Pediatric Infectious Disease Flashcards
Immunization: Hepatitis B
Hepatitis B : 3 doses
1st: at birth
2nd: at 1-2 months
3rd: at 6-18 months
Immunization: Rotavirus
Rotavrus
1st: 2 months
2nd: 4 months
(if using rotateq: 3rd dose @ 6 months)
Immunization: Dtap
Dtap
- diptheria, tetanus, acellular Pertussis
- for those under 7 years
- 5 doses
1st: 2 months
2nd: 4 months
3rd: 6 months
4th: 15-18months
5th: 4-6 years
Immunization: HiB
HiB
- hemophalus influ. B
1st: 2 months
2nd: 4 months
3rd: 6 months
booster (4th) : 12-15 months
Immunization: penumococcal conjugate (PCV13 or PCV15)
PCV13 or 15
1st: 2 months
2nd: 4 months
3rd: 6 months
4th: 12-15 months
Immunization: polio
polio
1st: 2 months
2nd: 4 months
3rd: 6-18 months
4th: after age 4 (6 months after 3rd)
Immunization: COVID 19
COVID- 19
- 2 or 3 dose primary or boosters
- from 6 months on
Immunization:flu
Flu
- annual dose starting at 6months
- first & seconda year: give two doses (1/2 each) for 6 months -8years
Immunization: MMR & Varicella
MMR
- measles, mumps, rubella
- varicella too (varicella is a live vaccine: hense why we wait until 12 months)
1st: 12-15 months
2nd: 4-6 years
Immunization: Hep A
Hep A
2 doses: between 12-23 months
6 months between
Immunization: Tdap
Tdap
- for those 7 years or older
age 11-12 : 1 dose
Immunization: HPV
HPV
- 2 doses starting 11-12 (early as 9)
- separate by 6-12 months)
Immunization: Meningococcal
Meningococcal (MenACWY)
- 1st: 11-12 years
- 2nd: 16 years
Immunization: Men B
for special populations
2-3 dose serires
0 months
1-2 months
6 months
Varicella (VZV, HHV-3)
etiology
rash description
spread
Varicella
- “chicken-pox”
Rash
- puritic, centrifungal
- papules which become vesicles, pustualar, pop and then crust over
- “dew drop on rose petal” : red base with vesicle on top
- on the trunk, back, face, scalp etc.
Infection Spread
- through direct or droplet contact
- 2-3 incubation period
Viral Progression
- 2-3 weeks incubation afte rexpsoure
- low grade fever, malaise
- rash appears: contageous period!!
- rash: papule, vesicle, pustule, crusts & ITCHYYYYY
- rash crusts: no longer contageous
Varicella
diagnosis
treatment
Diagnosis
- PCR of the vescicular fluid
Treatment
- reminder: the virus lays dorment in the spinal nerve root ganglion (dorsal root and crainla nerves) and reppears as shingles later
- treatment within 24 hours of rash
- Acyclovir for those under 2
- Valacyclovir
- monitor renals!
*technially dont have to treat if theyre healthy, but we do treat those under 2, those immunocomp.
Nonpharm
- isolate pt. until crusts
- calamine for itching
- NO asprin
- self litiming in healthy pt
high risk for severe disease : varicella
Pt at High Risk: need to treat
- under 2
- secondary case (second time)
- chronic cutaneous or pulm. disorders
- steroid users
- chronic salicyates
- unvaccinated and > 13
vaccine : live
12-18 months then 4-6 years
which vaccines are live
MMR
Varicells
Rotavirus
intranasal flu
Measles
etiology & spread
symptoms and disease progression
Measles
“rubeolla”
Etiolgoy/Spread
- direct contact/droplept
- highly contagous in the prodrome; pre-eruptive phase & then again 4 days post rash
- incubation 10-14 days
prodrome
- fever
- runny nose
- cough
- conjuctivitis
- malaise
- irriabiltiy
- photophobis
- koplik spots: in oral mucosa
Rash
- begins 2-4 days after prodrome
- brick red rash, maculopapular
- starts on FACE: spreads to trunk, then extermities
- fades within 3-7 days
RASH AND FEVER LEAVE AT THE SAME TIME!!!
infected: prodromal period: intensifies: RASH: spreads down and out from face: lasts 3-7 days
Measles
diagnosis
treatment
Diagnosis
- ELISA: IgM antibody test : detecting 3 days after apperance of rash
- RNA PCR: throat, urine or blood: can be done 5 days before symptoms so if they know they’re exposed: prior to sx. can do this
- lymphopenia on cbc?
