infectious disease Flashcards Preview

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Flashcards in infectious disease Deck (222):
1

What is the proper treatment in a septic newborn born to a mother with flu like symptoms and white nodules on placenta?

Amp and gent for listeria

2

What is the infectious etiology associated with rose spots in the skin?

Salmonella typhosa

3

What is the infectious etiology associated with ecthyma gangrenosum (large pustules on indurated inflamed base)?

Pseudomonas

4

What is the infectious etiology of non blanching rash and petechiae?

Neisseria

5

What is the common benign side effect of rifampin?

Orange secretions

6

What is the prophylactic drug of choice for meningococcemia?

Rifampin

7

What are the indications for meningococcemia prophylaxis?

Persons with contact to oral secretions
Household contacts or close contacts outside the house

8

What should you consider in a patient with elevated d dimer, low platelets and low fibrinogen?

DIC

9

What etiology should you consider in septic shock and how should you empirically treat?

Vancomycin and ceftriaxone to cover meningococcemia

10

What are the likely causes of meningitis in the neonate?

GBS
Listeria
E. coli
Enterovirus

11

What are the common causes of meningitis in young children?

Strep pneumo
Neisseria meningitidis
Enterovirus
Borrelia burgdorferi
Rickettsia

12

What complications of meningitis should be monitored for?

Focal deficits and SIADH

13

When does primary peritonitis occur?

Without an obvious intraabdominal source in patients with nephrotic syndrome or cirrhosis

14

What is the treatment for pneumococcal peritonitis ?

Third generation cephalosporin PLUS aminoglycoside

15

What type of abdominal infection is the likely source in a child with nephrotic syndrome? Why?

Encapsulated organism such as pneumococcus due to loss of IgG

16

What is the likely source of infection in a child with secondary peritonitis?

Gram negative organisms and anaerobes

17

What should you consider as a diagnosis in a dialysis patient with fever and abdominal pain ? What infectious etiology would you consider ?

Secondary peritonitis due to perforated bowel - due to staph epidermidis

18

What is the most common cause of vp shunt infection?

Staph epidermidis

19

What organisms does latex agglutination test for?

GBS
H. Flu
Neisseria meningitidis
Strep pneumo

20

When is latex agglutination helpful?

When partially treated infections are unreliably detected by culture

21

When can latex agglutination give false positives?

After HIb vaccine or with cross reactivity of E. coli

22

What is the treatment of choice in an immunocompromised child with fever or neutropenia ?

Zosyn + aminoglycoside OR
Ceftazidime (gram negative coverage)

23

What is used for prophylaxis against PcP?

Bactrim

24

What diagnosis should you consider in a patient with ground glass appearance on X-ray?

Pcp and HIV

25

What is the treatment for cryptosporidium ?

Nitazoxanide

26

What are the symptoms of cryptosporidium ?

Diarrhea that is severe, non bloody, watery lasting up to 10 days

27

What bacteria should you consider in a patient with intracytoplasmic inclusion bodies on scraping ?

Chlamydia pneumonia

28

What diagnosis should you consider in a patient with afebrile staccato cough, tachypnea and eye discharge?

Chlamydia pneumonia

29

How is chlamydia definitively diagnosed?

Chlamydia trachomatis - PCR
Chlamydia pneumoniae - microimmunofluotescent antibody test

30

How would you treat a chlamydia conjunctivitis ?

Oral erythromycin or Sulfonamides (do not treatment with topical)

31

How would you treat chlamydia pneumonia?

Azithromycin x 5 days
Erythromycin x 14 days

32

How would you treat an uncomplicated chlamydia genital infection ?

Doxycycline x 7 days
Azithromycin 1 gram x 2

33

A teenager presents with cough and low grade fever, chest x-ray shows scattered perihilar infiltrates. You want to choose mycoplasma on the exam but that option is not available, what is the diagnosis?

Chlamydia pneumonia

34

What disease should you consider if fever, myalgia, headache and petechiae rash that starts on hands and feet then spreads centrally? What "bug" is the culprit?

Rocky Mountain spotted fever - rickettsia rickettsii

35

What are the peak times for Rocky Mountain spotted fever?

May and June

36

What do you do when a patient presents with suspicion for Rocky Mountain spotted fever?

