Page 1090 - TNFlipTest

P56 Pediatrics
Infectious Diseases
Toronto Notes 2019
Table 23. Antibiotic Management of Bacterial Meningitis
Signs of Meningismus
BONK on the head Brudzinski’s sign Opisthotonos* Nuchal rigidity Kernig’s sign
*Opisthotonos: rigid spasm of the body, with the back fully arched and the heels and head
bent back
Age
0 to 28 d 28 to 90 d >90 d
Main Pathogens
GBS, E. coli, Listeria
Other: Gram-negative bacilli
Overlap of neonatal pathogens and those seen in older children
S. pneumoniae, N. meningitidis
Antibiotics
Ampicillin + cefotaxime
Cefotaxime + Vancomycin (+ Ampicillin If immunocompromised)
Ceftriaxone ± vancomycin
If Penicillin allergic: Vancomycin + Rifampin
• viral meningitis
■ mainly supportive (except for HSV) ■ acyclovir for HSV meningitis
■ report to Public Health
• prophylaxis:appropriatevaccinationssignificantlydecreaseincidenceofbacterialmeningitis(see Routine Immunization, P4)
Complications
• mortality:neonate15-20%,children4-8%;pneumococcus>meningococcus>Hib
• acute:SIADH,subduraleffusion/empyema,brainabscess,disseminatedinfection(osteomyelitis,septic
arthritis, abscess), shock/DIC
• chronic:hearingloss,neuromotor/cognitivedelay,learningdisabilities,neurologicaldeficit,seizure
disorder, hydrocephalus
Mumps
Definition
• acute,self-limitedviralinfectionthatismostcommonlycharacterizedbyadenitisandswellingofthe parotid glands
Epidemiology
• incidenceinOntariohasdeclinedsinceintroductionoftwo-doseMMRvaccinationschedule • averageof25reportedcasesperyr
• majorityofreportedcasesinchildrenbetween5-10yrofage
Etiology
• mumpsvirus(RNAvirusofthegenusRubulavirusintheParamyxoviridaefamily) • transmissionviarespiratorydroplets,directcontact,fomites
• incubationperiod:14-25d
• infectivityperiod:7dpre-parotitisto5dpost-parotitis
• upper respiratory tract lymph nodes salivary glands, gonads, pancreas, meninges, kidney, heart, thyroid
History
• non-specificprodomeoffever,headache,malaise,myalgias(especiallyneckpain)
• usuallyfollowedwithin48hbyparotidswellingsecondarytoparotitis(bilateral,preauricular,ear
pushed up and out)
• parotidglandistenderandpainworsenedwithspicyorsourfoods
• onethirdofinfectionsdonotcauseclinicallyapparentsalivaryglandswellingandmaysimplypresent
as an URTI
Investigations
• clinicaldiagnosis,butmaybeconfirmedwithIgMpositiveserologywithin4wkofacuteinfection ■ may also use PCR or viral cultures from oral secretions, urine, blood, and CSF
■ blood work: CBC (leukopenia with relative lymphocytosis), serum amylase (elevated)
Management
• mainlysupportive:analgesics,antipyretics,warmorcoldpackstoparotidmaybesoothing • admittohospitalifseriouscomplications(meningitis,pancreatitis)
• dropletprecautionsrecommendeduntil5dafteronsetofparotidswelling
• prophylaxis:routinevaccination(seeRoutineImmunization,P4)
Complications
• common:asepticmeningitis,orchitis/oophoritis
• lesscommon:encephalitis,pancreatitis,thyroiditis,myocarditis,arthritis,GN,ocularcomplications,
hearing impairment