Quick Review ID Flashcards
Trt: Lymphogranuloma venereum
Doxycycline x 21 days
(Chlamydia trachomatis)
Or erythromycin
Trt: Primary Syphilis
1 dose IM benzathine penicillin G
Trt: Chancroid (H. ducreyi)
IM ceftriaxone
Azithromycin
Ciprofloxacin
Erythromycin
Trt: PFAPA
Steroids
Time frame for transmission of lyme disease
Tick must be attached for >36 hours
Trt: lyme disease in kids under age 8
Amoxillin for 14-21 days
Trt: Ramsay-Hunt syndrome
reactivation of VZV along facial nerve (geniculate ganglion), vesicles ear
Steroids and Acyclovir
Trt: Listeria infection
Ampicillin or Penicillin or Bactrim
Chronic draining lesions that don’t grow anything– think:
mycobacterium.
e.g. M. marinum (swimming pool, fish tank)
What is the most common organism implicated in infective endocarditis in people without congenital heart disease?
Staph aureus most common in a normal heart…then viridans strep (more likely with abnormal valve)
Most common organisms in endocarditis in general
Staph aureus and viridans strep
Followed by AACEK organisms – gram negatives (Aggregatibacter, Actinomycetemcomitans, Cardiobacterium, Eikenella, Kingella)
Dry spasmodic cough with perioral cyanosis
Pertussis
(catarrhal stage 5-7 days, paroxysmal stage 7-10 days,
How is pertussis diagnosed?
PCR assay
Treatment for pertussis
Azithromycin; after pt in paroxysmal stage, this does not shorten symptoms but prevents transmission. 5 day course for pt and close contacts
Kids with eosinophilia coming from foreign countries should be tested for:
- strongyloides (all countries)
- schistosoma (SS Africa, SE Asia, Latin America)
- filariasis
Trt: Strongyloides
Ivermectin
Pharyngoconjunctival fever is caused by
Adenovirus
Exudative pharyngitis, conjunctivitis, cervical LAD…
Most specific test for Coccidioides infection
complement fixation testing
(SW united states)
Can also use serology or histopatholy showing spherules in tissues
How do you decrease duration of illness in campylobacter infection?
3 days of azithromycin (not necessary in most cases)
Treatment for meningococcemia
Ceftriaxone
Guttate psoriasis is usually caused by
pharyngeal or perianal S. pyogenes infeciton
Treat with topical steroids
Where do pinworm eggs hatch in the body?
Small intestine, and mature worms migrate to colon and deposit eggs in gluteal cleft at night. Transmission is fecal-oral via contact with fomites
Trt– albendazole/mebendazole/pyrantel pamoate. Usually repeat dose in 2 weeks
What is the expected course of hep C after maternal-fetal transmission?
Slow progressive liver fibrosis
When is antibiotic treatment indicated in uncomplicated nontyphoidal Salmonella gastro?
Infants <3 months Immunosuppressed Hemoglobinopathies (Sickle Cell) Malignancy Chronic GI disease
TMP/SMX, amoxicillin, ceftriaxone
Most common causes of retropharyngeal abscess
- S pyogenes (group A strep)
- S. aureus
- Respiratory anaerobe
Most common causes of acute otitis media
S. pneumo
nontypeable H. flu
Moraxella catarrhalis
Treatment of salmonella diarrhea prolongs…
Shedding of the bacterium in the stool. Don’t treat in a normal host.
In what time frame should postexposure varicella immunization be given?
Within 3-5 days. Give to unimmunized kids >12 months who have never had varicella before
In whom is VZIG indicated?
immunocompromised kids with no history of vaccination or varicella infection. Within 10 days of exposure.
- also to neonates whose mom gets varicella 5 days before or 2 days after delivery.
- nonimmune pregnant women exposed to varicella
What is the most common bacteria implicated in brain abscess in infants?
Citrobacter
What is an “id” reaction?
