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PNP Infectious Disease

10 organisms most commonly causing (suspected) bacterial infection in neonates. (bacteremia, meningitis, UTI & pneumonia) GEL SHE VRCC: GAS, E. Coli, Listeria Monocytogenes, Staph aureus, Enterococcus species, Herpes Simplex, Varicella zoster, RSV, candida, CMV
14 organisms that cause systemic infections most commonly associated with FEVER OF UNKNOWN ORIGIN in children SSATT I @ HMV CCCRL: Salmonella, Syphillis, Atypical prolonged common viral disease, Tuberculosis, Toxoplasmosis, Infectious mononucleosus, Histoplasmosis, malaria, viral hepatitis, CMV, Coccidiodomycosis, Rickettsial disease, Lyme.
Definition of DIC alteration of normal coagulation mechanism triggered by tissue injury such as infection, trauma, malignancy, etc.
Symptoms of DIC Bleeding, thrombosis, tissue ischemia. Respiratory failure, abdominal, renal failure, seizures.
Diagnosis of DIC Co-agulation studies. Especially D-dimer are diagnositic.
Management of DIC Remove cause/ event. Manage shock, respiratory compromise, acidosis. Vit K for clotting.
description of Adenovirus Associated with many system based processes: RESP (common cold, pharyngitis, tonsillitis, bronchiolitis +) OCULAR (keratoconjuctivitis), GI, SKIN (SJS), GU, CARDIAC (myocarditis or pericarditis, NEURO (meningitis). Management is system based.
Description/ symptoms CMV herpes family. primary & latent reactivated infection (immunocompromised) multi system: pna, myocarditis, pericarditis, uveitis, congenital infection associated with deafness. Tx imm comp pt 2-3 wk with anti viral otherwise supportive care
Description / symptoms EBV herpes family. Can be latent or active. Causes mono. Prodrome of fever, sore throat, malaise, fatigue. Cervical LAD,
Diagnosis & management of EBV monospot or mono tesr or viral antigen. Supportive care. Spleen gaurd & spleen caution if HSM.
What are the 'hallmark" symptoms that would warrant testing for pertussis in an infant lymphocytosis with classic cough. PCR for fast results, Culture for 100% specificity.
Teen with fever, malaise ST. 3+ tonsils with exudate. anterior and posterior cervical LAD & splenomegaly. What labs will you order CBC with diff, EBV specific IgG & IgM. Typically leukocytosis with 60%> lymphocytosis,& 50% pt with mild thrombocytopenia.
Typical symptoms of CMV pneumonitis, hepatomegaly, hepatitis & rashes
Which is the MOST characteristic finding in a child with a retropharyngeal abscess (RPA)? limited neck mobility (NOT hyperextension of the neck, drooling, stridor). Other findings: neck mass, asymmetric bulge of oropharynx, fever, sore throat, decreased oral intake and drooling. Stridor and respiratory distress are found much less frequently.
Symptoms of hepatitis asymptomatic or jaundice, palmar erythema, joint inflammation, distended abdomen, peripheral edema, exxhymosis, petechiae, altered LOC, liver tenderness on palpation.
Diagnostics/Labs of hepatitis LFT's, CPK, Coag, CBC with platelet function specific hepatitis antigen abdominal ultrasound.
Diagnostics/Labs of enterovirus cell culture isolation, PCR.
Presentation and diagnostics of herpes simplex Gingivostomatitis, genital herpes. Most concerning system based illness is encephalitis, can be congenitally acquired. Diagnosis: cell culture, antibody detection.
Management of HSV preventative tx with antiviral agents. Acyclovir etc.
What disease does parvo B19 cause to school age children and what condition if transmitted perinatally? fifth disease in school aged children. Presents with fever, arthralgias, rash. Perinatal transmission = hydrops fetalis.
Management of hepatitis based on thype and symptoms, consult GI, hepatologist,
What is full sepsis work up of a neonate? <28 days (up to 2 mth) with rectal temp of >38C : CBC with diff, UA cathed, blood cx, LP, cxray, if UR symptoms. Manage ABC's, treat 48-72hr.
most probable conditions in a neonate <28 days (up to 2 mth) with rectal temp of >38C UTI or occult bacteremia
most common organisms causing suspected bacterial infection in NN inc meningitis, UTI & pna (10) GEL SHE CCVR (car) GAS, E Coli, Listeria, Staph aureus, Enterococcus species, Herpes simplex, varicella, RSV, candida, CMV.
