Pedi Infectious Dz Flashcards
(55 cards)
1
Q
Meningitis can be a result of which types of infection?
A
Bacteria, virus
fungi & parasites if immunocompromised
2
Q
What organisms are most likely to cause meningitis in kids > 2mths?
A
- Streptococcus pneumoniae (Pneumococci)
- Neisseria meningiditis (Meningococcus)
- H. influenza type B
3
Q
What organisms are most likely to cause meningitis in newborns (birth to < 2mths)?
A
- Group B strep
- E coli
- Listeria monocytogenes
4
Q
Routes of infection for meningitis
A
- Bloodstream (most common)
- Seeding of meninges
- Direct invasion via contiguous focus
- Mastoid/paranasal sinuses
- Otitis media trauma/surgery
- Meningomyelocele, vertebral osteomyelitis
5
Q
Clinical manifestations of meningitis
A
- Fever
- Nausea
- Vomiting
- Irritability
- Anorexia
- Headache
- Confusion
- Nuchal rigidity
- Photophobia
- Papilledema (rare)
- Facial Nerve Palsy
- Seizures
- Back Pain
- Shock
Vary by age
6
Q
Clinical manifestations of meningitis in an infant
A
There are no pathognomonic sign of meningitis
- Infants:
- Poor sucking (50%)
- Irritability/ restlessness (60%)
- Temperature (60%)
7
Q
What is the work-up for meningitis?
A
- CBC, diff. , platelets, LP, U/A, electrolytes, cultures (blood, CSF, urine), EEG (if seizures) CT scan if focal seizures (maybe mass in brain c/I to LP)
8
Q
What is the Tx for meningitis?
A
- Prompt antimicrobial therapy
- Broad-spectrum agents (IV)
- 3rd Generation Cephalosporin
- Ampicillin (< 3 month)
- Add Vancomycin if resistance suspected
- Supportive care
- IVF restriction (SIADH)
- Head circumference
- Blood pressure support
9
Q
What are the sequelae of meningitis?
A
Hearing impairment (most common), paralysis or spasticity, ataxia, visual problems, hydrocephalus, seizures
- Detected abnormalities on neurological exam
- 30% at discharge
- <10% after 5 years
10
Q
DDx for meningitis
A
- Brain Abcess – may have neg gram stain, lots of WBCs, and normal glc
- Epidural/Spinal abcess
- Endocarditis with embolism
- Subdural empyema
- Ruptured dermoid cyst
- Brain tumor
- Medications
11
Q
What is the prognosis for meningitis?
A
Depends on
- Age
- Time or progression before onset of antimicrobial therapy
- Causative organism
- Rapidity of sterilization of CSF
- Underlying illness/ Co-morbidity
12
Q
What is bacteremia?
A
the presence of bacteria in the bloodstream
13
Q
What is sepsis?
A
a bacterial infection in the bloodstream.
14
Q
How can a person get bacteremia?
A
- Tooth brush + non-sterile mouth
- Bacteria may also enter the bloodstream from the intestine, but they are rapidly removed when the blood passes through the liver.
- Everyone gets some bacteremia – transient in very small amts*
15
Q
What should you do if you note bacteremia in a child?
A
- Get a good history - may suggest source (e.g., recent viral illness - damages epithelial barriers and allows bacteria in)
- Look for risk factors such as an IV or central line (CLABSI – central line associated bloodstreatm infection). Big deal now – public reportable.
- Know it may be benign but Never ignore a gram-negative rod!!
16
Q
How does sepsis occur?
A
- less common.
- most often - another infection somewhere within the body, e.g., lungs, abdomen, urinary tract, or skin.
- Although bacteria typically stay at the original site of infection, they sometimes spread into the bloodstream
17
Q
Risk factors for sepsis
A
- Immune suppression (HIV, drug, cancer) – cancer, neutropenic, can be very sick
- Antibiotic therapy (alters innate flora)
- Young age (birth to 24 months )
- Prolonged or severe illness
- Presence of a foreign object—IV, urinary catheter or prosthetic device
- Malnutrition
- Diseases or drug therapy that cause ulcers in the intestines (chemotherapy for cancer)
CF damages lung, can lead to sepsis
18
Q
Symptoms of sepsis
A
- Sudden development of high fever, chills, malaise, vomiting, diarrhea, irritability, shortness of breath, poor color
19
Q
Dx of sepsis
A
- Blood culture. Bacteria may not grow, particularly if taking antibiotics previously
- Cultures from urine, CSF, tissue from wounds, and material coughed up from the lungs (sputum)—may also be analyzed for the presence of bacteria
20
Q
Tx of sepsis
A
-
immediate Tx w/ antibiotics—even if results pending (delay decreases survival)
- target most likely to be present
- Often, 2-3 antbx together to increase the chances of killing the bacteria, until the source of the bacteria is known. (e.g., vanc, zosyn)
- Surgery prn to eliminate the source of the infection.
