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Pediatrics > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Rabies

Reservoir?

Name the two presentations

  1. AMS, agitation, hydrophobia, aerophobia, pharyngeal spasms
  2. ascending flaccid paralysis
A

Rabies

  • -neurotropic virus
  • -transmitted via saliva (eg, from bite)
  • -raccoon, bats
  • Encephalitic
  • -AMS, agitation, hydrophobia, aerophobia, pharyngeal spasms
  • Paralytic
  • -ascending flaccid paralysis

Tx
–PEP: rabies IG and vaccine

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2
Q

Childhood Infections with Exanthems
–name the disease and etiology

  1. cough, coryza, conjunctivitis, high fever, Koplik spots on buccal mucosa; rash begins at hairline, face, neck and spreads to trunk and extremities
  2. low fever and other constitutional symptoms; Forscheimer spots (patchy erythema or red petechiae) on soft palate; rash begins on face and spreads to trunk and extremities, lasts 3d; non-exudative conjunctivitis; posterior cervical and auricular lymphadenopathy
  3. h/a, fever, malaise, muscle pain; swollen parotid and submandibular glands
  4. low fever, malaise, URI s/s; crops of crusting papules and vesicles that spread central to peripheral
  5. mild URI s/s; slapped cheek rash that spreads to trunk; central clearing and lacy
  6. URI s/s, abrupt onset of high fever that breaks; then fine macular rash on trunk that spreads to face and extremities
  7. sore throat, exudative pharyngitis, strawberry tongue; circumoral pallor; maculopapular rah that feels like sand paper in antecubitus and inguinal areas; pastia lines (creases become brighter red)
A

Childhood Infections with Exanthems

  1. Measles (Rubeola)
    - -paramyxovirus
  2. Rubella
    - -togavirus
  3. Mumps
    - -paramyxovirus
  4. Varicella
    - -varicella zoster virus
  5. Fifth Disease (Erythema Infectiosum)
    - -Parvovirus B19
  6. Roseola
    - -HHV6
  7. Scarlet Fever
    - -Group A strep
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3
Q

Complications associated with childhood infections with exanthems
–name the disease and etiology

  1. subacute sclerosing panencephalitis
  2. encephalitis, orchitis, pancreatitis
  3. aplastic anemia
  4. febrile seizures
  5. acute rheumatic fever, glomerulonephritis
A
  1. Measles
    - -paramyxovirus
    - -subacute sclerosing panencephalitis

NB: another complication is leukopenia
*tx: Vitamin A

  1. Mumps
    - -paramyxovirus
    - -encephalitis, orchitis, pancreatitis
  2. Fifth Disease (Erythema Infectiosum)
    - -Parvovirus B19
    - -aplastic anemia
  3. Roseola
    - -HHV6
    - -febrile seizures
  4. Scarlet Fever
    - -Group A strep
    - -acute rheumatic fever, glomerulonephritis
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4
Q

Bacterial Meningitis

  • -fever, lethargy, irritability, anorexia, n/v, photophobia, neck pain and rigidity
  • -petechial rash at axilla, wrists, flanks, ankles
  1. Most common etiologies during age 0-2m (3)
  2. Most common etiologies during age 2m-12y (3)
  3. Initial empiric abx?
  4. Steroid to prevent 8th CN damage?
A

Bacterial Meningitis

Ages 0-2m
–GBS, E.coli, Listeria
(maternal vaginal flora)

Ages 2m-12y
–S. pneumo, N. meningitidis, HiB (haemophilus influenza bacteria, rare)

Empiric Abx: vancomycin plus cefotaxime OR ceftriaxone

IV dexamethasone to prevent CN8 damage

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5
Q

Viral (Aseptic) Meningitis

  • -fever, n/v, photophobia, neck, back and leg pain
  • older children: h/a, hyperesthesia
  • infants: irritability, lethargy

Cytology differences between bacterial and viral?

