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Questions and Answers
Which condition is most likely associated with recurrent pneumonias in a child with chronic granulomatous disease?
Which condition is most likely associated with recurrent pneumonias in a child with chronic granulomatous disease?
What is a significant laboratory finding in a child suspected of having chronic granulomatous disease?
What is a significant laboratory finding in a child suspected of having chronic granulomatous disease?
Which of the following organisms is typically responsible for infections in chronic granulomatous disease patients?
Which of the following organisms is typically responsible for infections in chronic granulomatous disease patients?
Which symptom is least likely to be associated with severe sepsis in children?
Which symptom is least likely to be associated with severe sepsis in children?
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In a child with suspected chronic granulomatous disease, which of the following findings would indicate a potential lung infection?
In a child with suspected chronic granulomatous disease, which of the following findings would indicate a potential lung infection?
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What is the most important clinical feature in diagnosing chronic granulomatous disease in children?
What is the most important clinical feature in diagnosing chronic granulomatous disease in children?
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Which pathogen poses the greatest risk to a child diagnosed with chronic granulomatous disease?
Which pathogen poses the greatest risk to a child diagnosed with chronic granulomatous disease?
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In the context of chronic granulomatous disease, which treatment option is least effective?
In the context of chronic granulomatous disease, which treatment option is least effective?
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What type of infection is frequently associated with Staphylococcus aureus in patients with chronic granulomatous disease (CGD)?
What type of infection is frequently associated with Staphylococcus aureus in patients with chronic granulomatous disease (CGD)?
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Which organism is known for causing severe lung destruction and is often associated with high fever in patients with CGD?
Which organism is known for causing severe lung destruction and is often associated with high fever in patients with CGD?
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In the context of CGD, which of the following respiratory infections typically does NOT lead to fever?
In the context of CGD, which of the following respiratory infections typically does NOT lead to fever?
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What is a common gastrointestinal manifestation that affects a significant portion of patients with chronic granulomatous disease?
What is a common gastrointestinal manifestation that affects a significant portion of patients with chronic granulomatous disease?
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Which condition, if present, warrants testing for chronic granulomatous disease in infants?
Which condition, if present, warrants testing for chronic granulomatous disease in infants?
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Which organism is specifically indicated as a common cause of osteomyelitis in infants with CGD?
Which organism is specifically indicated as a common cause of osteomyelitis in infants with CGD?
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What is a classic physical examination finding in children experiencing severe infections affecting CGD?
What is a classic physical examination finding in children experiencing severe infections affecting CGD?
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Which symptom is NOT typically associated with the pneumonia seen in CGD patients infected by Aspergillus?
Which symptom is NOT typically associated with the pneumonia seen in CGD patients infected by Aspergillus?
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What is a common feature of chronic granulomatous disease (CGD)?
What is a common feature of chronic granulomatous disease (CGD)?
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Which pathogen is NOT typically associated with chronic granulomatous disease?
Which pathogen is NOT typically associated with chronic granulomatous disease?
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Which of the following statement accurately describes a consequence of impaired phagocyte function in CGD?
Which of the following statement accurately describes a consequence of impaired phagocyte function in CGD?
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What is the estimated prevalence of chronic granulomatous disease in the US?
What is the estimated prevalence of chronic granulomatous disease in the US?
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Which immunodeficiency is characterized by a defect in leukocyte adhesion?
Which immunodeficiency is characterized by a defect in leukocyte adhesion?
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In patients with phagocyte dysfunction, which of the following types of infections is most likely to be recurrent?
In patients with phagocyte dysfunction, which of the following types of infections is most likely to be recurrent?
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What additional health issue is often observed in children with chronic granulomatous disease?
What additional health issue is often observed in children with chronic granulomatous disease?
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Which of the following is NOT a recommended focus for managing chronic granulomatous disease?
Which of the following is NOT a recommended focus for managing chronic granulomatous disease?
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Study Notes
Paediatric Infections (Neonatal)
- Neonatal deaths: Worldwide, more than 40% of deaths occur within the neonatal period. That is, 3.1 million newborn deaths each year. The majority of these deaths occur in low-income countries.
