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CPS- ID Flashcards

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1
Q

iS HCV testing during pregnancy routine

A

Not currently but likely will be once formally adopted by SOGC

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2
Q

global HCV prevalence

A

1%

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3
Q

what is the predominant rf for HCV infection in canada

A

IVDU

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4
Q

vertical transmission rate of HCV

A

5%

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5
Q

vertical transmission rate for HCV with co-infection of HIV

A

10%

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6
Q

what factors increase risk fo HCV vertical transmission

A

higher maternal HCV titers, elevated ALT in the year before pregnancy, maternal IVDU, fetal scalp monitoring, prolonged ROM, infant female sex, being the second born twin

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7
Q

does HCV genotype affect risk of transmission

A

no

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8
Q

what % of children clear HCV infection

A

20-30% by age 2-3

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9
Q

what factors increase likeilihood of spontaenously clearing HCV infection

A

elevated ALT in first 2 years of life, infection with genotype 3, interleukin 28B single nucelotide polymorphism

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10
Q

how do majority of infants with HCV that do not clear present

A

2/3 will have asymptomatic infection with intermittent viremia, normal ALT, no hepatomeglay

1/3 have chronic active infection with persistent viremia, elevated ATL and hepatomegaly in some cases

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11
Q

how does HCV present in children and adoelscents

A

subclinical

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12
Q

factors associated with progression of HCV to cirrhosis

A

genotype 1a, co infection with HIV or Hep B, steatosis on liver biopsy

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13
Q

extrahepatic manifestations of hep c

A

MPGN, sub clinical hypothyroidism, elevated ANA, autoimmune thyroiditis

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14
Q

How to prevent HCV

A

treat reporductive age women before pregnancy, insufficient evidence for treatment during pregnancy

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15
Q

is there a difference in HCV transmission vag delivery vs. c section

A

no

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16
Q

is c section delivery recommended to decrease HCV transmission risk

A

no

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17
Q

does amnio increase HCV transmission

A

no, but should be counselled on risk

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18
Q

can you transmit HCV through breastfeeding

A

no
breastfeeding should be encouraged unless nipples are cracked, bleeding or there is co infection with HIV

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19
Q

what is preferred testing strategy for HCV in infants

A

serology at 12-18 months
infants with reactive serology at 12mo should undergo PCR testing
if cant assure follow up at 12mo, then should do HCV PCR asap, should be done over 2mo of age because sensitivity is limited before then
negative PCR at 2mo usually means vertical transmission did not occur, serology should still be done at 12-18mo to confirm antibody clearance

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20
Q

what does it mean if antibodies are negative over 6mo

A

They dont have HCV, dont need to do further testing with PCR

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21
Q

how to test for hcv in older kids

A

serology adn then if that is positive do PCR testing

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22
Q

how often to test kids at high risk for HCV ie. street involved youth

A

every 6-12mo

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23
Q

can hcv be transmitted through ADLs at home

A

no, no need for special precatusions cant be transmitted in salive, urine, stool
unrestricted child care and activities and parents are NOT obliged to notify that child is HCV positive

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24
Q

Who should be treated for HCV

A

all children over age 3 with evidence of chronic infection, technially the drugs are not approved for <12 but have been shown to be effective and well tolerated so treat

