Infectious Disease Flashcards by Celene Lopez

During an infectious process, what inflammatory marker rises earlier?

CRP

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What inflammatory marker is a biomarker for early bacteremia detection? Helps predict bacterial vs. nonbacterial illness.

Procalcitonin

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Due to the absence of immunologic memory and adaptive immunity, what age group is at the highest risk for bacteremia and/or sepsis?

Infants less than 28 days old

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At what age does the immune system develop?

3 months of age

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S/S of neonatal sepsis includes
* >
* H
*L
* poor ____
* R___ ____
* J
* I

fever > 38
hypothermia
lethargy
poor feeding
respiratory distress
jaundice
Irritable

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The common etiologies for neonatal sepsis include
* U
* B
* M
* P

UTI
Bacteremia
Meningitis
Pneumonia

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Work up for neonatal sepsis includes a _____ to include?

Full Septic Work-Up
CBC, blood culture, UA, urine culture, LP

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Aside from a full septic workup in a neonate, What else do you need to obtain if the infant has respiratory s/s?

Chest x-ray
respiratory viral panel

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Aside from a full septic workup in a neonate, What else do you need to obtain if the infant presents with a rash, vesicles, or other skin findings?

HSV culture

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Common organisms for neonatal sepsis include?
*G
*E
*L
*___/____

GBS
E.Coli
LIsteria Monocytogenes
HSV/CMV

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All neonates with fever require _____ and __-___ hours of empiric?

hospitalization,
48-72 hours of empiric broad-spectrum antibiotics

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First-line antimicrobial therapy for neonatal sepsis includes?

Amp and Gent

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When an STI is suspected, First-line antimicrobial therapy for neonatal sepsis includes?
A______
C______
A______

Meningitic dosing of
Ampicillin
Cefotaxmin
Acyclovir

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In neonatal sepsis initiate acyclovir until?

HSV results are available and negative

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Fever without s/s on physical examination is called a?

fever without a source

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Most children with fever without a source have a _____ infection.

Viral

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Organisms for infants 1-3 months of age with fever without a source include?
*G
*L
*S
*E
* N___ _____
*S___ ______

GBS
Listeria monocytogenes
Salmonella
E. Coli
Neisseria Meningitidis
Strep Pneumoniae

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Organisms for infants and toddlers 3-36 months of age with fever without a source include?
*Sa
*N____ _____
*S___ ______

Salmonella
Neisseria Meningitidis
Strep Pneumoniae

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What 2 etiologies should you consider in infants 1-3 months of age who aren’t vaccinated?

HIB
Strep Pneumoniae

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Fever without a source diagnostic studies are usually dependent on?
This is because fever without a source is usually self-limiting.

physical examination findings

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Fever without a source management is guided by risk stratification. Children may need
1)a_____
2)a____
or 3) re-______ plan if stable

empiric antibiotics
admission
re-evaluation plan

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What are the 3 common causes of serious bacteremia?
B______
U____
P_____

bacteremia
UTI
Pneumonia

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What is the term for a common disorder presenting in an unusual way?

Fever of unknown origin

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What is the clinical definition of Fever of Unknown Origin:
* fever > ___ F or ___ C
*Lasting more then _____ days and up to ____ weeks
* No apparent ____ _____

101 F or 38.3 C
Lasting more than 8 days and up to 3 weeks
No apparent clinical diagnosis

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Fever of Unknown Origin is most often caused by i____ disease and c_____ t_____ disease.

infectious disease and connective tissue disease

The most common infectious disease etiologies found in children with Fever of Unknown Origin include *S *T *R *S *L *C *M

Salmonella TB Rickettsial disease syphilis Lyme disease CMV Mononucleosis

1/3 of children s/p chemotherapy and/or transplant will develop?

fever

Febrile neutropenia definition: A single temp > ____ for > ___ hour with an ANC < ___ or when ANC is expected to decrease to ____ within ___ hours.

38 C > 1 hour < 500 500 48 hours

Patients with febrile neutropenia are most at risk for ____ and ____.

Bacteremia and Sepsis

In a child with febrile neutropenia, GI tract infection will rise from what two possible sources?

Oral vs intestinal mucositis

In a febrile neutropenic child, diarrhea will often be caused by c____ and s____

C. Diff and Salmonella

Staph, strep, and MRSA are examples of what type of bacteria?

Gram +

E. Coli, Klebsiella, pseudomonas, actinobacteria, and enterobacter are examples of what type of bacteria?

Gram -

What diagnostic test is indicated for a neutropenic febrile child presenting with an altered mental status?

What diagnostic test is indicated for a neutropenic febrile child presenting with diarrhea?

C. Diff testing

What diagnostic test is indicated for a neutropenic febrile child being worked up for an abscess fluid or collection?

