Immun/Infectious 2 Flashcards
Oral Candidiasis
- another name for this?
- Type of infection / etiology?
- 3 sxs / presentation
- “thrush”
- yeast infection of oral mucosa - Candida albicans
- adherent white plaques (r/o milk residue)
- Underlying mucosa reddened & friable
- Decreased feeding (due to pain)
Treatment for Oral Candidiasis (Thrush)
- Nystatin suspension (0.5mL into each cheek 4x/day)
- Tx mom PRN (esp if breastfeeding)
Diagnosis?
Oral Candidiasis (Thrush)
- adherent white plaques
- underlying mucosa is red/friable
- pt w/ decreased POs due to pain
- Tx w/ Nystatin / Mom PRN
Enterobiasis (Enterobus vermicularis)
- Another name for this?
- Presentation?
- How is it transmitted?
- PE findings?
- “Pinworms”
- Usually asymptomatic
- Anal itching (esp at night)
- Eggs under fingernails –> transmission
- PE: excoriations in perianal area
Pinworms / Enterobiasis
- Diagnosed how? (2)
- Treatment? (3)
- Prevention? (3)
- Sxs / “scotch tape test”
-
Mebendazole (Vermox) - one 100mg tab, repeat in 2 weeks
- Treat ENTIRE family
- Wash bedding in hot water, careful bc eggs can go airborne, so fold linens inward
-
Prevention
- hand washing
- clip nails short
- avoid scratching anus
Diagnosis?
- Causes flesh colored, dome shaped papules w/ central umbilication
- Common in childhood
- Can be transmitted in adults through skin contact (sex / sports / sharing towels)
- Etiology?
Molluscum Contagiosum
- Poxvirus**
Tx for Molluscum Contagiosum (6)
- Curettage
- Cryotherapy
- Cantharidin
- Podophyllotoxin (Condylox)
- Retinoids
- Salicylic acid
- Lasers
(CCC Sally Recked her Podo stick)
(no great data for any)
Bacterial Meningitis
- Bacterial infection of meninges of what 2 structures?
- Suspected bacterial meningitis is an emergency
- Untreated mortality reaches almost ___%
- Brain & spinal cord
- 100%
Bacterial Meningitis
- ***Pathogen for 1 month - 3 month olds***
(ON EXAM)
- Group B Streptococcus
Bacterial Meningitis
- Pathogen for 3 months - 3 yrs
- S. pneumoniae
Bacterial Meningitis
- Pathogen for 3 yrs - 10 yrs
S. pneumoniae
Bacterial Meningitis
- Pathogen for 10 yrs - 19 yrs
N. meningitidis
Bacterial Meningitis
- 8 Sxs in pediatric pts? (which is most important?)
- Fever
- N/V
- Irritability**
- HA
- Confusion
- Photophobia
- Back pain
- Nuchal rigidity
4 possible signs of bacterial meningitis?
- seizure
- increased ICP
- papilledema
- altered LOC
(ISA party….) (;
- Which pathogen of bacterial meningitis causes a rash?
- Blanching or non-blanching?
N. meningitidis (10-19 yrs)
- non-blanching
Viral meningitis
- Sxs / presentation?
- How do you differentiate it from bacterial?
- What is the BOTTOM LINE?
- similar to bacterial
- lab studies (CBC , LP)
- it is bacterial until proven otherwise
What are the 6 Primary Immunodeficiencies on this test?
- Selective IgA Deficiency
- Common Variable Immunodeficiency
- Severe Combined Immunodeficiency (SCID)
- DiGeorge Syndrome
- Wiskott-Aldrich Syndrome
- Ataxia-Telangiectasia
Primary Immunodeficiency
- Disorders resulting from ___ defects of the immune system (both isolated & combined)
- Defect may be present in which parts of the immune system?
- Impaired antibody (Ig) production is called what?
- inherited
- any part (or multiple parts) including the humoral immune system
- Humoral immunodeficiency
Pediatric presentation of Primary Immunodeficiency
- Recurrent, severe URI / LRTI including what 3 infections?
- What type of bacteria?
- OM
- Sinusitis
- PNA
- Encapsulated Bacteria***
4 signs/sxs of Primary Immunodeficiency in peds patients
- Poor growth
- Failure to Thrive (FTT)
- Unexplained splenomegaly
- Chronic diarrhea
(Poor FUCking kid)
6 encapsulated bacteria of Primary Immunodeficiency
- Hib
- S pneumo
- N menigitidis
- Group B strep
- Klebsiella pneumoniae
- Salmonella typhi
- What is the most common immunodeficiency?
- This immunodeficiency is less common in what race?
- Selective IgA Deficiency
- Asian
Selective IgA Deficiency
- What 2 levels are normal in the serum?
- Child over what age? (kids under this age don’t always have optimized levels of Ig’s)
- IgA is __% of normal circulating Ig’s
- IgG and IgM are both normal
- 4 yrs
- 70%
Selective IgA Deficiency signs / sxs
- Typical presentation?
- Recurrent infections of what type?
- What disorders? (3)
- What type of reaction?
*
- Most are asymptomatic (<1/3 are actually diagnosed)
- sinopulmonary infections
- Autoimmune / GI / Allergic
- Anaphylactic transfusion rxns
What are the 5 indications for a workup of Selective IgA Deficiency?
