Infectious Disease Flashcards
(110 cards)
1
Q
11 mo old with resp distress, AOM, nl CXR, and lymphocyte predominance - most likely what virus?
A
hMPV. Could also be RSV.
BOTH cause bronchiolitis - indistinguishable
2
Q
Options for immunoprophylaxis after exposure to varicella
A
- passive varicella zoster immune globulin
- immunocompromised, neonates, and pregnant women
- up to 10 days after exposure - varicella vaccine
- not immune to varicella but does not meet criteria for IG
- only if 12 months of age or older
- up to 5 days after exposure
3
Q
What is perichondritis?
A
Infection of the connective tissue of the ear that covers the cartilage. Inflammation and pus can separate the cartilage from the connective tissue (that carries o2 and nutrients) leading to necrosis. Often occurs from a piercing.
Either from:
Pseudomonas (gram neg rods).
Staph aureus
Tx:
Ciprofloxacin for pseudomonas
4
Q
Salmonella Typhi
A
Fever + invasive infections (hepatitis, bacteremia, osteo, meningitis)
Hx:
Travel to resource limited country
Typhoid vaccine should be offered prior to travel.
Dx: BLOOD CULTURE. As stool cultures are often negative.
Non-typhi forms of salmonella usually just cause enteritis. And hosts include birds, reptiles, mammals whereas typhi is just humans.
5
Q
Toxic Shock Syndrome
A
Due to S. aureus releasing TSST-1 toxin.
Can occur: surgical and postpartum wound infections, burns, and as a complication of infections such as influenza, sinusitis, osteomyelitis, and enterocolitis
Dx is clinically! BCx may be negative for S. aureus
Fever> 102 Rash (diffuse erythroderma) Desquamation (usually palms/soles) Hypotension MULTISYSTEM involvement (3 or more)
6
Q
Tx for UTI for a patient with neurogenic bladder with UCx showing GPC in pairs/chains
A
Enterococcus!
Resistant to cephalosporins.
Tx: Ampicillin
7
Q
Rubella infection
A
Only TORCH infection that causes cardiac defects (PDA) and cataracts (complete absence of red reflex).
+ sensorineural hearing loss
VS:
- intracranial calcifications (toxo, CMV)
- microcephaly (CMV, Zika)
- chorioretintiis (white spots on retina vs. complete absence of red reflex - toxo)
8
Q
Peritonsillar abscess - org and treatment
A
Strep pyogenes
Tx: penicillin
9
Q
Trichomonas on wet mount and tx
A
Mobile Trichomonas
Sx: vag discharge (green, foamy) vulvovaginal pruritus and irritation, abdominal pain, dysuria and dyspareunia.
Tx: Metronidazole 2g. Abstinence from alcohol is recommended during treatment with nitroimidazoles.
10
Q
How to test for HIV in children
A
<18 months: nucleic acid: HIV DNA polymerase chain reaction or HIV RNA assays. Immunoglobulin assays are not useful bc they may have maternal antibodies
> 18 months: HIV-1 Ab/HIV-2 Ab/p24 Ag immunoassay.HIV p24 structural capsid protein antigen helps identify early infection during the 20- to 30-day window after infection has occurred until HIV antibody is present.
11
Q
Most common viruses causing the common cold
A
Rhinovirus is most common - also associated with 2/3 of all asthma exacerbations
Coronavirus is 2nd most common. Indistinguishable.
12
Q
Yersenia
A
- fever and diarrhea (often bloody in children), abdominal pain, nausea, and vomiting (frequently indistinguishable from other acute diarrheal illnesses)
- principally found in pigs
- slow subclinical onset and protracted duration of up to 3 weeks
- Pharyngitis may provide an important diagnostic clue for Yersinia as the causative pathogen because pharyngitis is not associated with other acute bacterial diarrheas.
Tx: Antibiotics are not beneficial in the treatment of acute uncomplicated yersiniosis.
Vs: C diff - usually doesn’t occur in those younger than 12-24 months bc lack the ability to bind and process the clostridial toxin, creating asymptomatic carriage and preventing colitis from occurring.
13
Q
Hepatitis A post-exposure prophylaxis
A
> 12 months: give Hep A vaccine (as effective as IG and is long-term protection)
Hep A IG - give to those < 12 months, or immunocompromised.
NOT indicated if exposure occurred > 2 weeks ago!
70% of children younger than 6 years of age with HAV infection are asymptomatic.
14
Q
Persistent hypothermia is a sign of?
A
Hypothalamic Dysfunction - need to get MRI head.
Ex: tumors and granulomas of the hypothalamus
Other sx: polyphagia, obesity, precocious puberty, adrenal insufficiency, short stature, polydipsia, polyuria.
