Infectious Disease Flashcards
Updated 01/04/2024
What characteristics (4) of a needle stick injury affect infection risk ?
- Volume of Blood in Syringe
- Depth of Injury
- Size (diameter and length) of Needle
- Needle User’s viral load
HCV-1
EPI BULLETS
- 1 % of all pregnancies worldwide have a HepC+ Mother
- HCV Prevalent countries : Russia, Uzbekystan, Pakistan, Mongolia, Gabon and Egypt
-
Vertical transmission rates of HCV are:
* 5.8 % without t/x and no HIV
* 10.8 % without t/x and HIV+ - 20 - 30 % of Fetal HCV cases resolve spontaneously by 2-3 Months (~2/6 clear, 3/6 chronic intermittent disease and 1/6 chronic active infection)
11
HCV-5
What are Risk Factors for Hepatitis C Virus
Risk Factors for Hepatitis C Virus
- HCV+ Mother
- Born in HCV Prevalent area/country
- IN/IV/Inhaled Drug Use
- Unprotected bloody sexual practices
- Victim of Sexual Assault (no matter what acts were reported)
- Receiving surgical managements in 3rd world
- Exposed to contaminated skin-breaking procedures
HCV countries: Russia, Pakistan, Mongolia, Uzbekystan, Egypt and Gabon.
What is the Infection Control Protocol for a febrile thrombocytopenic rash ?
(petechiae, ecchymoses)
Droplet Precautions
Until meningitis is ruled-out or 24 h of anti-biotics
(The big worry here is meningococcemia)
What are the 3 most common pathogens for acute osteomyelitis?
Acute Osteomyelitis Pathogens
- Staphylococcus aureus
- Kingella kingae*
- Streptococcus pneumoniae
- Streptococcus pyogenes
- Haemophilus influenza B (unvaccinated)
- Salmonella (sickle cell disease)
- Enterobacter spp. (NICU)
*Typically culture negative. Resistant to anti-staph medications (Clindamicin, Vancomycin, Cloxacillin)
What are the inclusion criteria for Pavilizumab therapy ?
RSV Prophylaxis Inclusion Criteria
- < 12 months old during the RSV season
- Hemodynamically important Heart Disease (If on meds/O2)
- Chronic Lung Disease needing medications
- Required Oxygen at 36 weeks gestation
- Indigenous or northern rural families < 6 months of age
Consider for < 24 months if severely Immunocomp., T - 21 or CPD
DO NOT GIVE TO ADMITTED CHILDREN / NICU BABIES
What are the common pathogens for
Opthalmia neonatorum
Opthalmia Neonatorum Pathogens
- Chlamydia trachomatis (2 - 40 %)
- Staph spp., Strep spp., Haemophilus spp., G -
- Gonorrhoeae (40 - 50 % if exposed during delivery)
Regarding Varicella zoster, how should camps restrict admission to protect their population ?
- Staff and Participants should have strict reporting of Varicella zoster vaccine and immunity status
- No admission if positive exposure in the last 21 days
- No admission if suspected or confirmed active disease
What volumes of blood are needed for a blood culture in a:
- 1 - 2 kg baby
- 2 - 12 kg baby
- 13 - 40 kg child
- > 40 kg child
Blood Culture Volumes
- 1 - 2 kg = 2 - 4 mL
- 2 - 12 kg = 6 mL
- 13 - 40 kg = 20 mL
- > 40 kg = 40 mL
In what contexts is a non-fully retractable foreskin physiologic ?
- Normal Urination stream (reflects fertility)
- No recurrent infections
~50 % of 6 y.o. can completely retract their foreskin & 95 % at 17 y.o.
What are 3 risk factors for contracting HPV ?
Risk factors for HPV
- Number of sexual partners
- Risky behaviours (EtOH, Marijuana, Illicit drugs, tobacco)
- Sexual Abuse
- Early age of sexual activity onset
- HIV + or other immune suppresion
- Previous STIs
What are Risk Factors for contracting neonatal HSV ?
