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Ped RC > ID > Flashcards

ID Flashcards

1
Q

Most common congenital infection?

A

CMV (0.5%)

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2
Q

Clinical Features of congenital CMV infection?

A
  • General. –> IUGR, prem
  • Skin: –> Petechia, purpura, achymosis, jaundice
  • Heme: –> Thombocytopenia, anemia, splenomegaly
  • Liver: –> Hyperbili, ALTs, hepatomegaly
  • CNS: –> microcephaly, sz, periventricular calcifications
  • Eyes: –> Chorioretinitis, stabismus, optic atrophy, microphtalmia
  • Ears: –> SHL
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3
Q

Newborn with + CMV PCR urine — treatment ?

A

Asymptomatic? – nothing

Symptomatic (eg fail HS): Valganciclovir x 6mo

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4
Q

Newborn started on Vangancyclovir- what to monitor?

A

ANC : weekly x 6wks , at 8wks, then monthly

ALT: monthly

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5
Q

Congenital Syphillis: early onset findings

A

1) Gen: Prematurity, IUGR, FTT
2) CNS: Aseptic meningitis, hydrocephalus, CN palsies
3) Eyes: salt & pepper chorioretinitis, uveitis, glaucoma
4) Skin: Snuffles, maculopapular rash –> desquamation, blistering+crusting, condyloma lata
5) Heme: Coomb’s negative hemolytic anemia, thrombocytopenia
6) Organs: HSM, LAD
7) MSK: pseudoparalysis, osteochondritis, osteitis/perisosteitis, demineralization/destruction of tibia metaphysis

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6
Q

Congenital Syphillis: Late onset findings

Fyi..wont be asked

A

1) CNS: GDD, hydrocephalus, CN palsies, Sz, juvenile paresis
2) Eyes: keratitis, healed chorioretinitis, corneal scarring, glaucoma, optic atrophy
3) Ears: SNHL
4) Face: Saddle nose, frontal bossing, protuberant mandible, high palate
5) Teeth: Hutchinsons teeth, mulberry molars
6) Skin: ragades (linear scars), gummas
7) MSK : saber shins, clutton joints, Higoumenakis sign

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7
Q

Pregnant mom with syphilis, 1) what level of titer in mom would be considered “treated” ?
2) Management for baby if higher titer?

A

Need to be 1:32 or less in mom

Baby receives:

  • full work up with LP
  • IV PCN x 10days (regardless of work up)
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8
Q

When to evaluate an infant for congenital syphillis?

CPS

A

1) has s/s of cong syph
2) mom not tx or tx not adequate
3) mom tx w non PCN Abx
4) mom tx w/in 30 days of birth
5) less than 4x drop in mom titer (or not assessed(
6) mom had relapse/re-infection after tx

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9
Q

Evaluation of infant with suspected syphilis (invx)

A

1) exam: stigmata, opts, audio
2) BW: CBC, LFTs
3) LP: CSF WBC, protein, treponema and non trep serologic tests
4) Skeletal survey
5) Syphilis serology (tree and non tree)
6) Direct detection: micro

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10
Q

Treatment of congenital syphilis ?

A

10d IV PCN

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11
Q

Congenital Zika: clinical features

A
  • severe microcephaly
  • partially collapsed skull
  • retinal mottling
  • congenital contractures (arthrogryposis, club foot0
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12
Q

Risk of congenital anomaly from Zika in pregnancy?

A

5-10% overall

1st trim of pregn: 8-13%
2nd/3rd trim: 3-5%

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13
Q

If infant of mother with possible zika exposure in pregnancy- what to test?

A

Maternal serology for Zika (and PCR if exposure in last 4 weeks)
If positive then test infant

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14
Q

If assessing for Zika due to unexplained microcephaly- what to test?

A

Assess possible exposure (time and health habits)
Test mom and baby for serologies + PCR .
Save placenta.
US and MRI

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15
Q

Clinical features of congenital rubella?

A 
IUGR
blueberry muffin rash
HSM
cataract*
bony lucency *
Cardiac: PDA *
SNHL
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16
Q

Clinical features of congenital Toxo?

classic triad
%age symptomatic vs non

A

Macrocephaly/Hydrocephalus*
Parenchymal calcification* (vs perventr)
Chorioretinitis***

Symptomatic 85%
Asymptomatic 15%

17
Q

classic triad congenital rubella

A

cataract
PDA
SNHL

18
Q

Congenital VZV infection- features

A

cicatrial scars **
limb hypoplasia **
micropthalmia, microcephaly

19
Q

GBS neonate:

1) Classify by onset
2) Type of transmission
3) Manifestations

A

1) Early (>7d)
Late (>7d)

