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RC Study Cards > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Name 3 risk factors for oral candidiasis

A
  1. Prematurity (systemic)
  2. Broad-spectrum antibiotic treatment
  3. Use of a soother
  4. Inhaled glucocorticoids
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2
Q

What age is safe to use clotrimazole troches (lozenges) for oral candidiasis?

A

≥3 years

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3
Q

What is the recommended treatment for oral candidiasis?

A

Nystatin 100,000 units/mL 1-4 mL q6h x 7-14 days

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4
Q

What is the most common superficial dermatophyte infection in paediatrics?

A

Tinea capitis

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5
Q

Name 2 treatments for tinea capitis

A
  • 1st line: Terbinafine PO x 4-6 wks
  • 2nd line: Fluconazole
  • PO Adjuncts:
    • Ketoconazole 2% or selenium sulfide 1% shampoo 2-3 times weekly to lower carriage of viable fungal elements
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6
Q

What 2 situations should prompt an ID referral for tinea capitis?

A
  1. Living in immigrant populations
  2. Exposed to infected household pets/farm animals
  3. Immunodeficiency or immune system compromise
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7
Q

Name a risk factor for dermatophyte infections

A
  1. Trisomy 21
  2. Immune system compromise
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8
Q

Name a complication seen with Azoles (fluconazole/itraconazole)

A
  1. Hepatic toxicity
  2. Drug interactions
    • Azithromycin: Prolonged QT
    • ↑toxicity w/ immunosuppressive agents, chemo, phenytoin, midazolam
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9
Q

How should you treat pityriasis/tinea versicolor?

A
  1. Topical antifungals:
    • 2% ketoconazole, 2.5% selenium sulfide lotion or 1% selenium sulfide shampoo
    • Apply for 15-30min to affected area nightly x 1-2wks, then q1mo x 3mo to avoid recurrence
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10
Q

What is the most common etiology of tinea capitis in North America?

A

Trichophyton tonsurans

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11
Q

Name 5 risk factors for community-acquired MRSA

A
  1. Close skin-to-skin contact
  2. Openings in skin, such as cuts or abrasions
  3. Contaminated items and surfaces
  4. Crowded living conditions (military recruits, prisoners)
  5. Poor hygiene
  6. Lower socioeconomic status
  7. Limited access to health care
  8. Participation in activities that result in abraded or compromised skin surfaces (IVDU, athletes, MSM)
  9. Indigenous population
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12
Q

Why are Indigenous people at increased risk of CA-MRSA?

A
  1. Household crowding (hard to separate personal items, maintain clean environment and personal hygiene)
  2. Lack of piped potable water (hard to maintain personal and environmental hygiene)
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13
Q

List 3 complications of CA-MRSA

A
  1. Osteomyelitis
  2. Septic arthritis
  3. Sepsis
  4. Pneumonia
  5. Necrotizing fasciitis
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14
Q

What is the treatment for a <1mo for CA-MRSA?

A
  1. Incision and Drainage
  2. IV Vancomycin x 7d
  3. If reliable, well with no fever, outpatient management with PO Clindamycin x 7d
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15
Q

What is the treatment for 1-3mo for CA-MRSA?

A
  1. Incision and Drainage
  2. If well w/no fever:
    • TMP/SMX x 7d; otherwise
    • IV Vancomycin
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16
Q

What is the treatment for ≥3mo for CA-MRSA?

A
  1. Incision and Drainage
  2. If well w/no fever: Observation
  3. If no improvement or another pathogen on culture: Treat.
  4. If significant surrounding cellulitis only (no fever/well):
    • PO TMP/SMX + Cephalexin
    • Systemic symptoms +/- fever:
      • IV Vancomycin
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17
Q

List 5 recommendations to prevent spread of CA-MRSA.

A
  1. Keep wound covered w/clean, dry bandage (if unable, exclude from contact sports or child care until drainage stops or healed)
  2. Dispose of used dressings in plastic-lined garbage container with sealed lid immediately after removed
  3. Use proper hand hygiene before and after changing dressings
  4. Avoid sharing personal items, especially towels, bedding, clothing and bar soap
  5. Bathing regularly and washing clothing and bedding often
  6. Regular cleaning of contact surfaces in the home with standard household cleaner/detergent
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18
Q

What causes Lyme disease and how is it transmitted?

A
  • Caused by Borrelia burgdorferi.
  • Transmitted by Ixodes scapularis (central/eastern Canada) and Ixodes pacificus (BC)
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19
Q

What time frame is Lyme disease usually preventable?

A

If tick removed within 24-36h after starting to feed.

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20
Q

When should post-exposure prophylaxis be provided for Lyme Disease? With what?

A
  1. If tick is engorged and has been attached for ≥36h (within 72h of removal)
  2. Known endemic areas:
    • Doxycycline 200mg (or 4.4mg/kg) x 1 dose
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21
Q

How is erythema migrans diagnosed and treated?

