Peds ID uworld Flashcards
causes of meningitis in children
v3 mos
- GBS
- e coli and other gram negatives
- listeria
- herpes simplex virus
3 mos to 10 yrs
- s pneumo
- neisseria meningitidis
^11 yrs
-neisseria meningiditis
tf
low wbc can be a sign of sepsis in an infant
t
espec w left shift (bands)
define neonatal sepsis
systemic bacterial infection v28 days of life
define early vs late-onset neonatal sepsis and what bug is the most common cause of each
early v7 days of life
late 7-28 days of life
GBS is the most common cause of both
most common cause of meningitis in peds v3 mos old
GBS
how have early onset vs late onset neonatal sepsis incidence changed relatively to each other and how is this accomplished
early onset, v7 days vertical transmission from mom during birth, has been much reduced thanks to Universal Screening and intrapartum abx
late onset 7=28 days horizontal transmission (person to person with unwashed hands) has not changed in incidence
signs of neonatal jaundice
non-specific
poor po, irritable, hyperthermic or hypothermic, respiratory distress, vomiting, jaundice…
symptoms of neonatal meningitis
hypotonia, full fontanelles, apnea, seizures
plus nonspecific sepsis symptoms
poor po, irritable, hyperthermic or hypothermic, respiratory distress, vomiting, jaundice.
TF
all neonates with suspected sepsisshould get bcx ucx csfcx and empiric abx
why or why not?
T
high incidence in newborns
non-specific presentation
high morbidity and mortality
TF
h flu b is a common cause of newborn sepsis
why or why not?
F
- low prevalence (herd immunity from older age vaccinations)
- protective maternal antibodies
when to think Listeria vs GBS as cause of newborn sepsis
usually GBS in kid v3mos, just the most common
think more Listeria if seems pregnant mom had flu-like symptoms after unpasteurized dairy, canned meats
chorioretinitis, hydrocephalus, intracranial calcifications in newborn think…
congenital toxoplasmosis
duration and symptoms of catarrhal phase of pertussis
1-2 weeks
mild cough, rhinitis
duration and symptoms of paroxysmal phase of pertussis
2-6 weeks cough with inspiratory whoop, posttussive emesis
duration and symptoms of convalescent phase of pertussis
weeks to months
gradual resolution of cough, whoop, posttussive emesis
diagnose pertussis
culture or pcr of nasopharynx
(or dx clinically if classic symptoms)
lymphocyte predominant leukocytosis
treat pertussis
wait to confirm diagnosis or treat based on clinical suspision?
macrolide (azythromycin, clarithromycin, erythromycin)
treat based on clinical suspicion, do not wait to confirm with nasopharyngeal pcr or cx or lymphocytosis on labs
paroxysmal cough, posttussive emesis, subconjunctival hemorrhages, lymphocytosis
think…
pertussis
tf
prior pertussiss infection and/or immunization with acellular pertussis vaccine provide lifelong immunity
F
immunity to pertussis wanes
that is why we give 5 DTaP doses during infancy
boost with Tdap age 11-18 and each pregnancy
heterophile antibody test for…
mono
tf
paroxysmal cough, posttussive emesis, subconjunctival hemorrhages, lymphocytosis
in unvaccinated patient
think flu
F
flu sx fever, cough, myalgias
this patient likely has pertussis
Congenital Rubella Syndrome
clinical triad
diagnosis
prevention
cataracts/glaucoma
sensorineural hearing loss
congenital heart disease (PDA)
Rubella IgM
PCR
maternal immunization with live attenuated rubella prior to conception
newborn
SGA small for gestational age
cataracts/glaucoma
PDA
think…
congenital rubella syndrome
prenatal maternal infection with rubella looks like…
asymptomatic
vs
prodrome fever cough conjunctivitis followed by diffuse maculopapular rash
when does maternal infection with rubella transmit greatest risk to fetus
1st trimester
