CPS ID Flashcards
1
Q
UTI prophylaxis
Indications & how
A
Grade 4/5 VUR or significant GU anomalies
Consult Nephro/urology
septra/nitrofuratoin 1/3 of treatment dose OD
duration 3 - 6 days
change/stop if resistance
warn low threshold for testing UA
2
Q
sinusitis (AAP) diagnosis & Treatment
A
- > 10 days cough, nasal discharge
- worsening (new discharge, fever, cough)
- acute onset (fever > 39, purulent nasal d/c)
Rx: amoxicillin or amox/clav 10 - 28 days
(45mg/kg/day or high dose 90mg/kg/day)
3
Q
Risk factors for influenza (6)
A
age < 5 Aboriginals asthma/CLD/CF etc cardiac - exclude isolated HTN DM, CKD, Liver disease, rheumatologic hemoglobinopathies immunodeficiency homes/chronic homes
4
Q
UTI risk factors
A
< 12 months old white race fever > 39 fever > 2 days no obvious source
5
Q
growth required for UTI
A
clean catch 10^8 CFU/L
catheter 5x10^7 CFU/L
suprapubic - any growth
6
Q
UTI microbiology & empiric choices (PO + IV)
A
Klebsiella Ecoli Enterococcus fecalis, enterbacter cloacae Pseudomonas Staph saprophyticus, serrata citrobacter
Cefixime PO (3rd gen) IV hospital - gent +/- ampicillin or ceftriaxone/cefotaxime
7
Q
ID control - pediatric office
Disinfection requirements
A
- critical - ie needles - sterilzation
- semicritcal (contact MM, non intact skin - speculum) - sterilzation or high level disinfection
- non critical (intact skin only - ie BPcuff) - immediate or low level - alcohol wipe
- environmental - low level or detergent/water
8
Q
ID control - pediatric office
health care worker - restrictions from office
A
influenzae, measles, mumps, pertussis, rubella, TB active, varicella
9
Q
how to prevent mosquitoes and tick bites?
4
A
- avoidance- dusk, dawn, woodlands for Ticks
- physical barrier - screens, bed nets
loos, long fitting. lightly colored clothes
Inspect child at least daily- remove with 24hr prevent Lyme disease - Repellant
6 mo - 12 years old - icaridin 1st choice
> 12yo - DEET up to 30% - insecticides - permethrin can be sprayed on clothing
10
Q
Indications for macrolides
A
atypical pneumonia - H influenzae, morexalla catarrhalis etc
2nd line - life threatening beta lactam allergy in acute GAS pharyngitis
Should not be used for AOM, pneumonia 1st line
11
Q
mucocutaneeous candidasis
- name 2 types and treatment
A
- oropharyngeal (oral) thrush
- topical gentian violet
- nystatin suspension - 80% for 2 weeks
- 1st gen - clometriazole
- 2nd gen fluconazole if fail conventional/immunocompromised - candida diaper dermatitis
- topical antifungals (clometrizole, nystatin)
12
Q
Tinea capitis
- describe lesion and rx
A
single or patches of alopecia with plaques
+/- boggy edematous plaque = Kerion
Rx: oral griseofluvin, terbinafine (lamisil) 4 - 6 weeks
13
Q
TInea corporis
-describe lesion and rx
A
ringworm - lesions, circular
via direct contact
topical clotrimazole, terbinafne BID 2-3weeks
14
Q
Tinea Pedis
-describe lesion and rx
A
athelete’s foot. pruitic, erythematous, scaly lesions between toes
topical clotrimazole
15
Q
Pityriasis versicolor
-describe lesion and rx
A
mild or chronic condition with scaly hypo/hyperpigmentation on trunk.
often adolescent
NOT dermatophyte infection - malassezia
Rx: topica ketaconazole, clotrimazole
nightly 1 -2 weeks, then qmonth x 3 months
16
Q
Risk factors for invasive meningococcal infection (5)
A
anatomical/functional asplenia immunodeficiency complement or factor D deficiency Travellers to high risk area lab personale with exposure military
17
Q
when to give MCV-C?
