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CPS statements - ID Flashcards

1
Q

Azole antifungals

- important to remember

A
  • monitor liver enzymes
  • drug drug interactions
  • may prolong QT interval
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2
Q

Benefits of reducing antimicrobial use

A
  • decrease adverse events
  • decrease superinfections
  • costs savings
  • possible association between preivous abx therapy and development of obesity and allergies
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3
Q 
Duration of antibiotics: 
(CPS AMS)
- strep pharyngitis
- children > 2 for uncomplicated AOM
- uncomplicated PNA
- UTIs
A
  • Strep: 10 days
  • AOM: 5 days > 2 yr (10 days if < 2 yr, recurrent or perforated TM)
  • PNA: 7 days
  • UTIs: 7-10 days
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4
Q

Risk factors for AOM

A
  • young age
  • frequent contact with other children
  • household crowding
  • cigarette smoke
  • pacifier use
  • shorter duration of breastfeeding
  • prolonged bottle feeding while lying down
  • family hx
  • First Nations or Inuit
  • low levels of IgA or biofilms in middle ear
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5
Q

Most common bacteria causing AOM

A
  • S. pneumo
  • H. flu
  • M. catarrhalis
    Less commonly: GAS (strep pyogenes)
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6
Q

Watchful waiting in AOM if:

A
  • > 6 months of age
  • no perforated TM with purulent drainage
  • mildly ill (T<39, <48h of illness)
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7
Q

Risk factors for spread of CA-MRSA

A
  • close skin-skin contact (cuts and abrasions)
  • contaminated items
  • crowded living conditions
  • poor hygiene
  • high risk populations: Athletes, daycare, Indigenous, military, IVDU, MSM, prisoners)
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8
Q

CA-MRSA reasons to use antibiotics after drainage

A
  • child < 3 months of age
  • significant associated cellulitis, fever or systemic signs of illnesses
    (abx usually for a 7 days course after drainage e.g. septra)
  • child with serious medical problems
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9
Q

C. diff risk factors

A
  • increased duration of hospital stay
  • older age
  • antibiotics
  • chemotherapeutic agents
  • immunosuppression
  • HIV
  • Hypogammaglobulinemia
  • manipulation of Gi tract e.g. surgery, tube feeding
  • mixed evidence for PPIs
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10
Q

C. diff recurrence rate

A

25%

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11
Q

C. diff mild illness vs. moderate vs. severe

A

Mild: watery diarrhea without systemic toxicity and < 4 abN stools
Moderate: 4+ abN stools per day, no systemic toxicity (+/- low grade fever, mild abdo pain)
Severe: high-grade fevers, rigors, hypotension, shock, peritonitis, colitis, megacolon

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12
Q

C. diff initial episode treatment

A 
Mild: 
- discontinue antibiotic 
- follow up and reassess
Mild/Mod:
-  metronidazole x 10-14 d
Severe: 
- vancomycin PO x 10-14d
First recurrence = repeat regimen for initial episode
2nd recurrence = vanco in a tapered or pulsed regimen
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13
Q

Features of congenital CMV

A 
90% = asymptomatic
At birth: 
IUGR
CNS: microcephaly, seizures
GI: hepatosplenomegaly
Heme/Derm: petechial rash, jaundice
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14
Q

Treatment of congenital CMV

1) asympto
2) mildly symptomatic
3) moderate to severe

A

Asymptomatic (+/- SNHL): regular audiologic , no evidence for antiviral (awaiting trials for isolated SNHL)
Mild (+/- SNHL, no CNS or chorioretinitis): individualized management, consult ID
Moderate to severe: ID consult, antiviral agents, oral valgan x 6 months (IV ganciclovir can be for first 2-6 weeks if very ill)

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15
Q

Treatment for cCMV

and adverse events of treatment

A
  • valganciclovir x 6 months (IV gancyclovir for first 2-6 weeks if really sick) to commence in first month

adverse events: neutropenia, thrombocytopenia, transaminases, elevated BUN and Cr

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16
Q

Varicella exclusion policy

A
  • return as soon as well enough to participate normally (regardless of state of rash)
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17
Q

