ID Flashcards
1
Q
What is the incidence and cause of neonatal sepsis?
A
1-8/1000 live births
Caused by transplacental spread (viral» bacterial, except syphillis and Listeria)
Ascending
Amniotic fluid contamination
Postnatal (breastmilk, mastitis)
2
Q
What are maternal risk factors for neonatal sepsis?
A
Chorioamnionitis PROM GBS colonization Untreated maternal UTI Maternal fever Malnutrition STI Lower socioeconomic status
3
Q
What are neonatal risk factors for neonatal sepsis?
A
Prematurity
Low birthweight
Indwelling catheter
Endotracheal tube
4
Q
What is the timing of early vs late onset neonatal sepsis?
A
Early onset: 0-6 days
Late onset: 7-90 days
5
Q
What is the most likely mode of transmission of sepsis in early vs late sepsis?
A
Early: Maternal genital tract
Late: Maternal genital tract or postnatal environment
6
Q
What are the most common organisms in early onset sepsis?
A
GBS>>>>>>> E. coli Listeria H flu Enterococcus
7
Q
What are the most common organisms in late onset sepsis?
A
Staph (coag-neg) Staph aureus Pseudomonas GBS E Coli Listeria
8
Q
What is the likely presentation of early onset sepsis?
A
Fulminant
Multisystem
More likely to involve pneumonia
9
Q
What is the likely presentation of late onset sepsis?
A
Slowly progressive
Focal
More likely to involve meningitis
10
Q
What are the likely organisms responsible for late-late onset sepsis?
A
Candida
Coag-neg Staph
Assoc with central lines, prematurity, intubation
11
Q
What is the clinical presentation of neonatal sepsis?
A
Respiratory distress, Apnea Lethargy Decreased perfusion, Cyanosis Shock Fever/hypothermia Vomiting, Diarrhea Abdominal distention/ileus, Feeding intolerance Focality (cellulitis, osteo, meningitis) Hypotonia Seizures Persistent jaundice Hypoglycemia Petechiae
12
Q
What is the evaluation for sepsis?
A
CBC Glucose Cultures: blood, urine, CSF, tracheal CSF studies C/AXR CRP- increased in 50-90% of patients with sepsis Viral studies (CSF and HSV) \+/-: ESR, fibrinogen, fibronectin, haptoglobin, cytokines
13
Q
What is the initial treatment of sepsis?
A
Broad spectrum antibiotics
Supportive care: fluid resuscitation, glucose/electrolyte support, respiratory support, vasopressors, transfusions
Consider antiviral and antifungal therapy as indicated
Consider meningitic antibiotics and dosing for concerns for meningitis
14
Q
Osteomyelitis is caused by
A
Spread of bacteremia
Staph aureus
GBS
E coli
15
Q
Osteomyelitis shows on x-ray
A
7-10 days after infection
16
Q
The most common site of osteomyelitis is
A
Metaphysis of long bones
Femur, tibia
17
Q
Most common neonatal age for GBS osteomyelitis
A
3-4 weeks
18
Q
___% of neonates with osteomyelitis will have a positive blood culture
A
60%
19
Q
Indication for a skeletal survey in osteomyelitis
A
Radiographic evidence of confirmed osteo
20
Q
Treatment of osteo is
A
Penicillinase-resistant penicillin
Aminoglycoside/cephalosporin
21-42 days
21
Q
Septic arthritis can be caused by
A
Hematogenous spread
Puncture inoculation
Spread of other infection including osteo
22
Q
Septic arthritis often involves ________
A
Multiple joints
Concurrent osteo
23
Q
Organisms causing septic arthritis are
A
Staph aureus
GBS
Staph epi
N. gonorrhoea (more common than in osteo)
24
Q
Joint aspiration culture and blood cultures are positive in septic arthritis ___% and ___%
A
70-80%
30-40%
25
Treatment of septic arthritis is
2-6 weeks of penicillinase- resistant penicillin and aminoglycoside (longer for S. aureus)
Surgical drainage prn
26
Organisms in omphalitis
Staph aureus
Group A strep
Gram neg bacilli
27
Treatment of omphalitis