Autoeczematization seen after treatment for tinea capitis. Type IV hypersensitivity reaction to a dermatophyte
Diffuse dermatitis. Treat symptomatically (can use steroid taper)
Potential side effects of minocycline
Autoimmune hepatitis
Pseudotumor cerebri
Treatment for Shigella
Ceftriaxone or Azithromycin(other macrolides)
Trt recommended in severe cases and can limit spread.
Bloody diarrhea, daycare centers, RECTAL PROLAPSE, bandemia, thrombocytopniea.
Electrolyte abnormalities side effect of Amphotericin B
low potassium
low magnesium
*Need to monitor these
also - fever, renal failure, phlebitis, acidosis
Bell’s palsy can be a symptom of early…
Lyme disease
Systemic lyme disease
fever, fatigue COMPLETE HEART BLOCK facial nerve (VII) palsy meningitis Arthritis of large joints
gallbladder hydrops is seen in
Kawasaki disease (acalculous gallbladder distension)
Peripheral eosinophilia is seen in pneumonia caused by:____
Chlamydia trachomatis
Infant 4-12 weeks: staccato cough, nasal stuffiness, rales, no wheezing, afebrile
Treatment of chlamydia conjunctivitis or pneumonia in infant
Erythromycin x14 days
Could also do azithro x3-5 days
Elevated cold antibody titers are seen in infections caused by ____
Mycoplasma EBV, CMV HIV Hep C Malaria
Empiric treatment for PID
- cefotetan + doxy
- Cefoxitin + doxy
- Clinda + gent
IV for 24-48 hrs then PO
Outpatient trt:
1) ceftriaxone + doxy
2) cefoxitin + probenecid + doxy
Add metronidazole for trich or h./o recent uterine instrumentation
Asymptomatic person with positive PPD and negative CXR. Treat or no?
Describes Latent TB.
Isoniazid x9 months.
Get PPD on household family members.
No reason to separate people.
Scrofula
cervical tuberculous lymphadenitis
most common form of extrapulmonary TB
M. bovis (unpasteurized milk), M. tuberculosis due to extension of primary lesion in lung.
Dx: FNA
When is varicella contagious?
Contagious 1-2 days prior to appearance of the rash and then until all lesions have crusted over
if live vaccines not administered on same day what is the required time interval between them?
4 weeks
one will interfere with immune response of the other
How does lymphogranuloma venereum present?
initial stage is papules then buboes develop (inguinal nodes)
Treatment for hydradenitis suppurativa
Topical/systemic antibiotics
Spironolactone (2nd line)
Treatment for otitis externa
ciprodex OR cortisporin (neomycin/polymixin/hydrocortisone)
Kids with cyclic neutropenia at risk for sepsis due to which organisms
Clostridium perfringens
CLostridium septicum
When does shedding of Hep A stop?
7 days of symptom onset. Keep fhome from school.
Increased risk of febrile seizures with this vaccine
MMRV - first dose
Rare adverse events associated with DTAP
swelling of entire limb
hypotonic-hyporesponsive episode
Complications of campylobacter infection
diarrhea/abd pain/fever/sometimes lboody stool
mimics appendicitis, intuss
Guillain-Barre, reactive arthritis, erythema nodoum
What is Ramsay Hunt syndrome
herpes zoster of geniculate ganglion. Vesicles in dermatomal distribution - ant 2/3 of tongue, ear pinna, EAC, unilateral ear pain.
BELLS PALSY (facial nerve palsy) within 1 week
Trt - systemic steroids and po acyclovir
Blistering distal dactylitis is caused by …
group A beta hemolytic strep (less likely S. aureus). Purulent fluid. Drain and culture
one large bulla on tips of fingers (volar fat pad) Contrast with herpetic whitlow which is several pustular blisters
Botulism symptoms may worsen with administration of this type of antimicrobial:
Aminoglycoside.
Increases effect of toxin at NMJ
Risk factor for botulism- higher in infancydue to lack of gastric acid, decreased gut flora and lack of secretory IgA.
