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pediatrics > 18. Intrauterine infections of the newborn > Flashcards

18. Intrauterine infections of the newborn Flashcards

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1
Q

what re the things to consider about congenital infections?

A

first trim usually the most dangerous time

infection of the mother might by trivial symptoms so the condition usually goes undiagnosed

infection in the motor does not always mean the baby is affected

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2
Q

some infection can be avoided by the mother through what

A

simple measures such as immunisation = rubella , varicella zoster virus during childhood or before pregnancy

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3
Q

some infections are treatable in intrauterine infections which are they ?

A

syphilus

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4
Q

what re the virus congenital infectious agents ?

A 
CMV *
HSV *
erythrovirus  B19 
enterovirus 
Hep B *
VZV *
HIV 
rubella *
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5
Q

what are the bacterial congenital infectious agent ?

A 
trepanoma pallidum *
mycobacterium tuberculosis 
salmonella typhus 
listeria monocytogenes 
campylobacter fetus 
borrelia burgfordi
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6
Q

what are the fungal agents for congenital infections ?

A

candida albicans

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7
Q

what re the parasitical agents for congenital infections ?

A

toxoplasma gondii *
plasmodium
trypanosome cruz

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8
Q

what Lethe most common organism giving infections ?

A

TORCH

one with the asterisk

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9
Q

pregnant women are exposed to these congenital infection through what ?

A

association with young children

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10
Q

congenital infection can result in ?

A

death and resorption

abortion and still birth

live birth of premature

term infant with abnormality

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11
Q

in survived congenital infection , the babies usually show which classical signs ?

A

low birth weight
developmental abnormalities
congenital infections persisting after even birth sometimes

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12
Q

what are the most common characteristics of rubella in born children ?

A

low birth weight and in utero growth retardation

cataracts , retinopathy ,

congenital malformation
cardiac - patent ductus arteriosus pulmonary stenosis

neurological - meningoencephalitis , mental retardation and behavioural changes motor change

liver associated - hepatosplenomegaly , early onset of jaundice , and

transitory
thrombocytopenia = purpuric skin lesions = blueberry muffin appearance from dermal erythropoeisi
and hepatitis

osteogenesis - radiolucent bones

later presenting features 
auditory - hearing loss 
diabetes mellitus 
glaucoma
mental retardation
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13
Q

why should infants with rubella be isolated ?

A

because they are still infectious for 1 year and shed live virus

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14
Q

what is the diagnosis of rubella

what is the treatment for congenital rubella ?

A

virus cultures from nasopahryengal swabs , urine , csf

csf examination - increased protein ratio
encephalitis

serological studies may be helpful - but disease itself can cause immunology aberration and delay in IgM and IgG production

radiological

no specific antiviral agent is currently available for rubella

vaccine should NOT be given to already pregnant women

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15
Q

are babies with rubella virus premature births ?

A

no

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16
Q

what is the most common pathogen of inutero infection

A

cytomegalovirus

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17
Q

rubella is most infectious at what stage of pregnancy

A

first trimester 1-12 weeks !

then third trimester = 60 percent
31-36 weeks

last month of pregnancy = 100 percent

however incidence of fetal effects is greater with earlier infections

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18
Q

in cmv the fetal damage is severe in ?

A

any stage of pregnancy the

but greatest risk at 22 weeks

earlier the mother contracts the infection the more severe the presentation

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19
Q

only 10 percent of babies born with CMV are symptomatic at birth , what are the symptoms ?

A

symptomatic at birth 10 percent

in utero growth retardation , low birth weight

hepaosplenomgealy , jaundice ,petechia

microcephaly
necrotic encephalitis
periventricular calcifications

chorioretinitis

developmental abnormalities

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20
Q

10 percent of babies born with cmv are asymptomatic and develop late complications such as

A

10 percent asymptomatic late complications :
deafness - [rogressive and can effect both ears
intellectual disability / mental retardation
seizures

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21
Q

what are the agents which are no perisirant postnatally ?

A

enterovirus

erythrovirus b19

listeria monocytogens

campylobacter fetus

salmonella typhus

b burgdoferi

trypansoma cruzi

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22
Q

CMV can be given to the baby after birth through what way ?

A

contact with genital secretion at delivery

through breast milk

however they result in no clinical manifestations

breast feeding is still advised as the benefits really outweigh the risk

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23
Q

is there reason to isolate cmv patients ?

