Infectious Diseases Flashcards

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1
Q

Name risk factors for acute otitis media

A

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

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2
Q

What are the four common bacteria associated with AOM?

A

S. pneumoniae, H. influenza, M. catarrhalis and GAS

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3
Q

What is the most common complication of AOM?

A

Acute mastoiditis (facial nerve palsy, cranial nerve VI palsy, and labyrinthitis can also be seen)

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4
Q

A 2 year old child presents with a mild fever, mildly bulging TM and mild otalgia presents to your clinic. What is your management?

A

Observation for 24 to 48 hours with planned reassessment

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5
Q

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?

A

Treatment with Amoxicillin 45-60mg/kg/d divided TID or 75mg/kg/d-90mg/kg/d divided BID for 10 days

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6
Q

An 18 month old presents with fever, purulent conjunctivitis, and a bulging TM on PEx. What is your management?

A

Amoxicillin-Clavulin 7:1 formulation of 45mg/kg/d to 60mg/kg/d divided TID for 10 days

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7
Q

What are the major pathogens seen in meningitis past age 2 months?

A

Neisseria meningiditis, strep pneumoniae, haemophilus influenzae and group B strep

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8
Q

What are the empiric antibiotics that should be used to cover infants 2 months and older with potential meningitis?

A

Ceftriaxone and Vancomycin

- Ceftriaxone covers Neisseria, haemophilus and GBS. Vancomycin covers resistent strep pneumo

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9
Q

If an infant has meningitis caused by haemophilus, who in the family should receive chemoprophylaxis?

A

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

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10
Q

When and at what dose should dexamethasone be administered for suspected meningitis in those over 2 months? What is the evidence for steroids?

A

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
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11
Q

What is the recommended duration of antibiotic treatment for strep pneumoniae, haemophilus influenzae and Neisseria meningitidis and GBS meningitis?

A

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

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12
Q

What factors influence the transmission of HSV infection to newborns?

A

The type of maternal infection, the mode of delivery, the duration of ROM and if there was intrapartum instrumentation

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13
Q

What are the features of in utero HSV infection?

A

Skin lesions or scars, CNS disorders and chorioretinitis

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14
Q

For women recurrent genital HSV, what is the prophylaxis regimen?

A

Acyclovir or Valacylovir from 36 weeks gestational age to birth.

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15
Q

When does HSV infection tend to present and what are the subtypes of infection?

A

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

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16
Q

What is the recommended treatment and length of treatment for NHSV? What is the potential side effect of the treatment?

A

Acyclovir 60mg/kg/d divided q8h (if renal function normal) and 14 days if is skin, eye and mucous membrane infection and 21 days if it is CNS or disseminated infection.
Acyclovir can cause neutropenia and is nephrotoxic so ensure adequate hydration.

17
Q

In a first clinical episode of genital HSV, after the infant is born what should be done?

A

Mucous membrane swabs should be obtained and Acyclovir started. If the mucous membrane swabs or blood PCR is positive, CSF PCR must be obtained to determine duration of therapy. If the swabs are negative, 10 days of Acyclovir should be given.

18
Q

In recurrent HSV at delivery when the infant is delivered vaginally, what should be done?

A

Obtain mucous membrane swabs at 24 hours and discharge home. If the swabs come back positive, blood and CSF PCR should be done to determine length of therapy. If negative, watchful close observation with no Acyclovir therapy.

19
Q

Name the congenital infections

A

CHEAP TORCHES
(Chicken pox, Hepatitis B, C, E, Enterovirus, AIDS, Parvovirus B19, Toxoplasmosis, Other (Zika, etc), Rubella, CMV, HSV, Every other STD, Syphillis

20
Q

Name the bacteria most likely to cause a pneumatocele in pneumonia

A

Staph aureus

Kids with hypotonia/neurologically inappropriate more likely to aspirate staph aureus

21
Q

Name the most common bacteria seen in pneumonia

A

Strep pneumo, mycoplasma pneumoniae, Haemophilus influenzae, staph aureus (less common) and chlamydophilia

22
Q

Treatment for uncomplicated lobar pneumonia

A

Amoxicillin for outpatient, Ampicillin for inpatient

23
Q

Treatment for moderately ill child with pneumonia

A

Ceftriaxone

24
Q

Treatment for atypical pneumonia

A

Azithromycin

25
Q

What disease has been associated with the rotavirus vaccine?

A

Intussusception

26
Q

What type of Vaccine is Rotavirus?

A

Live, oral vaccine that is given at 2,4 and 6 months

27
Q

Management of c. difficile infection

A
  1. Stop antibiotic if is cause and close follow up
  2. For mild/mod disease and no improvement after stop abx - Metronidazole PO 30mg/kg for 10-14d
  3. Severe disease - Vanco PO 40mg/kg for 10-14d (if have systemic symptoms of fever, unwell, etc.)
  4. Very severe disease - can add on IV Metronidazole 30mg/kg

DO not test of cure! As can always be colonized