Infectious Disease Flashcards
What are the stages of pertussis
1.) Incubation 7-10 days 2.) Catarrhal: URI symptoms 3.) Paroxysmal phase - 5-10 coughs with whoop in between, post-tussive emesis, cyanosis, apnea 4.)convalescent phase
Treatment of pertussis
Azithromycin 10mg/kg up to 500mg on day 1 then 5mg/kg on day 2-5 up to 250mg. Adults use zpack.
What do you do with exposed contacts to pertussis?
all get chemoprophy with azithro, regardless of immunization status
Immunizations for Pertussis
- DTaP vaccine at ages 2, 4, 6, 15–18 months, and 4–6 years
- Single dose of Tdap for adolescents aged 11–18
- Single dose of Tdap Adults aged 19–64 years in October 2005.
- Tdap each pregnancy third or late second trimester. Transient immunity potentiall passed to each infant.
MOA of cephalosporin
B lactam, inhibits peptidoglycan cell wall
MOA of aminoglycosides
Binds to 30s or 50s subunit and inhibits transcription of DNA
Carbapenem coverage
bacteriocidal for gram positive and gram negative. MRSA resistant.
Clindamycin coverage
gram positive and anearobic infections
Clindamycin MOA
Binds to 50s ribosome inhibiting protein synthesis
Aminoglycoside coverage
Anaerobes and gram negative, anti-pseudomonal.
Macrolide MOA
Binds reversibly to 50s unit, inhibits translocation of peptidyl tRNA
Macrolide coverage
Upper and lower respiratory tract, strep, syphilis, mycoplasma, lyme disease
Quinolone MOA
Inhibits DNA topoisomerase and prevents replication
Quinolone coverage
UTI, prostatitis, CAP, bacterial diarrhea, mycoplasma, gonorrhea
Sulfa MOA
Inhibit folate synthesis
What is the heterophile agglutination test?
IgM to EBV that appears in first 2 weeks of illness. May be negativein kids <4.
Who are candidates for VariZIG?
Immunocompromised children without history of VZV vaccine or prior varicella illness. Pregnant women without evidence of immunity, Newborn whose mother had onset of chickenpox5 days before delivery or within 48 hours after delivery, hospitalized preterm infant (>28weeks) with no reliable mother history of vzv protection or hospitalized preterm infant (<28 weeks) regardless of maternal history.
Smallpox rash
The smallpox rash first appears on the buccal and pharyngeal mucosa and most often spreads to the hands and face before spreading to the trunk, arms, legs, and feet. The centrifugally distributed skin lesions evolve synchronously (same stage of maturation on any one area of the body) from macules to papules to vesicles to pustules and eventually become crusted
Rubeola is also known as
measles
measles is also known as
rubeola
Measles (rubeola)
Prodrome of cough, coryza, conjunctivities, then koplik spots on buccal mucosa, then blotchy, erythematous, blanching, maculopapular eruptions that starts at hairline and spreads down over 3 days. Involves palms and soles. Quite ill systemicall, malaise, fever, anorexia. Peak season is late winter through early spring. contagious for 4 days before and after rash.
Rubella is also known as
german measles
german measles also known as
rubella
Rubella
Adolescents and adults get prodrome of fever, malaise, sore though, HA. In young kids, no prodrome, low grade fever with rash. pinking red, fine maculopapular eruption that starts on face and spreads down, becomes generalized and fades in 72 hours. Arthritis and arthralgia seen in older kids and adults. Peak season late winter and early spring
Adenovirus
Conjunctivitis, URI, pharyngitis, croup, bronchiolitis and pneumonia. Can also cause myositis, gastroenteritis, nephritis and encephalitis. Rash may be morbilliform, rubelliform or petchiael. LAD common. Late winter and early summer.
Coxsackie hand foot and mouth disease
Prodrome of fever, malaise, sore mouth, anorexia. in 1-2 days, lesions appear. Shallow yellow ulcers surrounded by red halos. on buccal mucosa, tongue, soft palate. Cutaneous lesions are erythematous macules on palmar aspect on hands and plantar surface of feet. If no cutaneous lesions = herpangina.
Parvovirus (erythema infectiousum)
Occurs year round. Fever unusual. May have HA, nausea, myalgia. RAsh begins on face with slap cheek. Start to fade, then slightly raised, lacy rash occurs on extensor surfaces of extremities.then buttocks and trunk. Virus replicates in blood cells in marrow. May have biphasic disease with rRBC suppression 1 week later.
