Infectious Disease in kid Flashcards
Congenital syphilis early manifestations
Jaundice: anemia maculopapular rash (palms of soles) lymphadenopathy rhinitis chorioretinitis hepatosplenomegaly Osteochondritis congenital nephrosis
Late manifestations of congenital syphilis
saber skins keratitis Hutchinson teeth saddle nose deafness
mc predisposing factor for acute bacterial sinusitis
Viral URI
Complications of sinusitis
orbital cellulitis w/ intracranial extension
First line Rx for acute bacterial sinusitis
amoxicillin plus Clavulanic acid
Herpangina is what
Coxsackie A virus
typical age of herpangina and what season
3-10 yrs
Summer/early fall
C/F of herpangina
Fever, pharyngitis
gray vesicles/ulcers on posterior oropharynx
Rx of herpangina
supportive management
Herpetic gingivostomatitis is what? age?
HSV1
6 months to 5 yrs
HSV1 C/F
fever, pharyngitis
Erythematous gingiva
clusters of small vesicles on anterior oropharynx/lips
Rx herpetic ging….
acyclovir
Stept pyogenes c/f in pharyngitis
fever, pharyngitis
tender anterior cervical LAD
tonsillar exudates!
2 year old kid has comes in with respiratory distress, hypotensive, 37.7C, coughing, 98% saturation RX with o2. DX is laryngotracheobronchitis, he begins to decline and 92% sat with 40RPM….
whats the next step?
Give racemic epinephrine in cases of croup before intubation
Epi: acts by a adrenergic(reduce bronchial secretions/ mucosal edema) and beta adrenergic (relax smooth muscle)
Immunizations in kids should be given according to
chronological age
Standard Inactivated (killed) Pediatric vaccine (2)
Polio
Hep A
Standard Toxoid (inactivated toxin) Ped vaccine (2)
Diptheria
tetanus
Standard Subunit/conjugate Peds Vaccine (7)
Hep B Pertussis Haemophilus Influenzae type b Pneumococcal Meningococcal HPV Influenza (injection)
Live attenuated standard ped immunization (4)
Rotavirus
MMR
Varicella
Influenza (nasal)
Preterm newborn is good to receive vaccines according to (1) but one exception (2)
- chronologic age
2. weight should be above 2 kg before 1st hep b vaccine
Neonatal tetanus general onset
Onset w/in first 2 weeks
Neonatal tetatnus signs and symptoms
poor suckling and fatigue
followed by rigidity, spasms and opisthotonus
Mortality in tetanus is due to
1st week: apnea
2nd week: septicemia
Child with painful non-itchy pustules and honey crusted lesions
Non-bullous Impetigo
Child with Rapidly enlarging flaccid bullae with yellow fluid; “collarette” of scale at the periphery of ruptured lesions
Bullous Impetigo
Treatment of Impetigo
Non-bullous: topical antibiotic: mupirocin
Bullous: oral anti: cephalexin, dicloxacillin, or clindamycin
Impetigo cause
S. Aureus (both)
S. pyogenes(non- bullous)
Epiglottitis classic presentation
High grade fever
sudden-onset resperiratory distress
dysphagia and drooling
Stridor (tripoding- leaning forward)
Rx of acute epiglottitis
OR- endotracheal intubation
unsucceful- Emergency tracheotomy
Differentiate btw periorbital and orbital cellulitis
Periorbital is before the orbital Septum; Orbital cellulitis:
- Opthalmoplegia,
- Pain w/ mvt
- Proptosis
- vision impairments
Anterior uveitis c/f
Red eye, pain and blurry vision
also Pupil defects, corneal precipitates and leukocytes
Causes of anterior uveitis
trauma
infection
AI disease
rx orbital cellulitis
IV antibiotics to cover s. aureus
may require drainage
Conjunctivits C/f
inflammation of conjunctiva: erythema, exudate
No proptosis, pain w/ mvt, or vision loss
Congenital Toxoplasmosis (7)
Hydrocephalus, microcephaly chorioretinitis Intracranial calcifications hepatomegaly diffuse LAD jaundice diffuse petechiae
risk of transmission during pregnancy increase as pregnancy progresses but severity of…
neonatal disease decreases
Congenital syphilis C/F (6)
intermittent fever osteitis osteochondritis mucocutaneous lesions LAD hepatomegaly persistent rhinitis
Congenital rubella (3ish)
Oko, ucho i serducho Congenital glaucoma sensorineural deafness cardiac anomalies(PDA, ASD) microcephaly, microphthalmia, meningoencephalitis
Congenital Herpes (3)
encephalitis
chorioretinits
disseminated disease
Neonatal conjunctivitis: first 24 hrs
Chemical prob from Silver nitrate
Rx: supportive management
Neonatal conjunctivits day 2-5
Gonococcal
Gonoccocal conjunctivitis findings
Marked eyelid swelling/exudates
Profuse purulent discharge
Gonococcal conjunctivitis Rx
IV or IM ceftriaxone or cefotaxime
Nenatal conjunctivitis day 5-15
Chlamydial infection
Chlamydial conjunctivitis C/F
Mild to moderate swelling of eyelids
thickened, injected conjunctivae (chemosis)
Watery or mucopurulent eye discharge
Blood stained eye discharge is highly characteristic
Conjunctival pseudomembrane
Rx chlamydial conjunctivitis
oral erythromycin
only macrolide used for chlamydial conjunctivitis
Risk of infant who recieves oral erythromycin
infantile hypertrophic pyloric stenosis
three stages of Pertussis
and what are the C/F in them?
