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Congenital Infections - Exam 1 Flashcards

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1
Q

What is a congenital infection? How can it be transmitted?

A

An infection of the fetus typically caused by viruses, or less commonly other infections,that infect the pregnant mother and may be passed to the fetus.

through blood, vaginal secretions or breast milk

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2
Q

**What are the 2 CI to breastfeeding?

A

HIV and CMV

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3
Q

What are the 10 things tested for in a TORCH test?

A

Toxoplasmosis

Others: HIV, enterovirus, parvovirus, varicella, hepatitis, syphilis

Rubella

Cytomegalovirus

Herpes

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4
Q

What causes toxoplasmosis? What type of organism? How will it present in a newborn?

A

Toxoplasma gondii

protozoan parasite

ocular disease and neurological defects

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5
Q

Frequency of toxoplasmosis of fetal infection increases steeply with _____. 70-90% newborns with congenital toxoplasmosis have no _______

A

advancing gestational age

manifestations on routine PE

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6
Q

Should you screen for toxoplasmosis?

A

NO! not recommended to universally screen for it

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7
Q

you should screen mom’s for toxo if you have a high suspicion and they are displaying signs of _______ and ______.

A

significant cervical lymphadenopathy, and high fever

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8
Q

What is the MC US finding of a fetus who has toxo?

A

Such as calcifications and or cerebral ventricular dilation

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9
Q

What are 4 risk factors for maternal to fetal transmission of toxo?

A

Maternal infection at advanced gestational age

High Parasite load

Maternal parasite source

Maternal immunocompromise

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10
Q

What are the 3 ways to contract toxo? Which way has the highest risk of fetal infection?

A

cat feces** highest risk with cat feces

undercooked meat and eggs

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11
Q

Cataracts /Chorioretinitis
Abnormal CSF fluid
Anemia
Microcephaly / Hydrocephalus
Hearing loss
Small for gestational age (SGA)
Early onset jaundice
HSM-hepatosplenomegaly
Generalized maculopapular rash
Seizures

What should you do next?
What am I? What is the distinguishing symptom?

A

order TORCH titers

Toxo

Chorioretinitis

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12
Q

**What is chorioretinitis? **What dz?

A

is an inflammation of the choroid (thin pigmented vascular coating of the eye) and retina of the eye.

toxo

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13
Q

______ is typically used for detection of IgM and IgG antibodies. **How do you detect toxo on CT?

A

ELISA

Can use Skull films and CT head that will show diffuse cortical calcifications

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14
Q

In an acute infection, toxo IgM usually appear within _____ and stay elevated for ______

A

appear within 1 week

stay elevated for months

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15
Q

When does toxo IgG appear? When does it peak? How long does it last?

A

IgG specific Ab appear in 2 weeks

peak @ 8

persist for life

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16
Q

When toxo dx has been confirmed in mom, what do you do next?

A

Testing for fetal infection via amniocentesis can be helpful in decision making after 18 weeks preferred

then tx MOM with either spiramycin or Pyrimethamine and Sulfadiazine with folinic acid depending on age

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17
Q

What is the tx for toxo in MOM? give both tx with gestational ages

A

If less than 14 weeks gestation -> Spiramycin

If after 14 weeks gestation -> Pyrimethamine and Sulfadiazine with folinic acid until delivery

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18
Q

Once delivered, what is the toxo tx for baby? For how long? What other tx/monitoring is required for these infants?

A

pyrimethamine plus sulfadiazine and folinic acid

Treat for one year

Repeated eye examinations by an ophthalmologist experienced with identifying Toxoplasma chorioretinal lesions in infants and toddlers should be obtained every 3 months until 18 months. Then every 6-12 months

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19
Q

What are some preventative measures for toxo?

A

Cook meat until it’s well done

Peel and wash thoroughly all fruits and vegetables

Wash all surfaces after contact with raw meat

Avoid untreated drinking water

Wear gloves when gardening

Avoid changing cat litter

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20
Q

**______ infection 40% lead to fetal death or premature stillborn delivery

A

Rubella (German measles)

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21
Q

When is rubella the worst for growing fetus?

