General Flashcards
Older kids sepsis Abx
Ceftriaxone/ Vanco or clox.
Orbital cellulitis abx
Clindamycim for staph and anaerobes,
Cefuroxime for h. Flu
Scarlet fever bug
GABHS produces 1 of 3 exotoxins A,B,C. A is most common. Can therefore have scarlet fever x3
How often are blood cultures positive in meingitis?
How many WBC can a normal neonate have? vs normal child?
How many WBC does it take to make the CSF turbid
- 80-90%
- up to 30, older is 5
- 200-400
can have increased lymphocytes in early bacterial meningitis and vice versa
Other causes of elevated PMN in CSF
TB - followed by lymphocytes fungal - followed by monocytes Amebae SLE Tumour or leukmia
What are the enteroviruses?
coxsackie
echovirus
oliovirus
enterovirus
Treatment of meningitis
ceftriaxone
cefotaxime
if can’t use - meropenem instead
+/- vancomycin to cover resistant strep pneumo
treat family with rifampin
treatment of Campylobacter
supportive care
erythromycin or azithromycin- treat if have dysenteric disease, fever, or
toxic or immunocompromised.
can decrease duration and decrease shedding
Parvovirus B19 mortality
Fetal hydrops - bone marrow suppression - anemia and CHF
once rash appears, no longer infectious
for aplastic anemia - infectious for one week since presentation
causes of GBS
postinfectious polyneuropathy
- Campylobacter
- Helicobacter pylori
- respiratory tract (especially Mycoplasma pneumoniae)
- vaccines - rabies, influenza, and poliomyelitis (oral) , conjugated meningococcal vaccine, particularly serogroup C
- EBV
Can you receive live vaccines while on steroids
If >2mg/kg/day or 20 mg/kg/d of pred for >14 days, no live vaccines until one month post Rx
If receive less than that, can give
if less than 14 days, can give when done Rx
eosinophilia causes - MC and infectious
Allergies, asthma, eczema
Infectious causes: Ascaris because travels to other part of body ( if stay in gut/sequestered), toxocariasis, trichimosis, hookwarm, strongyloides
Anal warts transmission
Perinatal
sexual abuse
transmission - from fingers
RX- 65 % DISAPPEAR IN 2 YRS, cryoi, anti wart med, Sx
herpes whitlow treatment
HSV 1 in mouth, treat with acyclovir for 10 days
Hep A Vaccine - when do we give it
Not in less than 1 yrs but ok if above. if family member has it.if high risk, also get Ig.
only good 2 weeks post exposure
pleurodynia def - brochman syndrome
myositis caused by coxsackie
Familial Mediterranean fever symptoms
periodic fever, irregular fever episodes, painful pleuritis, peritonitis,
Rabies prophylaxis
Bats - even if in room, treat
quarantine animal and monitor - 10 d observation
if high risk - can treat and wait for results
Rx- rabies Ig in bite and Vaccine
PANDA
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus pyogenes: OCD/Tic/Tourette anxiety emotional deterioration in hand writing enuresis
HIV pathophysiology
CD4 depletion kills host cells Syncytium formation Normal host response CD4 cell dysregulation
Chronic lymphadenitis causes
Non TB mycopla - drains
cat scratch - MOST COMMON
What are RF for HIV vertical transmission?
high maternal viral load, seroconversion during pregnancy, low maternal CD4, intrapartum events resulting in inc exposure of fetus to maternal blood, preterm delivery, prolonged ROM, SVD
Prevention of Mother to Child HIV Transmission
Screening in pregnancy
Antiretrovirals for Mom in pregnancy: if not getting HART then zidovudine during pregnancy and IV zidovudine intrapartum
C-section before ROM (if everything is not perfect)
AZT (zidovudine) for baby x6 weeks – started ASAP within 6 hrs
No breast feeding
When do you test a newborn whose mom was HIV +
within first 48 hours (you know that there was transmission), 2 wks, 2 months, 4-6 months
When can you truly rule out HIV in neonate exposed
with 2 negative HIV PCR results at or after 1 month and 4 months of age ( most still test at 18 mo)
MC presentation of HIV
Infants - asymptomatic, LN, HSM
Older infants - FTT, candida after 1 yr, HSM, interstitial pneumonitis
Toddlers and older - LN, recurrent infections, parotitis, encephalopathy, dev regression
Common opportunistic infections in pt with HIV
- encapsulated org
- MAC
- Oral candida
- Viruses
Congenital syphilis
stillbirth, hydrops, preterm birth, IUGR, HSM, haemolytic anemia, jaundice and maculopapular rash
First 4-8 weeks : o HSM, snuffles, microcephaly, lymphadenopathy, mucocutaneous lesions (peeling hands and feet), osteochondritis, pseudoparalysis (from pain of limbs), edema, rash, haemolytic anemia, thrombocytopenia, chorioretinitis, glaucoma , nephrotic syndrome
Late presentation of congenital syphilis
Late manifestations: Hutchinson triad-interstitial keratitis, eighth cranial nerve deafness and Hutchinson teeth (peg-shapted lateral incisors)
Anterior bowing of shins, frontal bossing, saddle nose Clutton joints (symmetric painless swelling of knees), rhagades (linear scars around mouth and nose), mulberry molars (round aggregates of enamel on molars)
Abx for pneumonia
0-1 mo: amp+ gent or cefotax
1-3 mo: cefuroxime or amp. Erythro for pertussis
Rest: cefuroxime or amp, niacin
Aspiration-clindamycim
Pseudomonas: cefotax
IE dx criteria
Two major criteria, one major and three minor, or five minor criteria suggest definite endocarditis
What are the Duke major criteria
(1) positive blood cultures (two separate cultures for a usual pathogen, two or more for less typical pathogens) and
(2) evidence of endocarditis on echocardiography (or new valve regurgitation)
What are the Duke minor criteria
FIVE PM
- Fever > 38
- Immune complex phenomena (glomerulonephritis, arthritis, rheumatoid factor, Osler nodes, Roth spots),
- Vascular phenomenon (Janeway, emboli)
- Echocardiographic signs not meeting major criteria.
