Congenital Infections and Syphilis

Questions and Answers

What is the percentage of blood cultures that are positive in Streptococcal toxic shock?

5% (correct)

80-90%

20-30%

50-70%

Which of the following is a major risk factor for Streptococcal toxic shock?

Varicella zoster virus infection (correct)

Sickle cell disease

Rocky mountain spotted fever

Hypotension

What is the appropriate management for a 4-year-old boy with sickle cell disease who is admitted with fever and hypotension?

Vancomycin plus gentamicin

Ceftriaxone

Ceftriaxone plus vancomycin (correct)

Cefuroxime plus vancomycin

Which of the following pathogens is responsible for overwhelming post-splenectomy sepsis in asplenic children?

Streptococcus pneumoniae Signup and view all the answers

What is the primary method of prevention for Streptococcal infections in post-splenectomy children?

Immunizations Signup and view all the answers

What is the name of the vaccine that is recommended annually for post-splenectomy children?

Influenza vaccine Signup and view all the answers

What is the risk factor for Capnocytophaga canimorsus infection?

Dog saliva exposure Signup and view all the answers

What is the clinical manifestation of Streptococcal toxic shock?

All of the above Signup and view all the answers

A 7-year-old boy develops mouth sores and rash after being treated with amoxicillin and acetaminophen. What is the most likely diagnosis?

Amoxicillin related Signup and view all the answers

A 16-year-old patient presents with oral ulcers and target-like rash. What is the most likely etiology?

Varicella zoster virus Signup and view all the answers

Which medication is associated with the highest risk of SJS/TEN?

Allopurinol Signup and view all the answers

A 12-year-old patient on infliximab for ulcerative colitis develops fever, malaise, cough, and pleuritic chest pain. What is the most likely diagnosis?

Mycoplasma pneumoniae Signup and view all the answers

Which of the following medications is associated with a lower risk of SJS/TEN?

Cephalosporins Signup and view all the answers

A patient develops a mucocutaneous rash after being treated with antibiotics and NSAIDs. What is the most likely diagnosis?

NSAID-related rash Signup and view all the answers

Which of the following is a case report of a medication associated with SJS/TEN?

Corticosteroids Signup and view all the answers

A patient develops a target-like rash after being treated with a medication. What is the most likely etiology?

Varicella zoster virus Signup and view all the answers

What is the most likely diagnosis for a newborn with maculopapular rash, microcephaly, chorioretinitis, hepatosplenomegaly, and bony changes?

CMV Signup and view all the answers

What is the suggested possible cause of Bell's palsy in children?

Herpes simplex virus Signup and view all the answers

What is a common manifestation of congenital syphilis in the mucocutaneous system?

Maculopapular rash followed by desquamation, blistering and crusting, condyloma lata Signup and view all the answers

What is the recommended approach to a situation where a patient's life may be at risk?

Treat it as a emergency Signup and view all the answers

What is the best management for Bell's palsy?

Steroids Signup and view all the answers

What is the prognosis for Ramsay Hunt syndrome?

Worse than Bell's palsy Signup and view all the answers

What is the significance of a drop in RPR from 1:128 to 1:64 after a single dose of IM penicillin in a pregnant woman with syphilis?

The treatment was successful, but the infant still needs to be treated Signup and view all the answers

What is the best course of action for a newborn whose mother was diagnosed with syphilis at 32 weeks of pregnancy, received a single dose of IM penicillin, and had a subsequent RPR drop to 1:64?

Full workup including LP, and give 10 days of IV penicillin regardless of workup findings Signup and view all the answers

What is the treatment for Ramsay Hunt syndrome?

Antiviral + corticosteroids Signup and view all the answers

What is the significance of pseudoparalysis in a newborn with congenital syphilis?

It is a common manifestation of congenital syphilis Signup and view all the answers

What is the percentage of facial nerve palsy cases in one review that are caused by Ramsay Hunt syndrome?

5% Signup and view all the answers

What is the recommended course of action for a newborn baby if the mother's HBsAg status is unknown?

Stat HBsAg on the mother and wait for results Signup and view all the answers

What is the recommended approach to a question that seems simple?

It probably is just that, a simple question Signup and view all the answers

What is the cause of paralysis in a patient with a cholesteatoma?

