pediatric infectious disease Flashcards
t cell independent responses are weak until
2 years of age - poor response to encapsulated bacteria with polysacharides
maternal igG starts at
28 weeks gestation
fever in children < 3 yrs of age
minor self-resolving viral
2 day old infant with fever
FULL WORK UP
0-3 month old toxic infant
full septic work up, empiric abx
Common infections (Bacteria) perinatally
- GroupB strep
- Ecoli, gram negative enteric (1)
- Listeria
Common infections (viral) perinatally
HSV
Entero/parechovirus
If infant is toxic, NO meningitis
- give Ampicillin + gentamicin Or cefotaxime
If infant is toxic, YES meningitis
- Ampicillin (for listeria) + cefotaxime
group B strep can cause (early onset) < 7 days
- Pneumonia
- septicemia
- meningitis
group B strep can cause (LATE onset) > 7 days
- vertical or horizontal transmission
- Meningitis
- osteomyelitis
- soft tissue infection
- sepsis
managing group B strep Abx?
amp +/- gentamicin IV 2-3 weeks
maternal Abx for GBS
- Penicillin G q 4hrs until delivery
or Amp
sufficient prophylaxis is
4 hours or more prior to delivery
clinical manifestations of HSV -
- skin eye mouth (45%) (day 10)
- neurological (2nd week days 16 -19)/disseminated disease - may not have skin manifestation
Tx duration for isolated mucocutaneous HSV
- 2 weeks
- 3 weeks disseminates or CNS
3 week infant fever x 12 hours
Full septic work up and empiric therapy
risk of serious bacterial infection in neonates with no risk factors is
3-6%
2 month old with fever and irritability 24 hours
outpatient management if low risk -
discharge - close follow up
Common bacterial infections 1-3 month old
- group B strep
- E coli
- Listeria
INCLUDE environmental - strep pneum
- N. meningitidis
- Staph aureus
- GAS
Low risk criteria for serious infection in 1-3 month old
- previously healthy/term infant
- Non-toxic
- No focal infection
- peripheral leukocytes 5- 15
urine < 10 WBCper high field
Stool < 5 WBC per high field
3-36 month old infants - infections
occult bacteria - strep pneump, N. meningitidis
HIB and Pneumococ - vaccines - less seen
Fever in 3 - 36 month olds non-toxic
1) - acetaminophen monitor 2 days
2) higher UTI risk in males - consider cbc AND BLOOD CULTURES if not immunized
empiric Abx for 0-28 days old
No meningitis - Amp+ gentamicin
Yes meningitis - Amp + cefotaxime
29-90 days empiric Abx
No meningitis - Amp + cefotaxime
Yes meningitis - Amp + cefo +/- VANCO
3- 36 months
No meningitis - Cefuroxime/Cefotaxime
YES meningitis - Cefotaxime + VANCO
Vancomycin mostly for
resistant strep pneumo
4 year old boy fever, headache, lethargy x24 hrs, nuchal rigidity, UTIs in classs
strep pneumo infection > 3 months
normal WBC count
5-15
3 month old with poor suck, constipation, afebrile but lethargic and FLOPPY
- Full septic work up! and empiric Abx -
what do you do for Botulinim toxin in infants?
- supportive care
Abx NOT helpful, aminoglycosides can exacerbate Sx
15 year old, fever cough, lethargic, hypotensive, elevated ddimer, elevated Serum creatinine and liver enzymes
- Group A strep
Toxic shock syndrome
managing toxic shock
- iv fluids
- Inotropes
- Penicillin and CLINDAMYCIN
IVIG
strawberry tongue or tonsils
strep pyogenes
newborn infant - hepatosplenomegaly and petechial rash and thromboytopenia
- CMV
common cause of acquired hearling loss
Majority ASYmptomatic at birth
congenital CMV can cause
- chorioretinitis
- periventricular calcification/brain atrophy
Osteomyelitis/periostitis can be due to
Syphilis infection
Cicatrical scars, and limb hypoplasia can be due to
Varicella zoster
Cataracts, blueberry muffin rash
Rubella
Hepatosplenomegaly
Chorioretinitis
CNS calcifications can be due to
Toxoplasmosis
4 month old - dry cough -
tachypneic
hypoxemic
inspiratory crackles
positive for pneumocystis and CMV
