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Pediatrics > Bacterial Infection > Flashcards

Bacterial Infection Flashcards

1
Q

Etiologic agent whooping cough

A

Bordetella pertusis gram + bacilli

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2
Q

Mot of pertusis

A

Close contact respiratotmry secretions

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3
Q

Incubation period pertussis

A

6-20days

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4
Q

Characteristic of whooping cough

A

100 days cough

Successive cough with inspiratory whoop

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5
Q

3 stages whooping cough

A

Catarrhal 1-3weeks
Paroxysmal 2-4week
Convalescent 100 days

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6
Q

What is catarrhal stage of pertussis

A 
Most contagious stage
Nonspecific manifestation
Mild uri
Low grade fever
Important to diagnose early to shorten disease course
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7
Q

Paroxysmal phase pertussis

A

Obvious sign and symptoms
Successive cough ending with high pitched inspiratory whoop
Clinical pertussis
Machine gun burst of cough

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8
Q

Convalescent stage pertussis

A

Reduce frequency and severity of cough last 100 days

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9
Q

Diagnosis of patient with pertussis.

A

Cbc: highleucocyte count 15,000-100,000 with absolute lymphocytosis(leukemoid reaction)
Xray: perihilar infiltrate, atelectasis or emphysema

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10
Q

Total duration of pertussis

A

Up to 12 weeks

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11
Q

Complication and hospitalization of pertussis

A

Occur most commonly in the young under 6 months

Pneumonia, apnea, otitis, conjunctival hemorrhage,epistaxis, seizure, acute encephalopathy, hernia, pneumothorax

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12
Q

Differential diagnosis pertussis

A

Atypical pneumonia, chlamydia, mycoplasma, adenovirus
Tracheobronchial Tb
Foreign body
Bronchiolitis

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13
Q

Confirmation of diagnosis

A

Isolation of the organism from bordet gengou culture of nasopharyngeal mucus
Best yield during 3 weeks of illness
Pcr, fluorescent antibody, serology

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14
Q

Treatment of pertussis

A

Most effective during first 2weeks of illness
DOC: erythromycin 40-50mg/kg/day x 14 days
Other drugs: azithromycin, clarithromycin
All household contacts should be given chemoprophylaxis regardless the age and immunization status
Supportive:paracetamol, iv fluids
Vaccination

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15
Q

Drug of choice for whooping cough

A

Erythromycin

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16
Q

Etiologic agent syphilis

A

Treponema pallidum-spirochette

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17
Q

Mot of syphilis

A

Direct contact with the lesion
Perinatal intrauterine infection
Blood transfusion

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18
Q

Adult syphilis vs congenital syphilis

A

Adult syphilis

  • sexually transmitted
  • prevalent in adolescent

Congenital syphilis

  • vertical transmission from pregnant mother
  • transmission can occur at any stage
  • usually infected fetus die in the utero or shortly after birth
  • surviving babies have severe congenital and developmental anomalies
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19
Q

3stages of syphilis

A

Primary (site of penetration)

  • painless indurated ulcer
  • chancre usually found in the genitalia
  • after few weeks ulcer heals then goes secondary

Secondary(dissemination)

  • condyloma lata(wart like lesion on the anal verge)
  • skin lesion, fever rash

Tertiary(deep organ involvement)

  • gumma(granulomatous lesion)
  • neurosyphilis(tabes dorsalis) most prominent
  • cardiosyphilis
  • not due to the bacteria but by the tissue damage brought about by the bacteria
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20
Q

Early onset of congenital syphilis

A
  • first 2years of life
  • hepatomegaly, snuffles, lymphadenopathy, mucocutaneous lesions, pneumonia, osteochondritis rash, pseudoparalysis, hemolytic anemia, thrombocytopenia

-can be mistaken with neonatal sepsis, maternal history is important

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21
Q

Late onset of congenital syphilis

A

2 yrs old and above
Bone malformation( frontal bossing, saddle nose, saber shin-bowing of tibia)
Neurosyphilis
Mulberry molars
Rhagades(fissure which appears at the mucocutaneous junction)
Hutchinson triad( keratitis, hutchinson teeth, 8th nerve deafness

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22
Q

Diagnosis of syphilis

A

Darkfield microscopy
Serology-mainstay
- non treponemal= VDRL, RPR ( screening monitor response to therapy- quantitative test to measure ab titer)
-treponemal= FTA TPHA (confirmatory)

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23
Q

Treatment of syphilis

A

DOC: penicillin G
Newborn: aqueous crystallography ne pen G or procaine pen G
Children: benzathine pen G
Alternative: erythromycin/ tetracycline

