Infectious Disease Flashcards Preview

Pediatrics > Infectious Disease > Flashcards

Flashcards in Infectious Disease Deck (147):
1

What are the stages of pertussis

1.) Incubation 7-10 days 2.) Catarrhal: URI symptoms 3.) Paroxysmal phase - 5-10 coughs with whoop in between, post-tussive emesis, cyanosis, apnea 4.)convalescent phase

2

Treatment of pertussis

Azithromycin 10mg/kg up to 500mg on day 1 then 5mg/kg on day 2-5 up to 250mg. Adults use zpack.

3

What do you do with exposed contacts to pertussis?

all get chemoprophy with azithro, regardless of immunization status

4

Immunizations for Pertussis

1. DTaP vaccine at ages 2, 4, 6, 15--18 months, and 4--6 years
2. Single dose of Tdap for adolescents aged 11--18
3. Single dose of Tdap Adults aged 19--64 years in October 2005.
4. Tdap each pregnancy third or late second trimester. Transient immunity potentiall passed to each infant.

5

MOA of cephalosporin

B lactam, inhibits peptidoglycan cell wall

6

MOA of aminoglycosides

Binds to 30s or 50s subunit and inhibits transcription of DNA

7

Carbapenem coverage

bacteriocidal for gram positive and gram negative. MRSA resistant.

8

Clindamycin coverage

gram positive and anearobic infections

9

Clindamycin MOA

Binds to 50s ribosome inhibiting protein synthesis

10

Aminoglycoside coverage

Anaerobes and gram negative, anti-pseudomonal.

11

Macrolide MOA

Binds reversibly to 50s unit, inhibits translocation of peptidyl tRNA

12

Macrolide coverage

Upper and lower respiratory tract, strep, syphilis, mycoplasma, lyme disease

13

Quinolone MOA

Inhibits DNA topoisomerase and prevents replication

14

Quinolone coverage

UTI, prostatitis, CAP, bacterial diarrhea, mycoplasma, gonorrhea

15

Sulfa MOA

Inhibit folate synthesis

16

What is the heterophile agglutination test?

IgM to EBV that appears in first 2 weeks of illness. May be negativein kids <4.

17

Who are candidates for VariZIG?

Immunocompromised children without history of VZV vaccine or prior varicella illness. Pregnant women without evidence of immunity, Newborn whose mother had onset of chickenpox5 days before delivery or within 48 hours after delivery, hospitalized preterm infant (>28weeks) with no reliable mother history of vzv protection or hospitalized preterm infant (<28 weeks) regardless of maternal history.

18

Smallpox rash

The smallpox rash first appears on the buccal and pharyngeal mucosa and most often spreads to the hands and face before spreading to the trunk, arms, legs, and feet. The centrifugally distributed skin lesions evolve synchronously (same stage of maturation on any one area of the body) from macules to papules to vesicles to pustules and eventually become crusted

19

Rubeola is also known as

measles

20

measles is also known as

rubeola

21

Measles (rubeola)

Prodrome of cough, coryza, conjunctivities, then koplik spots on buccal mucosa, then blotchy, erythematous, blanching, maculopapular eruptions that starts at hairline and spreads down over 3 days. Involves palms and soles. Quite ill systemicall, malaise, fever, anorexia. Peak season is late winter through early spring. contagious for 4 days before and after rash.

22

Rubella is also known as

german measles

23

german measles also known as

rubella

24

Rubella

Adolescents and adults get prodrome of fever, malaise, sore though, HA. In young kids, no prodrome, low grade fever with rash. pinking red, fine maculopapular eruption that starts on face and spreads down, becomes generalized and fades in 72 hours. Arthritis and arthralgia seen in older kids and adults. Peak season late winter and early spring

25

Adenovirus

Conjunctivitis, URI, pharyngitis, croup, bronchiolitis and pneumonia. Can also cause myositis, gastroenteritis, nephritis and encephalitis. Rash may be morbilliform, rubelliform or petchiael. LAD common. Late winter and early summer.

26

Coxsackie hand foot and mouth disease

Prodrome of fever, malaise, sore mouth, anorexia. in 1-2 days, lesions appear. Shallow yellow ulcers surrounded by red halos. on buccal mucosa, tongue, soft palate. Cutaneous lesions are erythematous macules on palmar aspect on hands and plantar surface of feet. If no cutaneous lesions = herpangina.

27

Parvovirus (erythema infectiousum)

Occurs year round. Fever unusual. May have HA, nausea, myalgia. RAsh begins on face with slap cheek. Start to fade, then slightly raised, lacy rash occurs on extensor surfaces of extremities.then buttocks and trunk. Virus replicates in blood cells in marrow. May have biphasic disease with rRBC suppression 1 week later.

