The Child with Infectious Disease

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 gt 24
  hours
• Intra-partum maternal fever gt 38C
• Prematurity
• Sustained fetal tachycardia gt 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
• gt 99.6 (37 C) or lt 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