Infectious Disease Flashcards
Sepsis in Neonates:
Bacteria + Abx
GBS, E. Coli
enteroccoci, listeria
ampcillin + gentamycin
if mengitis, amp + cefotaxime +/- acyclovir
sepsis in >3mo olds
S pneumo
N. meningitidis, S aureas, H influ, strep pyogenes
ceftriaxone + vancomycin
allergy: cipro + vanco
if hospital acquired / immune compromised:
MSSA, MRSA, VRE, viridans
meropenem + gent + vanco
sickle cell /w fever
ceftriaxone +/- vancomycin (if clinically septic)
meningitis in neonate
GBS, E Coli, listeria
amp + cefotaxime +/- acyclovir
meningitis in >1mo old
S pneumo, N meningitidis, H flu
ceftriaxone + vancomycin, + amp if <3mo and immunocompromised
pneumonia in neonate
GBS, listeria, myocplasma, chlamydia
amp + gent, +/- azithro if chlamydia
pneumonia in >1mo
S pneumo, H flu, S aureas, S pyogenes,
atypical: mycoplasma pneumoniae, chlamydia pneumoniae. Viruses, TB.
high dose ampicillin or amoxil (azithro if atypical features)
ceftriaxone + azithro if severe or RF for anaerobes, step down to amox-clav
add oseltamivir for flu (and use amox-clav instead of amox)
otitis media
amoxicillin = 1st line
cefuroxime-axetil if non-severe allergy, azithro if severe
amox-clav or if fails 1st line
if perforated: topical ciprodex
Strep phayngitis / scarlet fever tx
penicillin V x 10 d (amoxicillin alternative)
macrolide (azithro) if allergy
AOM bacteria
strep pneumo, non-type H flu, moraxella ctarrhalis = most common
20% viral
diagnostic criteria AOM
1) rapid onset otaliga /w fluid + inflammation
2) effusion: immobile TM or acute otorrhea
3) bulging membrane + discoloration
Management of AOM
no effusion or non-bulging - likely viral, reassess ear in 24-48hr
> 6 mo, healthy + mildly ill: can wait 24-48 before Abx
if severe sx, >48h illness, perforation, or <6mo = start abx now
10 day course 6mo-2yrs
5 day course if 2 yr +
AOM complications
mastoiditis bacteremia meningitis cerebral abscess transient hearing loss, speech delay
meningitis presentation
infants:
fever, poor feeding, vomiting, lethargy, crying, sepsis, bulging fontanelle, petechae
additionally in kids:
headache, back/neck pain, photophobia, confusion, nuchal rigidity, focal neuro signs
CSF analysis in meningitis
WBC:
5-50,000 = bacterial
20-2000 = viral
protein
>0.6 = bacterial
>0.3 = viral
glucose
<2.8 = bacterial
<3.3 = viral
treatment for meningitis
empiric abx
maintain BP
manage ICP
monitor fluids + lytes (SIADH)
dexamethasone if Hib meningitis or pneumococcal in 6wk+ old – must give BEFORE antibiotics
prophylactic antibiotics for close contacts if Hib or N Meningitidis
impetigo
staph aureus, strep pyogenes
topics: mupirocin, fucidin
oral: cephalixin
if resistant: vanco
UTI - bacteria + treatment
e coli = 80%, klebsiella, enterococcus, P aerginosa
complicated: ill, <3mo, vomiting, immunocompromised = admit, IV amp + gentamycin
uncomplicated: amox-clav 7-10d
renal + bladder US in all kids after 1st UTI
voiding cystourethrogram if scarring, high grade reflux, obstruction, or recurrence
presentation of UTI
young: fever, poor feeding, vomiting, urine colour, lethargy, vague
older: fever, LUTS, macroscopic hematuria, suprapubic/fklan pain, foul urine smell
diagnosing UTI
suggestive urinalysis AND 50,000 CFU/ml on culture
pharyngitis DDx
GAS - 5-11yo, fever, tonilar hypertrophy/exudates, absence of cough/rhinitis, sandpaper rash, palate petechaie, strawberry tongue
viral - variable URTI sx, arthralgia, diarrhea, etc
EBV - last long, tonsil hypertrophy, LN, hepatoplnomegally
adeno - /w conjunctivitis
pharyngitis tx
viral - none
GAS - amoxicillin or pen V for 10 days
allergy - erythromycin
strep pharyngitis complications
acute rheumatic fever (valves, chorea, subQ nodules, fever)
acute glomerulonephritis
abscess / cellulaitis, deep neck space infection, otitis media, sinusitis, mastoiditis
durations of sinusitis
acute: 10-30d
subacute: 30-90d
chronic >90d
recurrent: 3x in 6mo or 4x in 12
sinusitis presentation
nasal congestion, purulent discharge, periorbital edema, ear/throat pain, halitosis, fever, fatigue
also headache, facial pain, tooth ache, hyposmia in older kids
w/u for sinusitis
no imaging routinely
CT only if worried re complications, persistent or recurrent, anticipated surgery
treatment for sinusitis
high dose amoxicillin x 14d
complications of sinusitis
periorbital + orbital cellulitis, osteomyelitis, subperiosteal orbital fissure syndrome, orbital apex syndrome
older; meningitis, brain abscess, cortical thrombophebitis, cavernous or sag sinus thrombosis
orbital cellulitis red flags
decreased EOM, proptosis, decreased visual acuity, RAPD, optic disc swelling
w/u + treatment for orbital cellulitis
CBC, diff
blood cultures
emergent orbital CT scan
tx: admit! ENT + optho +/- ID consults
IV cloxacillin + IV ceftriaxone, +/- clinda/metronidazole
+/- surgical drainage
orbital cellulitis complications
cavernous sinus thrombosis, meningitis, vision loss
periorbital cellulitis treatment
traumatic: IV cefazolin or PO cephalexin
non traumatic: IV ceftriaxone or PO amox-clav
consider admission if <5, unwell, no trauma preceding. Admit if <2, sickle cell, bacteremia.
When do to full septic w/u for fever without a source
- <1mo old no matter what
- sick/toxic
full septic workup
cbc + diff blood culture urine cultures, U/A, microscopy LP culture + analysis \+/- CXR, stool, NP viral swab +/- CRP
FWS in 1-3mo old, well-appearing
CBC, blood cultures
CRP
U/A + culture
+/- CXR, stool
LP only if unwell or WBC high or low
can either discharge /w 24h follow up or admit, +/- abx
