Exam 2 - Immunocompromised, Rashes, Congenital Flashcards
intrauterine infections aka
congenital infections
transplacental infections cause infections in what timeframe
congenital, perinatal
infections transmitted by breastfeeding cause infections in what timeframe
perinatal, postnatal
what is vertical transmission
mother to baby
clinical manifestations of intrauterine transmission
low birthweight, malformations, rash, jaundice, anemia, low platelets, hepatosplenomegaly
congenital rubella ssx
sensorineural deafness, cataracts, congenital heart disease
congenital toxoplasmosis ssx
hydrocephalus, diffuse intracranial calcifications, chorioretinitis
congenital CMV ssx
microcephaly, ventricular calcifications
congenital parvovirus B19 ssx
diffuse edema (in utero hydrops fetalis)
congenital varicella zoster ssx
limb abnormalities, cicatricial lesions
congenital syphilis ssx
skin lesions, including palms and soles, dactylitis, osteochondritis, periostitis, rhinorrhea
mechanisms of perinatal infection
transplacental, ascending, maternal-fetal transfusion, inoculation, breastfeeding
clinical manifestations of perinatal infections
normal weight, no malformations, sepsis, hepatitis, coagulopathy, focal infection, may be asymptomatic
most frequent cause of perinatal conjunctivitis
chlamydia
causes of perinatal sepsis
group B strep, e coli, listeria, disseminated HSV, enterovirus
asymptomatic perinatal infections
hep B/C, HIV, HPV
causes of postnatal infections
HIV, CMV, Hep B
what infections can be congenital, perinatal, or postnatal
HIV, CMV
5 classic viral xanthems of childhood
measles, rubella, roseola, coxsackievirus, parvovirus-19
Rubella aka
german measles
roseola pathogen
HHV 6/7
parvovirus B19 aka
fifth disease, erythema infectiosum
measles prodrome
fever, cough/coryza/conjunctivitis, koplik spots
measles rash
nonpruritic, starts on face and spreads down
measles complications
secondary bacterial infection, encephalitis, subacute sclerosing panencephalitis
rubella prodrome
nonspecific, low grade fever, may be asymptomatic
rubella rash
starts on face and moves down, not as red as measles
rubella complication
congenital rubella causes hearing loss, mental retardation, cardiovascular and ocular defects
Roseola prodrome
upper respiratory ssx, high fever for 5-7 days
roseola usual population
< 2 y/o
when does rash start in roseola
when fever breaks
roseola rash`
spreads from neck/trunk to face and extremities
roseola complications
febrile seizures
coxsackievirus prodrome
fever, sore throat, malaise
coxsackie virus rash
painful sores on mouth, hands, feet that make break and ulcerate
coxsackievirus complications
nail loss, aseptic meningitis, encephalitis
fifth disease prodrome
flu-like, 3 days
fifth disease rash
slapped cheek with erythematous macular or papular lesions, lacy rash on trunk/extremities
fifth disease complications
arthralgias, aplastic crisis, fetal hydrops
scarlet fever pathogen
group A strep
scarlet fever prodrome
sore throat, high fever, HA, N/V, strawberry tongue
scarlet fever rash location
begins in neck, underarms, groin and then spreads
scarlet fever rash appearance
red rash with sandpaper feel, pastia’s lines, skin may desquamate
scarlet fever complications
rheumatic fever, post-streptococcal glomerulonephritis
molluscum contagiosum prodrome
none
molluscum contagiosum rash
2-5 mm painless, flesh colored, pearly papules with central umbilication
when does molluscum contagiosum resolve
6 months-4years
molluscum contagiosum complications
scarring, bacterial superinfection
HSV prodrome, 1st infection
fever, myalgias, HA, lymphadenopathy
HSV prodrome, recurrent infection
tingling or pain in skin
HSV rash
vesicles that open to painful ulcers that heal over 2-4 weeks
HSV complications
aseptic meningitis, encephalitis, blindness, disseminated infection if immunocompromised
shingles prodrome
pain, itching, tingling of dermatome with rare systemic ssx (fever, malaise, HA)
shingles rash
blisters to crusts in varying stages along a unilateral dermatome
shingles complications
