Micro Phase C 2nd half

90%

• MMRRV
• Measles, Mumps, Rubella, Rotavirus, Varicella

-Non-conjugate only have polysaccharide. They have a P in the middle (Pneu-P-23). They need a more advanced immune system, so they only work after patient in 2 years old. Not as long lasting

-Conjugate has polysaccharide attached to protein, which induces higher T-dependent Ab response. Therefore these can be used all the way down to infancy and last longer (better memory). They have a C in the middle of the name (Pneu-C-13)

orally

• -DTaP-IPV-Hib: Diptheria, Tetanus, acellular Pertussis, Inactivated polio, H. influenza b
• -Tdap: Tetanus primarily, smaller amounts of diptheria and pertussis
• -Measles Mumps Rubella (+/-Varicella)
• -Conjugated meningitis C
• -Influence

• -0-7 days after inactivated vaccine
• -0-6 weeks after live vaccines

common: Local reactions (swelling), systemic (fever, headache, anorexia, etc)

Less common: febrile seizures, non-specific rashes, excessive crying (3+ hours), hypotonic-hyporesponsive state (zombie-like)

• -anaphylaxis
• -Guillain-Barre Syndrome
• -Intussusseption

• 1) allergy (anaphylaxis) to a component (e.g. eggs)
• 2) Immunodeficient patient and live vaccine
• 3) Pregnancy (defer MMR only)
• 4) Recent IG admin (defer MMR only)
• 5) mod/severe illness +/- fever (defer until it has resolved)

It actually pushes the disease later into peoples lives (e.g. varicella) because there is less exposure

• 1) Child experienced mild AEFI (70%)
• 2) Parents had negative info from friends, family, or internet and are unsure about vaccines (25%)
• 3) Patients who strenuously object, armed with "information" (5%)

• -URTI
• -Low grade fever
• -Hx or FHx of seizures
• -FHx of allergies
• -Previous mild AEFI (does not mean increased risk of one in subsequent vaccinations)

tell them this is a quirk of math and is only because there have been so many kids vaccinated

NO! And even after it was removed in the states rates continued to rise

• 1) be knowledgable about each Vaccine preventable disease (VPD)
• 2) know when an exposure has occurred
• 3) access physician to manage exposure
• 4) allow Ig (passive) or vaccine (active) to prevent VPD
• 5) keep kid out of school during outbreaks
• 6) advise grown up kid that they are unprotected (they may want to catch up)

tetanus -> cannot decrease circulation because it comes from a wound or dog bite.

• high coverage needed: Measles (92-95% immunization rates)
• Low coverage needed: influenza (50-80%)

• 1) It's the law!
• 2) Ensure the case is being managed properly (e.g. contact precautions)
• 3) Identify the source of infection to prevent further transmission
• 4) Identify others who were exposed and may start spreading infection
• 5) To monitor communicable diseases in our community
• 6) Identify new, emerging infectious diseases

• -Positive Living Program (HIV/HCV)
• -Infection prevention and control
• -Sexual health clinics
• -Street health (reduce blood-borne pathogens)
• -TB Prevention and Control
• -Travel medicine
• -Vaccine Preventable Diseases to vaccinate

-active: vaccines, relies on one's own immune system to remember and defend against pathogens

-Passive: IGs, relies on others' immune armament to defend one against infection

Measles, varicella, Hep A, Hep B, Rabies

-works because the immune response to the vaccine is rapid and it these viruses have relatively long incubation periods

SIG - all antibodies in a donor; pre or post exposure prophylaxis against hep A and measles

IVIG - specific abs against a certain disease or depleted ab in people with AI disease. Also against certain diseases (see other flashcard)

When you are giving a live vaccine, Also Hep A

• Can give MMR when:
• -Isolated Ig deficiency
• -Neutropenic patient
• -Well controlled HIV
• -asplenic patients
• Varicella can be given when
• -ALL is well controlled and chemo can be witheld
• -give Varizig if exposed

• encapsulated bacteria like:
• -S. pneumonae
• -Hib
• -meningococcus

giving abx when there is NO infection present, but there is a high probability of future exposure to conditions that would put people at risk. 

For example, penicillin post splenectomy

• 1) potential infection severity greater than side effects of abx
• 2) abx should be given for the shortest time possible to prevent target infection
• 3) abx should be given before period of risk or as soon after exposure as possible

giving abx to when infection is present but with the goal of disease amelioration, not eradication.

Worried about staph/strep wound infections

Therefore, cefazolin vs vancomycin

again, worried about staph/strep: cefazolin or clindamycin

worried about staph-strep and endogenous flora

give fluoroquinolones

endogenous flora + staph/strep

cefazolin with metronidazole

mixed anaerobes and aerobes

clindamycin+gentamycin or monotherapy with a carbapenem or pip-tazo

want to cover meningococcus and pneumococcal

• rifampin
• ciprofloxacin
• ceftriaxone

Cover for staph, strep, pastuerella

amox-clav

mixed flora infection inevitable

imipenem

fluoroquinolones

the time between when a person becomes infected and tests show that they are infected

• 1) immediate care: wash wounds and skin with soap and water, flush mucous membranes
• 2) inform resident or attending
• 3) Call incident line for the health region you are in
• 4) Go to emerg
• 5) assess: exposure, source, and exposed (you)

• 1) exposure itself: date and time, type of exposure, type and amount of fluid exposed
• 2) assessment of source: known infection, hx of risk taking behaviour, current sx, PMHx
• 3) assessment of the exposed (you): immunizations, risk taking behaviours, meds, PMHx

HIV and HBV: negative test at 3 months means not infected

HCV: negative test at 6 months means not infected

• Until it is ruled out:
• 1) condoms or abstinence
• 2) no bodily fluid donations
• 3) no breastfeeding
• 4) pregnancy precautions

Get baseline serology of the exposed and the source

HIV: HIV post-exposure prophylaxis (PEP), need ID consult to get the full 28 days. ED MD can start

HBV: either HBIG or HBV vaccine. ED MD's call.