Maternal and neonatal risk factors for early onset bacterial sepsis

A 
Maternal GBS+
Maternal GBS bacteriuria during pregnancy
Previous GBS infant
Maternal fever
pROM > 18hrs
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18
Q

Adequate intrapartum antibiotic prophylaxis

A
  • Pen G at least 4hr before birth (or cefazolin)

not clinda/erythro/vanco

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19
Q

Markers of early onset sepsis

A 
WBC < 5 or >30
ANC <1.5
I:T ratio > 0.2
Procalcitonin 
CRP can be helpful serially
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20
Q

GBS +, not adequate IAP,

no other RFs (risk = 1-2%)

A
  • examine, observe closely (VS q3-4)for at least 24hr

- reassess and counsel before discharge

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21
Q

GBS+ and other RFs (risk > 1-2%)

A
  • At minimum, observe closely (Vs q3-4hrs) for at least 24hrs
  • reassess and counsel before discharge
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22
Q

GBS negative or unknown with multiple risk factors of maternal chorioamnionitis

A
  • At minimum observe closely VS q3-4hr for at least 24hrs

- consider CBC after 4hrs

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23
Q

HIV vertical transmission rate

A

< 2% in Canada

without intervention can be as high as 25%

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24
Q

Risk factors for HIV vertical transmission

A
  • late or no prenatal care
  • injection drug use
  • recent illness suggestive of HIV seroconversion
  • regular, unprotected sex with a partner known to be living with HIV or with sig risk for HIV
  • diagnosis of STIs during pregnnacy
  • emigration from an HIV-endemic area or recent incarceration
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25
Q

Woman in labour with unknown HIV status management

A
  1. Rapid HIV antibody testing
    - if positive: start antiviral prophylaxis while confirmatory antibody tests are pending and consult ped ID
    - if mom refuse, baby must undergo rapid antibody testing (consider child protection authorities)
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26
Q

Mom’s rapid test is positive for HIV at time of delivery management

A
  • start antiretroviral no later than 72hrs post-delivery
  • baby’s HIV DNA or RNA PCR should be tested within 48hrs (if positive, prophylaxis should be stopped and TREATMENT should be initiated)
  • no breastfeeding unless confirmatory test is negative
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27
Q

Risk factors for HPV infection

A
  • higher lifetime # of sexual partners
  • previous STIs
  • history of sexual abuse
  • early age of sexual intercourse
  • partner’s # of lifetime sexual partners
  • tobacco or marijuana use
  • immunosuppression
  • HIV
  • MSM
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28
Q

HPV vaccine dose schedule

A

2 doses 6 months apart if 9-13 yrs

3 doses if > 15 yrs or immunocompromised or if have HIV

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29
Q

Asplenic septic organisms:

A
  1. strep pneumo (50%)
  2. Haemophilus influenza type B
  3. neisseria meningitis
  4. salmonella species
    Other: e.coli, bordetella holmesi, fatal malaria and ticks, capnocytophaga
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30
Q

Asplenia

- most important immunzations

A

Most impt : S. pneumo, HIB, N meningitidis (can be administered earlier than routine)

  • all routine immunizations
  • pneumococcal 23 about 8 weeks after receipt of appropriate # of PCV 13 (then 5 year booster)
  • MCV4 (Men ACWY)
  • Men B
  • HiB
  • flu vaccine
  • salmonella typhi vaccine if travel
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31
Q

Timing immunizations around splenectomy

A

2 weeks before surgery

- if not possible then 2 weeks after

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32
Q

Antibiotic prophylaxis after splenectomy

A

amoxicillin < 5 yrs
penicillin or amox > 5 yrs
For a minimum of 2 yrs post splenectomy, and for all children <5 yrs (lifelong is preferred)

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33
Q

Indication for oseltamivir

A
  1. moderate, severe, progressive (hospitalized)
  2. not requiring hospitalization but RFs (other than young age) for severe disease (cardiac, resp, immunocompromised etc.)
  3. no risk factors but 1 to <5yrs with < 48hrs of sx (to be considered)
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34
Q