- Maternal Primary Infection (she has no anti-bodies to transfer)
- Intrapartum Skin Breakdown (foreceps, nuchal monitor…)
- Premature Rupture of Membranes (C/S and vaginal delivery)
- No anticipatory acyclovir in known HSV carrying Moms
What is the Infection Control Protocol for enteroviral infections ?
Contact Precautions
Duration of Illness
What three clinical aspects dictate evidence based prognosis for acute infectious meningitis in children ?
- Time to anti-biotic therapy (empirical)
- Hemodynamic and Neurologic Clinical Presentation
- Presence of Penicillin Resistant S. pneumoniae
What are the CENTOR Criteria for Strep Throat ?
CENTOR Clinican Design Tool
1. Exudative or Swollen Tonsils
2. Anter c-Lymphadenopathy
3. Fever
4. No Cough or URTI s/x
≥3 of these has a 32-56 % probability of an active GAS infection
EPI BULLETS
-
Soft and Firm toys were cultured 1 week after last clean, growing coliforms on 90 % and 13.6 % of them respectively.
*
What is the Infection Control Protocol for Pertussis?
Droplet Precautions
Until completing 5 days of appropriate anti-microbrial therapy
What is the Infection Control Protocol for gastroenteritis?
Contact Precautions
Duration of Illness or until treatable infectious etiology is identified
What are the Infection Control Precautions for Tuberculosis?
Airborne Precautions
Until Infectious Disease says they aren’t contagious anymore
What is the management of C. difficile disease ?
Clostridium difficile Management
- Reassess current anti-biotic regimen (80 % cure in mild disease)
- Metronidazole (PO if tolerated, otherwise IV)
- Consider PO Vancomycin (combined with IV Metronidazole in sev.)
- Probiotics to prevent recurrence, not to treat active dis.
- Tapering Tx with vancomycin as per the following:
- 4 doses (10 mg/kg/dose) per day x 7-14 days
- 2 doses per day x 1 week
- 1 dose per day x 1 week
- 1 dose per 2-3 days x 2 - 8 weeks
Remember that Vancomycin does NOT cross membranes very easily, so IV does not impact infections in the enteral lumen. There are no IV to PO equivalences.
HCV-3
List Fetal Risk Factors for Vertical HCV Transmission
Fetal Hepatitis C Virus Vertical Transmission Risk Factors
- Female Sex
- Premature Rupture of Membranes
- Fetal Scalp Monitoring
- Second Born Twin (Twin B or Triplet B/C)
There is NO difference of risk between a C/S or SVD
When is conjunctival erythromycin gel indicated for opthalmia neonatorum prophylaxis?
RARELY
The only CPS indication for this is for children exposed to known or strongly suspected Chlamydia at the time of delivery.
Chlamydia presents as congenital pneumonia
HCV-4
Describe your Management for Infants born to HCV+ Mothers
Management of Infants born to HCV+ Mothers
(1) Ante/Intra-partum actions
* Avoid trauma (Episiotomy, scalp monitoring, RF for perineal/vaginal tearing)
* f HIV status is unknown or sub-optimal treatment, prepare for HIV+ Management
* Blood born disease prevention protocols for yourself
(2) Immediate and Follow-up
* Bath the baby
* Breastfeeding is OK if Nipples are intact and HIV Negative
* Order infant **HCV serologies at 12 m.o. **
* You can order infant HCV serologies at 2 and 12 m.o. for anxious parents
* If Serologies are +, then order an HCV ag PCR
* If PCR is POSITIVE - the baby is infected and referred to GI and ID
What are the Isolation Protocols for SARS/MERS/CoVID19?
Droplet Precautions
Until 10 days after fever resolution
What is the management of a baby born to a Mother with inactive recurrent HSV?
