Flashcards in Congenital and Neonatal Infections Deck (18):
When is the fetus at the highest risk from toxins, mutagens, and infections?
For congenital infections, how can the fetus acquire them during gestation? What determines worse severity?
Placenta (maternal blood), fallopian tubes, cervix, amniocentesis;
earlier the mother is infected means more harm to developing organs and acute maternal infection WORSE than reactivation for fetus
Mother often has; detect in their serum
no symptoms of infection, so you'll only see something once INFANT is affected; think about fever, rash, sick children for maternal exposure;
IgM or rising IgG titer
Definitive diagnosis of congenital infection:
isolate pathogen from the infant (sample urine, saliva, CSF, nasopharyngeal swabs); something like maternal IgG confounds neonatal serology
Signs of congenital toxoplasmosis; lab tests; how to treat? Potential sequelae:
Chorioretinitis, hydrocephalus, intracranial calcifications;
IgM pos in infant is diagnositic (do PCR on infant samples, amniotic fluid, or placenta);
Pyrimethamine, sulfadiazine, folinic acid for 1 year;
think about chorioretinitis that results in vision loss if SUBCLINICAL
How does congenital syphilis arise? When do the symptoms appear and how can you diagnose? Treatment?
Crosses placenta and infects fetus (common miscarriage/stillbirth/neonatal death) to beget hepatomeg, rhinitis (snuffles), rash, and LAD;
think most often by FIVE weeks, but usually by 3 months of age;
think VDRL or RPR, along with darkfield or direct fluorescent Ab;
Treat both mother and infant with penicillin!!!
Congenital rubella pathogenensis, symptoms, and prevention/treatment:
Path: infects placenta, then fetus;
Symp: hearing loss (most common), microcephaly, PDA, cataracts, also thrombocypoenia purpura (blue baby like CMV);
Prevention: live-attenuated vaccine that is TRIVALENT!!!
Risk factors for congenital CMV; worst diagnosis?:
1. No prior infection with CMV
2. Pregnant at YOUNGER age
3. FIRST pregnancy
4. New sex partner during preg
5. A lot of interaction with babies and toddlers
6. Mother unaware she has problems;
primary infection (much higher virus levels in blood, whereas CMV reactivation rarely crosses placenta) with CMV during early pregnancy
Path and Symp of CMV; incidence of congenital CMV; diag?; treat and prevent:
Path: goes slowly through placenta, reaches FETAL blood, then damages developing organs;
think HEARING LOSS, HSM, purpura, microcephaly, chorioretinitis;
about 10000 cases of symp congenital CMV disease in US each year;
PCR on urine or blood; culture virus from urine or saliva
Treat: ganciclovir or valganciclovir (but not good);
Prevent: sanitize yourself around babies
Congenital Herpes simplex infections: variables that contribute to severity:
in mother, virus type HSV-2 worse than HSV-1, primary worse than reactivation, visible lesions worse than subclinical reactivation; in child, intrauterine worse than perinatal, disseminated infection worse than encephalitis and skin lesions
Most frequent HSV scenario vs. most severe scenario; how to treat and prevention
Frequent: mother with recurrence of HSV-2 at birth, neonate acquires virus at full term;
severe: mom with primary HSV-2 infection during preg, fetus born with DISSEMINATED virus;
Treat: IV acyclovir WELL-TOLERATED for infant;
Prevent: C-section if frequent outbreaks, but also antiviral prophylaxis
Congenital Varicella syndrome: treat and prevent?
Treat: acyclovir and derivatives for mom;
Prevent: vaccinate seroneg women who reach childbearing age
Parvovirus: symps; treat and prevent?
Symps: think school-age children during winter/spring, and look for febrile illness preceding slapped cheek rash along with maculopapular rash, arthralgia/arthritis;
seroneg pregnant women at risk for fetal death;
treat and prevent: NONE!!!
acquired during or shortly after birth;
Think exchange of maternal and fetal blood; also fetal monitors attached to scalp breaking the skin; also vaginal and skin flora colonizing neonate during birth; viruses can be secreted in breastmilk
Hep B: prevalence, prevention and treatment
Prev: up to 50% population is seropositive;
Prevent and treat: vaccinate ALL neonates and add HBIG
Prevention of perinatal transmission of HIV:
3-part zidovudine regimen: antenatal, intrapartum, and neonatal; also focus on antepartum, intrapartum, and infant antiretroviral prophylaxis in general
Group B strep: risk factors, risk reduction, symps
Risk factors: previous baby with GBS disease, GBS in urine, fever during labor, heavy maternal colonization, delivery before 37 wks of gestation, premature or prolonged rupture of membranes; intrapartum antibiotic prophylaxis reduces risk;
EOGBS: look for respiratory (grunt) symptoms, temp instability, shock (pneumonia early: week 1);
LOGBS: Meningitis (bulging fontanel, nuchal rigidity, focal neurologic findings; sepsis);
LLOGBS: sepsis with foci in CNS, soft tissues, bones and joints