A

no because there are really no clinical manifestations

they are really numerous in children - mother who is pregnant advised not to go near children in general

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24
Q

how is CMV infection tested and diagnosed ?

A

histopathology - focal necrosis , enlarged cells with intranuclaer incursions - cytomegalic cells
multinucleated gigantic cells

diagnosed through viral isolation

viral culture using blood , urine or saliva samples

serological testing IgM and IgG antibodies to CMV

A diagnosis of congenital CMV infection can be made if the virus is found in an infant’s urine, saliva, blood, or other body tissues during the FRST WEEK (vey important no later than that) after birth.

not recommend routine maternal screening for CMV infection during pregnancy because there is no test that can definitively rule out primary CMV infection during pregnancy.

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25
when women are infected with cmv they usually do not have any infections however what can be found int heir blood work ?
symptoms resembling mononucleosis = fever soar throat engaged lymph
26
what is the treatment of CMV in children who are tested positive
should start at 1 month of age and should occur for 6 months. The options for treatment are intravenous ganciclovir (mutagenic carcinogenic) and oral valganciclovir
27
herpes simplex virus infection in utero is how common ?
they are very rare
28
what is the triad of symptoms in herpes simplex virus in utero ?
1) skin vescicles and scarring 2) eye disease - chorioretintis , keratoconjuctivitus 3) microcephaly and hydranenecphaly
29
what is the most common rout of infection in herpes simplex virus ?
intrapartum - most of the time can also be intrauterine and postnatal!
30
what are the clinical signs and symptoms with infants affected postnatally or intrapartum of hsv ?
it is separated into three group localised - skin , eye and mouth -------- CNS involvement - encephalitis = seizures , spastic tetraplegy microcephaly / bulging fontanel tremors , lethargy , poor feeding with or without skin eye and mouth involvement ------- DIS herpes - affects multiple internal organs most especially the liver , lung , adrenal CNS etc
31
what is the treatment for HSV ?
antepartum - c section isolation of infants NO breast feeding antiviral treatments such as acyclovir second line vidarabine However, morbidity and mortality still remain high due to diagnosis of DIS and CNS herpes coming too late for effective antiviral administration
32
pregnant women with active genital herpes lesions at the time of labor be delivered?
through c section
33
how is the diagnosis of hsv made ?
viral culture and isolation nasopharynx immunological assay - HSV antigen testing monoclonal anti HSV antibodies ELISA lumbar punture - hemorrhagic CSF , white blood cells andportein high
34
does hsv have in utero growth retardation and associated with low birth weight ?
no
35
how rare is congenital varicella zoster virus
extremely rare
36
what are the clinical signs and symptoms of VZ
low birth weight , iugr hypertroph and cicatrix skin , red and inflamed hypo pigmentation ``` micropthalmia cataracts choioreteinitis optic atrophy anisoria horner syndrome ``` cortical atrophy microcephaly hydrocephaly apslaia of brain hypoplasia of extremities !! motor and sensory defect absent deep tendon anal and urinary sphincter dysfunction developmental anomalies
37
what is the period of risk for congenital varicella zoster ?
first 20 weeks of pregnancy
38
how is the diagnosis of congenital varicella syndrome
maternal varicella confirmation = presence of IgG antibodies for vxv ultrasound - LIMB malformations
39
what is the treatment of VZV ?
If a non-immune pregnant woman is exposed to chickenpox, varicella zoster immunoglobulin (VZIG) should be administered as soon as possible after exposure. VZIG is apparently most effective if used within 72 hours of exposure. or acycovir same fo the baby
40
does varicella zoster virus cause premature infants ?
no
41
does herpes simplex visors congenital cause premature infants
yes
42
does enterovirus cause prematurity ?
no
43
does enetrovirsu case in utero growth retardation and low birth weight ?
no
44
what are the clinical signs and symptoms of enterovirus ?
developmental anomalies
45
does hepatitis b congenital infection cause prematurity ?
yes
46
does hep b cause in utero growth retardation and developmental anomalies
no
47
what is the route of transmission of hep b ?
in utero | through the vaginal delivery
48
what are the clinical signs and symptoms of hep b infections ?
