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1

0-1 month Bacterial Meningitis

GBS, E. coli, Listeria

Ampicillin + Gentamicin or Cefotaxime

2

1-3 months Bacterial Meningitis

GBS, Strep pneumoniae, Listeria

Ampicillin + Cefotaxime (or + Vancomycin if suspect bacterial
meningitis)

3

3 months-3 years

Strep pneumoniae, HIB, Neisseria meningitidis

Cefotaxime (or + Vancomycin if suspect bacterial meningitis)

4

3 years to adult

Strep pneumoniae, Neisseria meningitidis

Ceftoxamine (or + Vancomycin if suspect bacterial meningitis)

5

Listeria

o Neonates are prone, especially those w/ T Cell defects
o Gram+Rod
o Can be maternally acquired from unpasteurized dairy, soft cheeses
Mom may just have flu-like illness
Has predilection for causing amnionitis
Brown, murky fluid
Can result abortion, stillbirth, neonatal sepsis
o Neonatal distress: Respiratory distress, temperature instability, poor feeding, lethargy/irritability
o Severeform
Gramulomatosis Infantiseptica
Pathognomic for Listeriosis
Granuloma formation and tissue destruction
o Skin (popular or ulcerative necrosis), liver, adrenals, lymphatics, lung, & brain

6

Neisseria Meningitidis

o Children ≤2 y/o at greatest risk
o Will have petechial rash prominent on ankles, wrist, axilla,
flanks
o Complication
Waterhouse-Friderichsen
Fulminant Meningococcemia
Vasomotor collapse
o Severe HoTN
Large purpura and petechiae on flanks from
Adrenal hemorrhage

7

Complications of Meningitis

Hearing loss (most common, 25%) (prevent with corticosteroids)
Global Brain Injury (5-10%)
SIADH, seizures, hydrocephalus, brain abscess, CN palsy
Can have developmental regression
o Ex. Forgetting how to copy shapes

8

Aseptic Meningitis

Definition
Inflammation of the meniges w/ CSF lymphocytic pleocytosis
And if caused by a virus
o Normal Glc, normal to minimally ↑ protein
Causes
Viral most common
o If involves the brain also, then meningoencephalitis
o Enteroviruses
Most common in US Summer & Fall
o Mumps,HerpesViruses
o Viruses that cause encephalitis
Arboviruses (St. Louis, Western equine, Eastern equine, West Nile), influenza, Herpes viruses
Bacterial (some can cause aseptic presentation)
o TB(Children<5y/o)
o Borrelia burgorferi(Lyme)
o Treponema pallidum (Syphilis)
Fungal
o Coccidioides immitis, Cryptococcus neoformans, Histoplasmosis capsulatum
Parasitic
o Taenia solum (cysticerosis)
o Toxoplasma gondii (immunocompromised pt.)

9

Simple URI (Common Cold)

Rhinovirus, parainfluenza, coronavirus, RSV S/Sx
Low grade fever, rhinorrhea, cough, sore throat
o Resolves in 7-10d
Color of nasal discharge alone doesn’t predict the presence of concurrent sinusitis
o Purulent nasal discharge may occur early in course of URI
Persistent Sx (>10d) or fever, suspect bacterial superinfection (sinusitis,
otitis media)

10

Sinusitis

Clinical Diagnosis
Persistent Sx, ≥10d w/out improvement
Or Severe Sx (Fever ≥102°F, purulent nasal discharge, face pain ≥3d)
Or Worsening Sx ≥5d after initial improvement of Viral URI
Pus drainage from the meatus Formation
Ethmoid & Maxillary: present at birth
Sphenoid: Develop between 3 to 5 y/o
Frontal: 7 to 10 y/o
Complications
Cerebral Abscess
o Visualized by CT or MRI
Tx
Antibiotics
o OralAmoxicillin-ClavulanicAcid(Augmentin)
Covers the most common (S. pneumoniae &
nontypeable Haemophilus influenzae)

