Infectious Disease Flashcards
During an infectious process, what inflammatory marker rises earlier?
CRP
What inflammatory marker is a biomarker for early bacteremia detection? Helps predict bacterial vs. nonbacterial illness.
Procalcitonin
Due to the absence of immunologic memory and adaptive immunity, what age group is at the highest risk for bacteremia and/or sepsis?
Infants less than 28 days old
At what age does the immune system develop?
3 months of age
S/S of neonatal sepsis includes
* >
* H
*L
* poor ____
* R___ ____
* J
* I
fever > 38
hypothermia
lethargy
poor feeding
respiratory distress
jaundice
Irritable
The common etiologies for neonatal sepsis include
* U
* B
* M
* P
UTI
Bacteremia
Meningitis
Pneumonia
Work up for neonatal sepsis includes a _____ to include?
Full Septic Work-Up
CBC, blood culture, UA, urine culture, LP
Aside from a full septic workup in a neonate, What else do you need to obtain if the infant has respiratory s/s?
Chest x-ray
respiratory viral panel
Aside from a full septic workup in a neonate, What else do you need to obtain if the infant presents with a rash, vesicles, or other skin findings?
HSV culture
Common organisms for neonatal sepsis include?
*G
*E
*L
*___/____
GBS
E.Coli
LIsteria Monocytogenes
HSV/CMV
All neonates with fever require _____ and __-___ hours of empiric?
hospitalization,
48-72 hours of empiric broad-spectrum antibiotics
First-line antimicrobial therapy for neonatal sepsis includes?
Amp and Gent
When an STI is suspected, First-line antimicrobial therapy for neonatal sepsis includes?
A______
C______
A______
Meningitic dosing of
Ampicillin
Cefotaxmin
Acyclovir
In neonatal sepsis initiate acyclovir until?
HSV results are available and negative
Fever without s/s on physical examination is called a?
fever without a source
Most children with fever without a source have a _____ infection.
Viral
Organisms for infants 1-3 months of age with fever without a source include?
*G
*L
*S
*E
* N___ _____
*S___ ______
GBS
Listeria monocytogenes
Salmonella
E. Coli
Neisseria Meningitidis
Strep Pneumoniae
Organisms for infants and toddlers 3-36 months of age with fever without a source include?
*Sa
*N____ _____
*S___ ______
Salmonella
Neisseria Meningitidis
Strep Pneumoniae
What 2 etiologies should you consider in infants 1-3 months of age who aren’t vaccinated?
HIB
Strep Pneumoniae
Fever without a source diagnostic studies are usually dependent on?
This is because fever without a source is usually self-limiting.
physical examination findings
Fever without a source management is guided by risk stratification. Children may need
1)a_____
2)a____
or 3) re-______ plan if stable
empiric antibiotics
admission
re-evaluation plan
What are the 3 common causes of serious bacteremia?
B______
U____
P_____
bacteremia
UTI
Pneumonia
What is the term for a common disorder presenting in an unusual way?
Fever of unknown origin
What is the clinical definition of Fever of Unknown Origin:
* fever > ___ F or ___ C
*Lasting more then _____ days and up to ____ weeks
* No apparent ____ _____
101 F or 38.3 C
Lasting more than 8 days and up to 3 weeks
No apparent clinical diagnosis
Fever of Unknown Origin is most often caused by i____ disease and c_____ t_____ disease.
infectious disease and connective tissue disease
The most common infectious disease etiologies found in children with Fever of Unknown Origin include
*S
*T
*R
*S
*L
*C
*M
Salmonella
TB
Rickettsial disease
syphilis
Lyme disease
CMV
Mononucleosis
1/3 of children s/p chemotherapy and/or transplant will develop?
fever
Febrile neutropenia definition:
A single temp > ____ for > ___ hour with an ANC < ___ or when ANC is expected to decrease to ____ within ___ hours.
38 C
> 1 hour
< 500
500
48 hours
Patients with febrile neutropenia are most at risk for ____ and ____.
Bacteremia and Sepsis
In a child with febrile neutropenia, GI tract infection will rise from what two possible sources?
Oral vs intestinal mucositis
In a febrile neutropenic child, diarrhea will often be caused by c____ and s____
C. Diff and Salmonella
Staph, strep, and MRSA are examples of what type of bacteria?
Gram +
E. Coli, Klebsiella, pseudomonas, actinobacteria, and enterobacter are examples of what type of bacteria?
Gram -
What diagnostic test is indicated for a neutropenic febrile child presenting with an altered mental status?
LP
What diagnostic test is indicated for a neutropenic febrile child presenting with diarrhea?
C. Diff testing
What diagnostic test is indicated for a neutropenic febrile child being worked up for an abscess fluid or collection?
CT
Oral outpatient therapy for a stable child with febrile neutropenia includes f_____ monotherapy or f______ and a____-____
*fluoroquinolone monotherapy
*fluoroquinolone and amoxicillin-clauvanate
High-risk children presenting with febrile neutropenia require coverage for ______ organisms, s___ v___, and p_______ a______.
gram negative organisms
strep viridian
pseudomonas aeruginosa
Antipseudomonal beta-lactam coverage for a febrile neutropenic patient includes what antibiotic?
