Infectious Disease Committee

Question 1

Men B Vaccine: what type of vaccine is it and who gets it?

Answer 1

It is a conjugate vaccine because the polysaccharide does not make a good response.

You are at risk for Men B if you are immunocompromised, you have asplenia, functional asplenia, complement deficiency or eculizimab (anti-complement)

Need 2-3 doses q 8 weeks.
If you receive it prior to 12 months then Booster q 3-5 years until 7 and then every 5 years after that.

Question 2

Rotavirus: Who is it contraindicated in and when is it given?

Answer 2

Given: 1st dose prior to 15 weeks; 2nd dose prior to 8 months

CI: Immunocompromised (live vaccine); previous history of intussuseption, anaphylaxis to any of the components.

Question 3

AOM: Statement pertains to what age?
Who is it safe to watch and wait? Who gets immediate antibiotics?
Length of Treatment

Answer 3

> 6 months of age. If there is perforation and purulent drainage, it is more likely to be a bacterial infection.
Immediately treat: Fever >39; Severe pain; moderate to severe unwell; Ill >48 hours

Length:
<2 years: 10 days
>2 years: 5 days

Question 4

Complications of AOM

Answer 4

Meningitis
Mastoiditis
6th nerve palsy
Sinus venous thrombosis 
Facial Nerve Palsy

Question 5

Palivuzumab - who qualifies? When is RSV Season

Answer 5

Season: November - March
Qualifying Children:
1. <1 years of age with CLD requiring ongoing therapy
2. <1 years of age with hemodynamically significant cardiac disease
3. Born at <31 weeks and are <6 months at the start of the season

Consider if:

1. Born <36 weeks and live in remote area
2. Inuit children <6 months of age
3. <24 months and high risk congenital syndrome or immunocompromised.

Question 6

Opthalmia neonatorium

What to do if mom is N. gonorrhea + or unknown.

Answer 6

All pregnant women should be screened for chlamydia and gonorrhea. If women are at risk, they should be screened in their third trimester or at delivery if they aren’t during 3rd.

N. Gonorrhea:
If mom’s status is unknown, she should be tested at the time of delivery. Tell about risks - baby looking unwell, eye crusting.
If unsure if parent will be compliant, then treat with IM Ceftriaxone (baby) prior to discharge

If mom POSITIVE (vaginal delivery or c/s) and untreated:
Baby needs to be treated right away and also have a swab. If the baby is unwell in anyway then they have the full work up including CSF.

Chlamydia: no routine cultures

Question 7

Asplenia: What are they at risk for developing?

Answer 7

PC SHiNE SKiS
Pneumococcus
crypto
Strep Pneumo
Hib
Neisseriea
Ecoli
Salmonella
Klebsiella
GBS

Question 8

Asplenia Prophylaxis

Answer 8

0-3 months of age: Clavulin or amoxicillin
3-5 years: Pen V or Amoxicillin
Can be life long, but at least needs to be 2 years post splenecomty and up to 5 years if asplenic secondary to sickle or other disease.

Question 9

HSV In pregnancy

Answer 9

The most common time for aquisition of disease is intrapartum (can be up to 75% chance of acquiring).
Scenarios of mom’s with HSV and treatment process:
Primary Infection (HSV 1 or 2): Biggest risk factor
- C/S AFTER rupture: MM swab at 24 hours (can NOT do before due to false negative) and initiate acyclovir. Await mom serologies. If Positive baby needs full work up including LP
- C/S no ruptuer: MM swab >24 hours

First episode but non primary (history of another type of HSV): Treat as if primary infection

Recurrent (will pass on to baby): mm swab >24 hours.

Question 10

HSV infections in newborn infants

Answer 10

Localized/ Skin Eyes and Mucous Membranes: 14 days
Disseminated: 21 days
CNS: 21 days at least and need repeat LP

Question 11

Needle Stick Injuries in Community

Answer 11

Risk of obtaining Hep B, Hep C and HIV
Management: Always clean the wound first with soap and water and do NOT squeeze out blood.
Determine vaccination status of Tetanus and Hep B.
Testing for HIV, Hep B and Hep C baseline. Do not require testing of the needle, as likely to be negative, but does not mean it is actually negative.
Hep B:
Known immune: no further treatment
Not fully immunized: Test HbAb and HbAg - if not available in 48 hours give HBIG and vaccine
If Fully vaccinated: Still test, because if HbAb negative, but HbAg + then they are infected and need further follow up.

HIV: If high risk and think you need prophylaxis, it is best to start within 1-4 hours (MAX would be 72 hours later).
Medium risk: 2 meds
High risk: 3 meds
Duration: 28 days.
Recheck antibody at 6 weeks, 3 months and 6 months.

HCV: no prophyalxis, check Hep C antibody at time of injury, 3 months and 6 months.