Tumor Signup and view all the answers

A baby is born to an HBsAg-positive mother and receives HBIG and HBV vaccine at birth. What is the recommended schedule for subsequent HBV vaccine doses?

1 and 6 months Signup and view all the answers

What is the significance of a CPS statement in relation to a Red Book?

CPS statements take precedence over Red Book Signup and view all the answers

What is the recommended age for testing an infant's HBsAg and anti-HBs status?

9-12 months Signup and view all the answers

What is the diagnosis for a patient with a history of two prior episodes of parotitis and a salivary swab growing viridans group streptococci?

Juvenile recurrent parotitis Signup and view all the answers

What is the cause of suppurative parotitis?

Bacterial infection Signup and view all the answers

What is the recommended course of action for a baby born to an HBsAg-positive mother if the baby's HBsAg status is negative and anti-HBs status is less than 10mIU/mL?

Revaccinate Signup and view all the answers

What is the recommended dose schedule for HBV vaccine in infants less than 2.0 kg at birth?

0, 1, 2, and 6 months Signup and view all the answers

What is the recommended course of action if the mother is a chronic carrier of hepatitis B?

Administer HBIG and HBV vaccine to the baby Signup and view all the answers

What is the timeframe within which HBIG should be administered to a term infant if the mother is HBsAg-positive?

Within 7 days of birth Signup and view all the answers

A baby born to an HBsAg-positive mother receives HBIG and HBV vaccine at birth, and subsequent HBV vaccine doses at 1 and 6 months. At 9 months, the baby is well. What is the most likely serologic pattern?

HBeAg-, HBcAg-, HBsAg+, HBcAb+, HBsAb+ Signup and view all the answers

What is the recommended management for a well-appearing term newborn with a positive GBS status and no other risk factors?

Routine care with discharge at 24 hours Signup and view all the answers

What is the recommended management for a well-appearing term newborn with a negative GBS status and one other risk factor?

Close observation with vital signs every 3-4 hours for 24-48 hours Signup and view all the answers

What is the recommended management for a well-appearing term newborn with a negative GBS status and two or more other risk factors?

Individualized care with CBC and blood culture at birth Signup and view all the answers

What is a risk factor for early-onset sepsis in term neonates?

Maternal intrapartum GBS colonization during current pregnancy Signup and view all the answers

What is another risk factor for early-onset sepsis in term neonates?

Prolonged rupture of membranes (≥ 18 hours) Signup and view all the answers

What is the recommended approach to a well-appearing term newborn at risk of early-onset sepsis?

Examine at birth, observe 24-48 hours, and reassess and counsel pre-discharge Signup and view all the answers

What is the most likely diagnosis for a 4-week-old baby with a staccato cough, tachypnea, and conjunctivitis?

Chlamydia trachomatis Signup and view all the answers

What is the recommended treatment for N.meningitidis?

Rifampin x2 days Signup and view all the answers

What is the recommended treatment for invasive S.pyogenes disease?

Cephalexin Signup and view all the answers

What is the recommended management for a newborn exposed to Neisseria gonorrhoeae?

Culture of conjunctiva; IM ceftriaxone Signup and view all the answers

What is the recommended post-exposure prophylaxis for measles?

IG within 6 days of exposure Signup and view all the answers

What is the risk of conjunctivitis if the mother is untreated with Chlamydia trachomatis?

30% to 50% Signup and view all the answers

What is the recommended treatment for B.pertussis?

Azithromycin x5 days Signup and view all the answers

What is the recommended investigation for a 5-year-old child with fever, hepatosplenomegaly, and scleral icterus?

Hemoglobin electrophoresis Signup and view all the answers

What is the risk of pneumonia if the mother is untreated with Chlamydia trachomatis?

10% to 20% Signup and view all the answers

What is the recommended treatment for a family with recurrent pinworms?

Treat all family members with one dose of albendazole Signup and view all the answers

What is the management of a newborn exposed to Chlamydia trachomatis?

PCR testing recommended if develop symptoms Signup and view all the answers

What is the recommended treatment for a cat bite?

Amoxicillin-clavulanate Signup and view all the answers

What is the next step in management for a 5-month-old girl with a UTI, who has been given cefixime, and has a culture result of E. coli > 108/L, resistant to amp, Septra, and cephalosporins, but sensitive to cipro and gent?