Oral outpatient therapy for a stable child with febrile neutropenia includes f_____ monotherapy or f______ and a____-____

*fluoroquinolone monotherapy *fluoroquinolone and amoxicillin-clauvanate

High-risk children presenting with febrile neutropenia require coverage for ______ organisms, s___ v___, and p_______ a______.

gram negative organisms strep viridian pseudomonas aeruginosa

Antipseudomonal beta-lactam coverage for a febrile neutropenic patient includes what antibiotic? What is second-line treatment?

cefepime carbapenem

In a febrile neutropenic patient, antibiotics should cover g____ and ___ bacteria, s____ v____, and p____

gram - and + strep viridians pseudomonas

When a febrile neutropenic patient becomes unstable while on current anti-microbial management, suspect resistant pathogens and add a g_____ such as v____ and a____ coverage such as with f___

glycopeptide ---vancomycin anaerobic coverage flagyl

in a febrile neutropenic patient, antibiotics can be discontinued when c___ s___, if there is no m_____ i_____ after __-___ hours, and if the patient has been afebrile for ___ hours

clinically stable microbiologic indication after 24-72 hours the patient has been afebrile for 24

Treat a febrile neutropenic patient presenting with cellulitis with? and pneumonia with ? v____ or l____

vancomycin linezolid (zyvox)

Treat a febrile neutropenic patient presenting with gram-negative bacteremia or pneumonia with an a_____ such as g____and car_____

aminoglycoside ----gentamicin carbapenem

Treat a febrile neutropenic patient presenting with abdominal s/s, mucosal impairment, or c.diff with an anaerobe such as m____

metronidazole (flagyl)

If you febrile neutropenic patient on broad-spectrum antibiotics remains febrile for > __-___ days consider adding _____ coverage. In this situation obtain a s__/c___/a____ ___ to rule out the presence of fungal lesions.

4-7 days antifungal sinus/chest/abdominal CT

The phases of sepsis include 1)S____ 2)S___ 3)s___ ____ 4) s___ ____

SIRS sepsis severe sepsis septic shock

SIRS is defined as a n___ s____ inflammatory response which can lead to ____

non specific sepsis

Sepsis is defined as a life threatening o___ d____ caused by a d____ host response to i____

organ dysfunction dysregulated infection

The lastest s/s in the sepsis continuum is?

hypotension

Septic shock is defined as a profound underlying c___, c____, and m____ abnormality that drastically increased mortality

cellular, circulatory, metabolic

Patients in septic shock will present with persistent ____ often require v____ to maintain M___

hypotension vasopressors MAP

The following conditions are risk factors for the development of what? immune problems musculoskeletal/neuro disease prematurity chromosomal/genetic disease chronic disease states

SIRS

SIRS pathology Infection leads to the release of t____ that initiate a c___ c____ leading to f____, v____, and h____ instability

toxins cytokine cascade fever, vasodilation, hemodynamic

What clinical manifestation increases the septic child's risk for death?

low cardiac output

septic neonates are more at risk for a____ and h____

acidosis and hypoxia

Acidosis and hypoxia presence in a newborn with septic shock increases the infants p___ v_____ r____ leading to p___ h____ and lifelong sequelae or disability

PVR (pulmonary vascular resistance) pulmonary hypertension

The presentation of septic shock includes f___ or s___ temp i___, l____, a____ t___ and respiratory d____ t_____, g____ rhythm with m____, poor p____ and h____ h____ or J____ o____ and/or r____

fever or subnormal temp irritability, lethargy, anxiety tachypnea and respiratory distress tachycardia, gallop rhythm with myocarditis, poor perfusion and hypotension hepatomegaly or JVD oliguria and/or rash

Septic shock Hour 1 bundle management * obtain ___ and ___ ___ *Give ____ -----preferably 3rd or 4th gen c___, c____, extended range p___, or b___ l___ inhibitors *F___ resuscitation __ ml/kg over __-___ minutes

obtain labs and blood cultures give antibiotics, cephalosporins, carbapenem, penicillins, beta-lactam fluid, 20 ml/kg over 5-10 minutes

Children in septic shock unresponsive to fluid resuscitation will require the addition of?

vasopressors

Septic workup includes *both peripheral and central ___ ___ *u__ and __ *l___ * if ETT in place, an ET ___ ___ *c__, c__, l__ ___ *___ of wounds or draining body fluids *___ if respiratory s/s present *__ or ___ of involved body organ

blood cultures UA and urine culture LP sputum culture CBC, CMP, lactic acid culture chest x-ray US or CT

septic shock management *optimize ___ delivery *h___ monitoring *treat anemia with ____ *correct coagulopathies with ____ *add ____ if anemia and coagulopathies are refractory

oxygen hemodynamic PRBCs FFP corticosteroids

What is the most frequent cause of DIC?

infection

DIC is an alteration in c___ r/t t__ injury

clotting tissue injury

Initial DIC s/s include b___ or t___ with tissue i____

bleeding or thrombosis tissue ischemia

What is the gold standard diagnostic test for DIC?

D. Dimer

In DIC, the D. Dimer will be?

prolonged

DIC management Goal 1) manage s___ 2)address c___ by administration of v___ _, c____, f___ or p___

shock coagulopathies vitamin k, cryoprecipitate, FFP, or platelets

Meningococcal infections are an acute ____ illness s/p viral infection

bacterial

What is the most common organism that causes meningococcemia?

Neisseria Meningitidis

Neisseria meningitidis is a gram __ and e___ bacteria

negative encapsulted

What are the most common Neisseria meningitidis serogroups in the U.S.?

B and C

The Neisseria Meningitides toxin load is __-___ X more than other gram-negative bacteria, leading to more severe d____

50-100 disease

The greatest prevention against Neisseria meningitidis is the?