11

Pharyngitis

Viral
o Coxsackievirus, EBV, CMV
Bacterial
o Strep pyogenes (GA β hemolytic Strep [GABHS] aka “Strep
Throat”)
o Arcanobacterium hemolyticum, Corynebacterium diphtheria
(diphtheria)
S/Sx
Viral and GABHS overlap
Viral
o Simple URI Sx
o Can have tonsillar exudates
o EBV Pharyngitis
Enlarged posterior cervical lymph nodes, malaise, & hepatosplenomegaly
o Coxsackievirus Pharyngitis
Painful vesicles/ulcers on P. Pharynx
Soft palate (herpangina) (not herpes)
Blisters on palms/soles (hand-foot-mouth disease)

12

GABHS pharyngitis

o Typically school age (5-15 y/o), winter & spring o Lack of other URI Sx (rhinorrhea, cough)
o S/Sx
Sore throat
Exudates on the tonsils, Petechiae on soft palate,
Strawberry Tongue, enlarged tender A. Cervical LN
Fever
Scarlatiniform rash (also in Scarlet fever)
Sandpaper rash
o Dx
Rapid Strep
o Tx
Amoxicillin
Erythromycin for penicillin allergic
o Complications
PSGN (ABx don't prevent) and Rheumatic Fever (ABx prevent)
Peritonsillar Abscess
Asymmetric tonsilar bulge
o Displaces uvula to side

13

Acute Otitis Media

Otitis media w/ effusion (OME): fluid w/ middle ear without Sx of infection Can have a retracted TM
If >3m then conduct audiometry testing to assess hearing loss If normal hearing then give ABx or can observe
o Causes
Bacterial
S. pneumoniae (most common), non-typeable H. influenzae, Moraxella catarrhalis
Viruses o S/Sx of AOM
AOM usually develops after simple URI
Fever, ear pain, ↓ hearing, pulling at ear
If TM perforates, may have drainage from ear
o Dx
Dx of AOM: fluid in middle ear (bulging TM, absent motility, otorrhea) & Sx of
Infection (erythema of TM)
Pneumatic Otoscopy identifies abnormal movement of TM
o From fluid
o Most reliable way of detecting middle ear fluid o BulgingTM
o Complications
Cerebral Abscess
Visualized by CT or MRI S/Sx
o Persistent fever, neurologic deficits,headache,seizures
o ↑ ICP
From accompanying edema from abscess
Mastoiditis
Erythematous, swollen, tender, skin overlying mastoid
Conductive hearing loss
Can spread to the meninges
o Tx
Don’t have to treat if ≥2 y/o and nonsevere
Treat if worsen w/in 48-72h ABx if used
Amoxicillin (80 mg/kg/day BID) initially o Higher dose than for Strep throat
If attended daycare w/in previous 2 months, then increased likelihood of penicillin resistant S. pneumoniae
o High dose amoxicillin, amoxicillin-clavulanic acid, or a cephalosporin
Macrolide (Erythromycin) if penicillin allergic No ABx for OME
Tube placement only if >3 infections in 6m or >4 infections in one year

14

Otitis Externa (OE)

o Infection of the external auditory canal (EAC)
o Predisposition
Cerumen removal, trauma, maceration of skin from swimming, excess moisture
o Causes
Pseudomonas aeruginosa, S. aureus, or C. albicans
2° to perforated TM from AOE
o S/Sx
Pain, itching, and drainage
o Dx
Erythema/edema of EAC
Sometimes purulent white discharge
o Tx
Restore EAC to natural acidic state
Mild (minimal pain/discharge): acetic acid
Severe: Topical ABx/Corticosteroids
Perforated AOM w/ OE: Both oral & topical ABx

15

Cervical Lymphadenitis

o Enlarged, inflamed tender lymph nodes o Causes
Localized Bacterial Infection
S. aureus, most common
o Fever &Tender
S. pyogenes, common
Mycobacterium: TB and MAC (atypical mycobacteriums)
Francisella tularensis
o Ulcerative lesion at inoculation site
o Regional extremely tender lymphadenopathy
B. henselae (cat scratch disease)
o May have Hx of cat exposure
o Papules develop at scratch site
o Nontender local lymphadenopathy: Cervical, inguinal, axial
o Nonspecific Sx: low-grade fever, malaise, fatigue
o Gram–bacilli on Warthin-Starry Stain
o Tx
Typically self limited, but can give Azithromycin