common presentation of congenital toxoplasmosis
maternal exposure to cat litter
macrosephaly, chorioretinitis, diffuse intracranial calcifications
infectious disease reasons to perform c-section
combine c-section with for even better results
maternal HIV with high viral load
active genital herpes lesions
combo with prenatal antiviral therapy
tf
congenital rubella syndrome is preventable with c-section and antiviral therapy
f
only preventable with vaccination.. no antivirals and transmission through placental blood flow in first trimester usually, well before birth
HIV and HSV preventable with c-section and antivirals
neonatal group B strep disease manifests as…
sepsis, pneumonia, meningitis
name a group A strep
strep pyogenes
Acute Rheumatic Fever epi clinical features late sequela prevention
peak incidence 5-15yo
2x more common in girls
major JONES criteria Joints migratory arthritis, Carditis, Nodules subq, Erythema marginatum, Sydenham chrea
minor fever, arthralgias, CRP ESR, prolonged P-R interval
mitral regurgitation/stenosis late
treat GAS pharyngitis with Penicillin
child with friction rub, diffuse ST elevations continuous irregular and rapid irregular jerks subcutaneous nodules elevated ESR
suspect…
Acute Rheumatic Fever
history of untreated sore throat and fever
(pericarditis, chorea)
tf
penicillin for strep pyogenes pharyngitis because does not self-resolve
F
does self-resolve
but give 10 days oral penicillin to prevent acute rheumatic fever
treat acute rheumatic fever
why
long-acting intramuscular benzathine penicillin G until adulthood - to eradicate bacterial carriage to prevent recurrent ARF
corticosteroids for severe chorea
NSAIDS for pericarditis and arthritis
most common organism responsible for pericarditis and myocarditis in peds
also causes pharyngitis (herpangina) in young children
cocksackie virus
tf
strep pneumo is group A strep
F
strep pyogenes is group A strep
strep pneumo is “ungrouped”… because lacks lancfield carbohydrate antigen (low yield)
TF
There is a lyme vaccine
Fish
Not available ANYMORE… poor demand, side effect concerns, never a recommended immunization
Cat scratch disease Etiology Gradual or Rapid onset Clinical features Dx Tx
Bartonella henslae from cat scratch bite or flea rarely
Gradual onset
Papule at scratch site
Regional tender lymphadenopathy
W/wo Fever of unknown origin ^14 days
Clinical dx w/wo serologies
Tx with Azythromycin
How long can LAN from cat scratch take to resolve
Can take 1-2mos
TF
Cat scratch disease typically resolved spontaneously
T…
But still treat with Azyhromycin…
How long can LAN from cat scratch take to resolve
Can take 1-2mos
Where is lymphadenopathy from mycobacterium tuberculosis most common and is it tender?
Cervical lymphadenopathy
Strikingly NON-tender
Pasturella multocida infection
Vector
Time to symptoms
Symptoms
Dog or Cat bite
1-2 days to symptomatic cellulitis or other soft tissue infection
Salmonella enteritidis infection
Vector
Symptoms
Reptiles including Turtles
Mesenteric adenitis and enteritis
Impetigo
Microbiology
Clinical features
Treatment
Staph aureus, GAS pyogenes
-painful pruritic pustules, honey-crusted lesions
Staph aure
5 Factors predisposing to IMPETIGO
Colonization with staph aureus or gas pyogenes
Hot humid weather
Crowding
Poor personal hygiene
Preexisting lesion like eczema or big bite
TF
Lymphadenopathy and fever w impetigo
T local lymphadenopathy common
F fever unusual
TF
Impetigo is contagious
T
So counsel hand washing
TF
Impetigo is contagious
T
So counsel hand washing
Why treat Impetigo
How treat impetigo
Speed recovery and limit contagious transmissiom
Topical mupiricin if limited skin infection, to avoid side-effects and resistance of systemic abx
Systemic cephalexin dicloxacillin or clindamycin if extensive skin infection