Infectious Disease

Question 1

What is the best test to evaluate for neonatal HIV? What is the recommended timing?

Answer 1

HIV DNA PCR is the preferred test to diagnose HIV in infants less than 18 months. (DNA not RNA!!!) Up to 95% will be positive by 1 mo of age in infants with HIV.

TIming:
1. Within 48 hours (think 2 days). Do NOT obtain from umbilical cord blood.
2. 2-3 weeks (think 2 weeks)
3. 1-2 months (think 2 months)
4. 4-6 months (think 4 months = 2 months after the last)

Testing at 2d, 2w, 2m, 2+2m

Question 2

Treatment for neonates exposed to maternal HIV? (Two categories)

Answer 2

Infant born to mother on ARV and low viral load: ZDV asap after birth (goal w/i 6-12 hours of age) and continue for 4-6 weeks. Monitor for anemia, abnormal LFTs.

Infant born to mother at higher risk - not on ARV, only received intrapartum ARV, lack of viral suppression, etc: ZDV x 6 weeks and nevirapine x 3 doses (birth, 48 hrs later, 96 hrs after 2nd dose)

Question 3

What is the treatment and duration for neonatal toxoplasmosis?

Prognosis with and without treatment?

Answer 3

If confirmed infected infant, regardless if symptomatic or asymptomatic, treat for ONE YEAR with sulfadiazone+ pyrimethamine with folinic acid to prevent neutropenia from pyrimethamine.

Delay in diagnosis and/or treatment results in poor outcome. Treated infants will have normal development 70% of the time despite initial neurological symptoms

Question 4

What are the three major illnesses that do AIRBORNE precautions with?

Answer 4

Think MTV:
Measles (remember how contagious it is)
TB (airborne and contact)
Varicella (airborne and contact)

Airborne required with smaller particles that stay in the air longer and can travel further.

“Patients stuck in room watching MTV”

Question 5

What are the major illnesses that do DROPLET precautions for?

Answer 5

Think PIMPR
Pertussis
Parvo B19
Influenza
Mumps, meningitis
Pneumonia
Rubella (contact & droplet)

Droplet - can use standard precautions and a SURGICAL MASK

Question 6

What is one illness that use CONTACT precautions for that is unique compared to the others? (one I think should be droplet but isn’t)

Answer 6

RSV

Others: Rubella (contact and droplet), HSV, TB (contact and airborne), varicella (contact and airborne), RSV

Question 7

Postexposure prophylaxis with VZIG is recommended for infants who have had exposure to varicella AND 1 of the following: (5 things)

Answer 7

-Maternal symptoms 5 days before-2 days after delivery
->/=28 weeks who remain hospitalized, if their mothers were not immunized, not serologically immune, or do not have a documented history of VZV
-<28 weeks or <1,000 g who remain hospitalized
-exposed infants who are born to mothers without immunity if <2 weeks old or in the NICU
-contact & airborne isolation

Question 8

Common infections that are just STANDARD precautions:

Answer 8

CMV
TOXO
HIV
LISTERIA

“Just your STANDARD HIV infected mom bringing KITTENS (toxo) and COLD CUT MEATS (listeria) to a DAYCARE (cmv)” sounds like a recipe I’m for disaster but just standard precautions.

Question 9

DNA viruses we need to know… name 4

Answer 9

CMV -dsDNA
HSV -dsDNA
VZV
Parvo B19-ssDNS

Question 10

RNA viruses we need to know… Name 3

Answer 10

HIV - RNA retrovirus
Rubella
RSV

Question 11

Spleen stuff
1) Encapsulated organisms.
2) functions
3) congenital asplenia syndromes
4) smear findings
5) vaccines

Answer 11

1) Organisms: SSHiN Salmonella, strep pneumo, Haemophilus, Neisseria
2) IgM/compliment production. Maturation of antibodies. Proliferation of T cells. Scavenges RBC & platelets. Recycles iron.
3) Ivemark, Pearson, Stormorken, Smith-Meyer-Fineman
4) Howell-Jolly bodies
5) all regular vaccines plus 23-valent pneumococcal vaccine after age 2.