A
  • Clinical Diagnosis
  • Treatment is either:
    • Doxycycline BID x 10 days
    • Amoxicillin TID x 14 days
    • If beta-lactam allergy: Cefuroxime BID x 14 days
      • If unable to take: Azithromycin OD x 7 days
22
Q

When does erythema migrans appear?

A

Usually 7-14 days after bite (3-30 days is possible)

23
Q

List 3 examples of Late Lyme Disease

A
  1. Arthritis 2. Facial nerve palsy 3. Heart Block (carditis) 4. Meningitis 5. Peripheral neuropathy (rare) 6. CNS manifestations (rare)
24
Q

What is the most common late Lyme disease presentation?

A

Arthritis (pauciarticular, large joints [esp. knees])

25
Q

What testing should you order for Lyme disease with late presentation?

A

ELISA IgM/IgG followed by Western blot IgM/IgG If CSF: IgM/IgG antibodies

26
Q

False positives are seen with ELISA testing for Lyme disease in what populations?

A
  1. Autoimmune disorders (SLE)
  2. Viral infections
  3. Spirochetes
27
Q

How long do you treat arthritis, facial nerve palsy, heart block and meningitis with Lyme Disease?

A
  • Arthritis: 28d
  • Facial nerve palsy, heart block + meningitis: 14d
28
Q

You just started treatment for Lyme disease. The patient suddenly develops a headache and myalgias. What is this called and how do you treat it?

A

Jarisch-Herxheimer reaction

Stop antibiotics.

Give NSAIDs

29
Q

6 months after treating Lyme Disease, your patient continues to have fatigue, myalgias and arthralgias.

What is this called?

Should you prescribe another course of antibiotics?

A

Post-treatment Lyme Disease Syndrome (PTLDS)

Can linger for ≥6mo.

Does not improve with antibiotics.

30
Q

List 3 ways to prevent Lyme Disease.

A
  1. 20-30% DEET or icaridin repellant
  2. “Full body” check for ticks everyday. Remove any found on yourself, children or pets.
  3. Shower or bathe within 2h of being outdoors to wash off unattached ticks
  4. Landscaping where play spaces adjoin wooded areas
31
Q

What causes scabies?

A

Sarcoptes scabiei

32
Q

List 5 risk factors for scabies infestation.

A
  1. Young 2. Elderly 3. Immunocompromised 4. Developmentally delayed 5. Overcrowding/bed0sharing 6. Malnutrition 7. Reduced access to health care
33
Q

What is the treatment for scabies for children ≤3mo?

A
  • Sulphur 8-10% precipitated in petroleum jelly.
  • Applied daily x 3 days.
  • Decontamination of all bedding/clothing worn next to skin (hot cycle washer + dryer).
    • If unable to wash, plastic bag x 5-7 days
34
Q

What is the treatment for scabies for children >3mo?

A
  • Permethrin 5% lotion or cream.
    • Applied to skin from neck to toes overnight, wash off in the morning.
    • Repeat treatment in 7 days.
  • Decontamination of all bedding/clothing worn next to skin (hot cycle washer + dryer).
    • If unable to wash, plastic bag x 5-7 days
35
Q

When can children return to day care/school after a scabies infestation diagnosis?

A

After their first treatment

36
Q

What is the first line treatment of lice infestation?

What is the mechanism of action?

A

Permethrin 1% or pyrethrins (≥2mo) Neurotoxic to lice Decontamination by washing items in close/prolonged contact with head (pillowcases, hats, brushes and combs) in hot water ≥66˚C or dry in hot dryer for 15min or store in sealed plastic bag x 2 weeks

37
Q

If 2 treatments of permethrin 1% is not effective for lice, what is recommended?

A
  • Rule out misdiagnosis or overdiagnosis or reinfestation.
  • Treat with different class, such as:
    • Resultz (≥4yo) (dissolves exoskeleton → dehydration and death) or
    • NYDA (≥2yo) (silicone oil flows into the breathing system to suffocate)
  • Decontamination by washing items in close/prolonged contact with head (pillowcases, hats, brushes and combs) in hot water ≥66˚C or dry in hot dryer for 15min or store in sealed plastic bag x 2 weeks
38
Q

What is a management strategy for residual itch/burning after lice treatment?

A

Topical corticosteroid or antihistamines

39
Q

How long should children be kept home from school/day care after lice diagnosis?

A
  • No exclusion required.
  • Recommend full course of treatment and avoid head-to-head activities.
40
Q

Name 4 methods to practice antimicrobial stewardship.

