Pod Block 3 - Infections In Infants & Children

Front 1

Risk factors for acute otitis media:

Lots of them (11 total)

Back 1

Age < 2, Male, siblings w/ disease, day care, lower socioeconomic status
smoking, allergies, pacifiers, Native American or Eskimo,
Cleft palate, immune deficiency

Front 2

Are ear infections more common in the winter or summer?

Back 2

winter

Front 3

What's the proportion of kids in the population who've had otitis media related surgical procedures?

Back 3

One in sixteen

Front 4

What is the pathology of AOM?

(Five steps)

Back 4

1. Antecedent event (usually viral URI)
2. Mucosal congestion of upper resp.
3. Swelling in Eustachian tube (obstruction)
4. Middle ear secretions can't drain via Eustachian tubes
5. Bug ascends into middle ear

Front 5

Nonspecific symptoms of AOM

Lots of them (8 total)

Back 5

Fever, irritability, insomnia, headache, anorexia,
nausea, vomiting, diarrhea

Front 6

Specific symptoms of AOM

(7 total)

Back 6

Otalgia, otorrhea, hearing loss, vertigo,
nystagmus, tinnitus, facial paralysis

Front 7

What is the key difference between acute otitis media (AOM) and otitis media w/ effusion (OME)?

Back 7

In OME, see presence of fluid in the middle ear with ABSENCE of acute infection.
(Don't see fever, earache, etc)

Front 8

Name five pathogens responsible for AOM.

Which is the most common?
(Bonus - Why is it the most common?)

Back 8

Strep pneumoniae, H. Influenzae, Moraxella catarrhalis
Strep pyogenes, Misc. bacteria

Of these, H. Influenzae edges out Strep Pneumoniae as the most common cause
The vaccine to strep is limiting the number of infections, while the vaccine to H. Influenzae does not stop it since the AOM bug is non-encapsulated

Front 9

(True or False) It is important to start a patient with AOM on antibiotics ASAP.

Back 9

False - many times the infection clears up on its own

Front 10

How is Strep. Pneumoniae gaining antibiotic resistance?

Back 10

Through alteration of penicillin binding proteins
NOT production of beta lactamase

Front 11

How are H. influenzae and M. catarrhalis gaining antibiotic resistance?

Back 11

Through production of beta lactamase

Front 12

Suppurative complications of AOM (6):

Back 12

Meningitis, mastoiditis, intracranial abscess,
lat sinus thrombosis, chronic suppurative otomastoiditis
Tympanic membrane perforation

Front 13

Nonsuppurative complications of AOM (4):

Back 13

OME->Hearing loss
Speech/language delay, impaired performance on IQ tests, cholesteatoma

Front 14

How do you distinguish between bacterial and viral pneumonias based on presentation?

Back 14

Trick question! You can't
*Although, some findings would suggest bacterial or viral

Front 15

What percentage of pneumonia in children is from viral etiology versus bacterial?

Back 15

90% of pneumonia is viral etiology.

Front 16

What is the most common cause of viral pneumonia?

Back 16

RSV

Front 17

Compare/contrast these symptoms for bacteria pneumonia versus viral pneumonia:

Rate of onset
Presence of associated complaints
Severity of fever

Back 17

Bacterial pneumonia has a more rapid onset, patients are more likely to appear "sick", and they have a higher fever.

The opposite is generally true for viral pneumonias, plus you see other conditions (headache, sore throat, myalgias, GI symptoms)

Front 18

Give two factors that would suggest a patient has M. pneumoniae, or Chlamydia pneumoniae:

Back 18

1. The patient is an older child/adolescent
2. Multiple organ system involvement

Front 19

Give two factors that would suggest a newborn has Chlamydia trachomatis infection (the STD):

Back 19

1. Afebrile pneumonitis w/ tachypnea and crackles
2. Eye infection/poor growth

Front 20

What is the most common reason why children under 5 are hospitalized?

Back 20

RSV

Front 21

Review: What do the F and G proteins do in RSV?

Back 21

F protein - Cell penetration
G protein - Attachment to respiratory epithelium

Front 22

Regarding RSV reinfections:

A. They are more severe
B. They are less severe
C. They don't ever happen
D. They are just as severe as the first episode

Back 22

B. They are less severe each time.

Front 23

What season do we see RSV?

Back 23

Winter

Front 24

Five signs/symptoms of infants with RSV:

Back 24

Bronchiolitis / pneumonitis
Respiratory distress
Difficulty eating/drinking
Fever
Decreased arteriolar oxygen saturation

Front 25

Which of the following treatments would you typically NOT give for a child with RSV in the ICU?

A. Increase Oxygen
B. Fluid replacement
C. Ventilatory support
D. Antivirals

Back 25

D. Antivirals

Front 26

Give five risk factors for severe RSV:

Back 26

Prematurity, chronic lung disease, immunodeficiency
heart disease, very young age

Front 27

What is the most common viral cause of acute gastroenteritis?