- Predisposition
- Microbi- a single + BCx or serologic evidence of infection
How do you differentiate orbital from preorbital cellulitis
- proptosis
- ophthalmoplegia
- vision change - blurry
- Chemosis
how do you diagnose AOM
- signs of middle ear effusion - immobile TM or TM rupture, +-opacification of TM, +-loss of landmarks, +- air fluid level
- signs of middle ear inflammation:bulging TM and erythema
- Acute onset of symptoms - otalgia, or irritability
When do you adopt watch and wait for AOM
if greater then 6 mo with no significant med issues, mild symptoms and signs for 48-72 hours and parents who can recognize if not doing well.
How is maternal genital HSV classified
- Newly acquired - first episode PRIMARY (60%!!! chance of transmission) or NON primary.
What are the types of HSV infections in neonates
- disseminated - MC liver and lungs
- localized CNS
- SEM - skin, eyes, mucous Mb
Most common causes of transient neutropenia
Viral infection - influenza, adenovirus, coxsackie, RSV, hep A and B, measles, EBV, CMV
From redistribution of neutrophils, sequestration in reticuloendothelial tissue, increased use in damaged tissue, marrow suppression
Management to contact TB
ask about symptoms
if less than 5, mantoux neg and N CXR = Rx INH 9 mo
INH - How to take it and SE
Empty stomach absorbed better.
SE= elevated LFT, periph neuropathy so take Vit B pyroxidine
Which TB med gives optic neuritis
Ethambutol
Mantoux / MMR - How do you give these when both are required
either give it at same time or 4 weeks apart
recurrent N. Meningitis
Think complement def
Cystinosis
AR, Lysosomal, cystine accumulation - get fancony syndrome - Kidney crap
CRF, ocular abnormalities, DM, Hypothyroidism
Sinusitis Rx
amoxicillin 10-14, saline washes can recommend but not studied
Amoxiclav if less than 2 yrs, recent Abx, daycare
Mono signs/symptoms
Fever, pharyngitis, LN, splenomegaly, elevated mononuclear cells and more than 10% atypical lymphocytes, hemolytic anemia, BM suppression
varicella and skin infections - what bug are you worried about
GAS***
Nec fas - penicillin and clinda for exotoxin
clinical presentation of Parvo B 19
fifth disease -
if pregnanct mom and exposed - do Ig and serial US to monitor for hydrops
GBS investigations
- stools for campylo
- CSF for increased protein
- MRI to tule out others
- EMG
- Serial spyrometry
Pinwarm treatment
mebendazole x 1
hygiene, treat household
congenital CMV
IUGR microcephaly hepatomegaly eye stuff SN hearing loss rash low plt
giardia RX
flagyl
When do you use Doxycycline
skin and soft tissue infection in kids > 7yrs
Aspergillus treatment
voriconazole
Most common bugs for line infection
Coag neg staph - CoNS- Vancomycin
Side effects of septra
neutropenia anemia low plts transient inc in creat hyPERKalemia
CP of mycoplasma pneumoniae
- gradual onset of headache,
- malaise,
- fever, and
- sore throat, followed by progression of lower respiratory symptoms, including hoarseness and cough. 5. Rash in 1/3
Coryza is unusual
Azithromycin - bacteriostatic or bactericidal?
static
Clindamycin - bacteriostatic or bactericidal?
static
what bites wounds require prophylactic antibiotics?
moderate to severe tissue damage - crush deep puncture hand/feet/face genitals in immunocompromised or asplenic
what antibiotic would you use for bites?
amoxiclav
if allergic - septra and clindamycin
what are clinical features of Blastomyces Dermatitidis?