Repeat urinalysis and culture Signup and view all the answers

What is the appropriate prophylaxis for a child with grade IV VUR who has completed treatment for their second UTI, with an organism resistant to TMP SMX and nitrofurantoin?

Trimethoprim Signup and view all the answers

What should be done if the 5-month-old girl remains symptomatic after being given cefixime?

Repeat urinalysis and urine culture Signup and view all the answers

What is the significance of a repeat positive urine culture in a 5-month-old girl with a UTI?

It may be a sign of contamination Signup and view all the answers

Why is it important to repeat the urinalysis and culture in a 5-month-old girl with a UTI?

To determine if the infection is still present Signup and view all the answers

What is the goal of repeating the urinalysis and culture in a 5-month-old girl with a UTI?

To determine if the infection has resolved Signup and view all the answers

What is the recommended antibiotic prophylaxis for children with asplenia?

Amoxicillin 10 mg/kg/dose bid for 0-5 years and Penicillin V 300 mg BID for >5 years Signup and view all the answers

What is the recommended testing for Chlamydia trachomatis in sexually active individuals?

Nucleic acid amplification test (NAAT) on first catch urine or urethra/vaginal/cervical swab Signup and view all the answers

What is the recommended treatment for uncomplicated gonococcal infection in children ≥9 years?

Ceftriaxone 250 mg IM SD plus Azithromycin 1 g SD Signup and view all the answers

What is the recommended education for caregivers of children with asplenia?

Awareness of the need for urgent assessment for fever illnesses Signup and view all the answers

What is the recommended testing for Syphilis in sexually active individuals?

Serology Signup and view all the answers

What is the recommended treatment for a well newborn infant of a mother with untreated gonorrhea?

Ceftriaxone 250 mg IM SD plus Azithromycin 1 g SD Signup and view all the answers

Study Notes

Congenital Infections

Congenital infections can cause a range of symptoms, including maculopapular rash, microcephaly, chorioretinitis, hepatosplenomegaly, and bony changes.
The most likely diagnosis for a newborn with these symptoms is Toxoplasmosis, Rubella, CMV, or Syphilis.

Early Onset Manifestations of Congenital Syphilis

Systemic manifestations: prematurity, IUGR, FTT
Mucocutaneous manifestations: snuffles, maculopapular rash followed by desquamation, blistering, and crusting, condyloma lata
Reticuloendothelial manifestations: hepatosplenomegaly, lymphadenopathy
Hematologic manifestations: Coomb's negative hemolytic anemia, thrombocytopenia
Skeletal manifestations: pseudoparalysis, osteochondritis, diaphyseal periostitis, demineralization/destruction of proximal tibia metaphysis, osteitis
Neurologic manifestations: aseptic meningitis, hydrocephalus, cranial nerve palsy

Management of Congenital Syphilis

If the mother is diagnosed with syphilis at 32 weeks of pregnancy and receives a single dose of IM penicillin, the infant should receive a full workup including LP and 10 days of IV penicillin regardless of the workup findings.

Streptococcal Toxic Shock

Definition: hypotension or shock PLUS two or more of the following: renal impairment, disseminated intravascular coagulation, hepatic abnormalities, adult respiratory distress syndrome, scarlet fever rash, or soft tissue necrosis.
Isolation of S. pyogenes from a normally sterile body site is also required for diagnosis.

Pediatric Infections

Infections in asplenic children: Streptococcus pneumoniae, Haemophilus influenzae type b, Neisseria meningitidis, Capnocytophaga canimorsus, and Salmonella spp.
Preventive interventions for children post-splenectomy: immunizations (Prevnar 13 & 23-valent polysaccharide vaccine, Quadrivalent meningococcal vaccine & 4CMenB, H. Influenzae type b, Influenza vaccine), and HB vaccine.

Hepatitis B

Prevention: HBIG and HB vaccine within 12 hours of birth for infants born to HBsAg-positive mothers.
Management: HB vaccine at 1 and 6 months, HBsAg & anti-HBs at 9-12 months.
Serologic patterns: HBeAg+, HBcAg+, HBsAg+, HBaAb+, HBsAb+; HBeAg-, HBcAg-, HBsAg+, HBcAb+, HBsAb+; HBeAg-, HBcAg-, HBsAg-, HBcAb+, HBsAb+.

