W12_08 pediatric infectious diseases

Question 1

what are the big six infectious diseases killers?

Answer 1

HIV/AIDS;
tuberculosis;
pneumonia/influenza;
diarrheal diseases;
malaria;
measles

Question 2

note: newborns don’t have an adaptive system - no T cells, so typically T-cell independent responses

Answer 2

thus they have poor responses to polysaccharide antigens

Question 3

when does the mother give the baby transplacental maternal IgG?

Answer 3

rule of thumb: 28 weeks

Question 4

what are three anatomical challenges that predisposes kids to infections?

Answer 4

narrower airways;
eustachian tube angle predisposes to ear infection;
anatomic malformations may be present (vesicoureteral reflex)

Question 5

note: age affects disease severity

Answer 5

e.g. rubella is devastating in infants but not a problem in children

Question 6

define fever without a souce in an infant

Answer 6

acute febrile illness without apparent etiology

Question 7

define serious bacterial infection

Answer 7

meningitis, sepsis, bone & joint infections, UTI, pneumonia, enteritis

Question 8

define toxic appearance

Answer 8

clinical picture consistent with the sepsis syndrome

Question 9

what’s the incidence of a serious bacterial infection in a child with a toxic appearance?

Answer 9

15-20%

Question 10

what’s the management of a serious bacterial infection suspicion?

Answer 10

full septic workup =
CBC/blood culture;
urinalysis and urine culture;
lumbar puncture;
CXR;
stool microscopy and culture

Question 11

what are some life-threatening bacteria infections in infants?

Answer 11

e-coli;
GBS;
listeria monocytogenes

Question 12

what are some life-threatening viruses infections in infants?

Answer 12

herpes simplex virus;
enteroviruses and parechoviruses

Question 13

if meningitis suspected, would you choose gentamycin or cefotaxime?

Answer 13

cefotaxime - 3rd gen ceph has better BBB penetration

Question 14

ampicillin covers E coli, group B strep, and listeria

Answer 14

ok

Question 15

if you suspect herpes simplex virus in an infant, which drug do you give?

Answer 15

acyclovir;
note, it’s a tough decision because of side effects of drug

Question 16

pneumonia, septicemia, and meningitis may indicate what?

Answer 16

early onset GBS infection (< 7 days)

Question 17

meningitis, osteomyelitis, soft tissue infections, sepsis may indicate what?

Answer 17

late onset GBS infection (> 7 days)

Question 18

how to manage the GBS infection?

Answer 18

ampicillin and maybe gentamycin;
iv fluids, inotropic support for hypotension, ventilatory support

Question 19

what’s the maternal treatment for GBS infection?

Answer 19

penicillin G (no resistance)

Question 20

what’s the threshold for WBC count in a baby that looks well and with risk of maternal GBS infection?

Answer 20

if WBC < 5, then FSWU and treat pending culture results

Question 21

note: you cannot exclude HSV infection in the infant on the basis of maternal history

Answer 21

60-80% of women who deliver an HSV infected child have never had genital lesions

Question 22

note:neurological symptoms of HSV tend to come later than the skin or disseminated symptoms (assuming the HSV is targeting that region)

Answer 22

ok

Question 23

what’s the diagnosis for HSV?

Answer 23

PCR or culture the lesions and bodily fluids;
lumbar puncture essential in all cases

Question 24

what’s the treatment for HSV?

Answer 24

IV acyclorvir 60 mg/kg/day

Question 25

the risk of bacterial infection in 1 month old neonates is high even in those without symptoms

Answer 25

ok

Question 26

what are common bacterial pathogens of the 29-90 day infant group?

Answer 26

same as the neonates, but with added
strep pneumo;
n.meningitidis;
staph aureus;
group a strep

Question 27

what’s the more common infection in the 3-36 month old child?

Answer 27

viral - treatment most often is to just watch

Question 28

note: you can start to use vancomycin in children older than 1 month for suspected meningitis

Answer 28

ok