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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)

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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
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3
Q

What are neonatal risk factors for neonatal sepsis?

A

Prematurity
Low birthweight
Indwelling catheter
Endotracheal tube

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4
Q

What is the timing of early vs late onset neonatal sepsis?

A

Early onset: 0-6 days

Late onset: 7-90 days

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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

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6
Q

What are the most common organisms in early onset sepsis?

A 
GBS>>>>>>>
E. coli
Listeria
H flu
Enterococcus
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7
Q

What are the most common organisms in late onset sepsis?

A 
Staph (coag-neg)
Staph aureus
Pseudomonas
GBS
E Coli
Listeria
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8
Q

What is the likely presentation of early onset sepsis?

A

Fulminant
Multisystem
More likely to involve pneumonia

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9
Q

What is the likely presentation of late onset sepsis?

A

Slowly progressive
Focal
More likely to involve meningitis

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10
Q

What are the likely organisms responsible for late-late onset sepsis?

A

Candida
Coag-neg Staph

Assoc with central lines, prematurity, intubation

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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
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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
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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

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14
Q

Osteomyelitis is caused by

A

Spread of bacteremia

Staph aureus
GBS
E coli

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15
Q

Osteomyelitis shows on x-ray

A

7-10 days after infection

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16
Q

The most common site of osteomyelitis is

A

Metaphysis of long bones

Femur, tibia

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17
Q

Most common neonatal age for GBS osteomyelitis

A

3-4 weeks

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18
Q

___% of neonates with osteomyelitis will have a positive blood culture

A

60%

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19
Q

Indication for a skeletal survey in osteomyelitis

A

Radiographic evidence of confirmed osteo

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20
Q

Treatment of osteo is

A

Penicillinase-resistant penicillin
Aminoglycoside/cephalosporin
21-42 days

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21
Q

Septic arthritis can be caused by

A

Hematogenous spread
Puncture inoculation
Spread of other infection including osteo

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22
Q

Septic arthritis often involves ________

A

Multiple joints

Concurrent osteo

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23
Q

Organisms causing septic arthritis are

A

Staph aureus
GBS
Staph epi
N. gonorrhoea (more common than in osteo)

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24
Q

Joint aspiration culture and blood cultures are positive in septic arthritis ___% and ___%

A

70-80%

30-40%

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25
Q

Treatment of septic arthritis is

A

2-6 weeks of penicillinase- resistant penicillin and aminoglycoside (longer for S. aureus)
Surgical drainage prn

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26
Q

Organisms in omphalitis

A

Staph aureus
Group A strep
Gram neg bacilli

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27
Q

Treatment of omphalitis

A 
Methicillin
Nafcillin
Oxacillin
Vancomycin
Anaerobic coverage if black periumbilical region
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28
Q

