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CPS Statement > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

H influenza b is now relatively uncommon in Canada, except in which groups of children?

A
  • unimmunized
  • partially immunized
  • child new to Canada
  • immunocompromised
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2
Q

How do the symptoms of meningitis differ between infants and children/adolescents?

A
  • Infants: more non-specific findings, absence of nuchal rigidity
  • Children/Adolescents: more likely to have specific symptoms (headache, nuchal pain/rigidity, impaired LOC)
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3
Q

List 4 contraindications to lumpar puncture

A
  1. Coagulopathy
  2. Cutaneous lesions at the proposed puncture site
  3. Signs of herniation
  4. Clinical instability (ie. shock)
  5. Focal neurological defects (unless head imaging normal)
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4
Q

List two potential complications of acute meningitis

A
  1. SIADH

2. Increased ICP

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5
Q

What are the bacterial organisms most likely to cause meningitis in patients older than 1 month?

A
  1. Strep pneumoniae
  2. N meningitidis
  3. GBS/E coli (only in infants
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6
Q

When should steroids be used in the management of acute meningitis?

A
  • when there are no other contraindications to steroid use, for patient suspected to have meningitis of bacterial aetiology
  • to be given before, concomitant with or within 30 minutes after the administration of the first dose of antibiotics.
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7
Q

What are the minimum durations of therapy for meningitis caused by S. pneumo, H influenza b, N meningitidis, GBS, respectively

A
  • S. pneumo = 10-14 days
  • H influenza b = 7-10 days
  • N meningitidis = 5-7 days
  • GBS = 14-21 days
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8
Q

What are the types of maternal genital HSV cases?

A
  • First episode primary infection (mother has no serum antibodies to HSV 1 or 2), newly acquired
  • First episode non primary infection (mother has serum antibodies to the opposite type of HSV than she is infected with), newly acquired
  • Recurrent infection (mother has pre-existing antibodies to the HSV type with which she is infected.
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9
Q

Which type of maternal genital HSV infection holds the highest risk of transmission to infant?

A
  • First episode primary infection (followed by First episode non primary infection, followed by low risk from Recurrent)
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10
Q

What are ways in which risk of transmission of HSV can be decreased when mother is known to have genital HSV infection?

A
  • elective C/S
  • prophylaxis with acyclovir/valacyclovir from 36 weeks onwards until delivery
  • avoidance of using scalp sampling/monitoring, forceps/vaccums
  • avoidance of PROM
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11
Q

How are perinatal/natal/postnatal HSV infections in the infant classified?

A
  • Skin, eyes, mucous membrane (SEM) infection
  • Localized CNS HSV
  • Disseminated HSV
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12
Q

What clinical features would raise suspicion of neonatal HSV infection?

A
  • unwell infant
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13
Q

List the different types of tests used to detect HSV

A
  1. Viral cultures (oropharynx, nasopharynx, skin lesions, mucous membranes swabs, rectal swabs, blood buffy coat and CSF)
  2. PCR testing (CSF, skin lesions, mucous membranes, blood)
  3. Direct immunofluorescent antibody staining of skin lesions
  4. Enzyme immunoassays for HSV antigens in skin lesions
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14
Q

What is the gold standard diagnostic method for HSV outside the CNS?

A
  • viral culture
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15
Q

What is the gold standard diagnostic method for HSV in the CNS?

A
  • PCR
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16
Q

What are the durations of therapy for treating SEM disease, CNS disease and disseminated disease with HSV, respectively?

A
  • SEM disease = 14 days
  • CNS disease = minimum 21 days
  • Disseminated disease = minimum 21 days
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17
Q

Follow-up for infants infected with HSV should include what?

A
  • neurodevelopment
  • vision/opthalmologic complications
  • hearing/audiologic complications
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18
Q

How is an infant born to a mother with suspected first-episode genital HSV via C/S with no rupture of membranes managed?

A
  • mucous membrane swabs

- +/- PCR of blood

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19
Q

How is an infant born to a mother with suspected first-episode genital HSV via C/S with membranes ruptured pre-delivery managed?

A
  • mucous membrane swabs

- IV acyclovir x 10 days

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20
Q

How is an infant born to a mother with suspected first-episode genital HSV via vaginal delivery managed?

A
  • mucous membrane swabs

- IV acyclovir x 10 days

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21
Q

How is an infant with positive HSV mucous membrane swabs managed?

A
  • Admit
  • Obtain CSF and blood for HSV PCR
  • Obtain liver enzyme levels
  • Treatment duration of 14 days for SEM, 21 days for disseminated or CNS infection
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22
Q

How is an infant born to a mother with recurrent genital HSV via vaginal delivery managed?

A
  • Mucous membrane swabs at 24 hours

- Treat only if positive

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23
Q

How is an infant born to a mother with recurrent genital HSV via C/S managed?

A
  • Mucous membrane swabs at 24 hours

- Treat only if positive

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24
Q

Which infants with neonatal HSV infection should receive suppressive therapy with oral acyclovir?

A
  • infants with localized CNS HSV (not as effective for SEM or disseminated disease, but could still be offered)
  • duration 6 months
  • monitor CBC, BUN, Cr monthly while on acyclovir
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25
Q

What causes a child to have absent or defective splenic function?

A
  • congenital anatomical absence of spleen
  • surgical removal of spleen (or part of spleen)
  • medical conditions that result in poor or absent splenic function (ie. SCD, thalassemia major, hereditary spherocytosis)
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26
Q

List the types of infectious agents that asplenic/hyposplenic patients are at most risk of?

A
  • encapsulated bacteria*
  • S. pneumoniae
  • N. meningitidis
  • H. influenzae
  • Salmonella species
  • E. coli
  • Pseudomonas, Klebsiella, streptococci, staphylococci (less common)
  • Capnocytophaga species (dog/cat bites)
  • malaria
  • Babesia
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27
Q

In addition to the regular childhood and adolescent immunizations, what additional immunizations should asplenic/hyposplenic patients receive?

A
  • 23-valent pneumococcal vaccine
  • quadrivalent meningococcal vaccine (serotypes ACWY), + coverage for serotype B
  • H influenzae b
  • Seasonal influenza vaccine
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28
Q

What type of prophylaxis is recommended for asplenic/hyposplenic patients age 0-3 months?

A
  • Amoxicillin/clavulanate BID + Pen VK BID
    or
  • Amoxicillin BID
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29
Q

What type of prophylaxis is recommended for asplenic/hyposplenic patients age 3 months to 5 years?

A
  • Penicillin VK BID
    or
  • Amoxicillin BID
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30
Q

What type of prophylaxis is recommended for asplenic/hyposplenic patients older than 5 years old?

A
  • Penicillin VK BID
    or
  • Amoxicillin BID
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31
Q

What is the recommended duration of antibiotic prophylaxis for children with asplenia/hyposplenia?

A
  • minimum 2 years post-splenectomy
  • minimum 5 first years of life
  • ideally recommended as lifelong prophylaxis
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32
Q

What antibiotic should be administered to a febrile child with asplenia/hyposplenia?