Meningococcal B vaccine

Meningococcemia is the presence of n____ m___ in the s___ c____

Neisseria Meningitidis systemic circulation

The onset of Meningococcemia is _____

rapid

Meningococcemia s/s include f___ poor _____ h____ i____ altered ___ ____ t____ t____ and p_____

fever poor perfusion hypotension irritability altered mental status tachypnea tachycardia purpura

Meningococcemia laboratory work-up includes obtaining a c__ s__ work up L____ r___ function L__ ____

CBC septic LFTs renal function lumbar puncture

What precautions should children with Meningococcemia be placed on?

droplet

The recommended antibiotics for Meningococcemia include __ generation cephalosporins which include r___ or cef____

3rd Rocephin cefotaxime

The close contacts to include family and healthcare workers of a Meningococcemia patient require prophylaxis with a ___ dose of c____ or r_____

single dose of ciprofloxacin or Rocephin

HAI host components include * Impaired i____ s___ or r___ *a___ associated vulnerabilities

immune system or response age

HAI environment components include *b___ colonies *s___ *r____ *g__/g___ tract

bacterial colonies skin respiratory tract GI/GU

HAI agent components include *p_____ *prolonged _____ therapy *i____ devices

procedures antibiotic invasive

The definition of an HAI is an infection not p___ at a___. *Develops within ____ hours of a___ *Not present at ___ but develops within ___ days

present at admission 48 hours of admission discharge, 10 days

The top 4 HAI infection sites include c___ c____ v____ s____

CLABSI CAUTI VAP SSI (surgical)

HAI s/s include *new ___ *___ instability * increase ____ need * wound _____

fever temperature oxygen purulence

HAI risk factors include i____ lines i____ states E___ E__/v___ f___ P___ infusions and P___ nutrition

invasive lines immunocompromised states ECMO ETT/Ventilator Foley PRBCs Parenteral

What is the best way to prevent a CLABSI?

provide bundle care

What is the best way to prevent VAP *elevate ___ *good ____ hygiene *provide o___ care *I__-___ suctioning

HOB hand hygiene oral care In-line

What is the best way to prevent SSI (surgical infections) *administer p____ antibiotics *d___ and d___ wounds

prophylactic antibiotics drain and debride wounds

What type of organisms are these? Strep, Staph, Enterococcus, Listeria, Mycobacteria, Pneumococcus, Corynebacteria, Bacillus, Nocardia

Gram Positive bacteria

What type of organisms are these? E. Coli, Pseudomonas aeurginosa, Klebsiella, Actinobacter, Neisseria Enterobacter, H. Flu, Legionella Salmonella

Gram-negative

Examples of Beta Lactams include P______ c_____ c_____ and monobactams

penicillins cephalosporins carbapenems

Examples of penicillins include *a_____ *a_____ *z_____ *p_____

augmentin amoxicillin zosyn penicillin, Pen-V

Penicillins are b_____

bacteriocidal -meaning they directly kill the organism

Penicillins cover gram __ and ___, as well as non b____ l____

- and + beta lactamase

Penicillins are good to treat U_____ s____ o___ ____ and l___ r____ t____ infections

UTI's sinusitis Otitis Media lower respiratory tract infections

What antibiotic class is good to use for bacterial prophylaxis?

penicillins

Cephalosporins are b____

bacteriocidal -meaning they directly kill the organism

Cephalosporin coverage increased with each?

generation class

What generation cephalosporins cover gram +, gram -, and pseudomonas?

4th generation

What is the only 3rd generation cephalosporin that also covers gram +, gram -, and pseudomonas? Ceft

Ceftazodine

1st generation cephalosporins include cefa____ and an____

cefazolin or ancef

The first-generation cephalosporins Cefazolin and Ancef are good to treat?

surgical prophylaxis

3rd generation cephalosporins include c_____, Ceft____, or cefo_____

ceftriaxone, ceftazidine, and cefotaxime

3rd generation cephalosporins are able to cross the?

blood brain barrier

The third generation cephalosporins ceftriaxone and cefotaxime are good to treat m____ or s_____

meningitis or sepsis

4th generation cephalosporins are good to treat s____ associated with f____ n_____

sepsis associated with febrile neutropenia

There is an increased risk of an allergic reaction to cephalosporins if the patient has had an anaphylactic reaction to?

penecillins

monobactams only cover what type of bacteria?

gram-negative --the only antibiotic example in this class is aztreonam

Carbapenems provide coverage for gram ___ and ____, p___, and _____ activity

- and +, pseudomonas, anaerobic

Examples of carbapenems include m____, erdipenem, and idipenem

meropenem

Carbapenems are used to treat m____, g__ vs. h___, E____ gram -, and m___ infections

mucositis graft vs. host ESBL (infections such as e. coli) mixed

What antibiotic is part of the glycopeptide class?

Vancomycin

Glycopeptides such as Vancomycin provide coverage for gram ___ bacteria and a____

+ anaerobes

Glycopeptides such as Vancomycin are good to treat M____ and M_____

MRSA MRSE

Lipopeptides only provide coverage from gram ___ bacteria to include V___

+ VRE (vancomycin resistance enterococcus)

What antibiotic is a Lipopeptide? Da_______

Dactinomycin

The Lipopeptide Dactinomycin can be used to treat v___ if it is resistant to vancomycin

VRE (vancomycin resistance enterococcus)

Tetracyclines provide coverage for gram __ and ___ bacteria, as well as a____ coverage

+ and - anaerobic

What antibiotic is an example of tetracycline?

