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Pediatric Boards > Infections > Flashcards

Infections Flashcards

1
Q

Enterococcus faecalis

A

GramPos Diplococcus (can look like Strep!)
NEC, Sepsis, UTI in child with GU abnormality
Tx: Vanc, amp, linezolid. Rifampin, quinolones
NOT clinda or cephalosporin

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2
Q

Listeria monocytogenes

A

GramPos diphtheroid (ROD)
Neonatal sepsis/infection
Nodules on the placenta, mild maternal fever/sx
Tx: Ampicillin covers Listeria, GBS, and Enterococcus. (Note: Gentamicin covers other GramNegs.)

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3
Q

Clostridium

A

GramPos, anaerobe
C. tetani
C. botulinum
Tx: Metronidazole or PCN, supportive care, anti-Ig

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4
Q

Corynebacterium diphtheria

A 
GramPos Rod  (histo might look like hyphae)
Diptheria = low fever, URI sx -> pseudomembrane on tonsils/pharynx, airway edema, neuro sx (GBS)
Tx: Metronidazole or erythromycin
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5
Q

Group A Strep (GAS)

A

GramPos Cocci in Pairs and Chains (Blue on Gram stain)
Group A (GAS) classic ex is Strep pyogenes
-GAS -> S for skin and oral abScesses
-Also P for pyogenes and pharyngitis (w/o viral sx)
-Scarlet fever, rheumatic fever, post Strep glomerulonephritis (PSGN)
-Strep Toxic shock syndrome (+/- necrotiz fasciitis)
Tx for pharyngitis: Ampicillin, PCN. If allergic, erythromycin or clinda.
MUST TX to prevent rheumatic fever (caused by GAS pharyngitis only)
But Tx does NOT prevent PSGN (caused by GAS pharyngitis or skin infection)
Tx for bad infection: IV -> PO

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6
Q

Alpha Hemolytic Strep

A 
Silly pneumonic: Green Alf doing moon walk
Strep viridans
Strep pneumoniae (aka Pneumococcus)
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7
Q

Beta Hemolytic Strep

A

GBS (agalactiae) and Strep pyogenes
Pneumonic: aBpA (note lower and upper case order)
algalactiae group B, and remember B for baby
pyogenes group A, and remember GAS, S for skin

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8
Q

Group B Strep (GBS) - descrip/features and example

A

GramPos Cocci in Pairs and Chains (Blue on Gram stain)

Group B classic ex is GBS/agalactiae (B for baby)

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9
Q

Other Strep (non Group A, non Group B, non Strep pneumo)

A

GramPos Cocci in Pairs and Chains (Blue on Gram stain)
Strep viridans, mutans, and bovis
-Endocarditis: viridans&raquo_space; mutans or bovis

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10
Q

Young child with fever, LAD, dysphagia/drooling, and

HYPEREXTENSION OF THE NECK

A 
Retropharyngeal abscess (from GAS)
Hyperextension likely pulls the posterior abscess away from the airway and helps open the airway
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11
Q

Young child with drooling and

LEANING FORWARD POSTURE

A

Epiglottis

Leaning forward allows epiglottis to be displaced anteriorly, keeping airway open

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12
Q

Young child with drooling, trismus, deviated uvula, unilateral tonsilar swelling, and “hot potato voice”

A 
Peritonsillar abscess (from GAS +/- anaerobes)
Tx: IV (ex. Clinda, ampicillin/sulbactam) -> PO (amox/clav)
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13
Q

Scarlet fever

A

Group A Strep (GAS)
Painless, sandpaper -> erythematous rash
Pastia’s lines (lines near creases)
Perioral pallor and strawberry or white tongue

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14
Q

Strep pneumoniae

A

GramPos diplococci. ENCAPSULATED!
aka Pneumococcus
-Most common cause of pneumonia in kids
-Most common cause of occult bacteremia (no need to tx if no symptoms)
-Common cause of meningitis, osteomyelitis, septic arthritis, sinusitis, otitis media, (endocarditis?), peritonitis
-Rare cause of cellulitis or brain abscess

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15
Q

Group B Strep

Neonatal Sepsis

A

Early: w/i first 3 DOL. Usually pneumonia
Late: after first 3 DOL - 90 DOL. Often focal, such as meningitis, cellulitis, osteomyelitis.
Tx: PCN G!

