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N827 > Infectious Diseases Pt. 1 > Flashcards

Infectious Diseases Pt. 1 Flashcards

1
Q

Important things to remember in peds acute care visits:

A
  • Diet Hx
  • Fluids
  • Stooling
  • Urine output
  • deviations from usual activity
  • Insomnia
  • Behaviors out of character
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2
Q

Reasons that a Child Should be Excluded from Daycare/School

A
  • Illness alters activity
  • Illness that requires greater care than staff can provide
  • Fever, lethargy, irritability, behavioral changes, persistent crying, sign of pain, trouble breathing
  • diarrhea not contained by diapers or toilet use
  • Vomiting more than 2x in 24hr
  • Mouth sores with drooling
  • MRSA with fever and/or behavioral changes
  • Purulent conjunctivitis with fever
  • Scabies before treatment
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3
Q

Reasons that Children Should NOT be Excluded from Daycare/School

A
  • Yellow/green nasal discharge
  • Nonpurulent conjunctivities without fever or behavioral change
  • Exanthem without fever
  • Fever less than 101 without other signs of illness
  • Hepatitis carrier
  • HIV
  • Mits, if treated
  • Scabies, if treated
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4
Q

Non-Polio Enteroviruses

A
  • Coxsackie (Herpangina & hand, foot, and mouth disease)
  • Echovirus
  • Pleurodynia
  • Acute hemorrhagic conjunctivitis
  • Myocarditis
  • Pericarditis
  • Orchitis
  • Aseptic meningitis
  • Encephalitis
  • Neonatal sepsis
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5
Q

Coxsackie

A
  • Hand-Foot-Mouth disease

- Vesicles on hand, feet, mouth, low-grade fever

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6
Q

Herpangina

A
  • Ulcers on oral mucosa

- HIGH fever

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7
Q

Pleurodynia

A
  • sudden, Chest pain

- Aggravated by breathing

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8
Q

Non-Polio Enterovirus: Basics

A
  • Incubation: 3-6d
  • Fecal-oral/respiratory transmission
  • Shed virus: 3wk for respiratory & 11wk GI
  • S/S: Mild URI Sx; sore throat; N/V/D; anorexia, ABD pain; fever; HA; rash; myalgias; photophobia; red eye, tearing
  • May have macular, papular, urticarial, vesicular, or petechial rash
  • Vesicles and ulcers on tonsils, uvula, pharynx, and edge of soft palate
  • nuchal rigidity
  • Guillain-Barre type syndrome has been described
  • Conjunctival erythema
  • Cardiac collapse/CHF from myocarditis: vomiting, coughing, anorexia, fever/hypothermia, rash, jaundice, cyanosis, tachycardia, dyspnea
  • pleural friction rub, wheezing, rales, rhonchi, stridor
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9
Q

Non-Polio Enteroviruses: Dx & Mgmt.

A
  • Dx: No testing usually done, may do PCR from throat, stool, rectum, and blood; CBC usually NL
  • Mgmt: Symptomatic treatment, prevention of spread
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10
Q

Enteroviruses: Polio - Basics

A
  • Asymptomatic to CNS involvement
  • Fecal-oral/respiratory transmission
  • Consider in unimmunized children
  • Dx of choice = viral culture from throat and stool; 2 samples taken 48hr apart
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11
Q

Hepatitis A Virus (HAV)

A
  • Fecal-oral transmission; contamination of food or water
  • Benign
  • Incubation: ~25-50d
  • Contagious: 3wk; 2wk before onset of jaundice & 1wk after
  • Dx: Test IgM and IgG to know which hepatitis
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12
Q

HAV: Clinical Findings

A
  • ** 2 Phases ***
    1) Preicteric - fever, malaise, anorexia, vomiting, ABD complaints, no symptoms
    2) Jaundiced: few days to months; appears shortly after onset of illness with dark urine and clay colored school
  • Not a chronic disease; full recovery expected but may relapse up to 6mo
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13
Q

HAV: Dx & Mgmt.

A
  • Dx: IgM & IgG antibodies; LFTs

- Mgmt: Supportive therapy; exclude from school for one week after onset of symptoms

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14
Q

Hepatitis B Virus (HBV)

A
  • Causes severe, chronic liver disease
  • Transmitted through blood and body fluids
  • NOT spread by fecal=oral route
  • Can live up to 1wk in dried state
  • Incubation = 120d
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15
Q

HBV: Clinical findings

A
  • May present as asymptomatic seroconversion or fulminant disease and death
  • Non-specific constitutional findings, i.e. fever nausea, ralgia, urtaria, rashes
  • Icterus of skin and/or sclera
  • Enlarged and tender liver
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16
Q

HBV: Dx and mgmt.