Fungal infection - makes abscesses cause a pyogranulomatous response =necrosis+fibrosis 1. pneumonia - acute /chronic 2.Skin - ulcers 3. GU - prostitis/endometritis 4. CNS - abscess 5. Bone - osteo Rx = Itraconazole for mild, Ampho B for severe
what are phases of Pertussis?
catarrhal 1-2 wks
paroxysmal 2-6 wks
convalescent >2wks
how do you treat pertussis?
0-5 mo - AZITHROMYCIN for 5 days, 10mg/kg
> 5 mo - AZITHROMYCIN 10mg/kg on D1, 5/kg until 5d
adult - 500mg d1, 250 mg for rest - 5 days
Clarithromycin for 7 d
Erythromycin for 14 d
what are the CP and treatemnt of Brucellosis
GN - livestock, unpasteurized milk
fever
arthritis
HSM
RX: 8yr - Septra + rifampin for 6 weeks
what organism is going to cause symptoms within 24 hours of an animal bite?
Pasteurella multocida
treat with Amoxiclav
what is the most common side effect of clindamycin?
diarrhea in 20%
higher risk of C. diff
what are extrpulmonary features of Mycoplasma
pharyngitis, rash = Erythema multiorme Stevens-Johnson syndrome, hemolytic anemia, arthritis, CNS disease = encephalitis, aseptic meningitis, cerebellar ataxia, transverse myelitis, and peripheral neuropathy
how does TSS present?
multisystem disease with fever,
hypotension,
diffuse rash, and
multiple organ involvement (eg, nausea, vomiting, renal involvement, hepatitis, central nervous system dysfunction, severe myalgias).
What are features of Chlamydia trachomatis pneumonia
tachypnea, nasal congestion, otitis media, rales on auscultation of the lungs, a staccato cough that can be paroxysmal palpable liver and spleen due to hyperinflation of the lungs.
how do you treat Chlamydia pneumonia
erythromycin (PREP 2014)
how do you Dx pertussi?
PCR ( and culture)
at the beginning of a viral illness, what might you see on BW
lymphopenia
can see inc in neutrophils too
what do atypical lymphocytes refer to?
mature T lymphocytes with larger Nu seen in: EBV CMV Toxo viral hepatitis rubella roseola mumps some drugs
what is the management after a ? rabies exposure?
- if domestic anaimal - observe animal for 10 d. if no signs of rabies = all good
- if wild animal and caught = euthenise and look at brain
- if wild animal known to harbor rabies and not captured = prophylaxis
who should get tetanus IG?
if received
what is the rabbies prophylaxis treatment
- clean wound with soap
- clean with virucidal agent
- rabies IG administered into the wound and rest IM
- rabbies vaccine day 0, 3, 7, 14
what is the definition of fever of unknown origin
> 14 d without etiology despite investigations
when is a patient with measles contagious?
5 days before the rash (1-2 days before onset of symptoms)
4 days after the rash
what are the MC features of measles?
Cough
Coryza
Conjunctivitis - stimson lines
Koplik spots
what is the post exposure mgnt for measles
Ig within 6 days of exposure
+ Vaccine within 72 hrs
what is german measles?
rubella
when is rubella contagious?
2 days pre rash
1 week post rash
are babies who had congenital tubella contagious
yes
They can shed the virus in their nasal secretions and urine for up to 12 months
what are clinical features of rubella
3 day rash LN - retroauricular, post cervical, post occipital conjunctivitis sore throat low grade T
what is the usual presentation of roseola
peak 6-9 mo very high temps for 3-5 days look unwell can get febrile seizure rash appears as they get better - can spare the face Caused by HHV6/7
what does Parvo B19 cause?
- Slapped cheek
- fetal anemia or hydrops
- Aplastic crisis
what is the typical rash of Parvo?
slapped cheek and circumoral pallor
erythematous maculopapular truncal rash which fades and followed by a lacy reticulated rash that can be pruritis and can recur with exercise, bathing or rubbing
when is a child with varicella contagious?
2 day pre rash
7 days post rash
which CN is involved in Ramsay Hunt
CN VII
what are the 2 MC secondary bacterial infections that can complicate Varicella?
