ID_UW Flashcards
Most common causes of neonatal sepsis
GBS, E. Coli and Listeria (in that order)
Tx for neonatal sepsis
Ampilicillin + Gentamicin
Meningococcal meningitis most commonly affects kids what age
3 years to adolescence
What is the most common cause of sepsis in the sickle cell population
Srep pneumonia, H influenza type B distant second
Patients with functional asplenia are at risk for
Strep pneumo, H influenza, neisseria meningitdes, and salmonella
Sickle cell patients should receive what vaccines
All regular vaccines + 23 valent polysaccaride pneumococcal and menigococcal conjugate vaccines.
What propylaxis should sickle cell patients take
Penicillin till age 5
Inability to extend neck, dysphagia, fever, muffled voice and widened prevertebral space on lateral x0ray suggest?
Retropharyngeal abscess
Most common organism/cause of septic arthritis and osteomyelitis in neonates?
E Coli and GBS
Most common organism/cause osteomyelitis in
GBS
Triad of infectious mono?
Exudative pharyngitis/tonsillitis, diffuse or posterior cervical lymphadenopathy, and fever
IM is most commonly caused by and in what age group?
Ebstein Barr virus, 15-24 year olds
When does a rash occur in IM?
Can occur in IM but most frequently after administration of amoxicillin or ampicillin
Precautions for people with IM?
Avoid contact sports for 3 weeks due to splenomegaly
3 stages of whooping cough (pertussis)
1) Catarrhal (1-2 weeks) 2) Paroxysmal (2-6 weeks) 3) Convalescent (Week to months)
What are the clinical sx a/w with the 3 stages of whooping cough
1) Catarrhal (1-2 weeks) - rhinits, mild cough 2) Paroxysmal (2-6 weeks) - post-tussive emesis, apnea/cyanosis in infants, coughing paroxysms with inspiratory whoop 3) Convalescent (Week to months) sx resolve gradually
Dx of pertussis
Bacterial culture and/or polymerase chain reaction from nasopharyngeal secretions in patients
What is the treatment for pertussis
Macrolides such as azithryomycin, erythromycin
Pertussis patients can develop marked (cbc finding)
Lymphocytosis
Pertussis prevent
Acellular pertussis vaccine
Pinworm infection aka
Enterobius vermicularis
complications of pertussis
Subconjunctival hemorrhages, pneumonia, weight loss, pneumothorax, respiratory failure, death (infants)
Treatment for enterobius vermicularis
Abendazole or pyrantel pamoate (latter preferred for pregs). Highly contagious. All household members should get treatment
Asymptomatic, immunocompetent and non-immune patients should get what if exposed to varicella?
within 3-5 days of exposure, get the varicella vaccine for post-exposure prophylaxis. Will work if given within 5 days of exposure
Asymptomatic, non-immune but immunocompromised/preggos should get what if infected with varicella?
Varicella IVIG. Does not prevent but will reduce disease severity but have to be be monitored closely becaues can extend incubation period to a month.
How long is incubation period of chicken pox and when is chicken pox contagious?
3 weeks but most sx surface in 2 weeks. Contagious 2 weeks before rash starts and till after all lesions are crusted over.
What are the most common causes of viral meningitis
Non-polio enteroviruses such as coxsackie virus or echovirus
incidence of viral meningitis decreases with?
Increasing age. Infants most affected with highest mortality and morbidity in this group.
What does CSF show with viral meningitis
Pleocytosis with lymphocytic predominance. Protein is normal to slightly elevated, glucose is normal. CSF gram stain will not show any organism.
Tx for viral meningitis?
this is usually a self limited leptomeningeal inflammation caused by a viral infection. Tx is usually supportive and sx resolve in 7-10 days.
Group A strep
Streptococcus pyogenes
Patients with group A strep should get?
10 day treatment of oral penicillin to prevent acute rheumatic fever.
Rheumatic fever diagnosis
2 major critiera, 1 major and 2 minor, or if either sydenham chorea or carditis is present.
Criteria for rhematic fever.
JONES - joints (migratory arthritis), heart (carditis), Nodules (subcutaneous), E (erythema marginatum), S sydenham chorea. Minor: fever, elevated CRP/ESR, prolonged PR interval, arthralgias.