```
Methicillin
Nafcillin
Oxacillin
Vancomycin
Anaerobic coverage if black periumbilical region
```
28
Prematurity increases risk of meningitis by
10x
29
Most infants get meningitis by ___ age
One month
30
Organisms in meningitis
GBS
E coli
Listeria
31
Transmission of meningitis is by
Hematogenous
| Or direct spread
32
___% of infants with meningitis present with seizures
40%
33
Treatment of meningitis
Ampicillin
Cephalosporin
Aminoglycoside only for synergy
10-14d GBS
14-21d listeria
21+d GN
34
Of infants with meningitis, _____ will have significant neuro sequelae
1/3-1/2
35
UTI is more common in _____ infants
Male
36
Most common organisms in UTI are
GNR- E coli, klebsiella, enterobacter
| Enterococcus
37
UTI transmission is by
Hematogenous or ascending spread
38
Treatment of UTI
Ampicillin and aminoglycoside
39
______ conjunctivitis usually occurs days 2-5
Gonorrheal
40
Chlamydia conjunctivitis usually occurs days _____
5-14d
41
Treatment of gonorrhea conjunctivitis is
3rd gen cephalosporin
| Prophylaxis erythromycin
42
Treatment of Chlamydia conjunctivitis is
Oral erythromycin x 14d
43
Most common cause of conjunctivitis in the first month is
Chlamydia
44
Age of herpes simplex conjunctivitis
4d- 5 weeks
45
Salmonella gastroenteritis is treated with
Cefotaxime
46
Shigella gastroenteritis is treated with
Ampicillin
47
Campylobacter or yersinia gastro is treated with
Erythromycin
48
GBS is ______ bacteria
Gram positive diplococci in chains
49
___% of infants born to GBS+ mothers are infected
1%
50
Most common etiology of early GBS disease are
Pneumonia (45%)
Sepsis (30-35%)
Meningitis (5-10%)
51
Late onset GBS usually occurs as
Meningitis (40%)
52
Listeria is a _____ bacteria
Gram positive rod
53
Placental microabscesses suggests
Listeria infection
54
Fetal spread of listeria infection is by
Transplacental
| Ingestion/aspiration
55
Brown stained amniotic fluid suggests
Listeria infection
56
Early listeria infection is typically
Sepsis or pneumonia
57
Late listeria infection is typically
Meningitis
58
Treatment of listeria infection is
Ampicillin and aminoglycoside x 10-14d
59
Mortality is listeria infection is
25% early
| 15% late
60
Transplacental treponema infection puts the fetus at ____% risk
70-100% if untreated
| 40% if early/latent
61
____% of fetus infected in utero with treponema are stillborn
30-40%
62
Most fetal infections with treponema are acquired
Hematogenously
63
An unexplained large placenta suggests
Congenital syphilis
64
Proximal medial metaphysis destruction, uveitis, hemolytic anemia, and nephrotic syndrome suggest
Congenital syphilis
65
Late signs of congenital syphilis are
```
High arched palate
Frontal bossing
Hutchinson teeth
Saber shins
Seizures
Deafness
```
66
Syphilis screening is with
RPR
VDRL
(Non treponemal tests)
67
Syphilis confirmatory testing is with
Treponemal tests:
| FRA-ABS
68
If both _____ and ______ are positive, diagnosis of syphilis is confirmed
VDRL or RPR
AND
FTA-ABS
69
Syphilis _____ testing is always positive following infection
FTA-ABS
70
Evaluation for congenital syphilis should include
```
Syphilis labs
LP
Long bone films
HIV testing
Ophtho exam
Placental testing
```
71
Titers that require syphilis treatment are
VDRL/RPR >4X maternal value
72
Neisseria gonorrhoea is a _____ bacteria
Gram negative diplococci in pairs
73
Congenital gonorrhea presents with
Conjunctivitis (2-5 days)
Scalp abscess
Arthritis
Systemic infection
74
Gonorrheal infections are diagnosed with
Thayer Martin culture
75
Untreated maternal Chlamydia results in _____% infants infected.
