DISORDERS OF THE RESPIRATORY SYSTEM PART 3.2 (based on T) Flashcards
What is the indication for corticosteroids in COVID-19?
Patients classified as severe & critical COVID-19.
What is the dosing regimen for IV dexamethasone in COVID-19?
0.15 mg/kg IV once daily (max dose: 6mg) for up to 10 days or until discharge.
What are the alternative IV corticosteroids if dexamethasone is unavailable?
Methylprednisolone: 0.8 mg/kg IV once daily (max dose: 32mg) OR Hydrocortisone based on age-specific dosing.
What is the dosing regimen for oral corticosteroids in COVID-19?
Dexamethasone PO: 0.15 mg/kg orally once daily (max dose: 6mg) OR Prednisolone: 1 mg/kg orally once daily (max dose: 40mg).
What are the contraindications for corticosteroids?
Systemic fungal infection, systemic infection unless treated, hypersensitivity to the active ingredient or any component.
What are the adverse effects of corticosteroids?
Adrenal suppression, immunosuppression, hyperglycemia, psychiatric disturbances, hypertension, edema, myopathy, hypernatremia, avascular necrosis, adrenal insufficiency.
What is the indication for Tocilizumab in COVID-19?
Patients with rapid respiratory deterioration requiring high oxygen and with elevated inflammation markers.
What is the dosing regimen for Tocilizumab in COVID-19?
8 mg/kg (≥30 kg) or 12 mg/kg (<30 kg) as a single dose (max: 800 mg). A second dose may be given ≥8 hours after if no improvement.
What are the contraindications for Tocilizumab?
Hypersensitivity to Tocilizumab or any component of the formulation.
What are precautions for Tocilizumab use?
Immunocompromised patients, ALT >5x ULN, high GI perforation risk, uncontrolled serious infections, ANC <500, platelets <50,000.
What are the adverse effects of Tocilizumab?
Serious infections (TB, opportunistic), increased cholesterol, constipation, neutropenia, elevated AST/ALT, injection/infusion site reactions.
What is the indication for Bamlanivimab + Etesevimab in COVID-19?
Child, non-hospitalized, lab-confirmed SARS-CoV-2, mild-moderate COVID-19, within 10 days of symptoms, high risk for severe disease.
What is the dosing regimen for Bamlanivimab + Etesevimab?
IV infusion based on weight: 1-12 kg: 12 mg/kg Bamlanivimab + 24 mg/kg Etesevimab, ≥40 kg: 700 mg Bamlanivimab + 1400 mg Etesevimab.
What are the contraindications for Bamlanivimab + Etesevimab?
Severe hypersensitivity (e.g., anaphylaxis) to Bamlanivimab, Etesevimab, or any component.
What are the adverse effects of Bamlanivimab + Etesevimab?
Fever, chills, dizziness, dyspnea, urticaria, pruritus, flushing, nausea, vomiting.
What is the indication for Casirivimab + Imdevimab in COVID-19?
Child/adolescent >12 years, >40 kg, non-hospitalized, lab-confirmed SARS-CoV-2, mild-moderate COVID-19, within 10 days of symptoms, high risk for severe disease.
What is the dosing regimen for Casirivimab + Imdevimab?
600 mg Casirivimab + 600 mg Imdevimab as a single IV infusion over ≥60 minutes.
What are the contraindications for Casirivimab + Imdevimab?
Severe hypersensitivity (e.g., anaphylaxis) to Casirivimab, Imdevimab, or any component.
What are the adverse effects of Casirivimab + Imdevimab?
Fever, chills, dizziness, dyspnea, urticaria, pruritus, flushing, nausea, vomiting.
What is the US NIH recommendation for mAb therapy in regions with Omicron VOC?
If Delta VOC is still prevalent, Bamlanivimab + Etesevimab or Casirivimab + Imdevimab may be used, but they are ineffective against Omicron.
What is the recommended monoclonal antibody for Omicron VOC?
Sotrovimab should be administered within 10 days of symptom onset in patients ≥12 years and ≥40 kg.
Is Sotrovimab available in the Philippines?
No, Sotrovimab is not yet available in the Philippines.
What is the recommended dosing regimen for methylprednisolone in MIS-C?
