Infectious Diseases Part I Flashcards
1
Q
CBC Laboratory Aids (4)
A
- Bacterial infections: Leukocytosis with a differential left shift
* Shift to polys or bands - Viral infections: Leukopenia.
3 . Specific exceptions
- Pertussis causes an elevated white blood cell count with lymphocytosis).
- Overwhelming sepsis, immunosuppressive drugs, and corticosteroids alters CBC and confuses the picture
- Monocytosis reflects recovery phase of viral illness
* Common finding as someone is getting better
* Can persist for a couple of weeks
2
Q
Acute Phase Reactants (5)
A
- Sed rate (ESR)
- C-reactive Protein
- Procalcitonin
* Used a lot with sepsis - Serum ferritin
- Platelets
3
Q
Cultures (3)
A
- Bacteria, viruses, fungi and parasites require different media.
- Gram stains:
* Helps in antibiotics choice before the culture sensitivity tests are available
* Want them to look at urine and do gram stain to see what the microorganism looks like - Blood cultures are sometimes done with a very sick child
* Less concern to do it nowadays with high fever because of PCV13 and Hib vaccines
4
Q
Serological Tests (4)
A
- Specific antisera can cause an agglutination reaction.
- Measured by dilutional factors.
- Fourfold rise is considered positive
- 4x over the normal value is considered a positive serology
* Ex: with syphilis tests
5
Q
Antibody Detection techniques (3)
A
- Complement fixation
- Hemagglutination inhibition
- ELISA (enzyme-linked immunosorbent assay) testing.
* Trumped by PCR testing; PCR is usually what we use to test for STDs
6
Q
Antimicrobial Sensitivity Testing (2)
A
- Standard zone diameters indicate sensitivity or resistance of a microbe to a specific antibiotic.
- Plate the microorganism of test and look for zone of inhibition; you want to pick the one that is the most sensitive when picking for antibiotics
7
Q
Chest Radiographs (2)
A
- PA and Lateral
- There is no indication for a chest X-ray in a well appearing child with a clinical pneumonia and a normal oxygen
* If you aren’t going to admit child, if it isn’t recurrent, and if it is improving with antibiotics then do not do chest X-ray!
8
Q
Sinus Series
A
Not recommended because the respiratory tract starts at the beginning of the nose, a sinus series would be positive and so would CT of sinuses but that’s simply because of a cold
*Don’t image unless it’s a recurrent problem
9
Q
Radioactive scans
A
Detection of osteomyelitis or abscesses.
*Ultrasound of abscesses
10
Q
CT and MRI (3)
A
- Abscesses or other purulent material collections
- Not first choice to do CT because it exposes a child to radiation
- MRI is good especially for osteomyelitis
11
Q
Coxsackie Etiology (7)
A
- Enterovirus family
- Related to both polio and echo viruses.
- RNA viruses
- A and B
- Coxsackie enteroviruses and polio enteroviruses
- Occur in MAY-OCTOBER; strong summertime predilection
- Can stay on surfaces for over 2 weeks
12
Q
Coxsackie Epidemiology (5)
A
Enteroviruses (entero = intestinal)
- Fecal-oral contamination, especially in diapered children
- Transmitted during parturition.
- Worldwide distribution
- Increased prevalence: May to October.
- Most commonly 1 to 4 years of age.
13
Q
Coxsackie Incubation Period (4)
A
- 3 to 6 days.
- Shed for several weeks
- Child can go back to school as long as not febrile because it is ubiquitous
- Viable on environmental surfaces for at least two weeks.
14
Q
Coxsackie Virus Type A - Hand, Food and Mouth Disease (6)
A
- Fever, vesicular eruption of the buccal mucosa of the mouth, and a maculopapular rash involving the hands and feet.
- Acrodermatitis distribution
- Evolves to vesicles, especially on the dorsa of the hands and the soles of the feet
- 1 to 2 weeks duration
- The hallmark disease of coxsackie virus type A
- No fever, no diarrhea, no vomiting → can go back to school
15
Q
Coxsackie Virus Type A - Aseptic Meningitis (5)
A
- Fever, stiff neck, and headache.
- Altered sensorium and seizures are common.
- Epidemics or as unique cases
- Recover completely.
- Will not look sick, but if they do then they probably need admission
16
Q
Coxsackie Virus Type A Paralytic Disease - Guillain–Barré-type syndrome (3)
A
- Acute ascending polyneuropathy
- Weakess starts in lower extremities and goes up
* Difficulty walking = first sign
* A-reflexia
* Difficulty breathing
* Anorexia
* Goes on to respiratory failure
* Can even go on to chronic inflammatory polyneuropathy to be treated long-term with IVIG - IVIG treats Guillain-Barre by coxsackie 2mg/kg
17
Q
Coxsackie Virus Type A - Childhood insulin-dependent disease (2)
A
- Link between this disorder and Type A coxsackie infection has been proposed but not proven
- Varicella: yes
18
Q
Coxsackie Infection Type B - congenital or neonatal infection (13)
A
- Symptoms occur within two weeks of birth.
- Transplacental infection occurs
- Serious disseminated disease affects the fetal liver, heart, meninges, and adrenal cortex.
- Sudden onset of vomiting
- Coughing
- Fits
- Cyanosis, dyspnea
- Mistaken for pneumonia.
- Pallor and tachycardia leads to myocarditis and congestive heart failure.
- May not have a murmur.
- Cardiac collapse and death can occur
- If the neonates survives, the recovery can be quite rapid.
- Very serious; can cause myocarditis, neonatal overwhelming septic infection
19
Q
Coxsackie Virus Type B - Pleurodynia (11)
A
(Bornholm’s Disease or devil’s grip)
- Generally epidemic but isolated cases happen
- Can occur with A, but less likely
- Sudden severe chest pain, pleuritic in nature and aggravated by deep breathing, coughing, or sudden movements.
- Waves of spasms of 15-30 minutes duration
- Being stabbed with a knife
- Prodrome 1 to 10 days before the onset of chest pain
- Headache, malaise, anorexia, and myalgia.
- Fifty percent of patients have crampy abdominal pain.
- Low to high fever occurs, and a pleural friction rub often is heard.
- Lasts from 1 to 10 days (mean 3.5 d).
