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Neo Board Review MAP > Infectious Disease And Immunology > Flashcards

Infectious Disease And Immunology Flashcards

1
Q

Encapsulated organisms

A 
SHiNS
Salmonella
H. Influenzae
Neisseria
S. Pneumo
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2
Q

Which serotype of GBS is most often associated with late onset sepsis?

A

Type 3

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3
Q

Disorders associated with congenital asplenia

A

Ivemark
Pearson
Smith-Meyers-Fineman
Stormorken

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4
Q

Early onset sepsis preterm infants

A

Gram-negative organisms more likely

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5
Q

Early onset sepsis in term infants

A

Gram-positive organisms more likely

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6
Q

What can cause early pneumonia in a neonate?

A

Aspiration of infected amniotic fluid
Transplacental transmission (syphilis, listeria, TB)
MCC GBS

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7
Q

What can cause late pneumonia in a neonate?

A

Ventilator associated pneumonia (ET tube in place)
Previous bacteremia
Usually colonized with bad bugs - pneumococcus, S. aureus, S. pyogenes, H. influenzae, Enterobacter, pseudomonas

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8
Q

How do you diagnose pneumonia In a neonate?

A

Very difficult
Worsening respiratory status
Chest x-ray is not pathognomonic
Tracheal aspirates do not really change management

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9
Q

Diagnosis of meningitis in a neonate

A

Abnormal CSF count with neutrophy predominance, increase protein, low glucose
Enteric gram neg 30-40%

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10
Q

What percent of infants with GBS bacteremia also have meningitis?

A

5-10%

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11
Q

What percent of neonates with listeria bacteremia also have meningitis?

A

5-20%

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12
Q

What complication do you worry about if a neonate has Citrobacter meningitis?

A

Brain abscess

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13
Q

Are UTIs more common in male or female neonates?

A

Males

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14
Q

Pathogenesis of UTIs in neonates

A

Urinary tract abnormality 20-50%
Ascending or hematogenous from bacteremia
E. coli causes 80%

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15
Q

How long after infection are the bony changes associated with osteomyelitis typically detectable by x-ray?

A

7-10 days

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16
Q

Pathogenesis of osteomyelitis in neonates

A

Majority via hematogenous spread
Typically in the metaphyses of long bones (reduced rate of blood flow)
Caused by S. aureus**, E. coli, GBS (majority S. aureus)

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17
Q

What symptoms would make you suspect osteomyelitis in a neonate?

A

Pain with passive positional changes
Lack of extremity use
Joint/limb swelling

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18
Q

How do you treat osteomyelitis?

A

Vancomycin + Aminoglycoside or 3rd gen cephalosporin

4-6 weeks and resolution of inflammatory markers

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19
Q

Complications of osteomyelitis in neonates?

A

Growth plate damage
Avascular necrosis
Limb length discrepancies
Angular joint deformities

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20
Q

What type of conjunctivitis does erythromycin prophylaxis reduce?

A

Gonococcal not chlamydial

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21
Q

What special media is needed to isolate gonorrhea?

A

Thayer-Martin media

Sheeps blood +4 antibiotics

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22
Q

Gonococcal ophthalmia neonatorum

A

2-5 days of life
Profuse bilateral purulent discharge
Ophthalmic emergency - can lead to corneal ulceration/perforation
Treatment with IV ceftriaxone

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23
Q

 Chlamydial conjunctivitis

A

5-14 days of life
Begins as clear discharge and progresses to perulant
Treatment with 14 days of oral erythromycin

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24
Q

When does Chlamydia pneumonia Present?

A

2-8 weeks of life

Cough/congestion without fever

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25
Q

What percentage of neonates develop gonorrhea conjunctivitis if mother is infected?

A

30-40%

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26
Q

What percentage of neonates will develop chlamydial conjunctivitis if mother is infected?

A

20%

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27
Q

Which organism causing conjunctivitis is an obligate intracellular bacteria?

A

Chlamydia trachomatis

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28
Q

Which organism causing neonatal conjunctivitis is a gram-negative intracellular diplococcus?

A

Neisseria gonorrhea

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29
Q

What are symptoms of omphalitis?

A

Cellulitis - periumbilical erythema/induration, tenderness

Purulent drainage from umbilical stump

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30
Q

Pathogenesis of omphalitis

A

Dirty cord
Aggressive cord care disrupts barrier
S. Aureus, GAS, GBS, GN bacilli

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31
Q

Which serotype of group B strep causes meningitis?

A

Type 3

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32
Q

IAP prevents which type of GBS infection?

