Id - 5-6 - Peds Infections

Front 1

In utero protection

Back 1

Placenta and amnion are usually sterile bc of mom's antibodies (IgG), which provide passive immunity (ramps up in the third trimester)

Infant abs start right before birth.

If prematurely born, moms abs havne't picked up all that much so there is more risk of infection.

Front 2

IgM for infant dx?

Back 2

hard - not made in all infections, doesn't distinguish btwn actue and reactivation, and rheumatoid factor gives false positives.

Front 3

Congenital infections

Back 3

CMV most common.
torches

toxoplasmosis
other (varicella-zoster)
rubella
CMV
Herpes/hep b or c/ HIV
enteroviruses
syphilis

Front 4

which congen infections are more severe?

Back 4

these are maternal infecs acquired during preg. early ones are more severe.

acute ones (vs latent) are also more severe because mom needs a little time to get the protection going.

Front 5

Consequences of congen infections

Back 5

Asymp is common. e.g. with CMV. 1% of newborns have it and 90% are asymp. But it can cause sensorineural hearing loss (so it is often picked up later during infancy)

chronic infections. - small, CNS, skin lesions, eye/ear, hepatosplenomegaly, anemia, cardiac defects, pneumonitis, musculoskel abnormalities...

Acute - during late preg or close to birth. can be mild or severe.

Reactivation - during infancy and childhood - e.g. a child who presents with zoster (reactivation) often times their mother had chicken pox during pregnancy. HSV and CMV cna do this too.

Front 6

__% of 1 year olds are infected peri and post-natal

Back 6

10%

Front 7

Peripartum infections

Back 7

due to maternal colonization or infection. during the birthing process or immediately post-partum.

herpes, GBStrep, E Coli

Front 8

Herpes simplex

Back 8

Primary infection is high risk but can be reactivation too (HSV, VZ, CMV).

susc during 4-8 weeks of life.

High mortality rate - tx asap with acyclovir.

Rarely is congenital. Mostly perinatal.

Front 9

Presentations of herpes simplex

Back 9

Skin, Eyes, Mouth - benign but can progress to the other 2.

Disseminatde/blood borne - to other organs. Usually presents early compared to CNS disease. high risk of mortality. some risk of disability.

CNS only - high risk of disability. some risk of mortality. worst outcomes with this one.

Front 10

Group B strep

Back 10

peri-partum

Colonizes genital tract of mom. Screen and give abx proph. to carriers.

Need to tx asap

Front 11

Signs of GBStrep

Back 11

Early onset - before age 7 - pneumonia, sepsis, meningitis. THe pneumotiis is pretty common...

Late - sepsis and meningitis

Front 12

Respiratory infections in infancy

Back 12

RSV
Parainfluenza
influenza
human metapneumovirus

seasonality (esp with RSV) and common causes of pneumonias.

Front 13

H1N1

Back 13

especially bad for pregnant women and young children compared to normal flus.

Front 14

Otitis media

Back 14

most common abx indic for young children in US

Front 15

func of auditory tube

Back 15

ventilation, drain middle ear, stop reflux of nasopharyng secretions

Front 16

pathophys of otitis media

Back 16

obstruc or dysfunc of auditory tube.

often due to viral URI, allergy, hypertrophied tonsils, cleft palate.

Front 17

Classifications of otitis media

Back 17

SECRETORY
1 OMEffusion/secretory - not always infectious. May just be fluid in the middle ear.
2 Persistent secreotyr otitis media - leads to hearing problems

BACTERIAL
acute suppurative OM
Recalcitrant OM - chronic and infective (can be persistent or recurrent)

Front 18

when do you see less mobilityy of TM and transudate?

Back 18

secretory otitis

Front 19

when do you see high pressure in mid ear with bulging of TM. and purulent exudate

Back 19

acute suppurative otitis

Front 20

causative agents of OM

Back 20

step pneum is number one.

also h inf, moraxella catarrhalis, strep pyogenes, staph aureus...

Front 21

at what age is there a decline in OM

Back 21

2 years

Front 22

complic of persistent secretory otitis media

Back 22

anatomic - glue ear and cholesteatoma (skin cyst in mid ear)

poor hearing

Front 23

tx of acute supp otitis media

Back 23

observation, pain control, abx, myringotomy (eardrum incision to relieve pressure)

most cases resolve without therpay but give abx bc in 10% of untreated, you can chronic supp otitis which can cause facial nerve paralysis, mastoiditis (leading to brain abscesses), osteomyelitis, venous sinus thrombosis.

Front 24

tx of persistent secreotry OM

Back 24

controvery. decongestants and oral abx shown not to be that great.

Front 25

which abx for OM

Back 25

first line - amoxicillin

if resistant, persistent, recurrent - amox/clav, cefuroxime, ceftriaxone...

beta lactam allergy - clinda or azithro.

Front 26

kawasakis dx

Back 26

in a child age 1-8. need fever and 4/5:

bilat bulbar conjunctival injection (no exudate)

erythematous mouth/pharynx ("strawberry tongue", cracked lips)

rash

induration and eryth palms/soles and/or periungual desquamation

nonsupp cervical cervical lymphadenopathy

Front 27

findings in kawasakis

Back 27

irritable, diarrhea, vomiting, urethritis, hepatic dysfunc, arthritis, aseptic meningitis, pericardial effusion...

Front 28

when do you see incomplete/atypical KS

Back 28

<12 month old baby

Front 29

worrisome issue with KS

Back 29

coronary aneurysms. do an echo.

tx - IVIG and aspirin.

Front 30

genetics of KS

Back 30

polymoprhisms implicated and no real candidite virus causes...

Front 31

ddx of kawaaskis

Back 31

Viral infections (eg, measles, adenovirus, enterovirus, Epstein-Barr virus)
Scarlet fever
Staphylococcal scalded skin syndrome
Toxic shock syndrome
Bacterial cervical lymphadenitis
Drug hypersensitivity
Stevens-Johnson syndrome
Juvenile idiopathic arthritis
Leptospirosis
Mercury hypersensitivity reaction (acrodynia)