A
  • Ceftriaxone (after blood cultures)
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33
Q

What ophthalmologic complications occur in gonococcal ophtalmia?

A
  • corneal ulceration
  • perforation of the clone
  • permanent visual impairment
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34
Q

For an asymptomatic infant exposed to gonorrhoea during delivery, what is the recommended management?

A
  • culture eyes

- give Ceftriaxone x1 dose

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35
Q

For a symptomatic infant exposed to gonorrhoea during delivery, what is the recommended management?

A
  • FSWU, start Ceftriaxone
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36
Q

For an asymptomatic infant who is suspected to have been exposed to gonorrhoea during delivery, what is the recommended management?

A
  • good education and follow-up instructions

- if in doubt of adequate follow-up, can administer Ceftriaxone x1 prophylactically

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37
Q

For an asymptomatic infant exposed to chlamydia during delivery, what is the recommended management?

A
  • monitor and treat only if symptomatic and eye culture positive
  • no regular eye cultures recommended
  • no prophylactic antibiotics recommended
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38
Q

What is antimicrobial stewardship defined by?

A
  • interventions geared toward: 1) optimizing prescribing of antimicrobials, 2) appropriate selection/dosing/route/duration of antimicrobial therapy, 3) optimizing patient outcomes, 4) decreasing adverse events related to antimicrobial therapy
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39
Q

What are the benefits of antimicrobial stewardship?

A

1) decreased risk of antimicrobial-resistant bacteria
2) decreased incidence of C diff gastrointestinal infections
3) decreased adverse events related to antimicrobial use
4) decreased super infections related to antimicrobial use
5) cost savings associated with lowering antimicrobial use

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40
Q

The principles of antimicrobial stewardship (ie. watchful waiting, narrow spectrum antimicrobials) may not apply to which groups of patients?

A
  • immunosuppressed patients
  • asplenic/hyposplenic patients
  • patients with congenital immunodeficiency syndromes
  • newborns with suspected infection
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41
Q

What are non-pharmacological methods of preventing RSV infections?

A
  • avoiding direct contact with other children with URTIs, especially during RSV season
  • good hand hygiene at home
  • breastfeeding (inconsistent data)
  • avoidance of cigarette smoke (inconsistent data)
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42
Q

In Canada, most RSV programs offer palivizumab to which groups of children?

A
  • infants with chronic lung disease

- infants with hemodynamically significant congenital heart disease who are

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43
Q

Which is the most common bacterial agent causing pneumonia?

A

Strep pneumoniae

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44
Q

What are the two most common clinical signs of pneumonia?

A
  • Fever

- Tachypnea

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45
Q

What is the prominent radiographic pattern in bacterial pneumonia? Viral? Atypical?

A

Bacterial: lobar consolidations with air bronchograms
Viral: poorly defined patches of infiltrates or atelectasis
Atypical: bilateral focal or interstitial infiltrates that appear more extensive than the clinical symptoms

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46
Q

When should NP swabs be sent in patients with pneumonia?

A

In all patients admitted to hospital with pneumonia during influenza season, as antiviral are likely to be of benefit for influenza pneumonia

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47
Q

List investigations for an uncomplicated bacterial pneumonia

A
  • CXR
  • CBC w/ diff
  • Blood culture
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48
Q

List the indications for hospitalization of a patient with pneumonia

A
  • Inadequate oral intake
  • Intolerance of oral therapy
  • Severe illness
  • Respiratory compromise
  • Complicated pneumonia
  • Higher threshold for infants
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49
Q

What is the outpatient and inpatient antibiotic choice for uncomplicated bacterial pneumonia?

A
  • Outpatient: Amoxicillin po

- Inpatient: Ampicillin IV

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50
Q

In a toxic patient presenting with pneumonia, what is the empiric choice of antibiotics?

A
  • Ceftriaxone/Cefotaxime

- +/- Vancomycin (add if rapidly progressing multi lobar disease or pneumatoceles)

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51
Q

In a patient with atypical pneumonia, what is the treatment regime?

A
  • Most children actually resolve on their own

- If not, Azithromycin x 5 days

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52
Q

What is the prognosis for uncomplicated bacterial pneumonia?

A
  • Should improve within 48 hours of starting antibiotics
  • CXR changes may persist for 4-6 weeks
  • No repeat CXR required to confirm clearance
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53
Q

List reasons for lack of clinical resolution in a bacterial pneumonia

A
  • Foreign body aspiration
  • Reactive airways disease with atelectasis
  • Congenital pulmonary anomaly
  • Tuberculosis
  • Unrecognized immunodeficiency with an opportunistic infection
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54
Q

List the modes of acquiring various infectious diseases for a patient undergoing an organ transplantation

A
  • the endogenous reactivation of latent pathogens
  • transmission from donated organ/tissue
  • transmission from within the community or health care setting
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55
Q

What is the time interval between administering an inactivated vaccine and transplantation?

A
  • more than 2 weeks
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56
Q

What is the minimal interval between the last dose of a live vaccine and onset of immune suppression

A
  • 4 weeks
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57
Q

What types of infections occur in the first month post-transplant

A
  • 95% similar to infections incurred by nonimmunosuppressed patient swho have undergone a comparable surgical procedure
  • remaining: infection that was present in recipient before transplantation, or infection transmitted by allograft
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58
Q

What types of infections occur in the 1-6months post transplant period?

A
  • Opportunistic infections
  • Viral pathogens (CMV, EBV, HHV6, HepB, HepC)
  • Listeria, aspergillus, pneumocystis jirovecii
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59
Q

What types of infections occur >6 months post-transplant

A
  • Well-maintained immunosuppression: same community-acquired infections as health children
  • Poorer post-transplant outcomes: high risk for recurrent infections, opportunistic infections
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60
Q

When is it safe to vaccinate a patient post-transplant

A
  • None for 6-12months (except annual influenza vaccine - vaccinate no earlier than 1 months post-transplant)
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61
Q

List vaccines that are contraindicated in post-transplant, immunosuppressed patients

A 
measles
mumps
rubella
varicella
rotavirus
BCG
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62
Q

Which vaccines are indicated in post-transplant patients

A
  • pneumococcal vaccines
  • meningococcal vaccines (conjugate MCV should be used instead of polysaccharide vaccine)
  • HPV vaccine
  • HepA/HepB
  • Inactivated polio, Hib, diphtheria, tetanus, acellular pertussis
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63
Q

Who should receive the annual influenza vaccination?

A
  • All children and youth >6 months of age
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64
Q

Which individuals are at high risk for influenza infection?

A
  • Children 65yo
  • All aboriginal peoples
  • All residents of chronic care facilities
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65
Q

What are the contraindications to influenza vaccine?

A
  • Guillain Barre within 6 weeks of influenza vaccination in past
  • Anaphylaxis to inflenza vaccination in past
  • Live attenuated influenza vaccine (LAIV) is contraindicated in those with egg-allergies, immunocompromised, severe asthmatics, pregnant women and those on ASA (aged 2-17yo)
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66
Q

Which strains of HPV in the HPV vaccine protect against cervical cancer? against genital warts?