asymptomatic individuals however likely to develop chronic hepatitis and hepatocellular carcinoma this way ! ------------ ``` symptomatic infants hepatosplenomegaly jaundice acute hepatitis - abdominal pain , dark urine , loss of appetite , vomiting ``` ------ chronic active hepatitis with or without cirrhosis yes piecemeal necrosis or intralobular fibrosis chronic persistant hepatitis - benign no piecemeal necrosis or intralobular fibrosis chronic asymptomatic HBcAG carrier fulminant fatal hepatitis (liver failure) - rare
49
babies born to mother with hepatitis b should beclincaly managed how ?
HBsAG positive with HBV vaccine and hepatitis b immune globulin within 12 hour of birth = but not helpful when there is the onset of the acute infection chronic hepatitis may benefit from antiviral drugs - such as interferon alpha , lamivudine ,
50
how od ewe diagnose hep b in congenital ?
transaminase levels increase before bilirubin bilirubin levels increases ``` acute first antibody antiHBc IgM HBcAG disappear in weeks IgG antiHBc detected = maybe present for life and HBe antigen = acute low high hbv dna in blood ``` if vaccinated only anti HBs antibody no hbv dna in blood ``` if chronic IgG antiHBc and HBs antigen with or without HBe antigen and anti HBe low high HBV dna in blood ``` ``` if cleared hep b IGg antiHBc anti HBs with or without anti HBe no HBV dna in blood ```
51
does hiv congenital infection cause prematurity ?
yes
52
what are the signs and symptoms of HIV congenital infection ?
asymptomatic - many infants do not have symptoms till opportunistic infections start coming or minor signs in utero growth retardation and low birth weight developmental anomalies failure to thrive fever persistent heaptsplenomegaly lymphadenopathy oral thrush and other opportunistic infection pneumonia - recurrent resp infection chronic diarrhea CALCIFICATION OF BASAL GANGLIA dermatitis
53
if the mother has HIV the fetus has how many percentage change of being infected ?
25 percent
54
when do the fetus get infected with HIV mostly ?
later in pregnancy and during delivery
55
what is the treatment to lower the chances of the baby getting infected with HIV
c section the last half of their pregnancy, during the birthing process, and treatment of the infant for 6 weeks following delivery can lower significantly the chances the baby will be infected with retrovir with nevirapine
56
is breast feeding recommend in HIV positive mothers
no
57
how do you diagnose hiv ?
HIV culture PCR children more than 18 months : ELISA and western blot to confirm anti HIV antibodies
58
what is the clinical manifestation of erythrovirus ?
inter hydros fetalis
59
does erythrovirus B9 have in utero growth retardation and low birth weight ?
no
60
does erythrovirus case premature birth ?
no
61
does erythrovirus b9 have developmental anomalies ?
no
62
trepanoma pallidum gets infection through which way ?
transplacental or through vaginal birth
63
do trepanomapallidum cause preterm birth
yes
64
does trepanoma pallidus cause hydrops fetalis and still birth
yes
65
what are the early symptoms of trepanoma palladium or congenital syphillus ?
can be asymptomatic early - occurring between 0-2 years old in utero growth retardation and low birth weight developmental anomalies hepatospenomegaly snuffles/ runny nose - rhinitis , coryza luetica lymphadenopathy mucocutanoeus lesions of the palms , soles and around the mouth and anus luetic pemphigus and vesicular bulle rash macular osteochondrits hemolytic anemia thrombocytepnea pneumonia alba
66
if congenital syphillus is left untreated what are the clinical manifestation so late signs and symptoms ?
after 2 years Hutchinson triad interstitial keratitis hutchinson teeth cranial nerve deafness frontal bossing saddle nose rhagades neurosyhpilus
67
what is the treatment of congenital syphillus ?
parenteral procaine penicillin or penicillin (G) for 10-14 days IM treatment cannot reverse any deformities if syphilus confirmed during pregnancy - start penicillin treatment
68
how do you diagnose or green for congenital syphillus
VDRL - blood test for syphillus basis of the test is that an antibody produced by a patient with syphilis reacts with an extract of ox heart (diphosphatidyl glycerol). It therefore detects anti-cardiolipin antibodies (IgG, IgM or IgA) FTA-ABS test is used to detect antibodies to the bacteria Treponema pallidum and confirm the VDRL positivety fluorescent treponemal antibody-absorption T. pallidum hemagglutination assays CSF pleocytosis, raised CSF protein level and positive CSF VDRL serology suggest neurosyphilis microscopic dark field microscopy blood count - hemolytic anemia
