ID Flashcards
Who is at increased risk for invasive meningococcemia disease?
Risk increased because of underlying medical conditions:
- Asplenia or functional asplenia, including those with sickle cell anemia
- Properdin, factor D or complement deficiency (including those with acquired complement deficiency from eculizumab (Soliris); primary antibody deficiency
- HIV
Risk increased because of the potential for exposure
- Laboratory workers who work with meningococcus
- Military personnel living in close quarters
- Travellers to endemic areas (currently, travellers to sub-Saharan Africa and Hajj pilgrims)
- Close contacts of a case of IMD
What vaccine schedule for meningococcal disease in health children?
Conjugated MenC at 12 months old
Quadrivalent conj MenC in adolescent
Treatment for head lice w ages?
When to try something else?
first line:
- Pyrethrins (> 2mo)
- Permethrins (>2mo)
- for both - 2 applications 7-10 days apart
other:
- Isopropyl myristate/ ST-cyclomethicone solution (Resultz - >4yo)
- Dimeticome (>2 yo)
If two permethrin applications 7 days apart do not eradicate live lice, consider administering a full treatment course using a medication from another class.
Should you exclude children from school w head lice?
No
- avoid head to head contact
- should clean hats, pillow cases, etc w warm water (not FULL environment)
Rate of HIV transmission in pregnancy without treatment
With no intervention, transmission rates up to 25%
Risk factors for HIV infection
Late or no prenatal care,
injection drug use,
recent illness suggestive of HIV seroconversion,
regular unprotected sex with a partner known to be living with HIV (or with significant risk for HIV infection),
diagnosis of sexually transmitted infections during pregnancy,
emigration from an HIV-endemic area or
recent incarceration.
Time frame of antiretroviral therapy in newborn period
If test results are positive for mother or infant, infant antiretroviral prophylaxis should be initiated immediately and no later than 72 hours post-delivery.
What viruses are of concern w a needle-stick injury
- which is most likely?
HBV, HCV, and HIV
Hep B
Mgmt if get a needle stick injury
Clean wound thoroughly w soap+water, do not squeeze to induce bleeding
Assess child’s immunization status for tetanus, Hep B
Obtain blood for HBV, HIV, and HCV status +/- LFT, CBC, RF if considering ART
When should person with varicella be excluded from camp?
When the camp includes persons with immunocompromising conditions, campers or staff with active VZV disease (varicella or zoster), or who have had an exposure to VZV in the past 21 days and are non-immune, should be excluded.
Common reasons for children not getting immunized
- parents simply forgetting that their child is due for an immunization,
- having difficulty getting to a clinic during regular hours,
- being unconvinced that vaccine-preventable diseases pose a real threat,
- believing that children are ‘too young’ for certain vaccines (or that they are receiving too many vaccines or that they should develop ‘natural immunity’), and, finally,
- having concerns about the trustworthiness of health care workers or the safety and efficacy of vaccines
Most common Bacteria causing AO?
Most common in infants
Staphylococcus aureus,
Kingella kingae,
Streptococcus pneumoniae
Streptococcus pyogenes
Kingella kingae
What to consider with S aureus bacteremia with no apparent source?
AO
Gold Standard for osteoarticular infection dx?
Gold standard: bone biopsy
most sensitive and specific test for osteoarticular infection dx?
MRI with gadolinium enhancement
Mgmt of OA
Consult surgery (SA) Blood cultures Aspirate joint first gen cephalosporin: cefazolin 100-150 mg/kg/day div q6h/q8h \+ Vanco if concern MRSA
When can you transition to oral Abx for OA
when neg BCx
clinical improvement
decrease in CRP
compliance and followup is ensured
Quadrivalent HPV vaccine
- which types of HPV
6, 11, 16, 18
Why HPV strains are maliganant
HPV 16 and 18 - most malignancies
What is schedule for HPV vaccine
9-14 yo get 2 dose
>14yo get 3 dose
Immunocompromised and HIV+ should get 3 dose
All 6 months apart
Meningococcemia - serotypes
- most common
- highest fatality
Five serogroups (A, B, C, Y and W - based on the polysaccharide capsule) Serogroups B and C predominate (B>C in <5yo, C is more in outbreaks of adolescents)
C has highest fatality rate
How does invasive meningococcemia disease present?
septic shock, meningitis or both
can present as sepsis, pneumonia, septic arthritis, pericarditis or occult bacteremia
Vaccine for invasive meningococcemia- when?
