Mehl./UW bact. inf. Scarlet f. + GSB sepsis in neonates 04-01 (2)

Question 1

Mehl./UW cause?

Answer 1

Streptococcus pyogenes (group A streptococcus)

Question 2

Mehl. CP?

Answer 2

strawberry tongue / red lips + salmon-pink maculopapular body rash.

Question 3

Mehl. Tx? why?

Answer 3

penicillin to prevent rheumatic fever (type II HS)

Question 4

Mehl. also group A strep what disease can cause? 2

Answer 4

rheumatic fever (type II HS)
can also lead to PSGN (type III HS).

Question 5

UW. CP? 5

Answer 5

fever + pharyngitis

tonsilar erythema and exudates

ANTERIOR cervical nodes tenderness (in mononucleosis = posterior)

Strawberry tongue (gali but paminetas ,,red tongue)

sandpaper rash

Question 6

UW. Dx? 2

Answer 6

Rapid streptococcal antigen test

Throat culture

Question 7

UW. Tx?

Answer 7

penicillin = to prevent rheumatic fever

Question 8

Uw. does any therapy required for rashes?

Answer 8

NO

Question 9

UW. skin around mouth might be circumoral pallor, sand paper rashes on cheeks.

Answer 9

.

Question 10

UW. ,,sandpaper” rashes pronounced in what locations mostly?

Answer 10

In skin folds, eg axillae and groins

Question 11

UW. classical CP: erythematous pharynx with tonsilar exudates, palatal petechiae, strawberry tongue.

Answer 11

.

Question 12

UW. what is the outcome of rashes?

Answer 12

as the illness resolves, desquamation of the rash results in skin peeling.

Question 13

UW. gram positive coci in pairs and chains?

Answer 13

Strep. agalactiae aka group B streptococus

Question 14

UW. most common cause of early-onset neonatal sepsis (typically within 24h)?

Answer 14

Strep. agalactiae aka group B streptococus

Question 15

UW. Strep. agalactiae aka group B streptococus trasmission?

Answer 15

vertical transmission during passage through a colonized vaginal canal.

Question 16

UW. GBS also can cause late onset infection in infants >=7days, what transmission?

Answer 16

due to HORIZONTAL transmission of bacteria from colonized household members

Question 17

UW. maternal intrapartum abs prophylaxis does not reduce what GBS presentation?

Answer 17

LATE-ONSET

because it is horizontally transmited, not vertically

Question 18

UW. GBS table. Early onset < 7d.
pathogenesis? 2

Answer 18

vertical transmission in utero OR during vaginal delivery

Reduced transmission with intrapartum abs prophylaxis

Question 19

UW. GBS table. Early onset < 7d.
CP? 2

Answer 19

Typically presents within 24h
Sepsis, pneumonia, meningitis

Question 20

UW. GBS table. Late onset >= 7d. pathogenesis? 1

Answer 20

Horizontal transmission from colonized individuals (household individuals)

Question 21

UW. GBS table. Late onset >= 7d. CP? 2

Answer 21

Typically presents age 4-5 weeks
Bacteremia, meningitis, focal infection (eg cellulitis)

Question 22

UW. GBS table. both early/late. Diagnosis? 1

Answer 22

Gram positive cocci in pairs/chain on culture of blood, CSF or body fluid

Question 23

UW. GBS table. both early/late. Tx? 2

Answer 23

Early initiation of empiric antibiotics
Definitive therapy with penicillin G

Question 24

UW. GBS. Mother did not get abs because underwent S/C. in case 12 days + sepsis. Cause?

Answer 24

GBS

Its more than 1 week, therefore trasmission is horizontal. abs for mother would not changes anything

Question 25

UW. intrapartum abs for GSB is not necessary for planned S/c without labor or ROM because transmission is low in such settings.

Answer 25

.

Question 26

UW. buvo case 2days old boy + respiratory insuff. Cause?

Answer 26

GBS pneumonia. Early GBS diseases (<1 week): sesis, pneumonia, meningitis.

Question 27

UW. buvo case 2days old boy + born 41 w + respiratory insuff. why not NRDS?

Answer 27

NRDS = presents within hours, not days. Presents in PRETERM, not term. xray = simmilar to GBS pneumonia.

Question 28

UW. GBS (aka strep. agalacties) pneumonia CP? what confirmx Dx?

Answer 28

respiratory distress (tachypnea, nasal flaring, retractions) + hypoxia. Dx of pneumonia is confirmed with xray.

Question 29

UW. GBS (aka strep. agalacties) pneumonia empiric Tx?

Answer 29

Ampicillin + gentamicin.

Question 30

UW. GBS (aka strep. agalacties) pneumonia Tx IF GSB is isolated from the blood (ie pneumonia and bacteremia)?

Answer 30

narrow coverage from empiric to definitive Penicillin G i.v.

Question 31

UW. neonatal sepsis. Table. causes? 3

Answer 31

GBS Ecoli Listeria monocytogenes (<7 days)

Question 32

UW. neonatal sepsis. Table. CP?

Answer 32

temp. instability (fever, hypothermia) CNS signs (lethargy, irritability, apnea) Poor feeding Respiratory distress (tachypnea, grunting) Jaundice

Question 33

UW. neonatal sepsis. Table. evaluation? 2

Answer 33

Inflammatory markers (ie CRP, ANC = absolute neutrophil count; procalcitonin) Blood, urine, CSF culture *buvo prierasas, kad limited evaluation (without CSF studies) and outpatient Mx may be considered in well-appearing, febrile meonates age > 21 days.

Question 34

UW. neonatal sepsis. Table. Tx?

Answer 34

Ampicillin + gentamicin I/V

Question 35

UW neonatal sepsis + meningitis. CP?

Answer 35

meningitis in neonates (age =<28d) = no nuhal rigidity or bruzinski/kernig sign. their CP is irritable, letargic, hypotonic.!!!!!!! buvo case kur tipiine sepsio israiska, apie nuhal nieko nepamineta, tik irritability. Dx = sepsis + meningitis

Question 36

UW neonatal sepsis why jaundice?

Answer 36

sepsis-associated cholestasis

Question 37

UW neonatal sepsis do all 3 cultures (blood, urine and CSF). Once obtained=>?

Answer 37

give empiric abs (ampicillin and gentamycin)

Question 38

UW neonatal sepsis. If neonate in critical condition (eg septic shok, status epilepticus) + cannot undergo lumbar puncture, what to do?

Answer 38

give abs prior culture.