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58 Cards in this Set
- Front
- Back
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For what condition are antibiotics most often given to kids?
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Acute Otitis Media
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What are some risk factors for acute otitis media?
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Under 2 yrs old
Male Day care Smoking in household Allergies |
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What are some risk factors for recurrent acute otitis media?
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Living with smokers
Daycare Early onset of first infection Siblings with recurrent otitis media Wintertime (viruses common cause) |
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What are the SPECIFIC sxs of AOM?
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Otalgia
Otorrhea Hearing loss Vertigo Tinittis |
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How is AOM diagnosed?
Why is this sometimes hard? |
Otoscope exam
Fluid in ear can last for up to 3mo (and in otitis media with effusion there may be no acute sxs), ear drum does not always look red and may look red without infection if child is crying |
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What are the common bacterial agents responsible for AOM?
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Nl nasopharyngeal flora that ascend
Strep pneumo H influenza M catarrhalis |
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What is the most common treatment for Amoxicillin.
What do the resistance patterns look like? |
Amoxicillin
H. influenza and M. catarrhalis form a beta-lactamase which makes it hard Strep pneumo can alter PBPs to resist |
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Does the H. influenza vaccine work at lowering incidence of AOM?
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No - it protects against the encapsulated type B and the form that causes AOM is nonencapsulated type A
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What is the recommended treatment for infants under 6mo old who get AOM?
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Treat with antibiotics to prevent hearing loss (need to be able to hear well at this age to develop speech)
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What is the recommended treatment for infants 6mo-2yrs who get AOM?
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antibiotics if severe, possibility of observation if not severe as long as there is good physician/parent communication (if does not get better in the next couple of days need to come back)
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What is the recommended treatment for those 2yrs old or older who get AOM?
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antibiotics if severe, observe if not severe or non-specific illness
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Which agent involved in AOM will often get better after a few days with just tylenol?
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H. influenza
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What are some of the suppurative complications of AOM?
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Meningitis
Mastoiditis Intracranial abscess Perforation of eardrum |
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What are some of the non-suppurative complications of AOM?
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Persistent effusion with hearing loss
Speech and language delay Poor performance on IQ test Cholesteatoma |
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What is the leading cause of hospitalizations in infants under one year old?
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RSV
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What are the associations of RSV?
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Bronchiolitis in infants
SIDS (not really....) Post infection wheezing/childhood asthma after RSV infection Severe disease in the elderly Giant cell pneumonia with deficient T cells Vaccine-enhanced disease |
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What are risk factors for RSV infection?
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Very young age (0-5mo)
Ex-premie |
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How does RSV cause disease?
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Causes cells in bronchioles to form syncytia which obstructs bronchioles and results in epithelial sloughing with exudates and fibrin
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What are some signs on Xray of RSV infection?
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Air trapping
Streaky markings Atelectasis |
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What type of virus is RSV?
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Paramyxo
G and F proteins RNA virus |
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Can children get re-infected with RSV?
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Yes - many different strains
Infections will usually not be as severe with subsequent infection though |
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What antibody is best at decreasing severity of RSV?
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Maternal IgG
F Ab>G Ab |
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What is the management used for RSV infection?
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Hospitalization if severe (maybe even ICU/vent)
O2 therapy B-adrenergic aerosols (albuterol) Fluid replacement |
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What are some risk factors for RSV infection?
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Prematurity (have more severe disease) - airway is smaller so easier to obstruct
Chronic lung disease Congenital heart disease (R-->L shunt) Immunodeficiency |
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What signs of pneumonia make it suggestive of bacterial etiology?
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Rapid onset
Likely to appear very sick High temperature |
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What signs of pneumonia make it suggestive of viral etiology?
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Low grade fever
Irritable but not toxic Sore throat Myalgias GI complaints Longer prodrome |
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What signs of pneumonia make it suggestive of mycoplasma etiology?
