ID Flashcards
disease NP will see Neuro, derm, Resps, immune
which one needs referral? 2
NEURO
Meningitis (C)
DERM Lyme Disease (D) Pityriasis Rosea (D)
RESP
Croup (D)
Influenza (D)
Epiglotittis (C)
IMMUNE
Infectious mono in adults (D)
8 ID in kids
Coxsackie (D) Fifth’s Disease (D) Roseola (D) Mumps (D) Measles Rubeola (D) Rubella (D) Varicella (D) Infectious mono (D)
what conditions will have rash
Meningitis
MMR
Varicella
Mono - with pen
Meningitis
Inflammatory disease of membranes (meninges) surrounding the brain and spinal cord
Defined by elevated WBCs in the CSF
Neurological sequelae are common among survivors
Community acquired Meningitis bacterial 2
other 2?
most cause?
fungal?
Bacterial
Streptococcus pneumoniae - has vaccine
Neisseria meningitidis - has vaccine
Haemophilus influenzae (haemophilus). Listeria monocytogenes (listeria). These bacteria can be found in soft cheeses, hot dogs and luncheon meats.
most cases are caused by a viral infection - usually mild and often clears on its own.
Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS
s/s of meningitis - Triad
non-blanching petechial or purpuric rash, stiff neck
acute febrile illness with rapid onset
intense headache, fever, nausea, vomiting, photophobia
Classic TRIAD
1 Fever
2 Nuchal rigidity (neck stiffness – the inability to flex the head forward due to rigidity of the neck muscles)
3 Change in mental status (increasing intracranial pressure can cause confusion)
if sepsis what happens?
if sepsis - Meningococcemia - circulatory collapse, haemorrhagic skin rash and a high fatality rate.
has long term sequelae which include hearing loss, neurologic disabilities, and digit or limb amputations.
Meningococcus organism releases a toxin which activates the clotting factor, can cause DIC - variety of small clots form in the vessels. These clots use up all the platelets and then there is bleeding throughout the body.
Meningitis Bacterial Dx
Bacterial – Diagnosis
Nuchal rigidity
+ Kernig flex knee and pull straigh
+ Brudzinski - bend head, knees automatically goes up
CSF – increased opening pressure
Leukocytosis, increased protein, decreased glucose
Blood Cultures
meningitis Vaccines? 4
Hib
Pneumococcal (Prevnar 13)
Meningococcal C (Neisvac-C) and B (Bexsero)
Menactra and Menveo (quadrivalent conjugate) – A, C, Y, W-135
S/E of lyme disease :
first stage
2nd
late signs - months - years
Erythema Migrans - bull eyes rash - spirochete Borrelia burgdorferi bacteria
2nd: Bell’s palsy (temporary paralysis of one side of the face, CN7) - usually self limiting arthralgia, joint to joint pain Headache, myalgia, fatigue, pruritis Cardiac involvement
late: Chronic arthritis-large joints affected Neurological complaints Memory loss Atrophic skin
test for lyme disease
treatment
CDC criteria for Lyme Disease
Serological testing IgG and IgM antibodies to B. burgdorferi
cdc : Presence of EM OR
At least one late manifestation plus laboratory confirmation of infection.
Joint swelling, Bell’s palsy, AV block
Tests: ELISA and Western Blot
Treatment:
Doxycycline (adults) 100mg po BID x 14-21 days Amoxicillin Cefuroxime Supportive
Pityriasis Rosea looks like? 2 followed by? tx? other tx?
heralds patch, xmas tree pattern
follows a viral infection
self limiting - clear in 4-6 weeks - supportive measures
Pruritis – topical corticosteroid or antihistamines
Severe itching–po acyclovir x 1 week (may reduce symptoms by 1-2 weeks)
2 Etiology of croup
whos at risk?
tx
Parainfluenza virus
Respiratory syncytial virus RSV
Children 3 months – 5 years
Peak at 18-24 months
Supportive treatment
Usually mild, lasting less than 1 week
Cool night air exposure or air humidifier (even though there is no evidence of benefit for this practice)
Stay calm.Comfort or distract your child — cuddle, read a book or play a quiet game. Crying makes breathing more difficult.
Acetaminophen for fever
Warm fluids – loosen secretions
No smoking in child’s home
Dexamethasone (0.15 – 0.6 mg/kg) – single dose - Max dose 10 mg
Epiglottitis definition and etiology
s/s?
what to do?
Rapid inflammation of the epiglottis which results in edema and airflow obstruction.
Etiology
H. Influenza type B
s/s toxic appearance Drooling High fever Muffled voice Severe sore throat
ER
mono virus?
SS Triad
dx?
tx? precaution?
Epstein-Barr virus
SS-TRIAD 1 Fever 2 Tonsillar pharyngitis 3 Lymphadenopathy (posterior cervical) Malaise, Fatigue, Headache Splenomegaly (50% of patients) rash with PEN
dx Lymphocytosis – 40-50% Throat culture to detect strep Mono spot test - bw for antibodies May see elevated LFTs
tx Symptomatic – rest, fluids, Tyl Corticosteroids (Prednisone) for tonsillar obstruction Acyclovir not recommended If + strep, do NOT use Amoxicillin Avoid saliva contact No contact sports X 1 month
precaution - no contact sports to prevent rupture of spleen
