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ID Flashcards

(43 cards)

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1
Q

clinical features of congenital CMV

A

Distinct: periventricular calcifications

Other: IUGR, hepatosplenomegaly, thrombocytopenia, microcephalty, SNHL, chorioretinitis

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2
Q

Congenital CMV treatment indications

A

Indicated for: neonates with “moderate to severe” disease
(e.g. mulitple manifestations or CNS invovlement)
Controversial = isolated hearing loss

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3
Q

Congenital CMV treatment

A
  • start during neonatal period
    oral valgancyclovir x 6 months
    (IV ganciclovir if unable to tolerate oral)
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4
Q

Evaluation of infant with suspected congenital syphilis

A 
Physical: stigmata, ophtho, audiology assessments
CBC (LFTs)
CSF
Skeletal survey
syphilis serology
direct dection
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5
Q

Treatment of congenital syphilis

A

IV crystalline pen G x 10 days

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6
Q

Infant of mother with possible Zika exposure in pregnancy - next steps

A
  • maternal zika virus serology (and PCRs if exposure in previous 4 weeks)
    if positive THEN zika serology and PCR and imaging of infant
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7
Q

Features of congenital rubella

A

Distinct: cataract, bony lucencies, cardiac anomalies (PDA)
Other: IUGR, blueberry muffin rash, hepatosplenomegaly, SNHL

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8
Q

Features of congenital syphilis

A

Distinct: snuffles, rash on palms and soles, osteitis/perichondritis

Other: rashes, chorioretinitis, aseptic meningitis

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9
Q

Features of congenital toxoplasmosis

A

Distinct: macrocephaly, hydorcephalus, parenchymal calcifications

Other: chorioretinitis

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10
Q

Features of congenital VZV

A

Distinct: cicatricial scars, limb hypoplasia

Other: microcephaly, micoophthalmia, GERD

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11
Q

Features of congenital Zika

A

Distinct: subcortical calcifications

Other: microcephaly, brain malformations, macular scars, contractures

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12
Q

Most common bacterial pathogens in infants without a source by age
(for fever without a source)

A

0-28 days: GBS, ecoli
(other = listeria, staph auresu, GAS, klebsiella)
29-90 days: GBS, E.coli, S. pneumo
(other = neisseria, listeria, staph aureus, GAS)
3-36 months: S. pneumo
(other = staph aureus, GAS, neisseria)

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13
Q

Neonatal HSV - skin eye mouth (45%) features

A
  • usually 10-12 days of life
  • appear well
  • clinically silent CNS can occur and dissmeination can occur
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14
Q

Neonatal HSV - encephalitis (30%) features

A
  • usually day 16-19 of life
  • fever, decreased LOC, seizures, skin lesion in 2/3 of cases,
  • majority of survivors suffer neuro sequelae
    (40% have no skin lesions)
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15
Q

Neonatal HSV - disseminated (25%)

- features

A
  • day 10-12 days of life
  • sepsis like presentation, multi-organ involvement
  • 2/3 have concurrent encephalitis
  • majority of survivors suffer neuro sequelae
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16
Q

Treatment of neonatal HSV

A

IV acyclovir 60/kg/day
- 2 weeks for isolated mucocutaneous
- 3 weeks for disseminated or CNS disease
(repeat LP toward end of treatment)
- suppressive oral acylcovir x 6 months improves neuro ourcomes for those withCNS disease
- long ternneurodevelopmental follow up

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17
Q

Neonatal HSV risk factors for transmission

A
  • rupture of membranes > 6 hrs
  • fetal scalp monitor
  • HSV1 (> HSV2)
  • vaginal delivery (vs. c section)
  • first episode primary infection
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18
Q

Bacterial meningitis

- role for dexamethasone:

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A
  • H. influenzae
  • possibly strep pneumo
    ideally before or within 4 hrs of abx
19
Q

Necrotizing fasciitis risk. factor assessment

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A
  • GAS: recent pharyngitis, VZV
  • colonization with MRSA
  • exposure to water-borne pathogens
  • clodstridial or polymicrobial: recent GI surgery, pregnancy complications, penetrating trauma
20
Q

Nec Fasc empiric tx

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A
  • Beta-lactam-beta-lactamase inhibitor (e.g. pip-tazo) OR a carbapenem With clindamycin
  • add vanco if MRSA is a concern

otherwise healthy child can consider: pen G+clindamycin

21
Q

Pathogens in asplenic children

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A
  1. strep pneumo!