What is second-line treatment?
cefepime
carbapenem
In a febrile neutropenic patient, antibiotics should cover g____ and ___ bacteria, s____ v____, and p____
gram - and +
strep viridians
pseudomonas
When a febrile neutropenic patient becomes unstable while on current anti-microbial management, suspect resistant pathogens and add a g_____ such as v____ and a____ coverage such as with f___
glycopeptide
—vancomycin
anaerobic coverage
flagyl
in a febrile neutropenic patient, antibiotics can be discontinued when c___ s___, if there is no m_____ i_____ after __-___ hours, and if the patient has been afebrile for ___ hours
clinically stable
microbiologic indication after 24-72 hours
the patient has been afebrile for 24
Treat a febrile neutropenic patient presenting with cellulitis with? and pneumonia with ?
v____ or l____
vancomycin
linezolid (zyvox)
Treat a febrile neutropenic patient presenting with gram-negative bacteremia or pneumonia with an a_____ such as g____and car_____
aminoglycoside
—-gentamicin
carbapenem
Treat a febrile neutropenic patient presenting with abdominal s/s, mucosal impairment, or c.diff with an anaerobe such as m____
metronidazole (flagyl)
If you febrile neutropenic patient on broad-spectrum antibiotics remains febrile for > __-___ days consider adding _____ coverage.
In this situation obtain a s__/c___/a____ ___ to rule out the presence of fungal lesions.
4-7 days
antifungal
sinus/chest/abdominal CT
The phases of sepsis include
1)S____
2)S___
3)s___ ____
4) s___ ____
SIRS
sepsis
severe sepsis
septic shock
SIRS is defined as a n___ s____ inflammatory response which can lead to ____
non specific
sepsis
Sepsis is defined as a life threatening o___ d____ caused by a d____ host response to i____
organ dysfunction
dysregulated
infection
The lastest s/s in the sepsis continuum is?
hypotension
Septic shock is defined as a profound underlying c___, c____, and m____ abnormality that drastically increased mortality
cellular, circulatory, metabolic
Patients in septic shock will present with persistent ____ often require v____ to maintain M___
hypotension
vasopressors
MAP
The following conditions are risk factors for the development of what?
immune problems
musculoskeletal/neuro disease
prematurity
chromosomal/genetic disease
chronic disease states
SIRS
SIRS pathology
Infection leads to the release of t____ that initiate a c___ c____ leading to f____, v____, and h____ instability
toxins
cytokine cascade
fever, vasodilation, hemodynamic
What clinical manifestation increases the septic child’s risk for death?
low cardiac output
septic neonates are more at risk for a____ and h____
acidosis and hypoxia
Acidosis and hypoxia presence in a newborn with septic shock increases the infants p___ v_____ r____ leading to p___ h____ and lifelong sequelae or disability
PVR (pulmonary vascular resistance)
pulmonary hypertension
The presentation of septic shock includes
f___ or s___ temp
i___, l____, a____
t___ and respiratory d____
t_____, g____ rhythm with m____, poor p____ and h____
h____ or J____
o____ and/or
r____
fever or subnormal temp
irritability, lethargy, anxiety
tachypnea and respiratory distress
tachycardia, gallop rhythm with myocarditis, poor perfusion and hypotension
hepatomegaly or JVD
oliguria and/or rash
Septic shock Hour 1 bundle management
* obtain ___ and ___ ___
*Give ____
—–preferably 3rd or 4th gen c___, c____, extended range p___, or b___ l___ inhibitors
*F___ resuscitation __ ml/kg over __-___ minutes
obtain labs and blood cultures
give antibiotics, cephalosporins, carbapenem, penicillins, beta-lactam
fluid, 20 ml/kg over 5-10 minutes
Children in septic shock unresponsive to fluid resuscitation will require the addition of?
vasopressors
Septic workup includes
*both peripheral and central ___ ___
*u__ and __
*l___
* if ETT in place, an ET ___ ___
*c__, c__, l__ ___
*___ of wounds or draining body fluids
*___ if respiratory s/s present
*__ or ___ of involved body organ
blood cultures
UA and urine culture
LP
sputum culture
CBC, CMP, lactic acid
culture
chest x-ray
US or CT
septic shock management
*optimize ___ delivery
*h___ monitoring
*treat anemia with ____
*correct coagulopathies with ____
*add ____ if anemia and coagulopathies are refractory
oxygen
hemodynamic
PRBCs
FFP
corticosteroids
What is the most frequent cause of DIC?
infection
DIC is an alteration in c___ r/t t__ injury
clotting
tissue injury
Initial DIC s/s include b___ or t___ with tissue i____
bleeding or thrombosis
tissue ischemia
What is the gold standard diagnostic test for DIC?
D. Dimer
In DIC, the D. Dimer will be?
prolonged
DIC management Goal
1) manage s___
2)address c___ by administration of v___ _, c____, f___ or p___
shock
coagulopathies
vitamin k, cryoprecipitate, FFP, or platelets
Meningococcal infections are an acute ____ illness s/p viral infection
bacterial
What is the most common organism that causes meningococcemia?
Neisseria Meningitidis
Neisseria meningitidis is a gram __ and e___ bacteria
negative
encapsulted
What are the most common Neisseria meningitidis serogroups in the U.S.?
B and C
The Neisseria Meningitides toxin load is __-___ X more than other gram-negative bacteria, leading to more severe d____
50-100
disease
The greatest prevention against Neisseria meningitidis is the?