Men-C-C (conj) offered at 12 mo
Men-C-ACYW for adol booster (Quadrivalent conj)
Who is at increased risk of invasive meningococcemia
Risk increased because of underlying medical conditions
- Asplenia or functional asplenia, including those with sickle cell anemia
- Properdin, factor D or complement deficiency (including those with acquired complement deficiency from eculizumab (Soliris); primary antibody deficiency
- HIV
Risk increased because of the potential for exposure
- Laboratory workers who work with meningococcus
- Military personnel living in close quarters
- Travellers to endemic areas (currently, travellers to sub-Saharan Africa and Hajj pilgrims)
- Close contacts of a case of IMD
how often should high risk its receive meningococcemia vaccine?
should receive booster every 3-5 years until 7 yo, and q5y thereafter
rotavirus transmission
Greatest incidence in children < 2 years
RF for severe rotavirus infection
Premature
Not breastfed
Immunocompromised
Schedule for rotavirus vaccine?
2 or 3 doses (dep on vaccine)
First: 6 weeks (latest 20 weeks)
4 weeks between doses
Last dose < 8 months (due to risk of intussusception with later dosing)
Contraindications to Rota vaccine
- Hx of intussusception or greater susceptibility to intussusception (ex Meckel’s)
- Hypersensitivity to any vaccine ingredients
- Known or suspected SCID
When do preterm infants get rota vaccine
Preterm infants can get vaccine
At or following D/C from NICU
Same schedule as term infants
Risk factors for AOM
Young age
Frequent contact with other children
Orofacial abnormalities (such as cleft palate)
Household crowding
Exposure to cigarette smoke
Pacifier use
Shorter duration of breastfeeding
Prolonged bottle-feeding while lying down
FHx of otitis media
Children of First Nations or Inuit ethnicity
AOM
bug
Virus and bacteria
Streptococcus pneumoniae
Moraxella catarrhalis
Haemophilus influenzae
Less common: Streptococcus pyogenes (group A streptococci [GAS])
How to diagnose AOM
1) Acute onset of sx (otalgia)
2) MEE (Decreased TM mobility; Loss of bony landmarks; Air fluid level)
3) Significant inflammation of middle ear
Complications of AOM
- most common
Mastoiditis (most common) Acute facial nerve palsy 6th cranial nerve palsy Failure of ipsilateral eye abduction Due to petrous bone inflammation or infection Gradenigo’s syndrome Labrynthitis Venous sinus thrombosis Meningitis
AOM
- when should you treat w abx
bulging TM,
T ≥39°C,
moderately to severely systemically ill
children who have severe otalgia or have been significantly ill for 48 h
AOM - abx
- first line
- next step
- if allergy
Amoxicillin 45-60 mg/kg/day div TID (or 75-90 mg/kg/day div BID)
5 days if >2ys, 10 days if <2ys
Amox Clav If purulent conjunctivitis, If recent AOM (<30d) tx w amox; if no improve in 2-3/7
Allergy to amox or penicillin: 2nd or 3rd gen cephalosporin
RSV prevention
RSV prevention
- Young infants should not be in contact w individuals with a RTI
- Hand hygiene
- Breastfeeding + avoidance of cigarette smoke
RSV vaccine name
Palivizumab
Who gets palivizumab
- Hemodynamically signif CHD/CLD on diuretics, bronchodilators, steroids or O2 if <12mo at start of season
- Prem w/o CLD born <30wga if <6mo at start of season
- Infants <36wga and <6mo at start of season in remote communities
N gonorrhoeae Ophthalmia Neonatorum complications
corneal ulceration
perforation of the globe
permanent visual impairment
What percent of Ophthalmia Neonatorum is caused by N gonorrhoeae
<1%
What to do if mom had untreated N gonorrhoeae infection at delivery
- test & tx immediately w/o waiting for results.
- If well: a conjunctival culture and a single dose of ceftriaxone IV or IM
- If unwell also do Blood and CSF cultures
What to do if mom had untreated Chlamydia infection at delivery
closely monitor for sx
don’t prophylactically treat or screen unless sx
Who to give prophylactic Abx for UTI?
How long?
Which Abx?