A
  • Cervical cancer: 16 & 18

- Genital Warts: 6 & 11

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67
Q

List risk factors for HPV infection

A
  • increased number of sexual partners
  • early age of first intercourse
  • never being married
  • never being pregnant
  • immunosuppression
  • STIs
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68
Q

What is the schedule for the HPV vaccine?

A

Administer to all girls 9-13yo
0, 2, 6 months
Contraindicated in pregnant women

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69
Q

What are the most common pathogens in the setting of complicated pediatric pneumonia in an immunocompetent host?

A
  • S. pneumonia
  • S. aureus
  • S. pyogenes (GAS)
  • MRSA
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70
Q

When should drainage of empyema be considered?

A
  • in a patient with moderate to severe respiratory distress
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71
Q

What empiric regimen of antibiotics should be considered for a patient with complicated pneumonia?

A
  • Cefotaxime/Ceftriaxone +/- Clinda (anaerobe coverage) or Vanco (MRSA coverage)
  • Duration 3-4 weeks
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72
Q

When should a patient with complicated pneumonia be transitioned to oral antibiotics?

A
  • when no further drainage of empyema
  • when afebrile
  • when off O2
  • When clinical improving
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73
Q

When should a CXR be repeated following a complicated pneumonia?

A
  • 2-3 months after to ensure resolution
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74
Q

By what age do most boys have retractile foreskin?

A

17yo

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75
Q

List potential benefits of neonatal circumcision

A
  • decreasing risk of UTI in high risk infants (ie. those with recurrent UTI, high grade VUR, obstructive uropathy)
  • decreased risk of HIV, HPV, HSV
  • small decrease risk of squamous cell carcinoma of penis
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76
Q

List potential risks of circumcision

A
  • Acute complications: minor bleeding, local infection, pain, unsatisfactory cosmetic result
  • Severe complications: partial amputation of penis, death from hemorrhage, death from sepsis
  • Most common late complication: metal stenosis, which may require surgical dilatation (prevent with vaseline x6 months to glans)
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77
Q

List the contraindications to neonatal circumcision

A
  • hypospadias

- bleeding diathesis

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78
Q

When should gloves be worn in office settings?

A
  1. If anticipating direct hand contact with blood, body fluids, secretions or excretions, or items contaminated with these.
  2. Direct hand contact with mucous membranes or non intact skin
  3. Direct hand contact with the patient when the health care worker has open lesions on the hands
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79
Q

All office personnel should be immune to which viruses>

A
  • measles
  • mumps
  • rubella
  • varicella
  • HepB
  • Polio
  • Acellular pertussis (at least one adult booster)
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80
Q

What is the work restriction for health care providers with the following illnesses:

  • Hep A
  • Measles
  • Mumps
  • Pertussis
  • Rubella
A
  • one week after onset of jaundice
  • four days after onset of rash
  • nine days after onset of parotitis
  • five days of appropriate antibiotics
  • seven days after onset of rash
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81
Q

What types of infections are asplenic and hyposplenic patients at risk for?

A
  • Encapsulated bacteria: Strep pneumoniae, H influenzae, N. meningitides
  • Also at risk of other infections: Salmonella, E. coli, Pseudomonas, Klebsiella, Streptococci, Staphylococci
  • More at risk of severe or fatal malaria, protozoan Babesia (tick bites)
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82
Q

What are the special vaccine schedules for asplenic/hyposplenic patients?

A
  • Pneumococcus: 13-valent (= Prevnar, 4 doses) and 23-valent (=Pneumovax, at 24mo and booster at 5yo)
  • Meningococcus: MCV4 (4 doses, 2/4/6/12-15mo, revaccinated q5 years), 4CMenB should also be given (? schedule)
  • Hib: 4 doses (2,4,6,18mo), repeat vaccine if they get Hib invasive infection
  • Influenza annually
  • Household contacts should be fully immunized
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83
Q

When should vaccines be given with relation to elective splenectomy?

A
  • best responses occur when vaccines administered at least 2 weeks before surgery is performed
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84
Q

In which populations is Hepatitis C infection higher?

A
  • IVDUs
  • Hemophiliacs
  • Those receiving blood transfusions before 1990s
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85
Q

How are Hepatitis C infections defined as chronic?

A
  • Active viral replication persisting for >6 months
  • Test indicated by presence of HCV RNA in blood on most or all blood specimens
  • 75% of acute cases become chronic
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86
Q

What is the rate of vertical transmission of HCV?

A
  • 5%
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87
Q

What are the factors that increase vertical transmission of HCV?

A
  • higher maternal viral titre
  • elevated ALT in year before pregnancy
  • Presence of maternal cirrhosis
  • mothers with HIV
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88
Q

What are the precautions to be taken during labour of a woman with HCV

A
  • no need for C/S
  • inconsistent evidence that PROM is risk factor
  • avoid scalp electrodes or amniocentesis
  • no contraindication to breastfeeding (unless flared with cracked nipples)
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89
Q

Which women are at high risk of HCV and should be screened antenatally for HCV?

A
  • Past or present IVDUs
  • Recipients of blood products before 1990
  • Recipients of blood products in developing countries
  • Patients with unexplained elevated aminotransferases
  • Patients who have undergone organ or tissue transplantation from unscreened donors
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90
Q

Mother with known HCV delivers a healthy infant. What is the recommended management?

A
  • Serologies at 12-18 months (if positive before 18mo, repeat at 18mo)
  • HCV RNA after 2months can be performed if significant parental anxiety or fear of loss to follow-up
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91
Q

How many infants will clear HCV?

A
  • Approximately 25% of infants with HCV vertical transmission will clear the virus
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92
Q

How to manage a woman with no documentation of previous rubella immunization?

A
  • screen during pregnancy
  • one dose of rubella vaccine postpartum if seronegative
  • breastfeeding not contraindication to giving mother rubella vaccine
  • immunizing all nonpregnant immigrant and refugee women at their first encounter with Canadian health care system unless have documentation of effective vaccination or natural immunity
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93
Q

What are the features of congenital rubella syndrome

A
  • microcephaly
  • cataracts
  • glaucoma
  • pigmentary retinopathy
  • hearing impairment
  • PDA
  • HSM
  • thrombocytopenia
  • radiolucent bone densities
94
Q

List the risk factors for severe rotavirus disease

A
  • prematurity

- immunocompromised children

95
Q

In which age group are the rotavirus vaccines approved?

A
  • 6 weeks to 32 weeks of age
96
Q

What are the side effects to RotaTeq and Rotarix?

A

RotaTeq: vomiting, diarrhea, nasopharyngitis, otitis media, bronchospasm, shedding shorter
Rotarix: no increased risk of severe adverse events, shedding longer

97
Q

What are the contraindications to rotavirus vaccination?

