Peds infectious disease Flashcards
1
Q
What are the types of vaccines
A
- Live: virus is alive but weakened (MMR, varicella, Flumist)
- Inactivated: killed virus, capsid proteins remain and are antigenic
- Viral particles: no viral DNA
- Subunit vaccine: virsl proteins only
- Toxoid: inactivated toxin stimulates Ab production (tetanus)
2
Q
Contraindications to vaccinations include
A
Immunocompromised or pregnant (no live)
Anaphylaxis Hx to a certain vaccine
Egg or chicken allergy (flu and yellow fever)
Moderate-severe illness
3
Q
You should NOT give the live flu vaccine to an immunocompromised individual if
A
<6 months old
Hx of stem cell transplant in last 2 months
Has graft vs host dz
has SCID (severe combined immunodeficiency)
4
Q
IF you give a live vaccine to a patient that is immunocompromised, they must
A
avoid contact with household members for 7 days
5
Q
Examples of acquired immunodeficiency are
A
HIV cancer transplant sickle cell disease acquired asplenia meds that suppress immunity diabetes pregnancy
6
Q
These are NOT contraindications to vaccines
A
mild illness low grade fever recent exposure to ID mild-mod rxn to previous vaccine on Abx breast feeding household contact is immunosuppressed premature malnourished FHx of SIDS or Sz
7
Q
What vaccines are administered inkids
A
Hep B, 3: birth- 2 mo- 6-9 mo Rotavirus, 3: 2 mo- 4 mo- 6 mo DTaP, 5: 2 mo- 4 mo- 6 mo- 15-18 mo- 4-6 y/o Hib, 4: 2 mo- 4 mo- 6 mo- 12-15 mo PCV13, 4: 2 mo- 4 mo- 6 mo- 15-18 mo PPSV23: 1 shot if high risk, >2 y/o IPV, 4: 2 mo- 4 mo- 6-18 mo- 4-6 y/o MMR 2: 12-15 mo, 4-6 y/o Varicella, 2: 12-15 mo, 4-6 y/o Hep A, 2: 12 mo- 18 mo HPV, 3: 0, 1 month, and 6 months MCV4, 2: 11-12 y/o, booster 16 y/o
8
Q
Contraindications to rotavirus vaccine include
A
weak immune system
recent blood transfusion
major GI illness
Hx of intussesception
9
Q
Contraindications to IPV vaccine
A
allergy to neomycin, streptomycin, or polymyxin B
10
Q
What is Synagis (palivizumab)
A
RSV immunoprophylaxis, not a vaccine
Given to high risk kids <2 y/o (premies <29 wks)
Monthly injections during RSV season
Very expensive
11
Q
What is in the flu vaccine
A
INactivated strains that change every year based on most likely strains
Usually has 3 most likely, but can get quadrivalent
Includes H1N1
-For everyone 6+ months
-If 6 mo-8 y/o, need two doses 4 weeks apart on your first time getting the vaccine
12
Q
What is in the inhaled flu vaccine
A
Quadrivalent strains of live but WEAKENED virus (can’t cause flu)
-For everyone 2-49 y/o
13
Q
Contraindications to the live flu vaccine ae
A
severe allergi to LAIV 2-7 y/o on ASA pregnant women immunosuppressed 2-4 y/o w/ asthma
14
Q
Normal reactions to vaccines are
A
Fussiness (<3 hours, consolable)
Tiredness
Low grade fever (<101.5)
Pain, red, swollen at injection site
15
Q
Abnormal reactions to vaccines are
A
inconsolable crying for 3+ hours High fever (>104) Seizure Neuro abn Anaphylactc reaction (facial/oral swelling, dyspnea)
16
Q
What must you report to the AZDHS
A
vaccine preventable diseases! they have a centralized immunization registry
17
Q
When considering peds ID, you must rule out
A
allergic rhinitis asthma CF FB aspiration conditions interfering with skin barrier function
18
Q
Warning signs for immunodeficiency include
A
Basically, too many illnesses too soon 4+ ear infx in 1 yr 2+ sinus infx in 1 yr 2+ mo on Abx w/ no effect 2+ PNA in 1 yr FTT recurrent deep abscesses persistent thrush need IV abx to clear infx 2+ deep seated infx w/ septicemia FHx of primary immunodeficiency
19
Q
When testing for immunoglobulins in babies, what do they mean
A
IgM and IgA levels are from babies; pay attention to these!