1-2 mg/kg/dose (max: 30 mg/dose) IV q12h initially, then shift to oral corticosteroids once defervescence occurs or after 3-5 days, tapered off over 3-4 weeks.
When is high-dose pulse glucocorticoids recommended in MIS-C?
In patients who do not respond to IVIG and low-dose corticosteroids, especially those on high-dose multiple inotropes.
What are the contraindications for corticosteroids in MIS-C?
Systemic fungal infection, systemic infection unless specific anti-infective therapy is employed, hypersensitivity to the active ingredient or any component.
What are the major adverse effects of corticosteroids in MIS-C?
Adrenal suppression, immunosuppression (reactivation of latent infections, secondary infections), hyperglycemia, psychiatric disturbances, increased blood pressure, peripheral edema, myopathy, hypernatremia, avascular necrosis, adrenal insufficiency.
What is the recommended dosing regimen for IVIG in MIS-C?
2 g/kg over 8-12 hours (max 100 g); assess cardiac function and fluid status before administration.
What are the contraindications for IVIG in MIS-C?
History of anaphylaxis to human Ig, IgA deficient patients with antibodies against IgA and a history of hypersensitivity.
What are the major adverse effects of IVIG in MIS-C?
Hypersensitivity reaction (including anaphylaxis), infusion reactions (headache, chills, myalgia, wheezing, tachycardia, lower back pain, nausea, hypotension), renal failure, thromboembolism, aseptic meningitis syndrome, hemolysis, transfusion-related acute lung injury, transmission of infectious pathogens.
What is the recommended dosing regimen for anticoagulation in MIS-C?
ASA 3-5 mg/kg/dose (max: 81 mg/dose) PO OD until platelet count normalizes and normal coronary arteries are confirmed at ≥ 4 weeks after diagnosis.
What additional anticoagulation is recommended for severe MIS-C cases?
MIS-C patients with a coronary aneurysm z-score ≥10.0, ejection fraction <35%, or documented thrombosis should receive low-dose aspirin and therapeutic anticoagulation with enoxaparin; consult Cardiology and Hematology.
What are the contraindications for anticoagulation in MIS-C?
Platelet count <100,000/μL, active bleeding, or significant bleeding risk.
What is the US CDC case definition for MIS-C?
An individual <21 years old presenting with fever, laboratory evidence of inflammation, and clinically severe illness requiring hospitalization with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, or neurological); AND no alternative plausible diagnoses; AND positive for current or recent SARS-CoV-2 infection or exposure within 4 weeks prior to symptom onset.
What are the additional comments on MIS-C diagnosis?
Some individuals may meet full or partial Kawasaki disease criteria but should still be reported if they meet MIS-C criteria. Consider MIS-C in any pediatric death with SARS-CoV-2 infection.
What are the mask recommendations for children in MIS-C?
Children <2 years old should NOT wear masks due to suffocation risk. Masks are not recommended for those with difficulty breathing, cognitive/respiratory impairment, or if masks increase face touching.
What are hygiene recommendations for children with MIS-C?
Proper hand washing with soap and water for 20 seconds should be performed before/after contact, after handling secretions, before/after feeding, after using the toilet, and if hands are visibly dirty.
What are the recommended precautions for caregivers of children with MIS-C?
Assign one caregiver in good health with no comorbidities. Caregivers should wear a surgical mask, use gloves for handling secretions, and practice hand hygiene.
What are key sanitation practices for children with MIS-C?
Avoid direct contact with secretions and stool. Flush toilets with the lid down. Disinfect frequently touched surfaces with household soap or detergent.
What are laundry and waste disposal guidelines for children with MIS-C?
Do not shake dirty laundry. Wash separately with warm water and detergent. Dispose of waste (diapers, tissues) in a sealed bin. Wear gloves and masks when handling soiled items.
What are the current recommendations for home therapies in MIS-C?
Paracetamol for fever relief. Avoid nebulization unless indicated. Antibiotics per physician’s discretion. Emphasize balanced diet, hydration, and vitamin intake.
What are the emotional and mental support recommendations for children with MIS-C?
Talk to the child about their condition in a reassuring way. Limit exposure to news and social media. Maintain routine, allow learning and play, and limit screen time.
What are the monitoring guidelines for children with MIS-C at home?
Caregivers should record symptoms and notify healthcare providers if symptoms worsen or if close contacts develop symptoms. Seek hospital care if no improvement in 2-3 days.
