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Pediatrics 2 > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Describe pinworms

A
  • Infection by a small, white nematode (roundworm), typically Enterobius vermicularis
  • Characterized by perineal and perianal itching
  • Usually worse at night**
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2
Q

Systems affected by pinworms

A
  • gastrointestinal

- skin/exocrine

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3
Q

Commonly associated conditions with pinworms

A

Pruritus ani

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4
Q

Pinworms epidemiology

A
  • Considered the MC helminthic infection of humans (the only known natural host) and the most common worm infection in the United States.
  • Occurs in school-aged children (5–10 years) and preschool children predominantly
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5
Q

Pathophysiology behind pinworm pruritus?

A
  • Pruritus is caused by the perianal deposition of eggs and a mucosal mastocytosis response.
  • Other GI symptoms, such as anorexia or abdominal pain, may occur because of the mucosal inflammatory response.
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6
Q

Pinworm etiology

A
  • Ingestion of organism via fecal–oral transmission
  • Can be spread directly, hand-to-mouth, or via fomites found on toys, bedding, clothing, toilet seats, and baths
  • spread can occur between family members easily - treat the whole family.
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7
Q

Pinworms

-Physical Exam

A
  • Exam may be normal, and the child may be well-appearing
  • May have self-inflicted, perianal excoriation
  • Pinworms may be visible perianally
  • Difficulty sleeping, decreased appetite, and/or abdominal pain may occur
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8
Q

What is the adhesive tape test?

A
  • Place cellophane tape on the perianal skin in the early morning before bathing and affixed to a microscope slide to look for pinworm eggs.
  • If performed on three consecutive mornings, this test has 90% sensitivity.
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9
Q

Tx of pinworms

A
  • Mebendazole
  • Albendazole
  • now use OTC drugs
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10
Q

Pinworm general measures

A

Reinfection is common especially if not all close contacts are treated.

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11
Q

Epstein-Barr Virus

A
  • Epstein-Barr virus (EBV) is a member of the herpes virus family (human herpes virus 4).
  • Infectious mononucleosis is a clinical syndrome in a patient with primary EBV
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12
Q

EBV epidemiology

A
  • Humans are the only known reservoir
  • Transmission occurs through saliva and, occasionally, via blood transfusions and solid organ transplant (SOT)
  • Incubation period is 4–7 weeks but can be up to 3 months
  • Antibodies to EBV are almost universally present in adult populations
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13
Q

EBV risk factors

A
  • Age
  • Sociohygienic level
  • Geographic location
  • Close, intimate contact – sharing drinks
  • Immunosuppression
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14
Q

EBV patient history

-prodrome

A
  • Most often, lasts 3–5 days

- Malaise, fatigue, with or without fever

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15
Q

EBV patient history

-acute phase

A
  • Fever: begins abruptly, lasts 1–2 weeks
  • Fatigue
  • Malaise
  • Anorexia
  • Sore throat
  • “Swollen glands”
  • Rash; MC with ampicillin/amoxicillin administration
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16
Q

EBV rash

A

Young children are more likely to have rash or abdominal pain**

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17
Q

EBV Physical Exam

A
  • Fever, lymphadenopathy, pharyngitis in >50%, with palatal petechiae and hepatosplenomegaly in ∼10%
  • Splenomegaly in 50%
  • Petechiae develop at border of hard and soft palates in 60%.
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18
Q

EBV antibiotic-induced rash

A
  • Morbilliform in appearance
  • MC after administration of ampicillin or amoxicillin
  • Usually benign; resolves with discontinuation of the antibiotic
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19
Q

What kind of lymphocytes would you see with EBV?

A

Atypical lymphocytes - WBC’s that are “atypical” because they are larger (more cytoplasm) and have nucleoli in their nuclei.

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20
Q

EBV diagnostic test & interpretation

A

CBC with differential: Lymphocytosis with greater than 50% lymphocytes (increase in lymphocytes and atypical lymphocytes)

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21
Q

EBV monospot

A
  • mononucleosis rapid slide agglutination test for heterophile antibodies
  • detects heterophile antibodies (nonspecific IgM antibodies to unrelated antigens)
  • appears in first 2 weeks of illness, usually slow decline over 6 months
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22
Q

EBV-specific antibodies

A
  • Acute or past infection can usually be detected and differentiated.
  • Viral capsid antigen-IgM (VCA-IgM) in most patients is detectable with symptom onset, peaks at 2 to 3 weeks, becomes unmeasurable by 4 months
  • Viral capsid antigen-IgG (VCA-IgG) peaks at 2 to 3 months, persists for life
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23
Q

Imaging for EBV

A
  • chest xray: hilar adenopathy possibly observed

- abdominal ultrasound in cases of splenomegaly

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24
Q

EBV treatment

A
  • Treatment is mostly supportive – you need to explain this to patients/caregivers – do not need antibiotic!
  • NSAIDs or acetaminophen
  • Warm salt water gargle
  • Magic mouthwash
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25
Q

When should you consider steroids in EBV?

A

Consider in severe pharyngotonsillitis with oropharyngeal edema and airway encroachment.

