ID volume 2 Flashcards
how do kids present with chronic HCV infection
hepatomegaly
+/- intermittent or chronic high LFT
what organisms transmitted via droplets are very fragile and will not survive in the environment or on hands
H. influenza b
N. meningitidis
bordetella pertussi
what bug need airborne precautions
measles
TB
varicella
small pox
what is the risk of transmission of HBV from needle stick injury?
2-40%
can survive up to 1 week
if needle stick injury and high risk of HBV, what is the treatment
anti-HBV Ig + hep B vaccine
what is the risk of transmission of HCV from needle stick injury?
3-10%
no post exposure Rx
what is the risk of transmission of HIV from needle stick injury?
0.2-0.5%
what are increased RF for transmission of HIV from needle stick injury
viral load size of needle depth of penetration whether bld was injected fresh blood
post HIV exposure prophylaxis will reduce the risk of HVI by….?
80%
how do you manage a needle stick injury
- clean with soap and water
- check the extent of the wound
- check vaccination status - Tetanus..
- document ++++
- Take bld for baseline HIV, HBV, HCV
- do not test needle
- if known user - assess risk and if possible test them
what is Hep B prophylaxis regiment for a pt not fully vaccinated?
if NOT vaccinated:
- test for anti-HBs Ab and HBsAg
- HBIG ideally within 48 h
- give vaccine within 7 d
if both #1 neg - complete vaccine series
if positive - do FU HBsAg
what is Hep B prophylaxis regiment for a pt fully vaccinated?
- test ant-HBs, if results not availbel within 48H - give vaccine
- if Anti-HBs + = do nothing because were immunized
- if anti-HBs Neg = test for HBsAg ( if neg do Ig+vacc)
when should a child receive HIV prophylaxis
if high risk
if source considered likely to have HIV
if visible blood in serynge/needle
if blood may have been injected
when should HIV prophylaxis be started?
within 1-4 hr post injury, max within 72 hours
what are the HIV prophylaxis regiments
HIGH risk = ZDV +Lamivudine + lopinavir/ritonavir
LOW risk = ZDV + LMV
for 28 days
what is the FU plan post HIV prophylaxis start
2-3 D via phone
IF on HIV prophylaxis = BW at 2, 4, 6 weeks for CBC, AST, ALT, BUN/Creat
at 4 weeks for 2 nd HBV if needs
at 6 weeks for anti-HIV Ab
at 3 month for anti-HIV and anti-HCV Ab
at 6 for anti-HIV/HCV/Bs ag Ab AND give 3rd Hep B if needed
who should get the flu vaccine?
- > 6 mo to 5 years
- chronic med issues
- pregnant
- family mb
- healthcare workers
- aboriginal children
- all in care
who cannot receive the live attenuated flu vacc
if immunocompromised if severe asthma if pregnant if on ASA if < 2 yrs
what are the 2 types of flu vacc
trivalent inactivated vaccine 0.5ml
LAIV .2 ml per nostril
when should we try to initiate Tamiflu?
< 12 hrs
can still get later if admitted, if illness is progressive
how can we give antiviral drugs for influenza?
oseltamivir via PO/NG
Zanamivir IV or inhaled
who should get zanamivir vs oseltamivir?
if not responding to oseltamivir
if illness despite oseltamivir prophylaxis
if severely unwell - can do IV
who should get influenza antiviral if they have mild disease?
if mild + RF - treat after 1 year
if mild and NO RF - (<48h) consider treateing the 1-5 yr olds
who should receive prophylaxis against IE
- Hx of IE
- CHD - unrepaired including palliative shunts/conduits
- CHD - with prosthetic material for 6 mo post
- CHD - repaired but residual defect
- Heart transplant if develop valvulopathy
what dental procedures warrant IE prophylaxis?
manipulation of gingival tissue
periapical region of teeth or perforation of oral mucosa
when should IE be taken and what Abx choice
1 to 0.5 hr pre and up to 2 hrs post
Amoxicillin
(clinda/azith/clarithro if allergic)
other than dental procedures, what other simple procedures require IE prophylaxis
any incision or bx of resp mucosa- T&A
bronchoscopy IF incision on mucosa
Maybe if have enteroccocus in urine and need cystoscopy
procedures on infected skin or muscle
what are the 5 important steps to bring up with vaccine hesitant parents
- what are their concerns - what is their understanding of disease risk? what is their understanding of vaccine benefits and risks?
- Explain clearly the benefits and risks
- discuss the rigorous vaccine safety system
- address issues of pain
- Do not dismiss children from your practice
what is the preferred treatment for pulmonary aspergillosis?
Voriconazole
what are SE of amphotericin?
nephrotixicity
infusion related - fever, chills and rigors
what are SE of fluconazole?
P450 inducer
hepatotoxicity
what is fluconazole NOT used for?
Aspergillus and other moulds
what is fluconazole used for?
candida
cryptococcus
prophylaxis for HSCT
what are SE of Itraconazole?
GI upset, vimiting, diarrhea
inc LFTs
inhibit P 450
what is Itraconazole used for
- prophylaxis HSCT- oral/esoph Candida and Aspergillus
- prophylaxis for lung transplant if colonized with Aspergillus
- Blastomycosis
- Chronic pulmonary histo
what are SE of Voriconazole?
skin rash visual abnormalities photosensitivity reaction elevated hepatic transaminase p450 interaction
when do we use caspofungin?
invasive candidiasis
invasive aspergillosis
SE: LFTs, fever HA, GI
When do we use Flucytosine?
in combination with Ampho B
for Candida of cryptococcal infection
ESPECIALLY CNS
When do we use Ampho B?
invasive fungal
febrile Neutropenia
what are complications of MUMPS
orchitis
meningitis
pancreatitis
thyroiditis
