Flashcards in ID Deck (182):
Risk factors for spontaneous primary peritonitis? (2)
Specific type of bug in one.
Cirrhosis, nephrotic syndrome (encapsulated: pneumococcus - loss of IgG
Treatment of spontaneous peritonitis?
3rd gen ceph + aminoglycoside
common complication of chronic peritoneal dialysis
Staph epidermis peritonitis
common bug in VP shunt infx
primary cause of occult bacteremia
bug to worry about in asplenic pts
Bugs causing septicemia in neonate
GBS, Ecoli, Strep pneumo, S aureus
Bug causing septicemia in infant
GBS, Ecoli, Strep pneumo, Saureus, salmonella
bugs causing septicemia in immunocompromised pts
GNR: pseudomonas, Ecoli, klebsiella
Abx for r/o sepsis in neonate
amp/cefotax or amp/gent
ecthyma gangenosum: large pustules on indurated inflamed base, think of what dz?
rose spots, what dz?
septicemia tx in >3 mo
prophylaxis for meningococcemia for who and with what?
all persons w/ contact w/ oral secretions, household contacts and close outside contacts
Tx w/ Rifampin q12 x2 days or CTX x1, or Cipro 500 x 1 in >18yo
Dx and Tx of DIC in sick kid
Expect low fibrinogen and high fibrin degredation products and high d-dimer.
Tx w/ ABX then clotting factors and platelets
what bugs does latex agglutination test for?
When to do this?
BINS: GBS, Influenza/H (HIB), Neisseria Mening, Strep pneumo
Helpful w/ partially treated infx when culture unreliable
latex agglutination caveats:
False positives in who?
cross reactivity w/ what?
False pos in children recently received HIB vaccine
Ecoli x-react w/ N. meningitidis.
transfusion related infx, esp pna?
PCP (pneumocystis carinii pneumonia)
tx for fever, neutropenia
-Zosyn (piperacillin-tazobactam) + aminoglycoside
-Ceftazidime or cefapime
water park bug, what does it cause
cryptosporidium (looks like viral gastro but lasts longer)
Tx of cryptosporidium or Giardia in child >1 yr w/ diarrhea
Tx if crypto and immunocompromised
IF immunocompromised crypto: oral human IG or bovine colostrum
immigration + acute abdominal obstruction
ascaris lumbricoides, tx: albendazole x 1, mebendazole x 3d, ivermectin x1
intracytoplasmic inclusion bodies
definitive dx of chlamydial pna?
Ab-specific test or PCR
4Cs of chlamydia
Cough, conjunctivitis, chlamydia, cixteen wks
lab finding and possible tx for chlamydial pna in newborn
emycin PO or azithro. Or if needed non-macrolide, sulfonamide
s/e of macrolides (azithro, clarithro)
diarrhea, abdominal stuff
dx of chlamydial pna in teen?
most common fatal tick-borne dz in US?
Dx w/ direct IF or skin bx
Tx w/ Doxy RIGHT away
rash in RMSF?
mac pap --> petechial,
extr --> trunk
season for RMFS?
Bug in Q fever
what does it cause
what is tx
Coxiella burnetti - inhalation of spore like particles, can be tick bourne
tx w/ doxy or supportive care
Bug causing amebiasis
Bug causing severe GI bloody diarrhea, liver and brain abscesses, and lung dz?
Amebic dysetery, entamoeba histolytica
Tx of amebiasis (E. histolytica)
Flagyl or tinidazole --> luminal amebicide (iodoquinol, paromyin)
Can just do luminal if asx cyst excreter
iodoquinol or paromocyin are what?
eosinophilia, exposure to dog/cats, preschooler eating dirt: Gi and Resp sx
3 clinical manifestations of toxocariasis?
1. viscera larva migrans: fever, hepatomegaly, wheezing
2. ocular larva migrans: visual disturbance
3. covert toxocariasis: GI sx, pruritis, rash
Viscera Larva Migrans in suspected toxocariasis
Dx and Tx?
Dx w/ ELISA and get stool cx to r/o other parasites
Tx w/ mebendazole or thiabendazole
(Longhaired cats, Licking dogs/dirt, ____Dz in Lungs and Liver)
What is the dz?
