Questions and Answers
What is the percentage of blood cultures that are positive in Streptococcal toxic shock?
Which of the following is a major risk factor for Streptococcal toxic shock?
What is the appropriate management for a 4-year-old boy with sickle cell disease who is admitted with fever and hypotension?
Which of the following pathogens is responsible for overwhelming post-splenectomy sepsis in asplenic children?
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What is the primary method of prevention for Streptococcal infections in post-splenectomy children?
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What is the name of the vaccine that is recommended annually for post-splenectomy children?
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What is the risk factor for Capnocytophaga canimorsus infection?
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What is the clinical manifestation of Streptococcal toxic shock?
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A 7-year-old boy develops mouth sores and rash after being treated with amoxicillin and acetaminophen. What is the most likely diagnosis?
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A 16-year-old patient presents with oral ulcers and target-like rash. What is the most likely etiology?
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Which medication is associated with the highest risk of SJS/TEN?
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A 12-year-old patient on infliximab for ulcerative colitis develops fever, malaise, cough, and pleuritic chest pain. What is the most likely diagnosis?
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Which of the following medications is associated with a lower risk of SJS/TEN?
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A patient develops a mucocutaneous rash after being treated with antibiotics and NSAIDs. What is the most likely diagnosis?
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Which of the following is a case report of a medication associated with SJS/TEN?
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A patient develops a target-like rash after being treated with a medication. What is the most likely etiology?
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What is the most likely diagnosis for a newborn with maculopapular rash, microcephaly, chorioretinitis, hepatosplenomegaly, and bony changes?
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What is the suggested possible cause of Bell's palsy in children?
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What is a common manifestation of congenital syphilis in the mucocutaneous system?
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What is the recommended approach to a situation where a patient's life may be at risk?
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What is the best management for Bell's palsy?
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What is the prognosis for Ramsay Hunt syndrome?
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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?
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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?
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What is the treatment for Ramsay Hunt syndrome?
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What is the significance of pseudoparalysis in a newborn with congenital syphilis?
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What is the percentage of facial nerve palsy cases in one review that are caused by Ramsay Hunt syndrome?
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What is the recommended course of action for a newborn baby if the mother's HBsAg status is unknown?
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What is the recommended approach to a question that seems simple?
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What is the cause of paralysis in a patient with a cholesteatoma?
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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?
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What is the significance of a CPS statement in relation to a Red Book?
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What is the recommended age for testing an infant's HBsAg and anti-HBs status?
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What is the diagnosis for a patient with a history of two prior episodes of parotitis and a salivary swab growing viridans group streptococci?
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What is the cause of suppurative parotitis?
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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?
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What is the recommended dose schedule for HBV vaccine in infants less than 2.0 kg at birth?
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What is the recommended course of action if the mother is a chronic carrier of hepatitis B?
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What is the timeframe within which HBIG should be administered to a term infant if the mother is HBsAg-positive?
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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?
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What is the recommended management for a well-appearing term newborn with a positive GBS status and no other risk factors?
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What is the recommended management for a well-appearing term newborn with a negative GBS status and one other risk factor?
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What is the recommended management for a well-appearing term newborn with a negative GBS status and two or more other risk factors?
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What is a risk factor for early-onset sepsis in term neonates?
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What is another risk factor for early-onset sepsis in term neonates?
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What is the recommended approach to a well-appearing term newborn at risk of early-onset sepsis?
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What is the most likely diagnosis for a 4-week-old baby with a staccato cough, tachypnea, and conjunctivitis?
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What is the recommended treatment for N.meningitidis?
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What is the recommended treatment for invasive S.pyogenes disease?
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What is the recommended management for a newborn exposed to Neisseria gonorrhoeae?
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What is the recommended post-exposure prophylaxis for measles?
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What is the risk of conjunctivitis if the mother is untreated with Chlamydia trachomatis?
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What is the recommended treatment for B.pertussis?
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What is the recommended investigation for a 5-year-old child with fever, hepatosplenomegaly, and scleral icterus?
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What is the risk of pneumonia if the mother is untreated with Chlamydia trachomatis?
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What is the recommended treatment for a family with recurrent pinworms?
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What is the management of a newborn exposed to Chlamydia trachomatis?
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What is the recommended treatment for a cat bite?
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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?
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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?
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What should be done if the 5-month-old girl remains symptomatic after being given cefixime?
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What is the significance of a repeat positive urine culture in a 5-month-old girl with a UTI?
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Why is it important to repeat the urinalysis and culture in a 5-month-old girl with a UTI?
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What is the goal of repeating the urinalysis and culture in a 5-month-old girl with a UTI?
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What is the recommended antibiotic prophylaxis for children with asplenia?
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What is the recommended testing for Chlamydia trachomatis in sexually active individuals?
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What is the recommended treatment for uncomplicated gonococcal infection in children ≥9 years?
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What is the recommended education for caregivers of children with asplenia?
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What is the recommended testing for Syphilis in sexually active individuals?
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What is the recommended treatment for a well newborn infant of a mother with untreated gonorrhea?
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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
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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.