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25
what type of Hib is in vaccine
B
26
what pneumococcal vaccine doe we use in canadad
PCV13
27
when should listeria be considered as cause of meningitis
risk factors such as immunosuppresion brain stem infection
28
MIC for pen resistant vs suceptible
suceptible if MIC <0.06mcg/ml resistant if >0.12mcg/ml
29
what should be used empirically for Hib
ceftriaxone because increasing beta lactam resistance so not suceptible to amp
30
rf for poor prognosis in meningitis
delay in antibiotic administration, severity of clinical state at presentation, isolation of non penicillin resostant suceptible strep pneumo
31
most likely organisms for meningitis in children over 2mo
strep pneumo and neissseria consider GBS until 3mo e coli also in younger
32
why add vanco for meningitis coverage
for possibility of cephalosporine resistant strep pneumo
33
who needs prophylaxisfor meingococcal disease
all close contacts
34
why gets priohp for hib
all occupants if cibtact households with infants < 12mo, children < 4 who are incompletely immunized immunocomprimised children of any age any index case <2 not treated with cefotax or ceftriaxone shuld get chemoprophylaxis at ed of therpay
35
how to treat GBS
pen G or amp add gent for the first 5-7 days or until CSF sterility confirmed
36
evidence for steroids in meningitis
when given just before or within 2h of anitbioitcs, decrease hearing loss in Hib if CSF gram stain shows gram negative coccobacilli consistent with H flu and H flu cultured, continue steroids for 4 ays if HIb not cultured within 48h, steroids should be dc same for strep
37
dose of steroids
.6mg/kg divided q6h given before or within 4h of antibiotics for better results
38
type of organism Hib
gram negative coccobacilli
39
fever after stopping steroids for meningitis
normal rebound fever, no need for additional testing if everything else is getting better
40
when to repeat CSF testing
if strep pneumo and received dex or resistant to penicillin or ceftriaxone GBS at 24-48h of therapy gram negative at 24-48h
41
when to image in meningitis
CSF not sterilized neurologic symptoms o other specific complications
42
how long to treat strep pneumo, neisseria, hib, GBS
strep pneumo 10-14 days neisseria 5-7 d hib 7-10 days GBS 14-21d
43
what is more common type of HSV
HSV 2 (75%), 25% HSV 1
44
factors that influence HSV transmission
mode of delivery, maternal infection, duration of ROM, use of itnrapartum instrumentation
45
in utero HSV effects
very rare can cause skin lesions or scars, CNS disorders and chorioretinitis
46
transmission rates for first episode of HSV
60% 30% if first episode nonprimary (ie they have antibdies to another type of HSV but this is first presnetation with another type) ebcause of cross reactivity of antibodies there is still some protection
47
risk of transmission with recurrent HSV infection
2%
48
how to manage women with recurrent genital HSV
acyclovir starting at 36weeeks until delivery, this decreases risk for shedding but unclear if transfers to reduced risk for baby of getting HSV
49
what are main organs impacted in disseminated HSV
liver and lungs
50
time period for hsv to present
up to 6 weeks, usually within 4 weeks
51
does absence of skin lesions mean they dont have hsv
no
52
which type of hsv has worst mortality
disseminated 85% with disseminated and 50% with CNS disease died
53
when are HSV swabs more reliable
over 24h after birth
54
does negative HSV PCR mean no HSV on CSF
no, can repeat within 72h, might be negative early in disease course
55
is infant serology useful for diagnosing HSV
no transplacental antibodies
56
how long to treat SEM disease HSV
14 days
57
how long to treat disseminated disease HSV
21 d
58
risk of acyclvoir
neutropenia renal tox
59
what to add for ocular disease in bb with HSV
triffluridine 1% in addition to acyclovir
60
diagnosis of CNS HSV
PCR from CSF
61
what to do for baby born to mom with HSV lesions, asymptomatic and born by C section without ROM
swabs from mm and nasophayrngeal at 24h, discharge pending results
62
what to do for bb born to mom with first episode HSV at time of delivery born by vaginal delivery or c section with ROM
mm swabs start acyclvoir if swabs or blood positive, need CSF if negative swabs, need acyclvoir for 10 days minimum
63
what to do for bb when mom had recurrent HSV born by c section
swabs at 24h and send home pendng results
64
what to do for bb when mom had recurrent HSV and vaginal delivery
mm swabs at 24h and discharge pending resukts
65
what to do when mom has known history of hsv but no active lesions at delivery
observe for signs of HSV no swabs or treatment required
66
acyclvoir dose
60mg/kg div q8
67
do you repeat csf for hsv meningitis
yes at end of 21d treatment if still positive, treatment should be extended with weekly sampling to determine stop time
68
when to give oral acyclvoir for bbbs
for suppression after treatment for CNS disease less convincing evidence for skin disease but could still be offerred
69
what to follow on acyclvoir
monthyl cr, ur, cbc
70
contact precautions for bbs with HSV
contact when skin lesions present and until they have crusted over asymptomatic neonates with mothers had active lesions until 14 days or swabs come back negative should ahve contact precautions
71
precatuions for mother with hsv
contact if active lesions until crusted over whena mask if herpes labalis and bb under 6 weeks until lesions are cruested and dried, dont kiss their infant, can bf unless herpetic lesion on breast cover skin lesions
72
encapsulated organisms
strep pneumo Hib neisseria salmonella capnocytophaga (cat and dog bites, high mortality)
73
how to give PCV13 vaccine
4 primary doses 2,4,6mo and 12-18mo patients over 12mo-24mo withoutnprevious PCV doses should receive 2 doses 8 weeks apart patient over 24mo only neeed one dose
74
when is highest risk for sepsis with asplenia
first 3 years of life if congenital first 3 years after splenectomy
75
pen alternative for proph for asplenia
clarithromycin but not as good, more pneumococcal resistance
76
current vertical transmission rates for HIV
<2% without intervention can be as high as 25%
77
rf for HIV transmission in preg
late or no prenatal care, IVDU, recent illness suggestive of HIV seroconversion, unprotected s with partner with HIV, diagnosis of STI in preg, emigration from HIV endemic area, recent incarceration
78
when does hiv transmission occur
time of delivery usually some in utero
79
how to test for HIV in mom preg
first step is testing for HIV antibodies using enzyme immunoassay if EIA is reactive, sample is re-tested using a more specific confirmatory test for HIV antibodies such as western blot
80
how to test for hiv in bb
HIV PCR, also used to quantify viral load
81
what to do is positive HIV test for mom or bb
immediate antiretrovirals for bb, ideally wihtin 72h
82
effects of antiretrovirals
anemia, neutropenia general health, growth,m neurodev
83
how long to precatution for measles
4 d after onset of rash and for duration if immunocomprimised
84
how long to precatuion for measles contact
5 days from first day of exposure to 21 days after last day of exposure
85
how long precatuion mumps
9 days after swelling
86
precautions for varicella contact
from 8 days from first exposure to 21 days after last exposure to 28 days if VZIG given
87
what are spread airborne
varicella, measles, Tb, smallpox

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