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Pediatric Board Review- ID > ID > Flashcards

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1
Q

S. Aureus- toxin mediated syndromes

A

toxic shock, staph scalded skil, staph food poisoning

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2
Q

methicillin resistance in S. Aureus is classified as:

A

Oxacillin MIC of >/= 4 mcg/ml

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3
Q

CA- MRSA is generally susceptible to:

A

TMP/SMX, Gentamicin, Doxy, Clinda (varying resistance)

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4
Q

Gene that confirms methicillin resistance

A

mecA gene, encodes for a low affinity binding protein (penicillin binding protein 2a) that permits organisms to grow in the presence of beta-lactam antibiotics

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5
Q

Abs for serious infections with MRSA

A

Vancomycin. Other alternatives: linezolid ($$$), daptomycin (no lung activity), Ceftaroline, Tigecycline

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6
Q

Empiric therapy of life-threatening infections where MRSA is a likely cause

A

Vanc AND Nafcillin (more effective against MSSA)

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7
Q

Impetigo

A

Typically S. Aureus, sometimes strep progenies

  • Honey crusted lesions
  • Can cause post strep glomerulonephritis, NOT rheumatic fever

Treatment:

  • Topial: Mupirocin
  • Systemic: Cephalexin, or Clindamycin if concern for MRSA. Linezolid if severe
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8
Q

the d-test

A

determines if there is clindamycin resistance

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9
Q

most common cause of osteomyelitis

A

S. Aureus (except in sickle-cell patients: Salmonella)

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10
Q

S. Aureus is the most common cause of:

A

Impetigo, boils, furuncles, bacterial parotitis, bacterial tracheitis, suppurative lymphadenitis

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11
Q

CA_MRSA pneumonia has increased risk of:

A

empyema

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12
Q

Influenza and Measles can predispose children to:

A

superimposed S. Aureus pneumonia

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13
Q

Staph Toxic Shock Syndrome

A
  • 50% associated with tampons
  • Rash with desquamation
  • Invovlement of >3 organ systems
  • Nafcillin or Vancomycin PLUS clindamycin (to decrease toxin production) +/- IVIG
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14
Q

SSSS

A
  • Caused by S. Aureus
  • exfoliative toxins A and B
  • Nikolsky sign
  • Watch out for dehydration and superinfection
  • Oder children may not have the skin sloughing (just red, tender skin.
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15
Q

Food poisoning- most commonly caused by:

A
  • S. Aureus
  • ingestion of preformed enterotoxin
  • incubation period: <4-6 hours
  • Supportive care
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16
Q

Coagulase negative Staph

A

Staph epidermidis and staph saprophyticus

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17
Q

Catheter related bacteremia and foreign body (prosthetic) related bacteremia: bacteria and treatment

A
  • Typically S. Epidermidis

- treat with Vanc +/- Gent (for serious infections) +/- Rifampin (prosthetic device infections)

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18
Q

Most common cause of late onset bacteremia in preterm infants

A

Staph Epidermidis (think catheter association)

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19
Q

Encapsulated organisms

A

Strep pneumo, N. Meningitidis, H. Flu

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20
Q

Encapsulated infection more common in:

A

Splenic patients (anatomically or functionally), very young or very old, hypogammaglobulinemia (Burtons, Nephrotic Syndrome), or dysfunctional immunoglobulins (HIV)

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21
Q

Children at higher risk for invasive pneumococcal disease include:

A
  • HIV
  • Cochlear implants
  • Alaska natives or Native americans < age 2
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22
Q

AOM: pathogen, antibiotic, treatment protocol based on age

A
  • Most commonly S. Pneuma
  • High dose Amox. If no response in 2 days > Augmentin or 2nd/3rd generation Cephalosporin
  • For children 6 months-2 years with UNILATERAL AOM w/o otorrhea AND for children > 2 years with unilateral or bilateral without otorrhea you can observe for 48-72 hours
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23
Q

Empiric treatment of meningitis

A

Vanc and Cefotaxime or Ceftriaxone

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24
Q

Group A Strep

A 
Strep Pyogenes
Causes:
-Pharyngitis
-Scarlet fever
-Impetigo, erysipelas, perianal cellulitis
-Strep TSS
-Rheumatic fever
-Acute post streptococcal glomerulonephritis
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25
Q

