Pediatric Infectious Disease - AMBOSS and OME Flashcards
Signs and symptoms of trachoma conjunctavitis
- Starts as follicular conjunctavitis, then progresses to mixed papillary and follicular
- Corneal haziness with neovascularization, aka pannus, is a classic finding
Fever and sore throat with papulovesicular lesions on the posterior orophaynx
Classic presentation of herpangina. Often occurs with HFM disease
Oropharyngeal herpes-like infection caused by Coxsackie virus
Most common in kids age 3-10
Best diagnostic test for confirming a diagnosis of osteomyelitis
Bone marrow biopsy
In stable patients, this should precede the administration of antibiotics.
Most common etiology of osteomyelitis in children and treatment
S. aureus
Treat w/ vancomycin
Mumps
- Caused by Mumps virus
- Seen in pubertal males who present with bilateral parotid swelling
- May cause orchitis in males, which may lead to sterility
- Diagnosis is clinical, treatment is supportive
Erythema infectiosium
- Parvo B19
- Starts on cheeks, then rarely appears in other places
- Fever and rash occur at the same time
- Diagnosis is clinical, treatment is supportive
- May provoke an aplastic crisis in patients with a hemoglobinopathy
- If mom is pregnant, separate her from the infected child – otherwise her current pregnancy could end in hydrops
Measles
- Caused by Paramyxovirus
-
Prodrome: The four C’s
- Cough
- Coryza
- Conjunctavitis
- Koplik spots
- Fever and rash then occur simultaneously
- Rash begins on face, then spreads down trunk and arms
- Really fever begins when the rash starts to spread
- Diagnosis is clinical, treatment is supportive plus vitamin A
- Later in life, at risk for subacute sclerosing panencephalitis
Rubella
- Caused by Rubella virus
- Prodrome: Tender postauricular and suboccipital lymphadenopathy
- Fever and rash then occur simultaneously
- Rash begins on face, then spreads down trunk and arms
- Really fever begins when the rash starts to spread
- Diagnosis is clinical, treatment is supportive
Roseola
- Caused by HHV-6
- Prodrome: Very high, spiking fever, >104F
- Rash occurs after fever breaks
- Rash starts on the trunk, then expands outward
- Diagnosis is clinical, treatment is supportive
- Since there is a high spiking fever, there may be a febrile seizure. If you are going to use the temperature, use acetominophen. Aspirin causes Reye syndrome.
Varicella
- Caused by VZV
- Rash without fever
- Diffuse rash with “vesicles on an erythematous base in different stages of healing”
- Diagnosis is clinical, treatment is supportive
- No Tzank smears. No PCRs. CLINICAL diagnosis.
- Shingles later in life
Hand-foot-mouth disease
- Caused by Coxsackie A
- Looks exactly like varicella, but only appears on the hands, feet, and mouth
- Can also involve oropharynx and buttocks, but not the trunk
- Diagnosis is clinical, treatment is supportive
Consideration of ICP in meningitis
If you suspect ICP may be elevated, start antibiotics NOW, then do CT, then an LP
If you don’t think ICP is elevated, do LP, then start antibiotics
Why don’t we like to use ceftriaxone in very young patients?
It causes hyperbilirubinemia in kids, particularly babies. It displaces bilirubin from albumin.
Ceftriaxone is contraindicated in premature infants up to 41 wks (GA at delivery + wks after birth) of age.
Pediatric empiric meningitis regimen for kids < 30 days
- Vancomycin
- Cefatoxime
- Ampicillin
- +/- steroids
How old does a kid have to be before we are confident that ELISA is a reliable test for HIV again?
18 months
If < 18 months, we use a DNA PCR
Prophylaxis in kids with HIV/AIDS
- 200
- PCP coverage w/ TMP-SMX (elseif dapsone, elseif atovaquone)
- 100
- Toxo coverage w/ TMP-SMX (elseif atovaquone)
- 50
- MAC coverage w/ azithromycin
___ is always the most common cause of osteomyelitis
Staph aureus is always the most common cause of osteomyelitis
Osteomyelitis workflow
- Start with X-ray. If positive for osteomyelitis, go to biopsy. If negative, do an MRI.
- If MRI is positive, go to biopsy.
- If toxic, give abx before biopsy
- If not toxic, biopsy before abx
Testing for pulmonary TB in kids
- If < 5, PPD
- If > 5, IFNg RA
Treating active vs latent TB
- Rifampin, isoniazid, pyrazinamide, ethambutol (RIPE) for active
- Isoniazid + B6 for latent
Lots of history and exam findings can suggest otitis media, but the diagnosis is made with. . .
