Infectious Disease CPS Flashcards
Which children are exempt from the CPS guideline around AOM treatment
< 6 months
Craniofacial abnormalities
Immunocompromising conditions
Tympanostomy tubes
Recurrent AOM
Most common bacterial causes of AOM (4)
Strep pneumo
H influenzae
M catarrhalis
GAS
Criteria needed to diagnose an AOM
Middle ear effusion**
Acute onset of symptoms
Inflammation of the middle ear
Bulging TM is most significant for bacterial AOM
Complications of bacterial AOM
Mastoiditis most common
Acute facial nerve palse
Labyrinthitis
Venous sinus thrombosis
Meningitis
Which children can have watchful waiting for their AOM
Mild or moderately bulging TMs
Mildly ill
Alert
Responding to antipyretics
Fever < 39
Mild otalgia
Drug of choice for AOM and dosing
Amoxicillin
75 to 90 mg/kg/day BID
45 to 60 mg/kg/day TID
When should you treat AOM with something other than amox? And what to use
AOM with purulent conjunctivitis suggests H flu or moraxella - give amox clav or cefuroxime
Treated with amox in past 30 days - give amox clav
Allergy to amox - give cefprozil, cefuroxime, 3rd gen cefalosporin, or macrolides if severe allergy
Duration of therapy for AOM
2 years or older = 5 days
< 3, recurrent AOM, perforated TM, failure of initial therapy = 10 days
Diseases to consider when a returned traveller has
JAUNDICE (5)
Hepatitis A, B, E
Viral hemorrhagic fever
Typhoid fever
Leptospirosis
Malaria
Diseases to consider when a returned traveller has
LYMPH NODE ENLARGEMENT (8)
EBV
CMV
HIV
Rickettsiae
Brucellosis
Mycobacterium TB
Visceral leishmaniasis
Trypanosomiasis
Diseases to consider when a returned traveller has
DIARRHEA (8)
Rotavirus
E coli
Shigella
Salmonella
Campylobacter
Yersinia
Giardia
Amebiasis
Diseases to consider when a returned traveller has
1. Hepatomegaly (3)
2. Splenomegaly (4)
- Hepatitis A, B, E, malaria, amebiasis
- EBV, typhoid fever, malaria, visceral leishmaniasis
Diseases to consider when a returned traveller has
HEMORRHAGIC RASH (4)
Dengue
Meningococcus
Rocky mountain spotted fever
Viral hemorrhagic fever
Which disease are you more likely to get from mosquitoes that bite in the
1. Night
2. Day
- Malaria (Anopheles)
- Dengue
Non specific symptoms of malaria
Fever, chills, headache, N/V/D, lethargy, myalgia, abdo pain
Incubation period of
1. Typhoid
2. Dengue
- 7 to 14 days
- 2 to 14 days
Presentation of typhoid (enteric) fever
Biphasic symptoms
Enterocolitis with diarrhea, then resolves
Fever, chills, rash, diaphoresis, headache, myalgias, confusion, psychosis, apathy
Symptoms of Dengue fever
High fever, chills, headache, myalgias, red reticulate rash over thorax/face/flexion areas
May see lymphocytosis, neutropenia, and elevated aminotransferases
3 symptoms of hemorrhagic dengue or shock syndrome
Hyponatremia
Hypoproteinemia
Circulatory collapse
3 suppurative complications of GAS
Peritonsillar abscess
Retropharngeal abscess
Sepsis
2 non suppurative complications of GAS
Post-strep glomerulonephritis
Acute rheumatic fever
Which complications of GAS does antibiotic treatment prevent?
Prevents suppurative complications and acute rhematic fever
Does NOT prevent post strep GN
JONES major criteria for Acute Rheumatic Fever
Joints: Polyarthritis
Carditis (clinical or subclinical)
Nodes: subcutaneous nodules
E: erythema marginatum
S: syndenham chorea
Need 2 major or 1 major and 2 minor to meet criteria
What rash is seen in acute rheumatic fever?
Erythema marginatum
Minor criteria of ARF
Fever > 38.5
ESR or CRP elevated
Prolonged PR interval
Symptoms of GAS pharyngitis (FACTS)
Fever > 38
Anterior cervical lymphadenopathy (tender)
Absence of cough and rhinorrhea
Inflamed or purulent tonsils
Moderate to severe sore throat
What age is strep throat most common in? Which age is it rare to see?
5-11 most common
Rare in children <3
CENTOR decision rule for GAS
For children 3-14 years
One point for each of: exudate or swollen tonsils, tender or swollen anterior cervical lymph nodes, fever, no cough
Score 3 or more = do a throat swab
What time frame do you need to treat strep throat to avoid complications
Within 9 days of symptom onset
Optimal treatment for strep throat
Penicillin or amoxicillin for 10 days
Can use macrolides if truly allergic but resistance up to 20%
Does GAS or viral pharyngitis respond faster?
GAS - should see rapid improvement in <24 hours
Viral takes 2-3 days