Meningococcal B vaccine
Meningococcemia is the presence of n____ m___ in the s___ c____
Neisseria Meningitidis
systemic circulation
The onset of Meningococcemia is _____
rapid
Meningococcemia s/s include
f___
poor _____
h____
i____
altered ___ ____
t____
t____ and
p_____
fever
poor perfusion
hypotension
irritability
altered mental status
tachypnea
tachycardia
purpura
Meningococcemia laboratory work-up includes obtaining a
c__
s__ work up
L____
r___ function
L__ ____
CBC
septic
LFTs
renal function
lumbar puncture
What precautions should children with Meningococcemia be placed on?
droplet
The recommended antibiotics for Meningococcemia include __ generation cephalosporins which include r___ or cef____
3rd
Rocephin
cefotaxime
The close contacts to include family and healthcare workers of a Meningococcemia patient require prophylaxis with a ___ dose of c____ or r_____
single dose of
ciprofloxacin or Rocephin
HAI host components include
* Impaired i____ s___ or r___
*a___ associated vulnerabilities
immune system or response
age
HAI environment components include
*b___ colonies
*s___
*r____
*g__/g___ tract
bacterial colonies
skin
respiratory tract
GI/GU
HAI agent components include
*p_____
*prolonged _____ therapy
*i____ devices
procedures
antibiotic
invasive
The definition of an HAI is an infection not p___ at a___.
*Develops within ____ hours of a___
*Not present at ___ but develops within ___ days
present at admission
48 hours of admission
discharge, 10 days
The top 4 HAI infection sites include
c___
c____
v____
s____
CLABSI
CAUTI
VAP
SSI (surgical)
HAI s/s include
*new ___
*___ instability
* increase ____ need
* wound _____
fever
temperature
oxygen
purulence
HAI risk factors include
i____ lines
i____ states
E___
E__/v___
f___
P___ infusions and
P___ nutrition
invasive lines
immunocompromised states
ECMO
ETT/Ventilator
Foley
PRBCs
Parenteral
What is the best way to prevent a CLABSI?
provide bundle care
What is the best way to prevent VAP
*elevate ___
*good ____ hygiene
*provide o___ care
*I__-___ suctioning
HOB
hand hygiene
oral care
In-line
What is the best way to prevent SSI (surgical infections)
*administer p____ antibiotics
*d___ and d___ wounds
prophylactic antibiotics
drain and debride wounds
What type of organisms are these?
Strep, Staph, Enterococcus, Listeria, Mycobacteria, Pneumococcus, Corynebacteria, Bacillus, Nocardia
Gram Positive bacteria
What type of organisms are these?
E. Coli, Pseudomonas aeurginosa, Klebsiella, Actinobacter, Neisseria
Enterobacter, H. Flu, Legionella
Salmonella
Gram-negative
Examples of Beta Lactams include
P______
c_____
c_____
and monobactams
penicillins
cephalosporins
carbapenems
Examples of penicillins include
*a_____
*a_____
*z_____
*p_____
augmentin
amoxicillin
zosyn
penicillin, Pen-V
Penicillins are b_____
bacteriocidal
-meaning they directly kill the organism
Penicillins cover gram __ and ___, as well as non b____ l____
- and +
beta lactamase
Penicillins are good to treat
U_____
s____
o___ ____ and
l___ r____ t____ infections
UTI’s
sinusitis
Otitis Media
lower respiratory tract infections
What antibiotic class is good to use for bacterial prophylaxis?
penicillins
Cephalosporins are b____
bacteriocidal
-meaning they directly kill the organism
Cephalosporin coverage increased with each?
generation class
What generation cephalosporins cover gram +, gram -, and pseudomonas?
4th generation
What is the only 3rd generation cephalosporin that also covers gram +, gram -, and pseudomonas?
Ceft
Ceftazodine
1st generation cephalosporins include
cefa____ and an____
cefazolin or ancef
The first-generation cephalosporins Cefazolin and Ancef are good to treat?
surgical prophylaxis
3rd generation cephalosporins include c_____, Ceft____, or cefo_____
ceftriaxone, ceftazidine, and cefotaxime
3rd generation cephalosporins are able to cross the?
blood brain barrier
The third generation cephalosporins ceftriaxone and cefotaxime are good to treat m____ or s_____
meningitis or sepsis
4th generation cephalosporins are good to treat s____ associated with f____ n_____
sepsis associated with febrile neutropenia
There is an increased risk of an allergic reaction to cephalosporins if the patient has had an anaphylactic reaction to?
penecillins
monobactams only cover what type of bacteria?
gram-negative
–the only antibiotic example in this class is aztreonam
Carbapenems provide coverage for gram ___ and ____, p___, and _____ activity
- and +, pseudomonas, anaerobic
Examples of carbapenems include m____, erdipenem, and idipenem
meropenem
Carbapenems are used to treat m____, g__ vs. h___, E____ gram -, and m___ infections
mucositis
graft vs. host
ESBL (infections such as e. coli)
mixed
What antibiotic is part of the glycopeptide class?
Vancomycin
Glycopeptides such as Vancomycin provide coverage for gram ___ bacteria and a____
+
anaerobes
Glycopeptides such as Vancomycin are good to treat M____ and M_____
MRSA
MRSE
Lipopeptides only provide coverage from gram ___ bacteria to include V___
+
VRE (vancomycin resistance enterococcus)
What antibiotic is a Lipopeptide?