Constipation, hypotonia, CN palsies, flaccid paralysis, poor feeding, weak suck and cry
BV associated with vaginal pH ___
> 4.5
ampicillin in neonatal sepsis is effective against…
Group B strep
Listeria
enterococcus
Cefotaxime in neonatal sepsis is effective against
gram negatives
e COLI
Puncture wound through tennis shoe - at risk for….
pseudomonas
also tetanus
what is the most common complication of a viral URI
otitis media
Treatment of Impetigo
Staph or strep
cutaneous larva migrans
Ancylostoma infection (hookworm) bullous tracks/red-brown-- intensely pruritic Albendazole or ivermectin
WHen is zoster not contagious?
Contagious by contact until all lesions have crusted over. (but can go out in public if lesions are covered)
Papular purpuric gloves and socks syndrome
Parvovirus B19
acute onset of progressive swelling of hands/feet with petechial purpura. Well-demarcated erythema stopping at wrists and ankles.
arthralgia, malaise, GI, resp symptoms
Still contagious
When is measles contagious?
4 days before to 4 days after onset of rash
How do you treat individuals exposed to measles virus?
- infants give IMIG within 6 days. Can give MMR within 72 hours of exposure
- IVIG for pregnant women without immunity and severely immunocompromised regardless of immunization status
Test for DEFINITIVE diagnosis of syphilis
dark-field microscopy demonstrating spirochetes from the ulcer
Not really used
What are nontreponemal tests?
RPR and VDRL used for screening and monitoring for treatment. Can have false positives
Treatment for RPA
Grp A strep, S. aureus, resp anaerobes
CLINDAMYCIN or UNASYN
Lateral neck XR - thickened prevertebral space
When can kids with strep throat go back to school?
24 hours after antibiotics started
Should kids with lice stay home from school?
Can finish out school day and return once 1st treatment completed
What is the difference between pneumococcal conjugate vaccine and the polysaccharide vaccine?
Conjugate is PCV-13 (for everyone, 4-dose series)
Polysaccharide is PPSV23 ( 1 dose after age 2 yrs for people at risk of invasive pneumococcal disease- heart, lung, DM, CSF fluid leak, cochlear implant))
Who gets 2 doses of pneumococcal polysaccharide vaccine (PPSV23)?
people with asplenia, sickle cell, or immunocompromised. Give after age 2.
2 doses 5 years apart (or in HbSS disease, 3 years apart)
What are the major Jones criteria for ARF?
- Joints (polyarthritis)
- Carditis
- Nodules (subcutaneous)
- Erythema marginatum
- Sydenham chorea
Req: 2 major OR 1 major, 2 minor with evidence of prior strep infection
What are the minor Jones criteria for ARF?
fever
arthralgia
elevated ESR/CRP
prolonged PR interval
Req: 2 major OR 1 major, 2 minor with evidence of prior strep infection
Treatment for tinea pedis
topical clotrimazole BID x2-4 weeks
if nail is involved, require terbinafine or itraconazole PO
Dx of acute EBV infection
Serology – heterophile antibody test detect IgM in first 2 weeks (kids <4 years dont have these)
CBC with >10% atypical lymphs in 2nd week of illness
***use antibody titers in younger kids. IgM to VCA without NA (nuclear antigen) antibodies = recent acute EBV infection
Most common cause of osteomyelitis in kids with HbSS
S. aureus
Salmonella
How do you treat first recurrence of C diff?
metronidazole (same as first)
Do not use for the next recurrences. Use oral vancomycin after
Treatment for syphilis primary
PCN G benzathine IM 2.4 million units for 1 dose
For syphilis with no chancre and you don’t know how long its been there, dose 1 shot per week x3
Stages of lymphogranuloma venereum?
Chlamydia L1-3
- Small painless papule/pustule, maybe a painless ulcer
- Painful inguinal/femoral LAD (2-6 weeks after the above heals)
WHen is zoster not contagious?