Roseola
Primarily affects children 6-36 months. HSV6. Abrupt fever occurs first, usually fairly high without a source. Fever and irritability persist for 72 hours then fever subsides. Then an erythematous, maculopapular rash appears once fever is gone. discrete, rose-pink macules that start on trunk then go to extremities. may last up to two days.
Treatment of Listeria sepsis in neonate
Amp and Gent. Remember, if mom with flu like illness - probably listeria
Ecthyma gangrenosum
large pustules on an indurated, inflamed base. Caused by pseudomonas
Who needs meningococcemia prophy?
All people who have had contact with oral secretions or examined patients mouth. All household contacts
What is used for meningococcemia prophy?
Rifampin in kids. If older can use ceftriaxone, cipro or azithro
Most common cause of sepsis is neonate
GBS, e.coli, listeria, s.pneumo
Most common cause of meningitis in neonate
GBS, listeria, e.cloi
in young children most common cause of meningitis
s.pneumo, n. meningitidis, enterovirus
Cryptosporidium
Often seen in immunocompromised patients, but can also be seen as self limited disease in kids. Severe, non-bloody, watery diarrhea. Treat with nitazoxanide.
Staccato cough and intracytoplasmic inclusions
Chlamydia infection
treatment of chlamydia conjunctivitis
erythromycin or sulfonamides
treatment of chlamydia pneumonia
azithro
Treatment of RMSF
doxycycline, even in kids less than 8
Treatment of cat-scratch disease
supportive care unless immunocompromised or unstable. Can use erythromycin, azithromycin, cipro, bactrim. NO PCN.
What kind of bacteria is H. influ
gram negative pleomorphic organism
Treatment of H. flu
ceftriaxone or cefotaxime
Common encapsulated organisms
s.pneumo, salmonella, neisseria meningitidis, and H. flu
Chemoprophylaxis following h. flu exposure
If at least one household contact younger than 4 who is incompletely immunized or immunocompromised child then all household contacts need prophy with Rifampin.
Diagnosis of pertussis
Use PCR
Treatment of pertussis
erythromycin, azithromycin. If treated during catarrhal stage will shorten the cough, if give during paroxysmal phase will decrease transmission, but not length of cough
Pertussis prophylaxis
Anyone exposed to someone with pertussis needs to be treated with a macrolide, regardless of immunization status
From what do you get salmonella
Chickens and humans are the carriers. eggs, poultry, infected veggies, contaminated medical instruments, reptiles like pet turtles
Treatment of Salmonella gastroenteritis
Supportive care if uncomplicated. Treatment can lead to the carrier state. Treatment is indicated in kids < 3mo and anyone at risk for invasive disease. Use cefotaxime or ceftriaxone.
What antibiotics work against pseudomonas
ceftazidime, zosyn, gentamicin, carbapenems, cipro and levo
Brucellosis is associated with what animal
cows and dairy
treatment of brucellosis
doxycycline or bactrim
first and second line treatment of strep throat
amoxicillin, then azithromycin or ceftriaxone
Who gets GBS prophy?
Women who have had previous infant with invasive GBS disease, those with GBS bacturia, those with positive GBS screen, Those with unknown GBS status, gestation less than 37 weeks, ROM more than 18 hours or intrapartum fever.
What is used for intrapartum GBS prophy?
PCN 5 million units every 4 hours until delivery. If allergic and did susceptibilities use clinda, if no time for susceptibilities use vanc
Most important manifestations of CMV
colitis, chorioretinitis, sensineural hearing loss, pneumonia, neuropathy
What is the vertical transmission rate of CMV?
Primary maternal infection during pregnancy has a 40% transmission rate to the fetus. The transmission rate to the fetus in a preconceptionally immune mother shedding CMV virus is 1% vs 40% for primary maternal CMV infection, and sequelae in the offspring generally are less severe.
How do babies get CMv postnatally?
Postnatal infection can occur after exposure to human milk, blood products, or transplanted organs
Manifestations of congenital CMV
jaundice, hepatosplenomegaly, prematurity, intrauterine growth restriction, microcephaly, thrombocytopenia, and skin manifestations (Fig 1), such as petechiae and purpura. Prenatally, congenital CMV infection can be associated with oligo- or polyhydramnios, periventricular calcifications (Fig 2), and hyperechoic bowel on prenatal ultrasonography.
If mom has Hep C, when should you test baby?
Nucleic acid amplification testing (NAAT) to detect HCV RNA may be performed on a potentially affected infant at 1 to 2 months of age for reliable evidence of viral transmission to the baby.
