infections of newborns Flashcards

1
Q

how do you tx congenital toxoplasmosis?

A

requires year of pyrimethamine and **sulfadiazine **

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2
Q

best way to make congenital toxoplasmosis dx?

A

serology

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3
Q

what is the most common perinatal infection?

A

cytomegalovirus

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4
Q

5-17% of newborns with asympomatic congenital CMV infection develop _______?

A

neurological sequelae (esp hearling loss)

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5
Q

should you order TORCH titers in the diagnosis of perinatal HSV?

A

NO. they are of no vaule

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6
Q

intracranial calficications (2 bugs)

A

toxo

CMV

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7
Q

cataracts (2 bugs)

A

rubella, HSV

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8
Q

chorioretinitis (2 bugs)

A

Toxo, CMV

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9
Q

bone lesions (2 bugs)

A

syphillis, rubella

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10
Q

congenital heart disease

A

rubella

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11
Q

microcephaly

A

CMV

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12
Q

hydrocephalus(which bug?)

A

toxo

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13
Q

vesicles associated with which 3 bugs

A

HSV, VZV, syphillis

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14
Q

how do you detect sphyllis?

A

dark field microscopy

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15
Q

describes what? Paler, thicker and larger than normal

Focal villositis with endovascular and perivascular proliferation

A

placenta of sphyllis

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16
Q

Dermatologic changes – copper rash associated with which disease?

A

congenital syphyllis -early manifestation

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17
Q

these are examples of:

Notched IncisorsTeeth
Eighth nerve deafness
Interstitial keratitis
Rhagades
Neurologic involvement
Clutton’s joints and sabre shins

A

late features of congenital sphyllis

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18
Q

radiologic features of syphillis

wide spread bony invovlement

A

metaphysitis

periostits

pathologic features

cortica thickening

19
Q

what is wimberg’s sign?

A

x-ray changes, moth eaten appearance at the upper end of the tibia

20
Q

characterized by mental retardation, microcephaly, cataracts, deafness, intrademral erythropoiesis(blueberry muffin apperance)

A

congenital rubella

21
Q

more severe disease associated with transmission in 1st semester disease(v. last trimester)

cases often associated with: hydrocephalus, chorioretinitis, juandice, splenomegaly, intracranial calcifications(diffuse)

what is the classic triad of this condition?

A

congenital toxoplasmosis

chorioretinitis, hydrocephalus, intracranial calcifications

22
Q

negative serology in mom +/- baby essentially excludes what?

what should mothers avoid?

A

dx of congenital toxoplasmosis

cat litter exsposure, undercooked beef

23
Q

all are examples of :

Multiorgan involvement
Non-immune hydrops
Hepatosplenomegaly
Bone involvement - periostitis
Cartilage involvement - snuffles
Pneumonia
Dermatologic changes – copper rash

A

clinical features of early syphillis

24
Q

t/f. infants with syphyliss are asymptomatic at birth?

A

true

25
Q

pathologic fractures associated with which neonatal infection?

A

congenital syphillis

26
Q

Late cortical thickening

A

syphyllis

27
Q

why does Concurrent maternal infection of T. pallidum and HIV lead to higher rate of fetal syphilis infection?

A

cellular immune dysfunction may permit higher treponemal proliferation
HIV-infected women may not respond well to recommended therapy

28
Q

Untreated syphilis during pregnancy complicated by HIV infection causes higher rates of_________

A

Untreated syphilis during pregnancy complicated by HIV infection causes higher rates of fetal HIV infection

29
Q

Tests to detect antibodies to cardiolipin(2)

A

Venereal disease research laboratory (VDRL)
Rapid Plasma Reagin (RPR)

30
Q

Mother’s serological status has to be determined prior to discharge for which condition?

A

syphyllis

31
Q

what are Tests to detect antibody to T. Pallidum?

A

TPI- T. pallidum immobilizing test
FTA-ABS – flurosecent treponemal antibody
TP-PA- particle agglutination test
MHA-TP- microhemagglutination test
ELISA – IgG and IgM antibody tests

32
Q

prenatal management of syphyllis

how often do you screen?

which populations?

A

Mandatory screening during pregnancy by serum RPR at least once

Should be done twice especially in high risk population
Drug use
HIV positive
Poor socio-economic status
Teenage pregnancy
Other STDs
High prevalence areas

33
Q

describes which disease?

Single dose of benzathine penicillin
Repeat doses weekly x 2 for HIV +
Follow titers during pregnancy and document four-fold drop in titers
Re-treatment anytime there is a four fold increase
Treatment of the partner

A

prenatal management of congenital syphyllis

34
Q

how do you treat infant with penicillin?

A

Procaine Penicillin 50,000 u/kg, IM for 10 days
Aqueous Penicillin 50,000u/kg, IV every 12 hours for 10 days
Benzathine Penicillin single dose IM

Only if guaranteed follow-up because inadequate CNS treatment

35
Q

Congenital HIV infection is a preventable disease–maternal screening is the key

The risk of transmission is ______if mother’s viral load is undetectable at the time of delivery

A

The risk of transmission is <1% if mother’s viral load is undetectable at the time of delivery

36
Q

in congenital HIV infection:

how do you dx?

what is the value of serolog?

A

The risk of transmission is <1% if mother’s viral load is undetectable at the time of delivery

serology is of little value

37
Q

Infants of HIV+ mothers are asymptomatic at birth but placed on AZT until proven negative by ______ DNA PCR tests, done_____ weeks apart

A

Infants of HIV+ mothers are asymptomatic at birth but placed on AZT until proven negative by two DNA PCR tests, done 6 weeks apart

38
Q

which condition?

Under-recognized in U.S.–especially milder cases (which are the majority)
Transmission more common late in pregnancy, but more severe disease associated with 1st trimester transmission
Severe cases often with hydrocephalus, chorioretinitis, jaundice, splenomegaly, intracranial calcifications (diffuse)

A

congenital toxoplasmosis I

39
Q

what is the best way to make dx of congenitan toxoplasmosis?

A

Serology is currently the best way to make the diagnosis, BUT commercially available assays not reliable

note: Negative serology in mom and/or baby essentially excludes the Dx

Positive titers require confirmation by reference lab (Palo Alto, CA)

40
Q

what % of CMV infections contracted congenitally? natally? postnatally?

A

CMV infections are highly prevalent in neonates, and are probably more common than all other perinatal infections combined
CMV infections can be acquired in utero, natally, or postnatally–and frequently are:
congenital: 0.6-2.4% live births
natal: 2-6% neonates
postnatal: up to 14-21% of neonates!!

41
Q

which condition?

Most (>90%) asymptomatic
Primary maternal infection leads to fetal infection in 30-50% of cases–10-15% of these have overt clinical disease
Secondary maternal infection less likely to lead to fetal infection (1-2% ) but can do so and may lead to severe disease (Boppana et al, NEJM 2001, 344: 1366)

A

congenital CMV infections

42
Q

symptoms of congenital infection?

Jaundice (62%)
Petechiae (58%)
Hepatosplenomegaly (50%)
IUGR (33%); Preterm (25%)
Microcephaly (21%)
Chorioretinitis (12%)
Fatal outcome (4%)

A

Symptomatic Congenital CMV Infection

43
Q

which symptoms do infants with CMV have?

A

>90% of newborns with symptomatic congenital CMV infection have visual, audiologic and/or other neurological sequelae

44
Q
  • 5-17% of newborns with asymptomatic congenital CMV infection develop ________
A
  • 5-17% of newborns with asymptomatic congenital CMV infection develop _neurological sequelae (esp. hearing loss) _