Question 12

Treatment of Uncomplicated Pneumonia

Answer 12

Non Severe: Amoxicillin
Non Severe + atypical features: Clarithro or azithro
Severe: Cefriaxone + macrolide
Pneumatocele present - vancomycin

Treatment: 7-10 days

Question 13

Lyme Disease: Stages of Disease

Answer 13

There are three stages to disease.
Stage 1: Classic Targetoid lesion rash. Patient is otherwise assymptomatic, and this will usually resolve by about 4 weeks.
Stage 2: Early disseminated disease: Migratory rash and nerve palsies
Stage 3: Big joint arthritis

Question 14

Jarish Herxhemier reaction

Answer 14

When you first start treatment and you have fever, headache, myalgias

Question 15

Treatment for Lyme Disease

Answer 15

Doxycycline (in children >8 years of age)
Amoxicillin
Cefuroxime
IV: Ceftriaxone

Question 16

5 Steps to working with vaccine hesitant parents

Answer 16

Talk about Canada's Vaccine Safety System
Do not dimiss from your clinic 
Stay on about the same message 
Understand ther specific concerns
address pain concerns

Question 17

Community Acquired MRSA Abscess Treatment

Answer 17

<1 month: Drain and Vacno (if looking okay then can think about vanco)
1-3 months: Drain and Septra (pending cultures)
>3 momths: Drain and observe.

Question 18

False Negative Results in TB

Answer 18

Children < 3 months
Immunocompromised
Active/Disseminated TB
Live Virus Vaccine
Immuno Drugs
Metabolic Disease

Question 19

False Positive Results in TB

Answer 19

BCG

Another Mycobacterium

Question 20

Postive TST

Answer 20

0-4 mm: Age < 5; highest risk individuals
5-9mm: All others
>10 mm: Conversion, DM, Malnutrition, Hematological malignancy

Question 21

Acute Otitis Externa

Answer 21

Diagnosis of Acute Otitis Externa:
Risk factors include: swimming, wearing a tight headscarf, trauma, foreign body in the ear, hearing aids, chronic ottorhea
Diagnosis:
1. Rapid onset (usually within 48 hours) in the past 3 weeks AND
2. Symptoms of ear canal inflammation (+/- hearing loss and jaw pain) AND
3. Signs of ear canal inflammation - tender tragus, pinna or both OR diffuse ear canal edema +/- otorrhea, regional lymphadenitis

Organisms that cause this: Pseud, Staph, polymicrobial, gram negatives and if you have DM then aspergillus or Candida
Treatment: Mild to Moderate: Cipro drops +/- steroids for 7-10 days; Adequate pain control and aural toileting and wick therapy to facilitate
Severe: systemic antibiotics that will cover S. aureus and P aeruginosa

Should usually see a response within 48-72 hours; can be up to 6 days. If you do not see a response then you think of obstruction, foreign body, non adherance to therapy or another diagnosis.

Question 22

Malignant Otitis Externa

Answer 22

Malignant OE: An invasive infection of the cartilage and bone of the canal and external ear with may present with facial nerve palsy and pain. Risk factors include immunocompromised patients and patients with insulin dependent diabetes.
Treatment: CT or MRI to confirm; aggressive debridement and Systemic antibiotics that target Pseud and aspergillosis.

Question 23

Antifungals in Outpatient Setting

a. Oropharyngeal Candidiase
b. Diaper Dermatitis
c. Pitarysis and Tinea Versicolor (organism)
d. Tinea Corporis
e. Tinea Pedis
f. Tinea Capitus
g. Sebhorrheic Dermatitis

Answer 23

Oropharyngeal Candidiasis: 5-10%
Recommended therapies: Oral Nystatin; Second Line: Fluc or Itraconazole if previous therapy does not work; Gentcian Violet. First generation imidazoles (clotrimazole) is not recommended.

Candida Diaper Dermatitis:
Treatment: Change diapers frequently, leave the diaper off for periods of time, topical antifungal (Clotrimazole, nystatin). No clear evidence for oral, or low dose steroids.

Pitarysis and Tinea Versicolor: Malassezia Furfur
Pitarysis rosea: a mild or chronic condition with scaling hypo or hyperpigmented lesions on the trunk. Usually occur in teens with hyper active sebaceous glands. Can be treated with antihistamines if needed; can also treat with topical ketoconazole, clotrimazole nightly for 1-2 weeks. You then treat for once a month for 3 months to avoid recurrence.

Tinea Corporis (body lice): superficial circular infection that is not covered with hair (ie the body). Treatment: Topical imidazoles or Azole (ketoconozole), or terbinafine. No steroids.

Tinea Pedis (Athletes Foot): Treatment: Topical antifungals, dyring agents and good foot hygeine. If there is an infection in the toe then you can use oral antifungal.

Tinea Capitis: Oral terbinifine (lamisil) along with topical therapy.

Seborrhic Dermatitis and Pityriasis Capitis (cradle cap): caused by Malazzia (similar to pitarysis and tinea versicolor). Treatment: Mild soaps and shampoos that contain selenium sulfide or an azole

Question 24

HIV Exposed Infants

Diagnosis

Answer 24

PCR is gold standard at 14-21 days, 1-2 months and 4-6 months.
If there are two or more negatives than the infant is negative.

Treatment:

a. If mom HIV +, on antiretrovirals but >1000 Viral load: C/S and AZT for baby
b. Unknown mom: Needs rapid test. If + then mom and baby on prophylaxis.

Baby Prophylaxis:
a. Mom on meds: AZT x 6 weeks
b. No meds for Mom: AZT x 6 weeks + Neveripine for 1 week.
PCP prophylaxis at 4-6 weeks check up unless HIV negative.