15
Q
Parvovirus B19 infection
A
- fifth’s disease - intense red appearance of the cheeks
- petechial papulopurpuric gloves and socks syndrome - petechiae on the hands/feet/legs
- aplastic anemia from hemolysis
- spontaneous abortion and hydrop fetalis
16
Q
Corynebacterium Diphtheriae
A
Sx due to the exotoxin.
Cutaneous - ulcers covered with gray membrane
Resp - forms pseudomembrane attached to the underlying resp mucosa
Cards - ST-T wave changes, QTc prolongation, 1st degree heart block, myocarditis
Neuritis - paralysis of soft palate/pharyngeal wall
17
Q
After exposure and sx suspicious for pertussis, when can a healthcare worker go back to work?
A
AFTER Treatment!
Clearance occurs after 5 days of antibiotic therapy such as Azithromycin (macrolide)
Despite immunization, you are still at risk.
Masking is not sufficient protection for someone who is symptomatic to avoid transmission.
18
Q
What abx regime to treat dog bite?
A
Empiric coverage for likely pathogens from the animal’s mouth (Pasteurella) and from the patient’s skin (Staphylococcus aureus, Streptococcus pyogenes).
Pasteurella is the most common pathogen isolated from animal bite wounds. Infection is characterized by an intense inflammatory response occurring within 24 hours of the initial exposure.
Options:
- Amoxicillin-clavulanate
- third-generation cephalosporin (cefixime or cefpodoxime)
- trimethoprim-sulfamethoxazole (Pasturella) + clindamycin (MRSA)
19
Q
Candidemia evaluation
A
Immunocompetent - thrush, dermatitis, onychia
Immunocompromised, premature/very low birth weight - invasive candidiasis
- Needs LP and Opthalmologic eval**
- If multiple positive cultures, consider Abd US and ECHO
20
Q
Hepatitis B post-exposure prophylaxis
A
If confirmed HBsAg positive source:
Nonimmune individuals
- hepatitis B vaccination series AND
- hepatitis B immune globulin as soon as possible
Immunized individuals
- one booster dose of hepatitis B vaccine.
If HBsAg status is unknown:
Nonimmune individuals: hepatitis B vaccination series
Immunized individuals: no further treatment.
21
Q
Recreational Water Illnesses
A
Most common is gastroenteritis - from Cryptosporidium
- can survive in chlorinated pool. Has watery brown diarrhea that can last for 2 weeks, but otherwise relatively well-appearing.
VS: norovirus (most common cause of AGE < 5: abd pain, n, v, fever - but most resolve in 3 days)
VS: salmonella - bloody diarrhea
Chlorine effective against noro and salmonella
Other RWI diseases:
Hot tub folliculitis - Pseudomonas
Pneumonia - steam or mist containing Legionella
Otitis externa (swimmer’s ear) - P aeruginosa and Staphylococcus aureus.
22
Q
Testing for TB
A
If you’re immigrant from endemic area:
2-14 yrs: PPD (TST) or Quantiferon (interferon gamma release assay)
15 or older: CXR
No routine testing for children < 2 unless suspecting it, known contact with active TB, or has HIV
TST = preferred for those < 5 (even if they got BCG!)
Once older than 5 and hx of BCG, then use Quant.
23
Q
Hepatitis B test interpretations
A
The presence of hepatitis B surface antigen and total antibody to hepatitis B core antigen without IgM hepatitis B core antibody is indicative of chronic hepatitis B virus infection.
The presence of hepatitis B e antigen suggests high viral replication and increased risk of hepatitis B virus transmission.
24
Q
What would be an indication to start abx in a burn patient?
A
Discoloration/change in appearance of the burn.
NOT
SIRS because burns naturally cause SIRS due to hypovolemia from cap leak and hypermetabolic state.
Extent of burn - this only dictates if they need to be treated at burn center.
25
What characterizes aseptic meningitis and what test to diagnose?
Relatively low wbc count
Mildly elevated protein
Low-normal glucose
No orgs on gram staining!
Dx through CSF PCR
26
Enterovirus types and clinical manifestations
Summer-Fall
Fecal-Oral contact
Febrile, nonspecific resp/GI: any
Aseptic meningitis: coxsackie B, echo, numbered entero
Herangina, hand foot mouth: coxsackie A
Carditis: coxsackie B
Neonatal: coxsackie B, echo (sepsis, meningoencephalitis, hepatitis, myocarditis)
27
What does HPV vaccine protect against?
4-valent (types 6, 11, 16, 18)
9-valent (types 6, 11, 16, 18, 31, 33, 45, 52, 58).