High risk for influenza-related complications of hospitalizations

A
  1. children <5 yrs
  2. children with:
    - cardiac/pulmonary, diabetes, cancer, immunocompromise, anemia/hemoglobinopathy,, neuro/ neurodevelopmental (includes febrile seizures and isolated dev delay), obesity (BMI >40), treatment on prolonged course of ASA
  3. Indigenous
  4. chronic care facilities
  5. pregnant women
  6. > 65 yrs
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35
Q

Live attenuated influenza vaccine contraindicated for:

A

< 2 yrs

  • immunocompromised (except stable HIV)
  • current active wheezing or on high dose IVS or medically attended wheeze within 7 days
  • pregnancy
  • chronic ASA therapy (Reyes syndrome)
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36
Q

Flu shot dosing regimen

A
  • for the first year a child < 9: 2 doses at least 4 weeks apart (but only 1 if received 1 dose before)
  • 9+ years: only 1 dose per year
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37
Q

Significant immunocompromised states (5)

A
  • HSCT (within 2 yrs or still taking immunosuppressant drugs)
  • organ transplant
  • current or recently treated malignancy
  • asplenia
  • HIV infection
  • SCID
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38
Q

Medications indicating immunocompromised

A
  • steroids > 2mg/kg of body weight or >= 20mg per day of pred when given for > 2 weeks
  • cancer therapeutics e.g. cyclophosphamide
  • antimetabolites e.g. azathioprine,
  • transplant-related immunosuppressive
  • biologics
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39
Q

Pretransplant immunizations

A

Live: 4 weeks before
Inactivated: 2 weeks before
MMRV as early as 6 months of age for solid organ transplant candiates

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40
Q

when to give live vaccines AFTER immunosuppression

A
  • 1 month after high dose steroid
  • 3 months after completion of immunosuppressive chemo
  • 5 months after tx with anti-B cell antibodies
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41
Q

Immunization after HSCT

A
  • re-immunize with all routine vaccines
  • inactivated vaccines 3-12 months after trasnplant
  • live vaccines 24 months after transplant if no GVHD/immunosuppression and considered immunocompetent
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42
Q

RFs for IGAS in children

A
  • recent pharyngitis
  • varicella
  • recent soft tissue trauma
  • NSAIDS
  • household contacts
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43
Q

Strep toxic shock

Criteria

A

Hypotension and 2 of the following:

  • renal impairment (Cr at 2x baseline or ULN)
  • coagulopathy (thrombocytopnia < 100 or DIC)
  • liver function abnormalities
  • ARDS
  • generalized erythematous rash that may desquamate
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44
Q

Features of nec fasc

A
  • severe pain or tenderness (out of proportion to apeparance)
  • toxic
  • hemodynamic instability
  • rapid rate of progression
  • woody induration
  • anesthesia or hyperesthesia of overlying skin
  • crepitus
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45
Q

Management of severe IGAS

A
  1. supportive with fluid and electrolytes
  2. clindamycin + pip-taz or carbapenem +/- vanco
  3. IVIG - on day of presentation
  4. other treatment e.g. surgical debridement
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46
Q

Close contacts for IGAS

A
  • household contacts (at least 4hr per day, or 20hr with index case)
  • non household who shared bed or sexual relations
  • direct mucus membrane contact or unprotected with skin lesion
  • shared needles for IVDU
  • contact in child care settings
47
Q

IGAS chemoprophylaxis

A

1st gen cephalosporin e.g. cephalexin x 10 days (or cefadroxil)

48
Q

Lyme bacterial spirochete

A

Borrelia burgdorferi

49
Q

Lyme treatment

- early localized disease (EM)

A

Doxy x 10 days

Amox x 14 days

50
Q

Lyme treatment:

- arthritis

A

Arthritis: Doxy (or amox) x 28 days

if persistent or recurrent, retreat with oral or do IV CTX 14-28 days

51
Q

Lyme treatment - carditis

A

oral agent (e.g. doxycycline) or ceftriaxone 14-21 days

52
Q

Non treponemal tests

Treponemal tests

A

Non-treponemal: RPR or VDRL

Treponemal: TP-PA or FTA-ABD

53
Q

Features of congenital syphilis

A

General: spont abortion, hydrops fetalis
Resp: snuffles and or rhinitis
GI/Heme: hepatomegaly, splenomegaly, lymphadenopathy, anemia, thormbocytopenia
MSK: osteochondritis, periondritis, pseudoparalysis, bony findings,
Derm: necrotizing funisitis (barbershop pole), hutchings teeth, mulberry molars,
SNHL