Toddlers with Group A Strep infection

A

thick, purulent nasal discharge

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26
Q

Suppurative complications of Strep throat

A

AOM, Sinusitis, cervical lymphadenitis, peritonsillar abscess

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27
Q

Non-suppurative complications of strep pyogenes

A

Rheumatic fever and acute glomerulonephritis

  • Acute GN cannot be prevented
  • RF can be prevented with therapy
  • Skin strains can cause GN but not RF
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28
Q

Scarlet fever

A
  • sandpaper rash
  • Can see Pastia lines (confluent petechia)
  • Circumoral pallor
  • Fades after about 1 week > desquamation of hands and feet
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29
Q

Erysipelas

A

Acute strep infection of the upper dermis and superficial lymphatics

  • tender skin
  • Often see well demarcated line (“leading edge”)
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30
Q

Treatment of choice for Strep Pyogenes infection

A

Penicillin

  • Amoxicillin for better palatability
  • PCN allergic: Cephalexin > Erythromycin or Azithromycin
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31
Q

Carriers of Group A Strep, pharyngitis

A

Typically doesn’t need to be treated unless:

  • Local outbreak of acute rheumatic fever or post-strep GN
  • Outbreak of GAS
  • Family history of rheumatic fever
  • Excessive anxiety
  • Multiple episodes of pharyngitis

Treatment: Clindamycin 20 mg/kg/day divided TID x10 days

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32
Q

Treatment of rheumatic fever

A

PCN IM q3-4 weeks, or oral PCN daily for at least 5 years or until 21 years (whichever is longer)
-Some rec treating all household contacts, though most say those >65 or with risk factors

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33
Q

Group B Strep

A

Strep Agalactiae

-major cause of neonatal infection

34
Q

Early onset GBS sepsis

A
  • occurs within first 7 days

- Bacteremia most common, then pneumonia, then meningitis

35
Q

Late onset GBS sepsis

A
  • Range of onset day 7- 3 months
  • Bacteremia most common, then meningitis, then osteomyelitis/septic arthritis
  • Maternal prophylaxis has no effect on late-onset disease
36
Q

Treatment of sick newborn

A

Initially with ampicillin and gentamicin

-If confirmed GBS, narrow to Penicillin or Ampicillin

37
Q

Most common cause of endocarditis in children

A

Viridian’s streptococci

  • often normal oral flora
  • frequently present in transient bacteremia
  • Strep anginosus, mitis, salivarius, mutans
38
Q

Enterococcus infection

A

Most common infections: UTI, polymicrobial abdominal infection, bacteremia

  • Resistance is increasing
  • Ampicillin or Vancomycin used in combination with Gentamicin causes synergistic killing of organisms
39
Q

Listeria infection

A
  • Most common in neonates and elderly
  • Exposure to contaminated milk products or meats
  • Resistant to cephalosporins
  • This is one reason why neonates get Amp and Gentamicin
40
Q

Diptheria

A
  • Caused by corynebacterium
  • see grey-white membrane on tonsils, LOW fever, sore throat
  • Often see conjunctivitis and “bull neck” (unilateral swelling)
  • Can result in respiratory compromise
  • Treatment: antitoxin and erythromycin
  • Prophylax close contacts
41
Q

Anthrax

A
  • Caused by bacillus anthracis
  • encapsulated, spore-forming gram positive rod
  • Three types: cutaneous, gastrointestinal, inhalation
  • Inoculation from handling contaminated hides or wool
42
Q

Cutaneous anthrax

A

-Painless ulcer with subsequent eschar development

43
Q

Treatment of anthrax

A
  • Cutaneous: amoxicillin or ciprofloxacin
  • GI or inhalation: 2 drugs, i.e cipro and clinda +/- antitoxin
  • Mortality of GI and lung disease is high
44
Q

Bacillus cereus

A

2 forms of gastro:

  • short emetic type due to consuming preformed heat stable toxin (typically in fried rice)
  • longer incubation diarrheal type due to heat-labile enterotoxin production in-vivo
  • Typically self-limiting
45
Q