Larval!! (Ls: Toxocariasis)
Tx of giardia?
flagyl, furazolidone, albendazole
Tx of schisosomal, liver fluke, tapeworm?
tx of strongyloidiasis
(strong guy doing bends)
Bug in cat scratch disease
When to tx
What to tx w/?
tx: supportive unless hepatomegaly, large painful LAD, immunocompromise --> azithro, emycin, cipro, Bactrim, Rifampin are all choices
bug to cover for in cat bite and tx
staph and Pasteurella multocida
Tx w/ Clinda and Bactrim (for pasteurella)
gram negative pleomorphic org in non-immunized child
HIB, H flu
3 encapsulated bugs to think about w/ asplenia
1. H flu
2. strep pneumo
3. N. meningitidis
when to give HIB prophylaxis?
if a child <4 incompletely immunized is in house or immunocompromised child in house.
Trick: no px if non-typeable Hflu
dx of pertussis
Tx of pertussis
Dx: culture and IF nasal swabs
Tx: erythromycin estolate, or clarithro/azithro
how does pertussis tx help?
1. catarrhal stage: shortens the URI phase
2. during paroxysmal stage: decr period of communicability but doesn't shorten coughing ever
how do you handle pertussis prophylaxis
anyone exposed gets erythromycin to prevent spread
classic salmonella poisoning: timing and dx
1-2 d after exposure. stool culture
who should be treated for salmonella infx? and with what?
< 3 mo infant, risk for invasive dz (malignancy, colitis, immune compromise). Tx w/ amox, bactrim, cefotax, cipro in adult.
type of bug causing pna / death in CF?
ABx for pseudomonas
gent, tobra, cefepime
dairy farm, fevers, myalgias
Dx and Tx
brucellosis, dx w/ Ab testing, tx Doxy, Bactrim + Rifampin
tx of cdiff
GBS risk fx?
1. low SES
2. multiple sex partners
3. hx stds, young maternal age
4. ROM >18h
5. fetal scalp monitor/instrument breaking skin
indications for GBS prophylaxis in pregnant lady
1. previous infant w/ invasive GBS dz
2. GBS bacteriuria
3. pos GBS screen
4. unknown GBS w/ gestation < 37wk, ROM>18, fever 38
descending paralysis in infant
mechanism of botulism
block release of Ach (presynaptic)
when to treat newborn w/syphilis?
1. if mom tx in last mo of pregnancy
2. if tx w/ emycin which doesn't cause placenta
3. if baby titers are higher than mothers
Whats the deal with newborn syphilis lab results
FTA-ABS are forever high
VDRL should go down
macular papular rash, HSM, and peeling skin in newborn
sniffles, bullous lesions, osteochonditis, HSM in newborn
Dx and Tx
white nodules on placenta in sick newborn
Listeria vs GBS regarding mom in pregancy
ASX during pregnancy: GBS
Flu like: listeria
the buzz words for campylobacter fetus
family w/ animal exposure
Tx for strep throat in pcn allergy
TO prevent ARF
gram negative bacteria from rabbits
tularemia (francisella tularensis)
Remembering treatment for Tularemia?
Rabbits: gentle, Gentle-mycin (Gentamicin)
Cause of bubonic plague
How do you get it
sx: buboes: inguinal painful LN, other LAD
from handling dead animals
three types of Bubonic plague?
Tx of bubonic plague (Yersinia)
gentamicin / streptamycin
OR doxy,chloramphenicol, tetracycline
resistance in hospital acquired MRSA?
multidrug: beta lactamase ABs and cephalosporins. NEED vanc
ABx that can be used in community MRSA
bactrim, gent, doxy
Causes of systemic candiasis?
YEAST: Widespread immunosuppression, Extensive burns, Abx, Suppressed immunity, TPN use
encapsulated yeast causing pulm dz and meningitis
exposure in cryptococcus
bird droppings, pigeons
Tx of cryptococcus
amphotericin B + fluconazole
ADD 5FC (flucytosine) for resistant infx
tx of Crypto in pt w/ renal dz?
liposomal form of amphotericin B
California, Arizona, Texas travel. Think what dz?
sx of coccidiodomycosis?
vague influenza sx, but severe
Tx of aspergillosis?