Treat with doxycycline x 7 days (even if child is under 8) -- then order direct immunoflourescence. TREAT FIRST

37

What is the difference between Rocky Mountain spotted fever and ehrlichiosis?

Ehrlichiosis may cause leukopenia and elevated LFTs

38

What are the symptoms of human ehrlichiosis ? And what disease presents with the same symptoms?

Fever, headache, myalgia
Thrombocytopenia and hyponatremia
Same as Rocky Mountain spotted fever

39

What is the treatment of Q fever?

Doxycycline

40

What are symptoms of Q fever?

Flu like symptoms followed by respiratory symptoms and pneumonia (no rash)

41

How is Q fever transmitted?

Inhalation of infected particles

42

What is the appropriate treatment for cat scratch disease with draining lymph node?

Nothing! Unless immunocompromised, hepatomegaly or large painful adenopathy

43

What is the bacteria that causes cat scratch disease ? How is it diagnosed ?

Bartonella henselae
Serologic testing (enzyme immunoassay or immunofluorescent antibody test)

44

Which antibiotics would be appropriate for cat scratch disease?

Azithromycin
Cipro (if >18)
Bactrim
Rifampin

45

What should NoT be done for treatment of cat scratch disease?

Penicillins
I&D

46

What should you use to treat cellulitis after a cat bite? What if penicillin allergic patient?

Augmentin --> if allergic, use:
Doxycycline
Azithromycin
Bactrim
Cefuroxime (if not severe PCN allergy)

47

What bacteria should you consider if described as a pleomorphic gram negative organism?

Haemophilus influenza

48

What disease should you consider in a patient from another country with peri orbital cellulitis or Pyogenic arthritis?

Haemophilus influenza

49

What bacteria should be considered in a non-immunized patient with bacterial meningitis?

Heamophilus influenza

50

What is the appropriate treatment if invasive haemophilus influenza infection is suspected?

Ceftriaxone or cefotaxime (if allergic, use chloramphenicol or merrem)

51

What 3 encapsulated organisms should be considered in patients without functioning spleen?

Strep pneumo
Neisseria meningitidis
H. Flu (non typable)

52

When is prophylaxis for H Flu contacts indicated?

If any household members who are immunocompromised or unvaccinated then all household members need rifampin prophylaxis

53

What is the appropriate prophylaxis for non typable h flu infection in household member?

None!! Prophylaxis Only in typable h flu

54

When do all nursery children need to be treated prophylactically for H. Flu?

Only if 2 or more cases within 60 days!

55

What are the three phases of pertussis?

Catarrhal
Paroxysmal
Recovery

56

How is diagnosis of pertussis confirmed?

PCR (DFA not used)

57

What is the treatment for pertussis? How does it help?

Erythromycin, azithromycin or clarithromycin
Bactrim can also be used

Decreases period of communicability but does not shorten the paroxysmal stage!

58

When should prophylaxis against pertussis be given?

Anyone exposed to someone with pertussis regardless of immunization status needs azithromycin

59

What should you consider in a preschool age child wth cough and elevated wbcs with high lymphocytes?

Pertussis

60

What is the appropriate diagnosis and treatment in a patient who ate chicken salad at a picnic and then developed vomiting and diarrhea?

Salmonella - supportive therapy

61

When should treatment for salmonella be given? What treatment is appropriate in those cases?

If under age 3 months, immunocompromised or with hx of colitis - give ceftriaxone

62

What is the treatment for invasive typhoid fever?

Broad spectrum cephalosporins

63

What should you consider as a diagnosis in a patient with diarrhea, malaise, fever and "rose spots"?

Typhoid serotype of salmonella

64

What infection should you consider when a nail goes through a shoe?

Pseudomonas osteomyelitis

65

In what population does pseudomonas cepacia cause pneumonia and death?

Cystic fibrosis

66

What should you consider in a child on a dairy farm who presents with fevers and myalgias?

Brucellosis

67

How do you treat brucellosis?

Prolonged treatment with tetracycline or bactrim and rifampin

68

How would you choose to treat pseudomonas?

Piperacillin/tazobactam and gentamicin
Ceftazidime for pulmonary infections

69

What are the most common antibiotics that cause clostridium difficile?

Clindamycin
Cephalosporins

70

What is the most appropriate first line treatment for pseudomembranous colitis?