21
Q
What causes TB?
A
- Mycobacteria –acid-fast organisms (M. tuberculosis)
22
Q
How is TB spread / contracted?
A
- Spread by airborne droplets that are inhaled
- Organism multiplies in lung and nodes
23
Q
How long after infection will skin test for TB be positive?
A
4-8 wks after infection, hypersensitivity develops and skin test turns positive
24
Q
What are some non-specific Sx of TB?
A
low grade fever, malaise, anorexia.
25
How is TB dxed?
* Skin testing
* _PPD_--purified protein derivative intradermal
* Produce **induration** and erythema
* Induced sputum for acid fast bacilli
* Quantiferon
26
Do all positive Dx of TB get a CXR?
CXR now for baseline, but TB won’t show up yet – will do mths later.
27
Tx for latent TB
* PPD positive CXR negative
* INH for 9 months in children
28
Multi-drug regimen for active TB
* Usually 3-4 drugs
* Directly observed therapy
* 6 months -1 year
29
What might you see on a TB CXR?
hilar adenopathy: Enlargement of the lymph nodes within the lung hilum
30
Who do you tell if TB Dxed?
TB is requires MANDATORY reporting
The state health department will follow up
31
What if health care worker exposed to TB w/o mask?
PPD now and another 3-6mths later
32
What is cellulitis?
redness, pain, swelling of soft tissue
Often associated with trauma, skin damage, eczema
33
Common organisms in cellulitis?
Staphylococcus and Group A streptococcus most common organisms. Animal bites expand this list
34
What antibiotics are used to tx cellulitis d/t staph and strep?
Keflex, Clindamycin, Dicloxacillin
35
What antibiotics are used to tx cellulitis d/t animal bites?
require Augmentin to cover additional organisms
36
What antibiotics are used to tx cellulitis d/t CA-MRSA?
Bactrim, Clindamycin, Doxycycline
37
When is a soft tissue infection suggestive of orbital cellulitis?
Erythema around the eye associated with proptosis, visual changes, reduction in eye movements
38
When is a soft tissue infection suggestive of septic arthritis?
Swelling, pain, erythema, decreased ROM at a joint
39
What does erythematous streaking from the original site of a cellulitis suggest?
fascial planes – infection is spreading
possible necrotizing fasciitis
40
What does severe muscle pain in a cellulitis suggest?
* Myositis, underlying abscess *- sometimes not too red or swollen, but lotta pain – get U/S, CK for evidence of muscle destruction*
41
What concerns you about a cellulitis that will not respond to oral therapy?
Resistant? Abscess that needs draining? Wrong Dx?
42
What type of tick spreads Lyme?
*Ixodes scapularis* tick
43
What organism causes Lyme?
Caused by spirochete *Borrelia burgdorferi*
44
Phases to Lyme Dz
1. Early localized disease
2. Early disseminated disease
3. Late disease
45
DDx of erythema migrans
* Eczema (nummular)
* Ringworm
* Cellulitis
* Spider bite (other bites)
* Erythema multiforme
46
How can early localized Lyme be Dxed?
* No testing is available
* Testing based on antibodies that take at least 14-21 days to develop
* Negative test does not mean not Lyme disease
* Treat empirically
47
Sx of early disseminated Lyme Dz
* Multiple erythema migrans *in bloodstream*
* Flu-like illness
* Aseptic meningitis
* Neuritis (7th nerve palsy) *esp in CT, consider*
* Carditis: *may present w/episodes of syncope d/t bradycardia – heart block*
48
Sx of Late Lyme Dz
1. Lyme Arthritis
a. The knee is affected \>90% of the time
b. Mono- or pauciarticular
c. Duration of arthritis is variable
d. Usually resolves completely with
treatment, though it may recur
e. Chronic/recurrent arthritis *– not d/t infection, but d/t inflammatory response to infection*
49
What is the first test in a two-tiered testing for Lyme Dz?
Enzyme Immunoassay (EIA) or Immunofluorescence Assay (IFA)
50
What if the EIA or IFA is negative for Lyme?
consider alternate dx
or if s/s of Lyme _\<_30 days, consider convalescent serum
51
What if the EIA or IFA is positive for Lyme?
* S/S _\<_ 30 days: IgM and IgG Western Blot
* S/S \> 30 days: IgG Western Blot ONLY
52
Tx for Lyme
* Amoxicillin
* Doxycycline-for children over 8
53
How soon should you see improvement after Tx for Lyme?
24-48 hours after starting antibx
54
How should a tick be removed?
Tweezers, grasp close to head as possible. IF attached awhile, will leave some behind but leave it and let body take care of it – may release secretions if you work at it.
55
Differentiating between staph and strep skin infections
Purulence not a good indicator – rely more on Family history (esp may help w/mrsa, but also others), clustered (strep) or single (staph), time course (staph slower)