Management of Baby born to Recurrent HSV
- Anticipatory acyclovir for the Mother pre-natally 36 w +
- Swab nasopharynx (consider serum) for HSV 1/2
- Routine newborn care
- Educate on signs of encephalitis, respiratory distress and cutaneous/occular lesions.
- If HSV + or baby develops symptoms, admit and treat
EPI BULLETS
- The incidence of breakthrough Varicella zoster infections is only 3.1 % (infection >42 days after vaccine)
- 72 % of these breakthroughs are in immunocompromised kids
- The magnitude of disease is lessened by vaccination
- There are 2 recorded camp outbreaks of Varicella; both outbreaks were secondary to lax screening protocols for immunity and/or active disease.
What infections are considered in community needle stick injuries ?
- Hepatitis B Virus (~30 % risk - 2 cases* described in literature)
- Hepatitis C Virus (~3 % risk - 3 cases* described in literature)
- HIV (~0.3 % risk - no cases* reported)
- Tetanus (Always assess vaccine status)
- Secondary bacterial infection of injury site (Assure wound is cleaned)
*Community Cases, not in hospital. Remember that infection risk varies based on needle user’s viral load, depth of injury, size of the needle and volume of blood remaining in it.
What is the management of suspected Strep. pharyngitis
- Pen G or V or Amox x 10 days
- Isolate until 24 h of abx is completed
- Cx throat with follow-up call
Pen V 300 mg PO BID if < 27 kg, 600 mg PO BID if > 27 kg. Pen G IM can be given once as well.
Amoxicillin 50 mg/kg PO BID
Under what conditions is Tuberculosis Contagious?
Take Precautions for TB when the following apply
- Disseminated Congenital Infection
- Extensive Lung Involvement
- Untreated Cavitary Lung Disease
- Laryngeal Involvement
- Positive Sputum
Describe what taking Droplet Precautions entails
Droplet Precaution
Goal is to prevent launched ENT/Respiratory droplets from making contact with your mucus membranes from direct shots (cough, sneeze) or surfaces-hands-face.
- Gown and Gloves (suggested by CPS)
- Procedural Masks (if < 1 m of contact with patient)
- NO ventillated rooms needed
EPI BULLETS
- Maternal Antibodies are transferred to fetus at 32w +
- 75 - 90 % of HSV+ people are unaware
- Neonatal Herpes Infections affect 6 / 100,000 births
- Disseminated Neonatal HSV has 85 % mortality and CNS NHSV has 50 % mortality
What are the Infection Control Protocols for Diagnosed Rubella and Exposure to Rubella ?
Rubella
Diagnosed: Contact Precautions for 7 days after Rash eruption
Contact: Contact Precautions for 7 to 21 days post-exposure
(e.g. If exposure on December 1st, isolate from December 8th to 22nd)
What are the Infection Control protocols for diagnosed measles and someone who made contact with measles ?
Measles
Diagnosed Measles : Airborne for 4 days after rash onset
Contact with Measles : Airborne starting 5 days after exposure to 21 days post-exposure
(e.g. If exposed on April 1st, you are infectious on April 6th until April 27th)
What is the empirical management for bacterial meningitis ?
Management of Bacterial Meningitis
- Lumbar Puncture if not contraindicated
- Ampicillin + Gentamicin if < 1 month old
- Ampicillin + Ceftriaxone if > 1 month old
- Consider Vancomycin if Staph/MDR S. pneumo prevalent
- When cultures or PCR are positive, focus antibiotics
- Audiology pre-discharge or within 1 month post-DC
- GBS treatment for 14 - 21 days
- S. pneumoniae for 10 - 14 days
- Haemophilus influenzae for 7 - 10 days
- N. meningitidis for 5 - 7 days
- E. coli/Enterobacter need repeated CNS, Image if +
What are the Isolation Protocols for Diagnosed Mumps and Exposure to Mumps ?
Mumps
Diagnosed: Droplet Precautions for 9 days from onset of Sx
Contact: Droplet starting 10 days from exposure to 26 days post-exposure
(e.g. If exposed on June 1st, isolate from June 11th to 27th)
What are the Infection Control protocols for suspected Varicella zoster, and exposure to suspected Varicella?