Menjugate serotype C
A
all children @ 12months
earlier if risk factors @ 2, 4, 12mo (or by provincial schedule)
18
Q
When to give MCV-4?
Menatra A, C, Y, W-135
A
ALL booster with MCV4 or MVC-C at ~ 12 yo
if risk factors @ 2 year old
if HIV at anytime if >/= 2 year old
19
Q
Neisseria Meningitidis
- what is most common serology
A
Vaccinate A, C, Y, W-135, so most common now type B serotype (just new vaccine)
peak incidence < 5 year old.
20
Q
why Neisseria Meingitidis so bad?
A
Serotype C- associated with outpbreaks, higher rate of sepsis and mortality
can cause meningitis, septic arthritis, pneumonia, conjunctivitis,
extremely variable - occult bactermia to fulminant fatal disease
10% mortality in invasive disease
21
Q
4CMenB or Bexsero
-who and when to give?
A
risk of meningococcal invasive disease -functional/asplenia -immunocompromise - complement or factor D deficiency -(military/lab personale)- unclear for B When: 3 doses @ 2, 4, 6months s/e - higher rates of fever
22
Q
Neisseria Meningiditis - B serology
epidemiology
A
vaccine still unsure effectiveness 70% before 6 months hence @ Vaccine 2, 4, 6mo mortality 3.8% for infants < 1 year old ICU for 60%, morbidity 10% dec IQ, seizures, SNHL, motor impairment, visual loss
23
Q
what is palivizimab
A
humanized murine monoclonal IgG-1 against RSV
reduces 80% of hospitalizations in premature infants
Decreased parent reported wheezing
No proven short term benefit for ICU/deaty
24
Q
Indications for RSV palivizimab?
A
GIVE: - hemodynamically sig CHD/CLD (need O2 @36GA) with O2/diuretics/puffers < 12mo old OFFER (not essential) -- premature < 30GA & < 6mo old -- Remote (air) < 36GA & < 6mo old CONSIDER: - Inuit term, if < 6mo old - immunocompromised & home O2 < 24mo old
25
How to give palivizimab
eligible - RSV prior to d/c
IM 15m/kg q30 days max 3- 5
if breakthrough - d/c
26
Types of vascular access device
| Name pros/cons
1. peripheral
- easy insert
- phebitis common. med extravastion
2. midline cateter
- easy insert. more stable than PIV
- limited # of sites, not widely used
3. PIC line
- insertion less invasive than others
- difficult blooddraw, may need TKVO
4. Tunnelled/Broviac
- multiple lumens, blood draws
- needs GA for insertion. ongoing care
5. Implanted port
- lowest infection risk. minimal effect on pt
- insertion invasive. Not good for daily access
27
Home IV therapy
| common complications
mechanical failure - insertion, thrombosis, dislodgement, occlusion, leakage
Infectious
metabolic - eletrolytes, hypoglycemia etc
Treatment related
28
3 considerations for home IV therapy candidate
1. clinical factor - indication, health of patient, risk for complications
2. patient/family - compliance, reliable
3. medication - duration, frequency, .
29
Prevention of blood infection
| 4
- restrictive donor selection
- limit # transfusions
- manufacturing - aseptic techniques, viral inactivation. Leukocyte reduction
30
blood transfusion - infection risk
```
HBV - ~1 in 1 million (1.1-1.7)
HCV - ~1 in 5 million (5-7)
HIV - ~1 in 10 million (8-12)
Syphillis < 1 in 100million
Bacterial (platelets) 1:50,000
```
31
Adverse Transfusion events
| 4
rate of adverse events per product transfused 1/3000
- TACO almost 50%
- severe allergy/anaphylaxis/anaphlyactoid 15%
- hypotensive 12%
- TRALI 10%
32
what is tested in blood?