  1. Most common etiology?
  2. Etiology re: temporal lobe involvement (focal seizures or imaging evidence)
  3. Etiology for cerebellar ataxia and acute encephalitis
  4. Etiology re: disseminated disease in immunocompromised host
  5. Etiology re: mild s/s, but with CN8 damage
A

Viral (Aseptic) Meningitis

Bacterial: PMNs
Viral: mostly lymphocytes

Etiologies:
–enteroviruses (most common)

–arboviruses (mosquitoes, ticks)

  • -herpes simplex (temporal lobe involvement)
  • can be lethal

–varicella zoster (cerebellar ataxia, acute encephalitis)

–CMV (disseminated dz in immunocompromised)

–EBV or mumps: mild, but with CN8 damage

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6
Q

Pertussis
(Bordetella pertussis)

Catarrhal phase: coldlike s/s

Paroxysmal phase: severe coughing paroxysms; inspiratory “whoop”, facial petechiae; subconjunctival hemorrhages, post-tussive emesis

Convalescent phase: gradual resolution of cough

Labs: what type of cell predominates the leukocytosis?

Tx: what antibiotic for 14d?
–treat all close contacts

A

Pertussis
(Bordetella pertussis)

Catarrhal phase: coldlike s/s
–2 wks

Paroxysmal phase: severe coughing paroxysms; inspiratory “whoop”, facial petechiae; post-tussive emesis
–2-5 weeks

Convalescent phase: gradual resolution of cough
–2+ wks

Labs: lymphocyte-predominant leukocytosis

Tx: erythromycin for 14d

  • -treat all close contacts
  • tx only decreases infectious period!
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7
Q

DDx: neonatal conjunctivitis

  1. less than 24 hrs; conjunctival irritation, injection and swelling after chemoprophylaxis with topical silver nitrate
  2. age 2-5d; marked eyelid swelling, profuse purulent discharge, corneal edema and abrasion;
  3. age 5-14d; eyelid swelling, chemosis, and watery, bloody, or mucopurulent discharge

Etiology?
Tx?

A

DDx: neonatal conjunctivitis

  1. Chemical
    - -eye lubricant
  2. Gonococcal
    –cefotaxime or ceftriaxone
    NB: don’t use ceftriaxone in infants with hyperbilirubinemia; it displaces bilirubin from albumin thus increasing kernicterus risk
  3. Chlamydial
    - -oral eyrthromycin

NB: topical erythromycin at birth can prevent gonococcal conjunctivitis; it does NOT prevent or cure chlamydia

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8
Q

Meningitis: CSF Analysis

Compare: WBC count, glucose, protein

Viral Meningitis

Bacterial Meningitis

Tuberculous Meningitis

A

Meningitis: CSF Analysis

Viral Meningitis

  • -Coxsackie, Echovirus, Rhino/Entero
  • -pleocytosis, lymphocyte predominance
  • -normal glucose (40-70)
  • -normal to slightly high protein (less than 100)

Bacterial Meningitis

  • -S. pneumo, N. meningitidis
  • -pleocytosis, neutrophil predominance
  • -low glucose (less than 40)
  • -high protein (greater than 250)

Tuberculous Meningitis

  • -pleocytosis, lymphocyte predominance
  • -low glucose (less than 10)
  • -high protein (greater than 250)
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9
Q

pharyngitis; circumoral pallor; red papular “sandpaper” rash; erythematous lines in skin creases (Pastia’s lines)

Dx?
Etiology?
First dx test?
Tx?