A
  • Hypersensitivity to vaccine
  • History of intussusception
  • Infants known or suspected to be immunocompromised
  • Can be given to those with GI diseases, previous rotavirus infection and premature infants
98
Q

What are the benefits of the rotavirus vaccination?

A
  • decreases incidence and morbidity (decrease dehydration, hospitalization)
99
Q

When should the first and second dose of Varicella vaccine be administered?

A
  • First: between 12-18 months
  • Second: between 4-6 years of age
  • Doses must be given minimum 3 months apart for children 12yo
100
Q

What is the most common adverse event in varicella vaccine?

A
  • pain and redness at injection site (slightly more with second dose than first dose)
101
Q

What is considered to be evidence of immunity to varicella (i.e. when screening pregnant women)?

A
  • IgG to VZV
  • documentation of receipt of 2 doses of varicella vaccine (no need for serology)
  • lab confirmation of varicella or herpes zoster form a lesion
  • previous diagnosis of varicella disease or herpes zoster by a health care provider
102
Q

In which populations does the TST have poor sensitivity?

A
  • immunocompromised
  • very young children
  • infants
103
Q

In which populations does the TST have poor specificity?

A
  • those previously vaccinated with BCG

- those infected with environmental nontuberculous mycobacteria (NTM)

104
Q

What are the indications for TST in children?

A
  • Contacts of known case of active TB
  • Children with suspected active TB
  • Children with known risk factors for progression of infection to disease
  • Children travelling or residing for >3 months in area with high incidence of TB
  • Children who arrived in Canada from country with high TB incidence within previous 2 years
105
Q

What are the benefits of the IGRA?

A
  • more specific (less false positives)
  • rapid turnaround time
  • only single visit required
106
Q

List the considerations in management of a pregnancy women with known HSV

A
  • Prophylactic acyclovir or valacyclovir from 36 weeks gestation until delivery
  • Avoid fetal scalp sampling and monitoring
  • Avoid forceps and vacuums
  • Avoid prolonged rupture of membranes
  • C/S if active lesions
107
Q

List the tests by which HSV may be detected

A
  • Viral cultures from oropharynx, nasopharynx, skin lesions, mucous membrane (eye and mouth) swabs, rectal swabs, blood buffy coat and CSF
  • PCR testing of CSF, skin lesions, mucous membranes and blood
  • Direct immunofluorescent antibody staining of skin lesions
  • Enzyme immunoassays for HSV antigens in skin lesions
  • Infants serology is not useful for diagnosing NHSV
108
Q

What is the treatment for SEM, CNS and disseminated HSV?

A
  • SEM: Acyclovir 60mg/kg/day x14 days
  • CNS: Acyclovir 60mg/kg/day x21 days, plus suppressive oral acyclovir x 6 months afterwards (need monthly CBC, BUN, Cr)
  • Disseminated: Acyclovir 60mg/kg/day x21 days
  • Topical ophthalmic agent (Trifluridine) and ophtho consult for neonates with ocular involvement
  • Repeat CSF at end of therapy, if still positive, treat another week and reassess etc.
109
Q

Management of infant of mother with active lesions, first episode/non-primary

A
  • If C/S with no ROM before delivery: swabs at 24 hours
  • If Vaginal or C/S with ROM before delivery: swabs immediately, start IV Acyclovir x 10 days
  • If swabs are positive in either setting, readmit for CSF and blood PCR and liver enzymes
  • SEM if CSF AND blood PCR are negative = 14 days
  • If CSF OR blood PRC positive = CNS/Disseminated = 21 days
110
Q

Management of infant of mother with active lesions, recurrent

A
  • Either vaginal or C/S: swabs at 24 hours, only treat if positive
111
Q

Management of infant of mother with history of HSV but no active lesions

A
  • No swabs required
112
Q

Which infants should be suspected of having NHSV and managed accordingly

A
  • Infants with sepsis-like syndrome, not improve rapidly on antibiotics and have negative cultures after 24 h incubation
  • Infants admitted with pneumonia of unknown aetiology and don’t improve after 24 h antibiotics, especially if viral- looking on CXR
  • Infants with unexplained bleeding from venipuncture or unexplained, documented coagulopathy
  • Infants started on IV antibiotics for suspected sepsis who have unexplained hepatitis
113
Q

What are the infection control precautions for NHSV?

A
  • contact until lesions have crusted

- Even if no lesions, contact precautions until end of 14d incubation period or if swabs negative

114
Q

List risk factors for transmission of blood-borne viruses in child care centres

A
  • aggressive behaviour with frequent biting
  • oozing skin lesions
  • bleeding disorders
115
Q

What types of bites have potential to transmit virus?

A
  • Bites that break the skin
116
Q

List ways to prevent bites in daycare settings

A
  • avoidance of stressful, frustrating situations and conflicts
  • provision of age-appropriate small group activities
  • observation of how, when, and why a child bites
  • paying attention to victim first, not biter
  • firm statements to the biter that this is not acceptable behaviour and won’t be tolerated
  • Directing biter to appropriate activities
  • positive reinforcement of appropriate behaviour
  • collaboration with family
117
Q

List general wound care principals in bites

A
  • If intact skin, clean with soap, water, cold compress can be applied
  • If skin broken, allow to bleed gently, without squeezing
  • Wound should be cleaned carefully with soap and water, mild antiseptic should be applied
  • File official report
  • Notify parents
  • Report to local public health authorities
  • Observe bit over next few days
118
Q

What to do if child with Hep B bites nonimmune/incompletely immunized child?

A
  • Give HBIG and HBV vx to bitten child
119
Q

What to do if nonimmune/incompletely immunized child bites child with Hep B?

A
  • Give HBIG and HBV to biter
120
Q

What to do if child bites another child and neither have known HepB status

A
  • Give HBV vx given
121
Q

What is the incubation period of varicella?

A
  • 10-21 days

- airborne transmission

122
Q

How long should a child with varicella be excluded from daycare?

A
  • Until they are well enough to participate in activities

- most transmission during prodrome (so usually miss the boat)

123
Q

Who should receive the MenB vaccine?

A

Those at high risk of invasive meningococcal disease

  • asplenic/hyposplenic
  • congenital complement deficiency
  • Primary antibody deficiency
  • properdin or Factor D deficiency
  • those with more than one episode of IMD
  • lab personnel who work ith the organism
124
Q

What is the vaccine schedule for MCV-C?

A
  • 12 months of age
  • 2 months of age for those at high risk
  • Booster of MCV-C or MCV-4 in adolescence (12yo)
125
Q

What is the vaccine schedule for MCV-4?

A
  • 2 years and older for those at high risk
126
Q

Who are at increased risk of invasive meningococcal disease?

A
  • asplenia or hyposplenia
  • primary antibody deficiency
  • complement, properdin or factor D deficiency
  • travellers to areas where meningococcal risk is high
  • lab personnel working with meningococcus
  • the military
127
Q

What is the schedule for pneumococcal vaccine?

A 
Conjugate
- normal risk: 2, 4, 12
- high risk: 2, 4, 6, 12
Polysaccharide
- 23-valent given to high risk individuals
128
Q

What are two strategies proposed to protect very young infants from influenza?