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16
Q

Group B Strep

Screening and Prophylaxis

A

GBS screen: 35-37 weeks gestation
Tx: PCN at least 4h prior to delivery. Monitor baby x 48h.
If Mom not treated but should have been, get CBC and blood culture on baby.
No tx for C/S with intact membranes (even if + indications)
Indications:
-Any evidence of GBS during current pregnancy
-Unknown GBS status plus PREM, PROM, fever, or NAAT (rapid nucleic acid amplification test positive)
-Mom had prior baby with GBS disease (but not just if Mom had GBS UTI or positive test in past pregnancy)

17
Q

Staphylococcus aureus

A

GramPos in clusters. Coagulase positive. Can be MRSA.

  • Purulent skin infections, toxic shock syndrome, sinusitis.
  • Most common cause of osteomyelitis. More common cause of septic arthritis than Strep pneumo.
  • If growing in blood, MUST tx with IV abx and get ECHO to evaluate for Staph aureus endocarditis
  • Tx skin infections: Clinda or Bactrim are first-line
  • Tx serious infection: Vancomycin or linezolid
18
Q

CONS: Coag negative Staph

A

Staph epidermidis. Can be MRSE.
Often extremely resistant to abx.
-If growing in blood, TREAT and TREAT BIG with Vancomycin. (Ignore residency training for purpose of boards) Might come back MRSA eventually.
-Secondary bacterial peritonitis in patient on dialysis - assume MRSE, tx with Vanc
-VP shunt meningitis - assume MRSE, tx with Vanc

19
Q

Strep vs Staph skin infections

A

Either can cause any, but in general:
Strep: cellulitis, necrotiz fasciitis, impetigo (more common than Staph, but usually not bullous), erysipelas (fever + cellulitis). Rash is usually erythematous and painful.
Staph: Purulent skin infections, carbuncles/furuncles (if <5cm, I&D, if >5cm give clinda or Bactrim), bullous impetigo (with VERY thin blisters), folliculitis, breast abscess (give the neonate IV abx)

20
Q

Recurrent abscesses, failure to thrive, Serratia in a boy

A

Chronic granulomatous disease (granulomatuX)

  • X-linked recessive (boys are affected). Present by 5yo
  • Serratia, fungi (Aspergillus, candida), E coli, Staph = catalase positive organisms
  • Not a cell line issue (cell counts normal) but a neutrophil function issue (poor nitro oxidative burst)
  • Low grade, recurrent infections: abscesses (skin, liver), osteo, lymphadenitis, skin infections, GI infections, granulomas
  • Dx: Nitroblue Tetrazolium (“neutrophil blue”) or Dihydrorhodamine Fluorescence test
  • Tx: PCP prophy, other prophy
21
Q

Recurrent bacterial infections (PNA, skin), aphthous stomatitis, foul smelling greasy stools, poor weight gain

A

Shwachman-Diamond Syndrome

  • Autosomal recessive
  • Bone marrow failure/aplasia (pancytopenia, neutropenia, low Ig levels) and neutrophil defects
  • Pancreatic insufficiency (can look like cystic fibrosis but electrolytes and lungs are normal)
  • Bone/skeletal abnormalities
  • Can have renal or liver abnormalities
22
Q

Baby with severe macrocytic anemic, triphalangeal thumbs, and cleft palate

A

Diamond-Blackfan Anemia

  • Pure red cell aplasia (only the red cell line is affected)
  • Severe macrocytic anemia with low retic counts but no signs of hemolysis (i.e. no icterus/jaundice or increase bilirubin). Presents before 3 mos of age.
  • Mnemonic: standing fan with three large black fan blades shaped like RBCs
23
Q

Frequent skin and lung infections, oculocutaneous albinism, neutropenia, normal lymphocyte count

A

Chediak-Higashi Syndrome

  • Autosomal recessive
  • Neutropenia and poor neutrophil chemotaxis
  • Neutrophils contain giant lysosomal granules
  • Platelet dysfunction
  • Oculocutaneous albinism (hig-“ashy skin”)
  • Frequent skin and lung infections with Staph and Strep
24
Q