postherpetic neuralgia, ocular involvement (5th cranial nerve), bacterial superinfection, disseminated zoster
chicken pox prodrome
mild fever/malaise 1-2 days before rash
chick pox rash location
starts on head/chest/back and then generalizes
chicken pox rash appearance
macules to papules to vesicles to crusts, will see lesions in different stages
chicken pox complications
secondary bacterial infections, pneumonia (adults), encephalitis, cerebellar ataxia
PCN skin rash timing
hours to days after exposure to PCN
PCN skin rash appearance
macular, papular, or hives with possible associated itching, swelling, wheezing, anaphylaxis
classic example of innate immune deficiency
neutropenia
infectious etiologies in neutropenia
recurrent pyogenic infections, skin infections, abscesses, bone/joint infections
neutropenia mechanism of infection
decreased chemotaxis and phagocytic capacity, defective intracellular killing
common pathogens in neutropenia
staph, strep, e coli, aspergillus
examples of humoral immune deficiency
x-linked agammaglobulinemia, multiple myeloma
humoral immune deficiency mechanism
fail to make antibodies to a new antigen
infectious etiologies in humoral immune deficiency
encapsulated organisms, chronic diarrhea, aseptic meningitis
pathogens in humoral immune deficiency
strep pneumonia, h influenzae, giardia, enteroviruses, campylobacter
causes of cell mediated immune deficiency
immunosuppressives (prednisone etc), CD4 deficiency/AIDS, DiGeorge syndrome
infectious etiologies seen with cell mediated immune deficiency
intracellular organisms, viruses, opportunistic infections
asplenia predisposes to what type of infection
encapsulated organisms
definition of neutropenia
absolute neutrophil count below 1500
mild neutropenia
between 1000 and 1500
moderate neutropenia
between 500 and 1000
severe neutropenia
less than 500
causes of neutropenia
chemotherapy, transplant patients, abx, congenital, hematologic malignancy, viruses, lupus
most common cause of neutropenic fever
bacterial infection
what is associated with more severe neutropenic fever
gram negative bacterial (pseudomonas)
what gram positive bacteria is associated with neutropenic fever
staph epidermidis
fungal causes of neutropenic fever
candida, aspergillus
empiric treatment for neutropenic fever
piperacillin/tazobactam +/- vancomycin
when to add vancomycin in empiric tx for neutropenic fever
hemodynamic instability, pneumonia, central line infection, skin infection, history of MRSA
when to provide prophylaxis for neutropenic patient
if ANC is less than 500 for more than 7 days
what prophylaxis to provide for neutropenic patient
cipro, fluconazole, acyclovir, bactrim
what to do prior to inducing neutropenia
screen for TB, hep B/C. Do not provide live vaccines 4 weeks prior to treatment
what is acute retroviral syndrome
flu-like symptoms occurring 2-4 weeks after HIV infection, highly infectious
clues of HIV infection
weight loss, fatigue, night sweats, recurrent candida infections, frequent pulmonary infections
non-infectious substances in HIV
urine, saliva, sweat, tears, nasal secretions, sputum, vomitus, stool
HI screening guidelines
test all 15-65 y/o and others outside that range if high-risk, all pregnant women
4th generation HIV testing advantages
uses monoclonal antibodies, detect between 12-26 days from exposure, allows detection prior to seroconversion
HIV treatment current guidelines
2 NRTI plus integrase inhibitor
HIV pre-exposure prophylaxis consists of
daily 2-drug regimen given before exposure
HIV post-exposure prophylaxis consists of
28 day course of daily 3-drug regimen within 72 hours of exposure
pneumocystis ssx
subacute, progressive dyspnea, dry cough, pleuritic chest pain, ground glass opacities on CXR
when to initiate pneumocystis prophylaxis
CD4<200
toxoplasma reactivation ssx
focal encephalitis with ring-enhancing brain lesion on CT
when to initiate toxoplasma prophylaxis and with what
CD4<100 and toxo IgG reactive, bactrim
MAC ssx
disseminated multi-organ infection
when to initiate MAC prophylaxis and with what
CD4<50, azithromycin
