Mehl. UW. Bacterial bullet cases 1 04-01 (2)

Question 1

Mehl. 11-month-old boy + red tongue + maculopapular body rash + fever 100.5F = Dx?
Causative m/o?
Tx?

Answer 1

Scarlet fever;

Group A Strep;

give penicillin to prevent Rheumatic Fever

Question 2

UW. 10 y/o boy + for 2 days had headache, fever, and sore throat. Temp. 38.3 C, BP 112/70, pulse 108/min, RR 20/min. Fine, erythematous, papular rash with a rough texture on the anterior trunk. The rash appears more concentrated in the axillae and groin and blanches with pressure. Tender, shotty, anterior cervical lymphadenopathy is present, and the posterior oropharynx is erythematous with tonsillar exudates and soft palatal petechiae. The father adds, “Two kids in his class had the same symptoms, and now their skin is peeling.” Dx?

Answer 2

SCARLET FEVER

Question 3

Mehl. Neonate born at term + fever + high WBCs (65% neutrophils) + CSF shows trace cells (90% lymphocytes); Dx?

Answer 3

Group B Strep (GBS; Strep agalactiae) sepsis;

students can get confused over the CSF findings, but this apparently is a normal finding; 65% neutrophils is slight left- shift for bacterial infection.

Question 4

Mehl. Neonate + GBS sepsis; Tx?

Answer 4

answer = ampicillin + gentamicin

Question 5

Mehl. Neonate + GBS sepsis; what is WRONG Tx?

Answer 5

ceftriaxone + vancomycin.

Question 6

UW. 5-week-old girl + become increasingly irritable over the past 48 hours with decreased appetite and frequent crying. Temp. 38.3 C. A 5 × 6 cm area of redness and induration is noted along the left cheek and submandibular region; it has greatly expanded over the past hour. Leukocyte 22k.

Blood, urine, and cerebrospinal fluid are collected for culture. The infant is admitted to the pediatrics unit, and broad-spectrum antibiotics are started. After 5 hours, the blood culture grows gram-positive cocci in pairs and chains. PATHOGEN CAUSED PRESENTATION?

Answer 6

STREPTOCOCCUS AGALACTIAE

late onset, in this case: cellulitis-adenitis -> + bacteremia
late onset CP: bacteremia, meningitis, focal infection (eg cellulitis)

Question 7

UW. Neonate + cellulitis -> bacteremia. You get results that its GBS. Tx?

Answer 7

Start empiric –> when get results confirming that its GBS => definitive Tx is iv penicillin G

Question 8

Mehl. 14M + fever + stiff neck + non-blanching purpura on abdomen + BP of 60/35 + IV fluids and norepinephrine have limited effect; Dx?

Answer 8

Dx = Waterhouse-Friderichsen syndrome.
Hemorrhagic necrosis of adrenal cortices secondary to meningococcal septicemia.

non- blanching rash in the setting of meningitis = meningococcus

Question 9

Mehl. 14M + fever + stiff neck + non-blanching purpura on abdomen + BP of 60/35 + IV fluids and norepinephrine have limited effect; Tx?

Answer 9

hydrocortisone

hydrocortisone is the answer because cortisol is deficient in this setting –> cortisol normally needed to upregulate alpha-1 receptors on arterioles, thereby permitting NE and E to do their job; that’s why NE has limited effect

Question 10

UW. 18-month-old boy + fever, vomiting, and lethargy. Throughout the day, the patient developed a progressive rash on the lower extremities and became increasingly lethargic. Immunizations are up to date. The patient lives with his parents and 3-year-old brother. Both he and his brother attend day care. Temperature is 40.2 C, and pulse is 124/min. On examination the patient is lethargic. He flexes his hips when his neck is flexed. There is an erythematous, nonblanching, pinpoint rash on the trunk and lower extremities. Causative mo?

Answer 10

NEISSERIA MENINGITIDIS

Question 11

UW. 2-year-old girl + Approximately 10 hours ago, the patient had several episodes of vomiting and began to feel increasingly lethargic. Vaccinations are up to date. Temp. 39.8 C, BP 70/36, pulse 135/min. The patient is poorly responsive on examination. The abdomen is nontender and nondistended. A rash is present on the bilateral lower extremities. Antibiotic therapy is initiated, and a lumbar puncture is obtained. Gram stain of cerebrospinal fluid shows gram-negative diplococci. Which of the following additional studies should be obtained in this patient?

Answer 11

SERUM FIBRINOGEN

Question 12

UW. 12-day-old boy + poor feeding. Born via scheduled S/c. Maternal GBS was positive, but intrapartum antibiotic prophylaxis was deferred due to the planned cesarean delivery. The patient’s 3-year-old brother attends day care and has had rhinorrhea and cough this week. Temp. 35.1 C. Physical examination shows a hypotonic, lethargic infant with a full anterior fontanelle. Initial laboratory studies reveal a leu 2,000/mm3 with 20% bands. During the evaluation, he becomes apneic and requires intubation. Causative Mo?

Answer 12

GBS

late onset neonatal meningitis (>1 week)
Trasmission = horizontal, not due to mother (because its late)

Question 13

UW. 2-day-old boy + difficulty breathing. Born 41w. The patient was initially well-appearing and roomed in with his parents, but over the past hour, he has developed respiratory distress. Temp. 37.5 C, RR 70/min. SpO2 91%. The patient is grunting, and nasal flaring and intercostal and subcostal retractions are seen. Chest auscultation demonstrates diffuse crackles. Heart examination is normal. Chest x-ray reveals bilateral, patchy, alveolar densities with pleural effusions. Dx?

Answer 13

GBS PENEUMONIA (zymejau NRDS)

early presentation (<1week old).
GBS complications = sepsis, meningitis, pneumonia

NRDS = presents within hours, not days. IN PREMATURES, not matures. xray = similar to GBS pneumonia.

Question 14

Mehl. 8F + fever + purpuric lesions over trunk and extremities + brother died of fulminant meningococcemia four years ago; Dx?

Answer 14

“complement system immunodeficiency”

terminal complement deficiency (C5-9) is associated with recurrent Neisseria infections (gonococcal and meningococcal)

Question 15

UW. A 21-day-old girl + Temp. is 35.1 C BP 78/52, pulse 150/min, RR 62/min. The neonate is irritable and difficult to console. She has a full fontanelle and dry mucous membranes. Scleral icterus and jaundice of the face and chest is present. The lungs are clear, and no murmur is present. Abdominal examination is normal. Neurologic examination shows equal movement of all 4 extremities with mildly decreased muscle tone. BEST NEXT STEP IN MX?

Answer 15

BLOOD, URINE, AND CSF CULTURES

is pradziu kulturos –> paskui abs

Dx: neonatal sepsis with meningitis
meningitis in neonatas (age =<28d) = no nuhal rigidity or bruzinski/kernig sign. their CP is irritable, letargic, hypotonic.