C. Diff

A
  • GI disease or asymptomatic carriage (5% of patients are carriers)
  • often antibiotic associated
  • often prolonged bloody diarrhea
  • diagnosis based on evidence of c. diff toxin (not stool culture)
  • Treatment: stop other antibiotics, 14 days metronidazole (oral drug of choice), addition of oral Vancomycin for severe disease
  • Treat first recurrence with Metronidazole, second with prolonged course with oral Vanc, +/- fecal transplant
46
Q

Tetanus: bug, 4 forms, clinical presentation

A
  • clostridium tetani
  • 4 forms: generalized, local, cephalic, neonatal
  • Portal of entry is often a small wound
  • often starts with generalized stiffness of muscles of neck, jaw and back. By 24 hours there is marked stiffness, followed by spasms of tetanus
47
Q

Tetanus: treatment

A
  • Low stimuli environment
  • mechanical ventilation & neurologic blocking agents
  • Human tetanus immune globulin is required and Flagyl for 2 weeks
48
Q

Tetanus prophylaxis

A
  • If the wound is dirty AND the immunization history is unknown or child has had < 3 tetanus shots: give TIG and immunize. If clean just immunize
  • If the wound is clean and immunizations are up to date (most recent < 10 years) > no treatment
  • Wound is dirty and immunizations are up to date (most recent < 5 years) > no treatment
  • If wound is dirty and last immunization > 5 years > give TDap (or DTap if < 7)
49
Q

Highest incidence of meningococcal infection

A

children < 2 (when maternal IgG antibodies wane) and teenagers 15-19 years

50
Q

Meningococcemia: presents with…

A

fever, hypotension, diffuse purpuric lesions, DIC

51
Q

Meningococcal prophylaxis

A
  • for close intimate contacts and passengers seated directly next to index case on plane for more than 8 hours
  • Close intimate contacts: household contacts, daycare/preschool mates, direct exposure to oral secretions.
  • Ppx with Rifampin x2 days or Ceftriaxone
52
Q

Meningococcal immunization

A
  • Meningococcal conjugate vaccine (Menactra or Menveo) to all 11-12 year olds with booster at 16 years of age
  • Anatomic of functional asplenia: get additional series starting as young as 2 months of age
  • Serogroup B (Trumemba or Bexsero): 2 doses based on clinical discretion, stating at age 16, or to those with functional or anatomic asplenia
53
Q

Ophthalmia in newborn

A
  • If < 48 hours after delivery almost always chemical conjunctivitis 2/2 prophylaxis
  • If 7-14 days post-birth and p/w bloody or serosanguinous discharge think chlamydia.
  • If concern for gonococcal conjunctivitis: blood culture and LP often indicated
  • Ceftriaxone is sufficient for treating ophthalmia neonatorum, however may need additional antibiotics for 2-3 days pending culture results
54
Q

Bordatella pertussis: 3 stages of infection

A
  • Catarrhal stage: mild respiratory infection
  • Paroxysmal stage: persistent cough
  • Convalescent stage: gradual improvement (6-10 weeks)
55
Q

Pertussis: treatment

A
  • Azithromycin (or erythromycin)
  • Chemoprophylaxis for all household and day care contacts (same medication)
  • Give booster dosages of pertussis vaccine if they are due
56
Q

Moraxella catarrhalis

A

3rd most common cause of AOM (behind S. Pneumo and non-typeable H. Flu)
-Often does not require ABx

57
Q

Salmonella

A
  • Non-typoidal salmonella: common cause of diarrheal illness, rarely causes bacteremia, meningitis or bone infection (think sickle cell)
  • Salmonella Typhi: common source of food borne outbreaks. Exotic pets can be carriers
  • Do not treat with antibiotics (for uncomplicated gastro) unless <3 months or immunocompromised
  • For invasive disease: given Ceftriaxone
58
Q

Typhoid fever

A
  • Leukopenia, fever, splenic enlargement, rose spots
  • Complications: intestinal perforation or metastatic abscesses or encephalitis
  • Treatment: based on susceptibilites
59
Q

Shigella

A
  • Diarrheal illness (can progress to dysentery)
  • person-to person transmission is very high
  • complications: rectal prolapse, new-onset seizures, HUS, reactive arthritis
  • Treatment for severe cases, does decrease spread
  • Must culture any symptomatic close contacts, no return to school until diarrhea stopped >24 horus
60
Q