- Grade IV or V VUR, or a significant urological anomaly.
- 3-6 months
- Trimethoprim/sulfamethoxazole or nitrofurantoin
Common bugs for UTI
Escherichia coli Klebsiella pneumoniae Enterobacter species Citrobacter species Serratia species adolescent females only: Staphylococcus saprophyticus
Empiric Abx for UTI
PO Amoxicillin Amox Clav Co-trimoxazole Cefixime Cefprozil Cephalexin Ciprofloxacin
Imaging for UTI?
children <2 years of age with a first febrile UTI: RBUS
- VCUG if abnormal
VCUG indicated for children <2 years of age with a second well-documented UTI
Most common cause of sepsis in Asplenia/hyposplenia
Encapsulated bacteria Strept pneumo = 50% H flu Neisseria Salmonella EColi
what is better for Asplenia - conj or polysaccharide vacccines
conjugated
Abx prophylaxis in Asplenia:
<3mo
3mo-5yo
>5yo
<3mo: amox clan
3mo-5yo: pen VK or amox
>5yo: pen VK or amox
How long is newborn at risk for vertical HSV transmission
Initial symptoms within 4 weeks of life, up to 6 weeks in some
Treatment of neonatal HSV
- med, duration, associations
IV Acyclovir 60mg/kg/day div TID Duration: - SEM = 14 days - Disseminated and CNS = 21 days Associated neutropenia and renal damage
How to dx neonatal HSV
HSV PCR
do CSF and swabs of any vesicular lesions and mucous membranes (conjunctivae, mouth and nasopharynx)
Consider blood PCR if suspected disseminated
Consider NPA for PCR if pneumonia
In exposed asymptomatic infant, do swabs of mouth, nasopharynx, conjunctiva at least 24 hours after delivery
How to manage ASx infant of mom w active HSV lesions at delivery
if
First episode primary or first episode non-primary
First episode primary or first episode non-primary:
- C/S before ROM = MM & NP swabs and discharge if well, if positive then manage as NHSV case
- SVD or C/S w ROM = MM swab and start acyclovir and check mom’s serology
- if baby has neg swabs and mom has recurrent HSV, can stop acyclovir
- If mom primary (or serology not available) continue acyclovir for 10 days even if swabs negative
How to manage ASx infant of mom w active HSV lesions at delivery
if
Recurrent HSV
Recurrent HSV at delivery by C/S
- MM & NP swabs and discharge if well, if positive then manage as NHSV case
Recurrent HSV at delivery SVD
- MM swabs at 24 hours and discharge if well pending results.
- Some recommend blood PCR too.
- Acyclovir only if swabs positive or lesions develop
Who to consider for neonatal HSV
Consider in all sick infants < 6 weeks
If on IV Abx for suspected sepsis, especially with seizures or abnormal CSF but negative bacterial blood culture and not improving
Pneumonia of uncertain etiology, not improving on 24h of IV Abx with viral picture on CXR
Unexplained bleeding at IV sites
Unexplained hepatitis in infant with suspected sepsis
Contraindications to LP
coagulopathy,
cutaneous lesions on site,
signs of herniation,
unstable clinical status (shock)
If papilledema, focal neuro signs, decreased LOC, do imaging before LP to r/o herniation
Mgmt for bacterial meningitis (meds)
Abx first choice 3rd gen ceph - ceftriaxone and cefotax
- Add vanco usually to cover for ceph resistant S pnuemo
- 3rd gen ceph should cover N mening and H flu
Hib and S pneumo: Give corticosteroids just before or within 2h of abx to reduce severe hearing loss
Close contacts should be treated with rifampin
C Diff presentation
mild, moderate, severe
complication?