IgG is inherited from mom
20
Q
What is the complement system
A
System of plasma proteins that interact with pathogens to mark them for destruction by phagocytes
21
Q
What are phagocytes
A
WBC that contribute to immune defenses by ingesting microbes and other cells infected with foreign particles
22
Q
What are T cells
A
Start as haematopoietic stem cells that go to the thymus
CD4 are helpers, they release cytokines to signa immune response
CD8 are cytotoxic, they perforate bad cell walls and release cytotoxins to kill them
Suppressors (CD4 and 25) play a role in preventing organ specific autoimmunity AKA keep the system in check from killing everything
23
Q
What are B cells
A
Make antibodies when a foreign antigen triggers the immune response
bind intact antigens
remember antigens
create B cell receptors
undergo mitosis and make many clones
Stay in secondary lymphoid organs (spleen and lymph nodes)
The next time that antigen enters the system, B cells activate!
24
Q
What is primary immunodeficiency
A
Inherited defects in any part of the immune system
25
What is humoral immunodeficiency
Impaired Ig production
26
How do peds present with primary immunodeficiency
recurrent, severe URI/LRTI (OM, sinusitis, PNA)
infectios with encapsulated bacteria (Hib, Strep pneumo, N meningitidis, GB strep, Klebsiella, Salmonella typhi)
Meningitis 1+ times
Recurrent candidiasis
Poor growth, FTT
Unexplained splenomegaly
Delayed umbilical cord detachment
27
To diagnose primary immunodeficiency, you must rule out
underlying chronic disease
| autoimmune, inflammatory, malignancy, allergic
28
If suspecting primary immnodeficiency, get these diagnostics
CXR: look at thymus
| CT of involved system
29
What is the MC immunodeficiency
Selective IgA deficiency (normal IgG and IgM) in child >4 y/o
Most are ASx
30
If Sx are present, what are they for IgA deficiency
```
recurrent sinopulmonary infections
AI d/o
GI infection
Allergic disorders
Anaphylactic transfusion rxn to anti-IgA abs
```
31
What is common variable immunodeficiency
Poor vaccine response + Decrease in blood levels of IgF + severe decrease in IgM and/or IgA
B cells must be present
Other immunodeficiencies must be ruled out
32
When do patients usually present with CVID
Puberty!
Variable manifestations b/c it is not a single disease
Recurrent sinopulmonary and GI infections
At risk for AI diseases and malignancies
33
What is severe combined immunodeficiency
Group of rare immunologic disorders with severe T cell deficiency (very susceptible to infection)
MC form is X linked (male)
Part of newborn screening
"Bubble boy" disease
If not treated, patient will die by 1 y/o
34
How does SCID present
1+ severe infections in first few months after birth (PNA, meningitis, bacteremia) or opportunistic infx (P. jiroveci, candidiasis, CMV)
Illness s/p live vaccine
No visible thymus on CXR
No tonsils or lymph nodes on PE
35
How do you treat SCID
Stem cell transplant
Gene therapy
Ig replacement therapy
36
What is DiGeorge syndrome
Deletion of chromosome 22q11.2
Causes cardiac defects (tet, ASD, VSD, truncus arteriosus, interrupted aortic arch)
Immune dysfunction (hypoplastic thymus) w/ T cell deficit
Cleft palate
Hypocalcemia
37
What is ataxia telangiectasia
rare, auto-recessive, neurodegenerative d/o caused my AT mutation on gene at 11q22-23
Presents w/ progressive cerebellar ataxia and oculocutaneous telangiectasias
38
How do children with ataxia-telangiectasia present
Don't fully develop gait
nystagmus
Telangiectasia of face, neck, conjunctiva
Malignancy common >10 (lymphoma)
39
What is bacterial meningitis
a medical emergency!
