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My Neo Board Quickfacts > ID/Immuno > Flashcards

ID/Immuno Flashcards

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1
Q

Treatment for infant born to woman with active TB

A

isoniazid until 3-4 mo of age until PPD can be placed; continued management dependent on results

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2
Q

2 month vaccines

A

2B DR HIP

2 months:
hep B

DTaP (diphtheria, tenanus, acellular pertussis)
Rota (not in NICU)

Hib
IPV (inactivated polio)
Pneumococcal

*diptheria and tetanus are toxoid vaccines

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3
Q

Duration of treatment for infant born to maternal untreated gonorrheal infection

A

tx: both ophthalmic erythro and IV/IM CTX

if disseminated (bacteremia, arthritis) - CTX or cefotax for 7 days

meningitis - 10-14d

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4
Q

most common bacteria a/w osteo in neonates

A

Staph aureus

less common: GBS, E coli, candida, neisseria gonorrheoae

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5
Q

Most common bones for osteo

A

femur > humerus > tibia > radius > maxilla

(femur and tibia in preterm; humerus in term)?

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6
Q

CMV virus type

A

double stranded herpes DNA virus

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7
Q

precautions for CMV+ infant

A

standard

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8
Q

time of CMV maternal infection w/ greater risk of neonatal disease/greater severity of neonatal illness

A

FIRST half of pregnancy

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9
Q

radiographic evidence of osteomyelitis - what and when

A

7-10 days

bony destruction, focal area of metaphysical necrosis, soft tissue swelling

*CT/MR more sensitive but not always possible due to need for transport/sedation

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10
Q

treatment duration for toxo

A

~1 year

pyrimethamine-sulfadiazine and folinic acid*

(supplement with folate b/c sulfadiazine a/w bone marrow suppression –>neutropenia)

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11
Q

symptoms in neonate of toxo

A

usually asymptomatic at birth

80% may develop learning disabilities and visual problems later

*preterm may develop CNS symptoms and eye problems in first 3 months of life (compared to later in term) but both at equal risk in general

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12
Q

MCC of EOS (< 72hr)
- overall
- in term
- in VLBW

A

overall: GBS and E coli

term: GBS

VLBW: E coli (risk of EOS 10x in VLBW than term)

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13
Q

MC serotype of GBS in Late Onset Sepsis

A

Serotype III

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14
Q

Chediak-HIgashi

A

abnormal neutrophil degranulation
leads to partial oculocutaneous albinism
nystagmus
peripheral neuropathy
recurrent infections

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15
Q

Leukocyte adhesion deficiency

A

d/o of neutrophil function despite increased #
defective adhesion and migration
recurrent bacterial infections
poor wound healing
necrotic lesions

*risk of ompholitis
*delayed umbilical cord (sometimes >21d)

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16
Q

Chronic granulomatous disease

A

abnormal phagocytic microbial ability
increased risk of abscesses
poor wound healing
granuloma formation

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17
Q

Hyper IgE aka Job’s syndrome

A

abnormal neutrophil chemotaxis
skin infections
coarse facial features
broad nasal bridge