HIV, HBV, HCV, syphillis
HTLV 1, 2, WNV
Bacteria on platelets
(CMV select units only)
33
what are the risk factors for invasive pneumococcal disease?
immunocompromised (HIV, CRF, nephrotic, meds)
functional/asplenia
immunocompetent: CHD, CLD, DM, CSF leaks
34
8 steps vaccine safety system
1. pre-license review & process (gv't regulator)
2. manufacture regulations (strict procedures)
3. independent expert review (NACI)
4. immunization competencies for providers
5. surveilence for AEFI (AE following immunizations) - passive & active
6. AEFI - causality assessment
7. effective signal detection
8. research network and special immunization clinics
35
what is Lyme disease caused by?
Borrelia burgdorferi (bacterial)
lxodes blacklegged (ticks)
primary hosts: mice, rodents, small mambles, birds, white tailed deer
climb & wait on grass/shrubs
36
Lyme disease
| (3) manifstations
1. Early local/Erythema Migrans
- 7-14 days after tick bite. erythematous macule w/ central clearing
- painless, non pruritic
- +/-fever, malaise, myalgia
2. early disseminated
- multiple EM
- secondary annular erythematous lesions
- neurological - facial nerve palsy, lymphocytic meningitis
- Lyme carditis (heart block, rare)
3. late disease
- pauriarticular arthritis (large)
- peripheral neuropathy,
37
Lyme disease diagnosis
EM - history and clinically needed only
Early disseminated & Late: 2 step serological
1) ELISA
2) western blot
- antibodies not detected within first 4 weeks
- if menigitis - CSF IgG and IgM possible
38
Lyme disease treatment
PO - amox < 8, doxy > 8 (alt cefuroxime 2nd)
1) EM - self resolve 4 weeks but rx PO 2-3ks
2) isolated Facial palsy PO 14 - 21 days
3) arthritis - PO 28 days
IV Pen G or cetriaxone
1) carditis/heart block IV 2 - 3 wks
2) meningitis 2-4wks
3) encephalitis/late 2 - 4 wks
39
Complications of Lyme disease (2)
Jarish-Herxheimer reaction
- fever, headache, aggravated clinical <24hr when Rx started
- NSAIDs, continue
Post-treatment Lyme disease syndrome
- unknown etiology
- 10-20% persistent fatigue, joint/muscle ache
- prolong abx course not helpful
40
S/E tetracyclines
discoloration of teeth/staiing
s/e nausea, diarrhea, rash, photosensitivyt
rare - hepatotoxicity, neutropenia
41
Why is Autism not related to vaccines
1998 Wakefield report based on 8 pts. retracted, pulled,
Causuality interpretation - fails consistency, strenghth, specificity
Thimersol - ASD inc despite removed from vaccines (was only in Influ and HBV)
42
Breastfeeding Contraindications
HIV, HTLV1, 2
Brucellosis
active TB (until rx 2weeks)
infant - classic galactosemia
Possible:
Active HSV lesions (cover with mask. if breast lesions, interrupt until crusted or use EBM)
Mastoiditis with pus (can pump/other side)
Med:
high dose metronidazole - d/c 12-24 for discard
caution antimalaria/sulfa med if G6PD
43
Tuberculin skin test
| false negatives
```
young children (< 6mo)
during incubation period (2-10weeks)
administration technique
concurrent - Measles, varicella, etc.
overwhelming TB
malnutrition
immunosuppression
immunocompromised (ie HIV)
```
44
TST
| false positives
previous bcg vaccine
non-tuberculosis mycobacterium
incorrect technique
incorrect interpretation
45
TST interpretation
| who positive < 10mm
0-4mm if child < 5 years old AND high risk TB infection
5 -9mm if immunosuppressed
(HIV, organ transplant, corticosteroid, TNF alpha, ESRD)
contact with active TB in past 2 years
fibronodular dz on CXR
>/=10mm all others
46
Who to screen for TB with TST?
- contacts known active TB
- children suspect active TB
- known risk factors for progression from infection to dz
- Travel > 3 mo in endemic area
- From endemic areas within previous 2 years
47
Who is high risk of development of active TB?