Anogenital warts
Precancerous lesions - intraepithelial neoplasia
Cervical, Anal, Vulvar, Vaginal cancers
28
How do you diagnose HUS?
Hemolytic anemia, thrombocytopenia, renal abnl
in a patient with hx of fever, bloody diarrhea.
NOT a blood culture because the E.coli is producing Shiga toxin!
29
Coccidioides
Inhalation of FUNGAL spores. Southwestern US, Mexico, Central/South America.
Asymptomatic or self-limited
Pulmonary infection, pleural, mediastinal
Cutaneous: erythema nodosum or multiforme
Disseminated is rare
Diagnosis: Complement fixation of IgG!
Not urine antigen, eosinophilia, or tree in bud which are supportive of diagnosis but not definitive.
30
Campylobacter
Spiral/Helical shaped Gram negative bacilli
Leading bacterial cause of foodborne gastroenteritis: fever, diarrhea, crampy abd pain, or bloody diarrhea in infants
Exposures in unpasteurized milk, undercooked poultry, contaminated water, animal contact. + Daycares!
Tx: azithromycin or erythromycin decreases the duration of diarrheal illness by hastening eradication of Campylobacter organisms in the feces by 2 to 3 days.
31
Meningococcemia
Neiserria Meningitidis
Sepsis (Fever, tachy, hypotension) + Rash (purpuric, blotchy, non-blanching). Vomiting, Stiff Neck for meningitis.
Why? Endotoxin from the bacterial capsule causes a severe host inflammatory response that can lead to cardiovascular collapse because of myocardial depression and vasodilation, disseminated intravascular coagulation, lethargy, respiratory failure, and death.
Tx: Ceftriaxone
32
How are pinworm infections spread?
Pinworms (Enterobius vermicularis) may be transmitted by the fecal-oral route indirectly from contact with toys, bedding, clothing, and toilet seats that are contaminated with eggs.
Autoinfection from scratching the perianal area and transferring eggs back to one’s own mouth is common.
Sx: pruritus, restless sleep, and occasionally vulvitis associated with dysuria
Pinworm infestation is often clinically diagnosed, and medical providers may choose to treat pinworm infestation empirically if the clinical scenario is consistent.
33
Vertical transmission of Hep C results in?
Slowly progressive fibrosis in childhood.
Only 5% of infants born to mothers with hepatitis C virus infection acquire the virus. Although the likelihood of vertical transmission of hepatitis C virus is low, a large portion of infected infants will develop chronic infection.
The possible long-term outcomes of patients who have chronic hepatitis C virus infection include slowly progressive fibrosis -> cirrhosis -> liver failure, and hepatocellular carcinoma.
Individuals with chronic hepatitis C virus infection should have annual evaluation of hepatic enzymes and function, and children with significant liver disease should undergo at least annual hepatocellular carcinoma screening through ultrasonography and α-fetoprotein measurement.
34
Listeria infection in neonate
Gram positive rods: purple (Listeria)
Gram negative rods: pink (E.coli)
Acquired when mom ingested contaminated food.
Neonate will either have early disease = sepsis or late disease = meningitis.
Tx: ampicillin and gent
35
How to definitely diagnose syphilis?
Painless genital ulcer with indurated border
Dark field microscopy to look for spirochetes.
- but most ppl use non-treponemal test (RPR, VDRL) but an have false positives, so if positive, have to use a treponemal test to verify (FTA-ABS, TP-PA)
36
Influenza Diagnosis
Molecular assays (RT-PCR, NAAT) are best 86-100% sensitivity. Rapid tests such as antigen detection are not as reliable.
If child is < 2 or has comorbidities predisposing to severe disease (asthma, cards, sickle cell, diabetes) = then give oseltamivir WITHOUT waiting for test results.
Flu season peaks Jan-March
37
Head Lice
Should NOT be sent home from school!
Head lice have low contagion within classrooms, and children with active infestations are likely to have been infested for some time. Therefore, a child with head lice should not be restricted from attending school, and no-nit policies should be abandoned.
Household members should be checked for head lice and treated when live lice or nits are found within 1 cm of the scalp. Empiric treatment is recommended for all family members who share a bed with the affected child. Items that have been in contact with the head of the infested person within 48 hours prior to treatment should be considered contaminated and washed, vacuumed, or dried at a temperature greater than 54.4°C. Alternatively, placing items in a closed plastic bag for 2 weeks is an effective decontamination technique.