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18
Q

Kostmann

A

severe congenital neutropenia
frequent infx in first few months

*elastase gene
responds well to rG-CSF

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19
Q

Iso precautions for:
CMV
Rubella
HSV
Toxo
HIV
TB
Varicella
RSV
Parvo
Listeria

A

Standard:
- CMV
- Toxo
- HIV
- Listeria

Contact only:
- HSV
- RSV

Droplet:
- Rubella (+ contact)
- Parvo

Airborn (+ contact)
- TB
- Varicella*

Congenital varicella does not require contact isolation if no active lesions

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20
Q

Rubella virus type

A

RNA

passed through respiratory secretions

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21
Q

HSV virus type

A

double-stranded DNA

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22
Q

Toxo infx type

A

intracellular parasite

passed by poorly cooked meat, cat feces

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23
Q

HIV virus type

A

RNA retrovirus

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24
Q

Varicella virus type

A

DNA herpes

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25
RSV virus type
RNA paramyxovirus
26
ParvoB19 virus type
single-stranded DNA
27
Listeria bacteria type
gram-positive rod
28
Treatment for listeria
ampicillin+aminoglycocide 14 d sepsis 21d meningitis *consider brain imaging to assess for abscess
29
maternal infections that increase risk of stillbirth or fetal loss
Listeria Parvo B19 Syphilis - 30-40% of congenital syphilis=stillborn
30
when do symptoms of congenital syphillis typically develop
3-14 weeks PNA (most asymptomatic at birth) *30-40% chance of stillbirth
31
CMV hearing loss characteristics
MCC (non genetic) of congenital sensorineural healing loss in children - progressive (may not be detected until after 1 year of life) - usually bilateral and moderate to profound - tx w/ gancyclovir* to infants a/w preservation of hearing *monitor for nephrotoxicity, neutropenia, rising LFTs
32
Cardiac disease in congenital Rubella
(50% chance of heart defect) PDA Pulmonary arterial hypoplasia
33
Salt and pepper chorioretinitis sensorineural hearing loss cataracts insulin-dependent diabetes thyroid disease
Rubella
34
treatment for congenital rubella
supportive only
35
chance of infant developing HSV i/s/o maternal lesion of primary vs secondary infx
primary - 50% secondary - 2% *higher risk in prematurity
36
mortality rate of disseminated HSV
50-70% 50% HSV- 2 70% HSV - 1 50% w/ encephalitis will have long term sequelae
37
MC presentation of listeria before and after 7d v
<7d - pneumonia/sepsis after first week - meningitis
38
when does all maternal IgG disappear from infant's circulation
9 months
39
How is IgG transported in placenta
endocytosis
40
when do IgM levels reach 75% adult levels
1 year (some fetal IgM production)
41
IgA levels reach ____% of adult levels by 1 year
20% *NO fetal IgA production
42
calcifications in CMV vs toxo
cmv - PERIventricular toxo - cortical
43
stain for chlamydia
giemsa stain of conjunctival scrapings
44
treatment for congenital TB
4 drug regimen: isoniazid rifampin pyrazinamide aminoglycocide length depends on sensitivity of organism note: symptoms present during 2nd or 3rd week of life
45
treatment for neonate born to mother with active TB
isoniazid alone if asymptomatic
46
risk of mother to child HIV transmission via breast milk
9-15%
47
presumptive vs definitive exclusion of HIV infection in an infant born to HIV+ mom
(both need to have no lab or clinical evidence of HIV) presumptive: - 2 negative DNA/RNA tests from separate specimens both at least 2 WEEKS and one at least 4 WEEKS of age - 1 negative DNA/RNA test at least 8 WEEKS of age - 1 negative Ab test at least 6 MONTHS of age definitive: - 2 negative DNA/RNA tests from separate specimens, one at least 1 MONTH of age and one at least 4 MONTHS of age - 2 negative Ab tests from separate specimens both at least 6 MONTHS of age
48
treatment with POSSIBLE benefit for Enteroviral sepsis
high dose IVIG --->(Ab to enterovirus from pooled population) ----> being investigated, no constant benefit pleconaril ---> antiviral capsid binding drug inhibits viral attachment to host cell ---> experimental; clinical trials blood products as needed for liver disfunction/coagulopathy **NOT acyclovir - only works in DNA viral infections; no role in RNA viruses (like enterovirus)
49
treatment for systemic candida infection
amphoterocin B *penetrates blood brain barrier, renal system, ocular orbit *NOT liposomal form first line (does not penetrate BBB, kidneys and also has liver toxicities); use if renal toxicity * could use fluconazole once sensitivities are known but Candida glabarata and Candida kruzii are resisistant