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26
Q

EBV patient monitoring

A
  • Avoid contact sports, heavy lifting, and excess exertion until spleen and liver have returned to normal size (ultrasound can verify in athletic populations).
  • Eliminate alcohol and exposure to other hepatotoxic drugs or herbal supplements until LFTs normalize.
  • Closely monitor patients during the first 2 to 3 weeks after the onset of symptoms since complication rates are highest during this period.
  • Alert patients that symptoms (malaise, fatigue, intermittent sore throat, lymphadenopathy) may persist for months.
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27
Q

EBV prognosis

A
  • Most recover in ∼4 weeks.

- Fatigue may persist for months.

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28
Q

Cytomegalovirus (CMV) definition

A
  • Cytomegalovirus (CMV) is a ubiquitous double-stranded DNA virus that is a member of the herpesvirus family.
  • It establishes latency in peripheral blood mononuclear cells and endothelial cells.
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29
Q

CMV congenital infection

A

Congenital CMV is the most common infectious cause of deafness.**

30
Q

CMV mononucleosis syndrome

A

CMV can cause a mononucleosis-like syndrome similar to that caused by Epstein-Barr virus (EBV) infection in immunocompetent patients.

31
Q

CMV symptoms

A
  • Prolonged fever
  • -Mononucleosis-like syndrome
  • Blurred vision
  • -CMV retinitis
  • Cough, dyspnea, wheezing
  • -CMV pneumonitis
  • Vomiting, abdominal pain, diarrhea (watery or bloody)
  • -CMV colitis
32
Q

CMV Physical Exam

A
  • microcephaly
  • hearing loss
  • photophobia, HA, nuchal rigidity
33
Q

CMV rash

A

Petechiae, purpura, “blueberry muffin” lesions, rubelliform rash

34
Q

Describe Herpes Simplex Virus

A
  • Exists as two distinct subtypes, HSV-1 and HSV-2, and is responsible for a wide spectrum of illness ranging from fever blisters to genital ulcers and fatal encephalitis.
  • It establishes lifelong latency and can lead to interval episodes of asymptomatic shedding and disease recurrence.
35
Q

HSV Pathophysiology

A
  • Spread occurs typically via contact with abraded skin or mucous membranes.***
  • The incubation period for primary infection is approximately 2–12 days.
36
Q

Risk factors for HSV

A
  • Immunocompromised state
  • Atopic eczema, especially in children
  • Prior HSV infection
  • Sexual intercourse with infected person
37
Q

HSV history

A
  • Many patients are unaware of a known exposure.
  • Majority of primary HSV infections are asymptomatic.
  • Infections “above the waist” are classically due to HSV-1, whereas HSV-2 MC causes genital infection (however, both serotypes can cause genital and/or mucocutaneous infection)
38
Q

HSV neonatal infection

A

Neonates may present with classic skin lesions or with nonspecific findings of irritability, fever, temperature instability, and poor feeding with or without a rash.

  • Disseminated neonatal HSV produces sepsis-like syndrome
  • HSV CNS disease
39
Q

HSV Ocular infections

A
  • primary herpes keratoconjunctivitis
  • unilateral conjunctivitis with regional adenopathy, blepharitis with vesicles on lid marginal keratitis with dendritic lesions, or with punctate opacities
  • lasts 2 to 3 weeks
  • systemic involvement prolongs process
40
Q

HSV Oropharyngeal infections

A
  • primary herpetic gingivostomatitis and pharyngitis
  • usually in early childhood; incubation from 2 to 12 days, followed by fever, sore throat, pharyngeal edema, and erythema
41
Q

HSV dermatologic manifestations

-eczema herpeticum

A

diffuse pox-like eruption complicating atopic dermatitis; sudden appearance of lesions in typical atopic areas (upper trunk, neck, head); high fever, localized edema, adenopathy

42
Q

HSV dermatologic manifestations

-herpetic whitlow

A
  • localized infection of affected finger with intense itching and pain, followed by vesicles that may coalesce with swelling and erythema.
  • mimics pyogenic paronychia; neuralgia and axillary adenopathy are possible; heals in 2 to 3 weeks
43
Q

HSV physical exam

A
  • the “classic” HSV rash consists of vesicles on an erythematous base, which subsequently ulcerate, become friable, and bleed easily.
  • lesions may not be readily apparent, particularly in cases of disseminated disease and CNS infection.
44
Q

HSV labs

A

Tzanck smear

45
Q

Define pharyngitis

A
  • specifically refers to inflammation of the pharynx as indicated by erythema and swelling of the structures in the posterior portion of the oral cavity including the tonsillar pillars, the tonsils, the inferior soft palate, the uvula, and the posterior wall.
  • usually caused by viral** or bacterial infections.
46
Q

Pharyngitis epidemiology

A
  • Group A Streptococcus (GAS) pharyngitis is most common in children between the ages of 5 and 15 years, is very rare in children younger than the age of 3 years, and may occur in outbreaks affecting up to 20% of children at risk.
  • Pharyngitis caused by Neisseria gonorrhoeae occurs primarily in sexually active adolescents
47
Q

Pharyngitis history

A
  • Pharyngitis associated with rhinorrhea, cough, hoarseness, conjunctivitis, diarrhea, or nonspecific rash is more likely to have a viral cause.
  • History of oral sex suggests possibility of N. gonorrhoeae infection.
48
Q

Pharyngitis Lab

-rapid antigen detection test

A
  • The diagnosis of GAS pharyngitis should not be made based on clinical features alone but should be confirmed by laboratory testing.
  • Testing children < 3 years old is not indicated, as those children are at very low risk for acute rheumatic fever (ARF).
  • Testing may be considered in this age group if other risk factors are present such as an older sibling with GAS.
49
Q

Pharyngitis treatment

A

largely supportive for most viral causes of pharyngitis, including pain control and hydration.