Varicella zoster
Diagnosed: Airborne plus contact until lesions are dried/crusted over
Contact: Airborne from 8 to 21 days post-exposure
(e.g. if exposed on March 1st, isolate from March 8th - 29th)
What valences of HPV are covered with the HPV-4 vaccine ?
(which are the cancerous one, which are genital warts typically)
HPV 4 Vaccine Coverage
- HPV 6 - Warts
- HPV 11 - Warts
- HPV 16 - Cancer
- HPV 18 - Cancer
What is the Infection Control Protocol for Avian (bird) Flu?
Droplet and Contact Precautions
14 days since onset of illness
What is the Infection Control Protocol for Meningitis?
Droplet and Contact Precautions
Until 48 h of appropriate anti-biotic/viral therapy is given
What are the managements for a baby of a Mom with Primary HSV Infection in the following contexts
- Asymptomatic baby born by C/S without ROM
- Asymptomatic baby born by C/S with ROM
- Asymptomatic baby born vaginally with ROM
- Symptomatic baby
Asymptomatic baby born by C/S without ROM
- Swab baby’s nasopharynx for HSV 1/2 PCR
- Consider baby’s serum HSV 1/2 PCR if available
- Routine well newborn care with education HSV signs
- If develops symptoms or HSV + admit and treat
Symptomatic or Asympt. born by C/S or vaginally with ROM
- HSV 1/2 PCR of nasopharynx and serum (if available)
- Lumbar Puncture for HSV PCR
- Acyclovir x 10 days
- Repeat PCR/LP at 48 h of life (initial PCR may be falsely negative)
How should we prepare parents of immunocompromised children Varicella zoster exposure?
-
Educate on infection risk based on exposure
- Children are contagious -48 h from rash eruption
- Incubation Period is 10 - 21 days
- Infection can be airborne, droplet and contact born
- When exposed, parents are to contact you to grade risk
- If exposure is High Risk, consider medication prophylaxis
What are the Infection Control Protocols for open, oozing or draining wounds?
Contact Precautions
Until wounds are closed/stop draining
EPI BULLETS
- C. difficile has a 2-3 day incubation period
- 15 - 63 % of infants, 3 - 33 % < 2 y.o.’s and 8.3 % of children are colonised with C. difficile
- There is a 25 % risk of recurrence in C. difficile colitis.
- Absence of C. difficile disease in the young is likely secondary to maternal anti-body persistence and immature receptors for C. difficile toxins a/b
What are the Infection Control Protocols for
Hepatitis A, B, C, D and E?
- Hepatitis A: Contact for 7 days since onset of symptoms
- Hepatitis B : None - caution with surgery/delivery/blood manipulation
- Hepatitis C : None - caution with surgery/delivery/blood manipulation
- Hepatitis D : None
- Hepatitis E : Contact for 7 days since onset of symptoms
What are the Infection Control Precautions for Impetigo?
Contact Precautions
Until 24 h of topical/systemic therapy has been completed
EPI BULLETS
- 20-30 % of bacterial pharygitis are S. pyogenes (GAS)
- Children 5 and above are asymptomatic carriers 11-15 % of the time
- The incidence of ARF in Northern Ontario FN communities is 21.3/100k vs 0.3/100k in the general population.
- This increased risk for ARF is likely a mix of M-protein serotypes native to the North, and healthcare access.*
What is the management of Acute Otitis Media ?
Acute Otitis Media Management
- Appraise for bacterial* versus viral aetiology
- If viral, educate on watchful waiting and return if development/persistence
- If bacterial infection or poor capacity for follow-up/access
- Assess for Mastoiditis
-
Amoxicillin as first line (cefuroxime for allergy)
- Clavulin as next step for refraction
- Ceftriaxone (IM/IV) as next step for more refraction
- Educate on return to care
*Signs of bacterial infection include Middle Ear Effusion WITH bulging, no viral URTI signs, severe persistent otalgia, TM perforation, ill appearance despite analgesia, > 48 h persistence of symptoms on presentation or return.