GAS
Staph aureus
what are common complications of varicella
INFECTION - GAS cerebellar ataxia encephalitis pneumonia Nephritis/NS orchitis pancreatitis MSK pericarditis/myocarditis
who should get treated with oral acyclovir for Varicella
non pregnant > 12 yrs
chronic cutaneous or pulm disease
ASA therapy
on steroid
when do we worry if a pregnant mom at end of pregnancy develops varicella
if she has Varicella (not shingles)
5 days pre delivery to
2 days post delivery
Gets a lot of virus but mom has not had time to make Ab
Baby needs VZIG
who can receive VZIG
- newborn whose mom had varicella 5 days pre or 2 days post delivery
- hospitalized prem > 28 wks whose mom lacks Hx or serology
- Hospitalized prem
what is the efficacy of varicella vaccine
85% in preventing any disease
97% effective in preventing moderate to severe
What is the daycare exclusion rule for impetigo
return 24 hr after start of Rx
how do you treat impetigo?
2% mupirocin TID x 10d
or if extensive, or around eyes or bullous
Cephalexin for 7 d
what usually causes cellulitis?
GAS = strep pyogenes - more spread
staph aureus - more localized
what is Erysipelas?
dermis infection
GAS
sharp margins with orange peel quality
may need IV
what is ecthyma?
GAS
dermis infection
painful ulcers
need PO abx
what is ecthyma gangrenosum?
systemic infection in immunocompromised pt
PSEUDOMONAS aeruginosa throws septic emboli to skin
deep ulcers
what causes Nec fasciitis
polymicrobial Staph aureus GAS E.Coli Klebsiella C. perfringens
what is nec fasciitis
subcutaneous infection + superficial fascia
how does necrotizing fasciitis present?
local swelling, erythema, tenderness Fever Constitutional signs are out of proportion to cutaneous signs, especially with involvement of fascia and muscle
how do you manage nec fasc
- support
- Sx
3.Clindamycin and penicillin as per review course
pip taz or
Ceftriaxone and Vanco
what causes hot tub folliculitis?
P. aeruginosa
CP of EBV
fever lymphadenopathy exudative pharyngitis splenomegaly hepatomagaly petechia on soft palate
what are hematological complications of EBV
low Plt
hemolytic anemia
hemophagocytic syndrome
splenic reupture
EBV has been linked with some Ca, such as
nasopharyngeal CA
Burkitt lymphoma
Hodgkin
What patient with EBV should receive steroids
tonsillar inflammation and potential airway issues massive splenomegally myocarditis hemolytic anemia HLH
what is the organism that causes cat scratch
BArtonella Henselae
what are the MC affected LN in cat scratch
- axillary
- cervical
- submand
How do you treat cat scratch?
most don’t need treatment - resolves 2-4 month
azithromycin for 5 days
what are possible complications of EBV
aseptic meningitis seizures transverse myelitis encephalitis GBS coombs + hemolytic anemia Ab mediated thrombocytopenia HLH
what CSF findings would be consistent with encephalitis?
increased lymphocytes
normal glucose
slight elevation in protein
MC cause of croup
laryngotracheobronchitis
parainfluenza
RSV
most common age group for croup
6 mo to 3 years
what is spasmodic croup?
6mo to 3 yrs sudden onset usually at night NO prodrome unclear etiology manage the same
What is the age group for epiglottitis?
3-4 yrs
what are features of epiglotittis
3-4 year old H. influenza type b - much less now GAS Staph aureus STRIDOR drooling sniffing position and tripod XRAY - thickened and bulging epiglotittis = thumb sign
how do you manage epiglotittis
- intubate
- IV cetriaxone
- If Hib - some family mb may need prophylaxis ( if less than 2 and not fully vaccinated, if unvaccinated, if immunocompromised) Rifampin 4 d
what causes infective endocaditis in all children
strep vididens - alpha hemolytic - usually subacute
if pt is known to have congenital heart disease and has never had Sx, what bug is the cause
strep viridens
what bugs cause endocarditis in pt who have had cardiac surgery, have valve replaces and endovascular materials?
Staph aureu - usually acute EI
staph epidermidis
what cardiac lesions are most at risk of infective endocarditis
left sided lesion: AS TOF PDA VSD
what are clinical features of IE
FROM JANE: Fever Roth's spots Osler's nodes Murmur Janeway lesions Anemia Nail hemorrhage (splinter hemorrhages) Emboli \+ malaise wgt loss heart failure splenomegaly
what is your initial Abx choice for IE
Vancomycin and gentamycin
if confirm strep - do pen g or ceftriaxone for 4 weeks
what are the clinical features of bacterial tracheitis
Staph aureus most common Moraxella catarrhalis, H. influenzae usually post viral croup brassy cough high temp toxic not the posturing of epiglottitis clinical Dx
how do you manage bacterial tracheitis
ceftriaxone + vanco
In what age group is strep most likely to cause pharyngitis?
School age
less likely before 3
airborne
measles
TB
varicella
zoster
who should get post exposure varicella vaccine?
within 72 hrs
if susceptible
if older than 12 mo
no contraindications
how do you manage TSS
Empiric therapy with cloxacillin (or cefazolin) plus clindamycin for most cases
Penicillin + clindamycin ± IVIG for TSS due to group A strep