HCV: nothing available, hope you didn't get it.

• Blood transfusion: 90%
• Percu needle stick: 0.3%
• mucocutaneous exposure: 0.1%

• +ve: offer PEP
• -ve: consider window period and source risk factors
• unknown: consider type of exposure and source risk factors

in the first 72 hours, preferrably in the first 2 hours

6-30%

• Pre: HBV vaccine (90-95% effective)
• post: HBIG (within 48/24) 70-75%; vaccine (3 doses) 70-75%; both combined (75-95%)

Need to make sure they have protective levels of HBsAb from vaccine. Give HBIG if there is a HIGH risk they will contract disease (e.g. HBV +ve carrier)

3-10%

2 hours, window period is 2 weeks

• 1) Leukocyte function: defects in chemotaxis, phagocytosis and intracellular killing
• 2) hyperglycemia may reduce complement levels
• 3) Organism factors: C. albicans adhesion proteins are induced by glucose

• 1) peripheral neuropathy (motor, sensory, and autonomic)
• 2) arterial insuff
• 3) foot deformities or limited joint mobility
• 4) inappropriate footwear

• 2+ of the following:
• -local swelling or induration
• -erythema
• -local tenderness or pain
• -local warmth
• -purulent discharge

gram +ve -> gram -ve -> anaerobes

• 1) dont culture a clinically uninfected lesion
• 2) dont obtain a specimen without first cleaning and debriding a wound
• 3) Don't get a culture by swabbing! Use a sterile needle or curette

Do a probe to bone test.

You should suspect this in any large ulcer, or an ulcer that overlies a bony prominence

• mild: amox-clav
• moderate (MSSA): ampcillin-sublactam
• Moderate (psuedomonas): pip-tazo
• severe (MRSA): vanco

• -preventative foot care (podiatrist)
• -proper footwear
• -daily visual self-foot exam
• -physician screening (monofilament test)

mucormycosis (fungal infection of resp tract)

• Sinus/cutaneous: about 90%
• Lungs: 24%
• Disemminated: 4%
• GI: 15%

pseudomonas

Dx: culture, elevated ESR but normal WBC, CT for bone involvement

TMT: ciprofloxacin

• tachycardia
• tachypnea or need mechanical ventilation
• temp >38.5 OR <36
• Leukocytosis or leukopenia OR >10% bands and other immature forms

Bacterial: E. Coli > GBS > Listeria

viral: HSV > enteroviruses

DONT FORGET TO THINK ABOUT INBORN ERRORS OF METABOLISM!!!

• early:
• -Sx < 7/7 days of age
• -usually infected maternal genital tract
• -GBS>Ecloi>Listeria>HSV

• Late:
• -Sx at > 7/7 days of age to 3/13 of age
• -usually non-maternal genital source
• -E. coli>GBS>Listeria>HSV

Bacterial: ampicillin+Cefotaxime OR Ampicillin+Gentamicin

Viral: start empiric IV acyclovir

bacteremia: 10-14 days for the three bacteria, 14 days of acyclovir for HSV

meningitis: abx for 2/52 in GBS and Listeria; 3/52 in E coli and other gram negatives; 3/52 for HSV

give IV pen G Q4h from start of labor until baby is delivered. maximal effectiveness if 2+ doses are given.

• indicated when:
• 1) previous infant with GBS
• 2) GBS bacturia in current preg
• 3) +ve GBS swab in this pregnancy (unless she is getting a C/S before ROM)
• 4) unknown GBS status and ANY of the following:
•   -Delivery <37/52
•   -amniotic rupture for >18 hours
•   -intrapartum temp > 38 C

listeria (boxcar)

• 1) Over-diagnosing UTI
• 2) Under treating S. Aureus bacteremia
• 3) Over-treating aspiration pneumonia
• 4) Slow treatment of meningitis
• 5) Under and over treatment of soft tissue infections

E. Coli (85%) and S. saprophyticus (15%)

Think bacteremia if you see S. aureus

2/52 of IV cefazolin

Cloxacillin sterilizes the blood faster

vanco is an independent RF for recurrence

• 1) abx should be given within 20 minutes regardless of CT or LP plans
• 2) Blood cultures should be drawn before abx are given

• 1) only use if S. pneumonae
• 2) NEED to give before abx for benefit
• 3) will have to give vanco intrathecally if dex is on board because it screws with CSF uptake from blood stream

Pip-tazo, not clindamycin

clinda can cause C. diff overgrowth and has no gram negative coverage

• -They get worse before they get better. Stay the course on the clindamycin that you initially prescribe
• -If n improvement, think of an underlying osteo or septic arthritis.