ID Flashcards
common bacteremia bugs in neonates
GBS, E coli, S pneumo, Staph aureus
common bacteremia bugs in infants
GBS, E coli, S pneuo, Staph aureus, salmonella
Common bacteremia bugs in immunocompromised patients
gram neg bacilli (pseudomonas, E coli, klebsiella), staph
common meningitis bugs in neonates
GBS, listeria, E coli
Common meningitis bugs in young children
strep penumo, N mening, enterovirus, Lyme, Rickettsia rickettsii
staccato cough and tachypnea in newborn
chlamydia
intracytoplasmic inclusion bodies
dx: PCR
tx: oral erythro, even if just conjunctivities
risk with oral erythromycin
pyloric stenosis
silver nitrate works for?
GC
NOT CT
erythromycin ointment works for?
GC ppx only
dx of C pneumoniae
immunofluorescent antibodies
dx of RMSF
serologic testing via indirect immunofluorescent antibody antibody - on presentation and 2-4 weeks later
dx: 4x increase in titers
RMSF like presentation but with leukopenia and elevated LFTs
erlichiosis
gram negative pleomorphic organism (or GN cocci in pairs)
HiB
conjunctivitis otitis combination
caused by H influenze - needs augmentin for tx
which type of meningitis can have IV steroids
HiB
HiB PEP
in household with an incompletely immunized child or immunocompromised child, everyone gets rifampin
underimmunized children should get Hib vaccine
HiB PEP in childcare/preschool
if 2+ cases within 60 days and incompletely immunized children at center –> rifampin for attendees and providers
underimmunized children should get Hib vaccine
cough with leukocytosis to 20-40 and lymph predominance
pertussis
dx pertussis
PCR
tx pertussis
erythro, clarithro, azithro
tx in catarrhal stage –> improves cough
tx in paroxysmal stage –> decreases communicability period
pertussis PEP
everyone exposed needs PEP with ABx to prevent spread
diarrhea from chicken, eggs, unpasteurized milk, unwashed raw fruits and veggies, turtles, hedgehogs
salmonella
who to tx with uncomplicated salmonella
< 3mos, hemoglobinopathies, malignancies, severe colitis, immunocompromise
fever, diarrhea, HA, HSM, rash - red spots
Salmonella typhi
tx: CTX/cefotax
watery diarrhea and fever –> bloody diarrhea with no fever
shigella
can have seizures, bandemia
tx for shigella
only if severe dz, dysentery, immunosuppression
tx: CTX, azithro, cipro
ABx for pseudomonas
zosyn, gent, carbapenems, ceftaz, cipro/levo
unpasteurized milk, cheese, cattle/sheep/goats
brucellosis
tx: bactrim or tetracycline
when can kid with C diff go back to child care
when diarrhea is resolved
tx C diff
flagyl –> PO vanc 2nd line
pharyngitis that mimics GAS but without palatal petechiae
arcanobacterium haemolyticum (corynebacterium haemolyticum)
resp infx mimic diphtheria
tx azithro, erythro, clinda
abscess size that only need I&D
<5cm
descending weakness
botulism
MOA of botulism
food- ingestion of preformed botulism toxin
infantile - ingestion of spores and germination –> toxin prod
toxin blocks ACh release at NM junction
dx of botulism
detection of toxin in specimen, no PCR
aminoglycosides and botulism
can potentiate paralysis
wound botulism tx
antitoxin, then PCN or flagyl
dx of syphilis
non treponemal tests (RPR, VDRL) –> treponemal test (FTA-ABS)
definitive: darkfield microscopy or DFA of specimen
what viruses cause false pos on nontreponemal tests
EBV, VZV, hepatitis
what else should you test for in pt with syphilis
HIV
how long is FTA ABS pos in syphilis
forever
false pos treponemal tests in which dz?