Da_______
Dactinomycin
The Lipopeptide Dactinomycin can be used to treat v___ if it is resistant to vancomycin
VRE
(vancomycin resistance enterococcus)
Tetracyclines provide coverage for
gram __ and ___ bacteria, as well as a____ coverage
+ and -
anaerobic
What antibiotic is an example of tetracycline?
Doxycycline
Macrolide antibiotics provide coverage for both gram __ and ___ bacteria. Macrolides also provide coverage for a____ bacteria
- and +
atypical
Macrolide atypical coverage includes the treatment for
C__ M___ and
L_____
CAP mycoplasma
Legionella
Macrolide antibiotic examples include
e____ and a______
erythromycin
azithromycin
The antibiotic class lincomycins provide coverage for gram ___ bacteria and a____
+
anaerobes
What antibiotic is an example of a Lincomycin?
clindamycin
The antibiotic class Aminoglycosides only provide gram ___ coverage
negative
What antibiotics are a part of the aminoglycoside class?
g____
t_____
amik_____
gentamicin
tobramycin
amikacin
The aminoglycosides gentamycin, tobramycin, and amikacin are used to treat s___, e___, and U____
sepsis
endocarditis
UTIs
The sulfonamide class of antibiotics provides coverage for gram __ and ___ bacteria
gram - and gram +
What antibiotic is an example of a sulfonamide?
Bactrim or Sulfa-TPMX
The Fluoroquinolone antibiotic class provides coverage for gram __ and ___ bacteria, as well as coverage for a____ organisms.
Gram + and -
atypical
What is the only fluoroquinolone that additionally provides anaerobic coverage?
moxif_____
moxifloxacin
What antibiotics are fluoroquinolones?
ci____
le______
ciprofloxacin
levofloxacin
The Fluoroquinolones ciprofloxacin and levofloxacin are good to treat
U____
bacterial d____ as well as
s___ t____ or b___ i____
UTIs
bacterial diarrhea
soft tissue or bone infections
In pediatrics, the use of Fluoroquinolones such as ciprofloxacin and levofloxacin can increase the child’s risk for?
tendon rupture
What is the most common cause of community-acquired pneumonia in children less than 5 YOA?
strep pneumoniae
CAP is treated with __ dose ____ when outpatient
high dose amoxicillin
CAP is treated with _____ if the patient is admitted
ampicillin
If Staph or MRSA is suspected as the cause of CAP add v____ or cl____ to the ampicillin course
vancomycin
clindamycin
In children > 5 YOA consider a____ organisms as the cause for CAP
atypical
In children > 5 YOA add a m_____ such as a____ to the ampicillin course
macrolide
azithromycin
What antibiotic provides no coverage for Strep pneumonia?
azithromycin
Otitis media guidelines recommended treating a child with antibiotics when
*____ s/s are presentt
*or when the child is __-___ months of age with ____ disease
severe
6-23 months of age with bilateral disease
Common otitis media pathogen include
s___ ____, h___ ___, and m. c_____
strep pneumonia
h. flu
catarrhalis
What is the first-line therapy for Otitis Media?
high dose amoxicillin
What are the common organisms of skin and soft tissue infections?
s__ ____ and g___ __ ____
staph aureus
group A strep
Treat skin and soft tissue infections with __ generation ____
1st generation cephalosporins
What antibiotics are good treatment options for skin and soft tissue infections
c____
b_____
v_____ or
L______
clindamycin
bactrim
vancomycin
linezolid (zyvox)
In the case of skin and soft tissue infections, 1st generation cephalosporins will not cover an ____ infection
MRSA
Skin and Soft tissue infections may initially be treated with an __ and ___
or topically if stable
I & D (incision and drainage)
What is the most common organism to cause bone and joint infections?
staph aureus
In a sickle cell patient, what is the most common organism to cause a bone and joint infection?
salmonella
Bone and Joint infection may occur as a secondary infection to
G___ ___ ____
Ki____
S__ ____
H__ ___ and
N. g____
Group A strep
Kingella
Strep Pneumoniae
H. flu
N. gonorrhoea
When a bone and joint infection occurs, it is prudent to consult with?
infectious disease
It is important to educate parents that bone and joint infections will require p____ treatment with _____
prolonged treatment with antibiotics
What two antibiotics are the preferred initial treatment for bone and joint infections?
cl___ or cefa_____
clindamycin or
cefazolin
If a child with a bone and/or joint infection is toxic appearing and has + cultures, initial treatment should include IV v____ and r_____
vancomycin and rocephin
MRSA treatment should be based on?
Local susceptabilities
Antibiotics that can treat MRSA include
B____
c_____
d___
and v_____
Bactrim
Clindamycin
Doxycycline
Vancomycin
Meningitis is defined as meninge inflammation related to a ____ or ____ infection
bacterial or viral
What type of meningitis is considered an emergency?