```
AIDS
transplant (related to med)
silicosis
CRF needing HD
carcinoma head and neck
recent TB (2 years)
abnormal CXR - fibronodular
```
48
Pros of IGRA testing
measures in vitro production of Interferon gamma by sensitized lymphocytes in response to TB. SPECIFIC antigens, not in BCG vaccine/non TB strains. = 1. more specific
2. . single visit (fast turn around)
3. less subjective to interpretation
49
When to test IGRA?
```
children > 5 + BCG vaccine
unable to return for TST read
To facilitate TST for dx
- not correspond to clinical suspicion to inc sensitivity
-non TB disease suspected
-low risk contact situations
```
50
What is bronchiolitis?
acute inflammation, edema, necrosis of epithelial lining of small airways & increased mucous production
51
Risks factors for severe bronchioloitis
premature < 35GA
< 3 months at presentation
hemodynamically significant Cardiac dz
Immunodeficient
52
discharge criteria for bronchiolitis
```
tachypnea and WOB improved
O2 > 90 without O2 or stable home o2
adequate PO
education provided
f/u arranged
```
53
In Rx of bronchiolitis, what is NOT recommended and what is equivocal?
Equivocal
- epi neb
- HTS nebs
- nasal suction
- epi/dex combo
NOT
- ventolin
- steroids
- antibiotics
- antivirals
- cool mist therapies
54
what is transmission risk for congenital syphilis?
primary/secondary untreated 70 - 100%
early latent - 40%
late latent < 10%
55
when is syphilis tested for in pregnancy?
@ first prenatal visit
rescreen 28 - 32weeks & @ delivery if HIGH RISK
If unexplained hydrops/stillbirth, screen post partum
56
When to evaluate for congenital syphilis
-signs and symptoms
-mother not treated or adqeuate documentation
-treated within 30 days delivery
-treated with NON-penicillin
-< 4fold drop in other non treponemal titre
Relapse or reinfection
57
What are clinical findings congenital syphilis
```
snuffles
maculpapular rash w desquamation
DAT neg hemolytic anemia
psuedoparalysis
chorioretinitis, glaucoma
```
58
What is the clinical scenario NOT to work up for cong. syphilis
1. appropriate treatment during pregnancy (not within 30 days of delivery)
2. 4fold or greater drop in maternal RPR titer
3. infant RPR non reactive or = mothers
4. infant asymptomatic
--> clinical and serological f/u 18 months
59
Evaluation of congenital syphillis
```
P/E - stigmata + ophtho + audiology
CBC, LE, LP
syphilis - RPR & treponemal testing
skeletal survey
direct detect - placental, umbiliical via darkfield microscopy
```
60
what is treatment for congenital syphilis?
- proven, probable disease OR
- asymptomatic, risk based on history:
IV Pen G 10 - 14 days
61
risk factors CA-MRSA?
```
overcrowding
frequent skin-skin
activities that result compromised skin surface
share contaminated personal items
difficult personal hygiene/cleanliness
limited access health care
Aboriginal, athletes
day care attendees
IVDU, MSM
Prisoners
```
62
CA-MRSA skin abscess treatment (empiric) ?
< 1 month - IV Vanco + admit
1-3mo + WELL = I&D, PO septra
>3mo + WELL = I&D only
>3mo + sx* = I&D + septra AND keflex
*significant cellulitis, < 38 fever
PO duration = 7 days.
cephlexin - better coverage of GAS
63
Head lice treatment
Permethrin 1%
-shampoo, leave 10mins, rinse cool water
- repeat in 1 week
s/e itch & mild burning sensation on scalp
- NO require school exclusion
64
Why 2 dose varicella vaccines?
Primary failure = protective ab not produce (unable to detect immunity with vaccines)
secondary failure = weaning immiunity
65
When to give Varicella vaccines?
2 doses
@ 12 - 18 months
@4 - 6 years
provide to people who only have 1 shot
post-partum if mom not immune
66
Approach to vaccine hesitant families?