A
  • Dx
  • HBsAg and anti-HBc IgM positive in acute infection
  • Recovery from infection: HBsAg clearance and appearance of anti-HBs and anti-HBc-IgG
  • Chronic infection: Presence of HBsAg for 6mo+
  • LFTs
  • Liver biopsy
  • Mgmt.: specialists, interferon-alpha, lamividine
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17
Q

HCV

A
  • Chronic, may be asymptomatic or severe
  • Same risk factors as HBV
  • Incubation ~45d
  • Clinical findings: similar to HBV, except fulminant is uncommon
  • Dx: HCV antibody, LFTs, Liver biopsy
  • Mgmt.: specialists, nonpegylated interferon alpha-2b and ribavirin
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18
Q

HDV & HEV

A
  • HDV: must have HBV to contract

- HEV: zoonotic transmission; very rare

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19
Q

Herpes Simplex Virus: HSV

A
  • 2 forms: HSV-1 & HSV-2
  • Both types are devastating to the newborn
  • Incubation: 2d-2wk
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20
Q

HSV-1: Basics

A
  • non-genital lesions of the mouth, eyes, lips, and CNS
  • most common in 6mo-5yrs
  • Causes gingivostomatitis
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21
Q

HSV-2: basics

A
  • genital and neonatal infection
  • Sexual activity
  • Must r/o sexual molestation, especially when found in a very young child
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22
Q

HSV: Clinical Findings

A
  • Eye findings (chorioretinitis, keratoconjunctivitis)
  • Skin vesicles
  • Encephalitis
  • Disseminated disease up to 11d after birth with 90% mortality
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23
Q

Findings of Traumatic Herpetic Infection

A
  • Oral, usually from trauma like teething; abrasion passed by orally infected person
  • Vesicles appear at the site of the lesion
  • Fever
  • Lymphadenopathy
  • Constitutional symptoms
24
Q

HSV: Recurrent Infections

A
  • The body NEVER eradicates the virus

- It lies dormant and recurrent infections are common as herpes labialis and herpes genitalis

25
Q

HSV: Dx

A
  • Viral cultures of the lesions or secretions (CSF)
  • In infants cultures are taken from the skin, vesicles, mouth, nasopharynx, eyes, blood, rectum, and CSF
  • MRI of the brain if encephalitis is suspected
26
Q

HSV: Mgmt.

A
  • Parental acyclovir in neonates
  • Valtrex 12+yr 2g x 2doses 12hr apart for recurrences of oral HSV
  • May use valtrex daily suppression therapy in recurrent genital herpes 500mg-1g q day
  • Monitor for increased cervical risk with HSV-2 infections
27
Q

Infectious Mononucleosis Syndrome: Basics

A
  • Caused by Epstein-Barr Virus in 90% of cases
  • Other viral causes include: CMV, toxoplasma gondii, adenovirus, viral hepatitis, and HIV
  • Incubation ~30-50d
28
Q

Infectious Mononucleosis Syndrome: Clinical Findings

A
  • Lymphadenopathy: anterior and posterior
  • Tonsillar hypertrophy: sore throat; very painful; wth exudate or ulceration
  • Hepatosplenomegaly
  • Fever
  • Rashes: maculopapular, urticarial, scarletinaform and frequently occurs w/ampicillin
  • Myalgia/arthralgia
  • Conjunctivitis
  • Gingivitis
  • Serious: PNA, myocarditis, aseptic meningitis
29
Q

Infectious Mononucleosis Syndrome: Dx

A
  • CBC-diff
  • Monospot
  • EBV panel (core and capsule antibody testing
30
Q

Infectious Mononucleosis Syndrome: Mgmt.

A
  • Supportive
  • Do NOT use steroids
  • Avoid contact sports
31
Q

Roseola Infantum: Basics

A
  • 6th disease of exanthem subitum
  • Spread via oral/nasal route
  • USually seen in 6-24mo
  • Incubation: 9-10d
32
Q

Roseola Infantum: Clinical Findings

A
  • Onset of fever: usually high for about 5-7d
  • Not acting ill
  • URI
  • Mild conjunctivitis
  • Fever disappears, then a diffuse, non-puritic, discrete pink, maculopapular rash appears; blanchable
33
Q

Roseola Infantum: Dx and Mgmt.

A
  • CBC w/low WBC count

- Mgmt.: Supportive

34
Q

Varicella: Basics

A
  • Spread by direct contact, droplets, airborne transmission
  • Incubation period: 10-21d (~14d)
  • Contagious 1-2d before rash and after all the rash is scabbed
35
Q

Varicella: Clinical Findings

A
  • Fever
  • HA
  • Anorexia
  • URI Symptoms
  • Rash: begins on scalp, face, or trunk with crops of very pruritic vesicles in a teardrop shape on an erythematous border that umbilicates and scabs at all different times during the disease
  • Lesions may be everywhere: throat, mouth, vagina, anus
36
Q

Varicella: Dx & Mgmt.