38
Infectious Mononucelosis
EBV = human herpesvirus4
Primary Epstein-Barr = infectious mononucleosis
- fever, malaise or fatigue, pharyngitis, and cervical lymphadenopathy, splenomegaly, palatal petechiae
- those treated with antibiotics, especially amoxicillin or ampicillin, can develop a distinct morbilliform rash (more severe than that associated with IM itself which is usually just trunk and spares extremities)
Dx:
1. 10% atypical lymphocytes on a peripheral blood smear + positive heterophile antibody test (but may not have if less 4 years old)
2. IgM antibody against viral capsid antigen in the absence of antibodies against Epstein-Barr nuclear antigen
39
Infant who presents with constipation, difficulty feeding, muscle weakness (unable to sit up), ptosis, weak cough and gag reflexes, diminished head control, and mild weakness of all extremities. Over the course of 2 weeks
Infant Botulism!
- usually 2-6 month age group
- inhalation of C. Botulinum spores (or honey or corn syrup)
- Botulinum neurotoxin binds to Ach-R irreversibly!
Sx:
- constipation
- weakness rostrocaudally: bulbar weakness, ptosis, decreased gag/cough reflex -> large muscles (poor head control, truncal instability
- also with parasympathetic involvement: dry MM, constipation
Tx: IV botulinum IG
VS:
- Duchenne's: preschool, large muscles NOT bulbar
- Myasthenia: waxing/waning (not in infants)
- GBS: ascending weakness (not in infants)
- SMA: can be in infants, BUT SLOW progression over MONTHS not days-weeks. And does not involve the face.
40
Ring-enhancing lesion on Brain MRI
T solium
Dx: Antibody assays to T solium serum (better than CSF). Serum antibody test results are often negative with minimal disease (a solitary cyst) but positive in patients with multiple lesions.
- Neurocysticercosis is a neglected tropical parasitic disease caused by 1 or more cysticerci (larvae) of the pork tapeworm Taenia solium. In the United States, most patients with neurocysticercosis are immigrants from Latin America or Asia.
- Seizures are the most common clinical manifestation of intracranial neurocysticercosis and often result from acute or chronic host inflammation of degenerating Taenia solium brain cysts. Also ocular.
41
EBV Titer interpretations
Acute/Recent infection: + IgM-VA and IgG-VA (persists for life). - IgG against nuclear antigen (EBNA). IgM lasts for about 2 months
Previous infection: - IgM and + EBNA
Reactivation: previous infection + early antigen
42
Lyme disease - treatment
Serologies are NOT detectable 1-2 weeks after the tick bite. So, if has erythema migrans, just Treat!
Doxy or Amox or Cefuroxime
Epi
- spirochete Borrelia burgdorferi and transmitted to humans by the bite of the infected Ixodes (deer) tick
- New England, the Eastern mid-Atlantic, and the upper Midwest.
Sx:
Early localized Lyme disease = erythema migrans (1-4 wks after tick bite)
Early disseminated = multiple erythema migrans lesions, facial nerve palsy, carditis (heart block), aseptic meningitis
Late = arthritis (usually knee)
43
Bacterial Meningitis Empiric Treatment
Vanco + CTX for anyone older than 1 month
Streptococcus pneumoniae and Neisseria meningitidis are the 2 most common bacteria causing pyogenic meningitis in previously healthy children older than 1 month. In unimmunized children younger than 4 years, Haemophilus influenzae type b must also be considered.
Vanco covers resistant strains of s.pneumo
44
What infectious etiology causes malabsorptive diarrhea?
Giardia!
Dx'ed with ova and parasite exam: direct microscopic evaluation and/or Giardia-specific enzyme immunoassay of stool samples.
TX: metronidazole
45
Causes of water-borne diarrheal AGE illnesses
- Cryptosporidium (not killed by chlorine)
- Shigella (Tx'ed with azithro or CTX if severe)
- Giardia (malabsorption)
- Norovirus
- Escherichia coli O157:H7
46
Cutaneous Larva Migrans
Parasite of the Hookworm family: larval stages of dog and cat hookworms (Ancylostoma caninum, Ancylostoma braziliensis
Lives in intestines of dogs and cats -> eggs in feces dropped in sand -> barefoot in sand and larva burrow through
Serpinginous, well-demarcated plaques, which may advance every day as the hookworm larvae move through the upper levels of the epidermis.
Tx:
- oral albendazole or ivermectin for children ≥ 2 years of age
47
Neonatal Conjunctivitis
Within 2-5 days of life = gonorrhea
- erythromycin ointment prevents this
- if born to a mother with untreated gonorrhea -> needs presumptive treatment with a single dose of ceftriaxone (25–50 mg/kg IM or IV, to a maximum of 125 mg). This is the same dose used to treat ophthalmia neonatorum.
