Transcript 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




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
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
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
Sepsis

Laboratory confirmed blood stream infection
Assessment



Temperature, heart and respiratory rate
Risk factors in any infant ill during the first 90 days of life
Review laboratory values
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.
Neonatal sepsis



Mortality rate 50%
1 to 8 cases per 1000 live births
Meningitis occurs in 1/3
Minor Risk Factors





Twin gestation
Premature infant
Low APGAR
Maternal Group B Streptococcus
Foul lochia
Major Risk Factors




Maternal prolonged rupture of membranes > 24 hours
Intra-partum maternal fever > 38C
Prematurity
Sustained fetal tachycardia > 160
Etiology

Group B beta-hemolytic Streptococcus

Escherichia coli

Haemophilus Influenza
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
Clinical Manifestations

Respiratory distress


Temperature instability


> 99.6 (37 C) or < 97 (36 C)
Gastrointestinal symptoms


Tachypnea / apnea / hypoxia
Vomiting, diarrhea, poor feeding
Decreased activity: lethargic / not eating
Empiric Treatment





Ampicillin
aminoglycoside or
cefotaxime
Vancomycin or ceftazidime for coverage of MRSA
Acyclovir: herpes
Interdisciplinary Interventions






Administer IV antibiotics
Monitor therapeutic levels
Monitor VS, temperature, O2 saturation
Activity level
Sucking
Infant parent bonding
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
Streptococcal Infections




Streptococcal pharyngitis
Streptococcal impetigo
Streptococcal cellulitis
Necrotizing fasciitis (invasive GAS disease)
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
Scarlet Fever
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.
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.
SCIDS



Severe Combined Immunodeficiency Disease
Hereditary disease
Absence of both humoral and cell mediated immunity
Clinical Manifestations

Susceptibility to infection

Frequent infection

Failure of infection to respond to antibiotic treatment
Treatment


Manage infection
Bone marrow
transplant
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
Killer T-cells
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.
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.
Diagnostic Tests

ELISA and Western blot test for HIV antibody
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%.
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.
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.
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
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.
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