Pasteurella multocida
Gram negative, non motile, penicillin sensitive coccobacillus
Cat bites are concerning for infection with?
eg. Pasteurella multocida
Prophylactic tx of cat bites
five day course of amoxillin / clavulanate.
Dangerous complications of orbital cellulities?
Cranial infection and blindness
Tx difference between preseptal and orbital cellulitis?
Preseptal can be outpatient oral abx tx, orbital has to be iv antibiotics and admitted for careful observation
Acute unilateral cervical lymphadenitis in children is usually caused by?
Bacterial infection
What is the most common cause of acute unilateral cervical lymphadenitis
Staph aureus followed by Group A Strep
Age and ppt of bacterial lymphadenitis?
Usually less than 5 years old, non toxic appearing, warm, tender, erythematous node measuring 3-6cm in size.
Most common cause of osteomyeolitis in children and infants
Staph Aureus
Other common organisms that can cause osteomyelitis
Group B strep and E. Coli in infants, Strep pyogenes in children.
What is one of the most frequent compliations of mumps?
Orchitis, most commonly in men between the ages of 15-29. Other common complications are aseptic meningitis and encephalitis
Bactrim has good effect against ? And poor effect against ?
Good affect against Staph, including MRSA but poor effect against GAS.
Tx for acute uniliateral cervical adenitis
Usually due to staph or strep so tx with Clindamycin with I&D
How does meningococcal meningitis present?
Fever, headache, neck stiffness, AMS, petechial or purpuric rash on axilla, wrists, ankles, flanks. Rash appears wtihin 24 hours of infection.
Most common predisposing factor for bacterial sinusitis
Viral URI
Patients with deficient cell immunity are at risk for infections with fungi such as
Cryptococcus neoformans, histoplasma capsulatum, pneumocystic jiroveci
Most common pneumonia in CF patients - infants and young children
Staph aureus
Most common pneumonia in CF patients - adolescents and young adults
Pseudomonas aeruginosa
E Coli is what kind of bacteria
Gram negative rod
Klebsiella and legionella pneumophilia are what kind of bacteria
Gram negative rod
Listeria is what kind of bacteria
Gram positive rod
Diagnosis of malaria
Thick and thin peripheral blood smears
Cyclic fevers in malaria correlate to what
Wave of rbc invasion when parasites are released from liver
Anti malarial drugs
Doxycycline, mefloquine, atovaquone-proguanil, hydroxychloroquine
Protective factors for malaria
Previous infection - therefore conferred immunity, hemoglobinopathies (Hgb S, Hgb C, thalassemias)
Congenital rubella ppt?
sensorineural hearing loss, intellectual disability, cardiac anomalies, cataracts (shows up as leukocoria which is white pupillary reflex), glaucoma,thrombocytopenic rash blueberry muffin rash.
Presentation of rubella in children?
low grade fever, cephalocaudal rash, blanching, maculopapular; conjunctivitis, coryza, cervical lypahdenopathy, Florscheimer spots
Dx of rubella
PCR, and acute and convalescent serology of anti-rubella IgM and IgG
Congenital toxoplasmosis presentation
Chorioretinitis, hydrocephalus, intracranial calcifications, hepatosplenomegaly Also a/w sensorineural hearing loss but not cardiac defects
Maternal fetal transmission of rubella is most teratogenic when
First trimester
What should be done ASAP in order to prevent long term joint destruction in septic arthritis
Surgical drainage of the joint, debridement and irrigation
Fluid description, WBC count and PMN% in septic arthritis?
Turbid, 50,000-150,000 and often>80-90%
Congenital syphillis presentation
If presenting early, presents with hepatosplenomegaly, cutaneous lesions (like ulcerative lesions on feet), jaundice, anemia, thrombocytopenia. Metaphyseal dystrophy and periostitis seen on radiography
What is the most prevalent rabid animal in the US
Raccoons
What are pathognomic features of encephalitic rabies
Hydrophobia and aerophobia => sends patient into involuntary pharygneal spasms. Patients usally die within weeks
What is the post exposure prophylaxis for rabies
Rabies Immunoglobulins and vaccine immediately after exposure
Common reservoirs for rabies
Wild carnivores, raccoons, and bats
Encephalitic and paralytic features of rabies
Encephalitic: Hydrophobia and aerophobia, pharyngeal spasms, spastic paralysis, agitation. Paralytic: ascending flaccid paralysis.