Within 1-2 wks of life = chlamydia
48
Most common etiology of brain abscess in an infant
Citrobacter koseri - GN bacillus
49
Intrauterine TORCH infections
Toxoplasma - parasite that lives in cats and oocytes transmitted through cat feces
- microcephaly, hydrocephalus, GENERALIZED calcifications, CHORIORETINITIS
CMV
- PERIVENTRICULAR calcifications
Rubella
- CATARACTS, PDA and pulm stenosis, blueberry muffin
50
Enterococcus Faecalis UTI - empiric therapy
IV ampicillin
- Can add gentamycin for synergy.
- Enterococcus is RESISTANT to cephalosporins of all generations - therefore, may not getting better on empiric UTI therapy.
- If resistant to PCN, use vanco.
- if VRE, most likely E. faecium species.
51
Discitis
Narrowing of the intervertebral spaces on MRI
- Usually < 5 years old
- Irritability, back pain, gait abnormality, +/- fever
- Typically low grade infection that recovers without abx but if severe - treat empirically to cover S. aureus
- Usually just CRP, ESR elevated
- Usually get MRI to rule out vertebral osteo.
52
D-test looks for
MRSA species with inducible resistance to clindamycin
53
Chlamydia Pneumonia - CXR findings
Hyperinflation with bilateral interstitial infiltrates (not alveolar, not lobar).
- passed vertically to infant from mom's genital tract
- presents in infant 2wks-5months
- causes conjunctivitis or PNA
- insidious onset of PNA: afebrile, cough, resp distress, crackles
- tx: erythromycin (even though higher risk of pyloric stenosis)
54
Lyme disease prophylaxis
Only if tick bite/attachment > 36 hours (bc that's how long it takes the spirochete to be activated in the tick and transmitted to human)
One dose of doxy.
55
Gianotti-Crosti
Papular Acrodermatitis of childhood -> EBV
- Flesh-toned/Brownish papules are monomorphous, flat, rather than umbilicated, and range in size from 1 to 10 mm.
- Symmetrically distributed, multiple in number, and most prominent on the face, buttocks, and extensor surface
- usually persists for 2–4 weeks, but may last several months.
Caused by viral illness (EBV classically but lots of others) or after immunizations (hepatitis A or B, influenza, and MMR).
56
R testicular pain and swelling + Bilateral submaxillary swelling
Mumps!
Parotitis and URI sx
Orchitis (4-8 days after parotitis)
Meningitis
Usually self-limited, recover by 2 weeks
CDC may recommend 3rd dose of MMR during outbreak
57
Hepatitis B titers
Hep B CORE antibody = remains positive indefinitely as a marker of past Hep B infection
Hep B E antigen = new acute infection. presence indicates higher HBV DNA levels and increased infectiousness.
58
Toxocara Canis - Ocular larva migrans
- children unintentionally ingest eggs excreted in soil (sandboxes, playgrounds) by infected dogs
- toxocara eggs hatch and release larvae -> penetrate intestine -> migrate to muscle (visceral) and eyes (ocular)
- visceral: fever, flu, abd pain, hepatomegaly, resp sx
- ocular: unilateral vision loss/strabismus or worse
- eosinophilia
Tx: Thiabenazole or Albendazole
- corticosteroids to reduce inflammation, and surgery.
- antiparasitic therapy may be used, but may not result in eradication of the parasite from the eyes (albendazole)
59
When to test for neonatal HSV born to women with active genital lesion?
AFTER 24 hours of life (bc positive surface cultures before this time may represent contamination from intrapartum exposure and not viral replication suggestive of infection).
If likely primary infection (no previous hx of maternal HSV) - get all the cultures (surface, blood, CSF) and start acyclovir
If previous mat hx of HSV, defer CSF cx and only get blood and surface and do NOT have to start empiric acyclovir. IF any of those positive, CSF, acyclovir.
60
Coccidiodomycosis
Fungal infection. Endemic to southwestern US
Self-limited flu sx or community acquired PNA (consolidation, interstitial, hilar, pleural) but can disseminate to bone, skin, and other organs (fever, night sweats).
Dx: serology (immunodiffusion, immunoassay, complement fixation)
Tx:
mild-mod: fluc or itraconazole
Severe: amphotericin B + oral azole for 12 months
61
When to test for Zika in neonate?
findings consistent with congenital Zika syndrome OR if there is laboratory evidence of possible maternal Zika virus infection during pregnancy.
- HUS, optho, ABR hearing testing within 1 month of age
Abnormalities associated with congenital Zika syndrome include microcephaly, intracranial calcifications (typically subcortical), other brain malformations, and eye anomalies, including abnormalities of the retinal and optic nerves.
Infants without findings of congenital Zika virus syndrome whose mothers do no have laboratory evidence of infection should receive standard care.
62
Worm in emesis is what?
Ingestion of soil-contaminated food.