Treatment of chlamydia ophthalmic infection
Erythromycin po for 14 days topical doesn’t work. Erythromycin associated with hypertrophic pyloric stenosis
Signs of maternal listeriosis
Flu-like illness, mec stained fluid, gi symptoms. Baby May have rash
Lemierre’s disease
Infection from the oropharynx extends to cause septic thrombophlebitis of the internal jugular vein and embolic abscesses in the lungs. Fusobacterium necrophorum, an anaerobic bacterial constituent of the oropharyngeal flora.
At what age does disseminated HSV occur?
Days 10-12. Usually resp failure, hepatitis, pneumonitis, dic. CNS disease common, may not have cutaneous disease.
At what age does cns HSV perinatal infection present?
Days 16-19. 60-70% have cutaneous vesicles
When is VSV most dangerous in pregnancy?
Before 20 can get congenital - limb hypoplasia, cutaneous scarring, chorioretinitis, cns damage. OR death if occurs at time of birth because no time for antibodies to get to them
How do you diagnosed HIV in a newborn?
Check HIV DNA PCR. Antibodies not helpful bc get from mom. RNA not helpful if on prophy. DNA PCR will be increasingly positive as time goes on (only 30% positive at birth) therefore check at 14 to 21 days, 1 to 2 months, and 4 to 6 months of age. If 2 separate tests are positive, the infant is considered infected with HIV.
Treatment of histoplasmosis
Itraconazole, if disseminated, use amp B
Why do we give dose of hep B at birth?
b/c incubation period is 45-160 days and getting vaccine can prevent getting the disease
Ho do you treat entameaoba histolytica
Treatment of amebic infection involves eradicating the active trophozoites (with metronidazole) and the intraintestinal cysts (with paromomycin or iodoquinol).
When do you change from Dtap to Tdap?
7 years old
Tetanus: Wound dirty and either child has had
Give TIG and Imm
Tetanus: Wound is clean and imms up to date (
Nothing
Wound is dirty and imm
Nothing
How to diagnose Brucellosis
Serial increasing titers and titers
Treatment of Brucellosis
Doxycycline second line bactrim
What infection should you think of with chronic LAD, HSM and exposure to unpastuerized milk or farm animals
brucellosis
Which bacteria has been associated with contact lens weareres after a traumatic eye injury
Bacillus cereus
Describe clostridium
strict anearobic, gram positive rod
Treatment of tetanus
tetanus immune globulin (human preferred, equine ok) treat with metronidazole (remember its clostridium tetani)
What should you test patients who have had meningococcemia for?
complement deficiency - need CH50 or CH100 assay. (1-17% of children with meningococcemia have def)
Treatment of mengococcemia?
PCN
Who needs prophylaxis for meningococcus?
household contacts, day care workers, intimate contacts, passengers sitting next to patient on the plane for >8 hours. Do not prophylax patients at school or work with routine contact. health care workers do not need unless they intubated or gave mouth to mouth.
meningococcal prophy for children, adults, preggos?
rifampin or rocephin (for preggos) - better than PCN for ridding of carrier state because these drugs concentrate in throat mucosa.
For which infections do you need to think about prophylaxis for contacts?
pertussis, meningococcus, invasive HiB, VZV
Describe moraxella
gram negative diplococci, 3rd most common cause of AOM and sinusitis. Almost 100% produce beta lactamase and resistent to pcn only.
Which infections are associated with reactive arthritis
yersinia enterocolitica, shigella, campylobacter.
If get citrobacter in blood culture, what should you order?
CT/MRI of brain looking for abscess.
Describe the bacteria of RMSF
rickettsia ricketsi. gram negative coccobacillus
what infection is seen in slaughterhouse workers, and infected animals products of conception
coxiella burnetti
treatment of lemeirres
metronidazole and ceftriaxone
Who can you use t spot in?
kids >5 years who have gotten BCG or unlikely to return for follow up
Which patients do you treat for TB if they have a close contact to active disease even if TST is negative? ( will need to check another one in 10 weeks)
<4yo, HIV, immunocompromised - treat. for all other kids, observe if initial TST is neg and r/p in 10 weeks.
treatment of active TB
2 months of 4 drug therapy, then 4 months INH and rifampin
treatment of nocardia
bactrim
What should pneumonia and splenomegaly make you think of?
C. psittaci (or histo)
Leptospirosis
spirochete, transmitted by infected animals in the water. Causes myalgias, calf cramping, fever, HA, severe hepatitis and jaundice. tx with PCN or rocephin or doxy
The ixodes scapularis tick carries which diseases
lyme and babesia
Until what age is thrush normal
5months
What does it suggest when the lab needs an olive oil overlay to grow?