Contagious by contact until all lesions have crusted over. (but can go out in public if lesions are covered)
Papular purpuric gloves and socks syndrome
Parvovirus B19
acute onset of progressive swelling of hands/feet with petechial purpura. Well-demarcated erythema stopping at wrists and ankles.
arthralgia, malaise, GI, resp symptoms
Still contagious
When is measles contagious?
4 days before to 4 days after onset of rash
How do you treat individuals exposed to measles virus?
- infants give IMIG within 6 days. Can give MMR within 72 hours of exposure
- IVIG for pregnant women without immunity and severely immunocompromised regardless of immunization status
Test for DEFINITIVE diagnosis of syphilis
dark-field microscopy demonstrating spirochetes from the ulcer
Not really used
What are nontreponemal tests?
RPR and VDRL used for screening and monitoring for treatment. Can have false positives
Treatment for RPA
Grp A strep, S. aureus, resp anaerobes
CLINDAMYCIN or UNASYN
Lateral neck XR - thickened prevertebral space
When can kids with strep throat go back to school?
24 hours after antibiotics started
Should kids with lice stay home from school?
Can finish out school day and return once 1st treatment completed
What is the difference between pneumococcal conjugate vaccine and the polysaccharide vaccine?
Conjucate is PCV-13 (for everyone, 4-dose series)
Polysaccharide is PPSV23 ( 1 dose after age 2 yrs for people at risk of invasive pneumococcal disease- heart, lung, DM, CSF fluid leak, cochlear implant))
Who gets 2 doses of pneumococcal polysaccharide vaccine?
people with asplenia, sickle cell, or immunocompromised. Give after age 2.
2 doses 5 years apart (or in HbSS disease, 3 years apart)
What are the major Jones criteria for ARF?
- Joints (polyarthritis)
- Carditis
- Nodules (subcutaneous)
- Erythema marginatum
- Sydenham chorea
Req: 2 major OR 1 major, 2 minor with evidence of prior strep infection
What are the minor Jones criteria for ARF?
fever
arthralgia
elevated ESR/CRP
prolonged PR interval
Req: 2 major OR 1 major, 2 minor with evidence of prior strep infection
Treatment for tinea pedis
topical clotrimazole BID x2-4 weeks
if nail is involved, require terbinafine or itraconazole PO
Dx of acute EBV infection
Serology – heterophile antibody test detect IgM in first 2 weeks (kids <4 years dont have these)
CBC with >10% atypical lymphs in 2nd week of illness
***use antibody titers in younger kids. IgM to VCA without NA (nuclear antigen) antibodies = recent acute EBV infection
Most common cause of osteomyelitis in kids with HbSS
S. aureus
Salmonella
How do you treat first recurrence of C diff?
metronidazole (same as first)
Do not use for the next recurrences. Use oral vancomycin after
Treatment for syphilis primary
PCN G benzathine IM 2.4 million units for 1 dose
For syphilis with no chancre and you don’t know how long its been there, dose 1 shot per week x3
Stages of lymphogranuloma venereum?
Chlamydia L1-3
- Small painless papule/pustule, maybe a painless ulcer
- Painful inguinal/femoral LAD (2-6 weeks after the above heals)
Secondary infection of croup is most likely
Bacterial tracheitis:
toxic child who was treated for croup and now suddenly worsening. Thick purulent secretions, pseudomembrane, ulces.
S. aureus
Strep
Moraxella
H flu
3rd gen cephalosporin +/- vanc
Serologic testing for lyme disease
- ELISA
- Western blot, if ELISA+
window period of about 2 weeks from infection to positive test results
Treatment of early lyme disease in kids <8 years of age
Amoxicillin or cefuroxime for 14 days
most common manifestation of nontuberculous mycobacterium infection in healthy kids
Cervicofacial lymphadenitis
70% are mycobacterium avium complex
Treat with surgical excision (95% effective) not necessarily with antibiotics
can have positive tb skin test (in about 50%)
+IgG to HBs alone indicates:
immunized to hep B
What antibodies do you have if you are immune due to hep B infection?
anti-HBc
anti-HBs
chronic hep B infection: serology
+HBsAg
+anti-HBc
serology of hep B infection with the highest infectivity
HBeAg = active infection, infectious
Hep A postexposure prophylaxis…
Hep A vaccine if over 12 months.
