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congenital and neonatal infections Flashcards

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1
Q

when is the fetus most susceptible to infections/toxins/mutagens, etc

A

the first trimester

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2
Q

what are the routes of infection to the fetus in congenital infections?

A

maternal blood, fallopian tubes, cervix, amniocentesis,

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3
Q

what are the barriers to infection for the fetus/

A

placenta and amniotic membrane.

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4
Q

what determines the severity of the infections to the fetus,

A

earlier the mother is infected more harm to organs.

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5
Q

what is more harmful to the fetus, acute or reactivation infections

A

acute because they typically have a higher infectious dose

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6
Q

what are the manifestations of congenital infections?

A

growth retardation/low birth weight, malformation, fetal loss/still births

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7
Q

what are the typical organisms of congenital infections

A

rubella, CMV, HIV, toxoplasmosis, T pallidum, parvovirus b19, HSV, VZV

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8
Q

what are the manifestations of perinatal infections

A

meningitis, septicemia, pneumonia, preterm labor.

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9
Q

what are the organisms involved in perinatal infectios

A

N. gonorrhea, C. trachomatous, strep agalactiae (group B), E. coli, listeria monocytogenes.

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10
Q

what are the manifestations of postnatal infections

A

meningitis, septicemia, conjunctivitis, pneumonitis.

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11
Q

what are the organisms involved in the postnatal infections

A

group B strep. listeria, E. coli.

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12
Q

what gives a high level of suspicion for infection

A

if the infant is born with abnormal head, eyes, blood, liver, spleen, jaundice or rash

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13
Q

does the mother usually show signs of infection>

A

no. nothing is usually suspected until the child is not normal.

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14
Q

what has the highest incidence of congenital infections?

A

CMV. 10X more than all the rest.

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15
Q

what are the other common congenital infections other than CMV

A

toxoplasmosis, syphilis, rubella.

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16
Q

torch infections>

A

toxoplasmosis, other, rubella, CMV, herpes,.

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17
Q

what comprises the other in TORCH

A

syphilis, hep b, VZV, parvovirus b19, HIV, HTLV-1

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18
Q

what are the presentations of torch at birth

A

rash, chorioretinitis, microcephaly, hepatosplenomegaly, intrauterine growth retardation.

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19
Q

where does toxoplasmosis come from

A

domestic animals, cats, mice, consumption of cystic bradyzoites.

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20
Q

what are the symptoms of congenital toxoplasmosis

A

most infants are asymptomatic. or fever, maculopapular rash hepatosplenomegaly, microcephaly, seizures, jaundice, thrombocytopenia,

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21
Q

what is the classic triad of toxoplasmosis

A

chorioretinitis, hydrocephalus, intracranial calcifications.

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22
Q

what laboratory tests daignose congenital toxoplasmosis

A

IgM+ on infant is diagnostic. PCR on the amniotic fluid, infant samples, or placenta. direct observation of the cysts.

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23
Q

what are treatment for toxoplasmosis

A

pyrimethamine (daraprima) + sulfadiazine + folinic acid (leucovorin) for 1 year.

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24
Q

what are the complications if not treated.

A

chorioretinitis vision loss. intellectual disability, deafness, seizures, spasticity,