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24
Q

Etiologic agent of salmonellosis

A 
Salmonella typhi(typhoidal human source)
S. Enteritidis, s. Cholerasuis(non typhoidal animal zoonitic source)
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25
Q

MOT of salmonellosis

A

Fecal oral contaminated food and water
Bacteria goes to the terminal ileum submucosal lymph node, monocytic infiltration of peyers patches

Non typhoidal: contaminated milk, dairy products water, pastries
Typhoidal: humans

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26
Q

Clinical features of s. Typhi typhoidal

A

Mild to severe prolonged presentation
Congenital infection/fetal typhoid: high fever low BW
Typhoid fever: high grade intermittent fever(stepladder) on and off for 2 weeks
Diarrhea(pea soup) or constipation
Abdominal distention
Rose spots appears on the 7th and 2nd week of illness on the trunk
Bradycardia, hepatomegaly, meningeal sign, typhoidal psychosis

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27
Q

Complication of typhoid fever

A

Occur on 2nd and 3rd week of illness-intestinal hemorrhage/ perforation- most dreaded complication
Peritonitis,jaundice, splenic rupture, pneumonia , encephalitis, nephritis, meningitis psychosis
Salmonella gastro enteritis= most common presentation of salmonellosis
-intestinal hemorrhage secondary to typhitis/ typhoid ileitis

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28
Q

Most common presentation salmonellosis

A

Salmonella gastroenteritis

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29
Q

Most dreaded complication of typhoid fever

A

Intestinal hemorrhage or perforation

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30
Q

Diagnosis of salmonellosis

A

Fecalysis: pus cells , rbc in the stool
Culture of blood (1-3wks), urine(first 2wks), stool (2nd -4wks), bone marrow aspirate(90%sensitive) last resort due to invasiveness

Widal test- for non endemic areas

Cbc: leukopenia, lymphocytosis-typhoid fever
Leukocytosis-non typhoidal

Serologic test: latex particle, elisa typhi dot( detects specific igm and igG

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31
Q

Mean incubation period of salmonellosis

A

24 hours

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32
Q

Treatment for typhoid fever

A

DOC: chloramphenicol 57-75mg/kg/day q6hx 14 days
Others:amoxicillin ceftriaxone, cefotaxime

NO ANTIBIOTICS FOR SALMONELLOSIS(self limiting)

33
Q

Treatment for salmonella gastroenteritis

A 
Fluids and electrolytes
Supportive antibiotics given only if:
1. <3 mos
2. Immunodeficient
3. Undernourished and blood culture positive
34
Q

Treatment for extra intestinal salmonellosis

A

Antibiotics prolonged for 4-6wks(bone infection), 4 wks (meningitis)

35
Q

Treatment for chronic carrier of salmonellosis

A

High dose ampicillin

36
Q

Prevention for salmonellosis and typhoid fever

A
  1. Personal hygiene
  2. Public health measures in food preparation and storage
  3. Infection control
  4. Vaccine- vi capsular polysaccharide vaccine one dose IM
37
Q

Etiologic agent of shigellosis

A

Shigella dysenteriae

38
Q

Mean incubation period of shigella

A

24hrs

Though as few as 10 organism can cause diarrhea (shiga toxin)

39
Q

Triad of shigellosis in infant

A

Dysentery
High grade fever
Seizure

40
Q

Clinical manifestation of shigellosis

A 
Bloody diarrhea(dysentery)
Fever
Abdominal pain, crampy borborygmous
Neurologic
Hus(just like EHEC)
41
Q

What is the most common cause of bloody dysentery

A

Shigella

42
Q

Treatment for shigellosis

A

Supportive and 3-5days antibiotics( cefixime, ceftriaxone,ciprofloxacin)

43
Q

Etiologic agent of cholera

A

Vibrio cholerae, vibrio parahemolyticus

Usually it is associated in history of eating shellfish that may lead to food poisoning

44
Q

Toxin of cholera responsible for epidemic disease

A

Strain 01 and 0139

Toxin is also called choleragen which causes severe secretory diarrhea

45
Q

Most characteristic manifestation of cholera

A

Voluminous diarrhea( rice water)

46
Q

Main problem in patient with cholera

A

Massive diarrhea that will lead to severe dehydration

47
Q

Clinical manifestation of cholera

A

Emesis
Low grade fever
Shock due to fluid volume depletion

48
Q

How to diagnose cholera

A

Stool rectal swab

Gold standard is culture of organism

49
Q

Complication of cholera

A

Renal- renal and pre renal failure
Cardiac-due to hypovolemic shock
Coma-due to poor cerebral perfusion
Volume depletion

