ID/Immuno Flashcards
Treatment for infant born to woman with active TB
isoniazid until 3-4 mo of age until PPD can be placed; continued management dependent on results
2 month vaccines
2B DR HIP
2 months:
hep B
DTaP (diphtheria, tenanus, acellular pertussis)
Rota (not in NICU)
Hib
IPV (inactivated polio)
Pneumococcal
*diptheria and tetanus are toxoid vaccines
Duration of treatment for infant born to maternal untreated gonorrheal infection
tx: both ophthalmic erythro and IV/IM CTX
if disseminated (bacteremia, arthritis) - CTX or cefotax for 7 days
meningitis - 10-14d
most common bacteria a/w osteo in neonates
Staph aureus
less common: GBS, E coli, candida, neisseria gonorrheoae
Most common bones for osteo
femur > humerus > tibia > radius > maxilla
(femur and tibia in preterm; humerus in term)?
CMV virus type
double stranded herpes DNA virus
precautions for CMV+ infant
standard
time of CMV maternal infection w/ greater risk of neonatal disease/greater severity of neonatal illness
FIRST half of pregnancy
radiographic evidence of osteomyelitis - what and when
7-10 days
bony destruction, focal area of metaphysical necrosis, soft tissue swelling
*CT/MR more sensitive but not always possible due to need for transport/sedation
treatment duration for toxo
~1 year
pyrimethamine-sulfadiazine and folinic acid*
(supplement with folate b/c sulfadiazine a/w bone marrow suppression –>neutropenia)
symptoms in neonate of toxo
usually asymptomatic at birth
80% may develop learning disabilities and visual problems later
*preterm may develop CNS symptoms and eye problems in first 3 months of life (compared to later in term) but both at equal risk in general
MCC of EOS (< 72hr)
- overall
- in term
- in VLBW
overall: GBS and E coli
term: GBS
VLBW: E coli (risk of EOS 10x in VLBW than term)
MC serotype of GBS in Late Onset Sepsis
Serotype III
Chediak-HIgashi
abnormal neutrophil degranulation
leads to partial oculocutaneous albinism
nystagmus
peripheral neuropathy
recurrent infections
Leukocyte adhesion deficiency
d/o of neutrophil function despite increased #
defective adhesion and migration
recurrent bacterial infections
poor wound healing
necrotic lesions
*risk of ompholitis
*delayed umbilical cord (sometimes >21d)
Chronic granulomatous disease
abnormal phagocytic microbial ability
increased risk of abscesses
poor wound healing
granuloma formation
Hyper IgE aka Job’s syndrome
abnormal neutrophil chemotaxis
skin infections
coarse facial features
broad nasal bridge
Kostmann
severe congenital neutropenia
frequent infx in first few months
*elastase gene
responds well to rG-CSF
Iso precautions for:
CMV
Rubella
HSV
Toxo
HIV
TB
Varicella
RSV
Parvo
Listeria
Standard:
- CMV
- Toxo
- HIV
- Listeria
Contact only:
- HSV
- RSV
Droplet:
- Rubella (+ contact)
- Parvo
Airborn (+ contact)
- TB
- Varicella*
Congenital varicella does not require contact isolation if no active lesions
Rubella virus type
RNA
passed through respiratory secretions
HSV virus type
double-stranded DNA
Toxo infx type
intracellular parasite
passed by poorly cooked meat, cat feces
HIV virus type
RNA retrovirus
Varicella virus type
DNA herpes
RSV virus type
RNA paramyxovirus
ParvoB19 virus type
single-stranded DNA
Listeria bacteria type
gram-positive rod
Treatment for listeria
ampicillin+aminoglycocide
14 d sepsis
21d meningitis
*consider brain imaging to assess for abscess
maternal infections that increase risk of stillbirth or fetal loss
Listeria
Parvo B19
Syphilis - 30-40% of congenital syphilis=stillborn
when do symptoms of congenital syphillis typically develop
3-14 weeks PNA
(most asymptomatic at birth)
*30-40% chance of stillbirth
CMV hearing loss characteristics
