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Unit 2 68 > Ch 42 Bacterial & spirochetal: Bacterial infections: Pneumoncoccal, H flu & pertussis, Chlamydia trachomatis > Flashcards

Ch 42 Bacterial & spirochetal: Bacterial infections: Pneumoncoccal, H flu & pertussis, Chlamydia trachomatis Flashcards

1
Q

How does pneumococcal bacteremia present?

age, finding, lab finding

A

6 - 24 months
high fever > 39.4C
Leukocytosis > 15000

all three of these findings should arouse suspicion

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2
Q

What findings are specific to bacterial pneumococcal pneumonia?

beaver, Tac-P, Luke-Side-Toe,

A

Fever, leukocytosis, tachypnea
localized chest pain
localized or diffuse rales
XRAY may show lobar infiltrate (with effusion)

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3
Q

What findings are specific to bacterial pneumococcal meningitis?

beaver, Luke-side-toe,

A

Fever, Leukocytosis
Infants: Bulging fontanelle, neck stiffness
irritability and lethargy

Older children: nuchal rigidity, positive Brudzinski and Kernig signs

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4
Q

What are essential diagnostic tools for all bacterial pneumococcal infections?

A

cultures - blood, CSF, pleural fluid, or other bodily fluid

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5
Q

What vaccine has decreased the incidence of bacterial meningitis?

A

pneumococcal conjugate vaccine

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6
Q

What comorbidities in children increases the susceptibility to pneumococcal sepsis and meningitis?

What catastrophic findings will present in these children?

A

Sickle cell disease and other hemoglobinopathies
Congential or Acquired Asplenia
Immunoglobin and complement deficiencies

shock and DIC often occurs in these children

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7
Q

What organ is important in the control of pneumococcal infection?

A

spleen

this is why sickle cell disease children are at an increased risk for pneumococcal infections

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8
Q

Children with _______________ are at higher risk for pneumococcal meningitis.

A

cochlear implants

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9
Q

T/F Neonates with serious disease is caused by S Pneumoniae

A

FALSE! - rarely S pneumoniae causes serious disease in children. However, pneumonia, sepsis, or meningitis is clinically similar to GBS infection

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10
Q

T/F The drug of choice for pneumococcal infections is penicillin

A

FALSE! - Pneumococcal infections are likely to be resistant to penicillin (use to be the agent of choice and not all strands are resistant)

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11
Q

Pneumococcal infections:
WBC may show?
Other lab findings will show?
What is present on CSF?

A

WBC - leukocytosis (20-45k) with left shift (elevated poly. neutrophils)
Elevated CRP and procalcitonin
CSF: elevated WBC with neutrophils, low glucose, elevated protein

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12
Q

What is the diagnostic tool that will diagnose pneumococcal meningitis?

A

Lumbar puncture - gram-stained smear and culture is necessary to distinguish pneumococcal from bacterial meningitis

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13
Q

What are differential diagnosis fora young infant with high fever and leukocytosis, when pneumococcal infection is suspected?

A 
Viral infection
UTI
Salmonellosis
early acute shigellosis
infection else where in the body
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14
Q

Children that are severely ill or immunocompromised with invasive infection with suspected S Pneumoniae, should be treated with what specific medication?
If meningitis is also suspected, what should be given in addition to this medication?

A 
bacteremia treatment:
IV Vancomycin (GLYCOPEPTIDE)

meningitis - IV Vancomycin and Ceftriaxone (CEPHALOSPORIN)

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15
Q

A infant over 1 month old with known susceptible organisms of pneumonia, what medication is given? What is another choice of medication?

A

Pneumonia treatment in infant > 1 month
IV Ampicillin (PENICILLIN)
or
IV Ceftriaxone

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16
Q

What is the medication of choice for mild pneumonia?

What class of medication (and name) can be given as an alternative for mild pneumonia?

A

Amoxicillin for 7-10 days

Oral cephalosporin (Cefdinir) is an alternative for penicillin allergic patients

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17
Q

What two medications are the choice for severely ill or immunocompromised children with pneumonia if susceptibilities are NOT known?

A

IV Vancomycin
or
IV Cephalosporin-resistant pneumococcus

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18
Q

What alternative regimens can be given to a child with pneumonia that is allergic to penicillin and cephalosporin?

A

Fluoroquinolones (Ciprofloxacin, Levofloxacin, Ofloxacin)

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19
Q

You are awaiting results of bacteriologic confirmation and susceptibility testing on a child you presume has meningitis. What medication should you prescribe this child?

A

IV Vancomycin
AND
IV Ceftriaxone

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20
Q

The child you suspect has meningitis, you are awaiting for bacteriologic results, is allergic to beta-lactam antibiotics. What medication should you treat this child with?

A

IV Vancomycin and Levofloxacin (FLUOROQUINOLONE)
or
IV Vancomycin and Meropenem (CARBOPENUM)

Beta-lactam antibiotics include penicillins and cephalosporins

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21
Q

What adjunctive therapy is recommended for pneumococcal meningitis?