Hep A immune globulin if <12 months
Chronic suppurative otitis media usually caused by
S. aureus
Pseudomonas
(biofilm-producing organisms)
trt with fluoroquinolone drops first
what color are gram positive bacteria on gram stain?
purple
granuloma inguinale
Klebsiella - genital ulcers. pseudobubo in inguinal area
Donovan bodies on Wright stain (encapsulated GNRs)
swimming pool related diarrhea typically caused by
Cryptosporidium
Can be resistant to chlorination
trt: NITAZOXANIDE
What is the regimen for meningococcal chemoprophylaxis?
Rifampin 10 mg/kg BID (600 mg) x2 days
Ciprofloxacin 500 mg x1
Can also do 1 dose IM ceftriaxone
Close contacts within 7 days of symptom onset
Erysipelas usually caused by
Strep
Treatment for PID outpatient
Ceftriaxone 250 mg IM x1
Doxycycline 100 mg BID x14 days
+/- metronidazole 500 mg BID x 14 days if suspecting trich, abscess, or recent gyn instrumentation
What organisms form ring abscesses?
Bacillus cereus (penetrating eye injury) Pseudomonas Proteus
Treatment for H. pylori infection
clarithromycin + amoxicillin OR clarithromycin + metronidazole \+ PPI 7-14 days
What protein correlates with high rate of replication and infectivity in a pt with Hep B infection?
Hep B “e” antigen+
highly infecitous period, high rate of perinatal transmission
How does hepatitis D virus replicate
Needs HBsAg to provider its outer coat
What are the indications for SBE prophylaxis?
- Prosthetic valve
- Previous endocarditis
- Unrepaired cyanotic heart disease
- Completely repaired heart disease with prosthetic material within last 6 months
- transplant pts with valvopathy
Amoxicillin 50 mg/kg x1 dose 1 hour prior to procedure max 2g.
PCN-allergic azithromycin/clindamycin
First line for Kingella kingae infection
Cephalosporins/PCN/beta lactams
Who gets postexposure ppx when a child has invasive meningococcemia?
Household contacts, regardless of vaccination status. Or people in childcare center with contact within 7 days of symptom onset. Seated next to pt on airplane for flight >8 hours
Treatment for coexistent diaper candidiasis and oral thrush
oral antifungal
What bacteria is associated with stye/hordeolum?
S. aureus
Usually only warm compresses required.
What is breakthrough varicella?
Varicella infection with wild-type virus in a fully immunized child.
Maculopapular rash, <50 lesions, less contagious, occurring >42 days after vaccination
Treatment for Trichomonas vaginalis?
Metronidazole 2g single dose
OR 500 BID x7 days
What is the best screening test for HIV in kid older than 18 months?
4th generation HIV1/2 antibody/p24 antigen immunoassay (same screening test as for adults)
What is the best HIV screening test in a child <18 months?
HIV DNA PCR
Or RNA assay
How to treat dog bite in pcn allergic patient?
clindamycin + bactrim (to cover pasteurella)
swimming pool related diarrhea typically caused by
Cryptosporidium
Can be resistant to chlorination
What is the regimen for meningococcal chemoprophylaxis?
Rifampin 10 mg/kg BID x2 days
Can also do 1 dose IM ceftriaxone
Close contacts within 7 days of symptom onset
How is Listeriosis treated in the neonate?
Ampicillin and gentamicin for synergistic effect then can use ampicillin alone
Toxocara infection
Cutaneous larva migrans. Dogs.
