Peds ID Flashcards
what are the different vaccination types?
live-attenuated inactivated viral particles subunit vaccine toxoid
Contraindications for vaccines
immuno or pregnant: NO LIVE VACCINES, anaphylaxis hx to specific vaccine, egg or chicken for influenza or yellow Fv, mod-severe illness
what kind of vaccine should family of an immunocompromised pt receive?
inactivated vaccine
if accidentally given live–> avoid contact w/pt for 7days
May give live attenuated influenza vaccine if pt is candidate except if…
immunocompromised pt: less than 6mo’s old, stemp cell transplant in prior 2 mo’s, has graft vs. host dz, has SCID
what is the main warning sign of immunodeficiency?
too many illnesses too soon that are unexplained
what are the parts of the innate immune system?
Skin and physical barriers
Bloodbourne and phagocytes
what is the complement system?
plasma proteins that interacts with pathogens to mark them for destruction by phagocytes (Scouts/spotters)
Acquired immune system: what do CD4 cells do?
what if you lose them?
Recognize bad cells then release cytokines signaling the immune response
HIV
acquired immune system: what do CD8 cells do?
Perforins open bad cell walls
Cytotoxins released to kill the bad cell
acquired immune system: what do B cells do?
Produces antibodies when a foreign antigen triggers the immune response
what is humoral immunodeficiency characterized by?
impaired antibody (Ig) production
PID peds clinical presentation:
recurrent, severe URI/LRTI incl OM, pna
infx w/encapsulated bacteria (GBS, S. pneumo, Hib)
poor growth, unexplained splenomegaly
Dx of primary immunodeficiency
fam hx
r/o underlying chronic dz
labs for PID
CBC with differential Chem panel Immunoglobulin levels Urinalysis ESR and CRP if child is sick
imaging/diagnostics for PID
CXR look for thymus +/- CT
What is the MC immunodeficiency?
selective IGA deficiency
dx of selective IGA deficiency
Deficiency of Serum IgA (w normal IgG& IgM) in a child > 4 yo
presenting s/s for selective IGA deficiency
most asxs!!!
Recurrent sinopulmonary infx’s, autoimmune disorders, GI infx’s and other intestinal disorders, allergic disorders, anaphylactic transfusion reactions d/t Anti- IgA Abs
what is common variable immunodeficiency (CVID):?
combo of poor vaccine response and a decrease in blood levels of IgG in conjunction with a severe decrease in levels of either IgM or IgA,
when do peds pt’s usu. p/w CVID?
present around puberty: variable presentation, recurrent, at risk for autoimmune dz’s and malignancy
dx criteria for CVID
Reduced serum IgA, G & M
Poor response (or no response) to vaccines
what is severe combined immunodeficiency? (SCID)
severe deficiency of T-cell
broad susceptibility to infection.
what is the tx for SCID?
no tx
death by 1yr
characteristics of SCID?
multiple forms (MC = x-linked males only)
severe infx’s 1st few mo’s after birth
become ill from live vaccines: varicella, MMR, OPV, RV
characteristics of digeorge syndrome (22Q11.2 deletion syndrome)
cardiac defects, immune dysfx (hypoplastic thymus gland), cleft palate, hypocalcemia (parathyroid hypoplasia)
presentation for ataxia-telangiectasia?
progressive cerebellar ataxia, oculocutaneous telangiectasias, don’t develop fluidity of gait, malignancy
bacterial meningitis characterized by? caused by?
opisthotontos posturing, mortality ~100%, medical emergency
S. pneumo, N. meningitidis, H. influenza type b
tx for bacterial meningitis in 0-29d old
requires adequate concentration of abx in the CSF
Ampicillin \+/-Gentamicin Cefotaxime Vancomycin Acyclovir
w/in 1 hr
tx for bacterial meningitis in 30-60d old
Ceftriaxone
+/- Vancomycin
w/in 1 hr
characteristics of bacterial arthritis?
predominantly the hip and knee, more than one join, particularly in neonates
sxs: septicemia, cellulitis, fv w/out source of infx
who should you suspect bacterial arthritis in?
monoarticular pain, fever, redness
tx for bacterial arthritis?
antistaphylococcal agent (nafcillin, oxacillin, vancomycin)
cefotaxime (covers gonorrhea)