E. Coli

A

EHEC produces shiga toxin which can cause bloody diarrhea, HUS and can stimulate TTP
-Do not treat with antibiotics

61
Q

Cat scratch disease

A

Bartonella henselae

  • Chronic, tender regional lymphadenopathy and h/o cat scratch (often kitten)
  • Avoid I&D of nodule (can cause persistent sinus tract)
  • Can treat with 5 days of azithromycin, but usually is self-limiting
62
Q

Cat or dog bites

A

pasturella multicida

  • Usually treat with Augmenting (penicillin drug of choice)
  • PCN allergy: Bactrim plus clindamycin
  • Given ABx for ALL cat bites and only for those dog bites that appear infected, involve a critical area or are deep wounds
63
Q

TB testing

A
  • Tuberculin skin test is preferred fro children < 5
  • Interferon-gamma is preferred if >5 and have previously received BCG vaccine or in children with limited follow-up
  • Also OK to use IGRA in children 2-5
64
Q

TST cutoffs

A

5 mm- for those with HIV, abnormal CXR, close contacts or severely immunocompromised
15 mm- No risk factors and >4 years
10 mm- all the rest

65
Q

Evaluation/Treatment of latent TB

A
  • CXR
  • If latent: Isoniazid for 9 months
  • If isoniazid resistant: rifampin for 6 months
66
Q

Treatment of active tuberculosis

A

4 drug regimen: (RIPE)

  • Rifampin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol

3 drug regimen: (RIP) only if sure that there is no drug resistance
-All except Ethambutol

67
Q

TB treatment of pyridoxine

A

Pyridoxine = B6

  • Use to prevent peripheral neuropathy
  • Give to exclusively breast fed infants, or to kids with milk or meat deficient diets, pregnant adolescents and HIV patients
68
Q

Monitoring during TB treatment

A
  • RIP meds are hepatotoxic!
  • Must monitor LFTs
  • Stop treatment when AST/ALT > 3x upper limit with symptoms, or > 5x upper limit without symptoms
69
Q

Testing for lyme disease

A

2 step approach

  • Follow a positive EIA or IFA with a western blot
  • Treat only if positive on both tests
70
Q

Treatment of localized lyme disease (and isolated Bells Palsy)

A

Doxycycline

  • or amoxicillin if < 8 years of age
  • for 14-21 days
71
Q

Lyme disease prophylaxis

A

Treat with single dose of Doxycycline if tick attached > 36 hours, within 72 hours of tick bite, in an area hyper endemic for Lyme disease

72
Q

Coccidioides

A

US southwest and northern mexico

-Flu-like illness> arthralgias > erythema multiforme/erythema nodosum

73
Q

Histoplasma

A

Mississippi, Missouri and Ohio river valley

-Present in bat and bird droppings

74
Q

Blastomyces

A

Arkansas and Wisconsin

  • Hunters and loggers
  • Beaver dam!
75
Q

Malaysia furfur

A
  • Superficial dermatitis: tinea versicolor

- Line infection in NICU babies getting TPN and lipids (requires olive oil overlay to grow)

76
Q

Roseola

A

HHV-6

  • Typically see fever 3-5 days then abrupt cessation of fever followed by red rash
  • Seizures can occur during febrile stage
77
Q

Rubella

A

German Measles

  • Adenopathy is usually first (post auricular lymphadenopathy)
  • Viral symptoms for 1-5 days
  • Rash: typically starts on face, then to turn and extremities
78
Q

Rubeola

A

Measles

  • Symptoms start with 3Cs: cough, coryza, conjunctivitis
  • Koplik spots (white spots on mucosa)
  • Rash: starts at hairline and spreads down and out
79
Q

Mumps

A
  • If symptomatic: see uni or bilateral parotitis, aseptic meningitis and/or encephalitis
  • in post-pubertal males with mumps: may see a epididymoorchitis that is often unilateral
80
Q

Parvovirus B19

A

5th disease

  • Slapped check rash
  • and may see a lattice-like rash
  • Can cause aplastic anemia in patients with chronic hemolytic anemias

Pediatric Board Review- ID (3 decks)

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