Pertussis/neonatal pneumonia Flashcards
What is the organism that causes Pertussis?
Bordetella pertussis
How is Pertussis transmitted?
By respiratory droplets
Adults and adults are reservoirs
Incubation period is 7-17 days
What are the three stages of classic pertussis?
3 stages take about 6 weeks:
Catarrhal stage (URI
Paroxysmal stage (cough)
Convalescent stage (decrease symptoms)
Describe the catarrhal stage
Sneezing, coryza, lacrimation, anorexia, malaise, hacking cough that starts at night then progresses to during the day
*this is the stage the patient is most contagious
Describe the paroxysmal stage
Bursts of quick, repeated coughs followed by a deep, high-pitched inspiration (whoop)
Describe the convalescent stage?
Begins 4 weeks after onset of illness
Occurrence and intensity of cough decrease
Describe the presentation of atypical pertussis?
Adults and adolescents
Distinct stages may be absent
Dx may not be considered in adults
Cough persisting 2+ weeks is suggestive of pertussis
May be asymptomatic (reservoir)
What is the workup for pertussis?
History and PE
WBC usually 15-20,000 mcL with increased lymphocytes
Nasopharyngeal culture to isolate organism is diagnostic
PCR assays may be available
What is the preferred AB treatment for pertussis?
Azithromycin 10mg/kg on day 1 then 5mg/kg on days 2-5
What are the other treatment options for pertussis?
Other ABx:
Erythromycin
Clarithromycin
TMP/SMX
Asymptomatic carriers should be treated as well
Post exposure prophylaxis indicated if any exposure in the last 3 weeks
Which age group should get the DTaP vaccine?
Infants aged 2 months
Five doses with final dose between ages 4 and 6
Which age group should get the Tdap vaccine?
Adolescents aged 11-18
Pregnant women between 27-36 weeks gestation who have not previously received Tdap
Those with close contact with an infant younger than 12 months
Who should get the ADACEL (Tdap) vaccine?
Patients between 11 and 64 in place of Td
How is neonatal pneumonia transmitted?
Early onset - part of sepsis that occurs within hours of birth
Late onset - after 7 days of age
-ICU
-intubation
-“healthcare related pneumonia”
What are the most common etiological agents in neonatal pneumonia?
Gram + cocci: Strep and Staph aureus
Gram - bacilli: E.coli, Klebsiella, Proteus
MRSA in healthcare related pneumonia
What clinical manifestation is associated with early onset pneumonia?
Respiratory distress
What clinical manifestations are associated with late onset pneumonia?
Worsening of patient’s respiratory status:
-tachypnea/apnea
-intercostal retractions
Changes in quantity and quality of secretions (brown and thick)
Temperature instability
Neutropenia
What will be seen diagnostically in neonatal pneumonia?
Infiltrates
Gram stain and culture of respiratory secretions
Blood cultures and LP to rule out sepsis
What are common ABx used to treat neonatal pneumonia?
Vancomycin and Cefotaxime
What should be used if chlamydia is the suspected cause of neonatal pneumonia?
Erythromycin
What are supportive treatments for neonatal pneumonia?
Maintenance of adequate O2 sat
Inpatient management