Ascaris Lumbricoides
- human roundworm infection. humans ingest embryonated eggs and larvae hatch from the eggs in teh small intestine, penetrate mucosa and travel to lungs -> pharynx -> swallowed and mature into adults in intestine. can present as abd obstructi
Tx: albendazole, ivermectin, etc
63
Liver abscess in immigrant most likely caused by ?
Entamoeba Histolytica
- abd pain, diarrhea, weight loss, abscesses (liver)
- Dx: SEROLOGY. serum antibodies
- Tx: metronidazole or tinidazole + amebicide
64
Roseola
HHV6
HIGH fever - can be associated with febrile seizures
After defervesces, gets rash - blanching maculopapular - that starts at trunk and spreads out. Usually persists for 1-3 days.
+ Nagayama spots (erythematous papules on soft palate and uvula
+ Berliner sign (palpebral/periorbital edema)
+ URI sx
65
What virus has risk of serious complications in pts with sickle cell disease?
Parvovirus! Can cause aplastic anemia.
66
Absolute contraindications to breastfeeding
HIV, HTLV, untreated brucellosis.
Untreated TB = can't breastfeed but can feed expressed breast milk. If treated for 2 wks, can breastfeed.
HSV lesions = expressed breastmilk
67
Lab abnormalities associated with RMSF
Hyponatremia
Thrombocytopenia, Leukopenia, Anemia
Elevated serum aminotransferases
Clinical sx:
- systemic signs and symptoms that include increased temperature, severe myalgias, headache and/or photophobia, anorexia (often associated with abdominal pain), nausea, vomiting, diarrhea, and rash.
- erythematous and macular rash that progresses to maculopapular and petechial lesions. It begins in the distal portions of the extremities, including the palms, soles, wrists, and ankles, often spreading to the trunk within 12–24 hours
68
Complications of Lemierre disease
Septic emboli to the lungs.
Lemierre:
- suppurative thrombophlebitis of the jugular vein
- due to extension of a recent preceding oropharyngeal or dental infection to the lateral pharyngeal space (such as peritonsillar abscess)
69
Treatment of epiglottitis
Ceftriaxone and Vanco
Today, gram-positive microbes such as Staphylococcus aureus, group A streptococci, or pneumococci are more likely than Hib to be the cause of epiglottitis. Because vancomycin offers coverage against S. aureus, drug-resistant Streptococcus pneumoniae, and other gram-positive organisms, it is now also added as the drug of choice.
70
6 wk old girl with Xray of the left arm reveals evidence of osteochondritis at the metaphyses and periostitis of the radius and ulna. What infection?
Congenital syphilis
Skeletal changes of congenital syphilis (found in the majority of symptomatic infected infants) include osteochondritis and periostitis, usually involving the metaphysis and diaphysis of the long bones.
Additional early manifestations of congenital syphilis may include cutaneous lesions on the palms and soles (which are highly contagious if ulcerated), hepatosplenomegaly, jaundice, and Coombs-negative hemolytic anemia. Rhinitis (“snuffles”) may lead to destruction of adjacent bone and cartilage, resulting in a “saddle-nose” appearance later in life.
71
What organism causes vocal cord lesions?
HPV acquired from mom during vag delivery
juvenile recurrent respiratory papillomatosis (RRP)
commonly diagnosed between 2 and 3 years of age, and most children are diagnosed prior to 5 years of age.
Symptoms may include hoarseness, stridor, and respiratory distress due to intermittent airway obstruction
72
Treatment of staph scalded skin syndrome
Empiric vancomycin
73
Treatment of toxic shock syndrome
Vancomycin + clindamycin
To cover staph, strep, and the toxin
If GAS identified, then use PCN + clinda
74
Strep infection in those 1-3 yrs of age
“Streptococcal fever”
Protracted nasal congestion (serous rhinitis) associated with thick, yellowish nasal discharge, low-grade fever, irritability, and tender anterior cervical lymphadenopathy are characteristic findings.
Can get impetiginization also.
The typical presentation of streptococcal upper respiratory tract infection (as acute exudative pharyngitis) is uncommon in children younger than 3–4 years of age. Acute rheumatic fever is also rare in this age group.
75
Endocarditis clinical manifestations
Roth spots—exudative, edematous, hemorrhagic lesions of the retina.
Petechiae, usually located on the mucous membranes and extremities, are the most common skin manifestation of SBE.
splinter hemorrhages—nonblanching, linear, reddish-brown lesions found under the nail bed
Osler nodes, which are painful, violaceous nodules located in the pulp of the fingers and toes.
Janeway lesions (macular, blanching, painless, erythematous lesions on the palms and soles) are more commonly seen in association with acute bacterial endocarditis.
