CPS- ID Flashcards
iS HCV testing during pregnancy routine
Not currently but likely will be once formally adopted by SOGC
global HCV prevalence
1%
what is the predominant rf for HCV infection in canada
IVDU
vertical transmission rate of HCV
5%
vertical transmission rate for HCV with co-infection of HIV
10%
what factors increase risk fo HCV vertical transmission
higher maternal HCV titers, elevated ALT in the year before pregnancy, maternal IVDU, fetal scalp monitoring, prolonged ROM, infant female sex, being the second born twin
does HCV genotype affect risk of transmission
no
what % of children clear HCV infection
20-30% by age 2-3
what factors increase likeilihood of spontaenously clearing HCV infection
elevated ALT in first 2 years of life, infection with genotype 3, interleukin 28B single nucelotide polymorphism
how do majority of infants with HCV that do not clear present
2/3 will have asymptomatic infection with intermittent viremia, normal ALT, no hepatomeglay
1/3 have chronic active infection with persistent viremia, elevated ATL and hepatomegaly in some cases
how does HCV present in children and adoelscents
subclinical
factors associated with progression of HCV to cirrhosis
genotype 1a, co infection with HIV or Hep B, steatosis on liver biopsy
extrahepatic manifestations of hep c
MPGN, sub clinical hypothyroidism, elevated ANA, autoimmune thyroiditis
How to prevent HCV
treat reporductive age women before pregnancy, insufficient evidence for treatment during pregnancy
is there a difference in HCV transmission vag delivery vs. c section
no
is c section delivery recommended to decrease HCV transmission risk
no
does amnio increase HCV transmission
no, but should be counselled on risk
can you transmit HCV through breastfeeding
no
breastfeeding should be encouraged unless nipples are cracked, bleeding or there is co infection with HIV
what is preferred testing strategy for HCV in infants
serology at 12-18 months
infants with reactive serology at 12mo should undergo PCR testing
if cant assure follow up at 12mo, then should do HCV PCR asap, should be done over 2mo of age because sensitivity is limited before then
negative PCR at 2mo usually means vertical transmission did not occur, serology should still be done at 12-18mo to confirm antibody clearance
what does it mean if antibodies are negative over 6mo
They dont have HCV, dont need to do further testing with PCR
how to test for hcv in older kids
serology adn then if that is positive do PCR testing
how often to test kids at high risk for HCV ie. street involved youth
every 6-12mo
can hcv be transmitted through ADLs at home
no, no need for special precatusions cant be transmitted in salive, urine, stool
unrestricted child care and activities and parents are NOT obliged to notify that child is HCV positive
Who should be treated for HCV
all children over age 3 with evidence of chronic infection, technially the drugs are not approved for <12 but have been shown to be effective and well tolerated so treat
what type of Hib is in vaccine
B
what pneumococcal vaccine doe we use in canadad
PCV13
when should listeria be considered as cause of meningitis
risk factors such as immunosuppresion
brain stem infection
MIC for pen resistant vs suceptible
suceptible if MIC <0.06mcg/ml
resistant if >0.12mcg/ml
what should be used empirically for Hib
ceftriaxone because increasing beta lactam resistance so not suceptible to amp
rf for poor prognosis in meningitis
delay in antibiotic administration, severity of clinical state at presentation, isolation of non penicillin resostant suceptible strep pneumo
most likely organisms for meningitis in children over 2mo
strep pneumo and neissseria
consider GBS until 3mo
e coli also in younger
why add vanco for meningitis coverage
for possibility of cephalosporine resistant strep pneumo
who needs prophylaxisfor meingococcal disease
all close contacts
why gets priohp for hib
all occupants if cibtact households with infants < 12mo, children < 4 who are incompletely immunized
immunocomprimised children of any age
any index case <2 not treated with cefotax or ceftriaxone shuld get chemoprophylaxis at ed of therpay
how to treat GBS
pen G or amp
add gent for the first 5-7 days or until CSF sterility confirmed
evidence for steroids in meningitis
when given just before or within 2h of anitbioitcs, decrease hearing loss in Hib
if CSF gram stain shows gram negative coccobacilli consistent with H flu and H flu cultured, continue steroids for 4 ays
if HIb not cultured within 48h, steroids should be dc
same for strep
dose of steroids
.6mg/kg divided q6h given before or within 4h of antibiotics for better results
type of organism Hib
gram negative coccobacilli
fever after stopping steroids for meningitis
normal rebound fever, no need for additional testing if everything else is getting better
when to repeat CSF testing
if strep pneumo and received dex or resistant to penicillin or ceftriaxone
GBS at 24-48h of therapy
gram negative at 24-48h
when to image in meningitis
CSF not sterilized
neurologic symptoms o other specific complications