16

Non-bacterial Cervical Lymphadenitis

Viral
Reactive lymphadenitis: EBV (tender generalized lymphadenopathy),
CMV, HIV
o Kawaskai
Unilateral cervical lymphadenitis
o T. gondii
Mono like illness w/ cervical lymphaenopathy
o Bilateral, symmetric, tender or nontender cervical adenopathy

17

Parotitis

o Inflammation of the parotid salivary glands
o Causes
Mumps and other Viruses (CMV, EBV, HIV) Bilateral
Before vaccination, mumps was #1 cause Bacterial parotitis (acute suppurative parotitis)
Unilateral
S. pyogenes & TB
o S/Sx
Fever
Neck Swelling centered above the angle of the jaw & fever
Pus in oropharynx
Can be expressed from Stensen’s Duct
o Complications
Mumps: meningoencephalitis (also complication of bacterial), orchitis (most common complications, esp. for post puberty), & epididymitis, pancreatitis

18

Staphylococcal Scaled Skin Syndrome(SSSS)

S. aureus exfoliative toxin
Scarlatiniform erythema
More erythematous in skin flexures and periorally
Fever, tender skin, bullae
Intact bullae are sterile (unlike impetigo bullae)
Nikolsky Sign
Extension of bullae when pressure applied
Skin Sloughs off
Extensive fluid and electrolyte loss
Tx
Clean and moisten skin w/ isotonic or burrow solution
IV Oxacillin or Naficillin (penicillinase resistant)

19

Scarlet Fever

GABHS that produce erythogenic toxin S/Sx
Exanthem may develop during any GABHS infection o Begins on trunk
Moves peripherally
o Skin is erythematous w/ skin colored papules (scarlatiniform
appearance)
Sandpaper Rash texture
o Pastia's Lines
Petechiae w/in skin crease
o Desquamation of dry skin as infection resolves
William Martin MD MBA 2016 TTUHSC SOM OC USN
2.23.2015
Fever
White exudates on inflamed tonsils, pharyngitis
Strawberry tongue w/ circumoral pallor
Dx
+ Culture/Throat Swab
Tx
Goal is to prevent Rheumatic Fever
Oral Penicillin VK, IM Benzathine Penicillin, or for penicillin allergic
erythromycin or Macrolide

20

Complications of Strep Pharyngitis

PSGN (ABx doesn't prevent), rheumatic fever (ABx prevent), Post Strep Arthritis (ABx doesn't prevent)
Pediatric autoimmune neuropsychiatric disorder associated w/ streptococcal infection (PANDAS)
o Acute OCD or Tic DO after Strep Infection
o ABx prevents

21

Toxic Shock Syndrome

Toxin Mediated
Fever, shock, desquamating skin rash, multiorgan dysfunction Causes
S. aureus #1, GABHS also
Tampons
Dx: 5 of 6 probable, 6 of 6 confirmed
Fever > 101
HoTN (SBP <90)
Diffuse macular erythroderma (looks like sunburn)
Desquamation (10-14d after illness)
Multisystem Involvement
o GI, Myalgias (↑CPK), Hyperemia of mucous membranes (pharyngitis, vaginits), pyuria, thrombocytopenia, CNS (∆MS)
- cultures other than S. aureus (CSF, blood, pharynx) Tx
Reverse shock, ABx, IVIG

22

Diarrhea

o Viral
Rota and Norwalk
Rotavirus
Most common infectious cause of gastroenteritis
o Winter Months
Incubation is 1-3d
Vomiting, watery osmotic diarrhea, dehydration
o Self limited for 4-7d
Supportive Tx
Norwalk Virus
Outbreak of gastroenteritis in all age groups
o Esp. closed populations (day care, cruise ships)
Same Sx as Rotavirus, just more prominent vomiting
o Shorter duration, 2-3d
o Evaluation
Recent ABx
C. difficile
Unusual pets (e.g. turtles)
Salmonella
ELISA
Rotavirus, Giardia lamblia, C. difficile If WBCs absent, culture is of limited use
o Non-anion gap Hyperchloremic Metabolic Acidosis Result of bicarb loss in stools
o Tx
Fluids