Prematurity increases risk of meningitis by

A

10x

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29
Q

Most infants get meningitis by ___ age

A

One month

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30
Q

Organisms in meningitis

A

GBS
E coli
Listeria

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31
Q

Transmission of meningitis is by

A

Hematogenous

Or direct spread

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32
Q

___% of infants with meningitis present with seizures

A

40%

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33
Q

Treatment of meningitis

A

Ampicillin
Cephalosporin
Aminoglycoside only for synergy

10-14d GBS
14-21d listeria
21+d GN

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34
Q

Of infants with meningitis, _____ will have significant neuro sequelae

A

1/3-1/2

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35
Q

UTI is more common in _____ infants

A

Male

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36
Q

Most common organisms in UTI are

A

GNR- E coli, klebsiella, enterobacter

Enterococcus

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37
Q

UTI transmission is by

A

Hematogenous or ascending spread

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38
Q

Treatment of UTI

A

Ampicillin and aminoglycoside

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39
Q

______ conjunctivitis usually occurs days 2-5

A

Gonorrheal

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40
Q

Chlamydia conjunctivitis usually occurs days _____

A

5-14d

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41
Q

Treatment of gonorrhea conjunctivitis is

A

3rd gen cephalosporin

Prophylaxis erythromycin

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42
Q

Treatment of Chlamydia conjunctivitis is

A

Oral erythromycin x 14d

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43
Q

Most common cause of conjunctivitis in the first month is

A

Chlamydia

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44
Q

Age of herpes simplex conjunctivitis

A

4d- 5 weeks

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45
Q

Salmonella gastroenteritis is treated with

A

Cefotaxime

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46
Q

Shigella gastroenteritis is treated with

A

Ampicillin

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47
Q

Campylobacter or yersinia gastro is treated with

A

Erythromycin

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48
Q

GBS is ______ bacteria

A

Gram positive diplococci in chains

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49
Q

___% of infants born to GBS+ mothers are infected

A

1%

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50
Q

Most common etiology of early GBS disease are

A

Pneumonia (45%)
Sepsis (30-35%)
Meningitis (5-10%)

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51
Q

Late onset GBS usually occurs as

A

Meningitis (40%)

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52
Q

Listeria is a _____ bacteria

A

Gram positive rod

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53
Q

Placental microabscesses suggests

A

Listeria infection

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54
Q

Fetal spread of listeria infection is by

A

Transplacental

Ingestion/aspiration

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55
Q

Brown stained amniotic fluid suggests

A

Listeria infection

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56
Q

Early listeria infection is typically

A

Sepsis or pneumonia

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57
Q

Late listeria infection is typically

A

Meningitis

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58
Q

Treatment of listeria infection is

A

Ampicillin and aminoglycoside x 10-14d

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59
Q

Mortality is listeria infection is

A

25% early

15% late

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60
Q

Transplacental treponema infection puts the fetus at ____% risk

A

70-100% if untreated

40% if early/latent

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61
Q

____% of fetus infected in utero with treponema are stillborn

A

30-40%

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62
Q

Most fetal infections with treponema are acquired

A

Hematogenously

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63
Q

An unexplained large placenta suggests

A

Congenital syphilis

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64
Q

Proximal medial metaphysis destruction, uveitis, hemolytic anemia, and nephrotic syndrome suggest

A

Congenital syphilis

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65
Q

Late signs of congenital syphilis are

A 
High arched palate
Frontal bossing
Hutchinson teeth
Saber shins
Seizures
Deafness
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66
Q

Syphilis screening is with

A

RPR
VDRL
(Non treponemal tests)

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67
Q

Syphilis confirmatory testing is with

A

Treponemal tests:

FRA-ABS

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68
Q

If both _____ and ______ are positive, diagnosis of syphilis is confirmed

A

VDRL or RPR

AND

FTA-ABS

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69
Q

Syphilis _____ testing is always positive following infection

A

FTA-ABS

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70
Q

Evaluation for congenital syphilis should include

A 
Syphilis labs
LP
Long bone films
HIV testing
Ophtho exam
Placental testing
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71
Q

Titers that require syphilis treatment are

A

VDRL/RPR >4X maternal value

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72
Q

Neisseria gonorrhoea is a _____ bacteria

A

Gram negative diplococci in pairs

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73
Q

Congenital gonorrhea presents with

A

Conjunctivitis (2-5 days)
Scalp abscess
Arthritis
Systemic infection

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74
Q

Gonorrheal infections are diagnosed with

A

Thayer Martin culture

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75
Q

Untreated maternal Chlamydia results in _____% infants infected.

A

25-60%

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76
Q

Chlamydia is a _____ bacteria

A

Obligate intracellular bacteria

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77
Q

Type of Chlamydia infection is most often ______

A

Conjunctivitis

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78
Q

Pneumonia will occur in ____% of congenital Chlamydia infection

A

25-50%

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79
Q

Characteristic CBC finding in Chlamydia infection:

A

70% with eosinophilia

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80
Q

Chlamydia is diagnosed with

A

Giemsa stain on culture

+/- IgM

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81
Q

Topical prophylaxis for congenital conjunctivitis is ineffective against

82
Q

A slow growing acid fast bacilli is

A

Mycobacterium tuberculosis

TB

83
Q

TB transmission is by

A

Hematogenous
Aspirations/ingestion

Postnatal inhalation or mucus membrane contamination

84
Q

Maternal TB should be treated with

A

Isoniazid (asymptomatic)-give neonate pyridoxine
Add pyridoxine if higher risk

Add rifampin and ethambutol if active disease

85
Q

Isolating mother from infant only recovered for TB if:

A

Mother has active disease

86
Q

Neonatal therapy for maternal disease

A

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
Q

Neonatal assessment for congenital TB:

A

PPD at birth and q 3 months until negative at 1 year

88
Q

Clostridium botulinum is a ____ bacteria

A

Anaerobe

Gram positive bacillus

89
Q

Botulism causes

A

Inhibited release of acetylcholine from nerves

90
Q

Giving aminoglycoside to a parent with botulism can

A

Worsened neuromuscular blockade

91
Q

Both staph epi and aureus are ______ bacteria, and are best treated with _____

A

Coag negative staph

Vancomycin- if staph aureus not resistant, switch to oxacillin or nafcillin

92
Q

Staph scalded skin and toxic shock syndrome are caused by

A

Staph aureus

93
Q

Primary gram negative causes of neonatal infection are

A 
CEEHKPPS
Citrobacter
E coli
Enterobacter
H. Flu
Klebsiella
Proteus
Pseudomonas
Serratia
94
Q

In E coli meningitis, there is a higher risk if it is the _____ subtype

A

K1 capsular polysaccharide antigen

95
Q

Gram negative causes of brain abscess are

A

Citrobacter

Enterobacter

96
Q

HUS is caused by

A

enterhemorrhagic E coli

97
Q

Galactosemia increases infection risk for

A

E coli UTI

98
Q

Treatment of gram negative infections

A

Ampicillin and aminoglycoside

Continued double coverage for enterobacter, citrobacter, serratia, and pseudomonas

99
Q

A pleomorphic bacteria without cell wall that may be associated with chronic lung disease

A

Ureaplasma urealyticum

Can also cause chronic chorioamnionitis and congenital infection

100
Q

Treatment of ureaplasma urealyticum

A

Erythromycin

+/- tetracycline for CSF

101
Q

HSV is a _____ virus

A

Double stranded DNA

Multinucleated giant cells

102
Q

Onset of Congenital HSV infection is

A

Systemic: 4-10 days

SEM: 6-9 days

CNS: 10-18 days

103
Q

Histology of HSV shows

A

Multinucleated giant cells
Eosinophilic intranuclear inclusions
Tzanck smear

104
Q

Treatment of confirmed HSV infection

A 
14 days (SEM)
21 days (CNS or disseminated)
105
Q

RSV is a ____ virus

A

Paramyxovirus

106
Q

The benefit of synagis is

A

Decrease hospitalization risk by 55%

107
Q

Hepatitis B is a _____ virus

A

Double stranded DNA

108
Q

Risk of vertical transmission in the setting of hepatitis B surface antigen positive mother increases from ____ to _____ If the mother is also positive for _______

A

10–> 85%

Hep E

109
Q

Hepatitis B surface antigen suggests

A

Acute infection

110
Q

HBIG decreases risk of chronic carrier state from

111
Q

Anti-hepatitis B service antigen antibody is indicative of

A

Vaccine immunity

112
Q

Presence of anti-hepatitis B core antigen is always indicative of

A

Current or past infection

113
Q

The significance of hepatitis D infection is

A

Worsened hepatitis B infection if co- infection exists

114
Q

Hepatitis C is ____ virus

A

Single stranded RNA

115
Q

Vertical transmission of hepatitis B is _____ If solo infection, _______ If co infection ______

A

20%

80%
Hep E

116
Q

Hepatitis A and E are both ____ viruses transmitted by ____

A

RNA

Fecal-oral

117
Q

Parvovirus is a _____virus

A

Single strand DNA

118
Q

Maternal proper virus infection is diagnosed by

A

What terminal I

PCR of amniotic fluid or fetal blood

119
Q

Varicella zoster is a ____virus

A

DNA herpes virus

120
Q

The time frame of greatest fetal risk of varicella infection is

A

5 days before delivery until 2 days after delivery due to insufficient maternal antibody passage

121
Q

The highest risk time for congenital varicella syndrome is

A

First 20 weeks of pregnancy

122
Q

Exposure or infection of varicella and pregnant women should be treated with

A

VZIG if asymptomatic

Acyclovir if symptomatic

123
Q

Dermatomal cicatricial lesions, limb atrophy, cataracts, choreoretinitis, and intracranial calcifications are all suggestive of