Mortality rate if untreated is near 100%
Neurologic sequelae are common among survivors
-Present with Opisthotontos posturing*
40
How do you treat bacterial meningitis
Abx covering strep pneumo, N. meningitidis, and Hib within ONE HOUR
-0-29 days: Ampicillin, Cefotaximine, Vancomycin, and Acyclovir +/- Gentamicin
-30-60 days: Ceftriaxone, +/- vancomycin
(Abx have to reach peak in CSF to treat!)
41
List abx that cover specific organisms
```
S. pneumo, N. meningitidis, and Hib: Ceftriaxone or Cefotaxime
Listeria: Ampicillin
GBS: Ampicillin
S. aureus: Vancomycin
Gram (-) rod: Ceftriaxone, Cefotaxime
Herpes: Acyclovir
```
42
ASAP after LP you should administer
Empiric Abx and dexamethasone
| Treat hypoglycemia, acidosis, and coagulopathy as necessary
43
How does Bacterial arthritis usually present
In hip and knee (>1 joint esp in neonates)
Septicemia (irritable, poor feeding)
Cellulitis
Fever w/o focus of infection
Lack of use of affected joint
-older kids also have fever and constitutional Sx
44
What bacteria is the common cause of bacterial arthritis
<3 mo: GBS (agalactiae)
3 mo- 3 yr: group A strep (pyogenes), or kingella kingae
>3 yr: GAS
45
Suspect bacterial arthritis if __ and order
Monoarticular pain, fever, and redness
| Get a CBC, ESR, and blood culture; imaging, consult
46
What antibiotics do you give for bacterial arthritis
Antistaph: Naficillin, Oxacillin, Vancomycin
+ Cefotaxime (also covers gonorrhea)
consider antifungals
47
What do you order and how do you treat osteomyelitis
CBC, ESR, CRP, blooc culture
Consult
IV abx
48
What causes myocarditis
Infx, toxins, and AI!
| Viral: enterovirus, Coxsackie B, adenovirus, parvovirus B19, EBV, CMV, HH6
49
What Sx come along with myocarditis
```
Chest pain
Viral prodrome
Respiratory distress
GI Sx
Hepatomegaly
Gallop rhythm
Poor perfusion/ diminished extremity pulses
```
50
E. Coli typically presents with
hemolytic uremic syndrome (acute renal failure+microangiopathic hemolytic anemia+non-immune thrombocytopenia)
No fever
WBC >10K
Abd ttp
51
Where are the sinuses
Ethmoid: around bridge of nose, present a birth
Maxillary: cheek area, present at birth
Frontal: forehead, develops around 7 y/o
Sphenoid: behind nose, develops in teens
52
Rhinosinusitis is caused by
Mostly viral
| Bacterial: H influenze, S pneumo, moraxella catarrhalis
53
IF bacterial, how do you treat rhinosinusitis
Augmentin x 10 days
54
What causes OM
H influenza
Strep pneumo
Moraxella Catarrhalis
55
How do you treat OM
Amoxicillin x 10 days
-If with penicillin allergy, can give 3rd gen Cephalosporin
Macrolide or Clindamycin
56
Do you immediately treat OM with antibiotics
No, you can obs for 48-72 hours to see if symptoms worsen or they do not improve IF:
2+, mild Sx, no otorrhea
57
What is mastoiditis
Complication of acute otitis media- bacteria get into the air saces of the mastoid bone
Caused by Strep pneumo, Strep pyogenes, Staph aureus, and P aeruginosa
58
Complications of mastoiditis include
Extracranial: subperiosteal abscess, facial nerve palsy, hearing loss, labrynthitis, osteomyelitis, bexoid abscess (under SCM in neck)
Intracranial: meningitis, temporal lobe or cerebellar abscess, epidural or subdural abscess, venous sinus thrombosis
59
How do you diagnose mastoiditis
```
Clinically! Presence of:
postauricular ttp, erythema, swelling
auricle protrusion
ear pain
-Lethargy, abnormal TM, fever, narrow EAC, ear pain, otorrhea
*Can image CT w/ IV contrast
```
60
How do you treat mastoiditis
Abx
Drain middle ear and mastoid*
Consult otolaryngologist
61
What organisms cause Lymphadenitis
Acute b/l: GAS
Acute unilateral: Staph aureus, GAS, anaerobes
Chronic unilateral: nonTB mycobacteria, cat scratch dz
Chronic b/l: EBV, CMV
62
How do you treat lymphadenitis
GAS, MSSA: Augmentin q8 hours (max 1.5g/d) or q12 hours (max 1.75 g/d)
Anaerobes: Clindamycin, piperacillin-tazobactam
Gram (-): Ampicillin sulbactam, piperacillin-tazobactam
63
What causes peritonsillar abscesses
Polymicrobial:
| GAS, Strep anginosus, Staph aureus
64
How do you treat a peritonsillar abscess
Must drain!