A
  • “cocooning” = immunizing postpartum women and household contacts
  • immunizing pregnant woman = delivery of maternal antibodies to fetus, prevent influenza infection during pregnancy
129
Q

What are the risks of influenza infection in first trimester?

A
  • increased risk for congenital anomalies
  • neural tube defects
  • hydrocephaly
  • congenital heart defects
  • cleft lip
  • GI and limb reduction defects
130
Q

When can influenza vaccine be given to a pregnant mother?

A
  • any point during pregnancy
131
Q

What are the contraindications to vaccines for individuals with egg allergy?

A
  • live attenuated influenza vaccine

- yellow fever

132
Q

What is the most frequent STI in Canada?

A
  • Chlamydia trachomatis
133
Q

What is the transmission rate for chlamydia?

A
  • 50% from untreated mothers to vaginally delivered infants
134
Q

What are risk factors for STI in males?

A
  • history of sex with known STI person
  • previous STI
  • new sexual partner or >2 sexual partners within last year
  • injection drug use
  • substance use
  • unsafe sexual practices
  • anonymous sexual partnering
  • sex workers and their clients
  • survival sex
  • street involvement/homelessness
  • time in detention facility
  • experience of sexual assault or abuse
135
Q

What are the screening recommendations for females regarding STIs?

A
  • Chlamydia: annually, NAAT (first void)
  • Gonorrhea: annually, first void NAAT
  • Gonorrhea throat cultures when history of oral sex
  • Gonorrhea rectal samples if history of receptive anal intercourse
  • Cotreatment for chlamydia with all proven gonorrhoea cases
  • Test of Cure for Gonorrhea
  • Syphillis: all pregnant adolescents
  • HIV: high risk
136
Q

How to prevent RSV (other than immunization)?

A
  • avoid contact with individuals with respiratory tract infections
  • hand hygiene
  • breastfeeding
  • avoidance of cigarette smoke
137
Q

Which groups qualify for palivizumab?

A
  • Children with HD significant CHD or CLD who require ongoing medical management
138
Q

List the risk factors for AOE:

A
  • trauma
  • foreign body in the ear
  • using a hearing aid
  • certain dermatological conditions
  • chronic otorrhea
  • wearing tight head scarves
  • immunocompromised conditions
139
Q

List the clinical presentation of acute otitis externa

A
  • otalgia
  • itching
  • fullness
  • +/- hearing loss
  • discharge
  • tenderness of the tragus when pushed and of the pinna when pulled
140
Q

What do you need to diagnose acute otitis externs?

A
  1. Rapid onset (
141
Q

What are the most commonly isolated organisms in AOE

A
  • Pseudomonas aeruginosa
  • Staph aureus
  • often polymicrobial
  • RARE FUNGAL (candida, aspergillus)
  • Only take swabs in unresponsive or severe cases, because they usually represent normal flora otherwise*
142
Q

What is malignant OE?

A
  • invasive infection of cartilage and bone of canal and external ear
  • facial nerve palsy + pain
  • CT or MRI may be needed
143
Q

What is the treatment of AOE?

A
  • Topical antibiotics +/- topical steroids for 7-10d (ie. Ciprodex = Cirpo + Dex)
  • NO OTOTOXIC AGENTS WHEN TM PERFORATED OR NOT SEEN
  • Systemic antibiotics (covering S aureus and Pseudomonas) in more severe cases
  • Analgesia
  • Should see improvement within 48-72hrs, but full response up to 6days
144
Q

List preventative measures for AOE

A
  • keep ears dry (plugs to block ears, dry ears well after swimming)
  • no cotton swabs
  • ## soft ear plug use
145
Q

What is the incubation period for C diff?

A
  • 2-3 days (very quick
146
Q

What are risk factors for pediatric C diff infection?

A
  • duration of hospital stay
  • older age
  • exposure to multiple antibiotic classes
  • chemotherapy (due to effects of immunosuppression and neutropenia on gut mucosa and flora)
  • GI surgery
  • manipulation of the GI tract, including tube feeds
147
Q

What do the toxins in C diff do?

A
  • Toxin A: disrupts neuronal function and causes aberrant release of calcium
  • Toxin B: affects leukocytes by altering chemotaxis and activation of macrophages and mast cells
148
Q

What are the features of mild-to-moderate C diff infection?

A
  • watery diarrhea
  • low-grade fever
  • mild abdo pain
149
Q

What are the features of severe C diff disease?

A
  • high grade fever
  • rigours
  • hypotension
  • shock
  • peritonitis
  • ileus
  • megacolon
  • progressively severe diarrhea
  • abdo pain
  • leukocytosis
  • stool containing blood, mucous and leukocytes
150
Q

List ways in which C diff infection can be prevented

A
  • meticulous hand hygiene (with soap and water - alcohol does not kill C diff)
  • identying and removing environmental sources of C diff
  • contact precautions for duration of symptoms (48 hours without diarrhea)
  • use of private rooms or cohorting
151
Q

When is treatment indicated for C diff?

A
  • moderate-to-severe diarrhea
152
Q

What is the treatment for initial or first recurrence of C diff disease?

A
  • Metronidazole orally +/- oral or rectal vancomycin (only in severe disease) for 10-14 days
    • PO Vanco + IV metronidazole for SEVERE, COMPLICATED CASES
  • Colectomy for intractable cases
  • Treatment does not eradicate C diff or toxin from stool* Need to follow symptoms, not toxin production
153
Q

What is the treatment of the second or later recurrence of C diff infection?

A
  • Tapered and/or pulse regimen with oral vancomycin.
154
Q

What is the role of probiotics in C diff infection?

A
  • May be a role in preventing relapses in patients with recurrent C diff infection
155
Q

How is C diff infection diagnosed?

A
  • Need to detect C diff toxin in diarrheal stool - culture is not sufficient
  • Do not test infants
156
Q

What is the treatment of mild C diff infection?

A
  • no antibiotics required

- stop offending antibiotics if possible

157
Q

Which is more effective for diagnosis of head lice: fine toothed lice comb or direct visual examination for detection of live lice?

A
  • comb
158
Q

What is required for the diagnosis of head lice?

A
  • detection of live head lice
159
Q

What is the recommended treatment of head lice?

A
  • two treatments of topical insecticide (7-10 days apart)
  • Permethrin 1%
  • Pyrethrin
  • Lindane (second-line because of potential for neurotoxicity and BM suppression) –> not recommended for infants, young children, pregnant and breastfeeding mothers***
  • Side effects: burning, itching, mild rash (itching doesn’t always mean resistance)
160
Q

What should be considered in a case of head lice “resistance”

A
  • misdiagnosis/overdiagnosis
  • poor compliance with both applications of insecticides
  • new infestation acquired after treatment
161
Q

Should head lice be an exclusion from school?

