroying T lymphocytes (cells that are critical to fighting infection and developing immunity). • HIV renders the immune system useless and the child is unable to fight infection. • HIV infection lead to AIDS

  27. Killer T-cells

  28. Modes of Transmission • Three chief modes of transmission: • Sexual contact (both homosexual and heterosexual). • Exposure to needles or other sharp instruments contaminated with blood or bloody body fluids. • Mother-to-infant transmission before or around the time of birth.

  29. Assessment • An infant who is HIV positive will generally exhibit symptoms between 9 months to 3 years. • Failure to thrive • Generalized lymphadenopathy • Enlarged liver or spleen • Thrush • Pneumonia, chronic diarrhea, opportunistic infections • Encephalopathy: leading to developmental delay, or loss of previously obtained milestones.

  30. Diagnostic Tests • ELISA and Western blot test for HIV antibody

  31. Treating Infants in Utero • Routinely offer HIV testing to all pregnant women. • Administration of zidovudine (AZT) can decrease the likelihood of perinatal transmission from 25% to 8%.

  32. Blood Testing in Infants • Babies born to HIV-positive mothers initially test positive for HIV antibodies. • Only 13 to 39% of these infants are actually infected. • Infants who are not infected with HIV may remain positive until they are about 18- months-old.

  33. Interdisciplinary Interventions • Maternal treatment during pregnancy. • Newborn receives zidovudine for 6 weeks after birth. • Prophylaxis with Septra or Bactrim when CD4 level starts to drop.

  34. Interventions • Age-appropriate immunizations except those containing live attenuated viruses. Can be given when T-Cell count is adequate • Chicken pox - Varicella • MMR – measles, mumps, rubella

  35. Community Interventions • Education and prevention are the best ways to manage AIDS. • Safe sexual practices • Monogamous relationship • Avoidance of substances such as alcohol and drugs that can cloud judgment.

  36. Changes in HIV • Number of infected newborns has dropped due to treatment of HIV infected mothers. • HIV has become a chronic disease in children • Team approach • Emphasis on community teaching

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