A

Scarlet Fever

Group A Strep

Rapid strep test

  • -no need to culture if positive
  • -if negative, culture if clinical suspicion is high

Penicillin
–if allergy, use erythromycin

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10
Q

DDx: infectious diarrhea

  1. bloody diarrhea; HUS
  2. associated with poultry and eggs; diarrhea may last wks; erythematous rash of “rose colored” spots on abdomen
  3. food poisoning; begins 12h post-ingestion
  4. watery diarrhea and vomiting; fever
  5. bloody diarrhea; liver abscess
  6. “rice water” diarrhea; severe dehydration; epidemics; seafood
  7. “traveler’s diarrhea”
  8. bloody diarrhea; comma- or S-shaped
A

DDx: infectious diarrhea

  1. EHEC O157:H7
  2. Salmonella
  3. S. aureus
  4. Rotavirus
  5. E. histolytica
  6. V. cholerae
  7. ETEC
  8. Campylobacter
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11
Q

What is the classic triad of HUS?

A

HUS

  • -hemolytic anemia
  • -thrombocytopenia
  • -uremia
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12
Q

Tx for Lyme, RMSF

  1. Lyme Disease
    - -tx for ages greater than 8
    - -tx for age less than 8; pregnant women
    - -tx for meningitis, carditis in disseminated disease?
  2. RMSF
    - -tx (2)
A

Tx for Lyme, RMSF

  1. Lyme Disease
    - -Doxycyline for ages greater than 8
    - -Amoxicillin for ages less than 8; pregnant women
    - -Ceftriaxone for meningitis, carditis
  2. RMSF
    - -Doxycycline or Tetracycline
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13
Q

Croup – viral etiology?
–URI followed by barking cough, hoarseness, inspiratory stridor

Epiglottitis

  • -acute onset, high fever, extremely sore throat, drooling, cannot swallow, sniffing or tripod position
  • -formerly HiB (vaccine success)
  • -now S. pyogenes, S. aureus, Strep pneumo, Mycoplasma

Peritonsillar Abscess

  • -adolescent with recurrent hx of acute pharyngotonsillitis
  • -asymmetric tonsillar bulge; displacement of uvula away from affected side
A

Croup

  • -parainfluenza (types 1, 2, 3)
  • -URI followed by barking cough, hoarseness, inspiratory stridor
  • -tx; racemic epinephrine

Epiglottitis

  • -acute onset, high fever, extremely sore throat, drooling, cannot swallow, sniffing or tripod position
  • -formerly HiB
  • -now S. pyogenes, S. aureus, Strep pneumo, Mycoplasma

Peritonsillar Abscess

  • -adolescent w recurrent hx of acute pharyngotonsillitis
  • -asymmetric tonsillar bulge; uvula displaced away from affected side
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14
Q

Neonatal Sepsis

  • -temperature instability (high or low), poor feeding, lethargy or irritability
  • -workup: blood cx, urine cx, CSF cx
  1. Three most common etiologies?
  2. Other common etiology if age greater than 7d?
  3. Abx for sepsis with no meningitis?
  4. Abx for sepsis with suspected meningitis?
A

Neonatal Sepsis

  1. GBS, E. coli, Listeria
  2. S. aureus
  3. Ampicillin, Gentamycin
  4. Ampicillin, Gentamycin, Cefotaxime
  • do NOT use ceftriaxone in jaundiced neonates!
  • -ceftriaxone displaces bilirubin from albumin
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15
Q

Viral versus Bacterial Pneumonia

  1. Compare viral v bacterial re:
    - -temp
    - -URI
    - -toxicity
    - -location of rales
  2. Most common viral etiology of bronchiolitis?
  3. Etiology of pneumonia associated with eosinophilia?
  4. Type of pneumonia associated with CXR showing “hyperinflation, bilateral interstitial infiltrates and peribronchial cuffing”?
  5. Which two types of pneumonia look worse on CXR than their clinical presentation?
A

Viral versus Bacterial Pneumonia

  1. Viral v Bacterial
    - -bacterial has higher fever
    - -viral assoc w several days of URI
    - -bacterial causes more toxic appearance
    - -rales: viral - scattered; bacterial - localized
  2. RSV
    - -most common viral etiology
  3. Chlamydia trachomatis pneumonia
    - -eosinophilia
  4. Viral pneumonia
    - -CXR: hyperinflation, bilateral interstitial infiltrates, peribronchial cuffing
  5. Mycoplasma, Chlamydia
    - -look worse on CXR
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16
Q