Bacterial Meningitis
Bacterial meningitis is severe and considered an emergency due to the child’s risk of cerebral e____ leading to increased ____, h___, c___ and/or d____
cerebral edema
increased ICP
herniation
coma
death
Meningitis clinical presentation includes
f___
c____
H____
__/___
L____
ph____
altered n___ status
decreased f____
a_____
and in infants a b___ f____
fever
chills
headache
n/v
lethargy
photophobia
neuro status
feeding
agitation
bulging fontanelle
In infants, the most common cause of meningitis is U____ b___ c____
URI bacterial colonization
What is this sign:
The child is laying supine with knees and hips flexed, but unable to extend without pain
kernigs
What is this sign:
The child is supine trying to raise or flex their neck but c/o pain.
brudzinski
Meningitis complications include
loss of h____
n___ i___
s____
d____
hearing
neurologic impairement
seizures
death
Meningitis LP evaluation will reveal elevated o___ p______
elevated opening pressures
If LP CSF results show a significant amount of RBC’s consider h___ s____ as a cause for meningitis
herpes simplex
Viral meningitis presents with
* ___ WBC usually < _____
*High p____
*normal g____
* n____ gram stain result
low, < 500
high protein
normal glucose
negative gram stain
*viral meningitis may be self-limiting or severe
Bacterial meningitis presents with
*___ WBC, usually > ____
*high p____
*low g____
*c___/p____ drainage
high, > 1000
protein
glucose
cloudy/purulent
80-90% or bacterial meningitis gram stains will be?
positive
viral meningitis is commonly caused by e___
enterovirus
What viral organism should be suspected in neonates admitted for meningitis with high CSF RBC?
HSV (herpes simplex virus)
In the summer, viral meningitis is commonly caused by a___
arbovirus
Hallmark s/s of viral meningitis include
H___
f____
altered L____ without n___ r___
Headaches
fever
altered LOC without nuchal rigidigy
In neonates, the most common cause of bacterial meningitis is?
GBS
Other causes of neonatal bacterial meningitis include
e___ and
L___ m____
E. Coli
Listeria Monocytogenes
Neonates with bacterial meningitis will present with
f___
L____
decrease in f____
j____
and b____ f_____
fever
lethargy
decrease in feeds
jaundice
bulging fontanelle
What is the most common cause of bacterial meningitis in kids 2 months of age through 23 months of age?
s__ p___
n___ m_____
strep pneumonia
Neisseria meningitis
What is the most common cause of bacterial meningitis in unvaccinated children 2 months of age through 23 months of age?
H. Flu
S/s of bacterial meningitis in children 2-23 months of age include?
f____
h____
n___ r____
+ k___ and b____ sign
decrease in f___
and poor m___ t____
fever
headache
nuchal rigidity
kerning and brudzinskis
decrease in feeds
poor muscle tone
What is the most common cause of bacterial meningitis in kids 2 YOA and older?
n__ M____
s___ p___
H__ ____
Neisseria Menigitidins
strep pneumoniae
H. flu
s/s of bacterial meningitis in children 2 YOA and older include
a__ m___ status
H____
decreased ____
P____ and
exan_____
altered mental status
hypertension
decreased heart rate
petechiae
exanthems (diffuse rash, anywhere)
Neonatal meningitis management
1) a___ and g____
2) a___ and c____
+ HSV coverage with a_____
amp and gent
amp and cefotaxime
acyclovir
Infant meningitis management includes
v____ + c_____ + a____
vancomycin
ceftriaxone
acyclovir
Meningitis treatment for kids 2 YOA and older includes
c___ and v_____
ceftriaxone and vancomycin
Children presenting with bacterial meningitis s/s should have antibiotics administered within?
1 hour of admission
In any child with meningitis, consider the addition of _____ to preserve hearing
dexamethasone
Meningitis supportive care may include
a______ therapy or
e___ I___ management
anticonvulsant
elevated ICP
S/P meningitis, children will require long-term follow-up to assess h___ and d___ to rule out L___ and b___ issues
hearing and development
learning and behavioral issues
Opportunistic infections occur when the host is _____
immunocompromised
—- examples include children with HIV or primary/secondary immunodeficiencies
What are the most common opportunistic infectious organisms?
t___
c____
ca____
cry_____
and toxoplasma cry____
tuberculosis
CMV
candida
cryptococcus
cryptosporidium
80% of opportunistic infections are caused by c____ leading to an invasive f____ infection
candida, fungal
—- Children with fungal infections often have a nonspecific presentation
Consider candida and/or a fungal infection when a child remains sick despite n____ c____
negative cultures
All children at high risk for fungal infection, require _____ prophylaxis when febrile
fungal
Pneumocystis Jirovecii (PCP) is and opportunistic a____ pathogen
airborne
Pneumocystis Jirovecii (PCP) prophylaxis includes the administration of ____, __-___ times a week
bactrim
2-3 times a week
Pneumocystis Jirovecii (PCP) s/s include
c___
f____
weight ____
d____ and
c____
cough
fever
weight loss
dyspnea
crackles
Pneumocystis Jirovecii (PCP) chest x-ray will reveal bilateral g___ g____ O_____
ground glass opacities
What is the diagnostic test for Pneumocystis Jirovecii (PCP)?
Lung biopsy
Pneumocystis Jirovecii (PCP) treatment includes a ___ day course of ____.
21-day course of bactrim
—consider also treating with pentamidine and dapsone
Nontuberculous Mycobacterium is an opportunistic infection that enters via s___, i____, i___, or m____ translocation
skin
inhalation
ingestion
mucosal
Nontuberculous Mycobacterium invades the _____ system and thus spreads to d___ o_____
lymphatic system
distal organs
Nontuberculous Mycobacterium presentation is often nonspecific, parents may c/o that their child’s illness has p____ for w_____
persisted for weeks
Nontuberculous Mycobacterium management includes starting the patient on cla___ and eth_____
clarithromycin and
ethambutol
If Nontuberculous Mycobacterium treatment with clarithromycin and
ethambutol is unsuccessful consider adding r____
rifampin
Resistant organisms evade antibiotic activity. What are the two most common resistant organisms?
