ID Flashcards by Misun Jung

What is the most common site of origin of osteomyelitis and common spread?

What about most common site?

Metaphysis

Hematogenous spread, therefore can spread to epiphysis bc blood supply is connected until 8-18 mo

Femur is most common site

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What is the most common organism in osteo and septic arthritis?

Which organism is more common in septic arthritis?

Staph aureus followed by Group b strep

Neiserria gonorrhea is more commonly found with septic arthritis than osteo

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What are the most common organisms in EOS vs late onset sepsis?

EOS: GBs, ecoli, listeria, nontypeable flu and enterococcus
In Preterm, E coli is leading cause of EOS

LOS: coag neg staph, mssa, pseudomonas, then gbs ecoli and listeria

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Initial treatment for osteo or septic arthritis?

Penicillinase resistant penicillins (nafcillin, oxacillin, methicillin) and aminoglycoside or cephalosporin. Narrow based on cultures. Osteo: 21-42 days vs septic arthritis if staph aureus 4-6 weeks vs group b strep 2-3 weeks

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Treatment for omphalitis

Penicillinase resistant penicillins (methicillin, nafcillin, oxacillin)

Vanco if high local incidence of mrsa

Gent/cephalosporin for gram negative coverage

If umbilical region black-add anaerobic coverage

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Infection with which ecoli subtype is more likely to lead to meningitis?

Ecoli with K 1 antigen

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Which organisms are associated with worse outcomes in meningitis?

Gram negative, CSF WBC>500

Gbs if comatose, shock WBC<5000, ANC <1000 or CsF protein>300

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Most common neonatal organisms for UTI?

Most common spread?

Ecoli (#1), klebsiella, enterobacter

Hematogenous or ascending vs old kids is ascending

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What infection shows with placental micro abscesses?

Listeria

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What are the clinical findings of a mother with rubella infection?

Highest risk of defects at what GA?

Fever, coryza, conjunctivitis and althralgia

50% risk 9-12 weeks

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Most common cause of EOS in VLBW?

E Coli

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First abnormality to manifest in xray in neonatal osteomyelitis?

Soft tissue swelling
Then bone destruction 7-10 days after
If affects adjacent joint then joint space widening

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Cream colored macules on placenta, name the organism?

Candida

Wedged shaped microabscesses containing hyphae yeast and neutrophils

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What is the recommended treatment for severe varicella infection prenatally?

IV acyclovir

If mild disease oral acyclovir

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Full PPE is needed for Airborne organisms such as

Varicella, Covid, tuberculosis, measles

Travels long distance

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90% of blood cultures are positive by how many hours?

36 hrs

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Toxo transmission is higher/lower with advancing gestation?
Toxo severity is higher at early/late gestational age?

Transmission is higher with increasing GA
Severity is higher earlier in gestation

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Which type of conjunctivitis is considered a medical emergency?

Gonococcal conjunctivitis which presents 2-5 days bc if not treated w IV cephalosporin can progress to involve cornea and ulceration/penetration

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Gram positive rod associated with placental microabscesses

Listeria

Also described as chocolate colored mec staining
EOS-mother with prodromal flu like illness, zero type Ia and Ib and baby has sepsis/pneumonia
LOS-from maternal colonization, serotupe IVb, meningitis w milder symptoms
Pregnant Hispanic women more likely

Tx:amp/gent 14 days or 21 if meningitis

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Name treponemal and non treponemal tests for syphilis

RPR: Initial Screen (non treponemal)

FTA - ABS: Confirmation (treponemal)

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Mother with +RPR, + FTA-ABS, and received PCN <4 wk before birth. Next steps for mother and baby?

Check non-treponemal in mom and baby
Check treponemal in baby
Full eval and tx w PCN
FU non treponemal testing throughout 1st year and csf non-treponemal @6mo

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VariZIG is recommended in which population

5 days before and 2 days after hospitalized newborn <28weeks or <1kg
Immunocompromised or non immune

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How does parvovirus lead to hydrops?

Aplastic anemia, myocarditis and heart failure which in turn lead to hydrops

MCA doppler helps measure severe anemia

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Most common cause of EOS in term vs preterm

Term GBS

Preterm ecoli

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Which stool colonizing organism is associated with NEC?

Clostridium perfringes

Which is the first organ affected in congenital TB?

Liver Transplacental/Hematogenous spread via umbilical vein

Treatment for infant with congenital TB?

INH, rifampim, pyrazinamide and aminoglycoside (4 drug regimen)

What is the treatment of congenital toxoplasmosis?

Pyrimethamine and sulfadiazine Folinic Acid 1 year

Torch infections: 1. Transmission increases with gestation, disease is more severe if acquired earlier in pregnancy 2. Disease more severe if acquired later in pregnancy 3. Transmission u shaped distribution but disease more severe if acquired early 4. Disease more severe if acquired early

1. Toxoplasmosis 2. Treponema pallidum 3. Rubella 4. CMV, varicella Early w severe disease: CMV, varicella, rubella, toxo Later: syphilis

MCC congenital heart disease in congenital rubella

PDA and pulmonary arterial hypoplasia

Most common reason to get neonatal tetanus and management?

Improper umbilical cord handling Tx: tetanus immunoglobulin and pen G 10-14 days Diazepam for spasm Still need to vaccinate bc doesn’t lead to immunity

Describe organism and Treatment of pertussis

Gram negative bacillus Human only host Oral erythromycin (may lead to infantile hypertrophic pyloric stenosis) Some use azithro <1mo (not fda approved for this use)

What are the greatest risks for CLABSI’s?