| Located between palatine tonsil and pharyngeal muscles
65
How do kids with a retropharyngeal abscess present
```
Ill with moderate fever
Dysphagia
Odynophagia
Drooling
Torticollis
Hot potato voice
Stridor
Trismus
```
66
How do you treat a retropharyngeal abscess
Secure airway!!
CT w/ contrast
Empiric therapy for GAS, Staph aureus, and respiratory anaerobes: Unasyn, Clindamycin +/- Vancomycin
67
What is periorbital cellulitis
infection of anterior eyelid NOT involving orbit
Caused by staph aureus, strep pneumo, or Hib
Can also be caused by fungus Mucorales, or Aspergillus
68
What would make you suspect Orbital as opposed to periorbital cellulitis
unilateral ocular pain and eyelid swelling and erythema
Fever, proptosis, toxic appearing
Chemosis can occur occasionally
+/- leukocytosis
69
How do you treat peri-orbital cellulitis
Empiric! based on knowledge of common infecting organisms: Ceftriaxone IM followed by Augmentin or Clindamycin
*Close follow up*
70
How do you treat Orbital cellulitis
```
Treat as sepsis!
Ceftriaxone, Unasym, Vancomycin, and Clinda mycin
Antifungal IV
CT w/ contrast
Consult optho-plastics
```
71
What causes cellulitis and abscesses
MC is MSSA/MRSA
| If growing rapidly, think strep
72
How do you treat an abscess
**Drainage!
You can give PO Clindamycin, or Bactim+Keflex
If febrile, admit for IVabx
-do NOT start with Vancomycin!
73
What is necrotizing fasciitis
Deep infection resulting in quick, progressive destruction of muscle fascia
Affected area is red, warm, swollen, and very tender
Pain out of proportion to findings
Crepitus
tachycardia, systemic toxicity
74
What causes Nec Fasc
If monomicrobial, usually GAS or other beta-hemolytic strep
may also be 2/2 Staph aureus
(no known poral of entry in >50%)
75
How do you work up and treat nec fasc
Septic workup, CT w/ IV of affected area
Immediate surgery consult
Empiric abx: Carbapenem + Vancomycin + Clindamycin
(cultures and gram stais during surgery to tailor abx)
76
What is impetigo
Bullous or non-bullous skin manifestation caused by Staph aureus and Beta hemolytic strep (group A, C, G)
77
How do you treat impetigo
```
Topical Mupirocin (bactroban)
Oral Keflex, Bactrim, Clindamycin
```
78
What causes mastitis
Usually Staph aureus!