MRSA and
Strep pneumoniae
Treat drug-resistant MRSA with
1) c___ or v____
2)s___ or l____
3) or dap_____
clindamycin or vancomycin
Septra or linezolid
daptomycin
Treat drug-resistant strep pneumonia with ___ dose beta-lactams such as
cl____
v____
or flu_____
high-dose
clindamycin
vancomycin
fluoroquinolones
Toxic shock syndrome is a m_____ febrile illness due to s___ and/or s____
multisystem
staph or strep
-toxins trigger a cellular host response
Patient with toxic shock syndrome will begin with nonspecific s/s, but then progress to f___, h____, and o___ dysfunction
fever
hypotension
organ dysfunction
Toxic shock syndrome clinical criteria include
* fever > ____ C
*h____
*diffuse m____ e____-d___rash
*p___ and s___ d____, __-___ weeks after s/s onset
38.9 C
hypotension
macular erythroderma (body-wide skin redenning)
palm and sole desquamation, 1-2 weeks
Toxic shock syndrome clinical criteria include presenting with at least 3 of the following s/s.
GI = __/___
muscular= m____, c__ > __x the normal
mucous= c___/o___/v___ h___
kidney= B__ and c___ > __x the normal, p___
LIver= a__, a___, b___ > __x the normal
Heme= p___ less than ___
Neuro= a___ m___ status without fever or hypotension
n/v
myalgias, CK > 2x
conjunctival/oropharynx/vaginal hyperemia (excess blood buildup)
BUN and Creatinine >2x, pyuria (pus in urine)
AST, ALT, bili > 2x
platelets less than 100,000
altered mental status
Children with Toxic shock syndrome will have negative cultures. Toxic shock syndrome is a probable diagnosis when there is __ clinical criteria + ___ criteria
4 + lab
Toxic shock syndrome is confirmed when there is ___ clinical criteria + ___ criteria
5 + lab
Workup of a female with toxic shock syndrome includes obtaining b___, c___, u___, sp___, t___ and v___ cultures
blood, CSF, urine, sputum, throat, vaginal
Toxic shock syndrome treatment includes the immediate administration of c_____ and v____
ceftriaxone and vancomycin
When toxic shock syndrome diagnosis is confirmed, add c____ to ceftriaxone and vancomycin regimen
clindamycin
Aside from ATBx, toxic shock syndrome treatment will include the removal of t___ and d___ of site
tampon
debridement
Aside from ATBx what other medication can be used to treat toxic shock syndrome?
IVIG
What is the most common organism found in dental plaque?
streptococcus
Dental infection prevention includes f___, avoidance of s___, and good oral h____
fluoride
sugar
oral hygiene
What infections are common in immunocompromised children, neonates, critically ill, and kids on long-term antibiotics?
fungal infections
-children may present asymptomatic or critically ill
What are the 3 most common fungal infections?
h_____, c____, b_____
histoplasmosis
coccidioidomycosis
blastomycosis
What fungal infection is most often seen in Mississippi, Ohio, and the Missouri river valley?
H________
histoplasmosis
What fungal infection is most often seen in hot + cold arid regions of the southwest
C_____
coccidioidomycosis
What fungal infection is most often seen in the Mississippi River, Ohio, lake Michigan, and southern states?
Blastomycosis
Fungal infection diagnoses are often delayed due to nonspecific findings. What is the gold standard diagnostic test?
fungal culture
–txt dependent on organism and ISDA guidelines
What treatment is best for serious fungal infections such as aspergillosis?
Vo_______
Voricanozole
What is the first-line treatment for Histoplasmosis?
Am_____-___
Amphotericin B
After inpatient treatment with amphotericin B, children with Histoplasmosis require oral a____ therapy once discharged.
azole
What is the first-line treatment for coccidioidomycosis?
azoles
What is the first-line treatment for mild-moderate blastomycosis?
___-___ months of I_____
6-12 months of itraconazole
What is the first-line treatment for severe blastomycosis?
1) am_____ -__ until s/s improve
followed by
2) o__ i____ x __-___ months
amphotericin B
*prolong IV amphotericin if CNS disease is present
oral itraconazole x 6-12 month
What is the most prevalent STI?