54
Q

When to treat babies for congenital syphilis

A
  • symptomatic
  • the infants test is 4x higher than their mother’s at birth
  • maternal treatment was inadequate, is unknown, did not contain penicillin, or occurred in the last month of pregnancy or maternal response is inadequate
  • adequate follow up of the infant cannot be ensured
55
Q

Contraindications for LP

A
  • coagulopathy
  • cutaneous lesions at puncture site
  • herniation
  • hemodynamically unstable
    CT first if: papilledema, focal neuro signs, decreased LOC or coma
56
Q

Most common organisms for meningitis > 2 months

A

Strep pneumo and N. Meningitidis

  • also consider e.coli and GBS up to 3 month sof age
  • HIB in incompletely immunized or other H. flu types
57
Q

Empiric antibiotic therapy for meningitis

A
  1. 3rd gen cephalosporin (CTX or cefotaxime)

2. Most recommend including vancomycin

58
Q

Steroids in meningitis indications

A
  • evidence to decrease hearing loss in HIB meningitis

- role in strep pneumo is less certain

59
Q

Indications for repeat CSF sampling

A
  • Repeat at 24-48hrs for gram negative enteric pathogens e.g. e.coli
  • Repeat if not improving with initial therapy
  • some say for GBS and s. pneumo to document sterilization at 24-48hrs
60
Q

Duration of treatment for meningitis by pathogen

  1. strep pneumo
  2. Hib
  3. neisseria
  4. GBS
A
  1. strep pneumo 14 days
  2. Hib 10 days
  3. Neisseria 7 days
  4. GBS 21 days
    logner if cerebritis or ventriculitis
61
Q

When to do audiology for children with meningitis

A

before discharge!

62
Q
  1. DEET limits by age

2. Icaridin limits

A

<= 10% for children <= 12 yrs
<=30% for children >12
Icaridin up to 20% (for all ages)

63
Q

Factors influencing transmission of HSV infection to newborns

A
  1. nature of maternal infection
  2. mode of delivery
  3. duration of rupture of membrane
  4. use of intrapartum instrumentation
64
Q

Neonatal HSV transmission rates

  • first episode primary
  • first episode non primary
  • recurrent
A

1st episode primary: 60%
1st episode non primary: <30%
recurrent: < 2%

65
Q

Pregnancy and HSV exposure prophylaxis

A

Acyclovir or valacyclovir from 36 weeks until delivery (not clear if it reduces risk)

66
Q

Timing of neonatal HSV

A

usually within first 4 weeks but can be up until 42 days of age

67
Q

Treatment of neonatal HSV

A

IV acyclovir
x 14 d for SEM
x 21 d for disseminated or CNS
then suppressive antiviral therapy for 6 months

68
Q

Managing term baby born to mom with active lesions at delivery (presumed 1st episode)

  1. C-section before rupture of membranes
  2. 1st episode of herpes delivered after ROM (c/s or SVD)
A
  1. C-section before rupture: education, take swabs (+/- blood PCR) at 24hr
  2. 1st episode after ROM: do swabs and start IV acyclovir do it for at least 10 days (more if swabs are positive)
69
Q

Managing term baby born to mom with active lesions at delivery

  1. recurrent HSV and c/section
  2. recurrent HSV and vaginal
A

C/S and/or vaginal: swabs at 24hrs then send home with pending

70
Q

Managing neonates born to moms with untreated to N. gonorrhea

A
  • conjunctival culture
  • single dose IM CTX
    (if unwell do blood and CSF)
71
Q

Managing neonates exposed to C. trachomatis

A
  • monitor for conjunctivitis and pneumonitis, treat if sx occur
  • generally no prophylaxis (concern about pyloric stenosis)
72
Q