how long to treat strep pneumo, neisseria, hib, GBS
strep pneumo 10-14 days
neisseria 5-7 d
hib 7-10 days
GBS 14-21d
what is more common type of HSV
HSV 2 (75%), 25% HSV 1
factors that influence HSV transmission
mode of delivery, maternal infection, duration of ROM, use of itnrapartum instrumentation
in utero HSV effects
very rare
can cause skin lesions or scars, CNS disorders and chorioretinitis
transmission rates for first episode of HSV
60%
30% if first episode nonprimary (ie they have antibdies to another type of HSV but this is first presnetation with another type) ebcause of cross reactivity of antibodies there is still some protection
risk of transmission with recurrent HSV infection
2%
how to manage women with recurrent genital HSV
acyclovir starting at 36weeeks until delivery, this decreases risk for shedding but unclear if transfers to reduced risk for baby of getting HSV
what are main organs impacted in disseminated HSV
liver and lungs
time period for hsv to present
up to 6 weeks, usually within 4 weeks
does absence of skin lesions mean they dont have hsv
no
which type of hsv has worst mortality
disseminated
85% with disseminated and 50% with CNS disease died
when are HSV swabs more reliable
over 24h after birth
does negative HSV PCR mean no HSV on CSF
no, can repeat within 72h, might be negative early in disease course
is infant serology useful for diagnosing HSV
no
transplacental antibodies
how long to treat SEM disease HSV
14 days
how long to treat disseminated disease HSV
21 d
risk of acyclvoir
neutropenia
renal tox
what to add for ocular disease in bb with HSV
triffluridine 1% in addition to acyclovir
diagnosis of CNS HSV
PCR from CSF
what to do for baby born to mom with HSV lesions, asymptomatic and born by C section without ROM
swabs from mm and nasophayrngeal at 24h, discharge pending results
what to do for bb born to mom with first episode HSV at time of delivery born by vaginal delivery or c section with ROM
mm swabs
start acyclvoir
if swabs or blood positive, need CSF
if negative swabs, need acyclvoir for 10 days minimum
what to do for bb when mom had recurrent HSV born by c section
swabs at 24h and send home pendng results
what to do for bb when mom had recurrent HSV and vaginal delivery
mm swabs at 24h and discharge pending resukts
what to do when mom has known history of hsv but no active lesions at delivery
observe for signs of HSV
no swabs or treatment required
acyclvoir dose
60mg/kg div q8
do you repeat csf for hsv meningitis
yes at end of 21d treatment
if still positive, treatment should be extended with weekly sampling to determine stop time
when to give oral acyclvoir for bbbs
for suppression after treatment for CNS disease
less convincing evidence for skin disease but could still be offerred
what to follow on acyclvoir
monthyl cr, ur, cbc
contact precautions for bbs with HSV
contact when skin lesions present and until they have crusted over
asymptomatic neonates with mothers had active lesions until 14 days or swabs come back negative should ahve contact precautions
precatuions for mother with hsv
contact if active lesions until crusted over
whena mask if herpes labalis and bb under 6 weeks until lesions are cruested and dried, dont kiss their infant, can bf unless herpetic lesion on breast
cover skin lesions
encapsulated organisms
strep pneumo
Hib
neisseria
salmonella
capnocytophaga (cat and dog bites, high mortality)
how to give PCV13 vaccine
4 primary doses 2,4,6mo and 12-18mo
patients over 12mo-24mo withoutnprevious PCV doses should receive 2 doses 8 weeks apart
patient over 24mo only neeed one dose
when is highest risk for sepsis with asplenia
first 3 years of life if congenital
first 3 years after splenectomy
pen alternative for proph for asplenia
clarithromycin but not as good, more pneumococcal resistance
current vertical transmission rates for HIV
<2%
without intervention can be as high as 25%
rf for HIV transmission in preg
late or no prenatal care, IVDU, recent illness suggestive of HIV seroconversion, unprotected s with partner with HIV, diagnosis of STI in preg, emigration from HIV endemic area, recent incarceration
when does hiv transmission occur
time of delivery usually
some in utero
how to test for HIV in mom preg
first step is testing for HIV antibodies using enzyme immunoassay
if EIA is reactive, sample is re-tested using a more specific confirmatory test for HIV antibodies such as western blot
how to test for hiv in bb
HIV PCR, also used to quantify viral load
what to do is positive HIV test for mom or bb
immediate antiretrovirals for bb, ideally wihtin 72h
effects of antiretrovirals
anemia, neutropenia
general health, growth,m neurodev
how long to precatution for measles
4 d after onset of rash and for duration if immunocomprimised
how long to precatuion for measles contact
5 days from first day of exposure to 21 days after last day of exposure
how long precatuion mumps
9 days after swelling
precautions for varicella contact
from 8 days from first exposure to 21 days after last exposure to 28 days if VZIG given
what are spread airborne
varicella, measles, Tb, smallpox