Metronidazole
Vancomycin PO is only used if flagyl does not work

71

What is the appropriate treatment for strep pneumo meningitis?

Vancomycin + ceftriaxone (or cefotaxime)

72

What are red lines in the skin folds and what infection are they associated with?

Pastia lines - scarlet fever and strep pharyngitis

73

What does treatment of strep throat prevent? What does it not prevent?

Prevents rheumatic fever
Does not prevent glomerulonephritis

74

What is the appropriate treatment for strep throat?

PCN or amoxicillin
If allergic, azithromycin, clindamycin or first generation cephalosporin

75

What is the name of strep cellulitis causing red streaks and lymphangitis?

Erysipelas

76

What diagnosis should you consider in a patient with rapidly evolving erythema and inflammation after minor trauma?

Necrotizing fasciitis

77

What infections can cause toxic shock syndrome?

Staph
Epstein Barr virus
Coxsackie
Adenovirus

78

How does late gbs infection occur?

Focal infection at 1-3 months

79

The CDC recommends prophylaxis for GBS under what conditions?

Previous infant with GBS.
GBS bacteriuria during current pregnancy
Positive GBS screen (35-37 wk)
Unknown GBS with preterm labor, ROM>18 hr or fever >38

80

How does the infantile form of botulism develop in infants?

Spores are ingested and they germinate in the underdeveloped GI tract

81

What condition should you consider in an infant with poor sucking/feeding, hypotonia with descending paralysis and ptosis?

Botulism

82

What condition should you consider in a 6 month old infant with constipation, urinary retention, weak cry and absent gag reflex?

Botulism

83

How is botulism caused in adults?

Ingestion of botulism toxin from poorly canned goods

84

How do you diagnose botulism?

Presence of toxin in stool or serum, PCR is not used.

85

How does the botulism toxin cause symptoms?

Toxin blocks release of acetylcholine into the synapse

86

What is the appropriate treatment for botulism and why?

Supportive care only!
Antibiotics cause lysis or spores and release of neurotoxins

87

What is the difference between botulism and myasthenia gravis?

With MG, tensilon is positive and onset is gradual
With botulism, tensilon is negative and onset is rapid

88

What is the worst choice of antibiotics for botulism?

Aminoglycoside potentiate the toxin

89

Under what conditions do you need to treat an infant for syphillis?

If mother treated within the last month of pregnancy or if she was treated with erythromycin; if baby's titers are higher than mothers

90

What disease should you consider in a newborn with maculopapular rash, hepatosplenomegaly and peeling skin?

Syphilis

91

Which syphilis screens are nonspecific nontreponemal antibody tests?

VDRL
RPR

92

What conditions may cause false positive VDRL and RPR?

Epstein Barr
Hepatitis
Varicella

93

What test for syphillis remains positive for life and what type of test is it?

FTA ABS - treponemal test used to verify positive screen

94

What is the appropriate treatment for congenital syphillis ?

Penicillin

95

What should you consider in an infant with poor feeding, sniffles, bullous lesions and osteochondritis of joints?

Syphillis

96

What hepatic defects are associated with congenital syphilis?

Hydrops fetalis
Hepatosplenomegaly
Hemolytic anemia

97

What type of skin findings are associated with congenital syphillis ?

Maculopapular rash
Bullous lesions

98

What should you consider in a patient with diarrhea, low platelets and anemia?

HUS

99

What is the treatment for campylobacter fetus ?

Broad spectrum cephalosporins or gentamicin

100

What is the treatment for campylobacter jejuni?

Azithromycin

101

Tularemia is caused by what type of bacteria? What is the appropriate antibiotic for tularemia ?

Gram negative francisella tularensis.
Gentamicin (second line: tetracycline, ciprofloxacin, streptomycin)

102

How does a child become infected with tularemia?

Consumption of rabbit meat - fever, hepatosplenomegaly, rash and lymphadenopathy

103

What disease is caused by yersinia pestis?

Bubonic plague

104

What is the best choice of treatment for bubonic plague?

Streptomycin and gentamicin
May also use doxycycline, chloramphenicol and tetracycline

105

What should you consider in a young child with bloody diarrhea and elevated WBC with hx of ingesting unpasteurized milk or raw meat?

Yersinia enterocolitica

106

What is the appropriate treatment for yersinia enterocolitica?