- Listeria monocytogenes: This bacterium is a significant cause of neonatal infections. It's a foodborne zoonosis that can pass from pregnant women to their fetuses and newborns, potentially causing septicemia, meningitis, and other severe complications. Risky foods include raw sprouts, soft cheese, smoked fish, and raw milk.
- Whooping cough (Pertussis): Caused by Bordetella pertussis, this highly contagious respiratory infection can be fatal, particularly in infants under 4 months old. It is spread through respiratory droplets and is characterized by distinctive paroxysmal coughing episodes. Vaccination is a crucial preventative measure. Pregnant women should get vaccinated. Babies, people with a weak immune system and those with waning immunity are at risk.
- Neonatal Infections: Common causes include E. coli, Staphylococcus aureus, Streptococcus agalactiae (Group B Strep), Listeria monocytogenes, and Haemophilus influenzae.
- Risk factors in the mother for early-onset infections include: invasive group B strep infection, prelabour rupture of membranes, preterm birth, intrapartum fever.
- Clinical indicators in the baby for possible early-onset infections include: altered behavior, feeding difficulties, abnormal heart rate, signs of respiratory distress, jaundice, need for mechanical ventilation, persistent fetal circulation, temperature abnormalities, signs of shock & unexplained bleeding, oliguria, altered glucose (hypo/hyperglycemia).
- Treatment of possible infections: Antibiotics such as penicillin or gentamicin should be administered rapidly - ideally within one hour of making the decision to treat.
Geriatric Infectious Diseases
- Geriatric population demographics: The elderly population (defined in this context as individuals >65 years old) is rapidly increasing globally. This trend has significant implications for healthcare systems and infectious disease management.
- Increased risk factors: Factors like lifestyle, pre-existing health conditions (e.g., diabetes, heart disease and organ dysfunction) and diminished immunity contribute to higher susceptibility of the elderly to infections.
- Healthcare-associated infections (HCAIs): These infections are a significant public health concern particularly amongst older adults who are often in long-term care facilities (LTCFs). Relocation between nursing homes is a crucial factor in the transfer and spread of antimicrobial resistance (AMR).
- Common infections: Common infections include respiratory and gastrointestinal infections. Nosocomial infections (occur within hospital setting), UTIs, hospital acquired pneumonia and bacteremia are frequent.
- Pneumococcal diseases: This highly contagious bacterial disease is a significant risk factor for the elderly, frequently leading to hospitalization and increased morbidity and mortality, in part, due to the consequences of complications from bacteraemia and meningitis. A vaccine is available.
- Influenza: Influenza (flu), especially strains A and B, are seasonal illnesses that pose a significant health risk for the elderly, due to their increased susceptibility to complications such as pneumonia, cardiac respiratory failure, and exacerbation of pre-existing conditions.Vaccination is recommended.
- Infections relating to chronic diseases associated with compromised immunity in the elderly, such as diabetes, is an important consideration—the physiological dysfunctions can affect susceptibility to infections.
- Mucormycosis (Zygomycosis): A potentially serious fungal infection is a risk for the elderly. Infections often related to compromised immunity.
Infections in Individuals with Primary Immunodeficiencies
- Primary immunodeficiencies: Hereditary or congenital deficiencies in the immune system.
- Defects in phagocyte function: Severe infections due to common pathogens and frequent granulomas (collections of immune cells).
- Complement deficiencies: Rheumatoid disorders, lupus and scleroderma,
- B-cell immunodeficiencies: Recurrent respiratory tract infections and chronic gastrointestinal infections.
- T-cell immunodeficiencies (Combined immunodeficiencies): T-cell immunodeficiencies (typically combined with B dysfunctions) can also cause failure to thrive and oral thrush.
- Chronic granulomatous disease (CGD): A hereditary disease in which neutrophil granulocytes are unable to destroy certain types of ingested pathogens. Consequently it leads to potentially life-threatening infections by a wide range of microbes such as Staphylococcus aureus, Burkholderia cepacia complex, Serratia marcescens, Nocardia sp., and Aspergillus.
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