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Pediatrics > Pediatric Infectious Diseases > Flashcards

Pediatric Infectious Diseases Flashcards

1
Q

8 questions to ask if infection suspected

A
  1. how sick?
    • do I need to start tx immediately
  2. how old?
    • infections sneaky and DEADLY in neonates
  3. immunizations up to date?
  4. what season is it, any outbreaks?
  5. history of current illness
    • what, when, how much, how bad?
  6. medical history
    • recurrent infections, similar sx, recent tx, surgeries, meds (immunosuppressive drugs), shunt, catheter
  7. exposures
    • home, daycare/school, travel, animal, ticks, mosquitoes, soil contamination, chemicals
  8. sanitation
    • water, food sources, cleanliness
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2
Q

Review Text Table 93-2

overview of where infections may be overlooked

A
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3
Q

Actions for Fever in Infants < 3mo

A
  • ask the questions
  • determine site of infection
  • determine course of treatment

* look for serious infetions 1st!

  • sepsis, UTI, meningitis, herpes
  • perform lab tests as indicated
  • MC: Group B strep, E coli, Listeria, Strep pneumo, H flu, Salmonella, Neisseria, Staph aureus
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4
Q
A
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5
Q

Actions for Fever in Children 3mo - 3y

A
  • ask the questions
  • do you have time to assess or is immediate tx required
  • EXPECT viral infections - self limited
  • labs not usually indicated (but may be key to some)
  • look for zebras!
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6
Q

Labs for Fevers

A
  • rapid strep
  • monospot/EBV titers
  • CBCd
  • ESR, CRP
  • procalcitonin, presepsin (check for sepsis)
  • UA
  • cultures: blood, urine, CSF, wound, mucous, membrane, rectal swab, stool
  • metabolics: electrolytes, LFT’s, amylase, lipase
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7
Q

Evaluation of Prolonged Fever

A
  • repeated cultures
  • serology: CMV, HIV, toxoplasmosis, etc.
  • abdominal US
  • CT: chest, abdomen, etc.
  • MRI if indicated
  • endoscopy
  • radionuclide: occult abscess, bone scan
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8
Q

Course for Fever >2 weeks w/ unknown cause

A

refer to infectious disease

http://reference.medscape.com/features/slideshow/fever-unknown-origin#page=1

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9
Q

hematogenous infection key points

A

sepsis

  • presents as ill child w/ rapid progression
  • treat first - culture as you go
  • get causative organism and sensitivities
  • monitor closely for deterioration
    • measure clotting factors
    • renal/liver function
    • electrolyte levels
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10
Q

common worldwide/all year infection w/ wide presentation

(polio vs. non-polio)

some non-polio can infect spinal tract causing paralysis/death

A

enteroviruses

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11
Q

vesicles on tonsillary pillars and sore blisters on hands/feet

A

Coxsackievirus

(hand foot mouth disease)

  • may cause non-specific febrile illness, aseptic meningitis, encephalitis, hemorrhagic conjunctivitis, non-specific viral rashes
  • though to be the underlying illness that leads to Type I DM
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12
Q

“slapped cheek” appearance / “drawn on” rash

A

Erythema infectiosum

(Fifth disease - Parvovirus B19)

  • very mild, often asymptomatic until rash presents
  • no contageous when rash presents
  • SPONTANEOUS ABORTION if contracted in 1st 1/2 of preg.
  • serious disease, chronic anemia in immunocompromised
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13
Q

Herpesviruses

(8 type infect humans)

A

become dormant for a lifetime

  1. chickenpox
  2. cytomegalovirus (CMV)
  3. herpes simplex (HSV)
  4. genital herpes
  5. infectious mononucleosis (EBV)
  6. Roseola
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14
Q

rash up back of neck and along hairline, good disposition

A

Roseola infantum - Herpesvirus 6

(exanthema subitum, pseudorubella)

  • high fever (103-105) for 3-5 days
  • no symptoms other than fever, malaise MC
  • fever plummets around day 4 then rash develops
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15
Q

fever, pharyngitis, fatigue, lymphadenitis

(biggest concern if congenital infection!)

A

Cytomegalovirus

  • rapid progression causing liver and spleen enlargement
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16
Q

oral lesion (fever blister) w/ typical viral symptms:

fever, irritability, poor oral intake, oral lesions, herpetic whitlow

(congenital often deadly! - look for scalp vesicles)

A

Herpes simplex Type 1

(NOT and STD)

17
Q

fever, malaise, genital vesicles

can be primary infection or tansmitted in birth canal

A

Herpes simplex Type 2

  • C-section can reduce but not prevent exposure
  • Ill newborns treated w/ variety of antibacterials AND antivirals pending diagnosis
  • early antiviral my prevent encephalitis
18
Q

pharyngitis “hot potato voice” and lymphadenitis

fever, fatigue, malaise

+/- splenomegaly

A

Infectious Mononucleosis - EBV

  • must be diagnosed w/ labs
    • Monospot
    • EBV titers
  • exclusion from contact sports for 6 weeks
    • IgM / herterophile 1st
    • IgG
    • EA
19
Q

red, bulging eardrum; opaque appearance w/ fluid behind TM

A

Acute Otitis Media

  • Tx:
    • Amoxicillin
    • Omniceph (cephalosporins) if Amoxicillin failure
    • Ceftiaxone IM x3 if severe/persistent or oral not tolerated
    • Azithromycin (Zithromax) if PCN allergy
      • NOT ideal for upper respiratory pathogens
    • Antibody drops first line if tubes in place
20
Q

mucopurulent eye discharge w/ redness, high % AOM, no itching

A

Bacterial Conjunctivitis (MC than viral)

  • MC: H flu, Strep pneumo, S pyogenes
  • vaginal flora in neonates: Klebsiella, E coli, Staph epi
  • complications:
    • periorbital cellulitis
    • meningitis
  • Tx
    • polymyxin/trimethoprim (Polytrim) - cheap
    • fluoroquinilone drops - better coverage, more expensive
21
Q

watery eyes w/ redeness and low incidence of AOM, no itching

A

Viral Conjunctivitis

22
Q

watery eyes w/ redness and no AOM, severe itching

A

Allergic Conjuntivitis

23
Q

conjunctivitis d/t immune complex vasculitis

A

Kawasaki disease

  • non-infectious
  • presents w/ other symptoms of Kawasaki disease
24
Q

conjunctivitis d/t immune mediated hypersensitivity affecting mucous membranes - typically drug reaction

(what is pathognomic and treatment)

  • prodrome fever, cough, HA, malaise
A

Steven Johnson syndrome

  • pathognomic:
    • target lesion rash with vesicular, purpuric, or nectrotic center
  • tx:
    • withdraw offending agent (antibiotic) and supportive care
25
Q

Cause of Primary Immunodeficiency

A

gene defects affecting:

  • macrophages
  • B cells
  • T cells
26
Q

S/s of Immunodeficiency

A
  • chronic rashes, thrush
  • persistent infection or drainage
  • FTT (failure to thrive)
  • abscence of lymphoid tissue (e.g. tonsils)
27
Q

Testing/Diagnostic Evaluation of Immunocompromise

A
  • CBCd
  • serum immunoglobulin levels
  • specific antibody titers (presuming immunized)
  • lymphocyte assessment (specific B/T cell classes)
  • complement assays
  • neutrophil function
  • genetic testing
  • high level testing by immunologist

Pediatrics (13 decks)

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