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25
congenital syphilis
crosses placenta and causes miscarriages/stillbirths/deaths in 40-50 of affected pregnancies.
26
what are symptoms of congenital syphilis at birth
66% are asymptom. they can appear at 3m months of age, mostly by 5 weeks. large puffy placenta, hepatomegaly, rhinitis, rash, LAD
27
diagnosis of syphilis
suspect in all mothers that are positive. VDRL or RPR titer. direct visualization on dark field or direct fluorescence antibody. examine the placenta and umbilical cord for fluorescence
28
when to test infants for syphilis
<1 month
29
how to treat syphilis
mother gets penicillin. infant gets 10 day course of aqueous penicillin every 12 hours if less than 7 days and every 8 hours if >7days.
30
alternative infant treatment for syphilis
procaine penicillin as single dose for 10 days
31
is congenital rubella serious?
severe disease in 80%. rare in the us. first the virus infects the placenta, then the fetus.
32
what are the symptoms of congenital rubella
hearing loss, heart defects, opthalmic problems, intrauterine growth retardation, microcephaly and psychomotor retardation.
33
what organs are affected by congenital rubella
hepatosplenomagaly, boine lesions, thrombocytopenic purpura, pneumonitis
34
is there a vaccine for rubella
yes
35
what are the risk factors for CMV infection
no prior infection, pregnancy at younger age, first pregnancy, new sex partner when pregnant, frequent contact with babies and toddlers.
36
what is concerning about CMV
the mothers illness can be subclinical and she wont know. primary infection during pregnancy has the worst prognosis
37
intrauterine CMV transmission
CMV in maternal blood infects the placenta (primary infection carries more viral load), viral spread is slow through placenta and reaches the fetus causing damage to developing organs.
38
does CMV reactivation cross the placenta?
rarely
39
what are the symptoms of congenitally infected neonates
asymp, only 10% have symptoms | small size, HSM, rash, jaundice, chorioretinitis, neurologic involvement, microcephaly, seizures, feeding difficulties.
40
how to diagnose congenital CMV
PCR on urine or blood, culture virus from urine or saliva.
41
why is serology not recommended for diagnosing CMV in the newborn
because the maternal IgG will confound results.
42
treatment for CMV of the newborn
gancyclovir IV or valgancyclovir PO.
43
prevention of congenital CMV
avoid kissing babies on the mouth. no sharing utensils, drinks or food. wash hands or use gloves when wiping noses, drool, diapers.
44
congenital herpes infections presentations
there are many. some are serious
45
what variables in the mother control the risk for herpes infection?
HSV-2 >> 1. primary >>reactivation, visible lesions >>subclinical
46
what are the variables in the child that moderate disease transmission of herpes?
intrauterine >> perinatal, disseminated infection>> encephalitis>>skin,
47
what is the incidence of neonatal herpes infections
very rare.
48
what is the most frequent scenario for neonatal herpes infection
mother has recurrence during time of birth neonate acquires the infection at full term,
49
what is the prognosis for neonatal HSV
very good. rare severe infectios.
50
most severe scenario for HSV infections of the newborn
mother has primary HSV-2 infection during pregnancy and the fetus is born with disseminated virus.
51
what is the prognosis for the most severe cases of congenital herpes of the newborn
severe mental impairment or death
52
how to treat congenital HSV of the newborn>
IV acyclovir is well tolerated.
53
prevention of congenital herpes
c-section birth is indicated for frequent outbreaks. antiviral prophylaxis
54
congenital varicella infections incidence
VERY RARE.
55
what happens when VZV infection of the newborn occurs
primary infection in the mother damages the fetus. limbs and brain development are impaired, there is a poor prognosis.
56
what is the treatment for congenital VZV
acyclovir
57
prevention of VZV
vaccination. advise seronegative women to avoid children with chicken pox or anyone with shingles.
58
parvovirus b19 (5th disease) presentation
erythema infectiosum lace like rash on extremities rash on face. slapped cheek face., erythematous maculopapular rash arthalgia and arthritis
59
when is parvovirus b19 (5th disease) most common
school-age children during winter/spring.
60
what type of disease is parvovirus b19 (5th disease)
biphasic
61
what are seronegative pregnant women at risk for when infected with parvovirus b19 (5th disease)
fetal death
62
what is the treatment for parvovirus b19 (5th disease)
none
63
what is the prevention for rparvovirus b19 (5th disease)
none
64
perinatal infections
acquired during or shortly after birth
65
what are the routes of transmission of perinatal infections
exchange of maternal and fetal blood, fetal monitors attached to the scalp break the skin, vaginal and skin flora colonize the neonate, relatives that are visiting transmit, passage through the vaginal canal. r
66
what are the risk factors for perinatal infections
extended delay between membrane rupture and delivery may allow the vaginal flora to ascend and then the fetus may aspirate.
67
risks for neonatal sepsis
low birth weight, premature or prolonged rupture, septic or traumatic delivery, fetal anoxia, maternal peripartum infection
68
neonatal hep b
easily transmitted through birth. infection is often asymptomatic in mother.
69
what are the symptoms of neonatal infection of HBV and what is the risk for chronic infection of the newborn?
usually asymptomatic, 90% chance of chronic infection
70
prevention of hep B of the new born
vaccinate all neonates, add HBIG immune globulin at birth if mom is HBV positive.
71
how do we prevent maternal transmission of HIV
antiviral medications during pregnancy reduces the transmission. combined antepartum, intrapartum and infant antiretroviral prophylaxis
72
what is antiviral treatment during pregnancy
3 parts zidovudine regime (antepartum, intrapartum, neonatal)
73
what do we avoid giving for the prevention of HIV in the first trimester and why?
efavirenz because it is a known teratogen
74
what is the rate of HIV transmission with and without treatment?
2% with treatment and 30% without
75
streptococcus agalactiae morphology and stain
gram positive diplococcus that is encapsulated
76
is streptococcus agalactiae common
25% of women are carriers
77
risk factors for early onset GBS disease
previous baby with GBS, streptococcus agalactiae in urine, fever during delivery, heavy maternal colonization, delivery before 37 weeks gestation, premature or proloinged rupture.
78
what reduces the risk of streptococcus agalactiae
intrapartum antibiotic prophylaxis
79
early onset GBS symptoms
tachypnea, grunting, hypoxia, appears ill, poor feeding, lethargic, irritable, temperature instability, hypotension and shock.
80
late onset GBS symptoms
sepsis, fever, irritability, lethargy, poor feeding, tachypnea, grunting, apnea, meningitis, bulging fontanel, nuchal rigidity, focal neurological findings.
81
general GBS findings from early to late onset.
earlier is more of a pneumonia and later is more of a meningitis.
82
late, late onset GBS symptoms
sepsis with foci in CNS, soft tissues, bone and joints.
83
diagnosis of streptococcus agalactiae
culture from normally sterile site.
84
treatment for streptococcus agalactiae
penicillin.
85
maternal management of streptococcus agalactiae
intrapartum antibiotic prophylaxis, pencillin G IV
86
empirical therapy for streptococcus agalactiae
give when GBS is suspected but not confirmed and if IAP was given, suspect resistance to pen. give vancomycin + penicillin G or ampicillin.
87
definitive diagnosis of streptococcus agalactiae
give penicillin G. alone
88
when are the prevention techniques most effective>
before pregnancy
89
when is the worst time for infection during pregnancy
1st trimester
90
is the maternal infection always diagnosed?
no. more often not
91
are infections always transmitted to the baby>
no
92
is the TORCH panel routine screening in the US
NO>
93
are congenital infections treatable?
some. HSV (acyclovir), HIV (zidovudine), GBS (penicillin)
94
are most babies born healthy>
yes.

micro unit 6 (7 decks)

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