PNP Infectious Disease
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| 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
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| 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.
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| Definition of DIC | alteration of normal coagulation mechanism triggered by tissue injury such as infection, trauma, malignancy, etc.
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| Symptoms of DIC | Bleeding, thrombosis, tissue ischemia. Respiratory failure, abdominal, renal failure, seizures.
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| Diagnosis of DIC | Co-agulation studies. Especially D-dimer are diagnositic.
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| Management of DIC | Remove cause/ event. Manage shock, respiratory compromise, acidosis. Vit K for clotting.
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| 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.
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| 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
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| Description / symptoms EBV | herpes family. Can be latent or active. Causes mono. Prodrome of fever, sore throat, malaise, fatigue. Cervical LAD,
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| Diagnosis & management of EBV | monospot or mono tesr or viral antigen. Supportive care. Spleen gaurd & spleen caution if HSM.
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| 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.
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| 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.
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| Typical symptoms of CMV | pneumonitis, hepatomegaly, hepatitis & rashes
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| 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.
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| Symptoms of hepatitis | asymptomatic or jaundice, palmar erythema, joint inflammation, distended abdomen, peripheral edema, exxhymosis, petechiae, altered LOC, liver tenderness on palpation.
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| Diagnostics/Labs of hepatitis | LFT's, CPK, Coag, CBC with platelet function specific hepatitis antigen abdominal ultrasound.
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| Diagnostics/Labs of enterovirus | cell culture isolation, PCR.
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| 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.
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| Management of HSV | preventative tx with antiviral agents. Acyclovir etc.
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| 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.
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| Management of hepatitis | based on thype and symptoms, consult GI, hepatologist,
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| 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.
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| most probable conditions in a neonate <28 days (up to 2 mth) with rectal temp of >38C | UTI or occult bacteremia
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| 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.
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| 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.
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| 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.
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| bacterial meningitis organisms & symptoms in neonates | GBS, E coli, Strep pna Symptoms: fever lethargy bulging fontanelle.
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| management of suspected shunt or csf infection W/ fever | shunt tapped & cultured
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| bacterial meningitis organisms & symptoms in infants | S. Pneumo, N. meningitis, H flu Symptoms: fever, h/a, neck stiffness, +kernig & brudinski
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| 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.
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| 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.
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| RMSF rash | RASH: starts on wrists & ankles, spreads to palms & soles. Blanching maculopapular -> petechial or purpuric 50%. APPEARS D3-6.
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| RMSF abx | doxycycline
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| 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)
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| 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
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| 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
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| Rx for lume | amoxicillin, doxycycline, ceftin
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| 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.
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| In what kind of meningitis is opening pressure elevated? | Bacterial (ie not viral, fungal, tubercular)
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| WBC's in viral vs vacterial meningitis | Bact: >1000 Viral: <100
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| Cell differential in bacterial, viral, fungal & tubercular meningitis | Bacterial: Predominance of PMN's. Viral, fungal & tubercular: predomoniance of lymphocytes
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| Protein in bacterial, viral, fungal & tubercular meningitis | Bacterial: mild to marked elevation. Viral: normal to elevated. Fungal and Tubercular: elevated
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| 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
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| Diagnosis of meningitis | : PE typically with + meningeal signs
Labs: LP – CSF for culture, cell count, protein and glucose, blood culture with CBC, electrolytes
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| Viral meningitis CSF findings | relatively low WBC, predominance of lymphs, normal glocose and protein.
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| 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.
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