76
Ppx for meningococcal disease
Close contacts of patients with meningococcal disease should receive antimicrobial chemoprophylaxis, including who were those vaccinated (bc MCV4 contains meningococcal serogroups A, C, Y, and W135, but not serogroup B. Serogroups B, C, and Y each account for about 30% of cases in the US).
Prophylax everyone!! With just 1 case (as opposed to h flu with 2 cases)
Rifampin BID x 2 days (10 mg/kg/dose for those > 1 month old and 5 mg/kg/dose for those < 1 month old)
Azithromycin 10 mg/kg (500 mg max) x 1
Cipro 500 mg x 1
77
gram-positive diphtheroid-like organism in a pregnant woman
Listeria!
Tx with ampicillin
78
Rabies prophylaxis
currently recommended following a bite, scratch, or mucous membrane contact with a bat. There is no need for intervention if the bat is available for testing and found not to be rabid.
Rabies IG + 4 dose vaccine at day 1, 3, 7, and 14 days (for a total of 4 doses).
79
International Adoptees - Screening
```
Stool O&P - giardia and cryptosporidium
Hep B, Hep C
Syphilis, HIV
CBC
TST/Quant
```
In children from countries with endemic infection:
– Trypanosoma cruzi serologic testing
In children with eosinophilia (absolute eosinophil count exceeding 450 cells/μL) and negative stool ova and parasite examinations:
– Strongyloides species serologic testing
– Schistosoma species serologic testing for children from sub-Saharan African, Southeast Asian, and certain Latin American countries
– Lymphatic filariasis serologic testing for children older than 2 years from countries with endemic infection
80
Cryptosporidium treatment
Generally, immunocompetent patients do not require treatment because it is a self-limiting illness.
Nitazoxanide:treatment can be given if symptoms are severe or persist beyond 2 weeks. In healthy children, the dose of nitazoxanide is weight-based
81
Peripheral neuropathy is a side effect of what medication?
Isoniazid. So we give B6/pyridoxine with it
82
Blistering distal dactylitis is caused by?
blistering distal dactylitis, most often due to group A beta-hemolytic Streptococcus (GABHS)
Lesions most commonly occur as a superficial infection on the volar fat pad of the fingers, but may also occur on the proximal phalangeal areas of the fingers, palmar, and dorsal areas of the hands, and on the feet and toes.
In contrast to a herpetic whitlow, w'hich tends to form a cluster of smaller discrete vesicles, distal dactylitis usually presents with only one large bulla.
83
Varicella embryopathy leads to
severe limb malformations and cicatrix scarring
| CNS and ocular anomalies.
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Side effects of TB meds:
| Rifampin
Rifampin - orange discoloration of urine, OCPS are ineffective
Isoniazid - hepatitis, peripheral neuritis
Ethambutol - optic neuritis, red-green color discrimination, GI upset
Pyrazinamide - hepatotoxic, elevated uric acid levels
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Cause and treatment for acute pharyngitis not caused by GAS.
Arcanobacterium haemolyticum.
| Tx: Erythromycin
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Chlamydia Trachomatis PNA - what lab finding associated with it?
Peripheral Eosinophilia
Sx: 4-12 wks of age, afebrile, with tachypnea, staccato like cough, nasal congestion and rales. No wheezing.
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Bright red erythema in the perianal area that is both tender and moist, and oftentimes associated with a purulent discharge and/or whitish pseudomembrane.
Perianal streptococcal dermatitis
Sharply defined cutaneous erythema is a common finding in group A β-hemolytic infections of the skin.
Can lead to constipation, blood streaked stools.
Tx: amox
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Back pain, limping, and refuses to bend forward and is tender over L3 and L4.
Discitis: an inflammation of the vertebral disc thought to represent a low-grade infection
The disorder is most common among children < 5 years of age—the age range in which vascular channels still communicate between the vertebral end plate and the vascular disc space.
Clinical findings may include limp or refusal to walk, refusal to bend forward, point tenderness over the involved area of the spine, decreased range of motion at the hip, and loss of lumbar lordosis
Plain radiographs typically show narrowing of the disc space after 2–3 weeks; changes on MRI are noted much earlier.
Empiric antibiotic therapy directed against Staphylococcus aureus is recommended for 1–2 weeks intravenously, followed by an additional 5–6 weeks of oral therapy. Anti-K. kingae therapy is often included in the treatment of young children.
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What skin finding found with mono?
Periorbital and eyelid edema
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Two conditions that cause craniosynostosis and how to differentiate
Apert - syndactyly
| Crouzon - ocular proptosis
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Rubella
Unimmunized immigrant.
