1. Pyogenic infections Meningococcus H. influenzae Pneumococcus S.aureus
GAS

7. Pneumococcus infections in the normal host
Infancy
Elderly
Recent viral infection
Malnutrition
Vitamin A deficiency
„Polvere fa danno” (Leonardo da Vinci)

8. Pneumococcus infections in IDs
B cell defects
Complement deficiency
Congenital asplenia
Hyposplenia
Neutropenia
AED-ID
NEMO/IB deficiency
IL-1R-associated kinase-4 (IRAK-4)deficiency

9. Arthritis of the right hip – 2.5 yr
We: 75 mm/h, CRP: 193 mg/l
RBC: 3.30 T/l, Hgb: 70.0 g/l
WBC: 4700 /mm3, PMNL: 2300 /mm3
Culture of hip joint fluid: S. pneumoniae, serotype 14
Treatment: ceftriaxon,12 days; clindamycin,10 days
Two episodes of low-grade fewer (< 38 OC)

10. Meningitis – 5½ yr Moderate headache, vomitus, subfebrility
We: 40 mm/hr, CRP: 8.1 mg/l  87 mg/l
RBC: 4.02 T/l, Hgb: 94.0 g/l
WBC: 4800 /mm3, PMNL: 56%
Culture of CSF: S. pneumoniae, serotype 14
Treatment: cefotaxim, 12 days; AMX, 4 weeks
Three episodes of low-grade fewer (< 38 OC)
IVIG monthly

11. SPAD: Selective anti-Polysaccharide Antibody Deficiency
Invasive disease by encapsulated bacteria
Poor Ab response to polysaccharide Ag
Normal levels of Ig and IgG subclasses
Intact responses to protein antigens

12. IRAK-4 deficiency
Recurrent, invasive infections caused by S. pneumoniae
No characteristic findings on physical exam
No developmental abnormalities such as ED
Febrile and inflammatory responses are minimal or delayed

13. Therapy IVIG substitution AB prophylaxis
Vaccination with both conjugated and non-conjugated capsular vaccines

14. Staphylococcus aureus
Multiple strains
Localizing strains Toxin-producing strains
Coagulase TSST-1 Enterotoxin Exfoliation
Clumping factor
Protein A Toxic shock Food Scalded skin
syndrome poisoning syndrome
Bacteremia Focal infection
Abscess
Disseminated Sinusitis
Infection Boil

15. Diagnostic criteria of Staphylococcus TSS
MAJOR CRITERIA (ALL REQUIRED)
Acute fever; temperature >38,80 C
Hypotension (orthostatic, shock; below age-appropriate norms)
Rash (erythrodema with late desquamation)
MINOR CRITERIA (ANY 3)
Mucous membrane inflammation
Vomiting, diarrhea
Liver abnormalities
Renal abnormalities
Muscle abnormalities
Central nervous system abnormalities
Thrombocytopenia
EXCLUSIONARY CRITERIA
Absence of another explanation
Negative blood cultures (except occasionally for S. aureus)

17. 3 - Scarlet fever

25. 3-year-old girl Fever (38.8 C) Right periorbital edema Conjunctivitis
3x3 cm erythematous area over the right eye
Intact extraocular eye movements
No evidence of chemosis or proptosis
Supple neck
Diagnosis?
Therapy?

26. Diagnosis Orbital osteomyelitis Orbital cellulitis
Periorbital cellulitis
Preseptal cellulitis

27. Presenting findings in periorbital cellulitis
Redness (color)
Swelling (rubor)
Tenderness (dolor)
Normal eye movements
Fever
Leukocytosis
Chemosis
Conjunctivitis
Blue-purple hue (Hib)

28. Characteristic findings in orbital cellulitis
Impairment of eye movements
Pain in the eye
Progress rapidly to
cavernous sinus thrombosis
meningitis
brain abscess

29. The best choice of treatment
Penicillin
Ampicillin
Cefuroxime
Cefotaxime
Erythromycin

30. Pathogens causing periorbital cellulitis
S. aureus
GAS
H. influenzae
Str. pneumoniae
Gram- organisms
Anaerob bacteria

31. Pathogenesis of periorbital cellulitis
Infection due to
contiguous skin infection
sinusitis
trauma

32. 6-year-old boy Fever (38.8 C) for 3 days Purulent nasal discharge
Bilateral otorrhea
Cough
Frontal headache
URTI ten days ago
Therapy?

33. The best choice of treatment
i.m. ceftriaxone
i.v. cefotaxime
p. os cephalexin
p. os erythromycin
p. os amoxicillin

34. Bacteria causing mild or moderately severe RTI
Str. pneumoniae
H. influenzae
M. catarrhalis
S. aureus (rarely)

35. 6-year-old girl No fever Healing varicella lesions
Rapidly enlarging skin lesion
3x4 cm area
erythema
tenderness
Gram+ cocci in clusters (Gram stain)
Other lesions are scabbed and dry

36. The best choice of treatment
penicillin G
ampicillin
nafcillin
ceftriaxone
vancomycin