Infectious Diseases Flashcards
List the Congenital Infections
CHEAP
TORCHES
Chicken pox Hepatitis B, C, E Enterovirus AIDS Parvovirus B 19
Toxoplasmosis Other (TB, WNV) Rubella CMV HSV Every other STD Syphilis
Key features of congenital CMV
-85 - 90% are congenital CMV are asymptomatic
- IUGR
- petechiae, purpura
- thrombocytopenia
- hyperbili, HSM
- Microcephaly, periventricular calcifications
- choriorentitis, strabismus
- SNHL
Who to treat for CMV
- all symptomatic neonates with CNS involvement, SNHL, chorioretinitis
- case by case for mildly symptomatic neonates
- Valganciclovir oral x 6 months
- may use IV ganciclovir in hospitalized severely affected neonates
- monitor CBC (neutrophils) and creatinine
- long-term f/u of hearing and neurocognitive development
Key features of congenital syphilis
- IUGR
- Snuffles, maculopapular rash followed by desqumation, blistering and crusting
- HSM, LN
- coomb’s neg hemolytic anemia
- pseudoparalysis, osteochondritis, diaphyseal periostitis
- aseptic meningitis, hydrocephalus
- salt and pepper chorioretinitis, glaucoma, uveitis
-key feature differing from CMV is the bone changes here and blistering rash
When to evaluate an infant for congenital syphilis
- infant has signs/symptoms of congenital syphilis
- mother not treated or txt not adequately documented
- mother txted with non-penicillin regime (only penicillin counts)
- mother txt w/n 30 days of child’s birth
- less than 4x drop in mother’s non-treponemal titre or not assessed or documented
- mother had relapse or re-infection after txt
What is the treatment of congenital syphilis during the neonatal period
proven probable disease:
IV crystalline pen G for 10 - 14 days
Asymptomatic but at risk based on maternal hx:
IV crystalline pen G for 10 - 14 days
Asymptomatic, mother adequately treated:
Close clinical follow-up
Can’t use IM in canada only IV b/c IM not good enough for CNS coverage
Key features of congenital toxoplasmosis?
Classic triad:
- hydrocephalus
- cerebral calcifications
- chorioretinitis
Symptomatic disease (15%)
- 1st and 2nd trimester infections
- macrocephaly, hydrocephalus, cerebral calcifications, seizures, cognitive impairment
- chorioretinitis, strabismus
- HSM, thrombocytopenia
Asymptomatic disease (85%)
- 3rd trimester infections
- untreated majority go one to have disease
- chorioretinitis most common manifestation
How do you dx and txt congenital toxo?
Dx:
-serology or PCR (CSF, blood, urine, tissue)
Txt:
- pyrimethamine + sulfadiazine + leucovorin x 12 months
- steroids for eyes/hydro
- +/- VP shunt
Congenital Zika Syndrome
Major features
- severe microcephaly with partially collapsed skull
- thin cerebral cortices, subcortical calcifications
- macular scarring, focal pigmentary retinal mottling
- congenital contractures
- infection in preg can be asymptomatic
- highest risk in 1st and 2nd tri
- antenatal dx: fetal u/s, amniotic fluid PCR
- postnatal dx: serology and PCR
GBS Early onset vs Late Onset disease
Early onset (< 7 days)
- vertical transmission
- pneumonia, septicemia, meningitis
Late onset (>/7 days)
- Vertical or horizontal transmission
- Meningitis, osteomyelitis, soft tissue infections, sepsis
Indications for intrapartum antibiotic prophylaxis
-positive GBS screen (35-37 wks)
- Unknown GBS status AND any of the following:
- previous infant with GBS
- GBS bacteriuria during current preg
- Delivery < 37 wks
- ROM >/18 hr
- Intrapartum fever (> 38)
- (Intrapartum nuclei acid amplification test positive)
Antibiotics for Intrapartum Proph
No allergy - penicillin or ampicillin
Mild penicillin allergy - cefazolin
Severe penicillin - clindamycin
-only penicillin/ampicillin considered adequate IAP
Low risk criteria for ferbrile infants 29 - 90 days
-previously health term infant
-non-toxic clinical appearance
-no focal infection (except OM)
-peripheral leukocyte count 5 - 15 x 10^9
-absolute band count 1.5 x 10^9
-urine 10 WBC/HPF
Stool (if diarrhea) < 5WBC /HPF
How do you dx and txt suspected HSV disease
Dx:
- culture/PCR/EM of vesicle fluid, nasopharynx, eyes, urine, stool, blood CSF
- Do LP even if clinical well (e.g. isolated mucocutaneous disease)
Txt: -IV acyclovir: isolated mucocutaneous disease: 2 weeks disseminated CNS disease: 3 weeks -suppressive oral acyclovir x 6 mon improves neurologic outcome for those with CNS disease
Long-term neurodevelopmental FU
Treatment for asymptomatic infant of mother with active HSV lesions at delivery
First episode; vaginal or c/s after ROM
- empiric acyclovir
- if swabs/blood + : full WU & txt
- if swabs/blood - : complete 10 days IV acyclovir
First episode; c/s prior to ROM
- empiric acyclovir not required
- if swabs/blood + : full WU & txt
Recurrent episode
- empiric acyclovir not recommended
- if swabs/blood + : full WU & txt
Length of txt for bacterial meningitis?
E coli: 21 days GBS: 14 - 21 days S. pneumonia: 10 - 14 days H. influ: 7 - 10 days N. meningitidis: 5 - 7 days
Treatment for Toxic Shock
- Empiric therapy with cloxacillin (or cefazolin) plus clindamycin for most cases
- penicillin + clinda +/- IVIG TSS due to GAS
- add vancomycin if MRSA is a concern
Pathogens in Asplenic children?
- strep pneumo = 50 - 90% of overwhelming post splenectomy sepsis
- Hib= rare due to Hib vaccination
- neisseria meningitidis = uncommon
- capnocytophaga canimorsus= dog saliva exposure
- slamonella spp = reptiles, food and water
What antibiotic prophylaxis can you use in aspelnic pts
Birth - 3 mon: amoxi-clav to cover for e.coli
>/ 3 mon: Penicillin (amoxicillin alternative) b/c s. pneumo for most
Cat Scratch Disease
- highest with those with kittens
- lymphadenitis (axillary most common)
- Perinaud oculoglandular syndrome ( granulomatous conjunctivitis unilateral with ipsilateral LN on the same side)
- hepatosplenic, neuroretinitis, encephalopathy
- FWOS
Treatment
- Azithro for lymphadenitis
- Doxy + rifampin for neuroretinitis/CNS disease