HPV
HPV may be acquired g____ or r____
genitally or respiratory
Children with HPV can be asymptomatic. Or they may present with g___ vs t___ w____
genital vs. throat warts
HPV is diagnosed with
1)v___ i___ and
2) HPV p___ testing
visual inspection
HPV pap
Malaria is a plasmodium species most often found in ____ regions
tropical
In America, malaria cases are seen in i____ or t_____
immigrants or travelers
Malaria is caused by a m____ transmitted p____
mosquito-transmitted parasite
Once malaria is contracted, the parasite travels into the l___ where is divides and multiplies over - days
liver
7-10
Malaria s/s begin once e____ become infected
erythrocytes
Malaria s/s include
p___ f____, c____, h___, m___, c____, h___a___, and t_____
paroxysmal fever, chills, headache, malaise, cough, hemolytic anemia and thrombocytopenia
Malaria urine s/s include
p____ and h____
proteinuria
hemoglobinuria
Severe malaria s/s include
c___ s/s
severe a____
A___
h____ instability and
severe acute k___ i____
cerebral s/s
severe anemia
ARDS
hemodynamic instability
severe acute kidney injury
The gold standard malaria diagnostic test includes t___ and t___ b___ s____
thick and thin blood smears
-which identify the parasite
Once malaria is confirmed, obtain thick and thin blood smears every __-__ hours until they are n____
12-24 hours until they are negative
In severe cases, individuals with malaria may require e___ t____
exchange transfusions
Dengue is present in the tropic and subtropic regions of p___ r___, the v___ i___ and s____
Puerto Rico
virgin islands
samoa
Dengue is a v___ illness transmitted via a m____
viral
mosquito
Dengue s/s include a nonspecific f____, retro-o____ h___, and a tr___ m___-p____ r____
fever
retro-orbital headache
transient maculopapular rash
Dengue severe s/s include c___ release, v____ p____, c____ and s_____
cytokine release
vascular permeability
coagulopathies and
shock
The gold standard Dengue diagnostic test is via E____ anti-dengue __ and ___ antibodies
ELISA
anti-dengue IgG + IgM antibodies
The CBC of a patient with Dengue will show
L____
t_____
and increased h____
leukopenia
thrombocytopenia
Hct
Dengue management includes
h____
avoidance of N___ and a___ to prevent bleeding and good supportive care because it is a viral infection and antibiotics are not indicated.
hydration
NSAIDS and aspirin
The Salmonella organism Salmonella eterica enters human hosts via the g__ t___
GI tract
Once Salmonella enters the GI tract, it travels into the l_____, b____, l___ and s_____
lymphatics
blood
liver
and spleen
Salmonella causes widespread b____ and e_____ release
bacteremia and endotoxin
Salmonella s/s include
f_____, h____, a__ p___, __/__/__, c____, h_____, and s_____
fever
headache
abdominal pain
n/v/d
constipation
hepatomegaly
splenomegaly
*CNS s/s may also be present
Upon diagnostic evaluation, salmonella is best detected via b___ c____
blood culture
Less than 50 % of salmonella can be detected in the ____
stool
Salmonella may increase what lab?
LFTs
Salmonella can be treated with ce___ or cip______
ceftriaxone or
ciprofloxacin
Due to a 10% chance of refractory salmonella, pediatric patients will require?
close follow up
West Nile virus is a m___ borne vector illness that causes v____ i______
mosquito
viremic inflammation
West Nile virus can enter the b____ via a blood-brain barrier alteration.
brain
West Nile Virus s/s include
abrupt f____, h____, d____, and M____ r____
fever, headache, diarrhea, maculopapular rash
West Nile virus neuroinvasion s/s include e____, m____ and f___ P_____
encephalitis, meningitis, flaccid paralysis
West Nile Virus diagnostic evaluation includes obtaining an I___ and n___ a____ levels
Igm
neutralizing antibody
In a child with HPV, no treatment is indicated if there is no?
warts
In a child with HPV, treat external warts with t__ p____
topical podofilox
HPV warts can be removed with c____ or l___ surgery
*** Ensure to consult OB
cryotherapy or laser surgery
What is the best preventative measure against HPV?
HPV vaccination
What is the second most common STI?
gonorrhea
Gonorrhea is a gram ___ bacteria
negative
females with gonorrhea are often asymptomatic until the following complications occur
d___
f_____
u____
d____
dysuria
frequency
urgency
discharge
Gonorrhea diagnostic testing includes a b___ c___, g___ s___, and N___
bacterial culture, gram stain, NAAT
What is the most common cause of pelvic inflammatory disease?
chlamydia
Chlamydia is caused by the bacteria c__ t___
c. trachomatis
Children with chlamydia may be asymptomatic. S/s of chlamydia may include v___, u____, e____ or P___
vaginitis
urethritis
endometriosis
PID
The gold standard diagnostic test for chlamydia is?
N___
NAAT (nucleic acid amplification)
Chlamydia is treated with
a___ or d______
azithromycin
doxycycline
The organism treponema pallidum causes what STI?
syphilis
Primary syphilis s/s include a mouth or anogenital u___ or c___
ulcer or chancre
secondary syphilis s/s include m___, f___ s/s, l____, and r_____
myalgias
flu-like s/s
lymphadenopathy
rash
tertiary syphilis s/s include c__ and n___ s/s
cardiac and neurological s/s
Diagnostic testing for syphilis may include
R____ p_____ r_____
RPR (rapid plasma reagin)
What is the gold standard syphilis diagnostic test?
non-t___ and t____ testing
non-treponemal and
treponemal
What is the gold standard treatment for syphilis?
b___ p___ _
benzathine penicillin g
In a child with HPV, no treatment is indicated if there is no?
warts
In a child with HPV, treat external warts with t__ podo____
topical podofilox
HPV warts can be removed with c____ or l___ surgery
*** Ensure to consult OB
cryotherapy or laser surgery
What is the best preventative measure against HPV?
HPV vaccination
What is the second most common STI?
gonorrhea
Gonorrhea is a gram ___ bacteria
negative
Males with gonorrhea are often _____
asymptomatic
females with gonorrhea are often asymptomatic until the following complications occur
d___
f_____
u____
d____
dysuria
frequency
urgency
discharge
Gonorrhea diagnostic testing includes a b___ c___, g___ s___, and N___
bacterial culture, gram stain, NAAT
Gonorrhea txt includes IM c____ or cefi____
*cover for chlamydia as well until chlamydia cultures are negative
ceftriaxone or cefixime
What is the most common cause of pelvic inflammatory disease?
chlamydia
Chlamydia is caused by the bacteria c__ t___
c. trachomatis
Children with chlamydia may be asymptomatic. S/s of chlamydia may include v___, u____, end____ or P___
vaginitis
urethritis
endometriosis
PID
Chlamydia is treated with
a___ or d______
azithromycin
doxycycline
The gold standard diagnostic test for chlamydia is?
