ID Flashcards
Most common congenital infection?
CMV (0.5%)
Clinical Features of congenital CMV infection?
- 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
Newborn with + CMV PCR urine — treatment ?
Asymptomatic? – nothing
Symptomatic (eg fail HS): Valganciclovir x 6mo
Newborn started on Vangancyclovir- what to monitor?
ANC : weekly x 6wks , at 8wks, then monthly
ALT: monthly
Congenital Syphillis: early onset findings
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
Congenital Syphillis: Late onset findings
Fyi..wont be asked
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
Pregnant mom with syphilis, 1) what level of titer in mom would be considered “treated” ?
2) Management for baby if higher titer?
Need to be 1:32 or less in mom
Baby receives:
- full work up with LP
- IV PCN x 10days (regardless of work up)
When to evaluate an infant for congenital syphillis?
CPS
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
Evaluation of infant with suspected syphilis (invx)
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
Treatment of congenital syphilis ?
10d IV PCN
Congenital Zika: clinical features
- severe microcephaly
- partially collapsed skull
- retinal mottling
- congenital contractures (arthrogryposis, club foot0
Risk of congenital anomaly from Zika in pregnancy?
5-10% overall
1st trim of pregn: 8-13%
2nd/3rd trim: 3-5%
If infant of mother with possible zika exposure in pregnancy- what to test?
Maternal serology for Zika (and PCR if exposure in last 4 weeks)
If positive then test infant
If assessing for Zika due to unexplained microcephaly- what to test?
Assess possible exposure (time and health habits)
Test mom and baby for serologies + PCR .
Save placenta.
US and MRI
Clinical features of congenital rubella?
IUGR blueberry muffin rash HSM cataract* bony lucency * Cardiac: PDA * SNHL
Clinical features of congenital Toxo?
classic triad
%age symptomatic vs non
Macrocephaly/Hydrocephalus*
Parenchymal calcification* (vs perventr)
Chorioretinitis***
Symptomatic 85%
Asymptomatic 15%
classic triad congenital rubella
cataract
PDA
SNHL
Congenital VZV infection- features
cicatrial scars **
limb hypoplasia **
micropthalmia, microcephaly
GBS neonate:
1) Classify by onset
2) Type of transmission
3) Manifestations
1) Early (>7d)
Late (>7d)
2) Early: vertical
Late: Vertical or horizontal
3) Early: PNA, septicemia, meningitis
Late: Meningitis, OM, ST infections, sepsis
Indications for intrapartum GBS proph
Positive GBS Cx (35-37 wks)
Unknown GBS and :
- hx infant w GBS
- GBS UTI
- Deliv <37 wks
- ROM >18
- Maternal fever
Congenital HSV: clinical manifestations
Skin, eye, mouth (45%)
- 10-12 DOL
Encephalitis (30%)
- 16-19 DOL
Disseminated (25%)
- 10-12 DOL
- sepsis lik, multi organ
Suspected congenital HSV disease: Dx
Culture/PCR of :
1) Vesicle
2) eyes
3) urine
4) stool
5) blood
6) CSF
DO LP even if clinically well.
Suspected congenital HSV disease: Tx
▫ 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
Factors affecting HSV transmission
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
HSV: asymptomatic infant of mother with active lesions at delivery : Invx?
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
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
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
Role of steroids in meningitis:
what species? what age? what dose?
1) for H. Influenza and S. pneumonia
2) >6weeks
3) 0.6mg/kg/day div 4 doses
When to consider repeat LP at 24-36h?
- failure to improve clinically
- immunocompromised
- S. pneumo resist PCN/Ceph
- Gram - bacilli
OM: what are 2 most common pathogens?
Staph Aureus Kingella Kinge ( >4)
OM: Tx course and duration
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
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
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
When to give tetanus vaccine and IG for wound?
- 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
Top pathogens per age group and Empiric ABx
1) Neonate
2) 1-3mo
3) >3mo
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
