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The Child with Infectious Disease

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Presentation on theme: "The Child with Infectious Disease"— Presentation transcript:

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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