A

Congenital varicella syndrome

124
Q

VZIG is given to infants who

A

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
Q

Rubella is a _____virus

126
Q

Congenital rubella with associated anomalies is highest risk in weeks

127
Q

Congenital anomalies due to rubella are rare after week

128
Q

100% of fetuses with congenital rubella less than ______ weeks gestation have _____

A

10 weeks

Cardiac defects and deafness

129
Q

Risk of fetal rubella infection is greatest at

A

36-40 weeks

100%

130
Q

Blueberry muffin rash with sensorineural hearing loss chorioretinitis cataracts PDA and celery stalking of long bone metastases is consistent with

A

Congenital rubella infection

131
Q

Diagnosis of the general rubella infection in uterus is by

A

Fetal IgM via pubs

132
Q

Post needle neonatal congenital rubella infection is diagnosed by

A

Viral culture
Rubella IGM and IGG
Abnormal long bone films

133
Q

Congenital rubella infection can be infectious for

A

Up to one year

134
Q

CMV is a ______ virus

A

Double stranded herpes DNA

Intranuclear and cytoplasmic inclusions

135
Q

The most common intrauterine infection worldwide is

136
Q

Greatest risk of neonatal disease and severe outcome is

A

First half of pregnancy

137
Q

Periventricular calcifications, deafness, choreoretinitis are concerning for

A

Congenital CMV

138
Q

Toxoplasmosis

A

Protozoa, intracellular parasite

139
Q

During which part of pregnancy does transmission of toxoplasmosis carry the greatest fetal risk?

A

Early pregnancy

140
Q

Neonatal taxoplasmosis presents with

A 
IUGR 
Lymphadenopathy 
Meningoencephalitis 
Microcephaly 
chorioretinitis 
blueberry muffin rash
 cortical brain calcifications
 dermal erythropoiesis
 deafness
141
Q

Evaluation of congenital toxoplasmosis should include

A

Brain ultrasound
Liver
Toxo IGM and IGG
CSF PCR

142
Q

Material toxoplasmosis should be treated with

A

Spiramycin

Late gestation, use pyrimethamine and sulfadiazine

143
Q

HIV is a _____

A

Retrovirus with its own reverse transcriptase

144
Q

There’s increased risk of transmission to neonate if maternal CD4 count is

A

Less than 200 or increased maternal viral RNA load

145
Q

Transmission of HIV for untreated mothers is

146
Q

Significant HIV transmission reduction is accomplished by

A

Two antiretroviral agent therapy

147
Q

The preferred test to diagnose HIV

148
Q

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 ____

A

48h

1 month of age

149
Q

Neonatal testing in the set of material HIV infection should occur by _____ and at ______ timing

A

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
Q

Maternal HIV infection is treated with

A

Zidovudine (NRTI)

CAN BE COMBINED WITH NNRTI, PROTEASE INHIBITOR, ENTRY INHIBITOR, INTEGRASE INHIBITOR

151
Q

Neonatal HIV prophylaxis is with

A

Zidovudine

+/- additional agents for high maternal load our confirmed neonatal infection

Bactrim prophylaxis

152
Q

Enterovirus is a _____ virus

A

Single stranded RNA

153
Q

In enterovirus, congenital anomalies are

A

Not increased

154
Q

Enterovirus can be transmitted

A

By direct contact or transplacental

155
Q

Fetal risk with enterovirus infection is

A

Preterm delivery

156
Q

Rotavirus is a ______ virus

A

Double stranded RNA

157
Q

Diagnosis of neonatal candidiasis is by

A

Culture
Renal/brain US
Echo
Ophtho exam

158
Q

Treatment of candidiasis is

A 
Nystatin
Fluconazole- inhibits cell membrane
Amphotericin B- disrupts cell wall synthesis
Liposomal amphotericin
Flucytosine- combined with ampho
159
Q

Non-candidal fungal infections are treated with

A

Amphotericin B

160
Q

Maternal UTI is most commonly caused by

A

E coli (80-90%)

Klebsiella
Proteus
Enterobacter
GBS

161
Q

Bordetella pertussis is a ____ bacteria

A

Gram negative pleomorphic bacteria

162
Q

Clostridium tetani is a ____ bacteria

A

Gram positive bacillus

Anaerobic

163
Q

Symptoms of tetanus are due to

A

Decreased acetylcholine release

164
Q

Measles and mumps are both _____ (viruses)

A

Paramyxovirus

165
Q

Of paramyxoviruses, _______ can be transmitted transplacentally

166
Q

Measles onset is at _____ days while mumps presents at _____ days.

