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85 Cards in this Set
- Front
- Back
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What is the most common cause of neonatal septicemia
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Group B strep
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define occult bacteremia
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fever without obvious focus of infection (except otitis media) in a well appearing child, and positive blood culture for a bacterial pathogen
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signs of occult bacteremia
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fever
leukocytosis |
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predisposing factors for occult bacteremia
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-loss of external defenses
-inadequate immune fxns -impaired reticulendothelial fxn -overwhelming inoculum |
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cause of occult bacteremia in neonates
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-Group B strep
-E coli -Listeria -Staph aureus -Candida |
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cause of occult bacteremia in children
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-Strep pneumonia (MC)
-Neisseria meningitidis -Salmonella -Staph aureus -Group A strep |
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Dx of occult bacteremia
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-blood and urine cultures
-CBC -lumbar puncture |
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signs of sepsis
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-sick-looking, listless infant who is not eating in the first 3 mths of life with a rectal temperature <98 is hypothermic and thus septic
-vomitng is usual symptom in any infant with fever |
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Dx of sepsis
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-same as occult bactermeia
-blood and urine cultures -CBC -lumbar punture |
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Define sepsis
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-hypoperfusion abnormalities include lactic acidosis, oliguria, and alternation of mental status, and an increase alveolar arterial oxygen gradient
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Sepsis risk factors
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-younger at greater risk
-prematurity -immunodeficiency -catheters -contact with N. meningitidis or H. influenza infection |
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Define septic shock
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-shock associated with systemic inflammatory response syndrome, is defined as hypotension persisting despite adequate fluid resuscitation along w/ the presence of hypoperfusion abnormalities or organ dysfunction
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Tx of septic shock
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-IV broad spectrum antibiotics
-manage shock w/ supportive therapy to maintain blood pressure, perfusion and oxygenation |
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what is the typical rash distribution of meningococcemia
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-buttocks and lower extremities
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Meningococcemia triad
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1. fever
2. purpura 3. rapid progression |
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Dx of meningococcemia
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-culture of blood
-CSF -skin lesions |
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What conditions are common in individuals with meningococcemia
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-adrenal hemorrhage (Waterhouse-Friedrichsen syndrome)
-adrenal insufficiency |
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Tx of Meningococcemia
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-IV cefttriaxone of cefotaxime
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signs of Perinatal HIV
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-lymphadenopathy
-hepatosplenomegaly -oral thrush -failure to thrive |
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Causes of HIV in infants and adolescents
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-infants: vertical transmission from mothers perinatally or through breast milk (preventable by antiretroviral prophylaxis)
-Adolsecents: sexual transmission or IV drug use |
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Tx for HIV
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three classes:
-nucleoside reverse transcriptase inhibitors -non-nucleoside reverse transcriptase inihibitors -protease inhibitors |
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Dx of HIV
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-prenatal: HIV-1 antibody test
-ELISA and western blot |
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signs of Toxoplasmosis
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-mononucleosis syndrome including fever, lymphadenopathy and hepatosplenomegaly
-disseminated infection w/ T cell deficiency |
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Dx of toxoplasmosis
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-serologic antibody tests
-biopsy -parasites in CSF |
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Tx of toxoplasmosis
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-pyrimethamine and sulfadiazine
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Signs of Cryptococcosis
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-subacute or chronic meningitis is the most common presentation in AIDS
-fever, HA and malaise -deafness -cranial nerve palsies -seizures -ataxia |
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Define cryptococcosis
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-fungal infection
-primary infection of lung -disseminates to brain, meninges, skin, eyes, and skeletal system in immune compromised |
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Dx of cryptococcosis
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-sputum
-bronchopulmonary lavage -CSF |
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TX of cryptococcosis
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-amphotericin B and flucytosine
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define Pneumocystis pneumonia
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fungus
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signs of Pneumocystis jiroveci pneumonia
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-acute onset of fever, tachypnea, dyspnea, dry cough, and progressive hypoxemia
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Dx of Pneumocystis jiroveci pneumonia
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-chest x ray- diffuse bilateral interstitial infiltrates or alveolar dz, ground glass appearance
-methenamine silver staining of bronchoalveolar fluid lavage to identify cyst walls or Giemsa staining to identify nuclei or trophozoites |
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Tx of Pneumocystis jiroveci pneumonia
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1st line: prednisone with Trimethoprim-sulfamethoxazole
other: Pentamidine, TMP-SMX plus dapsone, atovaquone |
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When should Pneumocystis jiroveci pneumonia prophylaxis be started
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-6 wks of age TMP-SMX if CD4<15%
-6-12 yrs old <200 -1-5 yrs old <500 |
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Dx of Atypical Mycobacterial
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-culture of blood, bone marrow or tissue
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Signs of atypical mycobacterial
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-fever
-malaise -wt loss -night sweats -may have GI symptoms |
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Etiology of atypical mycobacterial
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-mycobateriium avium complex (MAC)
-highest risk if CD4 <50 |
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Tx of atypical mycobacterium
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-Two drug regimen:
either clarithromycin or azithromycin plus ethambutol, rifabutin, rifampin, ciprofloxacin, amikacin |
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Prophylaxis for atypical mycobacterium
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for CD4<50: azithromycin once a wk
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what is the most frequently transmitted virus to a child before birth
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CMV
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what organs are affected by CMV
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lung, liver, kidney, GI tract, salivary gland
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signs of CMV
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-pneumonitis
-esophagitis -retinitis (can cause blindness) |
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Tx of CMV
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-Gancyclovir
-IV foscarnet |
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Rubeola classic findings
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-coryza
-cough -conjunctivits -koplik spots |
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signs of Rubeola
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-fever is high and together w/ 3 c's precedes rash
conjunctivits cough coryza |
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What is another name for Rubeola
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measles
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what is the treatment for measles
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vitamin A
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what is the distribution of the rash of Rubella
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-spreads to trunk, as it clears on face
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what is the peak age of Roseola
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6-24 mths
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the high fever seen with roseola often trigger what?