6 mos old baby with frequent otitis media, skin and sinopulm infections with neutropenia and lymphocytosis

A

Hyper-IgM syndrome

  • IgM to IgG class switch cannot occur due to missing signal from T cell problem
  • Lymph nodes and tonsils ARE present
  • Neutropenia and lymphocytosis
  • Opportunistic infections, including PCP, and risk of lymphoma/cancer
  • Diarrhea
  • Tx: IVIg and Bactrim
25
Q

Newborn with a black umbilical cord stump without any pus/inflammation that won’t fall off, plus leukocytosis and neutrophilia

A

Luekocyte adhesion deficiency/defect

  • Autosomal recessive
  • WBCs can’t get out of the vasculature
  • Delayed wound healing
  • High WBC (20-100)
  • Patients are <1yo (usually)
  • Dx: Rebuck skin window or CD11/CD18 flow cytometry
  • Tx: Bone marrow transplant or patient will usually die by age 1y
26
Q

Child with coarse facial features, delayed shedding of dentition, early eczema, and recurrent infections (sinus, pulm, skin)

A

Job syndrome, aka Hyper-IgE syndrome

  • Eosinophilia, Eczema (in first week of life), and Elevated IgE levels
  • Recurrent infections due to impaired humoral and cell-mediated responses (Staph, H flu, Candida, aspergillus)
  • PNA -> Pneumatoceles on CXRs
  • “Cold” Staph skin, lung, joint infections/abscesses
  • Delayed shedding of tEEth
  • Skeletal/bone abnormalities (scoliosis, fractures)
27
Q

Baby boy with many courses of antibiotics

A

Bruton’s agammaglobulinemia (aka X-linked agammaglobulinemia)

  • X-linked (boys)
  • No B cells, no immunoglobulins
  • High T cell count
  • Tiny/absent tonsils and lymph nodes (Brut’s smooth aftershave)
  • Encapsulated organisms but NOT PCP
  • Tx: IVIg, prophy antibiotics, Bone marrow transplant
28
Q

B-cell deficiencies

Humoral immunity

A
  • Sx usually start around 6 mos of age when maternal Igs wane
  • Dx: Low titers against vaccinated organisms
  • Encapsulated organisms
  • Fewer viral or fungal infections than T-cell deficiencies
  • Ex: Hyper IgM syndrome (kind of a B and T cell issue), Bruton’s agammaglobulinemia, transient hypogammaglobulinemia of infancy, IgA deficiency, Hyper IgE syndrome
29
Q

T-cell deficiencies

Cell-mediated immunity

A
  • Recurrent viral, fungal, and bacterial infections (ex Candida)
  • Increased risk of lymphoma/cancer
  • Dx: skin testing with Candida, mumps, tetanus, PPD (for TB) for delayed type hypersensitivity ANERGY
  • Ex: DiGeorge, SCID, Hyper IgM, wiskott-aldrich syndrome, CVID
30
Q

Complement deficiencies

A
  • Recurrent Neisseria infections prior to age 2y old

- Dx: CH50 (C1-C9)

31
Q

3 mos old baby with frequent otitis media, thrush, diarrhea, dermatitis, and lymphopenia (low ALC)

A

Severe combined immunodeficiency (SCID)

  • B and T cell deficiency (lymphopenia). Complete absence of T cell function. Can have normal WBC due to inc PMNs.
  • Small/absent lymph nodes (“skid across a smooth surface”). Small thymus
  • All kinds of infections, including PCP
  • Tx: Bone marrow transplant. No live vaccines
32
Q

Baby boy with frequent infections, petechiae, and eczema

A

Wiskott-Aldrich syndrome

  • X-linked (boys only). Boys wear ties.
  • TIE: small Thrombocytes, frequent Infections, Eczema
  • B and T cell problems (lymphopenia). Low IgM. High IgA. Can have normal WBC due to inc PMNs.
  • Petechiae , bloddy diarrhea, bloody circumcision
  • Small/absent lymph nodes and tonsils
  • Increased risk of lymphoma
  • Tx: Bone marrow transplant

Pediatric Boards (9 decks)

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