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41 Cards in this Set
- Front
- Back
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In what ways are the immune systems of newborns less developed?
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- No specific adaptive immunity
- Weak T cell independent responses prior to 2yrs (GBS!) although T cell dependent processes robust since birth |
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What Ab comes from mother starting 28 weeks gestation?
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IgG
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What is transient hypogammaglobulinemia of infancy?
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At 5 - 9 months, level of maternal IgG falls off and infant production remains low.
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How is infant anatomy different in ways predisposing to infection?
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Narrower airways
Eustachian tube angle Vesicoureteral refluz etc |
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What is the definition of fever in children?
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> 38C oral, 37-37.5C axillary
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What causes vast majority of fevers?
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Self-resolving viral illnesses.
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Questions to Ask before deciding on intensity of investigation...
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Age of host
Normal host? Exposures Focus of infection How sick does child look? |
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Def'n: Fever w/o a Source
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Acute fever w/ no obvious etiology after Hx and P/E
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Def'n: Serious bacterial infection
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Meningitis, sepsis, bone / joint, UTI, pneumonia, enteritis
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Def'n: Toxic
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Picture of lethary, poor perfusion, marked hypoventilation / hyperventilationm, cyanosis etc
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Name three life threatening bacterial infections acquired in perinatal period
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GBS,
E coli and other GN enterics Listeria monocytogenes (rare) |
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Name three life threatening viral infections occurring in perinatal period
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HSV, enteroviruses (and parechoviruses), VZV
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GBS (most common neonatal bacterial pathogen) : early onset
Onset Symptoms Prophylaxis |
Onset: Early onset -- within 48 hrs
Symptoms: pneumonia, sepsis, meningitis Prevention: intrapartum abx prophylaxis = 80% effective |
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Late onset disease:
onset, symptoms, prophylaxis |
Onset: after 1st week of life
Symptoms: bacteremia, meningitis, other focal infections Prophylaxis: intrapartum Abx not effective |
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Preventing GBS Disease in Neonates
Procedure and Indications |
Give intrapartum abx to...
Positive 35 week GBS Previous infant w/ GBS disease GBS bacteruria during current pregancy Unknown GBS status PLUS - prematurity OR - PROM OR - Intrapartum fever > 38 |
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Management: suspected GBS disease
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FSWU
IV abx 2-3 weeks: amp/ pen + / - gent Ventilation IV fluids / inotropic support IVIG (??? controversial) |
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What are the three forms of Neonatal HSV infection?
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Skin, eye, mouth
Encephalitis Disseminated |
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Can benign for (skin, eye, mouth) progress to severe form?
Are cutaneous lesions always present in encephalitis / disseminated? |
Yes.
No. |
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What is mortality rate of untreated disseminated disease?
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100%
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Prevention / Treatment of HSV
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Prevention: C/S if active genital lesions. Give oral acyclovir / vancyclovir to mother.
Tx: 2-3 weeks IV acyclovir (3 for sure if disseminated) |
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What is the incidence of serious bacterial infection in toxic looking infants?
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17%
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What are the elements of a FSWU?
How is a toxic neonate managed? |
- CBC and culture
- Urinalysis and culture - LP - CXR (with resp signs) - Stool microscopy / culture (if GI signs) FSWU and empiric therapy |
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What is the risk of serious bacterial infections in well appearing neonates?
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3-6%
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What is the approach to fever of unknown source in well appearing neonate?
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Same as for toxic! FSWU + empiric therapy.
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What are some common bacterial pathogens of the 1 - 3 month group?
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Perinatal: GBS, E. coli, GN enterics, Listeria
Environmental: Strep pneumo, N menigitidis, S. A. , Group A Strep |
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Management of 1-3 month infant
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Do a PSWU and stratify.
High risk --> FSWU and empiric Low risk --> d/c and follow-up; admit FSWU / empiric if deterioration |
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Approach to Fever without Source in non-toxic 3 - 36 month old
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If appear toxic, FSWU + empirics
If not, d/c with follow-up and tx fever with antipyretics |
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What is by far the most common etiology of fever w/o source in 3 - 36 month infants?
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Viral!
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What are the common bacterial infections in 3 - 36 month infants?
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Most common: strep pneumo
Less common: S.A., G.A.S, N. meningitidis |
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Antibiotics: Neonates...
w/ susp meningitis w/o |
w/ : Amp + cefotaxime
w/o: Amp + cefotaxime or gent |
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Antibiotics: 1 - 3 months...
w/ susp meningitis w/o |
w/ Amp + cefotaxime + / - vancomycin
w/o Amp + cefotaxime |
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Antibiotics: 3 - 36 months
w/ susp meningitis w/o |
w/: cefotaxime + vancomycin
w/o: cefuroxime or cefotaxime |
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What are the causes of acute bacterial meningitis in 1-3 month stage?
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Overlap between neonates (GBS, E coli etc) and older kids (Strep pneumo, N. meningitidis)
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What are some signs and symptoms of acute bacterial meningitis in infants?
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Non-specific: fever, lethargy, etc; bulding anterior fontanelle; petechial rash; nuchal rigidity not apparent
- Kernig / Brudzinsky NOT apparent |
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What are some signs and symptoms of acute bacterial meningitis in older kids?
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More focal signs, photophobia. K and B signs. Petechial rash.
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Which is more reliable: Kernig's or Brudzinski's?
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Brudzinski's Neck Sign (flex neck)
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What is empiric antibiotic therapy for meningitis in each pediatric age group?
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Neonate: Amp + cefo
1-3 months: Amp + Cefo + / - vanco 3 months + : Ceftriaxone + vancomycin (for resistant pneumococcus) |
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What electrolyte abnormalities often result from bacterial meningitis?
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Hypokalemia due to inappropriate ADH secretion
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What causes of ABM require public health prophylaxis for close contacts?
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H 'flu b
N. meningitidis |
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What syndromes can result from Group A Strep infection?
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Resp: abscess, pneumonia, everything!
Skin / soft tissue: impetigo, cellulitis, erysipelas, necrotizing fasciitsis Deep / Systemic: Bone and joint/ sepsis Toxin mediated: scarlet fever and TSS |
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What are some sequelae of GAS?
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RF, post strep glomerulonephritis, reactive arthritis
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