Vorixonazole or amphotericin B
Influenza sx + HSM in recent travel to mississippi or missouri, or ohio
crypto vs histo?
both bird droppings, but histo gives HSM
tx of histo?
supportive unless complicated or immunocompromised, then amphotericin b or fluconazole
lymphocutaneous manifestations after gardening. chain of nodules, bone/joint sx, superficial/deep tissues.
Sporothrix schenckii: sporotrichosis
Dx of CMV?
Urine culture for CMV w/in first 3-4 wks of life
Sx of congenital CMV
5Cs: chorioretinitis, cerebral calcifications (periventricular=center), censorineural hearing loss, urine Culture
blueberry muffin baby
Tx of CMV
Diagnosing arbovirus meningitis
CSF virus specific IgM or 4x elevation of IgG from acute to convalescent
type of virus mumps is
Complications of MUMPS?
meningitis, underwear (orchitis), muscle ache, pancreatitis, swelling of parotid
is infertility a complication of Mumps?
cause of intermittent parotid swelling?
salivary gland stone
fever then rash
rate of congenital rubella in affected mother during T1?
Congenital Rubella sx
when most contagious with measles?
5 days before and after rash
timeline of measles
prodrome x 2 days, Koplik spots, rash day 5-10
HIV pt w/ exposure to measles (rubeola)
who should get measles IM Immunoglobulin?
What else can you do?
HIV, child < 1 who is exposed within 6 days of exposure! Also immunocompromised and pregnant ladies.
Can also give MMR w/in 3 days of exposure
When to revaccinate after MMR or IM immunoglobulin after measles exposure?
if MMR before age 1, need to repeat after 1y birthday
if IM Ig, give MMR 5 mos later
DX of HIV In newborn
Ab crosses placenta, so need HIV DNA PCR
Rx to prevent vertical HIV trm
Rate of trm?
ziduvodine (AZT), nevirapine
Actual rate: 5% developed, or 30-40%
HIV buzzword mnemonic?
V: very poor Abx, frequent bact infx
testing and tracking for HIV seroconversion?
6 wks, 3 mos, 6 mos
needlestick by HIV person contam vs high risk exposure?
2 drugs for contaminated needlestick for 4 wks
3 drugs for hi risk for 4 wks
infant screening for HIV?
birth, 2, 4, 6, mos
What is foscarnet for?
CMV retinitis, severe mucocutaneous dz in acyclovir resistant HSV, Zoster in acyclovir resistance
HIV, MMR and VAricalla vaccines
YES if not markedly immunosuppressed
tx of infant exposed to varicella (time period of risk for newborn?)
VZIG: mother develops it between 5 days before delivery to 2 days after
type of precautions for mumps, rubella, pertussis
precautions for aspergillosis, TB, measles, varicella
airborne: need special units
most common cause of PNA in school aged child
two bugs in cervical adenitis and how to distinguish
s. aureus: in younger, more indolent, more likely to supporate
GAS in older kids, more acute
Often need surgical drainage
treatment of most cases of cat scratch adenitis?
usually self limited, and can observe
most common associated sx in Pertussis in 1 mo
pna (25%), 4% get sz
Heterophil antibodies are specific to what virus in mono?
EBV, not CMV/Toxo/HIV
viral capsid antibody for EBV shows what compared to EBNA (nuclear antigen)
EBNA: old infx
viral capsid Ab: acute infx
staph scalded skin, recover organism (which) from where?
Staph aureus from nasopharynx (toxin mediated skin rxn)
poor prognosis in meningococcemia (4)
2. WBC <10,,000
3. petechiae w/in 12 h
4. NO meningitis...
erythema multiforme w/ what bug
mycoplasma pneumoniae, HSV
koplik spots appear when in measles
brain abscess in neonate bug
citrobacter koseri (diversus)
scarlet fever and rheumatic fever mechanisms
scarlet fever: toxin mediated
rheumatic fever: immune complex mediated
meningitis after head trauma
Pregnant woman exposed to parvo B19
-risk to fetus is low, but needs more monitoring.
She's already exposed, so no need to take leave of absence from work
Best HIV testing for infant
Viral PCR (DNA)
Viral load (RNA)
Elisa at 18 mos x 2...
biggest bacterial infection concern in HIV+ infant
rare things for HIV only (2)
Lymphoid interstitial pneumonitis (real bad CXR)
When to start Bactrim prophylaxis (3)
<1500 CD4 count, infants born to HIV mom, or child after episode PCP
>15mm in normal no risk kids >4y, but >10 if younger or chronic dz or incr risk.
