ID Flashcards
clinical features of congenital CMV
Distinct: periventricular calcifications
Other: IUGR, hepatosplenomegaly, thrombocytopenia, microcephalty, SNHL, chorioretinitis
Congenital CMV treatment indications
Indicated for: neonates with “moderate to severe” disease
(e.g. mulitple manifestations or CNS invovlement)
Controversial = isolated hearing loss
Congenital CMV treatment
- start during neonatal period
oral valgancyclovir x 6 months
(IV ganciclovir if unable to tolerate oral)
Evaluation of infant with suspected congenital syphilis
Physical: stigmata, ophtho, audiology assessments CBC (LFTs) CSF Skeletal survey syphilis serology direct dection
Treatment of congenital syphilis
IV crystalline pen G x 10 days
Infant of mother with possible Zika exposure in pregnancy - next steps
- maternal zika virus serology (and PCRs if exposure in previous 4 weeks)
if positive THEN zika serology and PCR and imaging of infant
Features of congenital rubella
Distinct: cataract, bony lucencies, cardiac anomalies (PDA)
Other: IUGR, blueberry muffin rash, hepatosplenomegaly, SNHL
Features of congenital syphilis
Distinct: snuffles, rash on palms and soles, osteitis/perichondritis
Other: rashes, chorioretinitis, aseptic meningitis
Features of congenital toxoplasmosis
Distinct: macrocephaly, hydorcephalus, parenchymal calcifications
Other: chorioretinitis
Features of congenital VZV
Distinct: cicatricial scars, limb hypoplasia
Other: microcephaly, micoophthalmia, GERD
Features of congenital Zika
Distinct: subcortical calcifications
Other: microcephaly, brain malformations, macular scars, contractures
Most common bacterial pathogens in infants without a source by age
(for fever without a source)
0-28 days: GBS, ecoli
(other = listeria, staph auresu, GAS, klebsiella)
29-90 days: GBS, E.coli, S. pneumo
(other = neisseria, listeria, staph aureus, GAS)
3-36 months: S. pneumo
(other = staph aureus, GAS, neisseria)
Neonatal HSV - skin eye mouth (45%) features
- usually 10-12 days of life
- appear well
- clinically silent CNS can occur and dissmeination can occur
Neonatal HSV - encephalitis (30%) features
- usually day 16-19 of life
- fever, decreased LOC, seizures, skin lesion in 2/3 of cases,
- majority of survivors suffer neuro sequelae
(40% have no skin lesions)
Neonatal HSV - disseminated (25%)
- features
- day 10-12 days of life
- sepsis like presentation, multi-organ involvement
- 2/3 have concurrent encephalitis
- majority of survivors suffer neuro sequelae
Treatment of neonatal HSV
IV acyclovir 60/kg/day
- 2 weeks for isolated mucocutaneous
- 3 weeks for disseminated or CNS disease
(repeat LP toward end of treatment)
- suppressive oral acylcovir x 6 months improves neuro ourcomes for those withCNS disease
- long ternneurodevelopmental follow up
Neonatal HSV risk factors for transmission
- rupture of membranes > 6 hrs
- fetal scalp monitor
- HSV1 (> HSV2)
- vaginal delivery (vs. c section)
- first episode primary infection
Bacterial meningitis
- role for dexamethasone:
- H. influenzae
- possibly strep pneumo
ideally before or within 4 hrs of abx
Necrotizing fasciitis risk. factor assessment
- GAS: recent pharyngitis, VZV
- colonization with MRSA
- exposure to water-borne pathogens
- clodstridial or polymicrobial: recent GI surgery, pregnancy complications, penetrating trauma
Nec Fasc empiric tx
- Beta-lactam-beta-lactamase inhibitor (e.g. pip-tazo) OR a carbapenem With clindamycin
- add vanco if MRSA is a concern
otherwise healthy child can consider: pen G+clindamycin
Pathogens in asplenic children
- strep pneumo!