A

8-12 days

12-25 days

167
Q

Bilateral parotitis and orchitis is caused by

168
Q

Cough coryza conjunctivitis and Koplik spots are caused by

169
Q

Increased miscarriage risk occurs with measles or mumps?

170
Q 
Rubella
CMV
Syphilis
Toxo
Varicella
Coxsackie
Parvovirus
Listeria
HIV
can all be transmitted
A

Transplacentally

171
Q

Breastfeeding enhances neonatal immunity through

A

Lactoferrin

Lactoperoxidase

172
Q

Giemsa stain is used to diagnose

173
Q

Thayer Martin culture is used to diagnose

A

Neisseria gonorrhoea

174
Q

Bordet -gengou is used to diagnose

175
Q

Oxidase/catalase positive is used to diagnose

A

Pseudomonas

176
Q

Hemagglutination inhibition is used to diagnose

177
Q

Amikacin treats

A

Aerobic gram negatives

Gent resistant

178
Q

Ampicillin treats

A

GBS, listeria

Gram positive EXCEPT Staph

179
Q

Pipercillin, ticarcillin, aztreonam, and ceftazidime treat

A

Pseudomonas

180
Q

1st generation cephalosporin treat

A

Gram positive cocci
E coli
Klebsiella
Proteus

181
Q

2nd generation cephalosporins treat

A

Same bacteria as first generation cephalosporins plus more gram negatives

182
Q

Third generations cephalosporins treat

A

Excellent gram negative coverage

183
Q

Chloramphenicol treats ____ but is contraindicated in neonates due to _____

A

Broad spectrum

Gray baby syndrome

184
Q

Clindamycin treats

A

Anaerobic infections
Staph aureus
Strep

185
Q

Erythromycin treats

A 
Chlamydia
Pertussis
Staph or strep cellulitis
Mycoplasma
Ureaplasma
186
Q

Gentamicin treats

A

Gram-negative enteric bacilli
Staph
Synergy for listeria, GBS, enterococcus

187
Q

Meropenem treats

A

Broad spectrum, good CSF penetration

188
Q

Methicillin, nafcillin, oxacillin treat

A

Staph aureus, strep, coag negative staph

189
Q

Sulfonomides are not recommended in neonates due to increased risk for

A

Stevens Johnson syndrome
Exacerbation of G6PD
Bilirubin displacement

190
Q

Tetracyclines are contraindicated in neonates due to

A

Inhibited skeletal growth

Teeth discoloration

191
Q

Tobramycin treats

A

Gram negative organisms

192
Q

Vancomycin treats

A

Coag negative staph
MRSA
Gram positive aerobic organisms
Poor CSF penetration

193
Q

Bacteriocidal antibiotics are ideal for

A

Endocarditis, meningitis, severe staph and grim negative infection

194
Q

T and B-cell Lymphopoiesis occurs in the fetal liver until ___ weeks gestation

195
Q

The thymus begins contributing to lymphopoiesis at

196
Q

____ weeks gestation B cell lymphopoiesis moves to the bone marrow.

A

8-10 weeks

197
Q

B cells are produced in the liver lung and kidney starting at

A

18 to 22 weeks

198
Q

The primary site of B cell production is the bone marrow starting at

199
Q

Neutrophils are responsible for

A

Chemotaxis
Phagocytosis
Bacterial killing

200
Q

Monocytes are responsible for

A

Chemotaxis
Phagocytosis
Bacterial killing
Wound repair

201
Q

Complement is responsible for

A

Opsonization
Chemoattraction
Inflammation

202
Q

Leukocyte adhesion defects, histiocytosis, chediak higashi syndrome, Wiskott Aldrich syndrome, chronic granulomatous disease are all defects of function of

Neo Boards (15 decks)

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