Respiratory symptoms/peribronchial cuffing, recurrent wheezing, chronic nonproductive cough
Ocular symptoms
Hepatomegaly
LIVER EYES LUNGS
Kids at risk of pica- eat dirt containing oocysts
Who gets menveo vaccine?
Infants s/p Splenectomy.
2, 4, 6, 12 months of age
What is the treatment fro campylobacter infection in chronically ill patients?
Azithromycin
What is ppx given to neonate when mom has active gonorrhea infection?
IM ceftriaxone x1
Treatment for RPA?
Unasyn or Clindamycin
When do kids with sickle cell disease getmeningococal immunization?
age 2. Give booster dose 8 weeks later.
Vaccinate every 5 years.
Kids >age 10 also need MenB
What are the indications for SBE prophylaxis?
- Prosthetic valve
- Previous endocarditis
- Unrepaired cyanotic heart disease
- Completely repaired heart disease with prosthetic material within last 6 months
- transplant pts with valvopathy
Amoxicillin 50 mg/kg x1 dose 1 hour prior to procedure.
PCN-allergic azithromycin/clindamycin
Most common cause of ACUTE bacterial endocarditis
S. aureus
Most common cause of SUBACUTE bacterial endocarditis
Viridans strep
What meds should be avoided 6 weeks after varicella vaccine?
Salicylate meds which can cause Reye syndrome
aspirin, bismuth subsalicylate
Which vaccine given in infancy is not indicated after 8 months of age?
Rotavirus
What is breakthrough varicella?
Varicella infection with wild-type virus in a fully immunized child.
Maculopapular rash, <50 lesions, less contagious, occurs >42 days after vaccination
Pertussis treatment for infant <6 months
azithromycin 10 mg/kg x5 days
older kids get 10 mg/kg + 5mg/kg for 4 days
Periventricular calcifications on neonatal head US
CMV infection
Diffuse cerebral calcifications on neonatal head US
Toxoplasma
hydrocephalus, microphthalmia, chorioretinitis, seizures, HSM
Patients with selective IgA deficiency at risk of infections with
Giardia
These patients also have recurrent sinusitis and AOM
HPV vaccine schedule
<15 years: 2nd dose 6-12 months after first. 2-dose series
>15 years: 3 dose series. 2nd dose 1-2 months after first, 3rd dose 6 months after first dose
Most common infections in kids with Hyper-IgE syndrome (Job syndrome)
- cold abscesses (S.aureus), H. flu, S. pneumo
- sinopulmonary infections
- bad eczema
Bad lung infections –> bronchiectasis, fistulae, empyema, pneumatoceles LUNG CYSTS
Later infections can be pseudomonas, aspergillus, MAC
What reaction is pt with IgA deficiency at risk for if given IVIG
Anaphylaxis.
But this is not a contraindication to giving. Can select product with low IgA levels.
Toxocara infection
Cutaneous larva migrans
Respiratory symptoms/peribronchial cuffing, recurrent wheezing, chronic nonproductive cough
Ocular symptoms
LIVER EYES LUNGS
When can children with HIV infection get the varicella vaccine?
At 12-15 months If CD4+ count is >=15%.
Booster dose at least 3 months later if CD4 count stays up
Patients with hyper IgM syndrome are at particularly high risk for this type of infection
Pneumocystis pneumonia
What is the most sensitive test for acute phase of mononucleosis?
IgM to VCA
Roseola
HHV6 or 7
3 days fever then rash. Periorbital edema. cervical LAD. URI symptoms
Earliest age infant can receive rotavirus vaccine?
6 weeks. Even if preterm, as long as clinically stable.
Do not initiate immunization if older than 15 weeks. Must complete all doses by 8 months. 4 weeks between doses.
What is the best test to identify recent strep impetigo infection?
anti-DNAse B
in setting of PSGN
If MMR and varicella not given on same day, how much time needed between them?
4 weeks
When is child with parvovirus no longer contagious?
When slapped cheek rash has appeared
