Infectious Diseases Flashcards
Name risk factors for acute otitis media
Young age, craniofacial abnormalities (cleft palate), frequent contact with other children, household crowding, exposure to cigarette smoke, pacifier use, shorter duration of breastfeeding, prolonged bottle feeding while lying down, FHx of otitis media, children of First Nations/Inuit
What are the four common bacteria associated with AOM?
S. pneumoniae, H. influenza, M. catarrhalis and GAS
What is the most common complication of AOM?
Acute mastoiditis (facial nerve palsy, cranial nerve VI palsy, and labyrinthitis can also be seen)
A 2 year old child presents with a mild fever, mildly bulging TM and mild otalgia presents to your clinic. What is your management?
Observation for 24 to 48 hours with planned reassessment
An 11 month old presents with the complaint of a 2 day history of persistent high fevers, fussiness and a finding of a bulging TM on physical exam. What is your management?
Treatment with Amoxicillin 45-60mg/kg/d divided TID or 75mg/kg/d-90mg/kg/d divided BID for 10 days
An 18 month old presents with fever, purulent conjunctivitis, and a bulging TM on PEx. What is your management?
Amoxicillin-Clavulin 7:1 formulation of 45mg/kg/d to 60mg/kg/d divided TID for 10 days
What are the major pathogens seen in meningitis past age 2 months?
Neisseria meningiditis, strep pneumoniae, haemophilus influenzae and group B strep
What are the empiric antibiotics that should be used to cover infants 2 months and older with potential meningitis?
Ceftriaxone and Vancomycin
- Ceftriaxone covers Neisseria, haemophilus and GBS. Vancomycin covers resistent strep pneumo
If an infant has meningitis caused by haemophilus, who in the family should receive chemoprophylaxis?
Hib chemoprophylaxis to all occupants of contact household with infants < 12 months old (who have not completed the primary Hib immunization series), children <4 years old who are incompletely immunized or immunocompromised children at any age
When and at what dose should dexamethasone be administered for suspected meningitis in those over 2 months? What is the evidence for steroids?
Dexamethasone at 0.6mg/kg/d divided in four doses given every 6 hours, with the first dose immediately before, with or within 4 hours of the first dose of antibiotics.
- Empiric steroids administered just before or within 2 hours of antimicrobials, showed reduction in severe hearing loss in those with Hib meningitis
- Dexamethasone should be considered for infants and children with meningitis when CSF gram stain testing shows gram-negative coccobacilli consistent with H influenzae
- If Hib is subsequently identified by molecular testing or cultured within 48h, steroids should be continued for a total duration of 4 days. When Hib has not been positively identified within 48 hours, steroids should be discontinued
What is the recommended duration of antibiotic treatment for strep pneumoniae, haemophilus influenzae and Neisseria meningitidis and GBS meningitis?
Meningitis due to S pneumoniae is 10 to 14 days, due to Hib is 7 to 10 days and due to N meningitidis is 5 to 7 days.
For uncomplicated GBS meningitis, 14 to 21 days is recommended. Will be longer if cerebritis or ventriculitis is present
What factors influence the transmission of HSV infection to newborns?
The type of maternal infection, the mode of delivery, the duration of ROM and if there was intrapartum instrumentation
What are the features of in utero HSV infection?
Skin lesions or scars, CNS disorders and chorioretinitis
For women recurrent genital HSV, what is the prophylaxis regimen?
Acyclovir or Valacylovir from 36 weeks gestational age to birth.
When does HSV infection tend to present and what are the subtypes of infection?
Neonatal HSV tends to present within the first 4 weeks, but can be up to 6 weeks and includes disseminated HSV, localized CNS HSV and skin, eye and mucous membrane infection