A

Corticosteriods - Dexamethasone

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22
Q

The lumbar puncture shows CSF pneumococcal meningitis that is susceptible to penicillin. What medication can be given? What can be used alternatively based on susceptibility findings?

A

Aqueous Penicillin G IV
or
Ceftriaxone (isolate must be cephalosporin susceptible)

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23
Q

When should the NP reorder a lumbar puncture after CSF proves patient has resistant pneumococci?

A

24 - 48 hours to ensure sterility of CSF collection

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24
Q

What specific serious neurologic sequelae may be present following pneumococcal or H. Influenzae meningitis?

A

Hearing loss - check hearing throughout course of illness and shortly after recovery. Child may need cochlear implants (sensorineural loss)

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25
Q

What medical illnesses present although uncommon due to vaccination of Haemophilus influenzae type B?

(MACE PP)

A 
Meningitis
Arthritis - septic
Cellulitis 
Epiglottis
Pneumonia
Pericarditis
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26
Q

Unencapsulated, nontypeable H. Influenzae frequently colonizes what?

A

mucous membranes

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27
Q

What does unecapsulated, nontypeable H. Influenzae cause in adults and children?

A 
Otitis media
Sinusitis
Bronchitis
Pneumonia
*invasive disease*
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28
Q

What medication is resisted by nontypeable H. Influenzae?

A

Ampicillin

low BLNAR strains in US

29
Q

What treatment is necessary for people that are unimmunized, or partially immunized, household contacts of a Hib patient?
Any contraindications to this treatment?

A

Rifampin chemoprophylaxis of all household contacts (except pregnant women) to eradicate potential nasopharyngeal colonization with Hib and limit risk of invasive disease
Contraindications: pregnant women

30
Q

What are three examples of when Rifampin chemoprophylaxis should be given to all household contacts?

A
  1. families where at least 1 household contact is < 4 yr old and unimmunized/partially immunized against Hib.
  2. Immunocompromised child of any age or immunization status resides in the household
  3. a child younger than 12 months resides in the home and has not received the primary series of the Hib vaccine
31
Q

What symptoms are specific to Hib and non-type B invasive disease with suspected meningitis?

A

Infants: fever, irritability, lethargy, poor feeding with or without vomiting
high-pitched cry

32
Q

What symptoms are specific to Hib and non-type B invasive disease with suspected acute epiglottitis?

A 
evidence of *dysphagia* is most useful early sign with s/s of refusal to eat/swallow saliva, and drooling
high Fever (toxic child)
33
Q

What symptom may not always present in Hib and non-type B invasive disease with suspected acute epiglottis?

A

cherry-red epiglottis on direct examination - INTUBATE IMMEDIATELY

34
Q

What symptom is a late sign specific to Hib and non-type B invasive disease with suspected acute epiglottis?

A

stridor

35
Q

What symptoms are specific to Hib and non-type B invasive disease with suspected septic arthritis?

A

Unimmunized < 4 years old with fever and refuses to move involved joint and limb

swelling, warmth, redness, tenderness on palpitation, and severe pain on physical exam

36
Q

What symptoms are specific to Hib and non-type B invasive disease with suspected cellulitis?

A

3 months - 4 years old unimmunized child

cheek or preorbital (preseptal) area is often involved

37
Q

What will the CBC reveal in a child with suspected Hib infection?

A

high or normal with a shift to the left

38
Q

What other diagnostic tools are utilized in the suspicion of Hib infection?

A

positive blood culture
CSF - meningitis pleomorphic gram-negative rods
aspirated pus or fluid from site

FDA approved PCR test for CSF

39
Q

What XRAY is best for a child with suspected Hib infection?

A

lateral neck - epiglottits (can be misinterpreted)

40
Q

T/F All patients with bacteremic or potentially bacteremic H. Influenzae diseases require hospitalization for treatment

A

TRUE! - hospitalized and third generation cephalosporins

41
Q

What treatment should be selected for the child with suspected H. Influenzae meningitis infection? Duration of therapy?

A

IV Vancomycin and Ceftriaxone (IM if IV access lost)

10 days

42
Q

What class of medications is best for Hib infections?

A

3rd generation cephalosporins (cefotaxime or cefttriaxone

43
Q

Once the organism has been identified as H influenzae in a child with meningitis, what treatment should be given before antibiotics? What will this treatment prevent?

A

6 hours before antibiotics give Dexamethasone for up to 4 days

prevents hearing loss

44
Q

Why would a NP order a follow-up lumbar puncture for Hib meningitis?

A 
*the NP would not usually order this unless*
questionable clinical response
seizure after several days of treatment
abnormal neurological exam
recurrent fever
45
Q

What is the initial treatment for a patient with septic arthritis with suspected H. Influenzae organism?