69
medical conditions can produce false positive results vdrl?
rheumatic fever, rheumatoid arthritis, lupus, and leprosy The syphilis anti-cardiolipin antibodies are beta-2 glycoprotein independent,[2] whereas those that occur in the antiphospholipid antibody syndrome (associated to lupus for example) are beta-2 glycoprotein dependent, and this can be used to tell them apart in an ELISA assay.[
70
what re the signs and symptom for neurosyphilis ?
meningitis - early | cranial nerve palsy esp facial nerve
71
a pregnant mother is identified as being infected with syphilis, treatment can effectively prevent congenital syphilis from developing in the fetus, especially if she is treated before the
26 th / sixteen week of pregnancy - with penicillin
72
The fetus is at greatest risk of contracting syphilis when the mother is in which stage of infection
early stage a women in the secondary stage decreases passing on syphillus by 98 percent
73
toxoplasma gondi infection early in the trimester can cause what ?
death of th fetus and abortion is recommended
74
toxoplasma gondi infection later in the trimester can cause what
still birth orr PREMATURITY INTRAUTERINE GROWTH RESTRICTION LOW BIRTH WEIGHT HEPATOSPLENOMEGAKY MYOCARDITIS classic triad - microcephaly hydrocephalus intracranial calcification chorioretnitis SEIZURES bone abnormality
75
risk of fetal infection increases through
pregnancy lowest being the first trimester and highest being the third trimester goes 15 , 45 , 70 percent
76
toxoplasma gondiin pregnant women havee what ?
mild mononucleosis like syndrome regional lymphadenopathy ocasioanla chorioeretinits
77
neurological and ophthalmological sequel in toxoplasma gondi may be delayed for ?
years and decades and may be born asymptotic
78
how do we diagnose for cmv IN PREGNANCY?
serial IgG measurement for maternal amniocentesis amniotic fluid PCR - for fetal
79
what is the treatment for toxoplasma gondi in pregnant women ?
spiramycin maybe | appears to reduce vertical transmission by 60 percent
80
what's is the treatment for toxoplasma gondii in infants and neonates ?
pyrimethamine leucovorin sulfadiazine begun after neonatal jaundice has resolved regime is continued for 6 months
81
what are the clinical manifestation for streptococcus agalactiae group b ore ecoli ?
hepatosplenomegalu jaundice pneumonitis skin lesions petechia and puprura CNS lesions - meningoencephalitis
82
the severity or the clinical manifestation of these infections depends on ?
gestational age virulence primary or recurrent infection newborn recieved
83
the late in pregnancy the infection is required the more likely it is transmitted to the fetus ?
yes
84
what is the diagnosis of toxoplasmosis condo
serological testing for toxplasmic specific IGM = ELISA , indirect fluorescent antibody immunosorbent agglutination assay - IgM -ISAGA if IgM titres are high with specific IgG tigers aswell this suggests acute infection CSF - mononuclear pleocytosisi , high protein level of csf , xantochromia CT - intracranial calcifications ophthalmic exam - chorioenteritis
85
hw can toxoplasmosis be prevented ?
pregnant women should d avoid eating raw meat or raw eggs with exposure to cat feces
86
describe rubella virus ?
RNA virus spread through reps secretions , and stool and urine and cervical secretions maternal antibodies to previous infection are protective for etus
87
wh is at risk for rubella ?
women who have not recieved the mmr vaccinations
88
what are risk factors for cmv ?
low socioeconomic status drug abuse sexual promiscuity
89
has maternal hep b been associated with abortion , still birth or congenital malformations ?
no
90
what is diff diagnosis of hep b ?
acute billary atresia | acute hepatitis secondary to CMV or rubella
91
describe the transmission routes for hiv
in utero intrapartum - contaminated blood breast milk
92
what is the most common agent for neonatal sepsis ?
vaginal flora - group b streptococci | followed by ecoli
93
what are the alarm signs in neonatal sepsis ?
``` change in behaviour weight loss feeding problems vomiting grunting flaring ```
94
how do we prevent neonatal sepsis ?
4mg of ampicillin given during labour
95
in case of sepsis suspicion what is the treatment ?
antibiotic broad spectrum ampicillin gentamyci gram negative - cephalosporins listeria - ampicillin staph coagulase positive - oxacillin coagulase negative - vancomycin enter bacteria - aminogycogide and cephalosporin anaerobes - clindamycin andmetronidazole treatment varies fromm 10-21 days

pediatrics (19 decks)

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