ID Flashcards
Causes of congenital cataracts
congenitalle urbella
galactosemia
pierre robin syndrome
oculuocerebral syndrome
oculomandibulofacial syndrome
Frequency of hearing loss as complication of TORCH infections
CMV 5-10%, rubella most common manifestation, toxo 25% and syphilis late (>2 years)
What should you screen for if NYD hydrops or stillbirth
syphilis
nontrep tests
vdrl, rpr
false positives for treopnemal tests
collagen vascular diseases, pregnancy, injection drug use, lyme disease
whats more sensitive eia or rpr
eia
expected drop of rpr titer
at least fourfold at 6 months
common early features of congenital syphilis
spontaenous abortion, necrotixing funistis, rhinitis or snuffles, rash, hsm, lympahdenoapthy, neurosuphilis, osteochondritis, perichonridtis
late manifestations of cong syphilis
frontal bossing, saddle nose, winged scapula, saber shins, interstitial keratitis, hutchinson teeth, mulberry mplars, nerve deafeness
what to do if mom treated for late latent syphilis
serologic testing at 0,6 and 18 mo
treatment for cong syphilis
10 day course of IV pen G
when should you lose treponemal antibodies
18mo of age if adequately treated
how often to repeat csf in neurosyphilis
q6mo
is varicella live vaccine
yes
period of contagious for chicken pox
24-48h before rash to 3-7 days after onset of rash
presence of lesions in various stages of evolution is characteristic of…
varicella
is scarring common with varicella
no
when is bad time for moms to get varicella for passing on to infants
5 days before delivery to 48h after delivery
congential varicella syndrome features
cicatrical skin scarring in a zoter distribution, limb hypo[plasia, neuro abn, eye chorioretinitis, micropthalmia, cataractis, renal system, low brith weight
can people with isolated humoral immunodeficiencies receive varicella
yes
how far away from chemo to give varicella
3mo
do you give antiviral treatment for infants with congeital VZV
no
giardia treatment
falgyl
is there problems when mom has lyme disease during pregnancy
no
rash with lyme disease
ertyehma migrans
later complications of lyme disease
isoalted facial enrve palsy, arthritis, heart block, meningitis
are antibodies for lyme disease detectable in first four weeks
no so treat clinically
congenital rubella syndrome
cataracts, conge heart diseas,e hearing loss, microcephaly, IUGR, retinopathy, interstitial pneumonitiis
common CHD with rubella
pda and pps
congenital CMV features
HSM, petechial rash, juandice, microcephaly, IUGR, hyperbili, elebated liver enzymes, low plt, choriotetinitis, hearing loss
where are calcifications in CMV vs toxo
CMV periventricular, toxo diffuse
what happens to placenta in toxo
chronic inflammation and cysts
what is a risk factor for toxo severity
HLA DQ3
what do you get brucellosis from
unpastueized dairy products, camels, goats, pigs, cattle, sheep, hunting feral swine
brucellosis infection
arthralgias, fever, myalgias, back pain, hsm
treatment for brucellosis
doxy or septra in combination with rifampin for 6 weeks minmum, longer if more serious ifnection
where do you get tularemia
tick or deer fly bites, rabbits, prarie dogs
type of bacteria tularemia
gram negative
type of bacteria brucellosis
gram negative coccobacillary bacgteria
where do you get bartonella
cat scratch, Andes, sand fly
risk factors for HCV infection
IVDU*
women in correctional facilities (because of IVDU)
tatooing, piercing
remote risk from blood products, contaminated medical equipment
sexual contact
increased risk for vertical transmission pf HSV infection
higher HCV viral titers elevated ALT in year ebfore pregnancy, maternal IVDU, fetal scalp monitoring, prologned ROM, infant female sex, second born twin
does HCV genotype infleunce risk of vertical transmission
no
factors assoicated with high risk of spotaenous clearance of HCV infection
higher ALT during the first 2 years of life, infection with genotype 3
extrahepatic manifstations of HCV
MPGN, subclinical hypoT, autoimmune thyroiditis, elevated ANA
when should you treat women for HCV infection
BEFORE pregnancy, insufficient evidence to treat during pregnancy
do you recommend elective c/s for HCV infection
No, no difference in vertical transmission rate between vaginal or c/s
is breastfeeding safe with HCV
yes, unless cracked bleeding nipples
how to test bb for HCV infection
best test is serology at 12-18months, if positive then do HCV PCR
Can do HCV PCR as early as 2mo (before this limited utility) if concerns about follow-up or if parents are anxious to know, if negative still recommend doing serology at 12-18mo to confirm antibodies ahve cleared
do you need to tell schools/daycare about HCV infection
no
how often should you screen youth at risk for HCV infection
q6-12mo
what bug to think of if brainstem infection
listeria
empiric treatment for meningitis
ctx vanco
most likely organisms for meningitis >2mo
