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Neonatology Boards > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

MC site of osteo

A

METAPHYSIS (can spread to epiphysis since blood supply intact until 8-18 months)

femur>humerus>tibia>radius>maxilla
neonates often with multiple bone involvement

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2
Q

Chemical conjunctivitis

A

within 24 hours of exposure

following erythromycin prophylaxxis
negative culture
spontaneously resolves within 48 hours

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3
Q

acute purulent conjunctivitis

A

24-48 hours of age

staph (MC)- golden crust around eyelids
GBS, H. flu, strep pneumo, pseudomonas

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4
Q

Neisseria gonorrhoeae conjunctivitis

A

2-5 days of life
ABRUPT onset of EXTREMELY COPIOUS, PURULENT bilateral discharge
MEDICAL EMERGENCY- progress to involve cornea and ulceration/perforation
Tx: 3rd gen cephalosporin IV (ceftriazone)

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5
Q

Chlamydia conjunctivitis

A

5-14 days of life
MC cause of conjunctivitis in 1st month of life
watery discharge that becomes purulent
often associated with chlamydial pneumonia
DX: Giemsa-stain of conjunctival scrapings
Tx: oral erythromycin x 14 days (20% require 2nd course)

erytho ointment does not completely prevent this

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6
Q

HSV conjunctivitis

A

BROAD range- 4 days to 3 wks
MC viral etiology
symptoms: keratitis, chorioretinitis, retinal dysplasia
yellow-white exudates, retinal necrosis

assess for systemic herpes and herpes encephalitis

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7
Q

Chorioretinitis:
1. early congenital syphilis
2. HSV
3. rubella
4. CMV
5. toxo
6. candidiasis

A
  1. salt and pepper appearance to fundus
  2. yellow white exudates, retinal necrosis
  3. salt and pepper appearance to fundus, unilateral/bilateral diffuse granular pigmented areas
  4. yellow white fluffy retinal lesions, hemorrhage
  5. necrotizing retinitis –> large atrophic retinal scars that involve macula
  6. fluffy white balls
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8
Q

Congenital syphilis

A

Intrauterine infection: majority acquired by hematogenous route, incr risk of NI hydrops, IUGR, increased risk preterm birth

unexplained large placenta
snuffles infectious until > 24 hrs of tx

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9
Q
A

HSV
yellow-white exudates and retinal necrosis

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10
Q
A

Candidal chorioretinitis
white fluffy balls

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11
Q
A

CMV chorioretinitis

yellow-white fluffy retinal lesions, hemorrhage present

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12
Q
A

Toxoplasmosis
necrotizing retinitis

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13
Q

Antibiotic to treat following GI bugs:
1. Salmonella
2. Shigella
3. Campylobacter/Yersinia
4. C.dif

A
  1. Cefotaxime
  2. Ampicillin
  3. Erythromycin
  4. Vancomycin
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14
Q

Has intrapartum antibiotic prophylaxis changed incidence of late-onset GBS??

A

NO

HAS ONLY DECREASED EARLY-ONSET DISEASE RATES

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15
Q

Incidence of early onset and late onset GBS disease

A

Early:
< 7 days of life
sepsis 25-40%
pneumonia 35-55%
meningitis 5-10%
Serotype III
Mortality: 5-10%

Late:
> 7 days of life
meningitis 30-40%
sepsis 70%
neurologic sequelae 50%
osteo (humerus MC site) or septic arthritis (hip MC site)
Serotype III
Mortality: 2-6%

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16
Q
A

Syphilis retinitis
salt and pepper fundus

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17
Q

Congenital syphilis:
Treponemal vs. non-treponemal test

A

Treponemal:
used for estabishing presumptive diagnosis
TFA-ABS = fluorescent treponemal antibody absorption: detects specific Ab (IgG, IgM) to treponema pallidum
reactive for life even after successful treatment
antibody titers DO NOT correlate with disease activity

Non-treponemal:
used for screening, assessing response to treatment, determining reinfection
VDRL/RPR: detects a cell membrane cardiolipid nonspecific IgG Ab- sign of response to host tissue damage
becomes negative 2 years after treatment
titers CORRELATE with disease activity
Neonate positive = titer 4xx high than maternal (neonate 1:32, mom 1:8)
Can be false positive (autoimmune, viral infections, endocarditis, passively transferred maternal IgG antibody to neonate) or false negative

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18
Q

EEG finding in disemminated HSV disease

A

spike and slow-wave activity in temporal region

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19
Q

Neonatal neisseria gonorrhoeae

A

Gram negative intracellular diplococci
Vertical transmission: vaginal secretions, breastmilk

conjunctivitis: purulent, 2-5 days after birth, profuse bilateral purulent discharge- EMERGENCY
scalp abscess from fetal scalp monitor
arthritis, pneumonia, sepsis, osteo, meningitis

