Card Set Information
Pediatric board review
STD's pediatric board review
Prevalence of HIV published in CDC 2008 (1999-2006)
Adults aged 18-49 yrs
Non Hispanic black population:2/100
Mexican American population; 3/1000
AIDS in prenatal setting
Maternal antibody is passed to the baby
with no prenatal treatment only 20-30% will be truly infected but 100% will have antibody positive
What study is good to diagnose AIDS in neonates?
PCR for HIV DNA
HIV RNA assays
What is the best time to test for neonates?
confirm with antibody test at 12-18 mo
When do you suspect HIV in infants 1st year of life?
What is evidence of severe immunesuppression in infants?
<12 mo < 750 CD4
1-5 yrs < 500 CD4
(< 15 %)
>6 yrs < 200 CD4
what is the most common opportunistic infection in HIV pts?
Pneumocystis jirovenci (carinii)
Xray finding in Pneumocytis jirovenci?
minimal to diffususe interstitial disease
Dx; finding cysts or trophozoites forms in BAL or induced sputum specimens
tx; TMP/SMX for 21 days (15-20mg/kg/d div q6h IV or PO)
if PaO2 less than 70 mmHg give Prednisone 1mg/kg PO BID and taper after 5 days.
Who needs prophylaxis for PCP?
Any prior history of PCP
birth to 4-6 weeks, HIV exposed; no prophylaxis
4-6 weeks to 4mo HIV inderterminate or +; prophylaxis
HIV infection reasonably excluded; NO prophylaxis
1-5 yrs infected:CD4 + < 500 or <15 %
6yrs- adult HIV infected
: CD4 + <200 or 15 %
What medicine you use for prophylaxis?
TMP/SMX three times a week or Dapsone 100mg one daily if cant tolerate TMP/SMX.
Check for G6PD deficiency if using dapsone
Tuberculosis and HIV
PPD > 5mm induration= + PPD
IF negative never rules out infection
treat TB the same as in non HIV patients
4 DRUG REGIMEN (INH, RIF,PZA and etambutol or streptomycin)
Criteria for initation of antiretroviral therapy based on age of the Child
< 12 mo TREAT ALL
1 to 5 years symptomatic or CD4 <25% and HIV RNA
: Symptomatic or CD4 < 350
Consider for asymptomatic and CD4
350 and HIV RNA
Most common side effects of antiretroviral therapy?
Lamivudine 3TC- pancreatitis
Abacavir- hypersensitivity reaction
If any of these occur on therapy you must STOP
and NEVER rechallenge patient; Causes DEATH
Screen for HLA B*5701
Efavirenz- teratogenic...DO NOT use around pregnancy.
Adolescent female must stop.
Bottom line in treatment of HIV to remember...
throw out any answer that has ZDV(AZT)/D4T combined
ddC in the answer
except an infant born to a mother with HIV positive ZDV(AZT) unless the child is proven to be HIV-infected, then use the standard 3-drug therapy.
When to swith medicines in HIV?
laboratory markers of disease progression
inability to suppress viral load to undetectable levels after 4-6mo of therapy
return of detectsble viral load after being undetectable for a period of time
decline in CD4 cells
when you need post exposure prophylaxis for HIV?
If the fluid was bloddy and the skin integrity was compromised
give ZDV,3TC +/- lopinavir/ritonavir for 4 weeks
Neisseria Ghonorrhoeae medium of growth
Thayer Martin or Chocolate agar
gonorrhoea features in Men
2-7 days after exposure develop discharge
urethral irritation, erythema, dysuria
assymptomatic infection in 5-60% and can persists if untreated
local manisfestations can include epididymitis, prostatitis, periurethral abscess and penile lymphangitis
Gonorrhoea features in female;
1-14 days incbation period
Endocervix is most frequent primary site
assymptomatic infection is more common
Endocervical discharge, dysuria,urinary frequency, mestrual irregularities
Cervical erythema, friability, mucopurulent discharge on exam.
what is called the perihepatitis of ghonorreal infxn?