What are the Isolation Protocols for viral respiratory infections ?
Droplet Precautions
For the duration of illness, or until a respiratory virus is rule-out
What are the Infection Control Protocols for Scabies?
Contact Precautions
Until _first therap_y is applied
What are the common pathogens for bacterial meningitis?
For Ages
- 0 - 1 month*
- 1 month and older*
0 - 1 month (consider up to 3 months)
- Group B Streptococcus (Gram +, chained cocci)
- E. coli (Gram -, coccobacillus)
- Listeria monocytogenes (Gram +, bacilli, outbreak related)
- Enterobacter/Enterococcus spp. (NICU and surgical babies)
- S. pneumonia (rare)
1 month and older
- S. pneumoniae (Gram +, chained cocci)
- Neisseria Meningiditis (Gram -, diplococci)
- Listeria monocytogenes (Gram +, bacili, outbreak related)
- E. coli (Gram -, coccobacillus, associated with UTI sources)
- Group B Streptococcus (rare)
EPI BULLETS
- 95 % community immunity is required for Herd Immunity
What is the Pediatrician’s preventive role in needle stick injuries ?
Needle Stick Injury Prevention
- Educate schools/cities on environmental cleaning/safety
- Vaccinate children against Hepatitis B Virus appropriately
- Teach children how to repond to finding needles/drug parafenalia in their enviroment (call adult, parents etc.)
Describe what Contact Precautions entails
Contact Precautions
Goal is to prevent infectious particles on the patient from making contact with your mucus membranes, skin or clothes.
- Gown and Glove
- Wipe down environment after child plays in it
- Ask to stay in room or keep to themselves in waiting room
- NO masks needed
Describe C. difficile prevention in Hospital (and clinic) ?
(Housekeeping, Nursing and Physician responsibilites)
Physicians and Nurses
- Contact isolation at baseline, with droplet/contact when manipulating the anus
- Recognize and report the clinical symptoms of C. difficile colitis
- Foul smelling watery diarrhea
- Blood in stool
- Abdominal pain
- Recognize and report the risk factors for C. difficile colitis
Housekeeping
- Bleach clean twice rooms of patients with C. diff; this can take several hours and is important when doing bed management on weekends/evening/nights
Alcohol cleaning products do NOT kill C. diff endospores
What are the common pathogens that cause AOM?
Acute Otitis Media Pathogens
- S. pneumoniae (most virulent)
- H. Influenza
- Moraxella catarrhalis
- S. pyogenes aka GAS (rare)
EPI BULLETS
- Lifetime HPV incidence is 70 %
- HPV Vaccines are ~ 100 % effect if given early, and 70-90 % effective at keeping current infections in check (no symptoms)
- Studies show getting the HPV Vaccine is NOT associated with
- Risky Sex
- More Sex had
- Earlier sexual promuscuity
- Increased STI incidence
- Major side effects seen with other vaccines (Autoimmunity)
What is the Infection Control Protocol (PPE) for anti-biotic resistant organisms ?
(i.e. VRE, MRSA, CRO, Pseudomonas)
Contact Precautions
Indefinitely until they have been ruled-out or treated
What is the relationship between illness severity, contagiousness and viral load for Varicella zoster (chicken pox) ?
Viral load α Symptom Severity
Viral load α Contagiousness
Therefore
Symptom Severity α Contagiousness
- Given these correlations, you’ll note a change in recommendations to reflect the patient’s overall condition rather than rash-specific criteria for exposure restrictions.*
- I.e. Kids well enough to attend school, have low viremia, therefore less contagious.*
What are the CPS’ recommendations for your practice’s adminstrative and office policies for infection control?