A
  1. Treat infection, not contamination
  2. Narrow the spectrum of antimicrobials when causative organism is identified
  3. Optimize the dosing of antimicrobials to obtain maximal benefit
  4. Use shortest recommended course of therapy for uncomplicated infections
  5. Take care not to change or prolong antimicrobial therapy unnecessarily
  6. Promote vaccinations to reduce the likelihood of clinical disease
  7. Laboratories should produce local, age-specific antibiograms to guide antibiotic choices for selected infections
  8. Take a careful history of potential antibiotic side effects and, if possible, confirm an antimicrobial allergy
41
Q

Name 3 outcome goals for antimicrobial stewardship.

A
  1. Optimize therapy
  2. Minimize risk of adverse events
  3. Optimizing patient outcomes
42
Q

What are the indications for VariZIG?

What is a contraindication?

A

Should be administered within 96 hours of most recent significant exposure to varicella disease (but can be given up to 10 days after)

  1. Susceptible pregnant women
  2. Newborn infants of mothers who develop varicella during 5 days before to 48h after delivery
  3. Susceptible immunocompromised individuals (post-HSCT, HIV with CD4 <200 or <15%, high dose CS ≥2 weeks)
  4. NICU exposure within the first few weeks of life: <28wks GA or <1000g

Contraindication: IgA deficiency

Incubation period is 21 days

43
Q

What is the rate of vertical transmission with no prophylaxis?

If treatment during pregnancy?

When does the majority of vertical transmission of HIV occur?

A

25%

<2%

44
Q

List 5 risk factors for HIV in pregnancy

A
  1. IV drug use
  2. Late or no prenatal care
  3. Recent illness suggestive of HIV seroconversion
  4. Regular unprotected sex with partner known to be living with HIV (or at significant risk for it)
  5. Diagnosis of STI during pregnancy
  6. Emigration from HIV-endemic area
  7. Recent incarceration
45
Q

When should an infant be tested for HIV when born to an HIV positive mother? With what test?

When should prophylaxis be started?

What short term effects should be monitored?

Long-term?

A

Immediately (within 48h)

HIV DNA or RNA PCR

  • No breastfeeding - contraindicated
  • Consult paediatric ID with expertise in HIV

Immediately: Within 72h post-delivery (AZT or combination ART)

Short term: neutropenia, anemia

Long-term: Neurodevelopment, growth, general health

46
Q

What test should be conducted for all infants in foster care and adoptees whose birth mother’s HIV status is not known?

A
47
Q
A
48
Q

List 2 risk factors for invasive GAS.

A
  1. Recent pharyngitis
  2. Varicella
  3. Recent soft tissue trauma
  4. NSAID use
49
Q

List 4 infections that are considered invasive GAS.

List 4 non-severe GAS infections

A

Invasive GAS

  1. ​Meningitis
  2. Necrotizing fasciitis
  3. Streptococcal Toxic Shock Syndrome
  4. Pneumonia (if pleural fluid positive)
  5. Any other life-threatening condition or infection resulting in death

Non-severe GAS

  1. Osteomyelitis
  2. Cellulitis
  3. Bacteremia
  4. Lymphadenitis
  5. Septic arthritis
  6. Soft tissue abscess
50
Q

What is the diagnostic criteria for Streptococcal Toxic Shock Syndrome?

A

Must have HYPOTENSION + ≥2 of:

Renal impairment (Cr 2X ULN or 2X baseline)

Coagulopathy (plt ≤100 or DIC)

Liver function abnormality (AST or ALT ≥2X ULN)

ARDS

Generalized erythematous macular rash (may later desquamate)

51
Q

Define Congenital varicella vs Neonatal varicella

A

Congenital varicella:

  • If maternal infection in 1st or 2nd trimester:
    • Limb hypoplasia
    • CNS damage (microcephaly, seizures, dev delay)
    • Scarring of skin
    • Ophtho abnormalities (chorioretinitis, microphthalmia, cataracts)

Neonatal varicella:

  • occurs if maternal infection within 5 days prior to or 2 days post delivery
  • give VZIG
  • if infant has lesions, treat with IV Acyclovir 10mg/kg q8h
  • can be life-threatening
52
Q

When should you provide prophylaxis for Hib and with what drug?

A

Recommend for:

  • All members in households:
    • With at least one contact < 4 years of age who is unimmunized or incompletely immunized
    • With a child < 12 months who has not received the primary series
    • Immunocompromised child, regardless of Hib immunization status
  • Child care settings:
    • If one case of invasive Hib disease has occurred, then prophylax all incompletely or unimmunized children < 4 years
    • If 2+ cases of invasive Hib disease within 60 days and unimmunized or incompletely immunized children attend the facility, chemoprophylaxis for all attendees and childcare providers should be considered.

Use Rifampin:

  • ASAP - most secondary occur during the first week of index hospitalized case
  • Initiation of prophylaxis more than 7 days after hospitalization may still be beneficial

RC Study Cards (20 decks)

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