Infectious Diseases Flashcards by Samia Aleem

Most common site of origin of osteomyelitis

Metaphysis
Femur>Humerus>Tibia
Can spread to epiphysis because of blood supply

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Most common site for GBS osteo

Humerus

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Most common site for GBS septic arthritis

Hip

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Most common GBS serotype?

Serotype 3

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Indications for GBS IAP

Previous infant with GBS disease
GBS bacteriuria during current pregnancy
Positive GBS screening culture during pregnancy (unless planned C/S)
GBS unknown status, delivery<37 weeks, ROM>18 hours and maternal fever

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Infective organism associated with placental microabscesses?

Listeria

*gram positive rod, present in unpasteurized dairy and deli meats

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Chocolate colored or ‘meconium-like’ stained amniotic fluid is associated with which organism?

Listeria -> early onset disease with small papular rash (granulomas on histopath)

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How long are ‘snuffles’ in congenital syphilis infective?

Until after 24 hours of treatment

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Which infection can have an unexplained large placenta?

Treponema/syphilis

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Type of rash in syphilis?

Desquamating maculopapular rash

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3 most common types of infections with gonorrhea in neonates?

Conjunctivitis with copious purulent discharge, can lead to corneal ulceration. Needs ceftriaxone x1
Scalp abscess if scalp electrode is used
Arthritis

Systemic disease needs 7 days Rx, 10-14 if meningitis

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Most common cause of infectious conjunctivitis?

Chalmydia.. Also most common manifestion of neonatal chlamydia.
Typically B/L.
Prophylactic erythromycin does not prevent (only prevents gonorrheal)

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Triad of congenital HSV infection

Brain: microcephaly, intracranial calcifications, hydranencephaly, seizures, hypertonicity
Eyes: Chorioretinitis, cataracts, blindness
Skin: vesicular rash

Also presents with IUGR

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Which virus replicates within RBCs

Parvovirus B19

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Retic count and type of anemia with Parvo?

Aplastic anemia, so low retic

Can lead to hydrops, congestive heart failure

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Which pathogen has a primary reservoir outside of human and primates?

Toxoplasma

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What causes granulomatosis infantiseptica?

Listeria

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Which clinical factor has the highest sensitivity for maternal chorio?

Maternal fever

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Which GBS serotype is most commonly associated with meningitis?

GBS serotype 3

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How long after infection are osteomyelitis bony changes detectable on X-ray?

7-10 days.

By MRI you can see them within 24-48 hours

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What is Wimberger sign?

Destruction of metaphysis of tibia, and is seen with congenital syphilis

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Which virus replicates within RBC precursors?

Parvovirus

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During what time period is there greatest risk of VZV infection in infant?

Between 5 days before delivery until 2 days after.

There is insufficient time for protective antibodies to cross to the fetus

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At what time period is there highest risk of congenital varicella infection?

Between 8 and 20 weeks gestation

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Indications for VariZIG

1. Infant with mother who develops infections between <5 days prior to delivery until 2 days after 2. <28 weeks or <1000g if significant exposure 3. >28 weeks if significant exposure and mother is seronegative 4. Term healthy infant if exposed within 2 weeks post delivery and mom is seronegative 5. If infant is exposed between 2-7 days postnatally

At what gestational age is the highest risk of congenital anomalies with rubella?

Weeks 1-12 | 100% of fetuses will have deafness and congenital cardiac abnormalities

After which week of gestation are congenital anomalies from rubella rare?

Week 20

Hallmarks of congenital rubella?

Hydrops in utero Sensorineural hearing loss, microcephaly Cataracts, salt and pepper chorioretinitis Blueberry muffin rash Cardiac anomalies (PDA most common -> PPS) Long bone radiolucencies

Mechanism of blueberry muffin rash

Dermal extramedullary hematopoiesis

Most common intrauterine infection?

CMV

Intranuclear and cytoplasmic inclusions are seen with which virus?

CMV

What does hearing loss in CMV correlate with?

Presence of periventricular calcifications

Type of hearing loss in CMV?

Progressive sensorineural, often bilateral, moderate to profound

Treatment for congenital CMV and what do you monitor?