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febrile seizures
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What is the cause of Fifth disease
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parvovirus B19
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signs of fifth disease
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-slapped cheeks
-rash spreads to trunk and extremities |
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complications of fifth disease
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-aplastic crisis
-hydrops fetalis |
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cause of Scarlet fever
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group A Strep
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Signs of Scarlet fever
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-sandpaper
-pastia lines -Desquamation |
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Tx for Scarlet fever
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penicillin
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What condition usually presents with all lesions in the same stage
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smallpox (versus chickenpox at different stages)
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Post exposure prophylaxis in immunocompromised or newborns exposed to maternal varicella
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varicella zoster immune globulin (VZIG)
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Typhoid fever triad
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-bradycardia
-rose spots -hepatosplenomegaly |
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Lyme disease triad
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-erythema migrans
-Bell's palsy -heart block |
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What is the difference between treated and untreated lesions of Lyme disease
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-untreated lesions fade within 28 days, may have permanent neurologic or joint disabilities
-if treated lesions fade within days and the late manifestations are prevented |
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what is one of the only current indications to use chloramphenicol? Why?
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-Rocky Mountain Spotted Fever
- bc chloramphenicol causes gray baby syndrome (aplastic anemia) |
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Rash of Rocky Mountain Spotted Fever
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rash on distal extremities, including palms and soles, spreads toward the trunk
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Pathogens in bites
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-human: Eikenella corrodens
-cats: Pasteurella multocida -dogs: Capnocytophagia canimorus |
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What should be considered in a child with a human bite
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-child abuse
-risk for HIV and Hep B |
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What are the risk factors for Schistosomiasis
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-exposure to fresh water (lake, river)
-swimming, fishing, playing |
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what is another name for chickenpox
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Varicella
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Rash for chickenpox
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appears on face first and then spreads to trunk and extremities, sparing palms and soles
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When does Congenital varicella syndrome occur
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maternal varicella infection in first 20 weeks of pregnancy
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When is the congenital Varicella vaccine given
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-1st dose 12-18 mths
-2nd dose >4yrs old |
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What is the cause of Hand Foot Mouth Disease
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Cox A
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signs of Hand Foot Mouth Disease
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-GI discomfort
-Ulcerative mouth lesions -Hand and foot lesions, tender and vesicular -palms and soles |
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What are the signs of Mumps
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-swelling and tenderness of both parotid glands
-difficult to open mouth |
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When is Mumps vaccine given
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MMR
12-15 mths and booster at 4-6 yrs |
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cause of Typhoid fever
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-salmonella typhi
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signs of Typhoid fever
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-fever:
-transient rose-colored spots on trunks |
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Tx for Typhoid
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-ceftriaxone
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cause of Lyme disease
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Borrelia (spirochete)
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Signs of Lyme Disease
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-erythema migrans
-facial palsy - CN VII, Bell's palsy 3-5 wks after exposure |
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Tx for Lyme Disease
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-Amoxicillin (cefuroxime) or doxycycline
-ceftriaxone or Penicillin IV |
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cause of Rocky Mountain Spotted Fever
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-Rickettsia
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Tx for Rocky Mountain Spotted Fever
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doxycycline
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causes of Toxic shock Syndrome
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Group A strep
Staph aureus |
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Geography of Histoplasmosis
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mississippi, ohio, missouri river valley
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Geography of Coccidioidomycosis
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Utah, Arizonia, New Mexico, Texas, California
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