lyme (but would have negative non treponemal test)
tx of syphilis
parenteral PCN G
if allergic need desens
tx of neonate with maternal syphilis
if mom got PCN >1 mo prior to delivery, then no
if mom got erythro, must treat baby
if baby’s titers > mom’s titers must treat baby
HSM, corneal scarring, CN VIII deafness, lymphadenopathy, pseudoparalysis, poor feeding
congenital syphilis
membranous nasopharyngitis with bloody nasal discharge
diphtheria
neck swelling with cervical lymphadenitis
bull neck = diphtheria
complications of resp diphtheria
airway obstruction 2/2 membrane
myocarditis
neuropathies (cranial and peripheral)
tx diphtheria
equine antitoxin
tx enterococcus
ampicillin, vancomycin
most common Kingella infections
septic arthritis, osteo, bacteremia
tx kingella
penicillin
Meningococcal PEP
all close contacts with invasive disease, generally w/in 7 days
rifampin
farm animals, pets, untreated water, improperly cooked poultry
campylobacter
bloody diarrhea
can mimic intussusception or appendicitis
tx campy
azithro shortens duration and excretion
raw meat, unpasteurized milk, chitterlings, pigs
yersinia
pseudoappendicitis
tx yersinia
supportive unless bacteremia, immunosuppressed, hemoglobinopathies
tx: bactrim, cefotax, aminoglycosides, quinolones
dx bartonella
serology with enzyme immunoassay or immunofluorescent antibody
tx bartonella
supportive
if HSM, large/painful adenopathy, or immcomp –> azithro, erythro, bactrim, rifampin
tx latent TB
INH monotherapy x 9 mos
2nd line: rifampin monotherapy x 6-9 mos
can also do INH+rifapentine DOT x 12 weeks
forms of extrapulmonary TB
meningitis, adenitis, pleuritis, disseminated
petting zoos, swimming pools, child care centers
cryptosporidium
non bloody
lasts long time
toxicity of aminoglycosides
assoc with high trough (30 min before dose)
ototoxicity
Latin America/Africa/Asia, contaminated food/water, crampy abd pain, liquid stools x 1-2 weeks
E histolytica
can cause invasive disease with liver/brain abscesses, lung disease
dx E histolytica
definitive: enzyme immunoassay in stool
can also see cysts in stool, stool culture usually pos
can get abd US for liver cysts
tx entamoeba histolytica
flagyl/tinidazole –> iodoquinol
(if asymptomatic, only iodoquinol)
screen household contacts
toxo effects with timing of infection during preg
early: low risk of transmission, severe neonatal disease
late: high risk of transmission, less severe disease
microcephaly, hydrocephaly, chorioretinitis, diffuse calcifications
toxo
late manifestations of toxo
deafness, vision issues, seizures, ID, learning disabilities
VCA test
IgG to EBV viral capsid antigen - positive early and for life
EBNA test
antibodies to EBV nuclear antigen
positive weeks to month after onset of infection
periventricular calcifications, HSM, hypotonia, weak suck
CMV
most common nongenetic cause of SNHL
congenital CMV
dx congenital CMV
urine culture/PCR
3-5 days of fever followed by rash
roseola
can have febrile seizure
cataracts, PDA
congenital rubella
acquired rubella presentation
mild viral illness, maculopapular rash, lymphadenopathy
confluent rash, conjunctivitis, fever, cough
measles
AIRBORNE
incubation period of measles:
8-12 days
measles PEP
pregnant, <12 mos, immunocompromised –> give IG if <6 days since exposure
incompletely immunized –> give vaccine
how long after measles IG to give vaccine
minimum 5 months
measles vaccine timing and PEP
if <=3 days since exposure, give vaccine as may prevent disease
if > 3d, should give IG then vaccine later
mumps outbreak in school - who can go back
fully immunized - OK
due for booster/vaccine - get imm then OK
vaccine refusal - wait 26 days after last person had sx
has mumps - 9 days after onset of sx
dx of HSV
CSF PCR
DFA of vesicle scrapings
dx of neonatal HIV
HIV DNA and RNA PCR
dx of HIV in non-neonates
enzyme immunoassays –> Western blot
timing of HIV testing post exposure
0, 6 wks, 12 wks, 6 months
use antiretrovirals only if very strong likelihood of transmission
precautions for varicella
airborne and contact until all lesions are crusted
or for neonates of mothers w/ VZV - until 21-28 days of age
superinfection with VZV
staph aureus
immunocompromised VZV PEP
VZIG
needs to be given within 96 hours of exposure
when are people with VZV contagious
several days before rash until all lesions crusted
VZV PEP for neonate
mother with VZV 5 days before until 2 days after
give VZIG
dx of RSV
definitive: immunofluorescence
who gets synagis
CLD, preterm, congenital heart disease
dx flu
rapid antigen screen
dx rotavirus
antigen testing of stool
rabies PEP
HRIG inflitrate, 4 dose rabies vaccine
traveler with abd pain and sx of GI obstruction
Ascaris lumbricoides
ingestion of eggs from contaminated soil
tx: albendazole or ivermectin
eating undercooked pork, horse meat
trichinella
can get eye pain
stinging/burning, pruritus, papulovesicular rash –> microcytic anemia, growth delay, cognitive defects, developmental delay
hookworm = necator americanus
hepatomegaly and wheezing, eosinophilia
Toxocara canis
exposure to dogs/cats, eating dirt
manifestations of toxocariasis
visceral larva migrans - hepatomegaly, fever, wheeze
ocular larva migrans - visual disturbances
covert - GI, pruritus, rash
dx toxocara
ELISA
stool cultures to rule out other infx
tx toxocara
albendazole, thiabendazole
prianal or perivulvar itching
pinworms = enterobius
fecal oral, direct or via fomites
tx enterobius
pyrantel pamoate, albendazole
tx cryptococcus
amphotericin + fluconazole/flucytosine
travel to CA, AZ, TX with flu like symptoms
coccidiomycosis
tx coccidio
amphotericin, fluconazole, ketoconazole
dx aspergillus
galactomannan
tx aspergillus
voriconazole
ampho in neonates
OH, MO, MI with flu like symptoms, HSM
histoplasmosis
bird droppings
tx histo
healthy - supportive
disseminated or immcompro - amphotericin, fluconazole
pulmonary disease, meningitis, pigeons
cryptococcus