A
  • no!
162
Q

List the five important steps in the process of working with vaccine-hesitant parents

A
  1. Understand the specific vaccine concerns of parent
    - correct specific misconceptions
    - promote value of vaccination using compelling stories of children damaged/killed by preventable diseases
  2. Stay on message and use clear language to present evidence of vaccine benefits and risks fairly and accurately
    - impact on others (not just their child)
    - children more at risk
    - herd protection not possible for all diseases (i.e.. tetanus is always in dirt)
    - full protection not from only one vaccine
    - don’t bring up concerns they don’t
  3. Inform parents about the rigour of the vaccine safety system
    - held to a higher safety standard than drugs
  4. Address the issues of pain with immunization
  5. Do not dismiss children from your practice because parents refuse to immunize
    - many parents will decide to immunize after building rapport, relationship with provider
163
Q

What are the components of Canada’s vaccine safety system? (8 components)

A
  1. Prelicensure review and approval (review of vaccine efficacy, stability, teratogenicity, toxicity, safety data)
  2. Current good manufacturing practices (strict, globally recognized manufacturing procedures including regular and random onsite checks)
  3. Lot assessment before release (test every lot for potency, safety, purity)
  4. Independent expert review of national vaccine recommendations (reviews all safety and efficacy data and published recommendations)
  5. Post-marketing surveillance for adverse events (passive and active surveillance)
  6. Rapid response to vaccine performance concerns (immediate recall and/or non distribution of affected lot)
  7. Expert causality assessment of serious adverse events following immunization (undergo rigourous scrutiny to determine cause)
  8. International collaboration (data on adverse events sent to WHO)
164
Q

How do biologic response modifiers increase risk of infection?

A
  • inhibit the inflammatory response (specifically cell-mediated immunity) which can potentially permit reactivation of infections that had been previously controlled (ie. latent TB) and/or lead to inadequate immune response to new pathogens requiring cell-mediated immunity
165
Q

What infections are increased by using biologic response modifiers?

A
  • tuberculosis –> should all have TST and CXR before starting BRMs
  • fungal infections
  • mycobacteria
  • reactivation of chronic viral infections (HSV, VZV, hepatitis B, EBV etc.)
  • no increased risk of infections with common bacterial pathogens
166
Q

What work-up should be done before initiating biologic response modifiers?

A
  • TST
  • CXR
  • Document vaccination status and vaccinate accordingly (inactivated vaccines at least 14 days, live vaccines at least 4 weeks before starting)
  • Extra vaccines: 1) influenza 2) polysaccharide pneumococcal 3)
  • Ensure vaccination of household contacts
  • Consider toxo/histo serology if previous exposure
  • Consider Hep B, zoster, EBV serologies
  • Counsel re: 1) food safety, 2) dental hygiene, 3) exposure to garden soil, pets, animals, 4) high risk activities - ie. spelunking, 5) travel to endemic areas for fungi (i.e. SW USA) or TB endemic areas
167
Q

Where are mosquitoes and ticks known to thrive?

A 
Mosquitoes:
- dusk, dawn
- shady places during day
- breed in standing water
Ticks:
- woodland areas
- tall grasses
- spring/fall
168
Q

What physical barriers can be used to prevent mosquitoes and ticks?

A
  • screens on windows and doors
  • cover cribs/playpens/strollers with mesh netting
  • long, loose-fitting clothes
  • tuck pants into socks, shirts into pants
  • light-coloured clothes
169
Q

How should a tick be removed?

A
  • use fine-tipped tweezers to grasp tick close to skin surface
  • Pull upward with steady, even pressure (no twisting or jerking, don’t squeeze)
  • Clean bite area and hands with alcohol or soap/water
170
Q

What concentrations of DEET may be used in children?

A

10% in 12yo

171
Q

What are common adverse events from DEET?

A
  • contact dermatitis
  • eye irritation
  • toxic encephalopathy (rare) with prolonged or excessive use or ingestion
172
Q

What repellants can be used?

A
  • Icaridin (first choice of PHAC) for 6mo to 12yo

- Deet

173
Q

How to use repellents?

A
  • avoid products with combination of repellant and sunscreen
  • apply lightly
  • avoid applying on child’s hands
  • do no apply aerosol products directly to the face, avoid eye & mouth contact
  • do not apply to irritated/cut skin
  • do not apply under clothes
  • wash off with soap and water after day’s use
174
Q

If a child has a needle stick injury in the community, what is the prophylaxis?

A 
Immunized fully:
- Test for anti-HBs antibody, if no results in 48 hours, give HBV vx
- If no HBsAb, test for HBsAg: 
- if positive, arrange for follow-up
- give HBIG and HBvx
Not immunized fully:
- Test for anti-HBs antibody, if no results in 48 hours:
- Give HBI immediately, give HBV vx
175
Q

List reasons for home IV therapy:

A
  • bone and soft tissue infection
  • longterm parenteral nutrition
  • IV treatment of opportunistic infections (if stable)
  • clotting factors for hemophilia
  • chemotherapy
  • therapy for immunodeficiencies
  • medications for palliative care
  • anti-inflammatory mediators
176
Q

What are complications of home IV therapy?

A
  • mechanical (early = correct tip placement or vessel puncture, late = thrombosis, dislodgement, occlusion, leakage)
  • infectious (less frequent)
  • adverse reactions to antibiotics
  • metabolic complications (lyte abnormalities, hypoglycemia
  • hepatic complications (longterm PN cholestasis)
177
Q

Who should be on a home IV team?

A
  • pediatrician
  • primary care physician
  • infusion nurse specialist
  • community home care service
  • pharmacist
  • case manager
  • other specialties as needed (surgery, interventional radiologists, dietician, GI, SW)
  • access to physician and nurse 24h/day
178
Q

When is it safe to do a vaginal delivery in a mother with HIV?

A
  • Viral load
179
Q

Describe what should be done if a mother who has not been tested during pregnancy for HIV presents in labour?

A
  • every effort should be made to perform EXPEDITED HIV serology on the mother with informed consent during labour or even after delivery
  • If mother unavailable, can do EXPEDITED HIV serology on newborn with appropriate consent
180
Q

What is the name of the bacteria that causes lyme disease?

A

Borrelia burgdorferi

181
Q

What are the clinical manifestations of lyme disease?

A 
Early localized (7-14d)
- one erythema migrans
Early disseminated (weeks)
- multiple EM
- CNS symptoms
Late disease (weeks-months)
- arthritis
- neuropathy
- CNS symptoms
182
Q

How is the diagnosis of lyme disease made?

A
  • principally clinical diagnosis
  • supported by history of potential tick exposure
  • Can test for antibodies against B. burgdorferi but they aren’t present in first 4 weeks, but should still do the tests
183
Q

What is the treatment for Lyme Disease?

A

8yo

- Doxycycline

184
Q

What is a Jarisch-Herxheimer reaction?

A
  • Fever, headache, myalgia and an aggravated clinical picture lasting >24h
  • occurs when lyme disease treatment therapy is initiated
  • Management: continue antibiotic but provide NSAIDs
185
Q

Who should be given prophylaxis for lyme disease?