1. understand specific concerns of parent (dont add more)
2. clear, focused language
3. inform rigor of vaccine safety system
- independent, NACI, CPS, tracking, special clinics
4. Do not dismiss from practice
5. F/U, consider referral to peds ID
67
Strategies for antimicrobial stewardship (5)
1. Accurate diagnosis
- delay Rx if viral likely
- test judiciously
- know contamination vs infection
2. antibiotic selection
a) narrowest spectrum
b) optimize dosing to obtain max benefit (ie aminoglycosides OD for dose dependent dosing)
c) if drug reaction - address
3. antibiotic duration
4. prevention - vaccinations
68
what is recommendation for egg allergy & influenza vaccines?
FULL dose inactivated trivalent or quadrivalent SAFE
-observation as with other vaccines
not use live attenuated (intranasal) - insufficient data
69
What is rate of HIV vertical transmission with and without intervention?
25% no intervention
<2% (antepartum, intrapartum, neonatal Rx)
+ about 9%/yr if BF allowed
70
Strategies in HIV vertical transmission
HIV offered all preg early
1) Antenatal care
tripe ART 2nd T (or earlier)
2) intrapartum
- IV zidovudine during labor
- viral load < 1000copies/ml SVD or C/S
3) neonatal
Zidovudine 6 weeks
avoid BF
71
HCV vertical transmission what is rate?
| Confounding factor?
5% transmission rate
- lower if HCV-RNA neg
- HIV coinfection (up to 25%)
- high maternal viral titre
- mat cirrhosis
72
what is natural history of HCV in peds?
25% appear to clear (persistent HCV ab)
| 75% chronic - active viral duplication > 6 mo
73
How to minimize HCV vertical transmission
avoid mix blood (scalp electrodes, etc)
No absolute for C/S
Not C/I for BF
other: consider HBV vaccine 1st month and HAV vaccine > 1 year
74
HCV vertical - testing
diagnostic: 18month old HCV antibody
can do > 2mo HCV RNA test
if positive, repeat q6mo
-if neg, do 18mo testing
75
C.difficilie who to test & how?
any pt with abx within 3mo or signs bloody diarrrhea +/- systemic
immunocompromised w/ chemo/abx within 3 months with diarrhea illness (watery/blood)
Investigation: stool toxin
(+ not signficant in asymptomatic)
76
Rx c. diff
mild: d/c abx. no active rx. RTC if no improve 48hr
mod: Oral flagyl 10- 14d
severe: PO vanco 10- 14d
```
severe complicated (ileus, megacolon, peritonitis, HypoTN)
- IV flagyl AND PO vanco 10-14d
```
if recurrent - repeat rx above
if 2nd recur - Vanco pulse with tapered wean
77
Risk factors C.diff Infetion
```
long hospital stay
older age
multiple abx exposure
chemotherapy
hypoalbuminemia
GI sx, gut manipulation, tube feeting
```
78
2 prevention strategies for influenza protection infants < 6mo
1. cocooning - vaccinate close contacts
| 2. immunize pregnant women - passive transfer in BF (inactivated vaccine at any stage)
79
pneumonia microbiology
```
streptococcus pneumona
GAS
staph aureus
h. influenza
atypical:
mycoplasma pneumonaie
chlamydophilia pneumonaie
```
80
pneumonia investigations
| for hospitalized
if hospitalized
CBC, diff, CXR, Blood cuture
viral - if influenza season
81
uncomplicated pneumonia Rx
IV amp - hospital, not septic
IV ceftriaxone/cefot - resp failure or septic shock
+ IV vanco - progressive multilobar or pneumatoceles
+ macrolide if persistent cough or seriously ill
duration 7 - 10 days
82
Infective endocarditis indications (patient)
1. prosthetic cardiac valve
2. previous IE
3. unrepaired cyanontic CHD (include palliative shunt, conduit)
4 completely repaired CHD with device during 1st 6 mo
5. repaired CHD with residual defects close to prosthetic
6. cardiac transplant with valvuloplasty
7. rheumatic disease if prostheic valves/material
83
IE indications (high risk procedures)
dental procedure - gums/lining injured
Resp - incision/biopsy of mucosal like T&A (+/- bronch)
GI/GU surgery trough area infected
SSTI - if infected skin/MSK
