ID Flashcards
What are major pathogens in late-late onset sepsis?
Candida, Coag negative Staph
Most common site of origin in Osteomyelitis?
Metaphysis
(Femur, humerus, tibia, radius, maxilla)
How can osteo spread between epiphysis?
Blood supply between metaphysis and epiphysis is connected in infants.
Is there greater risk of permanent deformity with Osteo or septic arthritis?
Septic arthritis
but you can see decreased growth with osteo due to growth plates
What sites would require surgical drainage of septic arthritis vs just aspiration?
if hip and shoulder are involved.
Most common cause of Omphalitis?
Staph Aurues
How do you treat Nesseria eye infection
3rd generation cephalosporin
How do you treat Chlamydia eye infection?
oral erythromycin 14 days
Chorioretinitis finding syphilis
“salt and pepper” fundus
Chorioretinitis finding Herpes
yellow, white exudates and retinal necrosis
Chorioretinitis finding rubella
BILATERAL diffuse granular pigmented areas “salt and pepper”
Chorioretinitis finding CMV
yellow-white fluffy retinal lesions with hemorrhage
Chorioretinitis finding Toxo
retinal scars involving macula
Chorioretinitis finding Candida
Fluffy White balls
Difference between EOS GBS and Listeria Sepsis?
Listeria can be acquired by transplacental route
What might placenta look like with Syphilis in infection?
LARGE
What kind of rash do you see in neonate with Syphilis?
desquamating maculopapular rash (palms and soles)
Why do use non-treponemal tests (VDRL and RPR)?
to use for screening, assessing response to treatment, and determining re-infection
How do non-treponemal tests work?
detect a cell membrane cardiolipin non specific IgG
What is FTA-ABS test used for?
detects specific Ab (IgG or IgM) to Treponema
if it is reactive, it is reactive FOR LIFE
When would FTA-ABS be positive but VRDL negative?
Lyme disease
When do you follow up treatment for Syphilis in neonate?
2, 4, 6, 12 months
titers should decrease by 3 months, and become non-reactive by 6 months
if increasing titers or persistent 6-12 months of age, re-evaluate and treat with another 10 day course
What CBC finding will you see in chlaymydia?
Eosinophilia
How long do you treat infant exposed to maternal TB?
INH until 3-4 months of age, and then place PPD to determine further management
What are EMG findings in Botulism infection?
incremental response at high frequency, abnormal spontaneous activity, abundant, brief, small action potentials
Difference between Staph epi, and staph aureus?
Staph epi is coag-negative
staph aureus is coag positive
What is transmission breakdown of HSV infections?
Intrapartum (85%)
Postnatal (10%)
In Utero (5%)
What is most common incidence of HSV infection?
SEM, about 45% and presents on DOL 6-9
How would you diagnose in utero HSV infection?
elevated cord IgM levels
What is treatment for HSV infection?
10 days asymptomatic
14 days SEM
21 says CNS
oral acyclovir for 5 months after
At what point in pregnancy is infant most likely to develop congenital rubella?
11 weeks
What are some clinical signs of congenital Rubella Syndrome?
Extramedullary hematopoieses (blueberry muffin)
jaundice
cardiac, ophthalmologic, auditory, neurologic
Difference between congenital and neonatal varicella
congenital
trauterine growth restriction, ocular defects, scarring skin lesions, limb abnormalities, and central nervous system abnormalities.
neonatal
pneumonia, hepatitis, and meningoencephalitis.
Features of congenital Varicella
limb hypoplasia, cutaneous scarring (optic nerve atrophy, cataracts, chorioretiniits) damage to CNS
intellectual disability, microcephaly, hydrocephalus, seizures
how do you test for syphilis?
VRDL and RPR
(RPR not appropriate for CSF)
how do you treat chlamydia infection?
Azithromycin or erythromycin
how do you treat toxoplasmosis?
pyrimethamine, sulfonamide, and leucovorin
it inhibtis folate metabolism
How long are antiviral HIV meds indicated for infant to compliant mother with HIV?
6 weeks
Transplacental syphilis infection, more likely in early or late maternal infection?
40% if early latent infection
8% if late maternal infection
What histopathologic changes do you see in syphilis in placenta?
umbilical cord is edematous with spiral stripes of blue and red discolration alternating with streaks of white (barber pole)
concentric perivascular infiltrate with calficications.
What is positive syphilis test in neonate?
4 fold titer higher than mom
neonate 1:32, mom (1:8)
What is treatment of tetanus in infant?
Flagyl
What organisms are isolated from peritoneal fluids in a SIP?
Candida, Coag negative Staph
What virus is associated with Lissencephaly?
CMV
What is treatment for infant born to mother with active gonnorhea
Ceftriaxone, and erythromycin ointment
What infections require both airborne and contact precautions?
TB and varicella
What time period are infants most susceptible to varicella infection?
to a mother who develops varicella between 5 days before and 2 days after varicella infection.
What medication can preserve hearing loss in CMV?
ganciclovir
Syphilis more severe if acquired earlier or later in pregnancy?
Later
(transmission can occur at any time)
When do you evaluate infant born to mother with active HSV lesions?
> 12 hours after birth
When will maternal IgG disappear from infant’s blood?
By 9 months
What clinical presentation is unique to Varicella amongst TORCH infections?
Limb hypoplasia, cicatricial scarring
What is initial drug of choice for presumed systemic fungal infection in neonate?
Amphotercin B (has superior penetrance through blood brain barrier.
can switch to flucanazole once sensitivities are back.
At birth B-cells higher or lower in infants compared to adults?
Similar proportion, but infants have absolute higher number
What is order of activation in classic pathway?
C1 C4 C2 C3
Where do classic and alternative pathway converge?
c3
Erythromycin drops protect against what infection?
Neisseria
What is treatment for asymptomatic neonate, unremarkable lab workup born to mother with HSV lesion first infection?
10 days IV acyclovir
How Does SCID screening work?
measure TRECS (t-cell receptor excision circles)
Where is mutation in LAD deficiency?
B2 integrin
What bacteria resistant to cephalasporin?
Enterococci
List 4 functions of spleen
Assists in functional maturation of antibodies
recycles iron
produces IgM and complement
removes rbcs and platelets from circulation
supports proliferation of T-cells
What does negative NBT test mean?
Neutrophils isolated, stimulated, undergo a burst, an dye converted to blue
negative means, no conversion to BLUE
What is typical skin lesion seen with congential syphilis infection?
Vesiculobullous mucocutaneous lesions, involves palms and soles
Difference between Benzathine PCN G or Aqueous IV PCN G?
1 time BCN IM can be given in absence of positive disease (positive non-treponemal titers only)
otherwise treat active disease with IV for 10-14 days
what are PRESENTING symptoms of CMV
Petechiae, juaundice, and hepatosplenomegaly..
can also see chorioretinitis, hearing loss, and hemolytic anemia
What is a Cohort Study?