Doxycycline

Macrolide antibiotics provide coverage for both gram __ and ___ bacteria. Macrolides also provide coverage for a____ bacteria

- and + atypical

Macrolide atypical coverage includes the treatment for C__ M___ and L_____

CAP mycoplasma Legionella

Macrolide antibiotic examples include e____ and a______

erythromycin azithromycin

The antibiotic class lincomycins provide coverage for gram ___ bacteria and a____

+ anaerobes

What antibiotic is an example of a Lincomycin?

clindamycin

The antibiotic class Aminoglycosides only provide gram ___ coverage

negative

What antibiotics are a part of the aminoglycoside class? g____ t_____ amik_____

gentamicin tobramycin amikacin

The aminoglycosides gentamycin, tobramycin, and amikacin are used to treat s___, e___, and U____

sepsis endocarditis UTIs

The sulfonamide class of antibiotics provides coverage for gram __ and ___ bacteria

gram - and gram +

What antibiotic is an example of a sulfonamide?

Bactrim or Sulfa-TPMX

The Fluoroquinolone antibiotic class provides coverage for gram __ and ___ bacteria, as well as coverage for a____ organisms.

Gram + and - atypical

What is the only fluoroquinolone that additionally provides anaerobic coverage? moxif_____

moxifloxacin

What antibiotics are fluoroquinolones? ci____ le______

ciprofloxacin levofloxacin

The Fluoroquinolones ciprofloxacin and levofloxacin are good to treat U____ bacterial d____ as well as s___ t____ or b___ i____

UTIs bacterial diarrhea soft tissue or bone infections

In pediatrics, the use of Fluoroquinolones such as ciprofloxacin and levofloxacin can increase the child's risk for?

tendon rupture

What is the most common cause of community-acquired pneumonia in children less than 5 YOA?

strep pneumoniae

CAP is treated with __ dose ____ when outpatient

high dose amoxicillin

CAP is treated with _____ if the patient is admitted

ampicillin

If Staph or MRSA is suspected as the cause of CAP add v____ or cl____ to the ampicillin course

vancomycin clindamycin

In children > 5 YOA consider a____ organisms as the cause for CAP

atypical

In children > 5 YOA add a m_____ such as a____ to the ampicillin course

macrolide azithromycin

What antibiotic provides no coverage for Strep pneumonia?

azithromycin

Otitis media guidelines recommended treating a child with antibiotics when *____ s/s are presentt *or when the child is __-___ months of age with ____ disease

severe 6-23 months of age with bilateral disease

Common otitis media pathogen include s___ ____, h___ ___, and m. c_____

strep pneumonia h. flu catarrhalis

What is the first-line therapy for Otitis Media?

high dose amoxicillin

What are the common organisms of skin and soft tissue infections? s__ ____ and g___ __ ____

staph aureus group A strep

Treat skin and soft tissue infections with __ generation ____

1st generation cephalosporins

What antibiotics are good treatment options for skin and soft tissue infections c____ b_____ v_____ or L______

clindamycin bactrim vancomycin linezolid (zyvox)

In the case of skin and soft tissue infections, 1st generation cephalosporins will not cover an ____ infection

MRSA

Skin and Soft tissue infections may initially be treated with an __ and ___ or topically if stable

I & D (incision and drainage)

What is the most common organism to cause bone and joint infections?

staph aureus

In a sickle cell patient, what is the most common organism to cause a bone and joint infection?

salmonella

Bone and Joint infection may occur as a secondary infection to G___ ___ ____ Ki____ S__ ____ H__ ___ and N. g____

Group A strep Kingella Strep Pneumoniae H. flu N. gonorrhoea

When a bone and joint infection occurs, it is prudent to consult with?

infectious disease

It is important to educate parents that bone and joint infections will require p____ treatment with _____

prolonged treatment with antibiotics

What two antibiotics are the preferred initial treatment for bone and joint infections? cl___ or cefa_____

clindamycin or cefazolin

If a child with a bone and/or joint infection is toxic appearing and has + cultures, initial treatment should include IV v____ and r_____

vancomycin and rocephin

MRSA treatment should be based on?

Local susceptabilities

Antibiotics that can treat MRSA include B____ c_____ d___ and v_____

Bactrim Clindamycin Doxycycline Vancomycin

Meningitis is defined as meninge inflammation related to a ____ or ____ infection

bacterial or viral

What type of meningitis is considered an emergency?

