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Infections in newborns Flashcards

1
Q

What is stomatitis?

A

A broad term referring to inflammatory lesions of the oral mucosa of varied etiologies.

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2
Q

What are infections of the mouth?

A
  1. HSV
  2. Coxsackle
  3. Oral Candidiasis
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3
Q

What other conditions can cause stomatitis?

A 
Kwashirkor
chemotherapy
autoimmune disease
Steven-Johnson's syndrome
Certain immune deficiencies
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4
Q

How is stomatitis treated?

A 
Fluids
Magic mouthwash
Morphine
Ibuprofen
IV hydration
HSV acyclovir within 48 hours
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5
Q

What is another way to administer APAP and Ibuprofen if it can not be given orally?

A
  1. Rectally
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6
Q

What are the common infectious agents responsible for peritonsillar abscesses?

A
  1. Streptococcal
  2. Staph Aureus
  3. Anaerobes
  4. Haemophilus
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7
Q

What are local symptoms of peritonsillar abscess?

A
  1. Sore throat, dysphagia, odynophagia, drooling.
  2. Extensive swelling in tonsillar bed
  3. edema and medial deviation of the soft palate
  4. Unilateral cervical lyphadenitis
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8
Q

What is classic triad of symptoms?

A
  1. Trismus reflex spasm of the medial pterygoid the most reliable indicator of PTA
  2. Uvular deviation due to edema and medial deviation of the soft palate
  3. Dysphonia (hot potato voice) due to vagus nerve involvement causing failure to elevate the soft palate.
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9
Q

How is peritonsillar abscess managed?

A
  1. Not yet drainable or pre-abscess cellulitis treat with ampicillin/sulbactam if improving transition to amoxicillin/clauvulinate
    Clindamycin- 2nd line
    Steroids if airway is obstructed
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10
Q

How is peritonsillar abscess confirmed?

A

Collection of pus at time of drainage

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11
Q

What are complications of peritonsillar abscess?

A
  1. PNA
  2. Airway obstruction
  3. Retropharyngeal abscess
  4. Sepsis
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12
Q

What are some differential diagnosis for peritonsillar abscess?

A

Epiglottis

Retro

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13
Q

What should the clinician do if the peritonsillar abscess is drainable?

A
  1. ENT consult for I and D
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14
Q

What is the study of choice for peritonsillar abscess diagnosis?

A

CT with contrast

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15
Q

What is epiglottitis?

A

Epiglottitis (or “supraglottitis”) is an inflammation of the epiglottis and adjacent supraglottic structures

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16
Q

What causes epiglottitis?

A

majority of cases are caused by bacterial infection; however, several viral and fungal pathogens

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17
Q

What bacteria cause epiglottitis?

A

Strep

Staph. Aureus

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18
Q

Symptoms of epiglottitis?

A 
Rapid onset
high fever
sore throat
resp distress
tripod position
hot potato voice
stridor
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19
Q

How do you assess a child for epiglottitis?

A
  1. Leave child sitting in comfortable position
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20
Q

How is epiglottitis diagnosed

A

Thumbprint on a lateral neck x ray

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21
Q

How is epiglottitis managed?

A

Pediatric ENT or anesthesiologist

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22
Q

Which vaccine dramatically reduced the incidence of epiglottitis?

A

HIB vaccine

23
Q

What is a retropharyngeal abscess?

A

Retropharyngeal abscesses occur in the retropharyngeal space, which extends from the base of the skull to the posterior mediastinum.

24
Q

Infections are often polymicrobial and may include

A 
Aerobes
Staphylococcus aureus 
Streptococcus pyogenes
Anaerobes 
Bacteroides 
Fusobacteria
25
Q

What are symptoms of retropharyngeal abscess?

A 
Difficulty swallowing
Pain swallowing
Drooling
Difficulty moving neck don't want to look up
change in voice quality
26
Q

How is retropharyngeal abscess diagnosed?

A
  1. an exam on a child with inability to look up and imaging lateral neck x ray.
  2. CT with contrast- when going to OR
  3. MRI is possible
27
Q

How is retropharyngeal abscess managed?