A

Doxycycline single dose for children >8yo , started within 72 hours of removing a tick

186
Q

List the symptoms associated with West Nile disease

A
  • fever
  • headache
  • backache
  • myalgia
  • maculopapular rash
  • malaise/fatigue
  • arthralgias
  • GI symptoms
  • ocular pain
  • pharyngitis
  • conjunctivitis
  • LAD
  • resp symptoms
187
Q

What is the duration of WNV illness?

A
  • 3-6 days
188
Q

What are the symptoms of a severe WNV illness?

A
  • high fever
  • headache
  • disorientation
  • confusion
  • stupor
  • coma
  • neck stiffness
  • severe muscle weakness and paresis
  • flaccid paralysis
189
Q

What are the longterm sequelae of WNV neurological infection

A
  • muscle weakness
  • fatigue
  • cognitive dysfunction
  • loss of memory
  • depression
190
Q

How does Health Canada define a suspect case and a probably case and a confirmed case of WNV?

A
  • suspect case: acute febrile illness with clinical findings of encephalitis, meningoencephalitis, meningitis or acute flaccid paralysis with no other aetiology found and history of exposure in an area where WNV activity is occurring
  • probably casE: clinical presentation and serovoncersion by HI or ELISA IgM antibody in serum or CSF, a single high IgG titre confirmedly PRNT or having received donor blood that was positive on NAAT
  • confirmed case: seroconversion by PRNT, IgM antibody in CSF confirmed by positive PRNT….
191
Q

What are the main symptoms of scabies?

A
  • itching, worse at night
  • infested areas of web spaces
  • flexor aspects of writsts/elbows
  • axillae
  • male genitalia
  • women’s breasts
192
Q

Why is the aboriginal community at higher risk of scabies outbreaks?

A
  • crowded housing, shared beds, crowded schools/day cares
  • high pediatric population
  • failure to recognize infestation
  • reduced access to medical or nursing care
  • faulty application of treatment regimens
  • failure to treat close contacts
  • failure to eradicate scabies from clthing/bed linen
  • lack of running water which may predispose to secondary skin infection
193
Q

List steps of treatment for scabies

A
  • 5% permethrin cream: wash off after 8-14 hours, repeat in 1-2 weeks
  • Permethrin not recommended
194
Q

What is the daycare exclusion for scabies

A
  • may return once treatment completed
195
Q

List the contraindications to breastfeeding?

A
  • Active TB within first two weeks of treatment
  • Mastitis with obvious pus (pump and discard, BF other breast)
  • Brucellosis (untreated)
  • HSV/VZV with active breast lesions
  • HIV
  • HTLV
  • Primaquine, quinine (contraindicated during BF
  • High dose flagyl (discontinue BF for 12-24h to allow excretion of dose
196
Q

List safe food handling tips

A
  • choose foods that are safe (avoid unpasteurized milk.juice, raw meet)
  • Separate food be eaten raw from food to be cooked
  • Hands should be washed carefully before starting food preparation and between touching
    raw foods
  • Cook meats, poultry, eggs and seafood thoroughly
  • eat foods soon after they are cooked
  • store cooked foods appropriately (in fridge/freezer promptly)
  • Reheat cooked foods adequately
  • Keep kitchen meticulously clean
  • Portect foods from insects, rodents, animals
  • Always use safe water for food preparation
197
Q

List recommendations on food safety for immunocompromised patients

A
  • ensure all meats be cooked to appropriate temperatures. Avoid meat pates and other meat spreads
  • Caution with foods that have raw or undercooked eggs
  • Avoid soft cheeses and cheeses to which live microbial cultures have been added
  • wash fruits and veggies thoroughly, then peeled or cooked
  • Avoid fruits/veg that cannot be easily washed
  • Raw seed spouts should be avoided
198
Q

List methods used to decrease infectious diseases in donor blood transfusions

A
  • donor interview and selection protocols
  • careful aseptic technique for collection and infusion
  • diversion of first 40mL into diversion pouch (not used for transfusion)
  • donor screening serological and other tests
  • viral inactivation procedures
  • leukocyte reduction techniques
199
Q

What is the risk of infection from blood transfusion of: 1) HIV, 2) HCV, 3) HBV, 4) HTLV, 5) Parvo

A

1) HIV: 1 in 8-12 million
2) HCV: 1 in 5-7 million
3) HBV: 1 in 1.1-1.7 million
4) HTLV: 1 in 1-1.3 million
5) Parvo: 1 in 5000

200
Q

When is it appropriate to use antimicrobial chemical agents? And if so, which are preferred?

A
  • In high-risk scenarios: cleaning up bodily fluids (blood, feces, vomit)
  • Household bleach is commonly used (9 parts H2O to 1 part bleach)
  • No need for regular antimicrobial chemicals (triclosan, chlorhexidine and quaternary ammonium compounds exert more prolonged antimicrobial pressure)
201
Q

When is the risk of WNV infection greatest in the year?

A
  • late summer, early fall
202
Q

What are the recommended strategies for decreasing seasonal influenza risk in young infants (especially

A
  • vaccine has limited immunogenicity in not teratogenic, also protects mom, given that influenza infection in pregnancy can be more severe
203
Q

Which groups of children qualify for SBE prophylaxis?

A
  • Prosthetic cardiac valve or prosthetic material used for valve repair
  • Previous IE
  • Unrepaired CYANOTIC CHD (including palliative shunts and conduits)
  • Completely repaired CHD with prosthetic material or device during first 6 months after procedure
  • Repaired CHD with residual defects at site or adjacent to site of prosthetic patch or prosthetic device
  • Cardiac transplant recipients who develop cardiac valvulopathy
  • NO LONGER RECOMMENDED FOR MVP*
204
Q

List the procedures for which SBE prophylaxis in the appropriate groups is reasonable

A
  • All dental procedures that involve manipulation of gingival tissue, periodical region of teeth or perforation of oral mucosa (not injections, not loss of teeth)
  • Invasive procedure of reps tract that involves incision or biopsy of reps mucosa (ie. T&A), but not for bronchoscopy
  • procedure through infected GI/GU tract
205
Q

What is prophylaxis recommended for SBE?

A
  • Amoxicillin preferred (oral)

- one dose prior to surgery

206
Q

What are the risk factors for MRSA?

A
  • close skin-to-skin contact
  • openings of skin such as cuts or abrasions
  • contaminated items and surfaces
  • crowded living conditions
  • ## poor hygiene
207
Q

Which populations are at risk of MRSA?

A
  • Aboriginal populations
  • athletes
  • military
  • daycare attendees
  • IVDU
  • MSM
  • prisoners
208
Q

What are complications of MRSA?

A
  • osteomyelitis
  • septic arthritis
  • Nec fascitis
  • sepsis
  • pneumonia (especially following influenza)
209
Q

List the management of MRSA infections in children

A
  • 3mo (no systemic symptoms): Drain, then observe
  • > 3mo (with systemic symptoms): Drain, Septra + Keflex
  • Any systemically unwell patient: IV antibiotics (Vanco)
  • If suspect GAS could be contributor, use Septra with Keflex (Septra not good alone for Strep)
  • No need for decontaminations
210
Q

Why are children more at risk for AOM than adults?