Bacterial Meningitis

Bacterial meningitis is severe and considered an emergency due to the child's risk of cerebral e____ leading to increased ____, h___, c___ and/or d____

cerebral edema increased ICP herniation coma death

Meningitis clinical presentation includes f___ c____ H____ __/___ L____ ph____ altered n___ status decreased f____ a_____ and in infants a b___ f____

fever chills headache n/v lethargy photophobia neuro status feeding agitation bulging fontanelle

In infants, the most common cause of meningitis is U____ b___ c____

URI bacterial colonization

What is this sign: The child is laying supine with knees and hips flexed, but unable to extend without pain

kernigs

What is this sign: The child is supine trying to raise or flex their neck but c/o pain.

brudzinski

Meningitis complications include loss of h____ n___ i___ s____ d____

hearing neurologic impairement seizures death

Meningitis LP evaluation will reveal elevated o___ p______

elevated opening pressures

If LP CSF results show a significant amount of RBC's consider h___ s____ as a cause for meningitis

herpes simplex

Viral meningitis presents with * ___ WBC usually < _____ *High p____ *normal g____ * n____ gram stain result

low, < 500 high protein normal glucose negative gram stain *viral meningitis may be self-limiting or severe

Bacterial meningitis presents with *___ WBC, usually > ____ *high p____ *low g____ *c___/p____ drainage

high, > 1000 protein glucose cloudy/purulent

80-90% or bacterial meningitis gram stains will be?

positive

viral meningitis is commonly caused by e___

enterovirus

What viral organism should be suspected in neonates admitted for meningitis with high CSF RBC?

HSV (herpes simplex virus)

In the summer, viral meningitis is commonly caused by a___

arbovirus

Hallmark s/s of viral meningitis include H___ f____ altered L____ without n___ r___

Headaches fever altered LOC without nuchal rigidigy

In neonates, the most common cause of bacterial meningitis is?

GBS

Other causes of neonatal bacterial meningitis include e___ and L___ m____

E. Coli Listeria Monocytogenes

Neonates with bacterial meningitis will present with f___ L____ decrease in f____ j____ and b____ f_____

fever lethargy decrease in feeds jaundice bulging fontanelle

What is the most common cause of bacterial meningitis in kids 2 months of age through 23 months of age? s__ p___ n___ m_____

strep pneumonia Neisseria meningitis

What is the most common cause of bacterial meningitis in unvaccinated children 2 months of age through 23 months of age?

H. Flu

S/s of bacterial meningitis in children 2-23 months of age include? f____ h____ n___ r____ + k___ and b____ sign decrease in f___ and poor m___ t____

fever headache nuchal rigidity kerning and brudzinskis decrease in feeds poor muscle tone

What is the most common cause of bacterial meningitis in kids 2 YOA and older? n__ M____ s___ p___ H__ ____

Neisseria Menigitidins strep pneumoniae H. flu

s/s of bacterial meningitis in children 2 YOA and older include a__ m___ status H____ decreased ____ P____ and exan_____

altered mental status hypertension decreased heart rate petechiae exanthems (diffuse rash, anywhere)

Neonatal meningitis management 1) a___ and g____ 2) a___ and c____ + HSV coverage with a_____

amp and gent amp and cefotaxime acyclovir

Infant meningitis management includes v____ + c_____ + a____

vancomycin ceftriaxone acyclovir

Meningitis treatment for kids 2 YOA and older includes c___ and v_____

ceftriaxone and vancomycin

Children presenting with bacterial meningitis s/s should have antibiotics administered within?

1 hour of admission

In any child with meningitis, consider the addition of _____ to preserve hearing

dexamethasone

Meningitis supportive care may include a______ therapy or e___ I___ management

anticonvulsant elevated ICP

S/P meningitis, children will require long-term follow-up to assess h___ and d___ to rule out L___ and b___ issues

hearing and development learning and behavioral issues

Opportunistic infections occur when the host is _____

immunocompromised ---- examples include children with HIV or primary/secondary immunodeficiencies

What are the most common opportunistic infectious organisms? t___ c____ ca____ cry_____ and toxoplasma cry____

tuberculosis CMV candida cryptococcus cryptosporidium

80% of opportunistic infections are caused by c____ leading to an invasive f____ infection

candida, fungal ---- Children with fungal infections often have a nonspecific presentation

Consider candida and/or a fungal infection when a child remains sick despite n____ c____

negative cultures

All children at high risk for fungal infection, require _____ prophylaxis when febrile

fungal

Pneumocystis Jirovecii (PCP) is and opportunistic a____ pathogen

airborne

Pneumocystis Jirovecii (PCP) prophylaxis includes the administration of ____, __-___ times a week

bactrim 2-3 times a week

Pneumocystis Jirovecii (PCP) s/s include c___ f____ weight ____ d____ and c____

cough fever weight loss dyspnea crackles

Pneumocystis Jirovecii (PCP) chest x-ray will reveal bilateral g___ g____ O_____

ground glass opacities

What is the diagnostic test for Pneumocystis Jirovecii (PCP)?

Lung biopsy

Pneumocystis Jirovecii (PCP) treatment includes a ___ day course of ____.

21-day course of bactrim ---consider also treating with pentamidine and dapsone

Nontuberculous Mycobacterium is an opportunistic infection that enters via s___, i____, i___, or m____ translocation

skin inhalation ingestion mucosal

Nontuberculous Mycobacterium invades the _____ system and thus spreads to d___ o_____

lymphatic system distal organs

Nontuberculous Mycobacterium presentation is often nonspecific, parents may c/o that their child's illness has p____ for w_____

persisted for weeks

Nontuberculous Mycobacterium management includes starting the patient on cla___ and eth_____

clarithromycin and ethambutol

If Nontuberculous Mycobacterium treatment with clarithromycin and ethambutol is unsuccessful consider adding r____

rifampin

Resistant organisms evade antibiotic activity. What are the two most common resistant organisms?