Treatment
- symptomatic
Symptomatic
- antipyretics (tylenol/motrin)
- fluids
- treat any bacterial superinfections
- vitamin A supplemenation: helps
Antivirals
- Ribavirin
- helps decrease possibility of pneumonitis developing
- for those < 12 months or 12+ months with high risk
Mumps
Etiology & spread
symptoms and signs
Etiolgy
- paramyxovirus
- spread: through droplet, contact & fomite
Symptoms
- painful, swollen salivary gland (parotid most common)
- facial edema
- can have red/swollen parotid duct on exam)
Course of Disease 2 weeks
- prodromal symotoms: fever, malaise
- one paroid gland swells, then the other
- within 1 week, glands de-swell
- other symptoms rise in second week
Complicatiosn of Mumps
Complications
- orchitis: can infarct testis!
- meningitis/encephalitis
- GBS: upward progessive muslce weakness
- hearing loss
- pripaism
Mumps
Diagnosis
treatment
Diagnosis
- clinical dx.: reporatble disease
- onset: two specimens: oral/buccal & serum via Rt-PCR culutre
- vaccincation can cause false negative
- elevated IgM can dx. : repeat IGM 5-10 days after symptoms
Treatment
- symptomatic
Rubella
etiology & spread
symptoms and signs
Etiolgoy: Rubella
- togavirus
- transmission via close and prolonged contact
- 2-3 incubation
Symptoms
- no prodrome in kids = acute onset of rash
- lymphadenopathy
- forchheimer spots: pink on the soft palate
Rash
- a fine, pink , maculopapular rash rapid onset
- face –> trunk –> extremities
- Spares palms and soles
- non-tender
-
Congenital Rubella
symptoms
Congenital Rubella
- mom gets infected while pregnant
- severity of symptoms depends on gestational age
Symtpoms
- microcephaly
- cataracts
- heart defects
- deafness
- premature
- LBW
- death
Rubella
Diagnosis
Treatment
Diagnosis
- IgM antibodies: within first few days via serum or saliva
- mostly detectable; best detected by day4-5
- reportable disease: CDC needs IgG
Treatment
- symptomatic: isolation for 7 days after rash begins
- antipyreics
- oral fluids
Rash starts: they’re contagous: rash goes away in 1 week: not contagenous
Roseola
etiolgoy & spread
symptoms
treatment
Rosela
- HHV-6
Symptoms
- very very high fever: 103/104/105
- can be a cause of infantile seizures
- fever will GO away
- then rash will BEGIN
rash: maculopapular
- begins on neck and trunk –> face –> extermities
- not really itchy
Diagnosis
- clinical
Treatment
- symptomatic
Hand, Foot & Mouth Disease (coxackievirus)
etiolgoy
symptoms
treatment
HFM disease Etiology
- coxackievirus
- fecal-oral transmission or secretions
- 3-5 days incubation
Symptoms
- sore throat: wont eat!
Rash
- macular, maculopapular or vesicualr
- nonpuritic or painful!
- rash in oral mucosal: in the buccal areas
- rash on hands and feet
Treatment
- symptomatic
Impetigo
etiolgoy
symptoms
Impetigo: Etiology
- superfiscial bacterial infection
- 2-5 year olds: common
- due to close contact
- warm, humid conditions
- Group A strep & Staph
Symptoms
- “honey crusted lesions”
3 types
- non-bullous
- ecthyma
- bullous
Impetigo
3 types
non-bullous
- most common
- papules that progress to vesicles with errythema
- vseicles enlarge and become thickened and crust with golden color
- takes 1 week to progress
- usually on face and extermities
Ecthyma
- ulcerative formation
- deep into dermis
- punched out ulcers with yellow crust
Bullous
- in younger kids
- vesicules enlarge to create flaccid bullae, clear/yellow fluid inside them
- darker/turbid coloring later on
- trunk most often effected
- staph aureus
Impetigo
diagnosis
Treatment
Diagnosis
- gram stain and culture: to find GAS or staph
Treatment
topical: for skin involvement = mupriocin or retapamulin
oral treatment: for lost of lesions & for ecthyma
cephalexin and dicloxacillin
Staph-scaleded skin syndrome
etiology
symptoms
Etiology
- a staph infection in which the strain of staph produces exotoxins:
- toxin A and B: cleave the proteins in teh skin needed to adhese the superfisical skin to dermis: peeling skin off
Symptoms
- skin fragility: extremely painful condition
- superfisical blister and erosions of the blisters
- reddness in the skin folds first: progressiong to desquamation and erosion
- no muscoal involvment