Catarrhal : 1-2 wks -mild cough, rhinitis Paraxysmal: 2-6 wks - coughing paraxyms w/ inspiratory "whoop" -posttussive emesis - apnea, cyanosis (infant) Convalescent (wks-months) -symptoms resolve gradually
Rx pertussis
Macrolides
vaccine
Complications of Pertussis
Pneumonia weight loss subconjunctival hemorrhages pneumothorax RF death (infants)
Tinea Corporis or ringworm in kids Rx
Topical Antifungals
Ringworm C/f
erythematous, scaly, pruritic lesion
Red ring w/ central clearing
Ringworm exposure
infected animals, people, and public places
Cellulitis C/F
painful, erythematous, and indurated
Not scaly or itchy
Cellulitis Rx
IV antistaphylococcal antibioitic
Nafcillin
Erysipelas
Begins small erythematous patch
then red, indurated, tense and shiny plaqes
Presence of a raised, sharply demarcated margin is classic
may have LAD indicating lymphatic involvement
Mom right before birth is Dx with Hep B; kid delivered what do you do?
Give Hep B IG and Hep B vaccine
If mom has HBeAG negative or positive? risk for kids to develop chronic hepatitis
negative 20%
positive: 90%
Cystic fibrosis related pneumonia gram-negative rod
Pseudomonas Aeruginosa
burkholderia cepacia complex
stenotrophomonas maltophilia
Cystic fibrosis pneumo gram neg coccobacilli
nontypeable H.influenzae
CF pneumonia gram positive cocci in chains
Strept pneumoniae
CF pneumonia gram+ cocci in clusters
Staphylococcus aureus
Rabies clinical features
Encephalitic: Hydrophobia Aerophobia Pharyngeal spasm, spastic paralysis Agitation Paralytic: ascending flaccid paralysis
Rx of Rabies
Rabies immune globulin and rabies vaccine
Enterobius vermicularis
pinworm Rx
Albendazole or pyrantel pamoate
for patient and all household contacts (highly contagious)
Chagas disease Rx
trypanosoma cruzi
Benznidazole or nifurtimox
Stronygloidiasis: uritacaria, abd pain, resp problems
Rx?
Ivermectin
Scarlet fever C/F
Initial: Fever, chills, toxicity, abd pain, pharyngitis
12-48 hrs: rash neck, axillae, groin and generalizes w/in 24 hrs
Rash in scarlet fever
punctate or finely papular texture: Sandpaper like
Pharynx in scarlet fever
erythematous, swollen, possibly gray-white exudates
mouth:circumoral pallor
Rx: of Scarlet fever
DOC: Penicillin V
allergy: erythromycin, clindamycin, 1st gen cephalosporin
Viral symptoms in pharyngitis
Cough, rhinorrhea, conjunctivitis, oral ulcers
MC organisms for acute bacterial rhinosinusitis (3)
S. pneumoniae 30%
H. influenzae 30%
Moraxella Catarrhalis 10%
dacryostenosis
nasolacrimal duct obstruction
newborn: chronic tearing often unilateral
rx: massage gently
Lyme Disease rx in kid
Oral amoxicillin or cefuroxime
kids
MC organism for osteomyelitis in infants and children
Both: S. Aureus MC
Infants: GBS + E.coli
Children: S.pyogenes
cat bite kid, Rx w/?