Epstein-Barr Virus

  • -transmitted via oral secretions
  • -patient age 15-24
  • -may present with rash after having been treated with ampicillin or amoxicillin for URI s/s
  • -heterophile Ab test
  • -splenomegaly (no contact sports!)
  1. Infectious mononucleosis triad?
  2. Three associated malignancies?
A

Epstein-Barr Virus

Triad: fever, exudative pharyngitis, posterior or diffuse cervical lymphadenopathy

Malignancies: nasopharyngeal carcinoma, Burkitt lymphoma, Hodgkin disease

17
Q

Osteomyelitis

  1. Most common etiology?

Other Etiologies:

  • -sickle cell
  • -diabetics or IVDU
  • -sexually active young adult
  • -children age less than 1y
A

Osteomyelitis

  • -S. aureus (most common)
  • -Salmonella (sickle-cell)
  • -Pseudomonas (diabetics, IVDU)
  • -N. gonorrhoeae (sexually active young adult)
  • -GBS (children age less than 1yr)
18
Q

Cat bites in children may lead to infection with Pasteurella multiocida.

Tx?

A

Cat bite –> Pasteurella multiocida

Tx: Amoxicillin/Clavulanate (Augmentin)

19
Q

Which virus can cause the following presentations?

  1. Herpangina
    - -high fever, sore throat, vesicular oral ulcers
  2. Hand-Foot-Mouth Disease
    - -high fever, sore throat, vesicular ulcers at mouth, palms, soles

Which virus?
3. viral myocarditis

Tx: supportive care

A

Coxsackievirus A

Herpangina

  • -high fever, sore throat
  • -vesicular oral ulcers

Hand-Foot-Mouth Disease

  • -vesicular ulcers in oral mucosa, palms, soles
  • -“hand-foot-mouth” disease

Coxsackievirus B
–viral myocarditis

20
Q

Viral Exanthems

  1. reddish-brown macular rash that starts at nape of neck and behind ears and spreads to trunk and extremities
  2. differentiate from above by shorter duration (3d) and more pinkish color of rash and presence of patchy erythema on palate before onset of rash
  3. after breaking of high fever, a rose-colored papular rash on trunk that spreads to extremities, neck, face
  4. swollen parotid and submandibular glands
  5. pruritic rash with crops of lesions in various stages of macules, papules, vesicles, open vesicles, and crusting; begins centrally and spreads to extremities
  6. slapped cheeks; lacy reticular rash over trunk and extremities
A

Viral Exanthems

Measles

  • -macular rash that starts at nape of neck and behind ears, spreads caudally
  • -Paramyxovirus

Rubella

  • -similar rash as Measles
  • -Forscheimer spots may precede rash

Roseola

  • -after breaking of high fever, a rose colored papular rash on trunk that spreads to extremities, neck, face
  • -HHV-6

Mumps

  • -swollen parotid and submandibular glands
  • -Paramyxovirus

Varicella

  • -pruritic rash with crops of lesions (macules, papules, vesicles, crusting)
  • -begins centrally, spreads peripherally
  • -VZV

Erythema Infectiosum

  • -slapped cheeks; lacy reticular rash over trunk and extremities
  • -Parvovirus B19
21
Q

Acute Rheumatic Fever

Diagnosis

  1. recent group A strep infxn
  2. JONES criteria
    - -name the major criteria

Labs

  • -elevated ESR, CRP
  • -high antistreptolysin (ASO) titers

Tx: penicillin

  • -carditis?
  • -chorea?

Major complication?

Prophylaxis
–what type of penicillin?