MRSA and Strep pneumoniae

Treat drug-resistant MRSA with 1) c___ or v____ 2)s___ or l____ 3) or dap_____

clindamycin or vancomycin Septra or linezolid daptomycin

Treat drug-resistant strep pneumonia with ___ dose beta-lactams such as cl____ v____ or flu_____

high-dose clindamycin vancomycin fluoroquinolones

Toxic shock syndrome is a m_____ febrile illness due to s___ and/or s____

multisystem staph or strep -toxins trigger a cellular host response

Patient with toxic shock syndrome will begin with nonspecific s/s, but then progress to f___, h____, and o___ dysfunction

fever hypotension organ dysfunction

Toxic shock syndrome clinical criteria include * fever > ____ C *h____ *diffuse m____ e____-d___rash *p___ and s___ d____, __-___ weeks after s/s onset

38.9 C hypotension macular erythroderma (body-wide skin redenning) palm and sole desquamation, 1-2 weeks

Toxic shock syndrome clinical criteria include presenting with at least 3 of the following s/s. GI = __/___ muscular= m____, c__ > __x the normal mucous= c___/o___/v___ h___ kidney= B__ and c___ > __x the normal, p___ LIver= a__, a___, b___ > __x the normal Heme= p___ less than ___ Neuro= a___ m___ status without fever or hypotension

n/v myalgias, CK > 2x conjunctival/oropharynx/vaginal hyperemia (excess blood buildup) BUN and Creatinine >2x, pyuria (pus in urine) AST, ALT, bili > 2x platelets less than 100,000 altered mental status

Children with Toxic shock syndrome will have negative cultures. Toxic shock syndrome is a probable diagnosis when there is __ clinical criteria + ___ criteria

4 + lab

Toxic shock syndrome is confirmed when there is ___ clinical criteria + ___ criteria

5 + lab

Workup of a female with toxic shock syndrome includes obtaining b___, c___, u___, sp___, t___ and v___ cultures

blood, CSF, urine, sputum, throat, vaginal

Toxic shock syndrome treatment includes the immediate administration of c_____ and v____

ceftriaxone and vancomycin

When toxic shock syndrome diagnosis is confirmed, add c____ to ceftriaxone and vancomycin regimen

clindamycin

Aside from ATBx, toxic shock syndrome treatment will include the removal of t___ and d___ of site

tampon debridement

Aside from ATBx what other medication can be used to treat toxic shock syndrome?

IVIG

What is the most common organism found in dental plaque?

streptococcus

Dental infection prevention includes f___, avoidance of s___, and good oral h____

fluoride sugar oral hygiene

What infections are common in immunocompromised children, neonates, critically ill, and kids on long-term antibiotics?

fungal infections -children may present asymptomatic or critically ill

What are the 3 most common fungal infections? h_____, c____, b_____

histoplasmosis coccidioidomycosis blastomycosis

What fungal infection is most often seen in Mississippi, Ohio, and the Missouri river valley? H________

histoplasmosis

What fungal infection is most often seen in hot + cold arid regions of the southwest C_____

coccidioidomycosis

What fungal infection is most often seen in the Mississippi River, Ohio, lake Michigan, and southern states?

Blastomycosis

Fungal infection diagnoses are often delayed due to nonspecific findings. What is the gold standard diagnostic test?

fungal culture --txt dependent on organism and ISDA guidelines

What treatment is best for serious fungal infections such as aspergillosis? Vo_______

Voricanozole

What is the first-line treatment for Histoplasmosis? Am_____-___

Amphotericin B

After inpatient treatment with amphotericin B, children with Histoplasmosis require oral a____ therapy once discharged.

azole

What is the first-line treatment for coccidioidomycosis?

azoles

What is the first-line treatment for mild-moderate blastomycosis? ___-___ months of I_____

6-12 months of itraconazole

What is the first-line treatment for severe blastomycosis? 1) am_____ -__ until s/s improve followed by 2) o__ i____ x __-___ months

amphotericin B *prolong IV amphotericin if CNS disease is present oral itraconazole x 6-12 month

What is the most prevalent STI?

HPV

HPV may be acquired g____ or r____

genitally or respiratory

Children with HPV can be asymptomatic. Or they may present with g___ vs t___ w____

genital vs. throat warts

HPV is diagnosed with 1)v___ i___ and 2) HPV p___ testing

visual inspection HPV pap

Malaria is a plasmodium species most often found in ____ regions

tropical

In America, malaria cases are seen in i____ or t_____

immigrants or travelers

Malaria is caused by a m____ transmitted p____

mosquito-transmitted parasite

Once malaria is contracted, the parasite travels into the l___ where is divides and multiplies over _-_ days

liver 7-10

Malaria s/s begin once e____ become infected

erythrocytes

Malaria s/s include p___ f____, c____, h___, m___, c____, h___a___, and t_____

paroxysmal fever, chills, headache, malaise, cough, hemolytic anemia and thrombocytopenia

Malaria urine s/s include p____ and h____

proteinuria hemoglobinuria

Severe malaria s/s include c___ s/s severe a____ A___ h____ instability and severe acute k___ i____

cerebral s/s severe anemia ARDS hemodynamic instability severe acute kidney injury