Low birth weight Younger gestational age Similar rates between UVC (9 days) and PICC (14 days)

Risk factors for Hepatitis C transmission

- high maternal HCV viral load - High HCV RNA load - - maternal coinfection to on withHIV (increased risk 3-5 fold) - Female Neonate

Most serious side effect of ceftriaxone and MOA

Ceftriaxone can displace bilirubin from albumin leading to bilirubin toxicity

Most common site for Neonatal osteo

Metaphysis of long bones | Femur + tibia >>> humerus + fibula

Most common presentation of congenital syphilis

Hepatosplenomegaly (present in almost all affected | Respiratory distress

Pretern with LOS - what is Gram negative infection with highest mortality rate

Pseudomonas aeruginisa (45-70%) Psuedomonas is responsible for 2-5% of late onset infections with ELBW pts

Determine fetal risk by maternal parvo immunoglobulin levels

Maternal IgG + Maternal IgM - = Past infection No risk to fetus Maternal IgG + Maternal IgM + = Infection within last 7-120 days Possible risk to fetus Maternal IgG - Maternal IgM + = Acute infection High risk to fetus Maternal IgG - Maternal IgM - = Non immune pregnant 🤰🏽 No sign of acute infection *Consider repeating test in few weeks to assess if IgM becomes + (acute infection) No risk to fetus unless + IgM with repeat testing

Risk of late onset sepsis on VLBW

20%

Adverse antibiotic effects with VLBW

-Alteration of micro biome -Increased risk of candida infections (especially with 3rd generation cephalosporin in VLBW) increased risk for Nec Increased risk for late onset sepsis Increased mortality

Which intestinal microbe is most associated with pseudomembranous colitis?

Clostridium difficile

Most common organism for LOS?

CONS

Which side effect has been reported with fluconazole prophylaxis?

Transient hepatic dysfunction

If HepC is diagnosed after 18 mo and confirmed at 3 years which vaccines must be given to this child?

Hep A and HepB because a second cause of infectious hepatitis can increase cause of morbidity and mortality

Baby with HSV has been treated with acyclovir (IV) x 10 days. How do we minimize future neuro developmental disabilitues?

PO Acyclovir x 6 months

Infant with failed hearing screen, negatuve HUS, normal LFTs and paltelets, urine CMV PCR positive. Next best step?

Close audiologic followup q6 months for 3 years. If progressive hearing loss, offer early intervention. 10-15-% of asymptomatic infnats can have SNHL. Failed hearing screen and otherwise asymptomatic wouldnt meet criteria for valgancyclovir treatment. Only those w moderate to severe symptoms should begin treatment within 1 mo of birth

Hep B is a _____ _NA virus

Double stranded DNA

Which Hep B antigen is present when virus is rapidly replicating?

HepBeAg Usually present before symptoms and disappears before clinical symptoms resolve

How do you distinguish HepB immunity from prior infection vs vaccine?

Prior infection HepBsAg neg, AntiHepBc positive, AntibHepBs positive Vaccine HepBSAg negative, Anti-HepBc negative and AntiHepBs positive Remember you cannot have antibody core without having had hardcore HepB infection

Where does parvovirus replicate?

Within the RBC precursors Single stranded DNA

Celery stalking of long bone metaphysis. Which infection most likely?

Rubella Other associations: cataracts, salt and pepper chorioretinitis

Cmv is ____Stranded __NA virus

Double stranded herpes DNA virus Intranuclear and cytoplasmic inclusions

In patients of heterotaxy and poly/asplenia, which vaccines are recommended?

PCV 13 regular schedule and PCV-23 after 2 years. Meningococcal vaccine 2,4,6 and 12 months as well. In addition to routine vaccines.

Zidovudine toxicity manifests as

Lactic acidosis and hepatic abnormalities Macrocytic anemia and neutropenia are also possible effects of AZT treatment

Varicella Zoster Virus type

DNA herpes virus

Congenital Varicella Syndrome

Cicatricial lesions, limb abnormalities, cataracts/chorioretinitis

Chlamydia conjunctivitis treatment

Oral erythromycin 14 days Most common cause of conjunctivitis in the just month

Kostmann syndrome

Congenital neutropenia Responds to rG-CSF Autosomal recessive

GBS serotype responsible for meningitis

Serotype 3

Clostridium botulinum- what kind of bacteria, action

Anaerobe Gram positive bacillus Emits toxin inhibits release of Ach from nerves

Capsulated bacteria

Strep pneumoniae Haemophilus influenza Neisseria meningitides Salmonella typhi

Symptomatic congenital CMV disease treatment

Oral valganciclovir x 6 months neutropenia/LFTs side effects

Most common complication of subclinical congenital toxo that is untreated

Chorioretinitis

HIV Neonatal Management of: 1. Mom received standard ART w/ controlled viral load 2. Mom w/o ART or just intrapartum ART or lack of viral suppression 3. Confirmed neonatal diagnosis of HIV

1. Zidovudine 4-6 wks 2. Combination ART- Zidovudine x 6 wks + Nevirapine 3. Treat with at least 3 ART ALL HIV exposed infants receive PCP prophylaxis- batrim at 4-6 wks of age until determined uninfected

E coli strain- MC cause of meningitis

Citrobacter association

Brain abscesses- get MRI

Classic triad for toxo

Chorioretinitis Brain calcifications Hydrocephalus DNA PCR is the best test

Treatment for maternal primary toxo infection

Spiramycin

ID Flashcards

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