Mild: Watery diarrhea < 4/d, no systemic toxicicty
Mod: >/=4 watery stools/d, no systemic toxicity (may have low grade fever or mild abdo pain)
Severe: Systemic toxicity (high grade fevers, rigor), hypotension shock, peritonitis ileus, megacolon
Pseuomembranous colitis: severe diarrhea, abdominal pain, fever, leukocytosis, systemic toxicity, and stool containing blood, mucous and leukocytes
Toxic megacolon - can lead to perforation
how to dx c diff
toxin in stool
not culture
How to prevent C Diff spread
1) Meticulous hand hygiene
2) ID and remove environmental sources of Cdiff & use chlorine-containing or other sporicidal cleaning agents to eliminate environmental contamination in areas associated with increased rates or outbreaks of CDI
(Alcohol-based hand hygiene products do not kill Cdifficile spores)
3) Contact precautions until 48 h with no diarrhea
4) Use of private rooms or cohorting
How to treat CDiff infection
- mild, moderate, severe, severe complicated
Mild illness: No Abx
- If precipitated by abx, these should be stopped, if possible
- Should seek help if sx worsen or if a child has not improved within 48 h
Moderate illness: PO metronidazole
- Discontinue the offending Abx, if possible
Severe, uncomplicated illness: PO vancomycin
- Discontinue the offending Abx, if possible
Severe, complicated (ileus, megacolon, shock, peritonitis or hypotension) : PO or PR Vanco
AND IV metronidazole
How to treat CDiff infection recurrence
First recurrence
Same as first episode of Cdiff
Second or later recurrences
Vanco, using a tapered and/or pulsed regimen.
Higher Risk for Hep C
IVDU major risk factor
○ Being the sexual partner of an IVDU
○ Blood transfusion prior to 1990 (when Canada began HCV screening)
○ Patients/HCW exposed to contaminated blood/body fluids
○ Sexual transmission (consider a minor mode of transmission)
○ Infant female sex
○ ? Prolonged ROM
○ ? Intrapartum fetal scalp monitoring
○ ? Amniocentesis
Can Hep C + mom breastfeed?
yes
Polio - most serious complication
acute flaccid paralysis
Measles - presentation
3 C’s: cough, coryza and conjunctivitis, followed by a descending maculopapular rash; Koplik’s spots
What vaccine preventable disease will never be eradicated
tetanus
What vaccine preventable disease has common vaccine failure
Mumps
When is TB most infectious
Cavitary disease
Types of TB disease
Latent
Active:
- Pulmonary
- Extra pulmonary
- Disseminated
TB Testing
Culture = definitive Dx
sputum or AM gastric aspirates
Positive TST?
> 5mm if immunocompromised or known contact
>10mm for most others
Age limit for IGRA?
> 2yo
TST: what type of reaction
Type IV hypersensitivity reaction
TST - false positive
Cross-reactive with non-TB MB or BCG vaccine
TB tests - more specific and more sensitive
Specific IGRA
Sensitive: TST
Workup for child w TB contact
Hx, PE, CXR, TST
Meds for tx of TB
RIPE
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Indications for TB screening
- contacts of known active TB
- children w suspected active TB
- children w known RF for progression of infection to disease
- children traveling/residing >3mo in area w high incidence of TB
- children who arrive in Canada from countries w high TB incidence
Antibiotics for salmonella infection
Azithro mycin
Ceftriaxone
Who to treat with antivirals for influenza
Mild
- only consider if 1-5 yo and <48h illness
- or if risk factors present
Moderate, Severe, Progressive or Complicated
- start therapy
Key points for vaccine hesitant parents
1) Understand the key role that vaccine advice can play in parent decision-making, and do not dismiss vaccine refusers from your practice
2) Use presumptive and motivational interviewing techniques to understand vaccine concerns
3) Use simple clear language to present evidence of disease risks and vaccine benefits
Risks of VPDs > risks of vaccines
4) Address pain
5) Community protection (herd immunity) does not guarantee personal protection
What additional vaccines should be given for immunocompromised children?
● Pneumovax 23
● Hib
● additional boosters, ex. Hep B.
How soon after immunosuppression can live vaccines be given?
- high dose steroids
- immunosuppressive chemo
- anti-B cell antibodies (Rituximab)
● one month after high-dose steroid therapy
● 3 months or more after completion of immunosuppressive chemotherapy
● 6 months after treatment with anti-B cell antibodies (Rituximab)
Planned immunosuppression (ex solid organ transplant) - how early before to give vaccines?
inactivated: 2 weeks
live: 4 weeks
Transplant, how long after do you wait to vaccinate?