Back 27

Rotavirus

Front 28

What is the main reason why children with acute gastroenteritis die?

Back 28

Dehydration

Front 29

How is rotavirus spread?

Back 29

Fecal oral route

Front 30

What age group has the peak incidence for rotavirus?

A. <1 month of age
B. 2-8 months of age
C. 9-12 months of age
D. 12-24 months of age

Back 30

C. Nine to twelve months

Front 31

What is the seasonality of rotavirus?

Bonus: Is it the same all around the world?

Back 31

Winter time in temperate regions, year round in the tropics

Front 32

G and P serotypes pertains to which bug?

Back 32

Rotavirus

Front 33

Do reinfections commonly occur with rotavirus?

Back 33

Yes, but they are not as severe

Front 34

What are the major symptoms of rotavirus?

Back 34

Abrupt onset of vomiting and diarrhea,
Duration 3-9 days
Loose watery stools (nonblood)
Low grade fever

Front 35

Which of the following therapies is the best for treating rotavirus?

A. IV or oral rehydration
B. Antiviral
C. Peptobisomol

Back 35

A. Rehydration is most important

Front 36

How does the vaccine against rotavirus work?

Back 36

Protects against viral surface proteins
VP7 for G serotype
VP 4 for P serotype

Front 37

By far, which age group is most susceptible to group B strep?

Back 37

Neonates

Front 38

Which of the following describes Group B strep?

A. Gram negative cocci
B. Gram positive cocci
C. Gram negative rods
D. Gram positive rods

Back 38

Gram positive cocci

Front 39

What is the time cutoff for early onset versus late onset group B strep?

Back 39

Early onset = < 7 days
Late onset = > 7 days

Front 40

(True or False) African Americans and smokers are both higher risk carriers for group B strep.

Back 40

False
African Americans are, but nonsmokers are actually a higher risk

Front 41

When is the best time to administer antibiotics to a mother carrying Group B strep?

Back 41

Intrapartum (during labor)

Front 42

(True or False) Intrapartum antibiotics affect ONLY early onset group B strep and not late onset group B strep

Back 42

TRUE

Front 43

What, specifically are the screening-based guidelines for preventing the spread of group B spread from mother to infant?

Back 43

Culture the mother's vaginal flora at 35-37 weeks of gestation.
Offer antibiotic prophylaxis to GBS carriers and to preterms (unless negative culture)

Front 44

What, specifically are the risk-based guidelines for preventing the spread of group B strep from mother to infant?

Back 44

Use prophylaxis antibiotics for preterm babies, membrane rupture > 18 hrs, or intrapartum fever

Front 45

Which of the following is recommend for preventing the spread of group B strep?

A. Screening-based approach
B. Risk-based approach
C. Both
D. Neither

Back 45

C. Both

Front 46

What is the drug of choice for group B strep?

Back 46

Penicillin (Ampicillin)

Front 47

Regarding toxoplasmosis, ____ are infective when ingested by mammals, and following ingestion, gives rise to the ____ stage.

A. Sporozoite/tachyzoite
B. Tachyzoite/sporozoite
C. Sporozoite/bradyzoite
D. Bradyzoite/sporozoite

Back 47

A

Front 48

What is the name of the stage of toxoplsma that persists inside tissue cysts for the life of the host?

Back 48

bradyzoites

Front 49

What are two common ways that humans can be infected with toxoplasma?

Back 49

Handling undercooked meat
Contact with oocysts in cat feces

Front 50

What would be the results of a serologic test for Toxoplasma that indicated infection within the last 2 years?

Back 50

IgG positive, IgM positive

Front 51

What would be the results of a serologic test for Toxoplasma that indicated a recent infection?

Back 51

IgG positive but with low avidity, IgM positive

Front 52

What can you infer from an otherwise healthy child who has chorioretinitis regarding Toxoplasmosis?

Back 52

The child most likely had a reactivation of a congenital infection

Front 53

Which has a worse outcome for the child, a pregnant mother infected early in pregnancy, or infected later in pregnancy:

Back 53

Early in pregnancy

Front 54

In regards to early in pregnancy versus late in pregnancy, when is the risk of newborn infection with Toxoplasma higher? When is it more serious?

Back 54

Mothers infected by Toxoplasmosa early in pregnancy have a less risk of passing the disease on, but when they do it's more serious

Front 55

What are six symptoms/signs of congenital toxoplasmosis? (Those with > 50% incidence)

Back 55

Chorioretinitis, Intracranial calcifications,
Abnormal CSF findings
Anemia, Jaundice,
Lymphadenopathy

Front 56

How do you treat acute toxoplasmosis in pregnant women?

Back 56

give spiramycin until term

Front 57

How do you treat toxoplasmosis in an infant (congenital)?

Back 57

Pyrimethamine + Sulfadiazine + folic acid (+ corticosteroids if CSF or vision problems)