Dx: conjunctival, blood, skin lesion, CSF gram stin/culture using THAYER-MARTIN medium

Disemminated dx: ceftriazone IV/IM (cefotax if hyperbili) xx 7 days, meningitis = 10-14
Eval for chlamydia- add erythro if needed
Association with syphilis and HIV

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20
Q

Follow up for treated neonate for syphilis

A

VDRL at 2, 4, 6, 12 mo until nonreactive or dec by 4-fold (dec by 3 mo, NR by 6 mo)
If increasing/persistent titers at 6-12 mo–> re-evaluate with LP, 10 days PCN
If initially abnormal LP–> monitor Q6 mo with exam/LP until LP normal

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21
Q

Types of penicillin for syphilis tx

A

Aqueous PCN G: IV, dose based on age, x 10 days
Procain PCN G: IM, single daily dose xx 10 days, CSF entry not as good as aqueous
Benzathine PCN G: IM, 1 dose, long acting, poor entry into CSF, not for active syphilis

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22
Q

Chlamydia

A

Obligate intracellular bacteria
Conjunctivitis and pneumonia- stoccato cough, nasopharyngitis, eosinophilia 70%

Dx: Giemsa stain culture of conjunctiva scrapings, nasopharynx, pneumonia- incr chlamydia specific IgM levels
Tx: oral erythro x 14 days

NOT detectable by gram stain

remember association of erythro with pyloric stenosis

23
Q

Mycobacterium tuberculosis

A

Acid-fast bacilus

Congenital: hematogensou from infected placenta, aspiration/ingestion infected fluid
Postnatally acquired: inhalation of infected resp secretions, contamination of traumatized mucous membranes or skin

Present 2nd-3rd week of life
Non-specific sx: HSM, respiratory distress, fever, LAD

Congenital TB treatment: 4 drug regimen- INH, RIF, pyrazinamide, aminoglycoside- + steroids if meningitis

24
Q

Clostridium tetani

A

Gram positive vacillus

Tetanus toxin binds to neuromusclar junction and blocks GABA release
usually due to improper umilical cord handling
Tx: supportive, tetanus IG to neutralize circulating unbound toxin
IV penicillinG 10-14 days

25
Q

Bordetella pertussis

A

Gram negative pleomorphic bacillus

Presentation: mild URI (catarrhal stage) that progresses to paroxysmal cough
Dx: culture resp secretions with BORDET-GENGOU medium, PCR assay, lymphocotosis
Tx: oral erythromycin

remember association of pyloric stenosis and erythromcyin

26
Q

Hep B serology

A
27
Q

Unknown maternal Hep B status

A

> 2000g:
- Give Hep B vaccine within 12 hours
- Have 7 DAYS to find out results and then give HBIG
- needs 2 additional doses of Hep B vaccine

< 2000g:
- Give Hep B vaccine within 12 hours
- Have 12 HOURS to find out results then give HBIG
- needs 3 additional doses of Hep B vaccine

28
Q

Parvovirus B19

A

Single stranded DNA

Fifth disease = erythema infectiosum: malaise, low grade fever, slapped-cheek rash
Fetal infection: increased risk of fetal loss, aplastic anemia (low reticulocytosis) and CHF–> hydrops

Titers with highest risk to fetus:
negative IgG, positive IgM = acute infection

29
Q

Varicella

A

DNA herpes virus

Dx: Tzanck smear- multinucleated giant cells, PCR (most sensitive) of vesicular fluid, saliva

HIGHEST RISK OF NEONATAL TRANSMISSION: 5 days before delivery until 2 days post delivery- insufficient time for protective antibodies

Neonatal disease: cutaneous lesions, limb abnormalities (atrophy, distal to cutaneous lesions), eye (cataracts, chorioretinitis), severe mental deficiency, seizures, intracranial calcifications

VariZIG:
- infant with mother who develops varicella < 5 days from delivery –> 2 days after
- Preterm infant < 28 wks or </= 1000g significant exposure
- infant exposed postnatally 2-7 days- consider especially if preterm

30
Q

Rubella

A

Transmission: U shaped curve (highest risk in beginning and end of pregnancy)

Presentation:
In-utero: hydrops
Congenital: sensorineural hearing loss, salt and pepper chorioretinitis, cataracts, blueberry muffin rash, PDA> PPAS, celery stalking of long bones
Classic triad: ears, heart, eyes

Late onset: continued hearing loss, intellectual disability, DM, thyroid dysfunction, progressive panencephalitis

Dx: viral culture nasopharynx, blood, urine, Rubella IgM/IgG

Supportive treatment
Screenings: hearing, eye exam, assess for heart disease

contact isolation from other newborns x 1 year unless 2 negative cultures

31
Q

Echovirus

A

Type of enterovirus- single stranded RNA virus
Type 11: sepsis-like illness, hepatic necrosis, coagulopathy
Often fatal