84
Describe IE prophylaxis
single dose 30-60min before procedure, up to 2hr after
PO Amox 50mg/kg
IV amp or cefazolin or ceftriaxone
a
Alt: cephalexin, clinda, azithro, vanco
85
Rx of complicated pneumonia
```
ANTIBIOTICS:
IV ceftriaxone/cefotax
+/- clinda for anerobic or CaMRSA
+/- vanco - MRSA suspect
total 3-4 weeks
switch PO when drained, clinically improve
```
```
Procedure
chest tube +/- tPA up to 3 days
VAT
open thoracotomy
repeated thoracocentesis
```
f/u
CXR 2 - 3month until near normal
86
infection control chicken pox
| school vs hospital
IFwell, return regardless of state of rash
-notify school for immunosuppressed kids
Hospital - day 8 to day 21 from contact
acquisition up to 24-96hr BEFORE rash develop on sick contact
87
c/I to rotavirus vaccine
immunocompromised (esp SCID)
allergic reaction
history of intussusception
88
rotavirus vaccine
- when
- advice to parents
ALL infants unless C/I
start between 6 week, compete by 8 months (separate 4 weeks)
premature - give between 6-32weeks PNA
LIVE attenuated - Rotarix 2 doses
Slightly higher risk intussusception 1 week following.
89
Risk factors AOM
```
young age
frequent contact other children
orofacial abN
household crowding
cigarette exposure
pacifier use,
prolonged bottle lying down
FmHx, first nations, inuit
```
90
When treat AOM
buldging TM, high fever (>39)
mod/severe systemically ill
severe otalgia or
ill > 48hrs
91
watchful waiting AOM
> 6months, mild illness
92
AOM diagnosis
Otalgia AND signs of effusion AND inflammation or ruptured TM
93
AOM microbiology
strep pneumo, GAS >
| morexella catarrhalis, H influ
94
AOM treatment
** Amox BID high dose
5 days if > 2year old uncomplicated
10 days if 6-23mo OR perforate
IF recent amox (30d) - amox clav (7:1) 45-60mg/kg/d
IF otitis-conjunctivitis syndrome (more Hflu, M.Cat)
- amox clave or 2nd gen (cefuroxime)
IF amoxclav failed/NPO - IV/IM ceftri x 3 days
IF anaphlyaxis - azithro/macrolide
95
organ transplant - PRIOR prevention steps
```
optimize vaccine
Inactivated - minimum 2 weeks
live - minimum 4 weeks prior
vaccinate household
counsel - high risk lifestyle, food, travel in immediate period
```
96
Organ transplant
| vaccine recommendations
hold vaccines s/p 6 - 12mo
except for influenza inactivated s/p 1mo okay
```
PCV 13 series then PCV23
Men conjugate quad if > 2 year old
HPV - male and female
Hep A, B
if no Hib prior - give
```
97
Natural history of infection risk - organ transplant
1. first month s/p
similar to non-suppressed pts
other: infection present in recipient prior to transplant
2. 1 - 6mo s/p = immunosuppression noticable
viruses: cmv, ebv, HH6, hep B, C
bacteria: listeria, aspergillus, PJP
3. 6mo +
if well, similar to healthy community acquired infection
higher risk: PJP, Listeria, crytpococcus, nocardia
98
HPV vaccination recommendations
HPV 6, 11, 16, 18 (cancer 16, 18)
Girls 9-13 year old
(males - unable to make recommendation - efficacy unknown but likely beneficial)
IM @0, 2, 6 months
Still need PAP routine PAP smears
S/E rare - bronchospasm, GI, H/A, HTN, vaginal hemorrhage
99
acute otitis externa
| diagnosis, microbiology
1. rapid onset (48hrs)
2. symptoms (otalgia, fullness)
3. signs - tender tragus/pinna, canal findings etc
micro: staph aureus, pseudomonas
100
risk factors otitis externa
```
trauma
FB in ear, hearing aid
dermatological condition
tight scarves, ear piercing
chronic otorrhea
immunocompromised
```
101
Rx otitis externa
topical antibiotic +/- topical steroids 7-10 days
ie ciprodex 4 drops BID x 7 days
pain control
expect improvement 48-72 hrs
102
Complication otitis externa
```
malignant otitis externa
- invasive infection of cartilage/bone of canal
Facial N palsy and pain
nocturnal pian, extend to TMJ, pain with chewing
risk: DM, immunocompromised
Lx: CT/MRI
IV cipro or piptazo (pseudomonas).