23

HIV and AIDS

o S/Sx
Infants typically asymptomatic for the first few years
Early Sx of HIV infection
FTT, Thrombocytopenia, Recurrent Infections (otitis media, pneumonia, sinusitis) Generalized Lymphadenopathy, Parotitis, Recurrent Thrush, loss of developmental milestones, Severe VZV, diarrhea
Older children may present w/ weight loss (FTT), AIDS defining illnesses (e.g. oral lesions), lymphadenopathy
o Dx
Infants
All infants born to HIV infected mothers have maternal Ab that may last 18-24m
o HIV specific DNA PCR is the test <18m (bc maternal Ab will interfere)
HIV specific DNA PCR is performed at birth & monthly until 4m to detect those infected perinatally
Negative HIV specific DNA PCR @ 4m consistent w/ non infected
o Followed till 18-24m when lose maternal Ab Older Children
ELISA, confirm Western Blot
o Tx
Infants born to HIV mothers
Zidovuidine for 6w postexposure prophylaxis after birth o Also for mother starting @ second trimester
TMP/SMX for PCP prophylaxis at 6 weeks old until HIV DNA PCR - @4m
No breastfeeding
Urine CMV Culture to detect CMV/HIV co infection (5%)

24

Infectious Mononucleosis

o EBV #1 cause
Toxoplasmosis, CMV, and HIV can cause a similar clinical syndrome o S/Sx
Young children may be asymptomatic Older children: typical S/Sx
Fever, up to 2w
Malaise & Fatigue
Pharyngitis (typically exudative, resembling GABHS)
Posterior cervical lymphadenopathy
Hepatosplenomegaly
Takes weeks to months to resolve
o Complications
Post infectious Bell’s Palsy
o Dx
CBC shows atypical lymphocytes
May also have neutropenia, thrombocytopenia, & ↑LFT Monospot (first line)
Measures heterophile Ab
Less sensitive for children <4 y/o
o InsteadhaveEBVAbTiters
Viral Capsid Antigen (VCA) & EB Nuclear Antigen (EBNA)
Acute infection: ↑ IgM-VCA and absent EBNA Ab
CMV causes the majority of monospot negative mononucleosis Tx: supportive, corticosteroids for severe pharyngitis
Complications
Neurological, CN palsy and encephalitis
Severe pharyngitis can cause obstruction
Amoxicillin-Associated Rash
o EBV infected pts. who are misdiagnosed w/ GABHS and prescribed amoxicillin develop a diffuse pruritic maculopapular rash 1 week after
Splenic rupture
Malignancy: Burkitt's lymphoma and nasopharyngeal carcinoma

25

Measles

o Highly infectious
o S/Sx
Appear 8 to 10d after incubation
Classic prodrome followed by a transient enanthem (rash on mucous
membranes) and exanthem (skin rash)
Classic prodrome, The Three C's (Cough, Conjunctivitis, & Coryza)
Other early Sx: Photophobia & fever
Enanthem: Koplik spots (small gray papules on an erythematous base on the
buccocal mucosa)
Pathogonomic and present before the generalized exanthem
Exanthem: erythematous maculopapular eruption, begins around neck & ears, spreads down the chest and upper extremities during 24h
Covers the LE by 2nd day and becomes confluent by the third day Fever
o Complications
Bacterial Pneumonia
Otitis media, laryngotracheitis, encephalomyelitis (inflammation of brain and spinal cord), subacute sclerosing panencephalitis
o Tx
Supportive, Vitamin A
IVIG for immunocompromised postexposure prophylaxis