What is the gold standard for HIV testing in new infants?
PCR testing from birth to 18 months
HIV antibodies don’t’ get picked up for how many months?
3 months = “window”
Preferred antifungals for chronic pulmonary aspergillosis
Itraconazole, voriconazole.
Preferred antibiotic for community acquired strep pneumoniae?
high dose oral amoxacillin
Non-bullous vs bullous impetigo ppt
Non-bullous: Painful pustules and honey crusted lesions. Bullous: flaccid bullae with yellow fluid, collarette of scale at the periphery of lesions.
Non-bullous vs bullous impetigo microbiology
Non-bullous: Staph aureus, GAS Bullous: Staph aureus
Clindamycin MOA
Binds to the 50s ribosomal subunit of bacteria, disrupts protein synthesis by interfering with transpeptidation rxn.
Non-bullous vs bullous impetigo tx
Topical mupirocin; oral antibiotics like clindamycin, cephalexin, dicloxacillin
Cephalexin MOA
Binds to one of the penicillin binding proteins => inhibits final step of the transpeptidation of peptidoglycan synthesis in bacterial cell walls. Inhibits cell wall synthesis.
Dicloxacillin MOA
Binds to one of the penicillin binding proteins => inhibits final step of the transpeptidation of peptidoglycan synthesis in bacterial cell walls. Inhibits cell wall synthesis.
Septic arthritis is often preceded by
Skin or upper respiratory tract infections
Septic arthritis most often caused by which organisms. Abx coverage
Strep pneumo, Group A strep, Staph aureus. Nafcillin, clinda, cefazolin or vanco
Septic arthritis in kids younger than 3 months usually caused by? Abx coverage
Staph, group B strep, and gram negative bacilli. Anti staph (nafcillin or vanco) plus gentamicin or cefotaxime
Lab findings for septic arthritis
Elevated WBC, elevated CRP and ESR, >50,000 cells/microL
PE findings for septic arthritis
Erythema, warmth and swelling of joint, pain with active and passive motion
Initial management for septic arthritis
Arthrocentesis, blood an synovial fluid cultures, empiric antibiotic coverage
viral vs bacterial pharyngitis findings
Viral: cough, rhinorrhea, exanthem, conjunctivitis, oral ulcers. Bacterial: tonsillar exudates, erythema, tender anterior cervical nodes, palatal petechiae.
Abx of choice for streptococcal pharyngitis
Covering for Group A Strep - penicillin or amoxicillin
Gold standard for diagnosing strep throat
Throat culture
Common findings between herpangina and herpetic gingivostomatitis
Fever, pharyngitis and oral lesions in children
Different clinical features between herpangina and herpetic gingivostomatitis
Herpangina: Gray vesicles/ulcers on posterior oropharynx and tonsillar pillars that progress to fibrin coated ulcerations. Herpetic gingivo: clusters of small vesicles on anterior oropharynx and lips.
Seasonality of herpangina and herpetic gingivostomatitis
Summer/early fall but for herpetic: all year
Treatment for lyme disease?
Amoxicillin (tx of choice for kids under 8 yo), doxycycline, and cefuroxime.
Doxycycline is contraindicated in which patients?
Under 8 and pregnant women. Under 8 because it causes enamel hypoplasia and permanent teeth stains during tooth development in children.
Doxy is often used to treat lyme disease because?
It also treats coexisting anaplasma phagocytophilum also transmitted by the Ixodes tick.
Mumps presentation
Swelling moves to opposite side in a day after sx appear on first side. Other findings, redness and swelling around Stensen’s duct, edema and swelling in pharynx, displacement of uvula on the side.
Presentation of diptheria? What bacteria is it caused by?
Corynebacterium diptheria. Starts with mild fever and sore throat (50%) but progresses quickly with an adherent membrane that covers and can extend over glottic area, uvula, palate, posterior oropharynx, hypopharynx and potential airway compromise
What kind of propylaxis is good for infants born to HIV mothers
Bactrim for prophylaxis against pneumocystis jiroveci
If children with HIV are exposed to measles, they should get?
immunoglobuliens REGARDLESS OF vaccine history
Death from Reye syndroem is usually from
Cerebral edema and herniation
Bactrim used for?