Malassezia furfur - this is seen invasively in NICU babies on TPN and lipids
treatment of e. histolytica
Treatment of E histolytica infection is metronidazole or tinidazole, followed by a luminal amebicidal agent such as paromomycin or iodoquinol. Patients who are asymptomatic, but excreting cysts can be treated with a luminal amebicidal agent alone.
How long does ETEC last?
1-5 days, longer travelers diarrhea think e. histolytica
What is an importnat side effect of pyrimethamine/sulfadoxine
associated with risk of severe SJS
What does unilateral firm edema of the eyelids suggest?
chagas disease - a child from mexico or south america
cigarette paper scar
cutaneous leschmaniasis
For which infections should mothers not breastfeed at all
brucella, HIV, HTLV
For which infections should mothers pump but not breastfeed during acute period?
HSV with active lesions, Varicella (-5 to +2 days), untreated active TB
Arcanobacterium haemolyticum
It is not possible to distinguish pharyngitis caused by S pyogenes from that caused by A haemolyticum on clinical grounds. Fever, pharyngeal exudates, lymphadenopathy, and a scarlatiniform rash can be seen in both infections. A haemolyticum, like S pyogenes, can cause invasive infections, although invasive A haemolyticum infections are quite rare and tend to occur in immunocompromised patients. More common in young adults. Treat with erythromycin
Consumption of unpastuerized dairy products should make you think of
Brucella
Which worm can cause cutaneous larva migrans?
hookworm (necator) and strongylides
only helminth that replicates in body
strongylodies
which worm causes visceral larva migrans
toxocara canis
schistosomiasis
fever, LAD, diarrhea, HSM, eosinophilia, cirrhosis with esophageal varices, hematuria. increases risk for bladder cancer.
side effects of gancyclovir
granulocytopenia and low platelets
cough, coryza, conjunctivitis
measles
koplik spots
measles
describe the paralysis of polio
descending from prox to distal. No relfexes
In who does parvovirus cause aplastic anemia
patients with chronic hemolytic anemias, AIDS,
think of what disease when see severe hemorrhagic pneumonia, thrombocytopenia, and increased hematocrit
hantavirus (desert SW)
treatment of e. histolytica
Treatment of amebic infection involves eradicating the active trophozoites (with metronidazole) and the intraintestinal cysts (with paromomycin or iodoquinol).
The most appropriate screening test for HIV infection in children younger than 18 months
HIV DNA PCR
side effect of zidovudine
BM suppression and myopathy
side effect of didanosine
pancreatitis and neuropathy
side effect of abacavir
serious fatal hypersens reaction
side effect of efavirenz
teratogen
side effect of indinavir
hyperbili and nephrolithiasis
Most common cause of infective endocarditis in children
40% caused by viridans strep
most common cause of prosthetic valve endocarditis
s. epidermidis
JAneway lesions
vascular phenomenon. nontender, seen in acute endocarditis
Osler nodes
painful, immunologic phenomenon, seen in SBE
most common cause of meningitis <3 mos and treatment
GBS, listeria, gram neg. treat with ampicillin and cefotaxime
most common cause of meningitis 3mos - 10 years
s. pneumo. treat with rocephin and vanc
most common cause of meningitis 10-19yo
n. meningitidis. treat with rocephin and vanc
Most common cause of bacterial diarrhea
e. coli
treatment of campylobacter
azithro or quinolone
treatment of shigella
rocephin
treatment of travelers diarrhea
quinolone or azithro
treatment of UTI in pregnancy
nitrofurantoin, keflex, dont use bactrim in late preg or nursing moms
Which antibiotics should you avoid in preggos?
Tetracycline, quinolone, aminoglycosides, sulfa near term. If breastfeeding: all of the above. If mom has G6PD - avoid primaquine and nitrofurantoin
When can children go back to daycare after impetigo?
24 hours after antibiotic
When can children go back to daycare after pertussis?
5 days of appropriate antibiotics
When can children go back to daycare aftersalmonella typhi
diarrhea resolves and 3 negative stool cultures
When can children go back to daycare after non typhi salmonella?
diarrhea resolves. No stool cutlures required
When can children go back to daycare after shiga toxin e coli or Shigella?
diarrhea resolves and 2 negative stool cultures
When can children go back to daycare after strep throat
24 hours after antibiotics
treatment of n meningitidis
High-dose intravenous penicillin G for 5 to 7 days is the preferred treatment for infection due to N meningitidis.