A
  • eustachian tubes are shorter and more horizontal (more obstruction by enlarged adenoids)
  • more common viral infections and allergies
  • decreased IgA levels
211
Q

What are the risk factors for AOM?

A
  • young age
  • daycare attendance
  • orofacial abnormalities (midface hypoplasia, cleft palate0
  • household crowding
  • cigarette smoke
  • prem
  • not breastfed
  • immunodeficiency
  • FamHx of AOM
  • Aboriginal
212
Q

What are the necessary components to diagnose acute otitis media?

A
  • symptoms (acute onset of otalgia or irritability)
  • Signs of middle ear effusion (immobile TM, opacification, loss of bony landmarks/cone of light)
  • Signs of middle ear inflammation (bulging TM, discoloured)
213
Q

In which children with AOM is it appropriate to adopt a watchful waiting approach?

A
  • > 6 months
  • no immunodeficiency, chronic cardiac/pulmonary disease, anatomical abnormalities of head or neck, hx of complicated AOM, Downs
  • mild otalgia only, fever
214
Q

What is the antibiotic choices for AOM and when are they indicated?

A
  • Amoxicillin (no allergy)
  • Cefuroxime (non-Type 1 hypersensitivity)
  • Macrolide (Type 1 hypersensitivity)
  • Amoxicillin-Clavulinate (failure of Amoxicillin)
215
Q

What is the appropriate duration of antibiotic therapy for AOM?

A

6mo - 2yo = 10 days

>2yo = 5 days

216
Q

What can parents do to reduce their child’s risk of developing AOM?

A
  • avoid smoking
  • breastfeed until at least 3mo
  • simple hygiene practices (hand hygiene)
  • avoid pacifiers
  • limit daycare exposure for very young children
  • encourage childcare providers to practice hand hygiene
217
Q

What are risk factors for invasive GAS infection?

A
  • HIV
  • cancer
  • heart disease
  • diabetes
  • lung disease
  • alcohol abuse
  • injection drug use
  • pregnancy-related risk factors
218
Q

Define a confirmed case, severe case and probably case of invasive GAS

A 
Confirmed case:
- lab confirmation of infection with or without clinical evidence of invasive disease
Severe case:
- TSS
- Nec Fasc, myositis, gangrene
- Meningitis
- GAS pneumonia
- causing death
Probable case:
- Invasive disease in absence of another identified aetiology and with isolation of GAS from a non sterile site
219
Q

What are clinical evidence of invasive GAS disease?

A
  • a) strep TSS: hypotension and at least 2 of: renal impairment, coagulopathy, liver function abnormality, ARDS, generalized erythematous macular rash that may desquamate
  • b) soft tissue necrosis (NF, myositis, gangrene)
  • c) meningitis
  • d) combination of above
220
Q

Who should receive prophylaxis for invasive GAS disease?

A
  • close contacts of confirmed case of severe GAS 7d before onset of symptoms and 24h after initiation of Abx
  • administer ASAP, ideally within 24h of identification (but can do up to 7d from last contact)
  • clinical cases should be monitored for signs and symptoms of invasive GAS
  • Chemoprophylaxis not routinely recommended for cases that are NOT severe
  • Chemoprophylaxis: 1st generation cephalosporin (KEFLEX). Macrolides for type 1 hypersensitivity
221
Q

List the treatment regimen for the following:

a) Oropharyngeal candidiasis
b) Candida diaper dermatitis
c) Pityriasis versicolor (Tinea versicolor)
d) Tinea corporis
e) Tinea pedis
f) Tinea capitis

A

a) Nystatin suspension 200 000 units QID x2 weeks
b) Air dry, change frequently, Topical anti fungal (nystatin, miconazole, clotrimazole) (Use of steroids unclear)
c) Topical ketoconazole, selenium sulfide or clotrimazole
d) Topical Clotrimazole, ketoconazole, miconazole, terbinafine applied daily/BID for 14-21 days
e) topical antifungals or po antifungals if nails involved (terbinafine, fluconazole, itraconazole) + drying agents
f) PO antifungal (itraconazole, ketoconazole, fluconazole, terbinafine)

222
Q

What are the major toxicities associated with amphotericin B

A
  • nephrotoxicity

- infustion-related events (fevers, chills, rigours)

223
Q

What are the major toxicities associated with fluconazole?

A
  • hepatotoxicity

- Drug interactions via cytochrome P450

224
Q

What are common side effects of itraconazole?

A
  • Abdo pain
  • N/V
  • elevated liver enzymes
  • Cytochrome P450 interactions
225
Q

What are major toxicities associated with Voriconazole?

A
  • skin rash
  • visual abnormalities (photophobia, blurred vision)
  • photosensitivity reactions
  • elevated hepatic transaminase
  • elevated bilirubin
226
Q

If a child who has not been vaccinated against HBV gets a needle stick injury, what is the management?

A
  • Immediately give HBIG, HBvx
  • Check HBsAb and HBsAg:
    • If both negative: give full HBvx schedule
    • If both positive: discontinue vaccine series and refer for follow-up given that likely has HepB
227
Q

If a child who has been fully immunized against HBV gets a needly stick injury, what is the management?

A
  • Check HBsAb (if no results in 48hrs, give HBvx)
    • If HBsAb positive: no further action (protected)
    • If HBsAb negative: check HBsAg
      • If HBsAg negative: HBvx and HBIG
      • If HBsAg positive: refer for follow-up
228
Q

What are the factors that increase the risk of HIV transmission from needle stick injury?

A
  • presumed high prevalence of HIV in region (IVDU, MSM)
  • hollow-bore needle (larger lumens = increased risk)
  • visible blood in needle
  • deeper or more traumatic lesion
  • injury had actual blood injection
229
Q

List the follow-up schedule for a child with a needle stick injury

A

0: CBC, renal func’n, liver enzymes, HBVx
2-3d: F/U
2wks: F/U, B/W
4wks: F/U, B/W, stop antiretrovirals, HBVx
6wks: test anti-HIV
3mo: test anti-HIV, anti-HCV
6mo: test anti-HIV, anti-HCV, anti-HBsAg, HBVx

230
Q

List recommended management of pregnant mother with HIV

A
  • HIV screening in pregnancy and repeat if high risk
  • Rapid test if unknown HIV status at birth
  • Treat with combined ART and monitored throughout pregnancy for viral suppression
  • C/S without labour if viral load >1000 copies/mL
  • IV Zidovudine during labour
231
Q

List recommended management of infant born to a mother with HIV infection

A
  • start zidovudine mono therapy within 6-12 hours after birth
  • zidovudine for 6 weeks + 3 doses of nevi rapine in first week
  • avoid breastfeeding
  • HIV DNA or RNA PCR recommended for infants
232
Q

What are most common side effects of zidovudine?

A
  • neutropenia

- anemia

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