Infectious Diseases (13 -15 ques, High Priority)

Question 1

Pertussis (aka Whooping Cough)

Answer 1

• bacterial / respiratory tract
• sticky mucous / spasmodic cough can last for weeks/months
• resp distress/anoxia w/cyanosis & loss of consciousness can occur
• monitor neuro
• have suction & ambu bag at bedside
• contact & droplet precautions for 5 days after abx started
• tx = antibiotics (erythromycin, azithromycin, clarithromycin)
• prophylaxis for close & household contacts
• immunity from vaccine diminishes over time ==> Tdap boosters for 11-12 yo and 13-18 yo who missed booster

Question 2

Varicella (aka Chicken Pox)

Answer 2

Airborne & contact
Contagious 1-2 days before rash & until scabs are crusted/healed
Incubation: 10-21 days from exposure

Symptoms: URI, fever, malaise

• pruritic rash appears initially on trunk
• lesions’ stages: red papules –> vesicles w/red base –> crusts

Intervention: keep nails short / lukewarm oatmeal baths / antipyretics / antihistamine / hydration

Question 3

Varicella interventions for HIGH RISK GROUPS

Answer 3

Give varicella-zoster immune globulin (VariZIG) asap (w/in 10 days of exposure)

Question 4

Common complications of Varicella

Answer 4

• Secondary bacterial infection (abscess, cellulitis, sepsis)
• Shingles - can transmit chicken pox from contact w/shingles lesions, but can’t “catch” shingles

Question 5

Mononucleosis (Epstein-Barr Virus)

Answer 5

• acute, self-limiting viral infection
• transmitted via direct contact w/oropharyngeal secretions
• most common <25 yo

Dx - positive Monospot test
- malaise / sore throat / fever / lymphadenopathy
- SPLENOMEGALY - for ~3 weeks after – activity restrictions
- HEPATOMEGALY
Tx - acetaminophen / throat remedies / activity restrictions

Question 6

Tuberculosis (TB)

Answer 6

Spread thru air when infected person coughs or sneezes
Normally, prolonged exposure to an infected person needed

2 ways to screen:

1. tuberculin skin test - read test 48-72 hrs after
   - positive = area of induration (raised), not red
   - DOES NOT CONFIRM ACTIVE DISEASE
   - if + further testing & treatment required
2. X-ray & sputum culture
   - if negative = infected; treated w/Isoniazid (INH)
   - if positive = disease; INH, rifampin, ethambutol * pyrazinamide

Most children w/ TB are NOT contagious

Question 7

Fifth Disease

Answer 7

caused by: human parvovirus B19
Droplet precautions
S/S - red facial rash (“slapped face”); extremity rash starts 1 day after face rash; lasts 1 or more weeks

Tx - comfort; analgesics; keep finger nails short; lukewarm oatmeal baths

Question 8

Hand-Foot-and-Mouth Disease

Answer 8

Viral - really contagious
Most common in kids <5 yo
Droplet & contact

S/S - fever, poor appetite, malaise, & sore throat
1-2 days later – painful mouth ulcers
1-2 days later – skin rash w/flat or raised red spots & blister on palms of hands

Tx - supportive care

Question 9

Lyme Disease

Answer 9

• bacterial illness spread by tick bites
  3 Phases
  1. Early localized: bulls eye rash w/burning & warm – start abx
  2. Early disseminated: heart & nervous system
  3. Late disease: motor & sensory nerve damage; brain inflammation

Tx - PO doxycycline, amoxicillin, cefuroxime
Outcome: diagnosed early (w/bull’s eye rash) & tx w/abx, typically resolves w/in 1-2 weeks; no long term consequences

Question 10

Bacterial Conjunctivitis (Pink Eye)

Answer 10

Assm’t: itching/burning; purulent d/c; lids stick together when wake up

Intervention: abx ointment or drops

• stay home from school for 24 hours after starting abx
• warm compress
• infection control – wash hands, no sharing of linens

Question 11

Methicillin-Resistant Staphylococcus aureus (MRSA)

Answer 11

Community-associated, hospital acquired
Contact
Assm’t - pimple-like red bumps that turn to redness, swelling, pain, pus
Intervention - cover lesions w/dry bandage
- avoid sharing personal items
- child may attend school w/covered
- disinfect gym equipment & mats between uses
Treatment - drainage &/or abx