A

Early onset

No change in late onset

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33
Q

What Percentage of staph aureus infections in the NICU are methicillin-resistant?

A

25%

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34
Q

What kind of infections does S. Aureus cause in the NICU

A 
Osteomyelitis
Septic arthritis
Pneumonia
Bacteremia/meningitis
Skin and soft tissue infections (SSTIs)
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35
Q

What is the most frequent single organism isolated in late onset sepsis?

A

Coag negative staph

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36
Q

How does CONS infection present in neonates?

A 
Non-specific all the way to frank sepsis
Embolic phenomena
Line infections
Thrombi
Rarely meningitis
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37
Q

Which strain Of E. coli causes majority of meningitis?

A 
K1 strain (80%)
40% of sepsis
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38
Q

What bacteria can cause noma neonatorium?

A

Pseudomonas

Erosion of the gum/tongue, life-threatening

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39
Q

Which pathogens are primarily transmitted transplacentally?

A

Treponema pallidum
Mycobacterium tuberculosis
Listeria monocytogenes

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40
Q

What percentage of neonates will acquire syphilis if mother has untreated primary syphilis during pregnancy?

A

70-100%

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41
Q

In utero transmission of toxoplasmosis

A

Transmission increases with gestation

Disease is more severe at earlier gestational ages

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42
Q

In utero transmission of syphilis

A

Transmission can occur at any time during pregnancy

Disease is more severe at older gestational ages

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43
Q

In utero transmission of rubella

A

Transmission to fetus is most likely in early and late pregnancy (U-shaped distribution)
Disease is more severe at younger gestational ages

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44
Q

In utero transmission of CMV

A

Transmission can occur anytime during pregnancy

Disease is more severe at younger gestational ages

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45
Q

What is the most frequent presentation of late onset sepsis with listeria?

A

Meningitis

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46
Q

What is the most frequent presentation of early onset sepsis with listeria?

A

Pneumonia and sepsis

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47
Q

Immunoglobulin concentrations with age

A
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48
Q

Conjunctivitis in first 24 hours

A

Chemical following prophylaxis

Spontaneously resolves within 48 hours

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49
Q

Conjunctivitis at 24-48 hrs. of age

A 
S aureus - Golden crust around eyelids, MCC
GBS
H. influenzae - dacryocystitis
S. pneumo - dacryocystitis
Pseudomonas
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50
Q

Most frequent viral etiology of conjunctivitis?

A

HSV

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51
Q

Ocular complications of HSV

A

Conjunctivitis
Keratitis
Chorioretinitis
Retinal dysplasia

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52
Q

When does HSV conjunctivitis occur?

A

4 days to 3 weeks

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53
Q

Presumptive exclusion of HIV infection in neonates

A
  1. 2 neg HIV RNA/DNA from separate specimens both >2 weeks of age and 1 at least >4 weeks of age
  2. 1 neg HIV RNA/DNA >8 weeks of age
  3. 1 neg HIV antibody test >6 months of age
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54
Q

How to definitively rule out HIV infection in a neonate?

A
  1. 2 neg HIV RNA/DNA from separate specimens, both >1 month of age, 1 >4 months of age
  2. 2 negative HIV antibody tests from separate specimens >6 months of age
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55
Q

How can congenital tuberculosis infection occur?

A

Hematogenous spread across infected placenta
Aspiration of infected amniotic fluid
Ingestion of infected amniotic fluid

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56
Q

Treatment of congenital TB infection

A

Isoniazid
Rifampin
Pyrazinamide
Aminoglycoside

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57
Q

Initial drug of choice for neonatal candidal infections?

A

Amphotericin B

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58
Q

Why is liposomal amphotericin B not used in neonates?

A

Less penetrance into brain and kidney

Increased liver toxicity

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59
Q

Differences in neutrophils between neonates and adults

A

Neonatal neutrophils adhere poorly to endothelium
Neonatal neutrophils have impaired chemotactic response
Preterm neutrophils have a developmental defect in phagocytosis that corrects at term
Granule contents and degranulation response are similar to those in adults

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60
Q

Preterm infants have ____ B-lymphocyte numbers compared to term infants

A

Significantly lower

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61
Q

At birth the proportion of B cells is ____ to adults, but the absolute number of B cells is ____

A

Similar

Significantly higher

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62
Q

Which type of HSV is responsible for the majority of neonatal infections?

A

HSV 2

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63
Q

What is the most common route of HSV transmission during pregnancy?