(4 administration, 5 Office)
Administrative Policies
- Educate personnel on hygiene/cleaning standards
- Connect with Public Health for easy disease reporting
- Re-assess hygiene protocols every 2 years
- Have PPE available
Office Design
- Patient booking & Waiting Rooms layout to min. crowding
- Segregate Infectious and Immunodeficient patients
- No soft toys, No carpet - routine cleaning!
- Ventillation provides a minimum of 6 Air Exchanges/hour
- Fasciliate and Promote Hand Hygiene
HCV-2
List Maternal Risk Factors for Vertical HCV Transmission
~~~
```Maternal Hepatitis C Virus Vertical Transmission Risk Factors
- Elevated Maternal HCV antigen titres
- Maternal IV Drug Use
- Steatosis/Cirrhosis of Liver
- Concomitant HIV or HBV Infection7
HCV+ is NOT a contraindication to breastfeed, however CPS suggests cautioning if nipples are dramatically broken down
Describe management for an infant born to a mother with active risky HSV lesions
(Risky HSV lesions can be systemic disease, genital lesions or accidental contact with low risk lesions)
Management for Newborn with Maternal Active HSV
Vaginal Delivery, C/S with ROM or Maternal Systemic Disease
- Plan disposition with Parents and Consult Infectious Disease
- Swab nasopharynx and eyes for HSV
- Lumbar puncture for Culture, Cells, Protein/Glucose and HSV PCR
- Acyclovir x 10 days (IV)
- Repeat LP and PCR at 48 h of life
Remember that acyclovir is a Q8 h medication, so it may be beneficial for the family to be admitted for the 48 h pending consultation no matter what. Some centers have outpatient IV medication services, but this dosing schedule sucks for everyone - yet it could coincide with bilirubin checks so try to accomodate.
What is the Infection Control Protocol for Strep. Throat?
Droplet Precautions
Until 24 h of appropriate Antibiotic Therapy is completed
What are risk factors for Clostridium difficile disease ?
Risk Factors for Clostridium difficile disease
- Chemotherapy
- Multi-drug antibiotic regimens
- Immunosuppresion (HIV, Congenital, Infectious, Hormonal)
- GI manipulation (feeding tubes, surgery, scopes)
Proton Pump Inhibitors are NOT risk factors for C. diff
List 3 Complications of untreated GAS Pharyngitis
GAS = Strept. pyogenes
Complications of GAS Pharyngitis
* Peritonsillar Abscess (Older)
* Retropharyngeal Abscess (Young)
* Sepsis
* Acute Rheumatic Fever
* Post-Streptococcus Glomerulonephritis (PSGN)
* PANDAS
PSGN and PANDAS are not shown to decrease in incidence with anti-biotic treatment, whereas the others are.
EPI BULLETS
- 75 % of children have an ear infection by 1 year old
- 22 % of URTIs have acute otitis media (typically viral)
- 1 - 3 % of ALL infants are admitted because of RSV
- A season of Pavilizumab costs 5600 $/patient
- The development of Pavilizumab has decreased
- Ex-Prem admissions by about 8- %
- Chronic Lung Disease babies by 40 %
- Congenital Heart Diseasers by 45 %
EPI BULLETS
- S. pneumonia meningitis dropped 87 % since vaccine intro
- 96.1 % of S. pneumoniae are penicillin susceptible, 98.5 % are ceftriaxone susceptible
- There is development of Penicillin / Ciprofloxacin resistant Neiserria meningitidis to be concerned for
- B-lactamase heavy H. influenza prevalence is increasing
- Northern populations are at risk for Non-B H. influenza meningitis
What are the prophylactic medications for HIV from a needle stick injury or blood exposure ?
(For young and older children)
Young Children (< 12 y.o. and < 35 kg)
- Zidovudine
- Lamivudine
- Lopanivir or Ritonavir
Older Children (> 12 y.o. and/or > 35 kg)
- Emtricitabine
- Tenofovir
- Raltegravir or Dolutegravir
Any child currently on medications needs to be consulted with Pharmacy prior to prescription for cross-reactivity. Infectious disease should be contacted prior to presciption of renal/liver/GI absorption disease is present.