None unless immunocompromised, then give bactrim, Aminoglycosides or cefotaxime

107

What disease should you be concerned about in a patient with swollen painful lymph nodes and hx of exposure to a dead animal?

Bubonic plague

108

What is the appropriate first line treatment for MSSA?

Beta lactamase resistant agents such as oxacillin or nafcillin

109

What is considered a coagulate negative staph infection and when does it occur?

Staph epidermitis - with IV lines or catheter

110

What is the appropriate treatment for a carbuncle/furuncle?

Incision and drainage (if >5cm, treat for MRSA)

111

What is the treatment for hospital acquired MRSA ?

Vancomycin

112

What antibiotics are community acquired MRSA infections sometimes susceptible to?

Bactrim
Gentamicin
Doxycycline

113

When are peak and trough levels measured with Aminoglycosides?

Peak - 30 minutes after dose
Trough - 30 minutes before next dose

114

Why is it important to prevent high peak levels of Aminoglycosides ?

Ototoxicity

115

How do penicillins work?

Interfere with cell wall synthesis

116

What is "special" about beta lactamase bacteria?

They produce penicllinase which cleaves PCN - therefore penicillinase resistant antibiotics are required

117

How are MRSA infections resistant to methicillin?

They interfere with PCN binding proteins therefore the antibiotic can't bind to the organism

118

What is the dose of amoxicillin for otitis media, pneumonia or sinusitus?

80-90 mg/kg/day

119

What limitations are associated with use of first generation cephalosporins?

Do not penetrate the CSF
Not effective against listeria or enterococcus

120

What are first generation cephalosporins good for? What are the available oral Medications available in this class?

Gram positive cocci (including MSSA).
Cephalexin, cefadroxil

121

What is the fourth generation cephalosporin and what is it used for?

Cefepime - gram negatives (pseudomonas) and gram positives (staph)

122

What classes of infection are covered by clindamycin ?

Aerobic and anaerobic gram positives, anaerobic gram negatives cocci, chlamydia and Protozoa

123

What are the oral third generation cephalosporins?

Cefpodozime and cefdinir

124

What types of infections have good coverage with third generation cephalosporins?

Meningitis
Sinusitis / respiratory infections
Uti

125

What types of infections are covered by macrolides?

Mycoplasma
Moraxella / H. Flu
Strep pyogenes
Chlamydia
Pertussis
legionella
Nontuberculous mycobacterium

126

What types of infections can be treated with rifampin?

Staph osteomyelitis or endocarditis
TB

127

When would quinolones be indicated in children ?

Multiresistance
Pseudomonas
Anthrax

128

What interferes with quinolone absorption?

Antacids with aluminum, mag or calcium

129

When are tetracyclines contraindicated?

In children <8 unless Rocky Mountain spotted fever

130

What antibiotic increases risk for cardiac arrhythmia?

Quinolones

131

What should be used to treat enterococcus infection?

Ampicillin plus vancomycin (unless VRE)

132

What is the appropriate treatment for neisseria gonrrhea?

Ceftriaxone IM x 1

133

What 4 types of infections are treated with metronidazole?

Trichomonas
Syphilis
Gardnerella
H. Pylori

134

What test can be used to screen and to verify diagnosis of mono?

Heterophile antibody
If negative, confirm with serum IgM
There is high false positive rate of screening test in children <4

135

What is the diagnostic study for cmv?

Urine culture within first 3-4 weeks of life

136

What disease should you consider in an infant with chorioretinitis, periventricular cerebral calcifications and sensorineural hearing loss?

CMV

137

What TORCH infection causes petechiae and outputs secondary to thrombocytopenia (blueberry muffin baby)?

CMV

138

How is CMV infection spread?

Virus is shed in urine, saliva or genital secretions

139

A patient presents with mono type infection but mono testing is negative...what should you consider?

CMV

140

What is the treatment for CMV and what is the major side effect?

Ganciclovir - marrow suppression

141

What type of infections are caused by arboviruses and when do they typically occur?

Encephalitis - late spring and early summer

142

What are the csf findings in arbovirus encephalitis?

Mild pleocytosis and elevated protein

143

How is west Nile encephalitis diagnosis confirmed ?

IgM in serum or CSF or Fourfold elevation of serum IgG during acute infection

144

What diagnosis should you consider when a patient presents with high fever, rash and viral meningitis during summer?