Amoxicillin/clavulanate
worried about pasteurella multocida: cellulitis
Waterhouse-friderichsen syndrom is characterized by
sudden vasomotor collapse
Skin rash: purpura + petechiae
Due to adrenal hemorrhage
Viral meningitis in kids, organisms
90% enteroviruses: echovirus, coxsackievirus
Pertussis prophylaxis in family with child sick
Prescirbe a macrolide antibiotic for household contacts
age1 month: azitho 5 days; clarithryo 7xdays; erythro 14xdays
erythromycin in neonate is assoc with
pyloric stenosis
Pertussis sick child should be on antibiotics therapy for (1) days and what else
5 days
respiratory isolation for first 5 days with antibioitics
kept at home
infants
Lymph node becomes tender, erythematous and becomes enlarged (3-6 cm in size); Dx?
lymphadenitis
Mc pathogen for lymphadenitis
- S. aureus
2. GAS
Unilateral subacute-chronic LADl kid
Nontuberculous mycobateria lymphadenitis
acute unilateral lymphadenitis; older child with periodontal disease; dx?
peptostreptococcus lymphadenitis
anaerobic bacteria
mcc of neonatal jaundice are (4)
breastfeeding jaundice
breast milk jaundice
hematologic conditions
sepsis
Acute Otitis media pathogens
S. Pneumo
Nontypeable H.influenzae
Moraxella catarrhalis
AOM c/f
Acute onset
middle ear effusion
bulging tympanic membrane
AOM rx:
Initial: Amoxicillin- 10 days
2nd: Amox + clavulanic acid
Amox allergy: azithryomycin
Complications of AOM
Conductive hearing loss
mastoiditis
meningitis
Recurrnet AOM despite appropraite anitbiotic rx; do what next
Tympanocentesis and culture during myringotmy w/ tympanostomy tube placement
Laryngeal inflammation that results in hoarseness, barkin cough, varing degrees of respiratory distress over time; lateral xray subglottic narrowing, Dx?
Croup
Parainfluenza virus
Long term sequelae assoc w/ bacterial meningitis (5)
Hearing loss Loss of cognitive function(neuronal loss in dentate gyrus of hippocampus) Seizures Mental Retardation Spasticity or paresis
Edema, erythema and thick otorrhea, significan pain of outer ear, conductive hearing loss
preauricular nodes; Dx?
Otitis externa
Rx Otitis externa
topical otic preparations+/- steroids
Otitis externa pathogens
mc: P.aeruginosa
2nd mc: S.aureus
Rx of acute mastoiditis
Myringotomy and IV antibiotics
cyst like growth w/in middle ear r temporal bone; lined by keratinized stratified squamous epithelium; malodorous discharge
Acquired cholesteatoma
Rx cholesteatoma
Tympanomastoid surgery
Dx sinusitis (3)
Nonspecific complaints: nasal congestion, discharge, fever, cough
Persistent URI symptoms w/ou improvement for at least 10 days
Purulent discharge and fever (at least 102) for 3 consecutive days
Asymptomatic, scattered erythematous macules, papules and pustules throughout the body (spares palms/soles)
Erythema toxicum neonatorum
Rx: none
low grade Fever, postauricular adenopathy, conjunctivitis, LAD, fine truncal rash starts at forehead and moves down, patchy erythema on soft palate; Dx?
Togavirus: Rubella
High fevers up to 40C (104), coryza, malaise, rash spread gradually includes hand and feet, reddishbrown, conjunctivitis; Dx?
paramyxovirus: Measles
Follicular conjunctivitis and pannus (neovascularization) formation in the cornea, inflamed eye; Dx?
Trachoma; Chlamydia trachomatis infection
HSV keratitis c/f
Pain, photophobia, decreased vision
Dendritic ulcer MC presentation
minute clear vesicles in corneal epithelium
C/I for DTaP vaccine
Immediate anaphylaxis
unstable neuro disorders
encephalopathy w/in a wk of administration
post-antibiotic rash is
typically polymorphous and maculopapular
Inability to extend the neck and widened prevertebral space suggest a dx of
Retropharyngeal abscess
RPA organisms
polymicrobial:
S.pyogenes
S.aureus
anaerobes
RPA antimicrobial rx
Ampicillin-sulbactam and clindamycin
If not working: Vanco and Linezolid
Also surgical drainage of course
Congenital CMV
IUGR Periventricular calcification Chorioretinitis Microcephaly Hepatosplenomegaly, jaundice Thrombocytopenia- petechiae
which antibiotic is used to prevent vertical transmission of toxoplasmos from mother to fetus?
spiramycin
macrolide concentrates in placenta
Congenital VZV
zig zag skin lesions microphthalmia: small eyes extremity hypoplasia cataracts chorioretinits