HSCT:
3-12 mo for inactivated vaccines,
24 mo for live
Solid organ:
3-6 mo for inactivated vaccines,
live are C/I
Congenital zika virus features
CNS: severe microcephaly, cerebral atrophy, abnormal cortical development, callosal hypoplasia and diffuse subcortical calcifications
Ortho: Abnormal fetal tone can result in clubfoot or fetal akinesia deformation sequence (arthrogryposis)
Eyes: Microphthalmia, cataracts, and retinal abnormalities
SNHL
IUGR
How to diagnose congenital zika syndrome
Either Serology or ZIKV RNA by PCR
- blood and urine
If features of CZS: test mom and baby
If mom just had exposure: test mom first
Exposure to Zika: what time frame of sexual contact with male who traveled to endemic area is a potential exposure
If male traveled in the 6 months preceding sexual contact
What time frame does it take for mom’s negative serology to confirm no Zika
Negative maternal ZIKV serology > 4 weeks after exposure rules out ZIKV infection and congenital ZIKV infection.
Most common aetiologies of uncomplicated pneumonia
Viral most common
RSV, Influenza, Parainfluenza, HMPV
Bacteria
Strep pneumoniae > GAS > Staph aureus
Mycoplasma and Chlamydia – school age children
When to use Vanco in pneumonia
rapid progression or pneumatoceles
How long to treat pneumonia?
7-10 days in hospitalized patient;
5 days for outpatient
How best to protect infant. < 6mo against influenza
Immunizing pregnant women
During 2nd or 3rd trimester with inactivated flu vaccine
Risk Factors for STI
- Inconsistent or no condom use
- Contact with someone known to have STI
- New partner
- > 2 partners in past year
- Serial monogamy
- No contraception or only non-barrier contraception (e.g. oral contraceptive, intrauterine device, or Depo-Provera)
- Injection drug use
Any drug use (e.g. alcohol, marijuana, others – especially if associated with sex) - Previous STI
- Any unsafe sexual practices (e.g. involving exchange of blood or sharing sex toys)
- Sex workers and their clients
- Survival sex (e.g. exchange of sex for food, shelter, or drugs)
- Street involvement/precarious housing
- Anonymous sex (sex with a stranger after meeting online or elsewhere)
- Experience of sexual assault or abuse
Treatment of Gonorrhea
Ceftriaxone/Cefixime
+
Azithromycin
Bacteria in Lyme disease
Borrelia burgdorferi
window of opportunity to prevent lyme disease if tick on you (how soon to remove tick)
<36h
Lyme disease clinical manifestations
Early localized disease
Erythema migrans 7-14 days after bite; resolves spontaneously within 4 weeks
May also get fever, HA, malaise, neck stiffness, arthralgia
Early disseminated disease
Multiple EM rashes
Acute neuro signs (facial nerve palsy, lymphocytic meningitis, papilledema), lyme carditis with heart block rare in kids.
Late Disease
Arthritis most common (oligoarticular, large joints – knees) about 4 months post-bite
Peripheral neuropathy and CNS manifestations rare in children
Jarisch-Herxheimer reaction
fever, headache, myalgia after starting tx for Lyme dz
What are two main infections aimed at preventing with mosquito and tick bites?
West Nile
Lyme
Ingredients in insect repellants
DEET
Icaridin
Best way to prevent mosquito/tick bites
Protective clothing (if treated with permethrin even better) + Icaridin/DEET on exposed skin as repellent
What vaccines are C/I post solid organ transplant?