UTIs, shigella, salmonella, PNEUMOCYSTIC JIROVECI PROPHYLAXIS, PNEUMONIA TX AND PROPHYPYLAXIS AND TOXOPLASMOSIS PROPHYLAXIS
Shigellosis presentation
Wide range of presentations from days of watery stool for several days to severe infection with high fever, seizures, and abdominal pain. Often seizures precede diarrhea. Most common presenting sx is seizures and diarrhea. Diarrhea usually resolves in 1-2 weeks.
Scarlet fever is caused by?
Group A beta hemolytic strep
Scarlet fever and Kawasaki presentation similarities?
Rash, desquamation, erythema of mucus membranes that can cause injected pharynx and strawberry tongue, cervical lympathdenoapthy. Most serious complication of both is cardiac involvement.
How would you distinguish between scarlet fever and kawasaki?
You can isolate the organism from nasopharynx and rise in antistreptolysin titers will confirm diagnosis of Group A strep. Etiology of Kawasaki is sill unknown.
How to tx tinea capitis?
Does not respond to topicals, need to treat with long-term oral therapy with griseofulvin or another antifungal.
Roseola is caused by?
Human herpes virus 6
Hand foot mouth disease caused by?
Coxsackie virus A16
Infection with Parvovirus B19 causes what in 1) non-immunocompromised patient 2) sickle cell patient 3) pregnant patient 4) immunodeficient patient
1) Fifth disease - benign mild exanthem 2 ) can cause transient aplastic crisis. 3) can cause severe anemia in infectued fetus with secondary hydrops fetalis and death 4) chronic anemia
Leptospirosis?
Found in contaminated water with animal urine. Most common zoonotic infection in the world
Leptospirosis presentation?
most cases are mild/sub-clinical. Flu like sx (high fever, chills, muscle pain, pharyntitis), conjuctival injection without the exudate, photophobia, cervical adenopathy. After a few days of sx reolstuion, then patients can go on to a phase where meningitic sx can return and last up to a month. less than 10% of leptospirosis cases are icteric but these patietns go on to hae liver and kidney dysfunctiion.
Kawasaki presents at what age
80% present at lower than 5
What medication may be effective in preventing or shortening the duration of pertussis?
Erythromycine => achieves high concentrations in respiratory secretions and can eliminate organisms from respiratory tract. In exxposed peope, may prevent or lessen severeity of disease if adminstered during the parapaxosymal stage.
Triad of findings for mono
1) PE - diffuse adenopathy, enlarged spleen, small hemorrhages on soft palate, tonisllar enlargement 2) predominance of lymphocytosis 3) characteristic antibody response - traditionally heterophil antibodies can be deteceted when confirming a dx of IM
Streptococcis
Low grade fever, prolonged insidious nasopharyngitis that sometimes occurs in infected patients with group A beta hemolytic strep
Pneumococcal bactermia presentation
High grade fever, marked elevation and shift to left of WBC counts
Rubella in child presents with?
Mild URI sx, retroauricular, posterior cervical and postoccipital lymphadenopathy, diffuse erythematous maculopapular rash that clears in 72 hours.
What is the post exposure prophylaxis for rabies
wound cleansing (if wound is obvious), rabies immunogloblin, and 5 injection vaccine serires.
Clinical course of RMSF
brief prodromal period of headache and malaise, followed by abrupt onset of fever and chills, maculopapular rash starts on 2nd to 4th day of illness on flexor surfaces of writs and ankles before moving in centra direction. Palms and soles are involved. rash can become hemorrhagic wtihin 1 to 2 days. hyponataremia and thrombocytopenia can be seen.
How to treat RMSF?
Doxycycline
Wiskot Aldrich Syndrome, inheritance and immunity problems?
X linked recessive. Combined immunodeficiency problem. They have 1) thrombocytopenia 2) impaired humoral with low IgM and normal to low IgG 3) impaired cellular immunity with decreased T cells and decreased lymphocytic response.
Presentation of Wiskot Aldrich
Eczema, thromobocytopenia (bleeding from circumcision site) and increased susceptibility to infection. Most don’t live past teens.