28

Roseola

Primarily affects children 6-36 months. HSV6. Abrupt fever occurs first, usually fairly high without a source. Fever and irritability persist for 72 hours then fever subsides. Then an erythematous, maculopapular rash appears once fever is gone. discrete, rose-pink macules that start on trunk then go to extremities. may last up to two days.

29

Treatment of Listeria sepsis in neonate

Amp and Gent. Remember, if mom with flu like illness - probably listeria

30

Ecthyma gangrenosum

large pustules on an indurated, inflamed base. Caused by pseudomonas

31

Who needs meningococcemia prophy?

All people who have had contact with oral secretions or examined patients mouth. All household contacts

32

What is used for meningococcemia prophy?

Rifampin in kids. If older can use ceftriaxone, cipro or azithro

33

Most common cause of sepsis is neonate

GBS, e.coli, listeria, s.pneumo

34

Most common cause of meningitis in neonate

GBS, listeria, e.cloi

35

in young children most common cause of meningitis

s.pneumo, n. meningitidis, enterovirus

36

Cryptosporidium

Often seen in immunocompromised patients, but can also be seen as self limited disease in kids. Severe, non-bloody, watery diarrhea. Treat with nitazoxanide.

37

Staccato cough and intracytoplasmic inclusions

Chlamydia infection

38

treatment of chlamydia conjunctivitis

erythromycin or sulfonamides

39

treatment of chlamydia pneumonia

azithro

40

Treatment of RMSF

doxycycline, even in kids less than 8

41

Treatment of cat-scratch disease

supportive care unless immunocompromised or unstable. Can use erythromycin, azithromycin, cipro, bactrim. NO PCN.

42

What kind of bacteria is H. influ

gram negative pleomorphic organism

43

Treatment of H. flu

ceftriaxone or cefotaxime

44

Common encapsulated organisms

s.pneumo, salmonella, neisseria meningitidis, and H. flu

45

Chemoprophylaxis following h. flu exposure

If at least one household contact younger than 4 who is incompletely immunized or immunocompromised child then all household contacts need prophy with Rifampin.

46

Diagnosis of pertussis

Use PCR

47

Treatment of pertussis

erythromycin, azithromycin. If treated during catarrhal stage will shorten the cough, if give during paroxysmal phase will decrease transmission, but not length of cough

48

Pertussis prophylaxis

Anyone exposed to someone with pertussis needs to be treated with a macrolide, regardless of immunization status

49

From what do you get salmonella

Chickens and humans are the carriers. eggs, poultry, infected veggies, contaminated medical instruments, reptiles like pet turtles

50

Treatment of Salmonella gastroenteritis

Supportive care if uncomplicated. Treatment can lead to the carrier state. Treatment is indicated in kids < 3mo and anyone at risk for invasive disease. Use cefotaxime or ceftriaxone.

51

What antibiotics work against pseudomonas

ceftazidime, zosyn, gentamicin, carbapenems, cipro and levo

52

Brucellosis is associated with what animal

cows and dairy

53

treatment of brucellosis

doxycycline or bactrim

54

first and second line treatment of strep throat

amoxicillin, then azithromycin or ceftriaxone

55

Who gets GBS prophy?

Women who have had previous infant with invasive GBS disease, those with GBS bacturia, those with positive GBS screen, Those with unknown GBS status, gestation less than 37 weeks, ROM more than 18 hours or intrapartum fever.

56

What is used for intrapartum GBS prophy?

PCN 5 million units every 4 hours until delivery. If allergic and did susceptibilities use clinda, if no time for susceptibilities use vanc

57

Most important manifestations of CMV

colitis, chorioretinitis, sensineural hearing loss, pneumonia, neuropathy

58

What is the vertical transmission rate of CMV?

Primary maternal infection during pregnancy has a 40% transmission rate to the fetus. The transmission rate to the fetus in a preconceptionally immune mother shedding CMV virus is 1% vs 40% for primary maternal CMV infection, and sequelae in the offspring generally are less severe.

59

How do babies get CMv postnatally?

Postnatal infection can occur after exposure to human milk, blood products, or transplanted organs

60

Manifestations of congenital CMV

jaundice, hepatosplenomegaly, prematurity, intrauterine growth restriction, microcephaly, thrombocytopenia, and skin manifestations (Fig 1), such as petechiae and purpura. Prenatally, congenital CMV infection can be associated with oligo- or polyhydramnios, periventricular calcifications (Fig 2), and hyperechoic bowel on prenatal ultrasonography.

61

If mom has Hep C, when should you test baby?

Nucleic acid amplification testing (NAAT) to detect HCV RNA may be performed on a potentially affected infant at 1 to 2 months of age for reliable evidence of viral transmission to the baby.

