W12_08 pediatric infectious diseases Flashcards
what are the big six infectious diseases killers?
HIV/AIDS;
tuberculosis;
pneumonia/influenza;
diarrheal diseases;
malaria;
measles
note: newborns don’t have an adaptive system - no T cells, so typically T-cell independent responses
thus they have poor responses to polysaccharide antigens
when does the mother give the baby transplacental maternal IgG?
rule of thumb: 28 weeks
what are three anatomical challenges that predisposes kids to infections?
narrower airways;
eustachian tube angle predisposes to ear infection;
anatomic malformations may be present (vesicoureteral reflex)
note: age affects disease severity
e.g. rubella is devastating in infants but not a problem in children
define fever without a souce in an infant
acute febrile illness without apparent etiology
define serious bacterial infection
meningitis, sepsis, bone & joint infections, UTI, pneumonia, enteritis
define toxic appearance
clinical picture consistent with the sepsis syndrome
what’s the incidence of a serious bacterial infection in a child with a toxic appearance?
15-20%
what’s the management of a serious bacterial infection suspicion?
full septic workup =
CBC/blood culture;
urinalysis and urine culture;
lumbar puncture;
CXR;
stool microscopy and culture
what are some life-threatening bacteria infections in infants?
e-coli;
GBS;
listeria monocytogenes
what are some life-threatening viruses infections in infants?
herpes simplex virus;
enteroviruses and parechoviruses
if meningitis suspected, would you choose gentamycin or cefotaxime?
cefotaxime - 3rd gen ceph has better BBB penetration
ampicillin covers E coli, group B strep, and listeria
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if you suspect herpes simplex virus in an infant, which drug do you give?
acyclovir;
note, it’s a tough decision because of side effects of drug
pneumonia, septicemia, and meningitis may indicate what?
early onset GBS infection (< 7 days)
meningitis, osteomyelitis, soft tissue infections, sepsis may indicate what?
late onset GBS infection (> 7 days)
how to manage the GBS infection?
ampicillin and maybe gentamycin;
iv fluids, inotropic support for hypotension, ventilatory support
what’s the maternal treatment for GBS infection?
penicillin G (no resistance)
what’s the threshold for WBC count in a baby that looks well and with risk of maternal GBS infection?
if WBC < 5, then FSWU and treat pending culture results
note: you cannot exclude HSV infection in the infant on the basis of maternal history
60-80% of women who deliver an HSV infected child have never had genital lesions
note:neurological symptoms of HSV tend to come later than the skin or disseminated symptoms (assuming the HSV is targeting that region)
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what’s the diagnosis for HSV?
PCR or culture the lesions and bodily fluids;
lumbar puncture essential in all cases
what’s the treatment for HSV?
IV acyclorvir 60 mg/kg/day
the risk of bacterial infection in 1 month old neonates is high even in those without symptoms
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what are common bacterial pathogens of the 29-90 day infant group?
same as the neonates, but with added
strep pneumo;
n.meningitidis;
staph aureus;
group a strep
what’s the more common infection in the 3-36 month old child?
viral - treatment most often is to just watch
note: you can start to use vancomycin in children older than 1 month for suspected meningitis
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