A

Antistaphylococcal antibiotic
and
Cefotaxime or Ceftriaxone (CEPHALOSPORIN)

46
Q

How long is the duration of therapy to treat H. Influenzae septic arthritis?

A

2 - 4 week course of antibiotics (longer if complications or s/s are unresolved)

47
Q

Besides antistaphylococcoal and cephalosporin antibiotics for H. Influenzae septic arthritis, what else is an essential part of treatment?

A

Drainage of infected fluid - surgical drainage if in the hip, if treatment is delayed, or clinical response is slow

48
Q

What is the initial treatment for a patient with cellulitis with suspected H. Influenzae organism?

A

broad spectrum antibiotics

Amoxicillin - PENICILLINS or Clindamycin/Azithromycin (MACROLIDE) if penicillin allergy

49
Q

If a patient with cellulitis has positive results of H. Influenzae organism, what will be the medication of choice?

A

CEPHALOSPORIN - Cefotaxime or Ceftriazone
or
CARBAPENEM - Meropenem

50
Q

How long is the duration of therapy to treat H. Influenzae cellulitis?

A

3 - 7 days parenterally followed by PO therapy

**minimum course of 21 days in uncomplicated cases without abscess*

51
Q

T/F A fever above 38C is a typical finding of pertussis infection

A

FALSE! - a fever > 38.3 C is unusual and suggests an alternative diagnosis

52
Q

What are the three stages of Pertussis?

A
  1. Catarrhal: 7 - 10 days
  2. Paroxysmal: 1 - 6 weeks - high-pitched “whoop” at end of cough
  3. Convalescent: 7 - 10 days gradual recovery
53
Q

What clinical findings may follow coughing found in pertussis?

A

cyanosis
sweating
prostration (action of lying stretched out on the ground)
exhaustion
coughing fits are more frequent at night

54
Q

T/F It is best practice to wait for pending results of a potential pertussis organism before treatment

A

FALSE! - early treatment for suspected pertussis is best practice

55
Q

Pertussis
WBC:
Severe disease findings in young children:

A

WBC 20-30k with lymphocytes typically near the end of the catarrhal stage
the degree of lymphocytosis correlates with the severity of disease
Severe: Pulmonary HTN and Hyperleukocytosis

56
Q

T/F Older children with mild pertussis infection never demonstrate lymphocytosis

A

TRUE! - mild infections in older children and adults will never have lymphocytosis

57
Q

What finding may present on chest XRAY on a child that has a pertussis infection?

A

thickened bronchi and “shaggy” heart border

58
Q

What diagnostic test is only best for pertussis identification in the first 3 weeks of cough?

A

rapid antigen test (PCR) of nasal cavity

59
Q

What medications are best for treatment before the paroxysmal stage of pertussis infection?

A

Antibiotics in the catarrhal phase - no effect on clinical symptoms in the paroxysmal stage. Initiate as quickly as possible.

60
Q

What antibiotics are best for treatment of the catarrhal phase of pertussis infection?

A

Azithromycin (MACROLIDE) drug of choice
Erythormycin (MACROLIDE) is not preferred but acceptable
Clarithryomycin (MACROLIDE) must be > 1 month old

61
Q

What is a contraindication of erythromycin treatment for pertussis?

A

Infants < 1 month old
erythromycin can cause pyloric stenosis; azithromycin is least likely to cause this but inform parents of potential risk and signs of pyloric stenosis

62
Q

What therapy is most important during the paroxysmal phase of pertussis?

A

Nutrition - small frequent feedings, tube feeding, or parental fluid supplemenation
Minimize stimuli that trigger coughing

63
Q

What infection typically presents within a few days after birth until 16 weeks of life with watery, mucopurulent, to blood discharge and conjunctival injection?

A

Neonatal Chlamydia conjunctivitis

64
Q

What preventive measures are best to reduce the rate of chlamydia conjunctivitis?

A

diagnosis and treatment of pregnant women and their partners

oculcar prophylactic antibiotic after birth is only for gonococcal infection, NOT C. Trachomatis

65
Q

What specific chlamydia infection is the leading cause of acquired blindness worldwide?

A

C trachomatis trachoma - 4-6 years old and in poor hygienic countries often

66
Q

What findings are most present in infants with C trachomatis pneumonia?

A

afebrile
tachypneic
staccato cough

67
Q

What medication treatment is best for chlamydophila pneumonia?

A

Azithromycin or doxycycline (MARCOLIDE)

68
Q

What medications are most effective for neonatal conjunctivitis or pneumonia? What is a potential complication from these medications?

A

10-day course of Erythromycin base or Ethylsuccinate
Azithromycin - increased compliance

both are associated with pyloric stenosis

69
Q

What medication is recommended for children with trachoma?

A

single dose Azithromycin

consider treating the community/regional mass if population is > 10 % of trachoma cases

Unit 2 68 (32 decks)

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