N meningitidis, strep pneumo
consider GBS and e. coli up to 3mo
who should get prophylaxis for meningitis
occupants of contact household with Hib prophy infants < 12mo, chiildren < 4y not vaccinated and immunocmprimised person of any age, any index case not treated with ctx
gbs meningitis treatment
amp or pen G, add gent for first 5-7 days
steroid evidence in meningitis
decreases hearing loss with Hib, also possible with strep pneumo, give for 48h if netiher HIb or strep pneumo are identified then stop, if they are identified continue for total 4d
type of bacteria hib
gram negative coccobacilli
who gets repeat csf testing meningitis
if strep pneumo (esp if got steroids/resistant strep pneumo), sometimes for GBS to document sterility at 24-48h, for gram negative enteric pathogens
treatemtn length meningitis N. men
5-7d
treatment length strep pneumo meningitis
10-14d
treatment lenght Hib meningitis
7-10d
treatment length gbs meningitis
14021d minimum
Types of HSV that cause genital HSV
HSV 1 and 2
what babies are highest risk for HSV
born to mothers who have first episode/primary infectiona t time of delivery with transmission rates up to 60%
who is given acyclvoir prophy during pregnancy
if they have recurrent HSV from 36 weeks until delivery to lower the recurrence risk and shedding at delivery
when does HSV present in bb
within 4 weeks but can be up to 6 weeks
when should you get samples from bb to diagnose HSV
More than 24h after birth because otherwise they are more likely to represent contamination
se acyclovir
neutropenia, neurotoxicity
what to do if bb is born to mom with first clinical HSV episode via vaginal delivery or C/s with ROM
swab micous membranes and start acyclovir, controversial whetehr to do this before or after 24h
If swabs negtaive, should still treat for 10 days despite negative swabs
if swabs positive need to get CSF for PCR as well
What to do for bb born to mom with recurrent HSV and C/s
swab and send home
What to do for bb if mom has reucurrent HSV and they were delivered vaginally
obtain MM Swabs at 24h and sned home pending results, therapy only if swabs positive or symptoms
how long to treat HSV in CNS
at least 21 days, repeat CSF then and if positive extend with weekly CSF sampling until negative result obtained
Also need oral treatment for 6 months after acute treatment to try and prevent recurrence
why is orbital ceullitis more common in kids
thinnner bony septa, greater porosity of bones, open suture line snad larger vasular foramina
organisms for orbital ceullitis
GAS, strep species, anaerobes, staph aureus
Complications from orbital cellulitis
virual loss secondary to an increase in orbital pressure, cavernous sinus thrombosis, meningitis, empyeme, optic atorphy, exposure keratitis, retinal or choroidal ischemia
When should you drain a subperiosteal abscess
drain if over 9, if under 9 can wait until 48h of IV antibiotics and then drain if not improving, decreased vision or pupila banormlaities
What is the most common congeital infection
CMV
what is leading cause of SNHl
CMV
Physical exam findings CMV
SGA, microcephaly, jaundice, hydrops, petechiae, pneumonitiis, HSM, seizures, poor suck, hypotonia, lethargy, chorioretininit,s optic atrophy, micropthalmia, retinal scars, cortical visual impairemnt
Hearing
labs findings congenital CMV
low platelets most common, eleavted ALT< increased conjugated bilirubin, pleocytosis in CSF< positive CMV PCR, eevated protein
Head imaging findings CMV
calcifications, ventriculomegaly, atophy, cerebellar, ependymal, parenchymal cysts. polymicrogyria, lissenecpehaly, porencephaly, schizenpahly, extensive encpehaly, lenticulostriate vasulopathy
Who should you test for CMV
maternal CMV infection, fetal ultrasounnd findings suggestive of CMV, placental pathology consistent with CMV< HIV exposure, primary immunodefiiency, symtomatic CMV, failed newborn hearing screen or confirmend SNHL
Gold standard test for CMV
Urine CMV PCR before 21 days postnatal age
What tests to do if infant + for CMV
CBC, bilirubin, ALT, AS, CSF if seziures or sepsis, head ultrasound unless neuro concerns then MRI, MRI if HUS abnormal, hearing evaluation, optho evaluation
Who should you treat for CMV
CNS disease, chorioretinitis, sever single or multiorgan disease
treatment for CMV
start within 1mo with valgancyclvoir and continue for 6mo
Followup while on valgancyclovir
CBC weekyl for a month, every two weeks for two months then monthyl for three months, AST, ALT< ur, cr every 6 months
CMV followup
audiology freuently for first 2-3 uears then yearly, close dev followup for first two years, dental followup
rate of recurrent c. diff infection
25%
Who to treat for C. diff
dont treat if mild infection other than disconitnuing the antibiotic they are on. If moderate illness (>4 stools per day) then treat with falgyl for 10-14 days. if severe then treat with vanco PO
