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Fever in a Neonate (FIN) is defined as
a neonate, aged birth-28 days, with a fever derived as a rectal temp of ≥ 38
Why are neonates at higher risk of developing a serious bacterial infection (SBI)
- immune function (or lack thereof)
- during the 3rd trimester, the fetus receives some of the maternal IgG, but these wane over time.
How are neonate's immune system impaired?
- the function of the B & T cells is impaired
- natural killer cells cyctotoxic activity is decreased
FIN - 2 most common bacterial infections
- urinary tract infection
- occult bacteremia -25% develop meningitis
Most common cause of fever in a neonate (FIN)
Fever of unknown origin (FUO)
illness of more than 3 weeks duration with a fever of 38.3 or more on most days and without diagnosis after a week of intense investigation
Neutropenia is defined as
- an ANC of less than 500 neutrophils/mm3
- less than 1,000 neutrophils/mm3 and an anticipated decline to less than 500 neutrophils/mm3
health care-associate infections (HAI)
- are infections that occur within the health care facility
- these pts are often already impaired immunologically
Health care associated infections will often present
- with a new-onset fever
- EXCEPT THE INFANT/PREEMIE - who would present w/ temperature instability or hypothermia; poor feeding/increased irritability
Fungal infections - what are the 3 types that cause clinical illness in immunocompetent hosts
Histoplasmosis occurs when
mold spores are inhaled and migrate to the distal bronchioles and pulmonary alveoli, where they are phagocytized by alveolar macrophages
Histoplasmosis - once inside the macrophage, what happens to the mold
it converts to yeast
within 1-3 weeks, what happens to the respiratory tract?
- it becomes inflamed
- histopathologic changes occur
- subsequent lesions become encapculated, fibrotic, granulomatous and sometimes calcified
Coccidioidomycosis is caused by
dimorphic fugi that are spore forming molds in soil.
After inhalation of coccidioidomycosis,
the spores germinate in the lungs w/ subsequent cleavage and spread of endospores - these serve to exponentially increase the number of fungal elements in the host
What kind of inflammatory response stems from the granulomatous inflammation from coccidioidomycosis?
- and it's dependent upon T cell mediated immunity to clear the organism from the host.
Where doesn't the coccidioidomycosis infection usually present?
it rarely causes extrapulonary infection
Coccidioidomycosis species are endemic in
hot, arid regions of the southwestern US: southern CA, AZ, western & southern TX, NM, southern NV and UT, but also Mexico, central & south america
Coccidioidomycosis is also known as
San Joaquin Valley fever
Blastomycosis is a
dimorphic fungus that produces conidia from the hyphae of the mycelial for at room temperature & in soil
Blastomycosis. Infection occurs by
inhalation of the conidia into the lungs
Blastomycosis. Once the conidia reach body temperature in the infected tissue,
it is transformed into the yeast form
Blastomycosis. Once the fungus reaches yeast form, it ...
germinates and are phagocytized by pulmonary macrophages, beginning suppurtive inflammation
Blastomycosis thrives in
- warm, moist, acidic environments, like the eastern North America
- in the MI, OH and lower St. Lawrence River Valleys
- in the Lake Michigan basin
- in several eastern US states
- in northern Ontario
- in bordering eastern Manitoba