The gold standard malaria diagnostic test includes t___ and t___ b___ s____

thick and thin blood smears -which identify the parasite

Once malaria is confirmed, obtain thick and thin blood smears every __-__ hours until they are n____

12-24 hours until they are negative

In severe cases, individuals with malaria may require e___ t____

exchange transfusions

Dengue is present in the tropic and subtropic regions of p___ r___, the v___ i___ and s____

Puerto Rico virgin islands samoa

Dengue is a v___ illness transmitted via a m____

viral mosquito

Dengue s/s include a nonspecific f____, retro-o____ h___, and a tr___ m___-p____ r____

fever retro-orbital headache transient maculopapular rash

Dengue severe s/s include c___ release, v____ p____, c____ and s_____

cytokine release vascular permeability coagulopathies and shock

The gold standard Dengue diagnostic test is via E____ anti-dengue __ and ___ antibodies

ELISA anti-dengue IgG + IgM antibodies

The CBC of a patient with Dengue will show L____ t_____ and increased h____

leukopenia thrombocytopenia Hct

Dengue management includes h____ avoidance of N___ and a___ to prevent bleeding and good supportive care because it is a viral infection and antibiotics are not indicated.

hydration NSAIDS and aspirin

The Salmonella organism Salmonella eterica enters human hosts via the g__ t___

GI tract

Once Salmonella enters the GI tract, it travels into the l_____, b____, l___ and s_____

lymphatics blood liver and spleen

Salmonella causes widespread b____ and e_____ release

bacteremia and endotoxin

Salmonella s/s include f_____, h____, a__ p___, __/__/__, c____, h_____, and s_____

fever headache abdominal pain n/v/d constipation hepatomegaly splenomegaly *CNS s/s may also be present

Upon diagnostic evaluation, salmonella is best detected via b___ c____

blood culture

Less than 50 % of salmonella can be detected in the ____

stool

Salmonella may increase what lab?

LFTs

Salmonella can be treated with ce___ or cip______

ceftriaxone or ciprofloxacin

Due to a 10% chance of refractory salmonella, pediatric patients will require?

close follow up

West Nile virus is a m___ borne vector illness that causes v____ i______

mosquito viremic inflammation

West Nile virus can enter the b____ via a blood-brain barrier alteration.

brain

West Nile Virus s/s include abrupt f____, h____, d____, and M____ r____

fever, headache, diarrhea, maculopapular rash

West Nile virus neuroinvasion s/s include e____, m____ and f___ P_____

encephalitis, meningitis, flaccid paralysis

West Nile Virus diagnostic evaluation includes obtaining an I___ and n___ a____ levels

Igm neutralizing antibody

In a child with HPV, no treatment is indicated if there is no?

warts

In a child with HPV, treat external warts with t__ p____

topical podofilox

HPV warts can be removed with c____ or l___ surgery *** Ensure to consult OB

cryotherapy or laser surgery

What is the best preventative measure against HPV?

HPV vaccination

What is the second most common STI?

gonorrhea

Gonorrhea is a gram ___ bacteria

negative

females with gonorrhea are often asymptomatic until the following complications occur d___ f_____ u____ d____

dysuria frequency urgency discharge

Gonorrhea diagnostic testing includes a b___ c___, g___ s___, and N___

bacterial culture, gram stain, NAAT

What is the most common cause of pelvic inflammatory disease?

chlamydia

Chlamydia is caused by the bacteria c__ t___

c. trachomatis

Children with chlamydia may be asymptomatic. S/s of chlamydia may include v___, u____, e____ or P___

vaginitis urethritis endometriosis PID

The gold standard diagnostic test for chlamydia is? N___

NAAT (nucleic acid amplification)

Chlamydia is treated with a___ or d______

azithromycin doxycycline

The organism treponema pallidum causes what STI?

syphilis

Primary syphilis s/s include a mouth or anogenital u___ or c___

ulcer or chancre

secondary syphilis s/s include m___, f___ s/s, l____, and r_____

myalgias flu-like s/s lymphadenopathy rash

tertiary syphilis s/s include c__ and n___ s/s

cardiac and neurological s/s

Diagnostic testing for syphilis may include R____ p_____ r_____

RPR (rapid plasma reagin)

What is the gold standard syphilis diagnostic test? non-t___ and t____ testing

non-treponemal and treponemal

What is the gold standard treatment for syphilis? b___ p___ _

benzathine penicillin g

In a child with HPV, no treatment is indicated if there is no?

warts

In a child with HPV, treat external warts with t__ podo____

topical podofilox

HPV warts can be removed with c____ or l___ surgery *** Ensure to consult OB

cryotherapy or laser surgery

What is the best preventative measure against HPV?

HPV vaccination

What is the second most common STI?

gonorrhea

Gonorrhea is a gram ___ bacteria

negative

Males with gonorrhea are often _____

asymptomatic

females with gonorrhea are often asymptomatic until the following complications occur d___ f_____ u____ d____

dysuria frequency urgency discharge

Gonorrhea diagnostic testing includes a b___ c___, g___ s___, and N___

bacterial culture, gram stain, NAAT

Gonorrhea txt includes IM c____ or cefi____ *cover for chlamydia as well until chlamydia cultures are negative

ceftriaxone or cefixime

What is the most common cause of pelvic inflammatory disease?

chlamydia

Chlamydia is caused by the bacteria c__ t___

c. trachomatis

Children with chlamydia may be asymptomatic. S/s of chlamydia may include v___, u____, end____ or P___

vaginitis urethritis endometriosis PID

Chlamydia is treated with a___ or d______

azithromycin doxycycline

The gold standard diagnostic test for chlamydia is?