MCC (non genetic) of congenital sensorineural healing loss in children
- progressive (may not be detected until after 1 year of life)
- usually bilateral and moderate to profound
- tx w/ gancyclovir* to infants a/w preservation of hearing
*monitor for nephrotoxicity, neutropenia, rising LFTs
Cardiac disease in congenital Rubella
(50% chance of heart defect)
PDA
Pulmonary arterial hypoplasia
Salt and pepper chorioretinitis
sensorineural hearing loss
cataracts
insulin-dependent diabetes
thyroid disease
Rubella
treatment for congenital rubella
supportive only
chance of infant developing HSV i/s/o maternal lesion of primary vs secondary infx
primary - 50%
secondary - 2%
*higher risk in prematurity
mortality rate of disseminated HSV
50-70%
50% HSV- 2
70% HSV - 1
50% w/ encephalitis will have long term sequelae
MC presentation of listeria before and after 7d v
<7d - pneumonia/sepsis
after first week - meningitis
when does all maternal IgG disappear from infant’s circulation
9 months
How is IgG transported in placenta
endocytosis
when do IgM levels reach 75% adult levels
1 year
(some fetal IgM production)
IgA levels reach ____% of adult levels by 1 year
20%
*NO fetal IgA production
calcifications in CMV vs toxo
cmv - PERIventricular
toxo - cortical
stain for chlamydia
giemsa stain of conjunctival scrapings
treatment for congenital TB
4 drug regimen:
isoniazid
rifampin
pyrazinamide
aminoglycocide
length depends on sensitivity of organism
note: symptoms present during 2nd or 3rd week of life
treatment for neonate born to mother with active TB
isoniazid alone if asymptomatic
risk of mother to child HIV transmission via breast milk
9-15%
presumptive vs definitive exclusion of HIV infection in an infant born to HIV+ mom
(both need to have no lab or clinical evidence of HIV)
presumptive:
- 2 negative DNA/RNA tests from separate specimens both at least 2 WEEKS and one at least 4 WEEKS of age
- 1 negative DNA/RNA test at least 8 WEEKS of age
- 1 negative Ab test at least 6 MONTHS of age
definitive:
- 2 negative DNA/RNA tests from separate specimens, one at least 1 MONTH of age and one at least 4 MONTHS of age
- 2 negative Ab tests from separate specimens both at least 6 MONTHS of age
treatment with POSSIBLE benefit for
Enteroviral sepsis
high dose IVIG
—>(Ab to enterovirus from pooled population)
—-> being investigated, no constant benefit
pleconaril
—> antiviral capsid binding drug inhibits viral attachment to host cell
—> experimental; clinical trials
blood products as needed for liver disfunction/coagulopathy
**NOT acyclovir - only works in DNA viral infections; no role in RNA viruses (like enterovirus)
treatment for systemic candida infection
amphoterocin B
*penetrates blood brain barrier, renal system, ocular orbit
*NOT liposomal form first line (does not penetrate BBB, kidneys and also has liver toxicities); use if renal toxicity
- could use fluconazole once sensitivities are known but Candida glabarata and Candida kruzii are resisistant
most neonates colonized by CONS by ____ day of life
3-4 (days of life)
bacteria in omphalitis
polymicrobial - usually skin flora
staph aureus, Group A strep
e coli
MC complication of omphalitis
sepsis
B cells in fetus
pre-B cells in liver starting at 7 weeks (gone by 30)
bone marrow by 12 weeks
mature in bone marrow
higher absolute # of B cells as adult (but same proportion); peaks 3-4 months of age
neutrophils in fetus
starts at 10-14 weeks gestation
- defective phagocytosis until term gestation
- all neonates (term and preterm) have impaired chemotactic response and adhere poorly
- granulation response in term similar to adults
classic complement pathway
requires specific Ab against antigen
–>immune complexes (antigen/antibody reaction)