- Recurrent OM
- Recurrent Sinusitis
- Recurrent PNA
- Giardiasis
- Family hx of any primary immunodeficiency
Family POGS
- How is Selective IgA Deficiency diagnosed?
- Treatment/Management?
- Dx: Serum levels of IgA, IgG, IgM
- Tx: refer to immunology
Common Variable Immunodeficiency (CVID)
- Impaired production of what 3 cells?
- This leads to impaired production of what?
- B-cell
- T-cell
- Dendritic cell
- –> impaired Ig production**
Common Variable Immunodeficiency
- Common or uncommon?
- Pts usually present at what age?
- Peaks around what age?
- NOT a single disease
- What are the clinical manifestations?
- Common
- around puberty
- 8 yrs
- “variable” manifestations
4 criteria for Common Variable Immunodeficiency
- Reduced serum IgA, IgG, IgM***
- Poor response/ no response to vaccines***
- Presence of B cells
- Absense of other immunodefiency
What are the 4 signs/sxs of Common Variable Immunodeficiency?
- Chronic or recurrent URI/LRTI
- May develop bronchiectasis (even in peds!), watch for abnormal CXRs
- GI infections
- Diarrhea, malabsorption, weight loss –> FTT
- Atopic triad (asthma, allergies, eczema)
(GUFA)
Management / Tx of Common Variable Immunodeficiency (CVID)
- Refer to immunologist for further eval / Ig replacement***
- (may incidentally identify w/ titer screening)
Which condition?
- A severe defect in both the T & B lymphocyte systems, which leads to early death from overhwhelming infection, typically in the first year of life
Severe Combined Immunodeficiency
(SCID)
Severe Combined Immunodeficiency
- There are multiple forms, which one is MC?
- Another name for this disease?
- Which patients are screened for this?
- X-linked (males only)
- “bubble boy” disease
- Part of newborn screening in all states
What is the result of Severe Combined Immunodeficiency? (SCID)
One or more severe infections in the first few months after birth**
- PNA
- Meningitis
- Bacteremia
Severe Combined Immunodeficiency (SCID)
- Children may become ill from what?
- Infants might not have what structure visible on CXR?
- live vaccines: varicella, MMR, OPV, RV
- thymus
5 manifestations of Severe Combined Immunodeficiency**
- Persistent mucocutaneous candidiasis (thrush)
- Death from common viral infections (CMV, VZV, EBV, HSV, flu, etc.)
- P. jirovecii infection
- Intrauterine graft-vs-host disease- caused by transplacental maternal T-cells
- Lymphoma and other malignancies
“Paul died from thrushing intrauterine malignancies”
Tx / Management for Severe Combined Immunodeficiency
Managed by immunology:
- Stem cell transplantation
Which condition?
- Chromosomal deletion (22 q 11.2) affecting multiple body systems
- The most prevalent microdeletion syndrome in the US
DiGeorge Syndrome
5 results of DiGeorge Syndrome
- Cardiac defects
- Immune dysfunction (hypoplastic thymus gland)
- Cleft palate
- Hypocalcemia (parathyroid hypoplasia)
- Behavioral/emotional problems
“CHIC Bitch”
Infants with signs/sxs associated w/ DiGeorge Syndrome (Cardiac, Immune, Cleft palate, hypocalcemia, behavioral) should be screened with what 2 tests?
- T-cell level
- genetic screening
Signs / Sxs of which condition?
- Cleft palate
- Cyanosis
- Abnormal facial features
- Learning difficulties
DiGeorge Syndrome
Which condition?
- X-linked disorder caused by mutation in WASp protein (boys)
- Rare (1/100,000)
- Ranges from mild to more severe forms
Wiskott-Aldrich Syndrome
What is the classic presentation of Wiskott-Aldrich Syndrome? (3)
- Susceptibility to infections (bacterial, viral, fungal)
- Thrombocytopenia (platelets also small)
- Eczema
2 conditions which can develop with Wiskott Aldrich Syndrome
-
Autoimmune disease (70% of patients)
- hemolytic anemia, IBD, neutropenia, vasculitis, renal diseases
-
Malignancies
- B cell lymphoma & leukemia are MC
Management/Tx of Wiskott-Aldrich Syndrome (4)
- prophylactic abx & antivirals
- Platelet transfusion PRN
- Ig for those w/ deficiency
- Stem Cell Transplant (is the only curative tx)
Ataxia Telangiectasia
- Autosomal recessive or dominant?
- Homozygous presentation - what is the first sign?
- 5 other signs?
- Autosomal recessive
- 1st sign: progressive cerebellar ataxia
- abnormal eye movements
- neurologic abnormalities
- oculocutaneous telangiectasias
- immune deficiency (esp pulm infection)
- malignancy
Ataxia Telangiectasia - Children
- Walk at normal age, but don’t develop what?
- Difficulty coordinating what 2 movements? (saccades)
- Telangiectasias of what 3 structures?
- fluidity of gait (wobbly)
- eye & head movements (saccades) –> nystagmus
- conjunctiva, face, neck
Ataxia Telangiectasia in Children
- 25% develop what after age 10?
Malignancy (mostly lymphoma)
Management of Ataxia-Telangiectasia (3)
- Manage each disease manifestation individually (multidisciplinary team)
- Watch for aspiration
- Vaccinate if they make Ig