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Older children more likely to get this type
Multiple organ systems involved Rapid and progressive disease in sickle cell |
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What signs of pneumonia make it suggestive of Chlamydia trachomatis?
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Afebrile pneumonia with tachypnea and crackles
Conjunctivitis |
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What childhood illness does parainfluenza virus cause?
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Croup - wheezy cough
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What causes epiglottidis in most cases?
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H. influenza --- was seen in mostly older children but not seen much anymore because of the vaccine
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What is the equivalent of RSV seen in older kids?
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Human Metapneumovirus
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What is the most common cause of death in infants and children in developing countries?
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Dehydration caused by gastroenteritis (often rotavirus)
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What are some bacteria responsible for dehydration caused by gastroenteritis?
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Salmonella
Shigella Campylobacteria E. coli Yersinia |
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What are some viruses responsible for worldwide gastroenteritis in children?
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Rotavirus
Enteric adenovirus Norovirus Calcivirus |
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What type of virus is rotavirus?
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Reoviridae
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How does rotavirus cause gastroenteritis?
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Infects the villi of the SI (leads to destruction of cells), may lead to osmotic diarrhea, dehydration, metabolic acidosis
There is increased secretions and decreased absorption in the gut |
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Why don't neonates show signs of rotavirus infection?
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Lack the receptor for viral attachment
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What is the normal age range of rotavirus infection?
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6mo-3yrs
+immunocompromised outside this range |
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What are the clinical signs of rotavirus infection?
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Abrupt onset low grade fever and vomiting followed by watery diarrhea that lasts 3-9 days
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What is the treatment for rotavirus infection?
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Oral fluids
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Can reinfection with rotavirus happen?
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Yes but after third time should no lead to such severe dehydration
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Is there a vaccine available for rotavirus?
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Yes, live oral vaccine given at ages 2, 4, 6mo that covers 5 serotypes
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What are two settings that rotavirus is commonly spread in?
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Daycares
Hospitals |
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What is a type of infection that 10-30% of pregnant women are carriers for that they can pass onto their child?
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Group B strep (pre-natal culture is gotten and antibiotics given to prevent this)
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What makes a pregnant woman at high risk for passing Group B strep onto her baby?
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Genital innoculum
Preterm pregnancy with rupture of membrane Preterm delivery Multiple births UTI from group B strep Being African American Being a smoker |
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What are indications for giving intrapartum antibiotics?
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Prolonged ruptured membrane
Preterm delivery Fever during labor GBS bacteremia Previous infant with GBS |
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What are risk factors for Group B strep in pregnant women that do not necessarily require intrapartum antibiotics?
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African American
Smoker Young age Low antibodies to GBS |
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How far along in the pregnancy are cultures done for GBS?
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35-37wks
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What is the result of an intrauterine infection with GBS?
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Death within hours
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What are some early onset (within 7 days) complications of GBS infection in infants?
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Septic shock
Meningitis Pneumonia |
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What are two late onset (after 7 days) complications in GBS infection in infants?
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Meningitis
Osteomyelitis |
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What are two ways for pregnant women to get toxoplasmosis?
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Contact with sporozoites in cat feces in litterbox (sporolate from deposited oocysts)
Eating meat with tissue cysts |
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What kind of organism causes toxoplasmosis?
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Obligate intracellular protozoan called toxoplasma gondii
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What is the actively replicating stage of toxoplasma gondii that penetrates cells such as in the eye, CNS, muscle, or placenta?
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Tachyzoites
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What form of t. gondii stays in the tissue as cysts?
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Bradyzoites
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What are some of the clinical manifestations of 3rd-trimester acquired congenital toxoplasmosis?
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Mental retardation
Seizures Spasticity Impaired vision Deafness Chorioretinitis with reactivation |
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What may be seen on Head CT with congenital toxoplasmosis?
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Intracranial calcifications
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What is the treatment for children with congenital toxoplasmosis?
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Complicated - involves sulfa, clinda, pyrimethamine
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