A

Acute Rheumatic Fever

Diagnosis

  1. recent group A strep infxn
  2. JONES Criteria: two major; or one major and two minor
J - joints (migratory polyarthritis)
O - carditis
N - nodules (subcutaneous)
E - erythema marginatum (pink rash with sharp edges)
S - Sydenham chorea

Minor criteria: fever, arthralgia, inflammatory markers, prolonged PR interval

Tx: penicillin

  • -carditis w CHF –> prednisone
  • -chorea –> phenobarbital

Complication: valvular disease

Prophylaxis
–IM benzathine penicillin G

22
Q

DDx: TORCH infxns

  1. skin vesicles, keratoconjunctivitis, acute meningoencephalitis
  2. hydrocephalus, intracranial calcifications, chorioretinitis
  3. osteochrondritis, periostitis, desquamating skin rash involves palms and soles, snuffles (mucopurulent rhinitis)
  4. cataracts, deafness, and heart defects
  5. microcephaly, periventricular calcifications, petechiae with thrombocytopenia
A

DDx: TORCH infxns

Toxoplasmosis
–hydrocephalus, intracranial calcifications, chorioretinitis

Other (Syphillis)
–osteochrondritis, periostitis, desquamating skin rash involving palms and soles, snuffles

Rubella
–cataracts, deafness, heart defects

Cytomegalovirus
–microcephaly, periventricular calcifications, petechiae with thrombocytopenia

Herpes Simplex
–skin vesicles, keratoconjunctivitis, acute meningoencephalitis

23
Q

Infant; meningococcemia; sudden vasomotor collapse; petechial and purpuric lesions on flanks

Dx?

A

Waterhouse-Friderichsen Syndrome

–adrenal hemorrhage

24
Q

DDx: oropharyngeal lesions in children

  1. recurrent ulcers on anterior oral mucosa; no fever or systemic s/s
  2. gray vesicles and ulcers on posterior oropharynx; fever
  3. clusters of vesicles on anterior oral mucosa and around mouth; fever
  4. fever; exudative pharyngitis; anterior cervical lymphadenopathy
  5. fever; exudative pharyngitis; posterior or diffuse cervical lymphadenopathy
A

DDx: oropharyngeal lesions in children

  1. Apthous stomatitis (canker sore)
  2. Herpangina
    - -Coxsackie A
  3. Herpes gingivostomatitis
    - -HSV-1
  4. GAS (strep throat)
  5. EBV (infectious mononucleosis)
    * hepatosplenomegaly
    * maculopapular rash after amoxicillin/ampicillin
25
Q

Pharyngitis: viral v bacterial

Common Features
–sore throat, dysphagia, odynophagia, pharyngeal erythema

Bacterial (GAS)

  • -exudates, edema, palatal petechiae
  • -absence of what s/s?

Viral
–URI s/s: cough, rhinorrhea, conjunctivitis

A

Pharyngitis: viral v bacterial

Common Features
–sore throat, dysphagia, odynophagia, pharyngeal erythema

Bacterial (GAS)
–exudates, edema, palatal petechiae
–absence of cough
Tx: penicillin, amoxicillin

Viral Pharyngitis
–URI s/s: cough, rhinorrhea, conjunctivitis
Tx: symptomatic tx

Centor Criteria – to predict GAS

  • less predictive value in children!
    1. fever
    2. tender anterior cervical lymphadenopathy
    3. tonsillar exudates
    4. absence of cough
  • if all four present –> empiric abx
26
Q

Abx

  1. Strep
  2. Staph
  3. Unsure if strep or staph
A

Abx

Strep
–Amoxicillin

Staph
–Trimethoprim-sulfamethoxazole

Cover for both staph and strep
–Clindamycin

27
Q

URI, wheezing/crackles, and respiratory distress in an infant

Dx?
Complications (2)?

Prophylaxis for preterm babies (less than 29wks) and babies with significant congenital heart disease
–name of monoclonal Ab?