NAAT (nucleic acid amplification)
Primary syphilis s/s include a mouth or anogenital u___ or c___
ulcer or chancre
secondary syphilis s/s include m___, f___ s/s, l____, and r_____
myalgias
flu-like s/s
lymphadenopathy
rash
tertiary syphilis s/s include c__ and n___ s/s
cardiac and neurological s/s
Diagnostic testing for syphilis may include?
RPR (rapid plasma reagin)
What is the gold standard treatment for syphilis?
b___ p___ _
benzathine penicillin g
Lyme disease is a t___ borne illness
tick
Lyme disease presents with an e____ m____ with c___ of c___ known as e____ m____ or a t___ lesion
erythematous macule with the clearing of the center known as
erythema migrans
target lesion
Lyme disease s/s include f____, a____, h_____, f___ p___, and m_____
fever
arthralgias
headache facial palsy
myalgias
Lyme disease treatment includes
d_____ x __ days
a____ x __ days or
cefur_____ x __ days
doxycycline x 10 days
amoxicillin x 14 days
cefuroxime x 14 days
Rocky mountain spotted fever is a t__ borne illness that causes systemic v_____
tick
systemic vasculitis
Rocky mountain spotted fever incubation is __-___ days
2-14
Rocky Mountain spotted fever s/s include
f____, severe h___, m____, v___ and decreased o___ i____
fever
severe headache
myalgias
vomiting
decreased oral intake
In Rocky Mountain spotted fever, a r___ will develop about __-__ days s/p fever
rash
2-5 days s/p fever
The Rocky Mountain spotted fever rash begins on the w___, a___, p___, and s___. Will eventually spread to the t___
wrists, ankles, palms, soles
trunk
What is the gold standard diagnostic test for Rocky Mountain Spotted fever?
R___ sero____ as____
Rickettsial serologic assay
Do not delay Rocky Mountain spotted fever treatment. Treat Rocky Mountain Spotted fever with d____ for __-__ days.
doxycycline, 7-10 days
Doxycycline treatment for Rocky Mountain Spotted fever should be continued until there is no f___ x __ days
fever x 3 days
Untreated Rocky Mountain Spotted fever can progress to D___, s___ ___, and c___ sequela
DIC
septic shock
CNS
Adenovirus is a r___, o____, and g____ illness. Adenovirus requires what type of precautions?
respiratory, oral, gastrointestinal
contact
CMV is a c____ i____ infection
congenital infant
In infants, CMV can lead to s____ h___ l___
sensorineural hearing loss
CMV risk increases in adolescence due to their c___ c___ with c____
close contact with classmates
Treat immunocompromised patient with CMV with g____, v____, or f____
ganciclovir, valganciclovir, foscarett
EBV spread into the host __ cells increasing the child’s risk for l____ disorders such as P___
b
lymphoproliferative
PLTD
Children with EBV will often have an enlarged _____. Children are at greatest risk for rupture when engaging in c___ s____
spleen
contact sports
Enterovirus enters via the f___ o___ route. Treatment is s____. Place the child on c____ precautions.
fecal-oral route
supportive
contact
Herpes simplex virus enters via m____ m___ or s____
mucous membranes or skin
What herpes is acquired in childhood?
HSV-1
What herpes is acquired sexually?
HSV-2
In neonates, HSV can cause c___ and d___ disease
CNS
disseminated
Immunocompromised patients with HSV will develop g____
gingivostomatitis
When HSV vesicles are present, treat with a____. Place patient on c___ precautions
acyclovir
contact
Treat HSV resistant disease with f_____
foscarnet
What is the HSV diagnostic test?
E____ and
C___ P____
ELISA
CSF PCR
Parvovirus B19 requires ____ precautions
droplet
Parvovirus B19 enters via the r___ tract and invades e___ cells
respiratory tract
erythroid cells
Parvovirus may lead to ___ disease
5ths disease
5ths disease is characterized by c___ e____ and a___ s/s
cheek erythema
arthritis
Children with Parvovirus may present in an a____ crisis. Reticulocyte count will often be ___
aplastic crisis
0
Hepatitis causes L____ i_____
liver inflammation
Children with hepatitis will present with an acute onset of
__/___, f____, tra____, a___ p___, h_______, b____ disorder s/s, and a____ m____ status
n/v
fever
transaminitis
Abdominal pain
hepatosplenomegaly
bleeding
altered mental
Hepatitis lab workup is to include
a____, f___ levels, c___ levels
albumin
factor levels
coagulation levels (Pt-INR)
In a child with hepatitis, evaluate their liver status by obtaining an?
ultrasound
What is the gold standard syphilis diagnostic test?
non-t___ and t____ testing
non-treponemal and
treponemal
The organism treponema pallidum causes what STI?
syphilis
Gonorrhea txt includes IM c____ or cefi____
*cover for chlamydia as well until chlamydia cultures are negative
ceftriaxone or cefixime
Males with gonorrhea are often _____
asymptomatic