Organisms responsible for systemic infections most commonly associated with fever of unknown origin in children (14) salmonella, tuberculsosis, rickettsial, lyme, Cat scratch, histo, toxo,coccidioidomycosis, Malaria, Hepatitis, CMV, mono, syphillis, atypical prolonged common viral dx.
who has highest risk for occult bacteremia? A. 1 mth old toxic appear fever of 102°FB. 2 mth old, 3 days post imm fever to 101.4°F C. 3 mth resp congestion, wheezing 102.4°F D. 6 mth old 103°F, whose sibs recently had diarrhea A High risk children inc infants < 1MTH & B/T 1&3 mth, appear toxic & have no other symptoms to suggest illness. As infants age, fever is less of a concern, especially in the presence of other symptoms such as vomiting, diarrhea, cough or congestion.
bacterial meningitis organisms & symptoms in neonates GBS, E coli, Strep pna Symptoms: fever lethargy bulging fontanelle.
management of suspected shunt or csf infection W/ fever shunt tapped & cultured
bacterial meningitis organisms & symptoms in infants S. Pneumo, N. meningitis, H flu Symptoms: fever, h/a, neck stiffness, +kernig & brudinski
Rocky Mountian spotted fever Tick born, rickettsia rickettsii, Most common fatal tick borne dx in USA. All states. Eastern US: dog tick, western: rocky mountain wood tick. april-sept. Tick needs to be attached > 6hr for transmission.
Hx of RMSF Incubation 2-8 days following tick bite. Symptoms, gradual/abrupt >38.8, h/a, rash by d3, toxicity, myalgia, mental confusion, photophobia, HSM. RASH: starts wrists & ankles, spreads-> palms & soles.
RMSF rash RASH: starts on wrists & ankles, spreads to palms & soles. Blanching maculopapular -> petechial or purpuric 50%. APPEARS D3-6.
RMSF abx doxycycline
Lyme dx ticks, sprichette, May-oct Rash does not expand over days Patients complain of fever, myalgias, arthralgias, malaise and headache Aseptic meningitis may develop at this stage 7th nerve palsy common (Bell’s palsy)
Diagnostics of Lymes CBC with diff ESR C3 and C4 ANA Hematuria and proteinuria Serology is the standard of diagnosis in later stages of the disease
PE lyme EARLY EM rash, Fever, Myalgias, Malaise, Arthralgia, h/a, adenopathy DISS Multiple EM, Fever,adenopathy, Conjunctivitis, Carditis, Aseptic meningitis, Cranioneuropathy (bells paulsy) LATE DISS Arthritis in large joints, Warmth, swelling effusion
Rx for lume amoxicillin, doxycycline, ceftin
Typical organisms in NN sepsis & abx coverage ypical organisms: group B streptococcus, listeria Monocytogenes, E. coli, enterococcus, HSV** Treatment: 48 – 72 hours of gentamycin, ampicillin or ampicillin and cefotaxime.
In what kind of meningitis is opening pressure elevated? Bacterial (ie not viral, fungal, tubercular)
WBC's in viral vs vacterial meningitis Bact: >1000 Viral: <100
Cell differential in bacterial, viral, fungal & tubercular meningitis Bacterial: Predominance of PMN's. Viral, fungal & tubercular: predomoniance of lymphocytes
Protein in bacterial, viral, fungal & tubercular meningitis Bacterial: mild to marked elevation. Viral: normal to elevated. Fungal and Tubercular: elevated
CSF-to-serum glucose ratio in bacterial, viral, fungal & tubercular meningitis Bacterial: normal to marked decrease. Viral: usually normal. Fungal & tubercular: low. NEUTROPHILS IN BACTERIAL & LYMPHS MORE IN VIRAL
Diagnosis of meningitis : PE typically with + meningeal signs Labs: LP – CSF for culture, cell count, protein and glucose, blood culture with CBC, electrolytes
Viral meningitis CSF findings relatively low WBC, predominance of lymphs, normal glocose and protein.
Most common cause of systemic vasculitis in childhood Henoch-Schonlein purpura. Presentation: purpuric rash on LE which may develop 2-3 days s/p arthritic presentation. Renal disease is variable , most recover 3-4% develop end stage renal disease.
Created by: jjenlouu