Peds ID Case

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Peds ID Case

• 3 w/o infant w/2d hx of cough, incr WOB. No
  fever.
• Adm to OSH b/o O2 need.
• RSV neg. CXR obtained and pt sent here because
  CXR looks terrible though pt looks great.
• Bld cx obtained, cefotaxime given PTT

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Peds ID Case

• PMH Born at 37 wks to 16 y/o by SVD w/ROM 12-13
  hrs PTD. BW 7-12. Mom unaware of compl, infx.
  Home w/Mom at 2d.
• Soc Hx No other kids in house. No known exp. No
  DC.

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Peds ID Case

• Here Afebrile. Mild tachypnea, subcostal
  retractions. Diffuse rales.
• WBC 15.9 P56, B11, L13, M18, E2.
• Hgb 14.5, pl 342K.
• RSV repeated-neg.
• CXR reviewed.
• A diagnostic test was sent.

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Genus Chlamydia

• Species
• C. psittaci
• C. pneumoniae (TWAR agent)
• C. pecorum
• C. trachomatis (serotypes A,B,Ba,CD-KL1-3)

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Chlamydia trachomatis

• 5-20 of women infected
• 50-75 of exposed infants infected
• 30-50 develop conjunctivitis
• 10-20 develop pneumonitis

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C. trachomatis conjunctivitis

• Onset classically at 5-14 days of age
• Clinical findings vary
• Diagnosis
• Conjunctival swab
• DFA or EIA gt90 sens gt95 spec
• Culture
• Nucleic acid amplif tests not approved for kids
• Differentiate from GC

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C. trachomatis pneumonitis

• Onset at 3-12 wks of age
• Almost always AFEBRILE
• Tachypnea w/rales (few wheeze)
• CXR bilateral hyperinflation, diffuse
  infiltrates (not lobar)
• Eosinophilia (gt300/cu mm) in 70
• Increased serum total IgG, IgM, IgA

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C. trachomatis pneumonitis

• Diagnosis
• NP swab
• DFA or EIA sens 33-gt90 spec gt95
• Culture

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C. trachomatis- Tx of Infants

• Conjunctivitis or pneumonitis (same tx)
• Erythromycin orally, 50 mg/kg/d x 14d
• Topical therapy of conjunctivitis not recc
• High failure rate
• Will not affect NP carriage/pneumonitis
• Adds nothing to oral tx
• Association with pyloric stenosis
• ?Azithromycin daily x 3-5d
• Mother and contacts