62

Treatment of chlamydia ophthalmic infection

Erythromycin po for 14 days topical doesn't work. Erythromycin associated with hypertrophic pyloric stenosis

63

Signs of maternal listeriosis

Flu-like illness, mec stained fluid, gi symptoms. Baby May have rash

64

Lemierre's disease

Infection from the oropharynx extends to cause septic thrombophlebitis of the internal jugular vein and embolic abscesses in the lungs. Fusobacterium necrophorum, an anaerobic bacterial constituent of the oropharyngeal flora.

65

At what age does disseminated HSV occur?

Days 10-12. Usually resp failure, hepatitis, pneumonitis, dic. CNS disease common, may not have cutaneous disease.

66

At what age does cns HSV perinatal infection present?

Days 16-19. 60-70% have cutaneous vesicles

67

When is VSV most dangerous in pregnancy?

Before 20 can get congenital - limb hypoplasia, cutaneous scarring, chorioretinitis, cns damage. OR death if occurs at time of birth because no time for antibodies to get to them

68

How do you diagnosed HIV in a newborn?

Check HIV DNA PCR. Antibodies not helpful bc get from mom. RNA not helpful if on prophy. DNA PCR will be increasingly positive as time goes on (only 30% positive at birth) therefore check at 14 to 21 days, 1 to 2 months, and 4 to 6 months of age. If 2 separate tests are positive, the infant is considered infected with HIV.

69

Treatment of histoplasmosis

Itraconazole, if disseminated, use amp B

70

Why do we give dose of hep B at birth?

b/c incubation period is 45-160 days and getting vaccine can prevent getting the disease

71

Ho do you treat entameaoba histolytica

Treatment of amebic infection involves eradicating the active trophozoites (with metronidazole) and the intraintestinal cysts (with paromomycin or iodoquinol).

72

When do you change from Dtap to Tdap?

7 years old

73

Tetanus: Wound dirty and either child has had

Give TIG and Imm

74

Tetanus: Wound is clean and imms up to date (

Nothing

75

Wound is dirty and imm

Nothing

76

How to diagnose Brucellosis

Serial increasing titers and titers

77

Treatment of Brucellosis

Doxycycline second line bactrim

78

What infection should you think of with chronic LAD, HSM and exposure to unpastuerized milk or farm animals

brucellosis

79

Which bacteria has been associated with contact lens weareres after a traumatic eye injury

Bacillus cereus

80

Describe clostridium

strict anearobic, gram positive rod

81

Treatment of tetanus

tetanus immune globulin (human preferred, equine ok) treat with metronidazole (remember its clostridium tetani)

82

What should you test patients who have had meningococcemia for?

complement deficiency - need CH50 or CH100 assay. (1-17% of children with meningococcemia have def)

83

Treatment of mengococcemia?

PCN

84

Who needs prophylaxis for meningococcus?

household contacts, day care workers, intimate contacts, passengers sitting next to patient on the plane for >8 hours. Do not prophylax patients at school or work with routine contact. health care workers do not need unless they intubated or gave mouth to mouth.

85

meningococcal prophy for children, adults, preggos?

rifampin or rocephin (for preggos) - better than PCN for ridding of carrier state because these drugs concentrate in throat mucosa.

86

For which infections do you need to think about prophylaxis for contacts?

pertussis, meningococcus, invasive HiB, VZV

87

Describe moraxella

gram negative diplococci, 3rd most common cause of AOM and sinusitis. Almost 100% produce beta lactamase and resistent to pcn only.

88

Which infections are associated with reactive arthritis

yersinia enterocolitica, shigella, campylobacter.

89

If get citrobacter in blood culture, what should you order?

CT/MRI of brain looking for abscess.

90

Describe the bacteria of RMSF

rickettsia ricketsi. gram negative coccobacillus

91

what infection is seen in slaughterhouse workers, and infected animals products of conception

coxiella burnetti

92

treatment of lemeirres

metronidazole and ceftriaxone

93

Who can you use t spot in?

kids >5 years who have gotten BCG or unlikely to return for follow up

94

Which patients do you treat for TB if they have a close contact to active disease even if TST is negative? ( will need to check another one in 10 weeks)

<4yo, HIV, immunocompromised - treat. for all other kids, observe if initial TST is neg and r/p in 10 weeks.

95

treatment of active TB

2 months of 4 drug therapy, then 4 months INH and rifampin

96

treatment of nocardia

bactrim

97

What should pneumonia and splenomegaly make you think of?

C. psittaci (or histo)

98

Leptospirosis

spirochete, transmitted by infected animals in the water. Causes myalgias, calf cramping, fever, HA, severe hepatitis and jaundice. tx with PCN or rocephin or doxy

99

The ixodes scapularis tick carries which diseases

lyme and babesia

100

Until what age is thrush normal

5months

101

What does it suggest when the lab needs an olive oil overlay to grow?