Medications Associated with SJS/TEN

Highest risk: allopurinol, sulfonamides, sulfasalazine, anticonvulsants, antiretroviral medications, NSAIDs (oxicam).
Lower risk: antibiotics, antidepressants, NSAIDs (diclofenac).

Facial Nerve Palsy in Children

Causes: idiopathic (Bell's palsy), infection-related (otitis media, Lyme disease, Varicella zoster virus), tumors (cholesteatoma, facial nerve schwannoma, vestibular schwannoma, meningioma).
Treatment: corticosteroids for Bell's palsy, antiviral + corticosteroids for Ramsay Hunt syndrome.

Parotitis Differential Diagnosis

Suppurative parotitis: bacterial infection
Viral parotitis: viral infection
Parotid salivary duct stone: stone in the parotid duct
Juvenile recurrent parotitis: recurrent episodes of parotitis in children.

Management of Newborns at Risk of Early-Onset Sepsis

Risk factors for early-onset sepsis in term neonates:
Maternal intrapartum GBS colonization during current pregnancy
GBS bacteriuria during current pregnancy
Previous infant with invasive GBS disease
Prolonged rupture of membranes (≥ 18 hours)
Maternal fever (≥ 38.0°C)
Approach to well-appearing term newborns at risk of early-onset sepsis:
- GBS status: Positive (no other risk factors, adequate IAP) → Routine care
- GBS status: Positive (other risk factors or no IAP) → Close observation
- GBS status: Negative/unknown (no other risk factors) → Routine care
- GBS status: Negative/unknown (other risk factors) → Close observation
Close observation: Examine at birth, observe 24-48 hours (vital signs q3-4h), reassess and counsel pre-discharge
Individualized care: Consider CBC after 4 hours

Antibiotic Prophylaxis

Antibiotic prophylaxis for children with asplenia:
Amoxicillin 10 mg/kg/dose bid (0-5 years) or Penicillin V 300 mg bid ( > 5 years)
Antibiotic prophylaxis for children with asplenia:
Minimum of two years post-splenectomy and for all children

Sexually Transmitted Infections

Major pathogens and testing:
- Chlamydia trachomatis: Nucleic acid amplification test (NAAT)
- Neisseria gonorrhoeae: Nucleic acid amplification test (NAAT)
- Treponema pallidum: Serology
- HIV: Serology
- Hepatitis B/C: Serology
Treatment of uncomplicated gonococcal infection in children:
- Anogenital infection: Ceftriaxone 250 mg IM SD plus Azithromycin 1 g SD
- Pharynx: Ceftriaxone 250 mg SD plus Azithromycin 1 g SD

Management of Exposed Infants

Management of exposed infants:
- Well-appearing: Conjunctival culture, IM ceftriaxone 50 mg/kg (maximum 125 mg)
- Unwell: Conjunctival, blood, and CSF cultures, consult ID with established disease (IV ceftriaxone)

Neisseria gonorrhoeae

Clinical aspects:
- Conjunctivitis: Prominent bilateral purulent discharge, onset usually days 2-5 after birth
- Other manifestations: Scalp abscess, disseminated disease, septic arthritis, bacteremia, meningitis

Chlamydia trachomatis

Risk of disease if mother untreated:
- 30% to 50% risk of conjunctivitis
- 10% to 20% risk of pneumonia
Management of exposed infant:
- No antibiotic prophylaxis recommended
- Close clinical follow-up
- PCR testing recommended if develop symptoms
- Treat if PCR testing is positive

Urinary Tract Infections

Management of UTI:
- If asymptomatic: Repeat urinalysis and culture
- If symptomatic: Urinalysis and urine culture should be repeated and antimicrobial therapy modified pending results

Prophylaxis

Prophylaxis for grade IV VUR:
- Amoxicillin

Infection Control

Post-exposure prophylaxis:
- N.meningitidis: Rifampin x2 days
- S.pyogenes: Cephalexin
- B.pertussis: Azithromycin x5 days, erythromycin x14 days
- Measles: IG within 6 days of exposure
- Rubella: Generally none, but IG may be considered in pregnancy if termination not an option

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the symptoms and diagnosis of congenital infections, including Toxoplasmosis, Rubella, CMV, and Syphilis, as well as the early onset manifestations of congenital Syphilis.