25-60%
76
Chlamydia is a _____ bacteria
Obligate intracellular bacteria
77
Type of Chlamydia infection is most often ______
Conjunctivitis
78
Pneumonia will occur in ____% of congenital Chlamydia infection
25-50%
79
Characteristic CBC finding in Chlamydia infection:
70% with eosinophilia
80
Chlamydia is diagnosed with
Giemsa stain on culture
| +/- IgM
81
Topical prophylaxis for congenital conjunctivitis is ineffective against
Chlamydia
82
A slow growing acid fast bacilli is
Mycobacterium tuberculosis
| TB
83
TB transmission is by
Hematogenous
Aspirations/ingestion
Postnatal inhalation or mucus membrane contamination
84
Maternal TB should be treated with
Isoniazid (asymptomatic)-give neonate pyridoxine
Add pyridoxine if higher risk
Add rifampin and ethambutol if active disease
85
Isolating mother from infant only recovered for TB if:
Mother has active disease
86
Neonatal therapy for maternal disease
Pyridoxine if mother receiving isoniazid and breastfeeding
Isoniazid if concern for asymptomatic but unknown neonatal disease status
4-drug therapy if congenital TB confirmed
Steroids for TB in CSF
87
Neonatal assessment for congenital TB:
PPD at birth and q 3 months until negative at 1 year
88
Clostridium botulinum is a ____ bacteria
Anaerobe
| Gram positive bacillus
89
Botulism causes
Inhibited release of acetylcholine from nerves
90
Giving aminoglycoside to a parent with botulism can
Worsened neuromuscular blockade
91
Both staph epi and aureus are ______ bacteria, and are best treated with _____
Coag negative staph
| Vancomycin- if staph aureus not resistant, switch to oxacillin or nafcillin
92
Staph scalded skin and toxic shock syndrome are caused by
Staph aureus
93
Primary gram negative causes of neonatal infection are
```
CEEHKPPS
Citrobacter
E coli
Enterobacter
H. Flu
Klebsiella
Proteus
Pseudomonas
Serratia
```
94
In E coli meningitis, there is a higher risk if it is the _____ subtype
K1 capsular polysaccharide antigen
95
Gram negative causes of brain abscess are
Citrobacter
| Enterobacter
96
HUS is caused by
enterhemorrhagic E coli
97
Galactosemia increases infection risk for
E coli UTI
98
Treatment of gram negative infections
Ampicillin and aminoglycoside
Continued double coverage for enterobacter, citrobacter, serratia, and pseudomonas
99
A pleomorphic bacteria without cell wall that may be associated with chronic lung disease
Ureaplasma urealyticum
Can also cause chronic chorioamnionitis and congenital infection
100
Treatment of ureaplasma urealyticum
Erythromycin
| +/- tetracycline for CSF
101
HSV is a _____ virus
Double stranded DNA
Multinucleated giant cells
102
Onset of Congenital HSV infection is
Systemic: 4-10 days
SEM: 6-9 days
CNS: 10-18 days
103
Histology of HSV shows
Multinucleated giant cells
Eosinophilic intranuclear inclusions
Tzanck smear
104
Treatment of confirmed HSV infection
```
14 days (SEM)
21 days (CNS or disseminated)
```
105
RSV is a ____ virus
Paramyxovirus
106
The benefit of synagis is
Decrease hospitalization risk by 55%
107
Hepatitis B is a _____ virus
Double stranded DNA
108
Risk of vertical transmission in the setting of hepatitis B surface antigen positive mother increases from ____ to _____ If the mother is also positive for _______
10--> 85%
Hep E
109
Hepatitis B surface antigen suggests
Acute infection
110
HBIG decreases risk of chronic carrier state from
91 to 22%
111
Anti-hepatitis B service antigen antibody is indicative of
Vaccine immunity
112
Presence of anti-hepatitis B core antigen is always indicative of
Current or past infection
113
The significance of hepatitis D infection is
Worsened hepatitis B infection if co- infection exists
114
Hepatitis C is ____ virus
Single stranded RNA
115
Vertical transmission of hepatitis B is _____ If solo infection, _______ If co infection ______
20%
80%
Hep E
116
Hepatitis A and E are both ____ viruses transmitted by ____
RNA
| Fecal-oral
117
Parvovirus is a _____virus
Single strand DNA
118
Maternal proper virus infection is diagnosed by
What terminal I
| PCR of amniotic fluid or fetal blood
119
Varicella zoster is a ____virus
DNA herpes virus
120
The time frame of greatest fetal risk of varicella infection is
5 days before delivery until 2 days after delivery due to insufficient maternal antibody passage
121
The highest risk time for congenital varicella syndrome is
First 20 weeks of pregnancy
122
Exposure or infection of varicella and pregnant women should be treated with
VZIG if asymptomatic