EPI BULLETS
- 0.8 - 1.6 % of non-circs. will develop balanitis
- Phimosis occurs in 4 % of non-circs., and 80 % respond to medical therapy.
- Evidence supports that circumcisions do:
- Decrease STI rates
- Decrease Cervical CA, Squamous Cell CA
- Decrease UTI (by 90 %)
Describe your approach to a child with acute osteomyelitis
(Labs, Imaging, Medications, Follow-up)
Acute Osteomyelitis
- Consider differential (Cancers, autoimmunity, trauma)
- CBC + diff., CRP, Electrolytes* and Blood Cultures
- Plain films can be used to assess for Cancer
- Ultrasound to facilitate drainage of joint/collection
- MRI with Gadolinium or Nuclear Scan
- Consult Orthopedic Surgery for possible drainage
- Cefazolin/Cephalexin - total of 4 weeks
- Add Vancomycin if S. aureus is a concern
- Change to PO Antibiotics and discharge when:
- Blood Cultures Negative
- Tolerating PO Meds and no absorption issues (GI comorb.)
- CRP is decreasing
- Minimal to no symptoms with ambulation
What systematic approaches best optimize vaccination rates ?
- Centralised Vaccine Database
- Automated notification of vaccine needs for parents
- Optimize Access to Vaccine Clinics
- Vaccine School Programs to facilitate access
- Vaccination requirements for School Admission
Canimmunize is a free app. that prompts parents to seek out vaccinations for their children based on the current schedules in place for their province.
What is the acute management of a needle stick injury ?
Acute Needle Stick Injury Management
- Wash the wound with water and soap (do not squeeze blood out)
- Assess patient’s HBV and Tetanus vaccination status
- Assess risk* of bloodborne infection
- Baseline HBsAg, HBsAb, HCV Ag, HIV Ag levels
- If considering anti-retroviral prophylaxis measure labs**
- If no HBV immunity suspected, give HBIG* and Vaccine now, second at 4 weeks and 3rd at 6 months follow-up
- If no Tetanus immunity suspected, give vaccine
- Start Anti-retroviral* if indicated with 3 day, 3 weeks**, 3 months** and 6 months** follow-up
*High risk is known blood injection, deep penetration of injury, known seropositive user’s needle or endemic area.**Measure HIV ag/ab, HCV ag/ab, HBV ag and response to vaccine. If still on anti-retroviral therapy then LFTs, Renal Profile, CBC with diff. and lytes should be followed.
Describe what Airborne Precautions entails
Airborne Precautions
Goal is to prevent aerosolized particles from being inhaled and/or making contact with your mucus membranes. Droplets are aerosolized with intubation/CPAP/BiPAP/HFNC*
- Gown and Glove (droplets and particles will stick to your clothes)
- N95 Masks (must be fitted otherwise you are exempt from work)
- Negative Pressure Rooms
*Theoretically, not proven/institutionalised
COVID BULLETS
- Vertical transmission risk of COVID19 is 0.01 %. Risk factors are Maternal viral load/disease severity and immunodedeciency.
- Breastfeeding transmission of COVID19 is not a thing.
- Isolated Maternal COVID19 is NOT an indication for NICU to be present at the birth.
- Do not restrict delayed cord clamping because of maternal COVID19
- N95 with all aerosol generating manipulations of suspected COVID19 in the NICU… which means everything except isolated line placement
COVID BULLETS
- The Moderna and Pfizer vaccines are COVID-19 XBB.1.5 mRNA Vaccines
- There is no difference between Moderna and Pfizer preference now, since myocarditis rates are now shown to be rare and equivocal between the two.