26

Rubella

o Unlike measles, typically mild or asymptomatic, incubation 14-21d o S/Sx
Prodrome: Mild URI w/ low grade fever (<101oF) Painful lymphadenopathy
Suboccipital, posterior auricular, and cervical nodes Exanthem follows the adenopathy
Nonpruritic, maculopapular, and eventually confluent
Begins on Face and spreads to trunk/extremities
o Complications
Meningoencephalitis Polyarthritis
Teenage girls/young women Congenital Rubella Syndrome
First trimester infection
Thrombocytopenia, Hepatosplenomegaly, jaundice, purpura (blueberry muffin baby), MR
XR
o Longitudinal striations in metaphysis (osteochondritis or
periostitis = congenital syphilis)
Triad
o Cataracts, PDA, Sensorineural Hearing Loss
Pregnancy test priority if woman is infected of childbearing age

27

Entamoeba Histolytica

o Ingested cyst in contaminated food or water
Sx begin 1-4w later as trophozoite emerges from cyst and invades mucosa o S/Sx
Ranges from asymptomatic to disseminated Extraintestinal amebiasis Most asymptomatic
Symptomatic: mild Colitis to severe Dysentery
Cramping abdominal pain, diarrhea w/ blood or mucus, tenesmus (feeling of constantly needing to pass stools, despite an empty colon)
o Can mimic IBD in chronic forms Can last for weeks
Abdominal complications
o Intestinal perforation, hemorrhage, strictures, local
inflammatory mass (ameboma)
Extraintestinal amebiasis
Abscess, most commonly in the liver, although can form in brain or
lungs
o Dx
Trophozoites or cysts in stool Serum Ab Assay
US/CT of for liver cyst
o Tx
Metronidazole plus a luminal amebicide (iodquinol or paromomycin)

28

Giardiasis

o Giardia lamblia
o Travelers to Russia and drinking/swimming in contaminated mountain water in the western US, daycare
o S/Sx
May persist for 2-6w (prolonged) Diarrhea
Voluminous, watery, & foul smelling Bloating, flatulence, weight loss
o Dx
Cysts & trophozoites in stool Stool ELISA
o Tx
Metronidazole (same w/ Amebiasis)

29

Malaria

o Plasmodium: falciparum, vivax, malariae, ovale
o S/Sx
Initial: flulike Sx, headache, anorexia, fever Cyclical fevers: correlate w/ RBC rupture
Hemolytic anemia, splenomegaly, jaundice
o Dx
Thin and thick Giemsa peripheral smear
o Tx
Chloroquine, quinine, mefloquine, doxycycline
o Prevention
Chemoprophylaxis: chloroquine, mefloquine, doxycycline, atovaquone

30

Toxoplasmosis

o T.gondii
o Congenital
Triad
Diffuse Intracranial Calcifications, chorioretinitis, hydrocephalus
jaundice, hepatomegaly,
o Transmission: cat feces, ingestion of cyst contaminated, transplacental o S/Sx
Mononucleosis-like illness
Malaise, fever, sore throat, myalgias, lymphadenopathy

31

Pinworm

o Nocturnal anal pruritus or vulvovaginitis in prepubertal females
o Dx
Scotch Tape Test
o Tx
Mebendazole

32

Congenital CMV

S/Sx
IUGR (w/ microcephaly)
Cataracts, chorioretinitis seizures, hepatosplenomegaly, jaundice, purpura Periventricular calcifications
Sensorineural hearing loss
o If mother was previously infected, IgG will protect fetus in event of reactivation
o Can be shed in urine for years

33

Bell's Palsy

o Postinfectious HSV #1
EBV, VZV, Lyme have also been implicated o Tx
Eye drops to keep eye lubricated
Can do Glucocorticoids

34

Cat-Dog Bite

Pasteurella multocida (#1) & S. aureus
P. multocida causes swelling within 24-48h w/ tenderness, erythema, and
sanguinopurulent discharge
Complications: tenosynovitis, osteomyelitis, septic arthritis
Tx
Covers both: Amoxicillin-Clavulanate (Augmentin) (Ampicillin alone
doesn’t cover S. aureus)
Don’t close, leave open to heal if possible