- fever, irritability and poor feeding
Staph Scalded Skin Syndrome
diagnosis
treatment
Diagnosis
- clinical diagnosis: see rapid progression of redness in skin folds to the peeling
- bacterial culutres cna be send to confrim staph aureus and guide treatment
Treatment
- admit these kiddos
- IV abx. nafcillin or oxacillin : trasnfer to oral when clincially improving
- IV hydration
- gentle skin care: no baths, use vasoline and nonadhearnt dressing
- tylenol or motrin if > 6 months
-
Tinea capitis
Tinea corporis
Tinea capitis
- tinea (fungal) infection on the scalp
- trichophyton tonsurans and microspor. canis
- symptoms: thickened, broken-off hairs & scalding of scalp : red-scaley lesions
- dx: fungal culture
- treatment: oral griseofulvin and terbinafine
culutre hair every 4 weeks until negative
Tinea Corporis
- tinea (fungal) on the body
- annualr marginated plauques: thin scale on peripheary with clear center OR can be annualr confluent dermatitis
- dx: fungal culutre
- treatment: topical antifungal
Tinea Cruris
Tinea pedis
Tinea Cruris
- fungal infection in teh skin folds/inguinal areas
- fungus: t rubrum, mentagrphytes, floccosum
- symmetrical, sharply marginated lesions in inguinal
Tinea Pedia “athletes foot”
- t rubrum or mentagrpphyes
- red scales on soles of foot, between toes, can create cracks
treatment
- treat both of these with topicals
- topical fungal creams
Tinea Unguium
Tinea Unguium : tinea of the nail
- see oncyholysis: separation of the nail from the bed, yellow discoloration and thickeing of the nail which crumbles too
- t rubrum: fungal infection
- commonly 1-2 nails NOT all
dx: confirm with KOH and fungal culture
treatment
- terbinafine oral
- can use itraconazole in pulse therapy
Tinea Versicolor
Tinea Versicolor
- superfiscial infection: malessizia globosa
- yeast: like function
Symptoms
- areas of hypopigmented skin macules: very fine scales
- located where the sun hits the most
- winter time: macules appear red-brown
Treatment
- selenium sulfide left on overnight
- zinc pyrithoine shampoo left on overnight
repeat 1 week later or monthly
- topical antifungals
Candida Infections
Candida albicans = yeast infection
- diaper dermatitis
- oral thrush: thick, white patches in oral mucosa
- perleche: fissures at the mouth angles
- chronic paronychia: nail plate candida
Candida dermatitis: diaper rash
- sharp, demarkated areas of red platches in moist areas
- more common after abx. use in kids
Treatments
- topic imidazole cream for diaper
- nystain for oral thrush
- antifungal angets on the naisl left on overnight
Molluscum Contagiosum
Molluscum Contagiosum
- poxvirus
symptoms
-proliferates the epidermis
pale, papules which form as flesh colored with umbilcated
come in groups
will NOT be red
treatment
- monitor, they will resolve over months/years
Scabies
Scabies
- mites which grow and burrow in skin
Symptoms
- linear burrows seen in the ankels, finger webs, areoals, axillary folds, gentials and face
- scratch marks
- itchy!!!!
- honey crusted color
- pustules if secondary infection
Diagnosis
- ID the female mite/egg/feces via microscope from unscratched area or under nail
Treatment
permithrin from neck down (can use on face in infacnts if scabies there)
give to household contacts
Lice
Lice
- itchy papules and pusules with severe nighttime itching
To Note
- lice on teh body cnanot be seen: can be seen on clohtes
- they are tight within teh hair
- crawl on pubic hairs or see blue/black macules on pubis or eyelashes of newborns
Treatment
- OTC permethrin with manual removal
- malathoin: can kill the eggs
- ivermetcin/spinosad: topicals which you dont need to then manually remove the live
Removal of Lice and application of treatment
remove clothing ebfore application
- do not use conditioner before: do no wash hair for 1-2 days after application
- put on clean clothes: recheck for lice in 8-12 hours
- onlt reapply if you see lice still moving
- comb dead lice out
- if you apply, and no dead lice seen: come back to get rx. treatment
recehck Q2-3 days to ensure lice and nits are gone
for clothing and sheet: they will dei if in hot water
or tie off in bag for 2 weeks to suffocate