. . . pneumatic insufflation demonstrating rigidity of tympanic membrane
A swimmer with otitis externa is likely to have ___
A serial ear picker with otitis externa is likely to have ___
A swimmer with otitis externa is likely to have Pseudomonas
A serial ear picker with otitis externa is likely to have Staph
Great way to differentiate otitis externa and media in a single physical exam maneuver
Pull on the pinna
Otitis externa: It hurts like hell
Otitis media: It relieves the pain
Treating otitis externa
Most mild cases are self-limited and require no treatment
If it looks really bad or if the person is toxic, then you can treat with eardrops of fluoroquinolones and steroids
Mastoiditis
- Infection of the mastoid bone
- Syndrome looks like otitis media + mastoid swelling, sometimes with anteriorly rotated ear
- Caused by the same bugs that cause otitis media
- Hx of tympanoplasty is a risk factor
- Diagnosis is clinical
- Treat with surgical decompression and treatment with otitis media Abx (ampicillin-clavulonate)
Workup and treatment of sinusitis
It is usually viral, which requires no workup or treatment.
If it is bacterial, it will not be subtle. It will be obvious. Bilateral purulent discharge and high fever. There are no diagnostic imaging tests, this is a clinical diagnosis. Treat with amoxicillin-clavulonate.
Recurrent viral and/or bacterial sinusitis warrants. . .
. . . a CT scan to assess for anatomic defect or foreign body
CENTOR score for pharyngitis
- No Cough. +1
- Exudates, +1
- Nodes, +1
- Temperature >38oC, +1
-
OR:
- < 14, +1
- > 44, -1
- If < 1, it’s viral, do nothing
- If 2-3, do rapid Strep. If it’s negative and you still feel like they have it, you can do a culture too.
- If >=4, treat with amox-clav now, but get rapid strep anyway for documentation
How to approach an insect in an ear
May occur in anyone who sleeps outside for any reason. Patient will report a sensation of crawling or buzzing.
DO NOT shine a light in the ear to inspect. The insect will burrow deeper in the ear towards the tympanic membrane.
Instead, use lidocaine to paralyze the insect, then retrieve it.
Treating a simple nose bleed
- Lean forward (NOT back – you will be aspirating blood and when you cough you will just dislodge the clot)
- Let blood drip into sink or bucket
- Apply pressue and/or ice
- If anterior bleed, you can cauterize
- If posterior, packing works but they should be on prophylactic antibiotics (to prevent toxic shock)
When a patient with CF gets pneumonia, you should assume and cover for ___
When a patient with CF gets pneumonia, you should assume and cover for pseudomonas
Effects of pertussis toxin
- Mechanism: ADP-ribosylation of G protein and decreased downstream cAMP and MAPK signaling
- Results:
- Decreased neutrophil and macrophage recruitment
- Skewing of Th1 response and resultant inappropriate lymphocytosis
- Can also cross the BBB and lead to neurologic sequellae
Gianotti-Crosti syndrome aka papular acrodermatitis of childhood
- Erythematous papular eruption without associated symptoms
- Symmetrically distributed on face, extensor surfaces of arms and legs, and buttocks. Trunk and back are spared.
- Sometimes coalesce into plaques and become pruritic
- Occurs age 1-6 following a URI
- Assocaited viruses:
- EBV
- Varicella
- Hepatitis B
- Treamtent: Supportive. Self-resolving in up to 8 weeks.
- Always screen for risk factors, signs, and symptoms of Hep B. If present, order serologies.
Verrucae
- aka warts!!! Caused by HPV
- Benign, spread skin-to-skin. May develop at site of trauma
- Four types:
- Verruca vulgaris (the common wart)
- Verruca plantaris (plantar warts)
- Verruca plana (flat warts)
- Condyloma accuminata (genital warts)
- Treatment is with topical salicylate, liquid nitrogen cryotherapy, imiquimod cream, oral zinc sulfate. There are more still. May require multiple treatments.
Unilateral thoracic exanthem aka Asymmetric Periflexural Exanthem of Childhood
- Rash with varying morphologies
- May appear as erythematous macules or papules with a surrounding halo, morbilliform, eczematous, or scarlatiniform, or reticular
- Begins on one side of the trunk, spreads centripetally
- Most often seen in winter and spring months
- Preceded by low-grade fever, lymphadenopathy, respiratory and GI complaints
- Pruritis is common
- Occurs in children gae 1-5 years
- Presumed viral, but origin is unknown (much like pityriasis rosacea)
- Treatment: Topical or oral antihistamines and mild steroids for pruritis. Self-resolving in 6-8 weeks without treatment. May desquamate or leave post-inflammatory pigment changes.
Management of mild vs severe staphylococcal scalded skin syndrome
- Mild to moderate: Oral antistaphylococcal medication
- Severe: Treated as though they have a second-degree burn. This means meticulous fluid management and IV oxacillin or clindamycin.
For how long are children with chickenpox contagious?
From 24 hours before onset of rash until ALL lesions have crusted over.
Most common cause of tinea capitis in the US
Trichophyton tonsurans
A relative of rubrum, but not rubrum itself.
When is a VCUG indicated for workup of a UTI?
- UTI in a male
- Recurrence of UTI
- Urosepsis
Palivizumab usage
Used prophylactically to prevent RSV.
Given to premies and babies born with congenital heart disease in September to prevent infection during winter.
If croup or bronchiolitis is the suspected diagnosis, then ___ is not indicated.
If croup or bronchiolitis is the suspected diagnosis, then CXR is not indicated.
When do you stop treating osteomyelitis?
When ESR normalizes
What form of adenopathy is EBV most strongly associated with?
Posterior cervical