35

Scabies

o Multiple excoriated & crusted (w/ blood) erythematous plaques
Typically on extensor elbow, webs of fingers, axillary folds, near nipples o Burrows
Thin grey, brown, or red lines o Commonlyfamilyinvolved
o Tx
Permethrin Cream
Dry clean all linens/clothes

36

Acute Osteomyelitis

o Occurs from hematogenous spread, indirect spread of infected soft tissue, direct inoculation from trauma
o S/Sx
Fever, erythema
Tenderness (to palpation) & ↓ Motility (unable to stand on leg) o Causes
Children: S. aureus (most common), Group A Strep
After dog bite: Pasturella multocida
Puncture wound through shoe (rubber): Pseudomonas Sickle Cell Anemia: Salmonella
o Xray
Deep tissue edema

37

TB

o Fever, weight loss, and LRT S/Sx o PPD
≥5mm
+ if exposure history, abnormal CXR, or immunodeficiency
o Prolonged contact w/ someone diagnosed w/ TB Number one risk factor for children
No sign of disease
o High risk, should start Isoniazid prophylaxis even if initial
negative TB skin test
If repeat TB skin test is negative in 8 to 12w can
discontinue
3 to 8w after exposure is needed before
developing hypersensitivity to TB CXR shows Pulmonary disease
o 6months:Isoniazid+Rifampin
o Plus Pyrazinamide and Ethambutol for the first 2 months.

38

Tinea Capitis (ringworm of scalp)

o Dermatophyte
Trichophyton tonsurans (most common) or Microsporum canis
Trichophyton tonsurans: creates “black dot” pattern, spores w/in hair shaft Microsporum canis: spores surround hair shaft
o S/Sx
Multiple scaly circular patches of the scalp
Where hair has broken off
o Patchy hair loss
o Breaks off at level of scalp Enlarged lymph nodes
o Dx
Woods Lamp
Blue-green fluoresce: Microsporum canis
No fluoresce: Trichophyton tonsurans Potassium hydroxide prep of culture
Grows on Sabourad Medium
o Tx
Oral Griseofluvin

39

Postviral Synovitis (Transient Synovitis)

o 1 to 2 weeks after an URI or Rubella Vaccine o S/Sx
Tenderness of joint
May refuse to weight bear/walk Fever is absent or low grade
o Typically resolves spontaneously w/in one week

40

Citrobacter koseri

o Neonatal meningitis
80% develop an abscess
o Tx
3rd/4th generation cephalosporin and draining of abscess

41

Septic Arthritis

o Infection of the joint space
red, swollen, tender joint, w/ limited mobility
o ↑ ESR
o Dx
Arthrocentesis for joint fluid
WBC > 50,000 w/ >90% Nφ indicates bacterial ↓ Glc
o Tx
1st IV Empirical ABx
2nd Surgical drainage/debridement

42

Diaper Dermatitis

o From irritant contact dermatitis
Urine, feces, moisture, heat
o Erythematous scaly patches that spare skin creases
o Tx
Severe
Low dose corticosteroids and/or Zinc oxide

43

Candidiasis

o Well demarcated papules and plaques
Affects the skin folds (unlike Diaper Dermatitis)
o Can develop superimposed on diaper dermatitis
o Tx
Topical antifungal

44

Molluscum Contagiosum Virus

o Spread by skin to skin
o More common in people w/ HIV, atopic dermatitis, immunocompromised o Red to pink glossy papules w/ umbilicated centers
Pruritic
Causes further self annoculation (Koebnerization)
o Results in linear aggregations of papules Often surrounded by molluscum dermatitis
Mild eczematous eruption
o Tx: None, will reduce on own

45

HSV

o Herpetic Whitlow
Infection of distal finger
Painful coalescing vesicles w/ erythematous base
Tx
Analgesics and observation
o Acyclovir may shorten duration.