| Acyclovir if symptomatic
123
Dermatomal cicatricial lesions, limb atrophy, cataracts, choreoretinitis, and intracranial calcifications are all suggestive of
Congenital varicella syndrome
124
VZIG is given to infants who
Mother with infection 5 days prior to 2 days after delivery
Infant <28 weeks with significant maternal exposure
Infant > 28 weeks with significant maternal exposure and no history of chickenpox
Infant exposure days 2-7 of life
125
Rubella is a _____virus
RNA
126
Congenital rubella with associated anomalies is highest risk in weeks
1 to 12
127
Congenital anomalies due to rubella are rare after week
20
128
100% of fetuses with congenital rubella less than ______ weeks gestation have _____
10 weeks
| Cardiac defects and deafness
129
Risk of fetal rubella infection is greatest at
36-40 weeks
| 100%
130
Blueberry muffin rash with sensorineural hearing loss chorioretinitis cataracts PDA and celery stalking of long bone metastases is consistent with
Congenital rubella infection
131
Diagnosis of the general rubella infection in uterus is by
Fetal IgM via pubs
132
Post needle neonatal congenital rubella infection is diagnosed by
Viral culture
Rubella IGM and IGG
Abnormal long bone films
133
Congenital rubella infection can be infectious for
Up to one year
134
CMV is a ______ virus
Double stranded herpes DNA
| Intranuclear and cytoplasmic inclusions
135
The most common intrauterine infection worldwide is
CMV
136
Greatest risk of neonatal disease and severe outcome is
First half of pregnancy
137
Periventricular calcifications, deafness, choreoretinitis are concerning for
Congenital CMV
138
Toxoplasmosis
Protozoa, intracellular parasite
139
During which part of pregnancy does transmission of toxoplasmosis carry the greatest fetal risk?
Early pregnancy
140
Neonatal taxoplasmosis presents with
```
IUGR
Lymphadenopathy
Meningoencephalitis
Microcephaly
chorioretinitis
blueberry muffin rash
cortical brain calcifications
dermal erythropoiesis
deafness
```
141
Evaluation of congenital toxoplasmosis should include
Brain ultrasound
Liver
Toxo IGM and IGG
CSF PCR
142
Material toxoplasmosis should be treated with
Spiramycin
Late gestation, use pyrimethamine and sulfadiazine
143
HIV is a _____
Retrovirus with its own reverse transcriptase
144
There's increased risk of transmission to neonate if maternal CD4 count is
Less than 200 or increased maternal viral RNA load
145
Transmission of HIV for untreated mothers is
12 to 40%
146
Significant HIV transmission reduction is accomplished by
Two antiretroviral agent therapy
147
The preferred test to diagnose HIV
DNA PCR
148
30 to 40% of neonates who are HIV positive will test positive by _____ and 95% of neonates who are HIV positive will test positive by ____
48h
1 month of age
149
Neonatal testing in the set of material HIV infection should occur by _____ and at ______ timing
DNA PCR
At birth, 2 and 4 months of age
Positive diagnosis if two separate PCR samples are positive
Negative testing can be confirmed at 12 to 18 months
150
Maternal HIV infection is treated with
Zidovudine (NRTI)
CAN BE COMBINED WITH NNRTI, PROTEASE INHIBITOR, ENTRY INHIBITOR, INTEGRASE INHIBITOR
151
Neonatal HIV prophylaxis is with
Zidovudine
+/- additional agents for high maternal load our confirmed neonatal infection
Bactrim prophylaxis
152
Enterovirus is a _____ virus
Single stranded RNA
153
In enterovirus, congenital anomalies are
Not increased
154
Enterovirus can be transmitted
By direct contact or transplacental
155
Fetal risk with enterovirus infection is
Preterm delivery
156
Rotavirus is a ______ virus
Double stranded RNA
157
Diagnosis of neonatal candidiasis is by
Culture
Renal/brain US
Echo
Ophtho exam
158
Treatment of candidiasis is
```
Nystatin
Fluconazole- inhibits cell membrane
Amphotericin B- disrupts cell wall synthesis
Liposomal amphotericin
Flucytosine- combined with ampho
```
159
Non-candidal fungal infections are treated with
Amphotericin B
160
Maternal UTI is most commonly caused by
E coli (80-90%)
Klebsiella
Proteus
Enterobacter
GBS
161
Bordetella pertussis is a ____ bacteria
Gram negative pleomorphic bacteria
162
Clostridium tetani is a ____ bacteria
Gram positive bacillus
| Anaerobic
163
Symptoms of tetanus are due to
Decreased acetylcholine release
164
Measles and mumps are both _____ (viruses)
Paramyxovirus
165
Of paramyxoviruses, _______ can be transmitted transplacentally
Measles
166
Measles onset is at _____ days while mumps presents at _____ days.