Coxsackie (enterovirus)

145

How is an enterovirus infection confirmed ?

PCR

146

When can unimmunized children return to school if there is a measles outbreak in a local school?

Give the vaccine prior to return to school (or the booster if not completed) OR
Wait 26 days after the last person developed parotitis

147

When can a child with mumps return to school?

9 days after the onset of parotitis

148

What are the 4 complications of mumps infection?

Parotitis
Meningitis/encephalitis
Orchitis
Pancreatitis

149

What diagnosis should you consider In a patient with fever, headache, muscle aches and unilateral facial swelling anterior to the ear?

Mumps

150

What is the difference between mumps and viral parotitis?

Mumps is associated with low fever and non toxic appearance in unimmunized child

Viral parotitis is associated with high fever and toxic appearing child who is fully immunized

151

What should you consider in a patient with intermittent salivary gland swelling?

Salivary gland stone

152

What is the most likely manifestation in a patient with mumps and parotitis?

Orchitis (but not infertility)

153

What disease should you consider in a patient with high fever for 3 days followed by maculopapular rash?

HHV-6 aka roseola

154

What should you consider in an unvaccinated hold with maculopapular rash associated with mild viral symptoms ?

Rubella

155

What vaccine should NOT be given to pregnant women?

MMR

156

What occurs in 50% of infant infected with rubella in their first trimester?

Cataracts and PDA

157

What are the 7 main symptoms associated with measles ?

Cough
Coryza
conjunctivitis
Koplik spots
Confluent maculopapular rash
Fever
Photophobia

158

What is measles the most contagious?

5 days before to 5 days after the appearance of the rash

159

What is the method for measles diagnosis?

Serum IgM (elevated for one month)

160

How can immunocompromised patients be protected after measles contact ?

Immunization and immunoglobulin

161

What is the appropriate measles post-exposure management for incompletely immunized children ?

Immunoglobulin within 6 days
MMR vaccine within 3 days

162

When should children receive revaccination after post exposure treatment?

After age 12 months and at least 5 months after immunoglobulin was given

163

What is the diagnosis in a patient with slapped cheek rash that spreads to extremities?

Parvovirus b19 aka fifth disease

164

What virus can cause hydrops fetalis? What else can this virus cause?

Parvovirus B19 - also causes aplastic crisis in sickle cell disease

165

What is the best test for diagnosis of hsv?

Csf PCR

166

When is acyclovir used?

Hsv prophylaxis and treatment
Varicella only in immunocompromised

167

What is the appropriate test for HIV in children and why?
When should exposed infants be tested?

If <18 months, need PCR (antibodies can cross the placenta)
Birth, 2 months, 4 months and 6 months

168

What are 4 buzzwords that might point toward HIV infection in a child?

Recurrent bacterial infection
Hepatosplenomegaly
Failure to thrive
Developmental delay

169

When should testing for HIV be performed after any form of exposure to HIV?

At time of exposure
6 weeks, 12 weeks and 6 months

170

How can HIV vertical transmission be reduced?

Zidovudine and nevirapine during the perinatal period

171

Which vaccines are contraindicated in children with HIV?

Measles and varicella (only contraindicated if severely immunocompromised )

172

Why do children with HIV develop recurrent bacterial infections?

Increased production of nonfunctional antibodies

173

When can children with zoster return to school?

Once lesions can be covered or are crusted over

174

What are the only indications for use of Foscarnet?

CMV retinitis in immunocompromised
Severe mucocutaneous HSV resistant to acyclovir
Zoster

175

What should be the treatment for immunocompromised children exposed to active chicken pox infection?
When should it be given?

Varicella zoster immune globulin (also indicated for newborns)
Within 96 hours or exposure

176

How does adenovirus typically present in the summer?

Conjunctivitis, pharyngitis and otitis media
Intussusception or diarrhea

177

What test confirms RSV infection?

Immunofluorescence

178

How can you diagnose rotavirus infection?

rotazyme antigen test of the stool

179

What diagnosis should you consider in an infant with 1-2 days of fever, several episodes of watery stool and vomiting ?

Rotavirus

180

What should you do in a patient exposed to a bat but not bitten by it?

Treat for rabies - immunoglobulin plus rabies vaccine within 7 days

181

What are possible treatment options for ascaris lumbricoides infection?

