27 May Ped Infectious Diseases

Question 1

Newborn found to have macrocephaly, corioretinitis, calcifications intracranially. Dx?

Answer 1

These are the classic Sx of congenital Toxoplasmosis

Question 2

Newborn with IUGR found to have cloudy lenses and hearing loss. Dx? Other common finding in this syndrome?

Answer 2

Congenital Rubella Syndrome
Most commonly due to infection of mother during 1st trimester.
Also commonly have PDA

Question 3

What diseases require prenatal antiviral therapy and cesarian delivery to decrease transfer to baby?

Answer 3

HIV and Genital Herpes

It is important to not have active herpes lesions during delivery or do a C-section

Question 4

What is herpangina?

Answer 4

Mouth blisters caused by coxsackie A virus
Most common in kids and in the summer
Causes fever, sore throat, blistering lesions in the mouth
Self-limited, no treatment, Dx clinical

Question 5

What are leptomeninges?

Answer 5

Pia and arachnoid mater

Question 6

What is beta trace protein?

Answer 6

Protein produced by the leptomeninges

Can be used to Dx CSF leak from nose and ears and can also be used to estimate GFR

Question 7

Explain CSF analysis for infectious causes of meningitis such as Bacterial, TB, Viral, Guillain-Barre

Answer 7

Normal: Glucose (40-70), Protein (less than 40), WBC’s (0-5)
Bacterial: Glucose low, Protein high (over 250), WBC’s high (over 1,000)
TB Meningitis: Glucose really low (less than 10), WBC’s elevated but less than 1,000, Protein over 250 like bacterial
Viral: Glucose normal, WBC’s elevated but less than 1,000, protein elevated but less than 100
Guillain-Barre: normal glucose and WBC, but very high protein

Question 8

What might be the cause of CSF analysis of:
Glucose 40
Protein 250
WBC 1,000

Answer 8

Bacterial (Low glucose, high WBC, lots of protein)

Question 9

What might be the cause of CSF analysis of:
Glucose 10
Protein 250
WBC 500

Answer 9

TB (really low glucose, lots of protein)

Question 10

What might be the cause of CSF analysis of:
Glucose 60
Protein 100
WBC 200

Answer 10

Viral (normal glucose, moderate protein, elevated WBC)

Question 11

What might be the cause of CSF analysis of:
Glucose 60
Protein 500
WBC 4

Answer 11

Guillain-Barre (normal glucose and WBC but really high protein)

Question 12

What congenital syndrome causes limb hypoplasia, cataracts, and skin scarring?

Answer 12

Congenital varicella syndrome

Question 13

What are the classic findings of congenital syphilis?

Answer 13

Hepatomegaly, maculopapular rash, sniffles, osteoarticular destruction

Question 14

What causes toxoplasmosis? How is it acquired?

Answer 14

Toxoplasma gondii

An intracellular parasite from cat feces, undercooked meat, unwashed vegetables

Question 15

What are the two more common causes of chorioretinitis?

Answer 15

Toxoplasmosis and CMV

Question 16

What is the treatment for Enterobius vermicularis infection?

Answer 16

This is pinworm where the eggs are laid around the anus leading to itching at night.
Albendazole and pyrantel pamoate are first line with the latter for pregnant patients. All household members should be treated as this is highly infectious.

Question 17

What are the disease features of Chagas disease and the causative agent? Tx?

Answer 17

Trypanosoma cruzi
Cardiomyopathy, RBBB, megacolon, megesophagus
First line treatment is Benznidazole

Question 18

How does strongyloidiasis present? Tx? Other disease treated with same medication?

Answer 18

Urticaria, abdominal pain, respiratory problems including cough dyspnea and wheezing
Tx is Ivermectin which also treats Onchocerciasis or river blindness

Question 19

What are the primary uses for metronidazole?

Answer 19

Protozoan infections like amebiasis, trichomonas vaginitis, as well as intraabdominal anaerobic infections such as diverticulitis, peritonitis, cholangitis, and abscesses

Question 20

What is quinine used for?

Answer 20

Treats malaria that is resistant to chloroquine

Question 21

What are the disease features of amebiasis?

Answer 21

Acute dysentery and liver abscesses

Question 22

What are the primary causes of osteomyelitis in kids with and without sickle cell disease?

Answer 22

Healthy Kids: Staph. aureus

SCD: Salmonella most but also S. aureus

Question 23

What is the treatment for osteomyelitis in kids?

Answer 23

Most commonly caused by Staph and Salmonella
Must cover Staph with either Nafcillin/Oxacillin if no MRSA suspected and use Clindamycin or Vancomycin if MRSA suspected
Add 3rd gen. cephalosporin in SCD

Question 24

What are three common causes of neonatal conjunctivitis?

Answer 24

First 24 hrs: chemical caused by silver nitrate ophthalmic prophylaxis
2-5 days: gonococcal
5-14 days: chlamydia

Question 25

What is the finding on gram stain for gonorrhea infections?

Answer 25

Intracellular gram negative diplococci

Question 26

What is the difference between gonococcal and chlamydial conjunctivitis in a neonate? How are they treated?

Answer 26

G tends to be more severe with marked eye swelling, profuse purulent discharge, and corneal edema/ulceration that appears 2-5 days after birth
Tx with one dose of IM 3rd gen cephalosporin

C tends to be less severe with mild eye swelling, serosanguinous or mucopurulent discharge appearing 5-14 days after birth
Tx with PO macrolide