Disseminated Gonococcal Infection (DGI)?
Leading cause of acute septic arthritis in young adults
Menstruation may trigger dissemination
Terminal complement deficiencies at increased risk.
Urethral, Cervical, Rectal
Ceftriaxone 125 mg IM x 1 dose
allergic pts; spectinomycin
Bacteremia, Arthritis, Disseminated
Ceftriaxone 1g IV daysx 7-10 days or for 2-3 days followed by either;
cefexime 400mg PO bid or
cefpodoxime 400mg PO bid; to complete 7-10 days of therapy.
Ceftriaxone 250mg IM x 1 dose
doxycycline 100mg bid x 14 days
PID guidelines for Hospitalization?
Suspected pelvic/tubo-ovarian abscess
N/V precluding oral therapy
failure to respond to oral agents in 24-48 hrs
chlamydia in 20-30% of men with GC
Chlamydia causes 30-50% of non-gonoccocal urethritis
Chlamydia causes 2/3 of epididymitis in young men
Chlamydia in 30-60% of women co-infected with GC
Chlamydia in 1/3 of cervix and/or fallopian tubes of laparoscopically verified PID
Diagnosis Chlamydia infections?
leukocyte urethral exudate with >4 PMN's on Gram Stain of urethral swab without organism is correlated with Chlamydial NGU
what is lymphogranuloma venerum?
3 days to 3 weeks of exposure
a small painless vesicle or papule/ulcer appears at the site of initial contact (1/3 of patients only)
2-6 weeks after exposure;
regional lymphadenopathy develops. Painful periadenitis occurs with matted nodes and inflamed overlying skin
supuration occurs with fistula formation.
Describe 2nd and 3rd stage of lymphogranuloma venerum?
Fever, Chills, headache, myalgias,
Can get aseptic meningitis, meningoencephalitis, conjunctivitis, hepatitis,arthritis
Chronic ulcerative/infiltrative local structures, fibrosis, strictures, impaired lymphatic flow with resulting genital elephantiasis
Describe Mucopurulent Cervicitis (chlamydia)
yellow or creamy discharge from cervix
gram stain + for WBCs
Similar symptoms to GC
> 10 PMN's/HPF on Gram stained smear of cervical mucous correlates with Chlamydia if GC is ruled out
PID- probably as common as a cause as GC
Diagnosis of Chlamydia?
Detection of elementary bodies by giemsa or immunofluorecent staining with monoclonal antibody; most sensitive
Chlamydiazyme and MicroTrak; rapid assays for detection of Chlamydia in clinical specimens
Serologic 4 fold rise in antibody titer or IgM
Treatment of Chlamydia?
Urethritis, Cervicitis, Conjunctivitis, Proctitis
azithromycin 1 gm x 1 dose or doxycycline 100mg PO Bid x 7 days
azithromycin 1 gm x 1 dose or amoxicillin 500 mg tid x 7 days
Doxycycline 100 mg PO bid x 21 days
Mycoplasma infxns; Ureaplasma Urealyticum
"fried egg" appearance on solid media
found in 50% healthy adults
non gonococccal urethritis; most likely the etiology
Prostatitis; both found in symptomatic men
PID; M. hominis in 10% of acute salpingitis.
how to treat mycoplasma hominis?
same as chlamydia
painless skin lesion; chancre?
develops at site of inoculation on average 21 days after exposure
incubation period can range from 10-90 days
Skin lesions are painless.
hematogenous dissemination of treponema pallidum
fever, malaise, generalized lymphadenopathy
rash- macular, papular, annular, or follicular
alopecia, condylomata lata mucous patches
diagnosis of syphilis
VDRL or RPR for initial screen
confirm; FTA ABS (fluorescent treponemal ab absorbed)
MHA-TP (microhemagglutination assay for ab to T pallidum
Darkfield microscopy showing T pallidum from a clinical specimen.
Central Nervous system syphilis
hearing loss, facial weakness, visual disturbances
Focal CNS ischemia or stroke.