13 Peds ID

Meningitis

• FAILS: Focal Neurolgical Deficit, Altered Mental Status, Immunosuppresion, Lesion over the puncture site, or Seizure

• FAILS positive

  • increased ICP, not safe for LP

  • CT, antibiotics

• FAILS negative

  • LP, antibiotics

• Bulging fontanelles = ICP, sign of meningitis

• < 30 days:

  • antibiotics: vancomycin, cefotaxime, ampicillin (listeria), steroids

HIV/AIDS

• vertical transmission: AZT reduce risk of transmission

• < 18 mo: cannot use ELISA to screen (antibody can be from mom). Use DNA PCR

• HAART for any HIV positive

• prophylaxis

  • 200 PCP, bactrim, dapsone, atorvaquone

  • 100 toxo, bacterium, atorvaquone

  • 50 MAC, azithromycin

Osteomyelitis

• most common: staph aureus

• see salmonella = sickle cell

• toxic: give antibiotics before biopsy

• if not toxic: do not give antibiotics until biopsy

• diagnosis

  • Xray positive: go to biopsy

  • Xray negative: MRI

    • MRI positive: biopsy

  • Do not pick bone scan

• treatment: 4-6 weeks

Septic Arthritis

• Gonorrhea: sexually active teen

• staph: direct inoculation, stab wounds

• diagnosis: tap joints, arthrocentesis

  • Greater than 50k WBC, start antibiotics if septic

Skin Infection

Scabies

• itchy fingers, webs of hands

• diagnosis: scraping

• treatment: permethrin, also Lindane

LICE

• itchy scalp, share hats, combs

• diagnosis: see eggs (nits) and lice

• treatment: permethrin

pinworm

• itchy butt

• diagnosis: tape test

• treatment: albendazole

Pneumonia

• < 5 yo: viral

TB

• ignore BCG. BCG vaccine has no impact on pulmonary TB

• diagnosis

  • < 5yo: PPD

  • more than 5: INF gamma assay

• treatment

  • RIPE for full blown. INH with B6 for latent

  • Only separate mom from baby if mom is MDR

• PPD

  • 15: people never assessed in first place

  • 10: at risk. Homeless, prison, healthcare workers

  • 5: immunosuppressed, close contacts, TB on Xray