50
most neonates colonized by CONS by ____ day of life
3-4 (days of life)
51
bacteria in omphalitis
polymicrobial - usually skin flora staph aureus, Group A strep e coli
52
MC complication of omphalitis
sepsis
53
B cells in fetus
pre-B cells in liver starting at 7 weeks (gone by 30) bone marrow by 12 weeks mature in bone marrow higher absolute # of B cells as adult (but same proportion); peaks 3-4 months of age
54
neutrophils in fetus
starts at 10-14 weeks gestation - defective phagocytosis until term gestation - all neonates (term and preterm) have impaired chemotactic response and adhere poorly - granulation response in term similar to adults
55
classic complement pathway
requires specific Ab against antigen -->immune complexes (antigen/antibody reaction) C1 C4 C2 C3* classic and alternative pathways coverage at C3
56
alternative pathway
antibody-independent C3 is spontaneously cleaved by bacterial cel wall hydroxyl groups (gram pos and gram neg) cleaved C3 + factor B cause cascade
57
complement - common terminal pathway: what makes up the membrane attack complex
C5,6,7,8,9
58
Most common complement deficiency
C2 increases risk of infx (especially pneumococcal) and collagen vascular disease
59
deficiency of early complement components (C1-4)
increases risk of infx (especially pneumococcal) and collagen vascular disease *C2 most common
60
deficiency of lat components (C5-9)
increased risk of neisseria infections
61
Clostridium botulinum shape
gram+ rod
62
Neisseria gonorrhoeae shape
gram neg intracellular diplococcus in pairs
63
streptococcus shape
gram positive diplococcus in chains
64
listeria shape
gram+ rod
65
treatment for chlamydia conjunctivits
14 d oral erythromycin *a/w pyloric stenosis
66
why does erythromycin eye ointment not work for chlamydia
colonization of nasopharynx can still occur
67
when maternal varicella infection highest risk to fetus
early (first 20 weeks) - high risk of congenital varicella syndrome (1-2%) late (5 days before to 2 days after birth) - GREATEST risk; 17% risk of acute infection, 30% mortality
68
maternal varicella infection during 2nd half of pregnancy up to 21 days prior to delivery
LOW risk of congenital varicella may develop varicella zoster early in life
69
placenta of CMV infx
villous damage thrombosis villitis some villi w/ inclusion body cells and hemosiderin
70
placenta of syphilis
hydros marked round cell infiltration (maternal)
71
72
capsulated bacteria
Hflu Neisseria meningitides Salmonella typhi Strep pneumoniae
73
Functions of the spleen
site of IgM production site of complement production assists in maturation of Ab supports proliferation of T-cells scavenges od RBCs and platelets (recycles iron from hemoglobin for hematopoesis) reservoir of extra blood
74
SPECIFIC blood cell finding in asplenia
Howell-Jolly bodies (nuclear remnant usually removed by spleen by macrophages)
75
duration of valganciclovir for +CMV screening
6 months
76
greatest risk factor for clabsi
GA and BW
77
MCC pathogens for EOS (in order)
GBS (40%) E coli (28%)* - leading cause in preterm (38%) strep other than GBS (10%) enterococcus (3%) Staph aureus (2%) Listeria (<1 %)
78
MC complication of subclinical (asymptomatic untreated) congenital toxoplasmosis
chorioretinitis (other complications not common if not symptomatic)
79
chlamydia acquired during labor will cause late-onset pneumonia at what age
2-4 wks of age *not defined as congenital
80
MCC of early pneumonia
GBS (e coli end) HSV MC viral pathogen causing early pneumonia
81
white spots on umbilical cord and amniotic membrane
candidal chorioamnionitis
82
dose adjustment of zidovudine in preterm infants
reduced dose; increase with age - cleared via hepatic glucuronidation, which is not fully developed in preterm infants (still 6 week course)
83
recurrent purulent bacterial and fungal infx + nitro blue tetrazolium (NBT) test negative
Chronic granulomatous disease mutations in phocyte NADPH oxidase
84
neutrophil peak in healthy newborns
12-24hrs declines and reaches steady state by ~72hrs
85
collectins
host-defense; c-type lectin domain related in structure to C1q mannose-binding letin (MBL) conglutinin SP-A - do not activate compliment SP-D - do not activate compliment
86
FGR direct and indirect hyperbole coombs-neg hemolytic anemia thrombocytopenia lymphadenopathy mucocutaneous lesions
congenital syphilis lesions are vesicular or bullies, ultimately rupture to form superficial crusted erosions or ulcerations rash generalized band classically involves palms and soles
87

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