If aspergillosis, vori
```
103
Risk factors of fatalities with cold and cough medications
NOT advise for children < 6 years
```
Risk factors:
age < 2 years
used for sedation
used daycare setting
combine 2+ meds
failure to use measuring device
product misidentification
used products for adults
```
104
daycare bites
| HBV
overall very low
if unknown status both --> Vaccinate only (no test needed)
if one unimmunzed, one known HBV --> IM HBIG and vaccinate, serology 6 months
105
day care bites
| HIV
extremely low - prophy only with ID consult and exeptional
if known contact AND blood exposure
- start ASAP, within 72hrs f/u 6 wk, 3, 6 months
106
apslenia - what bacteria at risk for?
streptococcus pneumon > HiB, Neisseria menigiditis, salmonella, ecoli
- less: pseudomonas, klebsiella
- cat/dog bites- capnocytophagia
107
asplenia - vaccination recommendations
ideally 2 weeks prior to splenectomy. or 2wks post
ALL childhood vaccines
1) influenza - starting at 6mo
2) PCV 13 - 4 doses
PCV23 @ 2 yr + BOOSTER (5yr after)
3) MCV4 as primary series or 2 doses if missed - booster q5 years
4) Hib- routine (4doses). if > 5 missed x1 dose
+ travel immunizations (malaria)
108
asplenia prophylaxis
until 5 years old or longer if invasive disease (some lifetime)
< 3 mo - cover ecoli and klebsiella
otherwise, primarily for strep pneumo
Birth -3mo: amoxclav + Pen VK
> 3mo -5yo - Pen VK or amoxicillin (10mg/kg/dose BID)
if pen allergy - erythromycin + allergy testing
109
febrile asplenia - management
high mortality - medical alert bracelet
mortality 50-70% in < 2 years old
highest risk first 3 yrs of life (Congenital) or 3 years post splenectomy
CBC, diff, blood culture,
IV ceftriaxone +/- IV vancomycin
if allergy - ciproflox and canco
110
Congenital rubella
| clinical symptoms
1st trimester - spont abortion in 20%, anomalies in 80%
uncommon anomalies after 16 weeks GA
```
Classic triad = catarcts, PDA, SNHL
other:
unexplained microcephaly
cataracts, glaucoma, blueberry muffin rash
pigmentary retinopathy
hearing impairment
thrombocytopenia
radiolucent bone density
```
111
bacterial meningitis
| - when add steroids
Hib meningitis - decreases hearing loss if administered before or with initial abx
+/- strep pneumo
IV dex 0.6mg/kg/day immediate or within 30min of first antibiotic
total 2 days then d.c otherwise
112
bacterial meningitis
| - when for audiology testing
before d/c or within 1 month
113
(not empiric) antibiotic choices for bacterial meningitis & duration
HiB - Amp 7 - 10 days
N meningitidis - PenG/Amp 5 - 7 days
s pneumo- Pen (ceftria +/- Vanco) 10 -14 days
GBS PenG /Amp (add gent first 5-7days) - 2- 3 weeks
114
what defines invasive GAS infection?