The >5 PPD is only for immunocompromise or high suspicion for TB/known exposure
diarrhea + seizure?
think shigella (lots of extraintestinal manifestations)
Yersinia enterocolitica causes severe infx in who?
mostly a dz of toddlers from ingestions (pork intest) BUT can be very severe in iron overload states: thal or hemolytic anemia
Suspect what immune issues / lab findings in someone with chronic giardiasis
HIV, IgA def, Hypogammaglobulinemia (low IgG or IgA)
How do you dx Giardia?
cysts or trophozoites in stool (3 stools for 95% sens)
IF or enzyme immunoassay less sensitive
Treatment of Cryptosporidiosis
Niazoxanide x 3 d
Avoid recreational water: chloride won't kill it!
Diarrhea and liver abscess?
THink entamoeba histolytica
bug in human bites? (3)
streptococci, S. aureus, anaerobes like Eikenella
Test to look for inducible clinda resistance in MRSA
D-test... clinda resistance common in hospital acq MRSA
If there is a "D" its inducible to clinda, then don't give Clinda
(erythro Resistant but Clinda suscept but inducible... )
most common but in osteomyelitis or septic joint?
S. aureus (all ages)
osteomyelitis in chronic granulomatous disease? (2 bugs)
radiograph of choice for suspected osteo?
Ohio or Mississippi valley // cave bug?
hilar adenopathy, 95% asx, may have disseminated in young kids
Tx: amphotericin B with severe dz
Southwest US, sanJoaquin, northern Mexico bug
high risk groups
neonates, pregnancy, immunocompromised, Fillipinos!
Asx common, acute pulm, meningitis (subacute)
AMphotericin / Fluconazole
parasite to cause rectal prolapse and dysentery
Trichuris trichuria (whipworm)
parasite causing Fe def anemia, edema,
Necator americanus (hookworm)
parasite causing wheezing, eos, hypergammaglobulinemia
Toxocara canis (visceral larva migrans) dog ascaris worm. Not in stool
parasite causing acute intest obstrx, also eosinophilic pneumonitis
Ascaris lumbricoides, Loeffler's (eos pneumonitis)
parasite causing fever, myalgias, periorbital edema, conjunctival hemorrhages
After eating pork
Trichonosis: trichinella spiralis (tissue nematode)
dx in child
smear shows intraleukocytic includiosn (morulae)
looks like RMSF but less prominent rash and very anemic and TCP. HypoNa
Tx doxy also
What looks like catscratch but has bld cx with gram-neg coccobacillus? Bug?
Where most common?
Tularemia - Francisella tularensis
central states, tick biet most common. Also rabbits.
bug that invades skin from contaminated water (farm pond, slaughter house -dog/rodent) through cut in skin or mucus membranes
The severe liver disease high mortality form? Tx?
leptospirosis: self limited or doxy, CTX
Weil's disease: PCN G for severe disease
what causes rat bite fever?
Tx: PCN G or Doxy if allergic
peripheral neuritis esp if B6 def
staining of tears / contact lenses
methicillin, oxacillin, nafcillin s/e
s/e of ctx?
biliary sludging (not to use in newborn)
skin lesion in sick, neutropenic chemo patient?
pseudomonas: ecthyma gangrenosum
pin point red spots rash, fever syndrome with GNR
meningitis after head trauma /CSF leak?
Pneumococcus! H flu
top bugs in afebrile PNA syndrome in baby 4-12 wks (4)
Chlamydia, u. urealyticum, CMV, viral.
shunt infx bug/
COag neg staph, skin orgs
travel hx to Africca, fever, anemia, splenomegaly, CNS/Sz
cerebral malaria: plasmodium falciparum
chronic sinusitis, bronchiectasis with signet ring, situs inversus
painful regional LAD and pna, what bioterrorism
respiratory distress then shock and wide mediastinum in bioterror
papular lesion and cervical LAD in bioterror
sheet like pseudomembrane looks like epiglottitis, ragged air column
dx and bug
bact tracheitis, S. aureus