C1
C4
C2
C3*
classic and alternative pathways coverage at C3
alternative pathway
antibody-independent
C3 is spontaneously cleaved by bacterial cel wall hydroxyl groups (gram pos and gram neg)
cleaved C3 + factor B cause cascade
complement - common terminal pathway:
what makes up the membrane attack complex
C5,6,7,8,9
Most common complement deficiency
C2
increases risk of infx (especially pneumococcal) and collagen vascular disease
deficiency of early complement components (C1-4)
increases risk of infx (especially pneumococcal) and collagen vascular disease
*C2 most common
deficiency of lat components (C5-9)
increased risk of neisseria infections
Clostridium botulinum shape
gram+ rod
Neisseria gonorrhoeae shape
gram neg intracellular diplococcus in pairs
streptococcus shape
gram positive diplococcus in chains
listeria shape
gram+ rod
treatment for chlamydia conjunctivits
14 d oral erythromycin
*a/w pyloric stenosis
why does erythromycin eye ointment not work for chlamydia
colonization of nasopharynx can still occur
when maternal varicella infection highest risk to fetus
early (first 20 weeks) - high risk of congenital varicella syndrome (1-2%)
late (5 days before to 2 days after birth) - GREATEST risk; 17% risk of acute infection, 30% mortality
maternal varicella infection during 2nd half of pregnancy up to 21 days prior to delivery
LOW risk of congenital varicella
may develop varicella zoster early in life
placenta of CMV infx
villous damage
thrombosis
villitis
some villi w/ inclusion body cells and hemosiderin
placenta of syphilis
hydros
marked round cell infiltration (maternal)
capsulated bacteria
Hflu
Neisseria meningitides
Salmonella typhi
Strep pneumoniae
Functions of the spleen
site of IgM production
site of complement production
assists in maturation of Ab
supports proliferation of T-cells
scavenges od RBCs and platelets
(recycles iron from hemoglobin for hematopoesis)
reservoir of extra blood
SPECIFIC blood cell finding in asplenia
Howell-Jolly bodies
(nuclear remnant usually removed by spleen by macrophages)
duration of valganciclovir for +CMV screening
6 months
greatest risk factor for clabsi
GA and BW
MCC pathogens for EOS (in order)
GBS (40%)
E coli (28%)* - leading cause in preterm (38%)
strep other than GBS (10%)
enterococcus (3%)
Staph aureus (2%)
Listeria (<1 %)
MC complication of subclinical (asymptomatic untreated) congenital toxoplasmosis
chorioretinitis
(other complications not common if not symptomatic)
chlamydia acquired during labor will cause late-onset pneumonia at what age
2-4 wks of age
*not defined as congenital
MCC of early pneumonia
GBS
(e coli end)
HSV MC viral pathogen causing early pneumonia
white spots on umbilical cord and amniotic membrane
candidal chorioamnionitis
dose adjustment of zidovudine in preterm infants
reduced dose; increase with age
- cleared via hepatic glucuronidation, which is not fully developed in preterm infants
(still 6 week course)
recurrent purulent bacterial and fungal infx
+
nitro blue tetrazolium (NBT) test negative
Chronic granulomatous disease
mutations in phocyte NADPH oxidase
neutrophil peak in healthy newborns
12-24hrs
declines and reaches steady state by ~72hrs
collectins
host-defense; c-type lectin domain
related in structure to C1q
mannose-binding letin (MBL)
conglutinin
SP-A - do not activate compliment
SP-D - do not activate compliment
FGR
direct and indirect hyperbole
coombs-neg hemolytic anemia
thrombocytopenia
lymphadenopathy
mucocutaneous lesions
congenital syphilis
lesions are vesicular or bullies, ultimately rupture to form superficial crusted erosions or ulcerations
rash generalized band classically involves palms and soles