A

Intrapartum 85%

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64
Q

Multinucled giant cells on Tzanck smear

A

HSV

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65
Q

Which form of congenital HSV is most common in neonates?

A

SEM 45%

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66
Q

Cluster of grapes on erythematous base

A

HSV

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67
Q

Ideal timing to perform HSV swabs after birth?

A

12-24 hrs

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68
Q

Can maternal RSV infection transmit to fetus?

A

No because There is no maternal viremia

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69
Q

What kind of virus is RSV?

A

ssRNA

70
Q

What kind of virus is HSV?

A

dsDNA

71
Q

Viruses causing severe/fulminant hepatitis

A

Enterovirus > Adenovirus > HSV > CMV

72
Q

What kind of virus is hepatitis B?

A

dsDNA

73
Q

Which antigen associated with HBV increases the risk of transmission?

A

HBeAG

74
Q

Timing of hepatitis B immunoglobulin

A

<2kg HBIG in 12 hrs

>2kg HBIG in 7 days

75
Q

What type of virus is hepatitis C virus?

A

ssRNA

76
Q

Risk of maternal fetal transmission of HCV?

A

5% if mom positive for hepatitis C at delivery

10-20% if HIV coninfected and HCV positive at delivery

77
Q

Diagnosis of neonatal HCV

A

PCR for HCV RNA at 1-2 months of life

Antibodies after 18 months

78
Q

What kind of virus is hepatitis A?

A

ssRNA

79
Q

What kind of virus is parvovirus B19?

A

ssDNA

80
Q

When is parvovirus B19 infectious?

A

Before rash onset

Non-infectious after rash appears

81
Q

When does maternal IgG appear during parvovirus infection?

A

Day two of rash, persist for life

82
Q

What kind of virus is varicella zoster?

A

dsDNA

83
Q

When is varicella contagious?

A

1-2 days before rash until all lesions crusted

84
Q

Congenital VZV

A

<1%
VZV infected mother during first 20 weeks of gestation
Microcephaly, chorioretinitis, intracranial calcification, scarred skin (cicatricial lesions)

85
Q

Perinatal VZV

A

Five days before and two days after delivery greatest risk
30% mortality rate due to disseminated varicella
Not enough time for antibodies to cross to fetus

86
Q

When to give VZIG or IVIG if VZV +

A

Premature <28 weeks regardless of maternal history
When mother develops disease 5d before - 2d after delivery
>28 weeks and mother has exposure without h/o disease

87
Q

What kind of virus is rubella?

A

ssRNA

88
Q

Precautions for congenital rubella syndrome

A

Droplet until seven days after onset of rash

Contact until one-year-old or 2 cultures obtained 1 month apart after 3 months of age are negative

89
Q

What type of virus is CMV?

A

dsDNA

90
Q

Intranuclear giant cells

A

CMV histology

91
Q

Treatment for symptomatic congenital CMV

A

Valganciclovir for 6 months (start before 1 month of age)

Improves developmental/auditory outcomes

92
Q

When are neonates tested for HIV?

A

If mother HIV +

48 hours, 14-21 days, 1-2 months, 4-6 months

93
Q

What type of virus is enterovirus?

A

ssRNA

94
Q

Examples of enteroviruses

A

Echovirus - sepsis-like, hepatic necrosis
Coxsackievirus - myocarditis (B)
Polio virus - IUFD

95
Q

What type of virus is influenza?

A

ssRNA

96
Q

Symptoms of congenital cutaneous candidiasis

A

Diffusely erythematous papular rash at birth

Can develop vesicles and bullae or look like a burn

97
Q

Risk factors for invasive candidiasis

A 
Extreme prematurity
>2 wks of age
Prolonged antibacterial treatment
NICU site
Empiric 3rd gen cephalosporin (x2 risk)
Central lines
Gut injury
H2 blockers, dexamethasone, ET tube
98
Q

Evaluation of babies with candidemia

A 
LP and culture
UA and culture
Neuroimaging
Eye exam
Ultrasound kidney/spleen/liver
Echo
99
Q

Most common species of Candida?

A

C. Albicans
Most pathogenic
Sensitive to Ampho B and fluconazole

100
Q

Second most common cause of candida?

A

C. Parapsilosis
20 to 35%
Decrease sensitivity to ampho B

101
Q

What percentage of neonates with invasive candidiasis have Meningoencephalitis?

A

More than 15%

102
Q

When to use fluconazole prophylaxis?

A

Facilities were risk of invasive candidiasis is >5% in VLBWs

103
Q

What maternal exposures lead to toxoplasmosis?