Who should be admitted and tested for COVID-19?
All patients with moderate, severe, or critical symptoms should be admitted, assumed to have COVID-19, and tested.
What should be done if a facility cannot handle COVID-19 patients?
Referral to a COVID-19 referral center must be done.
Where should a child with moderate to severe COVID-19 symptoms be placed in the hospital?
In an isolation room or a dedicated COVID-19 ward/floor.
What personal protective equipment (PPE) should a healthcare worker wear when handling a COVID-19 patient?
Cap, N95 mask, goggles, face shield, full impermeable gown, gloves, and shoe covers.
What is the preferred method for diagnosing SARS-CoV-2 infection?
Reverse transcriptase polymerase chain reaction (RT-PCR).
What specimens are appropriate for RT-PCR testing?
Upper (pharyngeal swabs, nasal swabs, nasopharyngeal secretions) and/or lower airway samples (sputum, airway secretions, bronchoalveolar lavage fluid).
What is the Department of Health’s recommendation for specimen collection?
Collection of both nasopharyngeal and oropharyngeal specimens.
What type of specimen has the highest RT-PCR positivity rate in COVID-19 patients?
Bronchoalveolar lavage specimens (93%).
What was the RT-PCR positivity rate for nasal swabs in a study by Wang et al.?
0.63
What was the RT-PCR positivity rate for pharyngeal swabs in a study by Wang et al.?
0.32
Which specimens did not test positive for SARS-CoV-2 in the study by Wang et al.?
Urine specimens.
What is the estimated peak of viral shedding for SARS-CoV-2?
3 to 5 days after the onset of disease.
What is the median duration of viral RNA detection in COVID-19 patients?
20 days.
What is the longest observed duration of viral shedding in survivors?
37 days.
When should respiratory specimens be collected in suspected COVID-19 cases?
As soon as possible once a suspect case is identified, regardless of symptom onset timing.
What should be done if initial RT-PCR testing is negative but suspicion for COVID-19 remains?
Resampling and testing from multiple respiratory tract sites is recommended.
How does the sensitivity of RT-PCR change over time after exposure?
0% on day 1, 33% before symptom onset, 62% on symptom onset day, peaks at 80% on day 3 of symptoms, and declines to 34% by day 21.
What should always be included in the differential diagnosis for a patient with fever and respiratory symptoms?
COVID-19.
What type of antibodies can be detected after SARS-CoV-2 infection?
IgM and IgG.
What is the sensitivity of IgG/IgM serologic testing within the first 7 days of exposure?
30.1%.
What is the highest reported sensitivity of IgG/IgM serologic testing?
96% at 21 to 35 days post-exposure.
Which serologic test method has the highest pooled sensitivity?
Chemiluminescence immunoassay (CLIA) at 97.8%.
What is a common finding in the complete blood count (CBC) of children with COVID-19?
Lymphopenia with a median absolute lymphocyte count of 1,201 cells/uL.
What inflammatory markers are elevated in severe COVID-19?
Procalcitonin, D-dimer, and interleukin-6.
What oxygen saturation (SpO2) level suggests pneumonia in COVID-19 patients?
<95%.
What SpO2 level suggests severe pneumonia?
<90%.
Why should dengue serologic tests be interpreted with caution in COVID-19 patients?
There have been reported cases of false-positive dengue NS1 and serology in confirmed COVID-19 patients.
What is the first-line imaging modality for pediatric COVID-19 patients with respiratory symptoms?
Chest X-ray.
What are typical chest X-ray findings in pediatric COVID-19?
Bilateral peripheral and/or subpleural ground glass opacities and/or consolidation.
What imaging modality is not recommended as an initial diagnostic test for pediatric COVID-19?
Chest CT scan.
What are typical chest CT findings in pediatric COVID-19?
Bilateral, peripheral and/or subpleural ground glass opacities and/or consolidation in a lower lobe predominant pattern.
What imaging modality can be used as an alternative to chest X-ray and CT scan in COVID-19 diagnosis?
Chest ultrasound.
What are common ultrasound findings in COVID-19 pneumonia?
Thickened pleural line, B lines, multifocal consolidations, and pleural line irregularities.
What should be done before using investigational drugs in children?
Obtain informed consent from parents or legal guardians.