How to give vanoc for c. diff
PO, not effective if given IV
How to treat c. diff recurrence
first recurrence can repeat the original regimen or give PO vanco. If second or later recurrence then should be given vancomycin
What is there evidence for using probiotics for
antibiotic associated diarrhea, viral gastro, IBS, prevent NEC, colic
Is BCG a live vaccine
yes
Who is esp vulnerable to developing symptoms of Tb
infants less than 5 years
xray findings in kids with Tb
pneumonitis, subtle fround glass opacities usually wiht hilar lymphadenoapthy
what type of hypersensitivity reaction is Tb skin test
Type 4
Cutoffs for TB skin testing
> 5mm in immunocomprimised and >10mm in others
What is rpeferred test for Tb in kids under 2
skin test because more specific
How long to isolate a patient in hosptial with Tb
until three sputum specimens are negative, if initial smears are negative or after a full two weeks of DOT has been given
How to treat child under 5 who has had Tb contact
preventative prophylaxis with one drug and do a second TST 8-10 weeks later following last contact
How to treat a child over 5 with TB contact
still needs repeat skin test 8-10 weeks later but no treatment
oncogenic types of HPV
16 and 18
what is HPV Vaccine against
6, 11, 16 and 18
Do you get eosinophilia with pinworms
no because they dont invade tissues
treatment for pinworms
albendazole with one dose and repeat treatment in 2 weeks
Who to treat in pinworm infectin
Entire household regardless of symptoms because other household members are at risk given high transmission rates
preferred pinworm treatment for pregnant women
pyrantel
First line treatment for lice
pyrethrin and permeterhin are first line
give treatment and then repeat 7 days later
lice treatment options
first line- pyrethrin permeterhrin
diemticon solution or isopropyl nyristate (reslux)
DO NOT use lindane
Do you keep kids with lice home from school
NO no reason to do that
Is environmental cleaning or disinfection folowing head lice case warranted
no
When is deadline to give rotavirus vaccine
8mo, after this associated with increased risk for intussuception
risk of rotavirus
intussuception, esp in first week after giving the vaccine
contraindications to rotavirus vaccine
intussuception history, hypersensitivity to ingredients, immunodeficiency
do you repeat rota vaccine if they spit it out
no
when to give prems rotavirus vaccine
at or following discharge from nicu
What to do for bb exposred to N gonorrhae untreated at time of delivery who are healthy and term
single dose fo CTX IV or IM
conjunctival culture for N gonorrhae
if unwell should also do blood and CSF cultures
What to do for bb born to mom with untreated chlamydia infection
monitor for symptoms, no routine cultures, no prophylaxis
risk of macrolides
pyloric stenosis
How to prevent Hep B in bb born to mother with HbsAg positive mothers
Hb immunoglobulin and HBV immunization within 12h of life
Does breastfeeding increase risk of hep B transmission
No
Who to treat for Hep b
immune active form of disease evidenced by elevated ALt, AST, fibrosis on liver biospy
What percentage of babies born to GBS + mom will get GBS EOS without anitbiotics
1-2%
what is adequate GBS prophylaxis
pen/amp or Cefax within 4h one dose
what to give for GBS proph is true anaphylaxis to penicillin and is this adequate prophy
clinda or vanco and No
What to do for bb with GBS + mom who received inadequate Abx
Physical exam at birth, observe for 24 and reassessment between 24-48h
Well after 24h d/c home
NO investigations
What to do if mom is GBS + with addition rf
at minimum observe for 24-48h, may need sepsis workup, CBC after 4h may be helpful
What to do for bb born to mom with chorio
Cna osberve for 24h (CPS)
or culture and antbiotics (CDC and AAP)
what to do if GBS unknown and bb less than 37 weeks
given antibiotic prophy to mom
should observe for longer (48h)
what type of organism is c.diff
gram positive bacillus
what else do you have to treat for if someone has Tb
HIV
pinworms treatment
albendazole/mebendazole
if pregnant- pyrentel pamoate
Treat the whole house
Repeat the treatment in 2 weeks
What age can you use resultz in
> 4
What age can you use dimeticone in
> 2
what age can you use pyrtehrin and permtherin in
> 6mo
what % perinatal transmission for HCV
5%, 20% of these will clear spontaenously
what age can you give Hep A vaccine
over 12mo
brucellosis treatment
doxy or irfampin
listeria gram stain
gram + bacillus
what to use to treat yersinia
cephalosporin, septra, fluoroquinilones
how long to treat tine corporis
14 days minimum, 14-21 to prevent relapse
what % with c diff have recurent infection
25%
what is risk with flagyl
neurotoxicity with long term use
should you plan a csection for mom with HIV
yes if not on ARVT
Gram stain salmonella
gram negative bacilli
N. meningitidies gram stain
Gram negative diplococcus