50
Q

First line pharyngitis treatment

A

Amoxicillin: 50 mg/kg (max dose 1 g) daily divided b.i.d. for 10 days

51
Q

Second line pharyngitis treatment

A

Oral clindamycin 20 mg/kg/24 h (max 1.8 g/24 h) divided t.i.d. may be given to patients with type I hypersensitivity to penicillin.

52
Q

Pharyngitis complications

A
  • Rheumatic fever (e.g., carditis, valve disease, arthritis)
  • Poststreptococcal glomerulonephritis
  • Peritonsillar abscess (a.k.a. quinsy tonsillitis)
53
Q

Define epiglottitis

A
  • acute life-threatening bacterial infection consisting of cellulitis and edema of the epiglottis, aryepiglottic folds, arytenoids, and hypopharynx, resulting in narrowing of the glottic opening and airway obstruction
  • also known as supraglottitis
54
Q

Epiglottitis epidemiology

A

Disease due to Haemophilus influenzae type B occurs most often between the ages of 1 and 7 years (overall range: infancy to adulthood).

55
Q

Epiglottitis general prevention

A

Universal immunization with H. influenzae type B capsular polysaccharide conjugate vaccines at 2 and 4 months (potential dose at 6 months, depending on the vaccine), with booster at 12–15 months.

56
Q

MC organisms causing epiglottitis

A
  • Streptococcus pneumoniae
  • Streptococcus pyogenes (group A β-hemolytic Streptococcus)
  • Staphylococcus aureus
57
Q

Epiglottitis history

A
  • Abrupt onset of high fever (39–40°C), sore throat, and dysphagia
  • Drooling or difficulty handling secretions
  • “Hot potato” voice (muffled)
  • Child’s preferred position or way of sitting (i.e., sitting upright, leaning forward with chin hyperextended) - tripoding, sniffing sign
58
Q

Epiglottitis physical exam

A
  • Child often leaning forward with chin hyperextended to maintain airway in a “tripod” position
  • Drooling is seen as a manifestation of dysphagia.
  • Do not attempt to examine the throat if epiglottitis is a serious consideration***
59
Q

Epiglottitis on imaging

A

Lateral neck radiography (should not be performed until airway team is in place): characteristic “thumb sign” of edematous epiglottis, with narrowing of the posterior airway and ballooning of the hypopharynx

60
Q

Epiglottitis treatment

A

Cephalosporins

61
Q

Describe otitis externa

A
  • Diffuse inflammation of external auditory canal with or without infection
  • Also known as “swimmer’s ear”
  • May be categorized as acute, chronic, or malignant
62
Q

Otitis externa epidemiology

A

Peaks in children age 5–14 years

63
Q

Otitis externa risk factors

A
  • Prolonged exposure to water (e.g., frequent swimming, shampooing, long showers, excessive sweating) leading to impaired natural defense mechanisms in external ear
  • Debris from dermatologic conditions (e.g., atopic or seborrheic dermatitis)
  • Use of external devices (e.g., hearing aids or ear plugs)
64
Q

Pathophysiology of otitis externa

A

Too much cerumen can also lead to entrapment of debris and water retention, thus predisposing to infection.

65
Q

Otitis externa etiology

A

MCC by pseudomonas aeruginosa and staphylococcus aureus

66
Q

Otitis externa history

A
  • Symptoms are rapid in onset (generally within 48 hours) and include otalgia, pruritus, a sense of fullness, drainage, and occasionally impaired hearing.
  • Important to know status of immune system (e.g., history of diabetes, HIV infection)
67
Q

Otitis externa physical exam

-signs of inflammation

A

tenderness or pain with manipulation of the pinna and with pressure on the tragus, erythema and edema of the external auditory canal, and otorrhea

68
Q

When should you consider viral infection with otitis externa?

A

Consider viral infection (Ramsay Hunt syndrome) if there are vesicular lesions with facial paralysis, loss of taste, and decreased lacrimation on the affected side.

69
Q

First line treatment for otitis externa

A
  • Ciprodex

- ofloxacin

70
Q

Tips for medication administration in otitis externa

A
  • Patient should lie with affected ear upward.

- Consider using a wick if the ear is very swollen.

71
Q

Otitis externa pain management

A

-For mild to moderate pain, acetaminophen or ibuprofen and application of heat or cold packs often will suffice.

Pediatrics 2 (7 decks)

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