A

New kittens

Poorly cooked meat

104
Q

Treatment of congenital toxoplasmosis

A

Pyrimethamine
Sulfadiazine
Folinic acid

105
Q

What drug do you avoid in cases of botulism?

A

Aminoglycosides

Can increase neuromuscular blockade

106
Q

What can lead to neonatal tetanus?

A

Contamination of the umbilical cord

107
Q

Symptoms of neonatal tetanus

A

Stiffness, rigidity, spasms

108
Q

Symptoms of botulism

A

Symmetric, descending, flaccid paralysis

109
Q

Spore forming gram-positive rods that grow anaerobically

A

Clostridium tetani

Clostridium botulinum

110
Q

What does the tetanus toxin do?

A

Binds at neuromuscular junction and blocks GABA release

111
Q

Timing of neonatal tetanus infection

A

3-12 days of life

112
Q

Timing of botulism infection

A

3 weeks - 6 months

113
Q

Treatment of neonatal tetanus

A

Penicillin or metronidazole

You can give neuromuscular blocking agents

114
Q

What is granulomatosis Infantiseptica associated with?

A

Listeria infection

115
Q

 What type of bacteria is listeria?

A

Nonspore forming gram-positive rod

116
Q

What maternal exposures can lead to listeria infection?

A

Soft/raw cheese
Undercooked meats (bears, goat)
Salads

117
Q

Low ANC + high I/T ratio

A

Infection, autoimmune destruction

Increased production of immature forms with ongoing destruction of mature forms (not matched)

118
Q

Low ANC + low I/T ratio

A

Infection, PIH, SGA

Suppression of production with/without associated consumption

119
Q

Normal ANC + high I/T ratio

A

Infection, autoimmune state

Increase production of immature forms but ongoing destruction of mature forms (matched)

120
Q

Normal ANC + low I/T ratio

A

Normal

121
Q

What is the innate immune system

A

Performs nonspecific immune response
Acts within minutes of exposure
Includes barriers, inflammatory response factors, and cells

122
Q

Barriers of the innate immune system

A

Skin

G.I. and respiratory mucosa

123
Q

How does pathogen recognition occur?

A

Pathogen recognition receptors aka Toll-like receptors (TLRs)

124
Q

What inflammatory response mediators lead to vasodilation?

A

Histamine
Prostaglandin
Nitric oxide
Bradykinin

125
Q

What inflammatory response mediators lead to increased vascular permeability?

A 
Histamine
Complement
Bradykinin
Leukotrienes
Nitric oxide
126
Q

What inflammatory response mediators lead to leukocyte adhesion?

A

Cytokines
Complement
Eicosanoids (prostaglandins, leukotrienes)
Selectins

127
Q

What inflammatory response to mediators lead to chemotaxis?

A

Chemokines
Complement
Eicosanoids

128
Q

What inflammatory response mediators lead to fever?

A

IL-1
TNF-a
Prostaglandins

129
Q

What inflammatory response mediators lead to tissue necrosis?

A

Neutrophil granules

Free radicals

130
Q

What inflammatory response mediators lead to platelet aggregation?

A

Eicosanoids

131
Q

What are eicosanoids?

A

Prostaglandins

Leukotrienes

132
Q

What happens in the classical complement pathway?

A

Antigen antibody complexes are formed leading to complement activation

133
Q

What happens in the MB-lectin complement pathway?

A

Lectin binding to pathogen surfaces leading to complement activation

134
Q

What happens in the alternative complement pathway?

A

Complement binds directly to pathogen surfaces leading to complement activation

135
Q

Outcomes of complement activation

A

Recruitment of inflammatory cells
Opsonization of pathogens
Killing of pathogens

136
Q

Does complement cross the placenta?

A

No

137
Q

When do adult level/function of complement system develop?

A

6-18 months of age

138
Q

Genetics of chronic granulomatous disease

A 
X-linked recessive
Xp21.1
gp91phox
65-70% of cases
Deficient or absent function of NADPH oxidase
139
Q

Symptoms of chronic granulomatous disease

A

Severe, recurrent infections with catalase positive bacteria or fungi
Negative nitroblue tetrazolium test (remains colorless)

140
Q

Chediak-Higashi Syndrome

A

Abnormal degranulation
Albinism
Recurrent infections
Giant intracellular granules

141
Q

Monocytes in newborns

A

Poor cytokine production and antigen presentation in first year of life
Decreased migration

142
Q

Macrophages in neonates

A

Poor response to IFN-g

Decreased activation and migration

143
Q

What is the function of B cells?