Post transplant infection

  1. <1 month
  2. 1-6 months
  3. more than 6 months
A
  1. normal infections
  2. opportunistic infections - viral (EV, CMV, HCV, HBV, HHV6) and non viral (PHP, aspergillus, listeria)
  3. community-acquired if good graft fx and crhonic viral and opportunistic if poor graft function
73
Q

Chronic osteomyelitis

A

Symptoms > 1 month (may have Brodies’ abscesses)

74
Q

Osteomyelitis organisms

A
  1. staph aureus
  2. kingella kingae (<4yrs)
  3. strep pneumo
  4. strep pyogenes
    sickle cell think salmonella
75
Q

Indications for surgery in osteomyeltis

A
  • suspected subperiosteal fluid or abscess

- pt fails to improve clinically within first few days on antibiotics

76
Q

Duration acute osteomyelitis treatment

A

3-4 weeks of abx

77
Q

Septic arthritis duration of antibiotics

A

3-4 weeks

except 4-6 weeks if hip

78
Q

Otitis externa RFs

A 
Swimming
Foreign body in the ear
hearing aid
Certain derm conditions
Chronic otorrhea
Wearing tight head scarves
Immunocompromise
Ear piercing may lead to infection of pinna
79
Q

Otitis externa organisms

A
  1. pseudomonas
  2. staph aureus
    other = polymicrobial
80
Q

Otitis externa management

A

Topical antibiotic with or without steroids for 7 to 10 days

81
Q

Indications for palivizumab:

A
  1. hemodynamically significant CHD <12 months
  2. CLD who require ongoing diuretics, bronchodilators, oxygen or steroids < 12 months
  3. Prem < 30 weeks GA now < 6 months (reasonable but not essential)
  4. infants in remote communities born before 36 weeks and <6 months
82
Q

Infective endocarditis indications for prophylaxis

A
  1. prosthetic cardiac valves
  2. previous infective endocarditis
  3. unrepaired cyanotic congenital heart disease
  4. repaired CHD with prosthetic material within first 6 months
  5. repaired CHD with residual defects e.g. patch leak
  6. cardiac transplant recipients with cardiac valvulopathy
83
Q

Procedures for IE prophylaxis

A
  1. dental procedures with manipulation of tissue

2. procedures on infected skin, skin structure or MSK tissue

84
Q

Indication for hospitalization in pneumonia

A
  • inadequate oral intake
  • intolerant of oral therapy
  • severe illness or respiratory compromise
  • complicated pneumonia
  • < 6 months of age
85
Q 
Abx in pneumonia
1. outpatient
2. inpatient
3. resp failure or shock
4 pneumatoceles/rapidly progressing
A
  1. amox
  2. amp
  3. cefotax/CTX
  4. add vanco
86
Q

3 stages of empyema

A
  1. pus and effusion
  2. loculations
  3. fibrinous peel
87
Q

Most common empyema organisms

A
  1. strep pneumo
    2 staph aureus
  2. strep pyogenes
88
Q

Complicated pneumonia when to step down to oral

A
  1. drainage has been completed
  2. pt is improving
  3. pt is off oxygen
    3-4 week total course
89
Q

Malaria sx and signs

A

Sx: fever, headache, Nausea +/- V or diarrhea, lethargy, myalgia, abdo pain
Signs: jaundice, low white count, hepatomegaly, splenomegaly

90
Q

Typhoid (enteric) fever signs and sx

A

Sx: Fevers, chills, rash, HA, myalgias, confusion, +/- constipation, abdo pain
Signs: jaundice, hepatomegaly, splenomegaly

91
Q

Chlamydia screening and who to screen and tx

A

Screen all sexually active < 25 yrs annually (at least)

Screen with NAAT
Culture for medico-legal

Tx: azithromycin

92
Q

Contraindications to rotavirus vaccine

A
  • hx of intussception or susceptibility to intussuception (e.g. Meckel’s)
  • hypersensitivity to ingredients
  • known or suspected SCID, or other immunodeficiency
93
Q

