Infection and Immunity Case Study

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Sample Case


A previously fit and well 1 year old child develops fevers, high pitched cry and lethargy over an 8 hour period. He has become less responsive. He was brought to A&E by his parents. He was reviewed by a paediatrician and admitted to the children’s ward. The child was felt to be stable but septic. A FULL SEPTIC SCREEN was undertaken, a cannula inserted and IV CEFOTAXIME at high dose commenced. Following these procedures, the child became hypotensive with a delayed capillary refill time, tachycardia and rash. The rash was purpuric. The child was transferred to the local PICU for ongoing management. The microbiologist rang to confirm a CSF white cell count of 500 with no red cells. The cells were predominantly neutrophils. CSF glucose was low and CSF protein raised. Gram film confirmed that gram negative diplococci were seen. The latter finding was confirmed on blood culture after just 4 hours incubation.

Common Questions

What is a septic screen, and what does it screen for?

Blood Culture, Virology, FBC, Platelets, Glucose, Chest Xray, Lumbar Puncture, Stool Sample, Urine for microscopy and serology, ENT swabs. It screens for all causes of sepsis. Obviously.

What is the diagnosis?

Meningococcal sepsis (and probably meningitis) Since its a gram negative diplococci, its probably N. meningitidis

What should be done immediately?

  1. Check ABC
  2. Manage the shock with volume resusitation using fluids (check the paediatric shock page for more).
  3. Start them on IV Cefotaxime, nutil you get lab results back

What is the management of Septic Shock?

What is the cause of the purpura?

We don't know exactly why, but the inflammation in the bodywide sepsis causes blood vessels near the skin to break, and leaves purpura. You can generally just feel worried if you see an ill child with purpura.

His family are worried that they could catch the same disease - how do we treat close contacts?

Prophylactic antibiotics with Rifamricin, turns the urine and tears red. Check with the Health Authority

How does it get stopped

Immunisations - penumococcal, etc.