Presentation on theme: "The Child with Infectious Disease"— Presentation transcript:
1 The Child with Infectious Disease Jan Bazner-ChandlerRN, MSN, CNS, CPNP
2 Infants Immune System No active immune response at birth Passive immunity from motherPotential for immune response is present / active response is lacking
3 Immune ResponseIgG is received from mother trans-placental and in breast milk6 to 9 months infants start to produce IgGImmune system starts to assume defensive roleActive immunity begins after exposure to antigens
4 Test for Evaluating Infection Complete-blood count with differentialSerum C-Reactive Protein or CRPErythrocyte sedimentation rate or ESRUrine, stool or sputum cultureBlood cultureLumbar punctureEnzyme-linked immunosorbent assay or ELISARapid antigen extraction – group A strep or influenza A and B
5 SepsisSepsis 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 normLeukocyte count depressed or elevated for age or more than 10% immature neutrophils
7 Assessment Temperature, heart and respiratory rate Risk factors in any infant ill during the first 90 days of lifeReview laboratory values
8 Neonatal SepsisCan 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 StreptococcusFoul lochia
11 Major Risk FactorsMaternal prolonged rupture of membranes > 24 hoursIntra-partum maternal fever > 38CPrematuritySustained fetal tachycardia > 160
12 Etiology Group B beta-hemolytic Streptococcus Escherichia coli Haemophilus Influenza
13 Diagnostic TestsC-Reactive Protein * earliest indicator of infectious / inflammatory processCBC with differentialWBCBlood Culture – rule out blood borne bacteria – sepsis (take 3 days for final culture results)Lumbar Puncture – rule out meningitisUrine Culture – rule out UTI
14 Clinical Manifestations Respiratory distressTachypnea / apnea / hypoxiaTemperature instability> 99.6 (37 C) or < 97 (36 C)Gastrointestinal symptomsVomiting, diarrhea, poor feedingDecreased activity: lethargic / not eating
15 Empiric Treatment Ampicillin aminoglycoside or cefotaxime Vancomycin or ceftazidime for coverage of MRSAAcyclovir: herpes
16 Interdisciplinary Interventions Administer IV antibioticsMonitor therapeutic levelsMonitor VS, temperature, O2 saturationActivity levelSuckingInfant parent bonding
17 Outcomes Newborn will achieve normalization of body function Parents will participate in careNewborn will demonstrate no signs of CV, neurological or respiratory compromiseNewborn will experience no hearing loss as a result of antibiotic therapy
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
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 sandpaperRedder in the arm pits and groin area.Rash lasts 2-5 daysAfter rash disappears fingers and toes begin to peelFace 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 infectionFrequent infectionFailure of infection to respond to antibiotic treatment
26 HIV and AIDSHIV 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
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 AssessmentAn infant who is HIV positive will generally exhibit symptoms between 9 months to 3 years.Failure to thriveGeneralized lymphadenopathyEnlarged liver or spleenThrushPneumonia, chronic diarrhea, opportunistic infectionsEncephalopathy: leading to developmental delay, or loss of previously obtained milestones.
30 Diagnostic TestsELISA 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 InterventionsAge-appropriate immunizations except those containing live attenuated viruses. Can be given when T-Cell count is adequateChicken pox - VaricellaMMR – measles, mumps, rubella
35 Community Interventions Education and prevention are the best ways to manage AIDS.Safe sexual practicesMonogamous relationshipAvoidance of substances such as alcohol and drugs that can cloud judgment.
36 Changes in HIVNumber of infected newborns has dropped due to treatment of HIV infected mothers.HIV has become a chronic disease in childrenTeam approachEmphasis on community teaching