Non-typhoidal salmonella sources of human infection

A
  • Reptiles

- poultry, eggs, dairy, beef or produce

94
Q

Management non-typhoidal salmonella

A
  • antibiotics if bacteremia or invasive infections
  • infection precautions
  • abx if < 3-6 months, unwell, immunocompromised, asplenic
    e. g. 7 days azithro
95
Q

Management typhoid/paratyphoid fever

A
  • treat with azithromycin or other abx
96
Q

Gonorrhoea screening and tx

A

Screen all sexually active youth < 25 yrs
Screen with NAAT
cultures for medical legal, tx failure etc.
Tx: CTX + azithromycin

97
Q

TB skin test pros and cons

A

Pros:
- similar sensitivity and specificity as IGRa for latent TBI
- probably more sensitive for children < 2 yrs
Cons:
- false positives with non-TB mycobacgeria, BCG vaccine
- false negative in immunosuppression

98
Q

TB skin test interpretation

A

Positive if
>= 5mm for immunocompromsied and contacts of cases
>= 10 mm for others
0-5mm = infants or young children

99
Q

Indications for antibiotic prophylaxis for UTI

A
  • may be considered if grade 4 or 5 VUR OR a significant urological anomaly
    (should not last more than 3-6 months)
  • usually septra or nutrofurantoin and consider discontinuing if resistant to both
100
Q

Children with contact with an index case with TB

Management

A
  1. hx and physical (and obtain index case’s drug sensitivities)
  2. CXR and TST

If < 5 yrs old and TST < 5mm: start window prophylaxis and repeat TST in 2 months

If > 5 yrs with TST <5mm: no prophylaxis

If > 5 yrs and normal CXR with TST >5: treat as per latent infection

101
Q

Minimum colony counts

A

CFU/ml
Mid stream: > 10^5
iIn and out: > 5 x10^4
Suprapubic: any growth

102
Q

Treatment duration UTI

A

UTI: 7-10days
cystitis: 2-4 days

103
Q

Features suggesting a complicated UTI

A
  • hemodynamically unstable
  • elevated Cr
  • abdominal or bladder mass
  • poor urine flow
  • not improving within 24hr or no improvement in fever in 48hrs
    (IV abx for complicated UTIs until child is clearly improving)
104
Q

Polio sx

A
  • asymptomatic
  • short, self-limiting illness
  • 1% result in paralysis = acute onset of asymmetric flaccid paralysis
    = public health emergency of international concern!
105
Q

Diphtheria

A
  • sore throat, weakness, rapidly progressive swelling of neck leading to pseudomembrane in throat or nose leading to severe respiratory compromise
106
Q

Tetanus features

A
  • muscle rigidity, spasm

infection can be fatal

107
Q

congenital zika virus sx

A
  • severe microcephaly (may have normal HC with ventriculomegaly), may have redundant scalp
  • cerebral atrophy
  • abN brain development
  • subcortical calcifications
  • abnormal fetal tone
  • SNHL
    etc.
108
Q

Baby with possibly zika virus (sx and travel exposure)

A
  • test serology and PCR on mother and child
  • test placenta
  • u/s and MR of head
109
Q

Infant born to mother with potential exposure for zika

A
  • test mother’s serology first (also PCR if exposure was 4 weeks before delivery)
    if positive then test baby
110
Q

Meningococcal serogroups and age they peak

A

5 serotypes: ABCYW (B+C = most common)
<5 yrs: serogroup B peaks
Serogroup C peaks in adolescents, outbreaks, highest fatality

111
Q

people at high risk of invasive meningococcal disease

A

Underlying medical conditions:
- asplenia, sickle cell anemia, properidin, factor D or complement difiency, primary antibody deficiency, HIV
Risk from exposure:
- lab workers who work with meningoococcus, military ppl, travelers to endemic areas, close contacts to a case

112
Q

Treatment for baby >35 weeks:

  1. maternal HIV, treated with ART, no viral load
  2. maternal HIV, uncontrolled
A
  1. zidovudine PO x 6 weeks

2. triple ART (or dual therapy in some cases)

113
Q

Testing baby for HIV

A
  • HIV PCR tests at > 1 month and > 2 month
    (if treated with cART then at least 1 at > 4 months)
  • FINALIZE status with serology testing between 18 and 24 months

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