Live vaccines MMR Varicella Rotavirus Live influenza
What viruses to screen for pre transplant
HIV HTLA Hep A, B, C, D CMV EBV Herpes Varicella Toxiplasmosis MMR - if vaccinated TB Strongyloides
Most common bugs in acute otitis externa
Pseudomonas aeruginosa and Staphylococcus aureus
What are some transfusions related adverse events
Transfusion associated circulatory overload = 50% of serious adverse events;
severe anaphylaxis = 15%;
hypotension = 12%;
transfusion related acute lung injury = 8%
What viruses are at risk for transmission during transfusion
HIV 1/12 million; HCV 1/7 million; HBV 1/2 million; Bacterial 1/50,000 in platelets, syphilis < 1/100 million
What virus is not tested for in blood products
ParvoB19 1/5000
CA-MRSA risk factors for spread
close skin-to-skin contact openings in the skin such as cuts or abrasions contaminated items and surfaces crowded living conditions poor hygiene
Complications of MRSA
Osteomyelitis Septic arthritis Necrotizing fasciitis Sepsis Pneumonia (esp following influenza)
Abx options for MRSA
when to tx
- TMP/SMX (good coverage except not penetration)
- Doxycycline (>8yo)
- Clindamycin (incr resistance)
- Fluoroquinolones (cipro) (incr resistance)
- Linezolid
If <3mo or if no improvement after drainage or systemic illness
Treatment of candida
Fluconazole
Treatment for invasive Aspergillosis
Voriconazole
Caspofungin
Oropharyngeal Candidiasis
tx
Nystatin 200,000 units QID after feeds
Candida diaper dermatitis
Topical antifungal = miconazole or zinc oxide
Pityriasis versicolor (Tinea versicolor)
Topical Clotrimazole; shampoo antifungals as a lotion
Tinea corporis
TOPICAL
clotrimazole, ketoconazole, or miconazole BID for 14-21 days
no steroids
Seborrheic dermatitis
use soap and water, or selenium shampoo if more severe
Tinea capitis
Terbinafine PO
needs to be oral cause can cause hair loss
Invasive GAS infection presentations
Necrotizing fasciitis or myositis
Bacteremia
Pneumonia
Toxic shock syndrome
Risk factor for invasive GAS infection
Varicella
Toxic shock syndrome
TSS = hypotension and 2+ of:
renal impairment, transaminitis, coagulopathy (Plt < 100 or DIC), ARDS, generalized macular red rash (may peel)
Chemoprophylaxis for invasive GAS
- who
- abx
- duration
For close contacts of confirmed case of severe GAS from 7 days pre illness to 24 hours post antibiotic initiation
First Gen Cephalosporin preferred (Cephalexin)
(Alternative is 2nd and 3rd Gen = Cefuroxime, Cefixime
Macrolide if Penicillin allergy (Azithromycin))
10 days
Treatment of invasive GAS infection
Penicillin = best treatment Clindamycin added (inhibits protein synthesis)
Who should get prophylaxis for infective endocarditis for dental procedures
- Prosthetic cardiac valve or prosthetic material used for valve repair
- Previous IE
- Congenital heart disease:
- -Unrepaired cyanotic CHD, including palliative shunts and conduits
- -Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
- -Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
- Cardiac transplant recipients who develop cardiac valvulopathy
What abc to prophylaxis with for IE?
Amoxil
What are “Routine practices” in Canada?
assume blood, body fluids, excretions and secretions of any patient could contain pathogens.
What is airborne precautions for
Varicella, measles, TB, smallpox
Who should get the influenza vaccine
ALL high risk patients + anyone in contact with them
- Any child < 5 years of age and anyone with Chronic conditions
- Also: Indigenous peoples, All pregnant women (any trim)
- Household contacts of high risk conditions; household w babies <6mo; childcare to <5yo
What vaccine to give
Quadrivalent preferred
LAIV or IM
LAIV can only be given to >2yo and not to pregnant
If first time getting influenza vaccine <9yo: have to give 2 DOSES 1 month apart
When is the influenza vaccine contraindicated
- Hx of anaphylaxis to vaccine
- Hx of GBS within 6 weeks of previous vaccine
- LAIV in immunocompromised people or those with severe asthma (current wheeze/medical attention for wheeze in past 7 days or high dose steroid use)
- LAIV in pregnancy is contraindicated
- Do not give LAIV within 48 hours of completing antiviral therapy (Tamiflu)
Congenital syphilis: clinical features
SAB, hydrops
Necrotizing funisitis (barbershop pole)
Rhinitis and/or snuffles
Rash: in first 8 weeks - 50% of cases
HSM at first 8 weeks
LAN- 5%
Neurosyphilis: at birth or can be delayed
MSK: first week with permanent bony changes
Osteochondritis or perichondritis
Frontal bossing, poorly developed maxillas, saddle nose, winged scapulas, sabre shins
Recurrent arthropathy and painless knee effusions (Clutton`s joints)
Hematological: present at birth or can be delayed
Anemia, TCP
Interstitial keratitis 2-20 yrs
Hutchinson teeth: when permanent dentition erupts
Mulberry molars
13-19 mo
Sensory neural deafness (eighth nerve)
Treatment for congenital syphilis
- 10 days of IV penicillin G q12 if less than 1 week of age
- -Q8h if 1-4 weeks every 6 h if older than 4 weeks of age
If neurosyphilis need to repeat LP CSF q6months