A

RSV (Bronchiolitis)
–URI, wheezing/crackles, and respiratory distress in an infant

Complications: apnea, respiratory failure
*bacterial superinfection with temp greater than 38

Prophylaxis: palivizumab

28
Q

Young child with recurrent episodes of nocturnal vulvar or anal itching

Dx?
Dx Test?

A

Pinworm (Enterobiasis)
–young child with recurrent episodes of nocturnal itching in vulvar or anal area

Scotch Tape Test

29
Q

DDx: Helminthic Diseases

  1. cough and hemoptysis; abdominal pain; bile-stained emesis; eosinophilia
  2. itchiness at site of entry; iron deficiency anemia; abdominal pain; diarrhea; green-yellow skin discoloration (chlorosis); eosinophilia
  3. nocturnal vulvar or anal itching; no eosinophilia

Tx? (3 options)

A

DDx: Helminthic Diseases

Roundworm (Ascariasis)
–cough and hemoptysis; abdominal pain; bile-stained emesis; eosinophilia

Hookworm (Ancylostoma, Necatur)
–itchiness at site of entry; iron deficiency anemia; abdominal pain; diarrhea; green-yellow skin discoloration (chlorosis); eosinophilia

Pinworm (Enterobiasis)
–nocturnal vulvar or anal itching; no eosinophilia

Tx: albendazole, mebendazole, or pyrantel pamoate

30
Q

HIV/AIDS in newborn/infant

Initial S/S
–F2T, chronic diarrhea, oral thrush, lymphadenopathy, interstitial pneumonia, hepatosplenomegaly

Infections

  • -recurrent bacterial infxns with encapsulated organisms
  • -opportunistic infxns (PCP - silver stain!)
  • -MAI complex
  • -oral candidiasis
  • -herpes viral infxns

Dx

  • -best test in newborn to 18m: HIV DNA PCR
  • -screening test for age greater than 18m?
A

HIV/AIDS in newborn/infant

Dx – newborn to 18m
–HIV DNA PCR

Dx – age greater than 18m

  • -screen: ELISA IgG Ab
  • -confirm: Western blot

Poor Prognostic Indicators

  • -high plasma viral load
  • -CD4 count less than 15 percent
31
Q

HIV/AIDS in newborn/infant

Initial S/S
–F2T, chronic diarrhea, oral thrush, lymphadenopathy, interstitial pneumonia, hepatosplenomegaly

Infections

  • -recurrent bactertial infxns with encapsulated organisms
  • -opportunistic infxns (PCP)
  • -MAI complex
  • -oral candidiasis
  • -herpes viral infxns

Tx

  • -what medication at birth?
  • -what Abx for PCP prophylaxis at 1 month?
A

HIV/AIDS in newborn/infant

Tx – maternal

  • -perinatal triple anti-retroviral
  • -IV ZDV at birth

Tx – infant

  • -ZDV at birth
  • -TMP-SMZ for PCP prophylaxis at 1 month
  • -anti-retroviral tx with presence of s/s
32
Q

Impetigo

Etiologies? (2)

Tx?

A

Impetigo

Etiologies

  • -S. aureus
  • -GAS (S. pyogenes)

Tx: topical abx
–mupirocin

33
Q

Post-Exposure Management (in non-vaccinated people)

  1. Varicella
    - -age greater than 1y; immunocompetent?
    - -age less than 1y or immunocompromised?
  2. Measles
    - -age 0-6m?
    - -pregnant, immunocompromised?
    - -all others: vaccine
  3. Hepatitis B
A

Post-Exposure Management (in non-vaccinated people)

  1. Varicella
    –age greater than 1y and immunocompetent
    Tx: vaccine
    –age less than 1y or immunocompromised
    Tx: VZIG
  2. Measles
    - -age 0-6m: immune serum globulin
    - -pregnant, immunocompromised: immune serum globulin
    - -all others: vaccine
  3. Hepatitis B
    - -Hep B Ig and vaccine

Pediatrics (13 decks)

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