Malassezia furfur - this is seen invasively in NICU babies on TPN and lipids

102

treatment of e. histolytica

Treatment of E histolytica infection is metronidazole or tinidazole, followed by a luminal amebicidal agent such as paromomycin or iodoquinol. Patients who are asymptomatic, but excreting cysts can be treated with a luminal amebicidal agent alone.

103

How long does ETEC last?

1-5 days, longer travelers diarrhea think e. histolytica

104

What is an importnat side effect of pyrimethamine/sulfadoxine

associated with risk of severe SJS

105

What does unilateral firm edema of the eyelids suggest?

chagas disease - a child from mexico or south america

106

cigarette paper scar

cutaneous leschmaniasis

107

For which infections should mothers not breastfeed at all

brucella, HIV, HTLV

108

For which infections should mothers pump but not breastfeed during acute period?

HSV with active lesions, Varicella (-5 to +2 days), untreated active TB

109

Arcanobacterium haemolyticum

It is not possible to distinguish pharyngitis caused by S pyogenes from that caused by A haemolyticum on clinical grounds. Fever, pharyngeal exudates, lymphadenopathy, and a scarlatiniform rash can be seen in both infections. A haemolyticum, like S pyogenes, can cause invasive infections, although invasive A haemolyticum infections are quite rare and tend to occur in immunocompromised patients. More common in young adults. Treat with erythromycin

110

Consumption of unpastuerized dairy products should make you think of

Brucella

111

Which worm can cause cutaneous larva migrans?

hookworm (necator) and strongylides

112

only helminth that replicates in body

strongylodies

113

which worm causes visceral larva migrans

toxocara canis

114

schistosomiasis

fever, LAD, diarrhea, HSM, eosinophilia, cirrhosis with esophageal varices, hematuria. increases risk for bladder cancer.

115

side effects of gancyclovir

granulocytopenia and low platelets

116

cough, coryza, conjunctivitis

measles

117

koplik spots

measles

118

describe the paralysis of polio

descending from prox to distal. No relfexes

119

In who does parvovirus cause aplastic anemia

patients with chronic hemolytic anemias, AIDS,

120

think of what disease when see severe hemorrhagic pneumonia, thrombocytopenia, and increased hematocrit

hantavirus (desert SW)

121

treatment of e. histolytica

Treatment of amebic infection involves eradicating the active trophozoites (with metronidazole) and the intraintestinal cysts (with paromomycin or iodoquinol).

122

The most appropriate screening test for HIV infection in children younger than 18 months

HIV DNA PCR

123

side effect of zidovudine

BM suppression and myopathy

124

side effect of didanosine

pancreatitis and neuropathy

125

side effect of abacavir

serious fatal hypersens reaction

126

side effect of efavirenz

teratogen

127

side effect of indinavir

hyperbili and nephrolithiasis

128

Most common cause of infective endocarditis in children

40% caused by viridans strep

129

most common cause of prosthetic valve endocarditis

s. epidermidis

130

JAneway lesions

vascular phenomenon. nontender, seen in acute endocarditis

131

Osler nodes

painful, immunologic phenomenon, seen in SBE

132

most common cause of meningitis <3 mos and treatment

GBS, listeria, gram neg. treat with ampicillin and cefotaxime

133

most common cause of meningitis 3mos - 10 years

s. pneumo. treat with rocephin and vanc

134

most common cause of meningitis 10-19yo

n. meningitidis. treat with rocephin and vanc

135

Most common cause of bacterial diarrhea

e. coli

136

treatment of campylobacter

azithro or quinolone

137

treatment of shigella

rocephin

138

treatment of travelers diarrhea

quinolone or azithro

139

treatment of UTI in pregnancy

nitrofurantoin, keflex, dont use bactrim in late preg or nursing moms

140

Which antibiotics should you avoid in preggos?

Tetracycline, quinolone, aminoglycosides, sulfa near term. If breastfeeding: all of the above. If mom has G6PD - avoid primaquine and nitrofurantoin

141

When can children go back to daycare after impetigo?

24 hours after antibiotic

142

When can children go back to daycare after pertussis?

5 days of appropriate antibiotics

143

When can children go back to daycare aftersalmonella typhi

diarrhea resolves and 3 negative stool cultures

144

When can children go back to daycare after non typhi salmonella?

diarrhea resolves. No stool cutlures required

145

When can children go back to daycare after shiga toxin e coli or Shigella?

diarrhea resolves and 2 negative stool cultures

146

When can children go back to daycare after strep throat

24 hours after antibiotics

147

treatment of n meningitidis

High-dose intravenous penicillin G for 5 to 7 days is the preferred treatment for infection due to N meningitidis.