32
Q

Toxoplasmosis

A

Protozoal organism
Poorly cooked meat, cat feces

Transmission during pregnancy greater with increasing gestational age
- acquired early in pregnant = greater risk of severe disease

ASYMPTOMATIC: 70-90% at birth
SYMPTOMATIC: chorioretinitis, cortical brain calcifications, hydrocephalus, blueberry muffin rash, microcephaly, hearing loss

Eval: eye exam, hearing test, neuro exam, brain imaging

Pleocytosis on CSF

33
Q

CMV

A

Double stranded herpes DNA virus- intranuclear and cytoplasmic inclusions
MC intrauterine infection worldwide
If maternal infection during 1st 20 weeks = greater risk of neonatal disease and severity of neonatal illness

ASYMPTOMATIC at birth: 85-90%; increased risk of hearing loss that correlated with presence of PERIVENTRICULAR calcifications, chorioretinitis

SYMPTOMATIC at birth: 10-15%; IUGR, HSM, blueberry muffin rash, thrombocytopenia, microcepaly, PERIVENTRICULAR calcifications, chorioretinitis, sensorineural hearing loss, seizures, long term neurologic sequelae

Tx: symptomatic congenital CMV disease = oral valgancyclovir x 6 months

can be acquired through breastmilk- incr risk in preterm infant

34
Q

Treatment for congenital HSV

A

IV acyclovir for 14 days for SEM disease, 21 days if CNS involvement, 21 days for disseminated disease

oral acyclovir x 6 months to improve neurodevelopmental outcomes

35
Q

Components of BM that target infections

A
  1. Lactoferrin: high amounts in BM, bacteriostatic against numerous bacteria
  2. Lactoperoxidase: low amounts in BM, requires hydrogen peroxide and thiocyanate for antibacterial effect
36
Q

Infections that can cross breast milk

A
  1. CMV
  2. HIV
  3. Hep B- little risk of transmission especially if infant received vaccine and IVIG
  4. Rubella
  5. HSV
37
Q

Contraindications to breastfeeding

A
  1. Maternal HIV
  2. Maternal HSV lesion on breast- can feed on non-affected breast
  3. Symptomatic mother with positive PPD and CXR (presumed active TB)
  4. Active breast abscess
38
Q

Stain for Chlamydia

A

Giemsa-stein

39
Q

Growth medium for Neisseria gonorrhoeae

A

Thayer-Martin

MUST PLATE FAST!

40
Q

Growth medium for pertussis

A

Bordet-Gengou

41
Q

Pseudomonas aeuginosa

A

Oxidase-positive
Catalase-positive

42
Q

Rubella

A

Hemagglutination inhibition

43
Q

Bactericidal

A

Completely destroy bacteria

Ideal for:
- endocarditis
- meningitis
- severe Staph and gram negative infection

Ex: penicillins, cephalosporins, aminoglycosides, vancomycin, quinolones

44
Q

Bacteriostatic

A

Inhibit growth and reproduction of bacteria

Ex: erythroycin, clindamycin, chloramphenicol, tetracycline, sulfonamides

45
Q

MIC
Minimal inhibitory concentration

A

measures degree of antibiotic activity against a specific organism
- lowest antibiotic concentration that completely inhibits IN VITRO visible growth of the organism
- correlates with potency of antibiotic
- DOES NOT suggest time period for antimicrobial activity

46
Q

MBC
minimal bactericidal concentration

A

concentration of the antibiotic that kills the organism
- lowest antibiotic concentration that reduces growth by 99.9%
- bactericidal antibiotics MBC = MIC
- bacteriostatic antibiotics MBC > MIC

47
Q

Classic triad: skin lesions, brain abnormalities, occular findings

A

Congenital HSV

48
Q

Organisms most commonly associated with intrapartum infections

A

Ureaplasma urealyticum
Mycoplasma hominis

49
Q

GBS serotype associated with meningitis

A

III

50
Q

Wimberger sign

A

bilateral focal destruction of the medial aspect, proximal tibial metaphysis

in congenital SYPHILIS

51
Q

HBIG and Hep B vaccine if maternal testing positive/unknown

A

< 2 kg: give HBIG AND HEP B vaccine < 12 hours of birth

> 2 kg: give Hep B vaccine imediately and can wait on HBIG up to 7 days of life

52
Q

anti-hep b core

A

consistent with immunity due to natural infection

53
Q

pinpoint yellow-white nodules on the umbilical cord with subamniotic microabscesses

A

congenital cutaneous candidiasis

tx with amphotericin B and cover for STAPH (amp/gent)

no fluc unless sensitivities are known

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