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ID Flashcards

1
Q

clinical features of congenital CMV

A

Distinct: periventricular calcifications

Other: IUGR, hepatosplenomegaly, thrombocytopenia, microcephalty, SNHL, chorioretinitis

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2
Q

Congenital CMV treatment indications

A

Indicated for: neonates with “moderate to severe” disease
(e.g. mulitple manifestations or CNS invovlement)
Controversial = isolated hearing loss

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3
Q

Congenital CMV treatment

A
  • start during neonatal period
    oral valgancyclovir x 6 months
    (IV ganciclovir if unable to tolerate oral)
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4
Q

Evaluation of infant with suspected congenital syphilis

A 
Physical: stigmata, ophtho, audiology assessments
CBC (LFTs)
CSF
Skeletal survey
syphilis serology
direct dection
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5
Q

Treatment of congenital syphilis

A

IV crystalline pen G x 10 days

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6
Q

Infant of mother with possible Zika exposure in pregnancy - next steps

A
  • maternal zika virus serology (and PCRs if exposure in previous 4 weeks)
    if positive THEN zika serology and PCR and imaging of infant
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7
Q

Features of congenital rubella

A

Distinct: cataract, bony lucencies, cardiac anomalies (PDA)
Other: IUGR, blueberry muffin rash, hepatosplenomegaly, SNHL

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8
Q

Features of congenital syphilis

A

Distinct: snuffles, rash on palms and soles, osteitis/perichondritis

Other: rashes, chorioretinitis, aseptic meningitis

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9
Q

Features of congenital toxoplasmosis

A

Distinct: macrocephaly, hydorcephalus, parenchymal calcifications

Other: chorioretinitis

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10
Q

Features of congenital VZV

A

Distinct: cicatricial scars, limb hypoplasia

Other: microcephaly, micoophthalmia, GERD

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11
Q

Features of congenital Zika

A

Distinct: subcortical calcifications

Other: microcephaly, brain malformations, macular scars, contractures

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12
Q

Most common bacterial pathogens in infants without a source by age
(for fever without a source)

A

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)

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13
Q

Neonatal HSV - skin eye mouth (45%) features

A
  • usually 10-12 days of life
  • appear well
  • clinically silent CNS can occur and dissmeination can occur
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14
Q

Neonatal HSV - encephalitis (30%) features

A
  • 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)
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15
Q

Neonatal HSV - disseminated (25%)

- features

A
  • day 10-12 days of life
  • sepsis like presentation, multi-organ involvement
  • 2/3 have concurrent encephalitis
  • majority of survivors suffer neuro sequelae
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16
Q

Treatment of neonatal HSV

A

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

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17
Q

Neonatal HSV risk factors for transmission

A
  • rupture of membranes > 6 hrs
  • fetal scalp monitor
  • HSV1 (> HSV2)
  • vaginal delivery (vs. c section)
  • first episode primary infection
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18
Q

Bacterial meningitis

- role for dexamethasone:

A
  • H. influenzae
  • possibly strep pneumo
    ideally before or within 4 hrs of abx
19
Q

Necrotizing fasciitis risk. factor assessment

A
  • GAS: recent pharyngitis, VZV
  • colonization with MRSA
  • exposure to water-borne pathogens
  • clodstridial or polymicrobial: recent GI surgery, pregnancy complications, penetrating trauma
20
Q

Nec Fasc empiric tx

A
  • 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

21
Q

Pathogens in asplenic children

A
  1. strep pneumo!

others: H. flu type B, neisseria meningitidis, campnocytophaga canimorsus (dog saliva), salmonella species

22
Q

Lymphadenopathy etiology

  • acute + bilateral
  • acute + unilateral
A

Bilateral: Resp viruses, enteroviruses, adenovirus, EBV, CMV

Unilateral: S. pyogenes (80%), S. aureus

23
Q

Infectious lymphadenopathy etiology:

  • subacute bilateral
  • subacute unilateral
A

Bilateral: HIV, EBV, CMV, toxoplasmosis
Unilateral: non-TB mycobacteria, M. tuberculosis, bartonella henselae, tularemia, plaque

24
Q

Cat-scratch organism

A

Bartonella henselae

25
Q

Lyme organisms

A

Borrelia burgdorferi

26
Q

West Nile Virus features

A

Most common: asymptomatic (80%)
20% = west nile fever
< 1% = west nile neurologic disease (aseptic meningitis, encephalitis, acute flaccid myelitis)

27
Q

Complications of varicella

A

General: pneumonia, hepatitis, pancreatitis, nephritis, orchitis, thrombocytopenia
Bacterial infections: e.g. nec fasc
Neurologic: cerebellar ataxia, encephalitis, Reye syndrome, stroke, zoster

28
Q

well-appearing baby born to mother with untreated gonorrhea

A
  • conjunctival culture, IM ceftriaxone

if unwell, conjunctival blood and CSF cultures and consult ID

29
Q

Baby exposed to chlamydia

A
  • abx prophylaxis NOT recommended (risk of pyloric stenosis)
  • close follow up
  • PCR testing if develop sx
  • treat if PCR is positive
30
Q

Reasons for reactive TB skin test

A
  • tuberculosis
  • non TB mycobacteria infection
  • BCG in past
  • incorrect technique
31
Q

Treatment latent TB infection

A
  • INH x 9 months OR
  • rifampin x 4 months OR
  • INH+rif x 3 months OR
  • INH + rifapentine x 12 weekly observed doses
32
Q

TB medication adverse effects

  • rifampin
  • isoniazid
  • pyrazinamide
  • ethambutol
A

Rif: liver, hypersensitivty rxn, memory, drug interactions, orange body fluids
INH: liver, peripheral neuropathy
Pyrazinamide: liver, increased uric acid
Ethambutol: optic neuropathy

33
Q

Prevention of HIV transmission

A
  • 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!
34
Q

Needlestick injury and previously vaccinated

A
  1. send anti-HBsAb stat
    - if positive can reassure
  2. if negative do HBsAg
    - if HBsAg negative: HBIG and vaccine
    - if HBsAG positive: refer
35
Q

Needlestick injury and incompletely vaccinated

A

Send anti-HBsAg AND HBsAG:

  • if both negative: HBIG and vaccine
  • if anti-HBsAg positive: complete vaccine series
  • if HBsAG positive: refer
36
Q

HBsAg positive mother

- care of newborn

A
  1. HBIG and HB vaccine within 12 hrs of birth
  2. HB vaccine at 1 and 6 months
  3. check immunity at 9-12 months
37
Q

VZIG indications

give within ASAP within 10 days of exposure

A
  1. immunocompromised children without hx of varicella (or immunziation)
  2. susceptible pregnant women
  3. newborn infant with mother having VZV within 5 days before delivery or within 48hrs of delivery
  4. hospitalized prem infant > 28 weeks whose mother lacks proetction
  5. hospitalized prem infant < 28 weeks regardless o fmatenral hx
38
Q

Chemoprophylaxis

  • HIB
  • nesseiria meningitis
  • Strep pyogenes invasive disease
  • B Pertussis
A

HIB: rifampin

Neisseria: rifampin

Strep: cephalexin

Pertussis: azithromycin

39
Q

Chemoprophylaxis

  • Measles
  • rubella
A

Measles: Ig within 6 days, IVIG (alternative)
Rubella: generally none but Ig may be considered in pregnancy

40
Q

Daycare exclusion rules

  • strep and impetigo
  • diarrhea
A
  • 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)

41
Q

Daycare exclusion rules

  • measles
  • mumps
  • pertussis
A

Measles: until 4 days after onset of rash
Mumps: until 5 days after parotid gland
Pertussis: until 5 days after treatment

42
Q

Daycare exclusion rules

- Hepatitis A

A

until 1 week after onset of illness or jaundice

43
Q

Airborne precaution bugs

A
  • varicella, zoster
  • measles
  • TB
  • smallpox

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