50
Q

Treatment of cholera

A
  1. Correct hydration -very important to correct loss , antibiotics are only given for 3days so its not enough
    2.antimicrobials- doxycyclinie, tetracycline, TMO-SMZ, erythromycin,
    Ciprofloxacin,cotrimoxazole
51
Q

K1 capsular is associated with

A

NeonatL sepsis and meningitis

52
Q

Diarrhea strains

A

EPEC
EHEC
ETEC
EIEC

53
Q

Escherichia coli is

A

Gram negative bacteria

Belongs to enterobactericiae

54
Q

Travelers diarrhea strain

A

ETEC

55
Q

Manifest with bloody stool strain

A

ETEC

EHEC

56
Q

Manifest with watery stool strain e. Coli

A

EPEC

EAEC

57
Q

Produces shiga like toxin

A

Enterohemorrhagic e. Coli
0157 H 7
Colitis with bloody diarrhea

58
Q

Strain of infantile diarrhea

A

EPEC

59
Q

MOT OF e. Coli

A

Fecal oral route

60
Q

Most common cause of UTI

A

E coli due to poor perineal hygiene,ascending infection

61
Q

Diagnosis of diarrhea

A

History of uncooked meat

Stool culture-gold standard

62
Q

Treatment for diarrhea in patient with e.coli

A
  1. Rehydration
  2. ETEC-self limited
  3. Antibiotics are contraindicated with EHEC due to increase progression to HUS
  4. UTI- amoxicillin clavulanate, ampi sulbactam, cotrimoxazole
  5. Sepsis meningitis , pneumonia-ceftriaxone, cefotaxime
63
Q

Etiologic agent of tetanus

A

Clostridium tetany- anaerobic sporeformer neurotoxin

64
Q

Sourceof clostridium tetani

A

Soil, dust human and animal(feces, unsterile suture,rusty instruments nails scissors or pins)

65
Q

MOT of tetanus

A

Spores introduce into the area of injury or wound(direct inoculation)

66
Q

Portal entry of tetanus

A

Dental carried, otitis media, penetrating wounds, illiciting drug injections, abscesses, ear piercing, fire cracker injuries

Greater risk in deep punctured wounds, avulsion, crushing injuries

67
Q

Incubation period of tetanus

A

2-14 days after the injury

68
Q

Pathogenesis

A

Upon inoculation tetanospasmin bind with NMJ prevent neurotransmitter release-hypersympathetic state due to. Locked inhibitory neurons- nonstop tetanic spasm

69
Q

Clinical forms of tetanus

A

Neonatal tetanus
Generalized tetanus- most common
Cephalic tetanus
Localized tetanus

70
Q

Neonatal tetanus

A

Usually 3-10day
Difficulty in sucking, jaw stiffness
Excessive cry hoarse to starngled
Opisthotonous, apnea, paralysis,constipation, urinary retention spasm

71
Q

Generalized tetanus

A

Stiffness of the voluntary muscle- trismus/lockjaw, risus sardonicus, dyasphagia, opisthotonus,board like rigidity, flexed arms extended legs laryngeal spasm, tachycardia, sweats
-excitants provoke painful spasm and seizure
-intact sensorium
-dysuria
Urinary retention
Accumulation of secretion
Hyperactive dtr

72
Q

Cephalic tetanus

A

Involve bulbar musculature

Retracted eyelids,deviated gaze, trismus, risus, spastic paralysis of the tongue and pharungeal muscle(CN 3,4,7,9,10,11)

73
Q

Localized tetanus

A

Painful spasm of muscle adjacent to wound site

74
Q

Ddx of tetanus

A 
Rabies
Tetany
Polio
Bacterial meningitis
Drug reaction or withdrawal syndrom
75
Q

Diagnosis of tetanus

A

Based mainly on clnical lab testing, cant confirm or exclude the disease
CBC: mild pmn leukocytosis
Normal csf with mild opening pressure

76
Q

Complication of tetanus

A
  • aspiration pneumonia
  • atelectasis
  • laryngospasm
  • vertebral fracture
  • im hematoma
  • tongue lacerations
77
Q

Treatment of tetanus

A

Tetanus immuniglobulin 500units IM for infants 3000-6000 units IM (children and adults)

Antitetanus serum (ATS) caution for side effect—serum sickness

Recommended antibiotics:pen G and metronidazole
Alternatives: erythromycin and tetracycline(>8y/o)
Wound debridement
Admit to a quiet area with minimal stimuli
Supportive management

78
Q

Etiologic agent of staphylococcal infection

A

S. Aureus abscesses and toxin related

Colonizer of anterior nares

79
Q

Patient came in with high grade intermittent fever stepladder for 2 weeks with diarrhea(pea soup), abdominal pain and rose spots

A

Typhoid Fever

Pediatrics (6 decks)

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