NAAT (nucleic acid amplification)

Primary syphilis s/s include a mouth or anogenital u___ or c___

ulcer or chancre

secondary syphilis s/s include m___, f___ s/s, l____, and r_____

myalgias flu-like s/s lymphadenopathy rash

tertiary syphilis s/s include c__ and n___ s/s

cardiac and neurological s/s

Diagnostic testing for syphilis may include?

RPR (rapid plasma reagin)

What is the gold standard treatment for syphilis? b___ p___ _

benzathine penicillin g

Lyme disease is a t___ borne illness

tick

Lyme disease presents with an e____ m____ with c___ of c___ known as e____ m____ or a t___ lesion

erythematous macule with the clearing of the center known as erythema migrans target lesion

Lyme disease s/s include f____, a____, h_____, f___ p___, and m_____

fever arthralgias headache facial palsy myalgias

Lyme disease treatment includes d_____ x __ days a____ x __ days or cefur_____ x __ days

doxycycline x 10 days amoxicillin x 14 days cefuroxime x 14 days

Rocky mountain spotted fever is a t__ borne illness that causes systemic v_____

tick systemic vasculitis

Rocky mountain spotted fever incubation is __-___ days

2-14

Rocky Mountain spotted fever s/s include f____, severe h___, m____, v___ and decreased o___ i____

fever severe headache myalgias vomiting decreased oral intake

In Rocky Mountain spotted fever, a r___ will develop about __-__ days s/p fever

rash 2-5 days s/p fever

The Rocky Mountain spotted fever rash begins on the w___, a___, p___, and s___. Will eventually spread to the t___

wrists, ankles, palms, soles trunk

What is the gold standard diagnostic test for Rocky Mountain Spotted fever? R___ sero____ as____

Rickettsial serologic assay

Do not delay Rocky Mountain spotted fever treatment. Treat Rocky Mountain Spotted fever with d____ for __-__ days.

doxycycline, 7-10 days

Doxycycline treatment for Rocky Mountain Spotted fever should be continued until there is no f___ x __ days

fever x 3 days

Untreated Rocky Mountain Spotted fever can progress to D___, s___ ___, and c___ sequela

DIC septic shock CNS

Adenovirus is a r___, o____, and g____ illness. Adenovirus requires what type of precautions?

respiratory, oral, gastrointestinal contact

CMV is a c____ i____ infection

congenital infant

In infants, CMV can lead to s____ h___ l___

sensorineural hearing loss

CMV risk increases in adolescence due to their c___ c___ with c____

close contact with classmates

Treat immunocompromised patient with CMV with g____, v____, or f____

ganciclovir, valganciclovir, foscarett

EBV spread into the host __ cells increasing the child's risk for l____ disorders such as P___

b lymphoproliferative PLTD

Children with EBV will often have an enlarged _____. Children are at greatest risk for rupture when engaging in c___ s____

spleen contact sports

Enterovirus enters via the f___ o___ route. Treatment is s____. Place the child on c____ precautions.

fecal-oral route supportive contact

Herpes simplex virus enters via m____ m___ or s____

mucous membranes or skin

What herpes is acquired in childhood?

HSV-1

What herpes is acquired sexually?

HSV-2

In neonates, HSV can cause c___ and d___ disease

CNS disseminated

Immunocompromised patients with HSV will develop g____

gingivostomatitis

When HSV vesicles are present, treat with a____. Place patient on c___ precautions

acyclovir contact

Treat HSV resistant disease with f_____

foscarnet

What is the HSV diagnostic test? E____ and C___ P____

ELISA CSF PCR

Parvovirus B19 requires ____ precautions

droplet

Parvovirus B19 enters via the r___ tract and invades e___ cells

respiratory tract erythroid cells

Parvovirus may lead to ___ disease

5ths disease

5ths disease is characterized by c___ e____ and a___ s/s

cheek erythema arthritis

Children with Parvovirus may present in an a____ crisis. Reticulocyte count will often be ___

aplastic crisis 0

Hepatitis causes L____ i_____

liver inflammation

Children with hepatitis will present with an acute onset of __/___, f____, tra____, a___ p___, h_______, b____ disorder s/s, and a____ m____ status

n/v fever transaminitis Abdominal pain hepatosplenomegaly bleeding altered mental

Hepatitis lab workup is to include a____, f___ levels, c___ levels

albumin factor levels coagulation levels (Pt-INR)

In a child with hepatitis, evaluate their liver status by obtaining an?

ultrasound

What is the gold standard syphilis diagnostic test? non-t___ and t____ testing

non-treponemal and treponemal

The organism treponema pallidum causes what STI?

syphilis

Gonorrhea txt includes IM c____ or cefi____ *cover for chlamydia as well until chlamydia cultures are negative

ceftriaxone or cefixime

Males with gonorrhea are often _____

asymptomatic

Infectious Disease Flashcards

(355 cards)