1) lab confirmation +/- clinical
2) Streptococcus TSS
3) soft tissue - Nec fac, myositis, gangrene
4) meningitis
5) combo of above
115
risk factors invasive GAS
HIV, cancer, heart disease, DM,
lung disease, alcohol abuse
IVDU
varicella (in children major risk factor)
116
GAS chemoprophylaxis indications
close contact with CONFIRMED severe GAS
(ie not bactermia or septic arthritis)
7 days before onset sx to 24hr initiate rx
117
GAS chemoprophylaxis - how and when
ASAP, ideally < 24hr but up to 7 days
1st 1st gen Cep (cephalexin) 10days
2nd line erythromycin, clinda, clarithro 10 days
118
scabies - treatment
5% permethrin cream
neck to toes, leave 12-14hrs then wash off
repeat 7 days later
all bed linen - laundry hot or seal 5 - 7 days
Can return to school after 1st treatment
119
scabies risk factors
```
poverty, overcrowding
bedsharing
malnurtrition
Aboriginal
young children, elderly
immunocompromised
lack of clean running water
```
120
influenzae vaccine (live) contraindications
severe asthma (currently high dose ICS/oral)
pregnancy, immunocompromised
children 2 - 17 yrs on ASA (Reye syndrome)
121
Who to screen STI in males? (6)
```
If risk factors:
- contact with known STI
- previous STI
- new sexual parter or >2 in past year
IVDU
unsafe sexual practices
anonymous sexual partners
sex workers, survival sex
homeless
detention facility
sexual assault/abuse
```
122
Who to screen STI in feamles
ALL who are sexually active or victims of assault/abuse
| largely asymptomatic
123
What STI to test for?
first urine catch OR (m=urethral, f=vaginal) swab for Chla, gonorrhea
serology - syphilis, HIV
other consider: HAV, HBV, HCV
124
Primary & secondary prevention for STI
Primary:
vaccination - HBV, HPV
condom use
behavioral change
Secondary:
partner notification
screen & treat STI in asymptomatic
125
who to do test of cure?
prepubertal children with Ngonorrea and/or chalmydial
retest 6 mo for adolescent/adults for N gonrrhea and/or chlamydia due to risk of reinfection
126
Treatment of uncomplicated gonococcal infection
IM ceftriaoxone 250mg PLUS 1 dose azithro 1g OR
PO cefixime single dose PLUS 1 dose azithro
if pharyngeal infection
IM ceftriaxone plus azithromycin
(covers for chlamydia co-infection)
127
Chlamydia treatment
Doxycycline PO 7 days OR
azithromycin single dose
alternative - erythromycin
128
syphilis treatment
Primary - IM pen G x1 dose
129
zika virus - what is it?
flavirus transmited by aedes aegypti and aedes albopictus
transmitted via semen, blood, sexual contact
80% asymptomatic
maculopapular rash,low grde fever
rare - encpehalititis, hearing loss, GBS, TTP
130
congenital zika - distinguishing features (4)
severe microcephaly with partially colapsed skull
thin cortical cortices with subcortical calcificaiton
macular acarring, focal pigmentary retinal molding
congenital contractures
marked early hypotonia and extrapyramidal movements
131
if clinical congenital zika, what investigations?
ZIVK serology & blood & urine ZIKV serology on mom and child
Save placenta
U/S and MRI head non urgent
-if child with IgM ZIKV, confirm with PRNT assay (plaque reduction neutralization test)
132
biologics and infection risk
TB, fungal, non-TB mycobacteria
MANAGEMENT
evaluate for latent TB infection
-TST and CXR (5mm cut off)
if high, empiric 9mo isonizaid
-food -avoid undercooked meats, unpasteurized etc
- avoid direct contact with kitty (toxo, barotnella), reptiles, (salmonella)
- construction sites, cave exploration, farmlands (fungal spores)
- vacination PRIOR
(inactivated 2 wks prior, live 4 weeks prior)
Live vaccines C/I in treatment
household vaccination