others: H. flu type B, neisseria meningitidis, campnocytophaga canimorsus (dog saliva), salmonella species
Lymphadenopathy etiology
- acute + bilateral
- acute + unilateral
Bilateral: Resp viruses, enteroviruses, adenovirus, EBV, CMV
Unilateral: S. pyogenes (80%), S. aureus
Infectious lymphadenopathy etiology:
- subacute bilateral
- subacute unilateral
Bilateral: HIV, EBV, CMV, toxoplasmosis
Unilateral: non-TB mycobacteria, M. tuberculosis, bartonella henselae, tularemia, plaque
Cat-scratch organism
Bartonella henselae
Lyme organisms
Borrelia burgdorferi
West Nile Virus features
Most common: asymptomatic (80%)
20% = west nile fever
< 1% = west nile neurologic disease (aseptic meningitis, encephalitis, acute flaccid myelitis)
Complications of varicella
General: pneumonia, hepatitis, pancreatitis, nephritis, orchitis, thrombocytopenia
Bacterial infections: e.g. nec fasc
Neurologic: cerebellar ataxia, encephalitis, Reye syndrome, stroke, zoster
well-appearing baby born to mother with untreated gonorrhea
- conjunctival culture, IM ceftriaxone
if unwell, conjunctival blood and CSF cultures and consult ID
Baby exposed to chlamydia
- abx prophylaxis NOT recommended (risk of pyloric stenosis)
- close follow up
- PCR testing if develop sx
- treat if PCR is positive
Reasons for reactive TB skin test
- tuberculosis
- non TB mycobacteria infection
- BCG in past
- incorrect technique
Treatment latent TB infection
- INH x 9 months OR
- rifampin x 4 months OR
- INH+rif x 3 months OR
- INH + rifapentine x 12 weekly observed doses
TB medication adverse effects
- rifampin
- isoniazid
- pyrazinamide
- ethambutol
Rif: liver, hypersensitivty rxn, memory, drug interactions, orange body fluids
INH: liver, peripheral neuropathy
Pyrazinamide: liver, increased uric acid
Ethambutol: optic neuropathy
Prevention of HIV transmission
- antiretroviral therapy (triple ART starting in 2nd trimester or earlier)
- IV zidovudine during labor
- zidovudine x 4-6 weeks for infant
- elective CS if viral load > 1000
- avoidance of breast feeding!
Needlestick injury and previously vaccinated
- send anti-HBsAb stat
- if positive can reassure - if negative do HBsAg
- if HBsAg negative: HBIG and vaccine
- if HBsAG positive: refer
Needlestick injury and incompletely vaccinated
Send anti-HBsAg AND HBsAG:
- if both negative: HBIG and vaccine
- if anti-HBsAg positive: complete vaccine series
- if HBsAG positive: refer
HBsAg positive mother
- care of newborn
- HBIG and HB vaccine within 12 hrs of birth
- HB vaccine at 1 and 6 months
- check immunity at 9-12 months
VZIG indications
give within ASAP within 10 days of exposure
- immunocompromised children without hx of varicella (or immunziation)
- susceptible pregnant women
- newborn infant with mother having VZV within 5 days before delivery or within 48hrs of delivery
- hospitalized prem infant > 28 weeks whose mother lacks proetction
- hospitalized prem infant < 28 weeks regardless o fmatenral hx
Chemoprophylaxis
- HIB
- nesseiria meningitis
- Strep pyogenes invasive disease
- B Pertussis
HIB: rifampin
Neisseria: rifampin
Strep: cephalexin
Pertussis: azithromycin
Chemoprophylaxis
- Measles
- rubella
Measles: Ig within 6 days, IVIG (alternative)
Rubella: generally none but Ig may be considered in pregnancy
Daycare exclusion rules
- strep and impetigo
- diarrhea
- strep + impetigo: 24hr after tx initiated
- until resolution of diarrhea (+ 2x negative stool culture for E.coli 0157:H7, 3x negative culture for typhoid fever)
Daycare exclusion rules
- measles
- mumps
- pertussis
Measles: until 4 days after onset of rash
Mumps: until 5 days after parotid gland
Pertussis: until 5 days after treatment
Daycare exclusion rules
- Hepatitis A
until 1 week after onset of illness or jaundice
Airborne precaution bugs
- varicella, zoster
- measles
- TB
- smallpox