A

Produce antibodies
Sometimes need T cell co-stimulation
Neonatal B cells differentiate into predominantly IgM secreting cells

144
Q

Immunoglobulin levels with age

A
145
Q

What is the only source of IgA initially in newborns?

A

Colostrum

146
Q

What are the functions of CD4 T cells?

A

Helper cells- coordinate immune system
Secrete cytokines
Stimulate besels to make IG
Activate macrophages

147
Q

What are CD4 T cells stimulated by?

A

Cytokines

Antigen presenting cells

148
Q

What do CD8 T cells do?

A

Release preforins, degradative enzymes, cytokines

Cytotoxic activity is limited in neonates

149
Q

When do Predominant antibody defects become more apparent?

A

After six months of age

150
Q

X-linked agammaglobulinemia

A

Profoundly diminished immunoglobulin levels
Tyrosine kinase mutation -> B cells can’t become mature
No plasma cells in G.I. tract
Normal T cell numbers

151
Q

Hyper IgM syndrome

A 
Low/absent IgG, IgA, IgE
Normal to elevated levels of IgM
Neutropenia
Perirectal abscesses
Oral ulcers
Infection with PCP, cryptosporidium, salmonella
Associated with congenital rubella
70% X-linked
152
Q

What antibodies are low in turner syndrome?

A

IgG and IgM

153
Q

What antibodies are low in trisomy 21 and trisomy 8?

A

IgG, IgM, and IgA

154
Q

Syndromes associated with defects in cell mediated immunity

A 
DiGeorge
Wiskott-Aldrich syndrome
Perinatal HIV infection
SCID
Ataxia telangiectasia
IPEX syndrome
155
Q

Symptoms of cell mediated immune disorders

A

Opportunistic infections
Macular erythematous rash
Hepatitis
Chronic diarrhea

156
Q

Symptoms of Wiskott-Aldrich syndrome

A

Eczema, thrombocytopenia, increased infections
Platelets small, defective, abnormally shaped
Decreased lymphocytes
Abnormal T cell function
Elevated IgA and IgE
Decreased IgM
Normal IgG

157
Q

Genetics of Wiskott-Aldrich syndrome

A

X-linked recessive
Xp11.23
WAS gene

158
Q

Genetics of SCID

A

X-linked -> due to defects in cellular signal transduction
Abnormal purine salvage pathway -> adenosine deaminase deficiency
Omenn syndrome (RAG1/2)

159
Q

Symptoms of SCID

A

Deficient antibodies and cell-mediated immunity
Diarrhea, pneumonia, otitis, sepsis, cutaneous infections
Eosinophilia
Graft versus host disease following blood transfusion

160
Q

Levels of T regulatory cells in neonates

A

High, especially in premature neonates

Decrease to adult levels by 3-6 years of age

161
Q

Metabolic disorders with neutropenia

A 
Isovaleric acidemia
Propionic acidemia
Methylmalonic acidemia
Glycogen storage disease 1B
Orotic aciduria
Hyperglycemia
162
Q

Syndromes causing congenital neutropenia

A 
Kostmann
Pure white cell aplasia
Reticular dysgenesis
Cartilage-hair hypoplasia
Hyper IgM syndrome
Shwachman-Diamond
Dyskeratosis congenita
163
Q

Genetics of IPEX syndrome

A

X linked

Forkhead box protein three mutation

164
Q

Symptoms of IPEX syndrome

A

Immunodysregulation, polyendocrinopathy, enteropathy (IPEX)
Impaired Treg suppressor function
Decreased IL-2 and IFN-g production
Severe watery diarrhea, FTT, dermatitis, type 1 DM
Increased IgE levels
Eosinophilia

165
Q

Electrolyte abnormalities with amphotericin B

A

Hypomagnesemia

Hypokalemia

166
Q

Placental findings with listeria infection?

A

Microabscesses

167
Q

Where are B cells produced in utero?

A

Start in liver at 8 weeks gestation

By 30 weeks solely produced in bone marrow

168
Q

Immune deficiency in patients with DiGeorge syndrome

A

Thymic hypoplasia and mild to moderate peripheral lymphopenia (CD3 cells especially)

169
Q

Leukocyte adhesion deficiency

A

Recurrent bacterial infections
Delete separation of umbilical cord
Neutrophilia

170
Q

What can be done to breastmilk to reduce CMV transmission?

A

Freezing

Pasteurization

Neo Board Review MAP (18 decks)

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