46

Orbital Cellulitis

o S/Sx
Proptosis, periobrital swelling, painful eye movements, & opthalmoplegia
Fever
o Associated w/ preexisting sinusitis o Tx
Head CT to asses degree of orbital involvement Broad Spectrum ABx
Both anaerobic and aerobic

47

Bacterial Conjunctivitis

Acutely painful and red eye w/ copious purulent discharge
No fever or impairment of extraoccular movements

48

Torch Infections

o Isolate neonate from pregnant women

49

Meningitis due to TORCH Infections

o Toxoplasmosis, Other, Rubella, CMV, HSV
o Jaundice, hepatosplenomegaly, rashes
Can present w/ seizures
o Head CT
Intracranial calcifications

50

Lyme Disease

o Erythema Migrans
o Tx
Doxycycline ≥8 y/o
Because of tooth discoloration
Amoxicillin <8 y/o

51

DIC

o Can result from overwhelming sepsis
o Mechanism: widespread thrombi in small vessels w/ resultant platelet & factor
consumption resulting in mix bleeding/clotting picture

52

VZV

o Vesicles, pustules, & crusts in various stages of evolution/healing.
o Complications
Pneumonia
Uncommon, but most common cause of hospitalization following VZV
infection
o More common in immunocompromised (ex. ALL)
Progressive dyspnea, fever, and dry coughs
Tx: IV Acyclovir
Superinfection w/ GAS
Most common complication
Tx: Acyclovir not indicated, Tx bacterial infection
CNS
Rare
Cerebellar ataxia
No Tx required
o Tx
If mom develops infection
w/in 5 days prior to delivery or two days after delivery o VZIG for infant
Full term infants > 10 days old do not need prophylaxis after sick contact, but do need to be isolated from that person for the course of their infection (e.g. mom)
Don’t give the vaccine before 1 y/o Children >13 y/o
Oral Acyclovir
Younger w/out complication, no acyclovir IVIG (VZIG) for pregnant women exposed

53

X-linked Agammaglobulinemia (Burton's Agammaglobulinemia)

o B-lymphocyte Tyrosine Kinase Defect
o May have absent tonsils
o Dx
Male w/ FHx of recurrent resp bacterial infections, normal T-lymphocytes (CD3+), Absent B-lymphocyte (CD19+)
o Live vaccines are contraindicated
o Tx
Regular infusions of IVIG

54

Congenital Syphilis

o Treponemapallidum
o Severe
Still birth, neonatal death, over infection (e.g. hydrops fetalis) o Early manifestations w/in 5w (other source said <2y??????)
Cutaneous lesions on palms/soles (Rash all over body)
Hepatosplenomegaly, jaundice, anemia, snuffles (profuse rhinorrhea) Metaphyseal dystrophy and periostitis on radiographs
o Late manifestations w/in first 3m (othersourcesaid>2y??????)
Can be prevented w/ early Tx
Frontal bossing, short maxilla, high palatal arch, hutchinson’s triad (blunted
upper incisors, interstitial keratitis, CN 8 Deafness), saddle nose, perioral
fissures
o Scrapies from skin contain treponemes

55

Congenital HSV

o Vesicularrash
o Three patterns w/in 4w
Localized to skin, eyes, mouth Localized to CNS
Focal Seizures
Fulminant, multiple organs
o Highest risk of transmission 3rd trimester
Half mothers unaware they’re infected

56

GBS Infection

o First 7 days of life (usually first 24h)
o Risk factors: Delivered at home
o Sepsis, pneumonia, and/or meningitis
Most common cause of neonatal meningitis
o Fever, lethargy, irritability, respiratory distress
o Blood culture: gram + cocci in chains

57

Rocky Mountain Spotted Fever

o American dog Tick,Mid alantic region
o Rash begins on ankles and wrist and spreads centrally
o Headache, fever, malaise
DIC can follow or ∆MS in severe cases
o Tx
Doxycycline (even in young pt.)