Also enterococcus, GAS, anaerobe strep, pseudomonas, GBS
-If w/ nipple piercing, think Actinomycoses
79
How do you treat mastitis
>2 mo, looks ok: Keflex, Clinda
>2 mo, looks ill: IV Clindamycin (or vanc if PCN allergic); IC cefazolin or naficillin
Durgical consult, I&D
80
What is neonatal mastitis
Less common
Caused by Staph aureus
Need full workup (CBC, blood cultures, would culture)
Need I&D ans surgical consult
Empiric Abx are IV vancomycin, naficillin, and CTX
81
What bacteria do you suspect for different bites
Dog/Cat: Pasteurella! Capnocytophagia can be fatal
| Human: Eikenella*, staph aureus, strep
82
How do you treat bites
*Augmentin
Doxycycline, Bactrim, or Cipro+Flagyl, or Clindamycin for anaerobe
CT head for scalp bite
Do NOT close puncture wounds, leave open and let heaal by secondary intention
Prophylactic Abx: Unasyn IV then Augmentin
83
What causes croup
Parainfluenza type 1*
| RSV, adenovirus
84
What causes epiglottitis
Hib (bacteria)*
| H influenza, GAS, Staph aureus
85
What is bacterial tracheitis
Invasive, exudative bacterial infection of soft tissue of trachea
Occurs mostly in fall and winter (like parainfluenza, RSV, and flu)
Caused by Staph aureus, GAS, Moraxella catarrhalis, Hib
86
When should you suspect bacterial tracheitis
In kids presenting with acute onset airway obstruction, in setting of viral URI
In kids with laryngotracheitis who are febrile, ill appearing, and dont respond to Tx with glucocorticoids
87
What is bronchiolitis
Viral infection (RSV) in kids <2 characterized by upper resp. Sx (rhinorrhea) then LRI (wheezing, crackles)
88
How do you treat bronchiolitis
```
Nasal suction
High flow O2
If all else fails, try albuterol (not usually indicated bc beta receptors not developed in infants)
-NO abx
-NO CXR
```
89
What causes neonatal PNA
GBS, E. coli, Klebsiella
90
How do you treat neonatal PNA
Early onset: Amp+Gent
| Late onset: Vanco + Gent
91
What causes CAP
6mo-5yr: Strep pneumo (Tx amoxicillin)
| >% yr: M. pneumo, Chlamydia pneumo (Tx azithromycin)
92
What is pertussis
Bordatella pertussis causes serious complications in infants; FTT, apnea, PNA, respiratory failure, Sz, death
Suspect if frequent coughing interferes with daily function
93
When are individuals most contagious with pertussis
Catarrhal stage! (first stage after incubation, lasts 1-2 weeks)
94
Pertussis classically presents with
Coughing, Inspiratory whoop, and post-tussive vomiting (in unvaccinated kids)
Inyoung infants, presentation is atypical and harder to dx
95
Atypical presentation of pertussis (<4 mo, vaccinated) is
short or absent catarrhal stage (looks like a common URI)
Paroxysmal stage: gagging, gasping, eye bulging, vomiting, cyanosis, bradycardia
Complications: apnea, seizure, respiratory distress, PNA, pulmonary HTN, hypotension, renal failure, death
96
Lab findings in pertussis include
Leukocytosis (WBC 10K+)
WBC >30K at presentation w/ rapid rise are associated with increased severity and death
CXR are not usually helpful
97
Suspect pertussis in infants <4 months if
Cough is not improving
Rhinorrhea w/ watery discharge
Apnea, seizure, cyanosis, vomiting, poor weight gain
Leukocytosis with lymphocytosis
98
Suspect pertussis in infants 4+ months if
```
Nonproductive cough for 7+ days
Rhinorrhea with watery discharge
Whoop, apnea, posttussive vomiting, subconjunctival hemorrhage, or sleep disturbance
Cyanosis
Sweating episodes between paroxysms
```
99
How do you treat pertussis in infants <4 months
Hospitalize, start Abx (Azithromycin)
+/- critical care, constant monitoring, fluids, nutrition
*post-exposure antimicrobial prophylaxis for all household contacts
100
How do you treat pertussis in infants 4+ months
+/- hospital
Start Abx (Azithromycin, any macrolide, or Bactrim)
Symptomatic care
*post-exposure antimicrobial prophylaxis for all household contacts
101
What is Rickettsial infection
RMSF (diagnosis confirmed retrospectively)
Potentially lethal, but curable tick borne disease
Serology not helpful during first 5 days of Sx, which is when therapy should be initiated
102
RMSF presents with
blanching, erythematous rash with macules 1-4 mm that become petechial over time
Fever, HA, rash, arthralgias
+/- abdominal pain in children
(if fulminant, start Abx ASAP- death can occur in like 4 days!)