others: H. flu type B, neisseria meningitidis, campnocytophaga canimorsus (dog saliva), salmonella species

22
Q

Lymphadenopathy etiology

  • acute + bilateral
  • acute + unilateral
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A

Bilateral: Resp viruses, enteroviruses, adenovirus, EBV, CMV

Unilateral: S. pyogenes (80%), S. aureus

23
Q

Infectious lymphadenopathy etiology:

  • subacute bilateral
  • subacute unilateral
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A

Bilateral: HIV, EBV, CMV, toxoplasmosis
Unilateral: non-TB mycobacteria, M. tuberculosis, bartonella henselae, tularemia, plaque

24
Q

Cat-scratch organism

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A

Bartonella henselae

25
Lyme organisms
Borrelia burgdorferi
26
West Nile Virus features
Most common: asymptomatic (80%) 20% = west nile fever < 1% = west nile neurologic disease (aseptic meningitis, encephalitis, acute flaccid myelitis)
27
Complications of varicella
General: pneumonia, hepatitis, pancreatitis, nephritis, orchitis, thrombocytopenia Bacterial infections: e.g. nec fasc Neurologic: cerebellar ataxia, encephalitis, Reye syndrome, stroke, zoster
28
well-appearing baby born to mother with untreated gonorrhea
- conjunctival culture, IM ceftriaxone | if unwell, conjunctival blood and CSF cultures and consult ID
29
Baby exposed to chlamydia
- abx prophylaxis NOT recommended (risk of pyloric stenosis) - close follow up - PCR testing if develop sx - treat if PCR is positive
30
Reasons for reactive TB skin test
- tuberculosis - non TB mycobacteria infection - BCG in past - incorrect technique
31
Treatment latent TB infection
- INH x 9 months OR - rifampin x 4 months OR - INH+rif x 3 months OR - INH + rifapentine x 12 weekly observed doses
32
TB medication adverse effects - rifampin - isoniazid - pyrazinamide - ethambutol
Rif: liver, hypersensitivty rxn, memory, drug interactions, orange body fluids INH: liver, peripheral neuropathy Pyrazinamide: liver, increased uric acid Ethambutol: optic neuropathy
33
Prevention of HIV transmission
- antiretroviral therapy (triple ART starting in 2nd trimester or earlier) - IV zidovudine during labor - zidovudine x 4-6 weeks for infant - elective CS if viral load > 1000 - avoidance of breast feeding!
34
Needlestick injury and previously vaccinated
1. send anti-HBsAb stat - if positive can reassure 2. if negative do HBsAg - if HBsAg negative: HBIG and vaccine - if HBsAG positive: refer
35
Needlestick injury and incompletely vaccinated
Send anti-HBsAg AND HBsAG: - if both negative: HBIG and vaccine - if anti-HBsAg positive: complete vaccine series - if HBsAG positive: refer
36
HBsAg positive mother | - care of newborn
1. HBIG and HB vaccine within 12 hrs of birth 2. HB vaccine at 1 and 6 months 3. check immunity at 9-12 months
37
VZIG indications | give within ASAP within 10 days of exposure
1. immunocompromised children without hx of varicella (or immunziation) 2. susceptible pregnant women 3. newborn infant with mother having VZV within 5 days before delivery or within 48hrs of delivery 4. hospitalized prem infant > 28 weeks whose mother lacks proetction 5. hospitalized prem infant < 28 weeks regardless o fmatenral hx
38
Chemoprophylaxis - HIB - nesseiria meningitis - Strep pyogenes invasive disease - B Pertussis
HIB: rifampin Neisseria: rifampin Strep: cephalexin Pertussis: azithromycin
39
Chemoprophylaxis - Measles - rubella
Measles: Ig within 6 days, IVIG (alternative) Rubella: generally none but Ig may be considered in pregnancy
40
Daycare exclusion rules - strep and impetigo - diarrhea
- strep + impetigo: 24hr after tx initiated | - until resolution of diarrhea (+ 2x negative stool culture for E.coli 0157:H7, 3x negative culture for typhoid fever)
41
Daycare exclusion rules - measles - mumps - pertussis
Measles: until 4 days after onset of rash Mumps: until 5 days after parotid gland Pertussis: until 5 days after treatment
42
Daycare exclusion rules | - Hepatitis A
until 1 week after onset of illness or jaundice
43
Airborne precaution bugs
- varicella, zoster - measles - TB - smallpox
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