8-12 days
12-25 days
167
Bilateral parotitis and orchitis is caused by
Mumps
168
Cough coryza conjunctivitis and Koplik spots are caused by
Measles
169
Increased miscarriage risk occurs with measles or mumps?
Mumps
170
```
Rubella
CMV
Syphilis
Toxo
Varicella
Coxsackie
Parvovirus
Listeria
HIV
can all be transmitted
```
Transplacentally
171
Breastfeeding enhances neonatal immunity through
Lactoferrin
| Lactoperoxidase
172
Giemsa stain is used to diagnose
Chlamydia
173
Thayer Martin culture is used to diagnose
Neisseria gonorrhoea
174
Bordet -gengou is used to diagnose
Pertussis
175
Oxidase/catalase positive is used to diagnose
Pseudomonas
176
Hemagglutination inhibition is used to diagnose
Rubella
177
Amikacin treats
Aerobic gram negatives
| Gent resistant
178
Ampicillin treats
GBS, listeria
| Gram positive EXCEPT Staph
179
Pipercillin, ticarcillin, aztreonam, and ceftazidime treat
Pseudomonas
180
1st generation cephalosporin treat
Gram positive cocci
E coli
Klebsiella
Proteus
181
2nd generation cephalosporins treat
Same bacteria as first generation cephalosporins plus more gram negatives
182
Third generations cephalosporins treat
Excellent gram negative coverage
183
Chloramphenicol treats ____ but is contraindicated in neonates due to _____
Broad spectrum
| Gray baby syndrome
184
Clindamycin treats
Anaerobic infections
Staph aureus
Strep
185
Erythromycin treats
```
Chlamydia
Pertussis
Staph or strep cellulitis
Mycoplasma
Ureaplasma
```
186
Gentamicin treats
Gram-negative enteric bacilli
Staph
Synergy for listeria, GBS, enterococcus
187
Meropenem treats
Broad spectrum, good CSF penetration
188
Methicillin, nafcillin, oxacillin treat
Staph aureus, strep, coag negative staph
189
Sulfonomides are not recommended in neonates due to increased risk for
Stevens Johnson syndrome
Exacerbation of G6PD
Bilirubin displacement
190
Tetracyclines are contraindicated in neonates due to
Inhibited skeletal growth
| Teeth discoloration
191
Tobramycin treats
Gram negative organisms
192
Vancomycin treats
Coag negative staph
MRSA
Gram positive aerobic organisms
Poor CSF penetration
193
Bacteriocidal antibiotics are ideal for
Endocarditis, meningitis, severe staph and grim negative infection
194
T and B-cell Lymphopoiesis occurs in the fetal liver until ___ weeks gestation
9
195
The thymus begins contributing to lymphopoiesis at
10 weeks
196
____ weeks gestation B cell lymphopoiesis moves to the bone marrow.
8-10 weeks
197
B cells are produced in the liver lung and kidney starting at
18 to 22 weeks
198
The primary site of B cell production is the bone marrow starting at
30 weeks
199
Neutrophils are responsible for
Chemotaxis
Phagocytosis
Bacterial killing
200
Monocytes are responsible for
Chemotaxis
Phagocytosis
Bacterial killing
Wound repair
201
Complement is responsible for
Opsonization
Chemoattraction
Inflammation
202
Leukocyte adhesion defects, histiocytosis, chediak higashi syndrome, Wiskott Aldrich syndrome, chronic granulomatous disease are all defects of function of
Monocytes