103
How do you treat RMSF
Doxycycline for kids weighing 45kg or less (max dose 200mg)
Alternate: Chloramphenicol
*If you suspect RMSF, treat it!!
104
UTI occur 2/2
E. Coli (MC)
Viral UTI limited to lower urinary tract
If immunosuppressed, think fungal
(rare in boys, but can occur sooner if circumcised boys)
-If >2 UTI, you need a renal US
105
How do you treat a UTI
Keflex x 10 days
106
When looking at a lab, how can you distinguish the causative organism
E. Coli, Klebsiella, and Proteus produce Nitrite (on UA)
| Pseudomonas, Enterococci, and Staph Saprophyticus do not!
107
Parvovirus B19 causes
Slapped cheek syndrome (fifth disease)
- Erythema infectiosum (slapped cheeks, then lacy rash over trunk), fetal infection, arthropathy
- Fetal complications including miscarriage, IU death
* NO treatment*
108
What does HHV 6 cause
Roseola
3-5 days of fever (can be >40C) followed by rash
Rash starts on neck and trunk, then face and extremities
*Supportive care*
109
Varicella zoster virus is a herpes virus that causes
Itchy, vesicular rash to head, then trunk, then extremities
Highly contagious
Mild in kids, serious and fatal in neonates
Prodrome of fever, malaise, or pharyngitis
Complications: acute cerebellar ataxia
Diffuse encephalitis
Raye syndrome
Hepatitis
*Supportive Tx*
110
What is measles
SS (-) enveloped RNA from Paramyxoviridae
Incubation: 6-21 days
Prodrome: fever, malaise, anorexia, conjunctivitis, coryza, cough, Koplik spots
Exanthem: 2-4 days after fever; red, blanching maculopapular rash starting on face, then neck lower trunk, extremities, LAD, and high fever
Recovery: cough can persist for 1-2 weeks
111
Complications of measles include
```
Systemic immune suppression
Diarrhea
PNA (MCC of measles death)
Encephalitis
Acute disseminated encephalomyelitis
Subacute sclerosing panencephalitis (fatal)
```
112
What are the mumps
highly infectious paramyxovirus
Causes fever, HA, myalgias, fatigue, and anorexia- then parotitis
Usually self limited
Complications: orchitis, oophoritis, meningitis, encephalitis, deafness
113
What is Rubella
a Togavirus that causes rash, fever, and LAD
Red rash is a discrete maculopapular rash starting on the face and spreading caudally (3-8 days)
LAD to posterior cervical, auricular, and posterior suboccipital nodes
Pinpoint pink maculopapules
*Supportive care*
114
What is congenital rubella syndrome
```
Pregnant women who contract rubella at risk for miscarry or stillbirth- developing babies at risk for severe birth defects
Deafness, cataracts, heart defects, intellectual disabilities, liver and spleen damage
low birth weight
skin rash at birth
glaucome
brain damage
thyroid and other hormone problems
inflammation of lungs
```
115
What is hand foot mouth disease
Herpangia caused by Coxsackie A16 or Enterovirus A71
Low grade fever with mouth/throat pain
Abrupt onset herpangia with high grade fever
-Pain control, oral hydration
116
What is molluscum contagiosum
Poxvirus
lesions are shiny with central umbilication
Anywhere on body except palms and soles
LEAVE IT ALONE
117
Suspect malaria if
```
patient is febrile after traveling to an endemic area
tachycardia, tachypnea, chills, malaise, fatigue, diaphoresis, HA, cough, anorexia, n/v, abd pain, diarrhea, arthralgias, myalgias
Kind (severe): convulsions
coma
hypoglycemia
metabolic acidosis
severe anemia
neurodevelopmental sequeale
```
118
What are pinworms
Enterobius infections
Perianal itching (mostly at night)
Kid scratches it and gets eggs on their hands
They dont wash their hands and eat, or suck thumb
Ingest eggs and cycle starts all over
*Celophane tape for eggs at night*
119
How do you treat pinworms
Pin-X
treat the whole family
Wash bedding in hot water
Fold linens in because eggs go airborne