Albendazole x 1
Mebendazole x 3
Ivermectin x 1

182

What diagnosis should you consider in a patient with recent travel from a tropical region who presents with signs of acute abdominal obstruction?

Ascaris lumbricoides

183

What is the antibiotic of choice for entamoeba histolytica?

Flagyl

184

What medications should Never be given to people with amebiasis?

Corticosteroids or anti motility agents

185

What infection should you consider in a patient with 1 week of abdominal pain, tenesmus and bloody diarrhea as well as liver or brain abscess?

Entamoeba

186

What is seen on stool culture in amebiasis?

Hematophagous trophozoites

187

What is the recommended treatment for intraluminal entamoeba infection?

Amebicide (iodoquinol, paramomycin, diloxanide)

188

What infection should you consider in a child with hepatomegaly, abdominal pain and wheezing?

Toxocara canis

189

Exposure to what animal may lead to toxocariasis?

Dogs and cats

190

What signs and symptoms are present in visceral larval migrans?

Fever, hepatomegaly and wheezing

191

What form of toxocariasis presents with visual problems ?

Ocular larval migrans

192

What symptoms are seen with covert toxocariasis?

GI symptoms plus pruritis and rash

193

How is toxocariasis diagnosed?

Elisa
Stool cultures should still be done to rule out other parasitic infections

194

What is the treatment for visceral larval migrans?

Mebendazole or thiabendazole

195

What is the treatment of giardia?

Flagyl, tinidazole and nitazoxanide

196

What is the treatment for tapeworm?

Praziquantel

197

What is the treatment for strongyloides?

Thiabendazole

198

What is the treatment for enterobius vermicularis?

Mebendazole, Albendazole or pyrantel (given once then repeated in 2 weeks)

199

What is permethrin 1% used for?

Lice ( the 5% must be used to treat scabies)

200

How should anti-malaria medication be taken when traveling to a chloroquine resistant region?

Chloroquine x 1, one week prior to travel, weekly during travel and for 4 weeks after travel

201

Which fungal infection is an encapsulated yeast?

Cryptococcus

202

What infection is associated with pigeon droppings ?

Cryptococcus

203

What is the treatment of cryptococcal infection?

Amphotericin b PLUS Fluconazole

204

What medication should be added to the recommended treatment for cryptococcosis when the infection is resistant?

Flucytosine

205

What infection should be considered in a patient with aids who develops severe pulmonary disease or meningoencephalitis?

Cryptococcus neoformans

206

What infection should you consider in a patient with flu like symptoms from California, Arizona or Texas?

Coccidioidomycosis

207

What is the treatment for coccidioidomycosis?

Amphotericin, Fluconazole or Ketoconazole

208

What infection should you consider in an asthmatic with worsening symptoms with eosinophils or infiltrates on CXR?

Aspergillosis

209

What is the treatment for invasive aspergillosis ?

Voriconazole or amphotericin B

210

What infection should you consider in a patient with flu like symptoms and hepatosplenomegaly ?

Histoplasmosis

211

What is the treatment for histoplasmosis ?

Amphotericin

212

What regions of the country is histoplasmosis found in?

Ohio, Missouri and Mississippi River valleys

213

What animal is associated with histoplasmosis ?

Pigeon droppings

214

What infection causes an ulcer on the skin with a chain of nodules parallel to the drainage lymphatic channel which may also cause joint involvement ?

Sporotrichosis

215

What are possible side effects of amphotericin ?

Fever
Hypokalemia
Nephrotoxicity

216

What medication should be given to an immunocompromised patient with low neutrophils who is not responding to antibiotics ?

Amphotericin

217

What is Fluconazole used for?

Candida albicans (used once daily for resistant oral thrush)

218

What type of contact precautions are needed for RSV?

Direct contact - hand washing for transmission prevention

219

What type of precautions are needed for mumps, rubella and pertussis?

Droplet precautions (no special ventilation system needed)

220

What type of precautions are needed for legionella, candida and pseudomonas?

Droplet precautions (no special ventilation system needed)

221

What type of precautions are needed for aspergillosis, measles and varicella?

Airborne transmission (special hospital ventilation system needed)

222

What is the etiology of septicemia in a child 1-12 months?

GBS
E. coli
Strep pneumo
Staph aureus
Salmonella