Fever, URI sx, cough, coryza, sore throat
posterior cervical, postauricular, and suboccipital lymphadenopathy
enanthem (Forchheimer sign) characterized by soft palate petechiae and/or larger reddish spots
Rash: exanthem of rubella (which usually lasts about 72 hours) is characterized by numerous generalized, fine, discrete, pinkish maculopapules that begin on the face and then spread to and coalesce on the trunk during the 2nd day; usually, the rash disappears completely by the 3rd day.
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HbsAG positive mother - what to do in newborn
HBIG and hep B vaccine
Continue vaccine series in 1-2 mo, 6 mo
Then check hbsag and anti hbsag at 9 mo (well child check). If not immune, restart series.
If birth wt < 2000, first dose does not count in series.
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GAS infection worsens what?
OCD - PANDAS
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CMV vs Toxo
In congenital cytomegalovirus, calcifications are classically located in a linear, periventricular distribution (when they circumvent the ventricles, the cause is almost always CMV).
In congenital toxoplasmosis, calcifications occur throughout the brain parenchyma, especially in the caudate nucleus and basal ganglion.
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Unilateral nonpurulent conjunctivitis—sometimes associated with an ocular granuloma—and ipsilateral preauricular lymphadenitis
Parinaud occuloglandular syndrome
- atypical presentation of cat scratch (bartonella henselae)
- tx: azithro
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Chronic draining lesions in combination with water exposure (e.g., fish tank, swimming pool)
Mycobacterium marinum.
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A penetrating eye injury with ring abscess formation
Bacilius Cereus
vision-threatening emergency, and it is seen following a penetrating foreign body injury to the eyeball, especially with soil and vegetative matter.
Intravitreal vancomycin may be required in addition to systemic therapy to save the infected eye.
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Treatment of Tularemia
Gentamicin
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Alternative to Amox for strep
Clindamycin can be used as treatment for recurrent GAS pharyngitis or as a first-line agent when the patient has had an anaphylactic reaction to penicillin. x 10 days
For patients with a nonanaphylactic reaction to penicillin, a 10-day course of an oral cephalosporin is recommended.
Azithro is also considered an effective treatment; however, resistance rates as high as 20%
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Retropharyngeal abscess vs. Peritonsillar abscess
file:///C:/Users/iamla/Downloads/C28.pdf
Retropharyngeal abscesses present with the insidious onset of symptoms including fever, sore throat, neck stiffness, and in more severe cases, tachypnea, drooling, and stridor.
Retropharyngeal abscesses are most common in children younger than 6 years of age.
Lateral neck radiographs of retropharyngeal abscesses show thickened prevertebral soft tissues.
Peritonsillar abscesses, most common in adolescents and young adults, present with fever, sore throat, muffled voice, and dysphagia.
Ultrasonography or computed tomography is useful in making the diagnosis of peritonsillar abscesses.
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Rash develops 6 days after administration of amoxicillin for presumed GAS
Infectious Mononucleosis!
| You would see absolute lymphocytosis with > 10% atypical lymphocytes
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Erlichiosis
South central, southeast, and east coast
like Arkansas
- tick bite
- pantocytopenia
- elevated serum transaminases
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Most common infectious cause of bloody or serosanguinous vaginal discharge and vulvovaginitis
Shigella***
less commonly GAS
May have recent or concurrent diarrhea.
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Endocarditis Causes
Acute presentation - S. aureus
SUBACUTE presentation - VIridans strep
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Varicella-Zoster Immunoglobulin ppx for neonates
If mom develops varicella 5 days prior to or 2 days following delivery.
Bc in this case, baby does NOT receive maternal antibodies via transplacental transfer
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Bloody diarrhea - microscopy
Campylobacter - spiral/helical shaped GN
Shigella - rod-shaped GN
Salmonella - rod-shaped GN
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Tx for Salmonella indications
infants < 3 months of age
chronic gastrointestinal tract disease (e.g., inflammatory bowel disease)
hemoglobinopathies (e.g., sickle cell disease), and immunosuppressive illnesses or undergoing chemotherapy.
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PREP TO REVIEW
2017: 4, 15, 16, 21
2018: 7, 27
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Coag neg staph - line removal indications
Prompt line removal is indicated for certain pathogens (gram-negative bacteria, yeast, and Staphylococcus aureus) and in the setting of clinical deterioration or sepsis.
BUT for CoNS - multiple blood cultures.
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Measles Prophylaxis
Exposed ppls:
younger than 6 mo: immune globulin
- asap but may be given within 6 days of exposure.
older than 6 months: MMR vaccine
- within 72 hours of exposure.
Infants receiving MMR vaccine before their first birthday should be revaccinated at 12 through 15 months of age and receive a third dose at least 28 days later, usually at 4 through 6 years of age.