58

Roseola (Sixth Disease)

o HHV 6
o Children 6m to 3 y/o
o High Fever (103 to 106°)
o Rosy rash (maculopapular) after 3d of high fevers (Fever resolves)
Starts on trunk and spreads to his arms/face
Non-pruritic
o Self-limited, no Tx

59

Hand-foot-mouth disease

o Prodrome
Fever & anorexia
o Ulcers on tongue and oral mucosa
o Vesicular rash on hands & feet

60

Blueberry Muffin Rash

o TORCH infections, specifically CMV and Rubella
o Result of extramedullary hematopoesis

61

Hepatitis C

o No contraindication to breastfeeding

62

Hepatitis A

o 90% asymptomatic
o Daycare outbreaks
o Shed in stools for 2-3w before Jaundice and up to 1w after o Dx
IgM HepA
Peaks 4 to 6w, but doesn’t last past 6m
o IgG HepA
Persists a lifetime and doesn’t mean active infection
o Tx
IG prophylaxis for household and close contacts w/in 2w of exposure

63

Asplenia

o Vulnerable to
Encapsulated: Strep pneumoniae, HIB, Neisseria meningitidis
Malaria, babesiosis

64

Group A Strep

o Strep progenies
o Pharyngitis
Rapid Step Test +
o Treat immediately w/penicillin -
o Confirm w/culture

65

Kawasaki Syndrome (KS)

o Medium Sized Artery Vasculitis o Most common in Asians < 5 y/o o Hydrops of Gallbladder
Gallbladder becomes distended w/out stone or inflammation
Abdominal pain
Seen in:
KS, GAS, Leptospirosis, Henoch-Schonlein Purpura
o S/Sx
Strawberry Tongue
Erythema w/ prominence of papillae
Seen in
o Scarlet Fever, KS, Toxic Shock Syndrome
High Grade Fever >4d, Unilateral enlarged cervical lymph nodes (>1.5cm) Exanthem (widespread polymorphic rash)
Eventual desquamation
Thrombocytosis (>500,00 often much higher)
o Complication
Coronary Artery Aneurysm
Can lead to an MI
o Dx
Fever > 4d, Bilateral Bulbar Conjunctivitis (non-purulent), Lesions of the
lips/oral cavity (strawberry tongue, cracked lips, pharyngeal erythema), peripheral extremity edema/erythema (swollen red hands/feet), rash, and cervical lymphadenopathy (unilateral cervical, > 1.5cm)
o Tx
IVIG and High Dose ASA

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Rheumatic Fever

o GAS
Follows infection by 2 to 4w
o MajorCriteria
Migratory Polyarthritis, erythema marginatum, sub cutaneous nodules, chorea
(hand movements, lip smacking, facial twitches), carditis (endo/myo/pericarditis)
Erythema Marginatum: Erythematous, serpiginous (wavy margins), macular (flat, < 1cm,) lesions w/ pale centers that aren't pruritic (itchy)
o MinorCriteria
↑ ESR/CRP, First Degree AV Block
o ↑ ASO titers
Anti-DNase B, antistreptolysin O, antihyaluronidase
o Murmurs
Mitral Regurgitation
Pansystolic Mitral Stenosis
Loud S1 w/ mid-diastolic rumble at the apex
Can cause atrial fibrillation from LA enlargement
o EKG
↑ PR interval
o Tx
Infection
Penicillin Symptoms
NSAID for the arthritis
Steroids for the carditis
Diuretics & Inotropic agents if CHF
Prophylaxis against recurrence
Daily oral Penicillin or monthly IM
o RheumaticFeverw/outCarditis
For 5y or until 21 (whichever is longer)
o Rheumatic Fever w/ Carditis, but w/ no residual heart or valvular disease
For 10y or until 21 (whichever is longer)
o Rheumatic Fever w/ Carditis and valvular or heart disease
For 10y or until 40 (whichever is longer)

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Parvovirus B19

o Fifth disease (aka Erythema infectiosum) o Slapped Cheek Rash
Starts on face before spending to trunk and extremities Lace like
Intense Red on face
o In absence of rash presents as arthraligas (esp. in older females) o Mild systemic Sx
Low grade fever (~99°) o Aplastic Anemia
If underlying sickle cell anemia, hereditary spherocytosis o Infection during pregnancy can cause nonimmune hydrops fetalis