A
  1. Ampicillin/Sulbactam and transition to Augmentin
  2. Clindamycin
    If no response
    Vanc or Linezolid
28
Q

What are complications of retropharyngeal abscesses?

A
  1. Mediastinitis
  2. Internal jugular vein thrombosis
  3. Carotid artery rupture
  4. Airway obstruction
  5. Septicemia
  6. Epidural abscess or diskitis
29
Q

What are differential diagnosis for retropharyngeal abscess?

A

Epiglottitis:
Peritonsillar abscess
Parapharyngeal abscess or prevertebral space infection
Meningitis

30
Q

When are steroids indicated in retropharyngeal abscess?

A

Airway obstruction

31
Q

What is croup?

A
  1. A viral infection of the larynx
32
Q

What ages does croup affect children?

A

3 months to 3 years

33
Q

what causes croup

A 
Parainfluenza virus
Mycoplasma pneumoniae
Staphylococcus aureus
Haemophilus influenzae
Streptococcus pneumonia
Moraxella catarrhalis
34
Q

what symptoms do children with croup present with?

A 
Fever
barking cough
hoarseness
difficulty swolling
drooling
throat pain
stridor
35
Q

What is the westley croup score?

A

croup rating scale

36
Q

What causes stridor?

A

Narrowing of the upper airway

37
Q

What is the test of choice for diagnosing croup?

A

X ray, looks like a church steeple

38
Q

How is croup treated?

A
  1. Humidity
  2. cold air
  3. Dexamethasone has longer half life can give 1 dose of dexamethasone as opposed to 3 doses of prednisone
  4. Racemic epinephrine in the ER, monitor for rebound, short acting 1 hour
39
Q

When are children with croup discharged for the ER

A
  1. When they no longer have stridor and can breath
40
Q

What is pediatric community acquired pneumonia?

A

Infection of the lower airway in children

41
Q

What is the etiology of most community acquired pna.

A
  1. Most CAP is viral
42
Q

What is most likely to cause CAP in children

A 
<3 months of age strep pneumo
chlamydia trach
GBS
E. Coli
S. Aureus
43
Q

What are the causes of CAP in infants and children?

A
  1. Strep pneum
    H. flu
    S. Areus
    Mycoplasma pneumoniae
44
Q

What are special circumstances that can cause

CAP in children?

A
  1. TB
  2. Pseudomonas species
  3. Legionella
  4. Fungal
  5. Coxiella, C psittaci, parasites
45
Q

Neonates with CAP will have what kinds of symptoms?

A
  1. Fever
    lethargy
    apnea
46
Q

How do infants and children present with CAP?

A
  1. Tachypnea, fever, cough, abdominal pain.

2. Minimal URI symptoms

47
Q

What is seen on assessment of a child with CAP?

A
  1. Rales
  2. Dullness to percussion
  3. Decreased aeration
  4. Wheezes more common in viral
48
Q

Should labs, x ray and viral swabbing of the nose be done?

A

No

49
Q

When is a C X ray indicated for children with CAP

A

if the child is hospitalized to distinguish between viral and bacterial

50
Q

What percentage of infants with a fever have a UTI?

A
  1. 7% of infants with fever will have a UTI
51
Q

What is the most likely causative agent of a UTI?

A 
1. E. Coli most common
Klebsiella
Proteus 
Enterococcus faecalis 
Staphylococcus saprophyticus
Group B streptococcus (neonates)
Pseudomonas
Fungal (especially with instrumentation):
Candida spp
Asperigillus spp
Cryptococcus neoformans
Viral: adenovirus and other viruses (seen in cystitis with gross hematuria)
52
Q

Risk factors UTI in children

A
  1. Constipation
  2. reflux
  3. Neurogenic bladder
  4. young children <1 month < 1 year common
  5. female after 3 months of age
  6. children <3 months of age, bacterial, males slightly more higher in early infancy
  7. Sexual activity
53
Q

What is the ascending UTI?

A

Uro-pathogens (most commonly fecal flora) colonize peri-urethral area → ascend to bladder via urethra.
If pathogen reaches kidney via ureter → pyelonephritis or upper UTI

Neonate (6 decks)

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