Oral valganciclovir for 6 months | Monitor for neutropenia and GI disease

Which outcomes does oral valganciclovir have an effect on in congenital CMV?

Improves hearing and neurodevelopmental outcomes

What are cortical calcifications seen with?

Toxoplasmosis

Which cells does HIV infect?

Helper T lymphocytes and macrophages

Most common infection in children in the US leading to diagnosis of HIV?

Pneumocystis carinii pneumonia

Test of choice to diagnose HIV in infants?

HIV-1 DNA PCR If positive in first 2 days of life, infection transmitted in utero If between 2-6 weeks, then infected during intrapartum

Which fungal infection is associated with lipid emulsions?

Malassezia

Test medium to diagnose chlamydia

Giemsa stain

Test medium to diagnose Neisseria

Thayer Martin

Test medium to diagnose pertussis

Bordet Gengou

Test buzzword to diagnose pseudomonas

Oxidase positive, catalase positive

Test buzzword to diagnose rubella

Hemagglutination inhibition

Organisms causing chorioretinitis?

``` CHoRioreTinitiS CMV, Candida Herpes Rubella Toxoplasmosis Syphilis (early congenital) ```

Listeria findings

Think hot chocolate made with unpasteruized milk Chocolate colored amniotic fluid Microabscesses and granulomas 'marshmallows',

What are the non treponemal tests and what do they detect?

RPR, VDRL Test cell membrane cardiolipin IgG Ab Used for screening, assessing response to treatment and determining reinfection Positive if titer is 4x that of mom

What's the treponemal test and what does it detect?

FTA-ABS Detects specific antibody. Used to establish presumptive diagnosis. Reactive for life

What causes a positive treponemal test?

Antinuclear antibodies

Asymptomatic, positive PPD or IGRA, negative sputum, CXR, and contact with contagious person

INH and pyridoxine for 9 months

Active TB disease in pregnant mother

INH, rifampin, ethambutol for 6-9 months | Add pyridoxine to prevent B6 deficiency

Asymptomatic neonate, mother with positive PPD and active disease

Start INH for 3-4 months in neonate, if positive PPD continue for total 9 months if negative PPD -> d/c INH and follow serial PPDs Isolate from mom is symptomatic

Asymptomatic neonate, mother with positive PPD, negative CXR

No need to separate | No treatment

Most common congenital viral disease?

CMV Also most common cause of sensorineural hearing loss Hearing loss is usually bilateral, moderate to profound Treatment with ganciclovir will reduce severity of hearing loss

Most common congenital parasitic disease?

Toxoplasmosis Kittens more likely to transmit the disease Infants may develop learning and visual impairments later in life, asymptomatic at birth Rx with pyrimethamine and sulfadiazine and folinic acid for 1 year

Which GBS serotype is associated with EOS and LOS?

Type 3

Which vaccines should an HIV positive baby not receive?

MMR Varicella Oral polio BCG

Congenital infections increasing risk of stillbirth?

Parvovirus Listeria Syphilis

At which time point during pregnancy would varicella infection lead to greatest risk to fetus?

5 days before and 2 days after delivery (insufficient time for immunoglobulins to pass) Give the baby VZIG

Transmission of syphilis at which time during pregnancy leads to more severe disease?

Later in pregnancy

Which congenital infection has a U-shaped distribution of transmission?

Rubella. More severe if earlier

Limb hypoplasia is characteristic of which infection?

Congenital varicella

Characteristic features of congenital varicella?

Limb hypoplasia and cicatricial scarring Cataracts Chorioretinitis Brain abnormalities

Most common organisms for omphalitis? And most common complication?

Polymicrobial with skin flora | Most common complication is sepsis

Recommended treatment for syphilis during pregnancy?

A single intramuscular (IM) dose of benzathine penicillin G | Eradicates maternal disease and prevents congenital syphilis

Treatment options for congenital syphilis

Aqueous crystalline PCN IV for 10 days Procaine PCN IM for 10 days Benzathine PCN IM x1 (only if all tests are negative)

When is screening for vertical HCV done?

Antibody testing is done at 18 months (because maternal antibodies can be present till then) You test NAAT at 3 years to determine whether to treat. Treatment isnt approved before 3 years

Infectious Diseases Flashcards

(68 cards)