2) Early: vertical
Late: Vertical or horizontal

3) Early: PNA, septicemia, meningitis

Late: Meningitis, OM, ST infections, sepsis

20
Q

Indications for intrapartum GBS proph

A

Positive GBS Cx (35-37 wks)

Unknown GBS and :

  • hx infant w GBS
  • GBS UTI
  • Deliv <37 wks
  • ROM >18
  • Maternal fever
21
Q

Congenital HSV: clinical manifestations

A

Skin, eye, mouth (45%)
- 10-12 DOL

Encephalitis (30%)
- 16-19 DOL

Disseminated (25%)

  • 10-12 DOL
  • sepsis lik, multi organ
22
Q

Suspected congenital HSV disease: Dx

A

Culture/PCR of :

1) Vesicle
2) eyes
3) urine
4) stool
5) blood
6) CSF

DO LP even if clinically well.

23
Q

Suspected congenital HSV disease: Tx

A

▫ IV acyclovir 60 mg/kg/day

  • -> Isolated mucocutaneous disease: 2 weeks
  • -> Disseminated, CNS disease: 3 weeks

▫ If CSF PCR positive, repeat LP towards end of treatment

▫ PO acyclovir: x 6 mo improves neurologic outcome for those with CNS disease

24
Q

Factors affecting HSV transmission

A

1) Type of maternal infection & serostatus (1st primary (high), 1st episode non-primary (medium), recurrent (lower)
2) ROM >6h
3) Fetal scalp monitor
4) HSV 1 vs 2 (31% vs 2.7%)
5) C/S reduces risk

NB: majority of HSV infant –no maternal hx of genital herpes

25
Q

HSV: asymptomatic infant of mother with active lesions at delivery : Invx?

A

1) Sample from mouth, NP, conjunctiva, and anus at ~24h of life for culture/PCR
2) Maternal serologies (HSV-1 or 2) – recommended by some, not always available

26
Q

HSV: asymptomatic infant of mother with active lesions at delivery : Tx?

1) 1st ep SVD (or CS before ROM)
2) 1st episode: C/S no ROM
3) Recurrent episodes

A

1) 1st episode SVD or (CS after ROM)
- –> emp IV Acyclovir
- –> 24h swab +ve : full w/u + tx
- –> 24 swab -ve: 10d IV Acyclovir

2) 1st episode: C/S, no ROM
- –> NO emp IV Acyclovir
- -> if 24h +ve: full wu + tx

3) Recurrent episodes
- –> NO emp IV Acyclovir
- –> If 24h swabs +ve: ful w/u + tx

27
Q

Role of steroids in meningitis:

what species? what age? what dose?

A

1) for H. Influenza and S. pneumonia
2) >6weeks
3) 0.6mg/kg/day div 4 doses

28
Q

When to consider repeat LP at 24-36h?

A
  • failure to improve clinically
  • immunocompromised
  • S. pneumo resist PCN/Ceph
  • Gram - bacilli
29
Q

OM: what are 2 most common pathogens?

A 
Staph Aureus 
Kingella Kinge ( >4)
30
Q

OM: Tx course and duration

A

IV ancef (unless MRSA)

IV to PO when 
- clinically improved 
- CRP down
- compliance + fu assured
Duration: 
- Uncomplicated: 3-4 weeks
- Septic hip: 4-6 weeks
31
Q

Skin abscess (S.Aureus): management for

1) <1mo
2) 1-3 mo no fever/systemic
3) >3mo: low grade or no fever
4) >3mo: sign cellulitis, low grade/no fever, no systemic

A

1) IV ABx: ( +/- Vancouver) , can consider PO clinda in well and <1cm
2) Septra
3) No Abx. Abx if no improvement or Cx diff org.
4) Septra + Keflex pending Cx results

32
Q

When to give tetanus vaccine and IG for wound?

A
  • Give tetanus Ig only for:
    - non-clean non-minor wounds for someone received <3 shots of tetanus.
  • Give tetanus vaccine for:
    • non-minor and minor wounds for someone received <3 shots of tetanus or if last shot was 10y+ for minor wounds, 5y+ for major wounds
33
Q

Top pathogens per age group and Empiric ABx

1) Neonate
2) 1-3mo
3) >3mo

A

Neonate:

  • Group B streptococcus
  • Gram negative bacilli (E. coli)
  • Listeria spp.
  • ** Ampicillin + cefotaxime

1-3 mo.

  • overlap above and below
  • ** Ceftriaxone + vancomycin ± ampicillin

> 3 mo.

  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Haemophilus influenzae type b
  • ** Ceftriaxone + vancomycin

Ped RC (9 decks)

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