Peds ID Flashcards
2 parts of immune system and their components
- innate
- barriers
- complement
- macros and neutros - adaptive
- humoral
- cell
how is immune system not fully developed in infants
- no specific adaptive immunity - no ABs
- T-cell indep responses weak prior to 24 months - no humoral system
- T-cell dep. is well dev. from birth
what are 2 maternal factors
- IgG in gestation
2. IgA in milk
def. transient hypogammaglobunemia
period when Moms Ig gone and haven’t got all of their own yetr
3 ways anatomy is diff.
- airways narrow
- eustachian tube angle
- may have malformation
how is fetal gut diff.
sterile
- reduces attachement of more pathogenic bacteria
what is key in fever
vast majority will resolve, but need to be ableto find those that are serious
def. fever w/o source
acute febrile illness in which the etiology is not known after throurough exams
def. serious bact. infection
sterlie site infection
- menigitis, bone and joint, sepsis, UTI
def. toxic appearance
clinical picture consistent with sepsis
- 15-20% chance of serious infection
mgmt to toxic child
- full workup-
- CBC
- urinanalysis
- LP
- CXR - empiric ABs
3 life threatening bact.
- GBS
- E coli
- listeria
2 life threatening virus
- HSV
2. enteroviruses
what is ABs for no menigitis
ampi (for listeria) and gentamycin or cefotaxime
what is ABs for meningitis
ampi + cefotaxime
what to give for HSV
add acyclovir
what is cause and effect of GSB in
vertical
- dissemniated - pneumonia, septicemia
what is cause and effect of GSB in >7day
vertical or horizontal
- focal - meningitis, osteomylitis, sepsis
mgmt of neonatal GBS
ampi +/- gentamycin
- IV fluids
- ionotrops
- ventilation
indication of post-partum AB prophylaxis
mom is GBS + if unknown - previous infant with GBS - GBS bacteruria in preg. - delviery 18hrs - intrapartum fever
what is maternal AB for prophylaxis
pen G every 4 hours until delviery
mgmt of infant at risk of GBS
if sick - full sepsis work up and treat
if well, but risk factors - do CBC - WBC >5 observe, WBC
when to consider HSV
should always keep in mind, even if mom had no lesions
3 HSV presentation
- skin,eye, mouth
- encephalitis
- disseminated
diagnosis and mgmt of HSV
PCR or culture - LP is neccesary
treat - IV acyclovir
what is risk of serious infection in well appearing BB with no risk factors
3-6%
what is approach to well appearing neonate (0-28day) with fever
full workup and empiric treatment
2 times of bacterial infections in 29-90day old
- perinatal (vertical)
2. env.
3 perinatal infections in 29-90day
- GBS
- E coli
- listeria
4 env. infections in 29-90
- strep pnemoniae
- neisseria meninigitis
- staph. aureus
- group A strep
7 criteria for low risk baby
- previously healthy
- non toxic
- no focal infection
- leukocytes 5-15
- absoulte band count
what to do with high and low risk 29-90 day old
high - admit and treat
low - outpatient
approach to fever in 3-36 month old
maybe do tests, acetominophen
come back in 48 hours if fever persists
see AB therapy table
do it
meningitis bact. in 0-28 days
- GBS
- E coli
- listeria
meningitis bact. in 29-90 days
same but some overlap with older
meningitis bact. in >90 days
- strep pneumonia
2. neise=seria
Sx and signs of meningitis in infants
can be very non-specific
- bulgin fontanelle
- dimished activity
- petechiale rash
kernig and brud signs
kernigs - leg lift
bruds - head lift
ABs for meningitis at each age
neonate- ampi + cefotaxime
1-3month - ampi + cefotaxime +- vanco (for strep resistant)
>3 month - ceftriaxone + vanco
what does botulism do
stops the release of Ach
3 botulism forms
- food borne - preformed toxin
- wound - contamination of wound with spores
- infant - ingestion of spores
- honey and construction
clinical picture of botulism
floppy child
diagnosis of bot.
mouse assay
Mgmt of botulism
- supportive care
- airway, nutrition, stool softener - human botulism Ig
def. of streptococcal toxic shock syndrome
hypotension + 2 of
- renal impariment
- DIC
- hepatic abnormlaity
- adult RSD
- scarlet fever rash
- soft tissue necrosis
patho of strep toxic shock
- superantigen mediated release
- activation of large number of T cells
- cytokine storm
mgmt of strep toxic shock
- support
- ABs - pen. + clindamycin
- IVIg
- surg for nec. fascitis
5 strep syndromes
- resp tract
- skin and soft tissue
- deep and systemic
- toxin mediated
- non-suppurative
incidence of CMV
- most common congential infection
- most common cause of aquired hearing loss
2 types of CMV
symptomatic at birth -10-15%
asymptomatic at birth
2 outcomes of CMV
brain and eye disease
CMV epidemiology
- less common in dev. countries and high SES
- transmission through saliva
CMV diagnosis and mgmt
diagnosis - detect in urine or saliva
treat - gancyclovir
HIV manifestation in infants
- opp. infections
- recurrent bact infections
- trush
- failure to thrive
- chronic diarrhea
- dev. delay
3 ways to prevent HIV transmission to BB
- ARV
- elective C-section if VL>100 copies
- exclusive formula feeding