A
  • Dx: None, may take viral culture
  • Mgmt.: relief of itching, acyclovir with immunocompromised or severe disease
  • FYI: Shingles is a reactivation of the disease and victims of shingles are also infectious and can cause primary varicella illness
37
Q

Influenza: Basics

A
  • 3 Antigenic types: A, B, and C
  • Type A and B are responsible for epidemic Dz
  • Type C is sporadic and mild
  • Type A is further classified into: H1N1, H1N2, and H3N2
  • Peaks in winter months
  • Younger children (6mo-2yr) have highest rates of hospitalizations
  • Incubation: 1-4d, contagious 24hr before Sx
38
Q

Influenza: Clinical Findings

A
  • Sudden onset high fever
  • HA
  • Chills
  • Cough
  • Vertigo
  • Sore throat
  • N/V/D
  • conjunctival injection
  • PNA
  • CHF
39
Q

Influenza: Dx

A
  • Rapid influenza testing from nasopharynx
40
Q

Influenza: Mgmt.

A
  • Tamiflu for 5d
  • Supportive treatment
  • Must check CDC website yearly for specific changes in treatment seasonally
41
Q

Measles: Basics

A
  • Rubeola
  • Very serious associated w/significant morbidity
  • Sources of infections include respiratory secretions, blood, and urine
  • Incubation: 8-12d
42
Q

Measles: 3 Stages of Clinical Manifestations

A
  • Incubation period: no Sx
  • Prodromal period: 1st sign of illness, lasting 4-5d with URI Sx: fever, cough, conjunctivitis, Koplik spots on the oral mucosa
  • Rash stage: about the 4th day of illness as temp rises to 105, maculopapular rash starting behind the ears and forehead moving all over the body
43
Q

Measles: Dx

A
  • Measles IgM and then serial IgG antibodies

- Viral isolation from urine, blood, throat, and nasopharyngeal swab

44
Q

Measles: Mgmt.

A
  • Consultation with ID since reportable
45
Q

Mumps: Basics

A
  • Causes painful enlargement of the salivary glands
  • Source of infection is salive
  • Incubation period: 16-18d
46
Q

Mumps: Clinical findings (2 Stages)

A
  • Prodromal Stage: fever, HA, anorexia, neck pain

- Swelling stage: parotid glands swell 24hr after the prodromal stage; Stensen’s duct is red; orchitis can occur

47
Q

Mumps: Dx and Mgmt.

A
  • IgM and IgG titers

- Mgmt.: Supportive

48
Q

Erythema Infectiosum (Fifth Disease): Basics

A
  • Caused by parvovirus B19
  • Spread by vertical transmission from mother to fetus, respiratory secretions; and percutaneous exposure to blood or blood products
  • Seen in 5-15yr
  • Secondary spread to household contacts 50%
  • Incubation: 4-21d
49
Q

Erythema Infectiosum: Clinical Findings (2 stages)

A
  • Prodrome: mild fever; myalgia; HA; malaise; URI symptoms
  • Rash: appears 7-10d after prodrome (2-3wk after exposure); communicable until rash disappears; 3 stages of rash
    1) Appears as “slapped cheek; lasts 1-4d
    2) lacy maculopapular eruptions on trunk; moves to arms, thighs, buttocks, sparing palms and soles; lasts one month
    3) rash disappears
50
Q

Erythema Infectiosum: Dx & Mgmt.

A
  • Dx: not indicated, clinical diagnosis

- Mgmt.: self-limited; support

51
Q

Parainfluenza: Basics

A
  • Similar to influenza and mumps virus and is an important cause of croup, bronchiolitis, and PNA
  • Incubation: 2-6d; can be shed for 4-7d before Sx onset
52
Q

Parainfluenza: Clinical Findings

A
  • 80% after upper airways

- Sore throat common in older children

53
Q

Parainfluenza: Dx & Mgmt.

A
  • Dx: Not needed

- Mgmt.: supportive, no vaccine available, no anti-viral treatment

54
Q

Rubella ((German Measles): Basics

A
  • Acute disease of childhood that occurs in two forms: post-natal and congenital
  • Rubella is an RNA virus, humans are the only reservoir
  • Vaccine limits # cases
  • Incubation: 14-21d
  • Period of infectivity: 3-8d after exposure
55
Q

Rubella: Clinical Findings (3 stages)

A

1) Prodrome: fever, GI upset, Sore throat, eye pain, arthralgia (this stage often missed)
2) Lymphadenopathy: begins within 24hr; Postauricular, posterior cervical, and posterior occipital are primary nodes involved
3) Rash: an exanthem can appear in 20% just before the general rash that looks like a small rose-colored to reddish spots on the soft palate followed by exanthem of discrete papules that coalesce, lasting 3d

N827 (19 decks)

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