- Children 5 y.o. and above should receive XBB.1.5 [Dosing frequency in footnote]
- COVID-19 vaccination is safe during pregnancy and breastfeeding
- COVID-19 vaccines can be given WITH other vaccines
https://cps.ca/en/documents/position/covid-19-vaccine-for-children-and-adolescents
When can patients with a history of Multisystem Inflammatory Syndrome associated with COVID-19 (MIS-C), receive a COVID-19 vaccination ?
You must wait a for complete recovery from OR 90 days since diagnosis of the MIS-C.
This does NOT apply to myocarditis. At this time, a history of COVID-19 associated myocarditis means no vaccine until more data is available.
https://cps.ca/en/documents/position/covid-19-vaccine-for-children-and-adolescents
What are patient risk factors for COVID-19, meritting vaccination before 5 years of age ?
- Children below the age of 5 y.o. can receive the COVID-19 vaccine.
- The vaccine is strongly recommended for those who:
- > 1 comorbidities, neurologic d/o, chronic lung disease
- Trisomy 21 (independant of specific associated diseases)
- Immunocompromise (in any form)
- Social risk factors for COVID-19 exposure
- Vaccines are** still offered** to those with a Hx of confirmed COVID-19 infection.
- First dose of XBB.1.5 should be at minimum** 6 months** from the last COVID-19 vaccine OR infection.* [See footnote for schedule]*
https://cps.ca/en/documents/position/covid-19-vaccine-for-children-and-adolescents
Who should receive an influenza vaccine ?
Everyone.
When should a Mother be checked for Syphillis serologies ?
Syphillis Screening in Pregnancy
* Performed during first pre-natal visit
* Repeated at 28 - 32 weeks
* At delivery (if there is an outbreak in the area)
* If clinically suspicious (e.g. symptoms of syphillis, another STI)
*Treponemal specific tests have great sens/spec., but once positive will be positive for life and cannot assess reponse to therapy. Non-specific VDRL (for CSF) and RPR (for blood) should be repeated in 4-6 weeks if negative, as their response may be delayed. Direct PCR swabbing of Amniotic fluid, ulcers and umbilical cord is available. *
https://cps.ca/en/documents/position/congenital-syphilis
How does one appraise a Mother’s chart, when looking for Congenital Syphillis Risk ?
Adequate treatment of Confirmed Maternal Syphillis
* Treated with Penicillin G
* Treatment was > 4 weeks before delivery
* Appropriate treatment for infection stage
* > 4x decline in VDRL or RPR
If any of the above are false - the baby is at high risk
Red Flags to consider treatment
* Maternal reinfection risk (e.g. multiple unprotected partners, partner was not treated)
* Fetal US suggests congenital syphillis
* Neonate’s labs or Mother’s lesions are suggestive of syphillis
https://cps.ca/en/documents/position/congenital-syphilis
What are common findings in an infant with Congenital Syphillis ?
Common Findings in Congenital Syphillis
* Failure to Thrive
* Maculopapular desquamating rash
* Hepatosplenomegaly
* Periostitis
I’ve attached the full list of clinical findings, but they’re super non-specific
https://cps.ca/en/documents/position/congenital-syphilis
What is the management of an infant born to a Mother with positive syphillis serologies ?
See attached flowchart from the CPS
This flowchart is applicable for :
1. Confirmed positive maternal syphillis serologies
2. Mother’s status is unknown
https://cps.ca/en/documents/position/congenital-syphilis
What investigations are required for suspected Congenital Syphillis in an infant ?
Congenital Syphillis Work-up
* CBC w/ differential
* AST, ALT, BiliT, Albumin, ALP, GGT
* CSF for cell count/diff., glucose, protein and VDRL
* Long-bone radiographs with prompt for suspected syphilis
* Solid organ abdominal ultrasound
* Cranial ultrasound or MRI
Refer to specialists with a prompt to assess of syphillis
* Infectious disease (facilitates the investigations with the lab)
* Opthalmology
* Placental pathology
* Audiology
Repeats and follow-up based on the attached flow-chart