A

85% infected in FIRST trimester, congenital defects as high as 80-85%

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22
Q

What is the name of this syndrome? What are the spots called? What causes them?

A

Rubella

“Blueberry Muffin Syndrome”

thrombocytopenia with petechiae or purpura, LOW platelets

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23
Q

thrombocytopenia with petechiae or purpura
cataracts, retinopathy, glaucoma
PDA and Peripheral pulmonary artery stenosis
sensorineural hearing loss
behavior disorder, meningoencephalitis and mental retardation
Microcephaly

What am I?
**What is an important symptom to remember?

A

rubella

**causes sensorineural hearing loss

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24
Q

How can you confirm the dx of rubella? What bodily fluids can be used? How long does the infant shed the virus?

A

Measurement of IgG over several months can be confirmation

Cultures of blood, urine and CSF are detectable as well

Tend to shed live virus in urine, stool, and respiratory secretions for up to 1 year

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25
What are common eye findings in rubella? Ear findings?
cataracts/glaucoma will be deaf due to sensorineural hearing loss
26
**_____ is the MC congenital infection. What is the structure? How is it transmitted?
CMV Double stranded DNA herpes virus intimate contact: blood, saliva etc
27
**What trimester is the worst time to be exposed to CMV? Can it be transferred through breast milk? Is it typically worse for younger or older mothers?
Severe problems can occur at any trimester but greater if exposed FIRST trimester YES!! do not breastfeed WORSE in teen pregnancies
28
Microcephaly Intracranial calcifications / periventricular Hepatosplenomegaly / Jaundice Mental Retardation Retinal Disease Sensorineural hearing loss Cerebral Palsy Thrombocytopenia / Petechiae What am I? **What is the best way to test for it?
CMV aka: tiny head, rash, calcifications around the ventricles, big ventricles **CMV detection in urine or saliva (within first 3 weeks of life)
29
**______ is the leading cause of non-hereditary sensorineural hearing loss. What additional labs are usually elevated?
CMV Elevated liver transaminases, thrombocytopenia, elevated bilirubin
30
What will a head CT scan of a pt with CMV show? Why would you order a PCR test?
intracranial lesions - usually periventricular to check viral load
31
How do you determine if CMV is congenital or perinatal?
Detection of CMV *within first 3 weeks* after birth is considered proof of congenital CMV infection *after first 3 weeks* - think of perinatal exposure
32
**What is the APPROVED tx for congenital CMV?
**NO antivirals are currently approved!!
33
What is the tx that symptomatic CMV babies receive? Why?
ganciclovir and valganciclovir which has shown to decrease progression of symptoms such as sensorineural hearing loss
34
How is CMV best isolated in the baby?
through urine and saliva
35
_____ of pregnant women have evidence of past HSV infection. Which type of HSV accounts for 70% of neonatal herpes infections. **If you have a vaginal birth, what is the risk of infecting the baby?
30-60% HSV 2 25-50% risk of infecting the baby
36
What trimester does HSV carry the highest intrauterine risk? Is neonatal or congenital HSV more commmon?
3rd trimester neonatal is MORE common
37
** ____ infants who acquire HSV infection are born to mothers with no previous history or clinical findings consistent with HSV infection. Where does the virus life for the entire life of the host?
75% dorsal root ganglia
38
How can the fetus be exposed?
The fetus may be infected transplacentally or through retrograde spread through ruptured or seemingly intact membranes
39
If a neonate presents with symptoms of sepsis, liver dysfunction and negative bacteria culture OR fever, irritability and abnormal CSF findings what should you think? Are HSV infections in newborn typically mild or severe?
consider HSV infection!!! SEVERE
40
**What is the congenital HSV triad? Give 3 additional symptoms. What are usually the first indication of HSV infection?
1. Skin vesicles 2. Ulcerations 3. Scarring eye damage other 3: large liver and lungs, CNS abnormalities, less than 36 weeks gestation Localized infections of the skin, eyes and mouth is usually first indication of infection (45%
41
How do you dx HSV? What is the tx?
specimen culture the vesicle somewhere on the body IV acyclovir
42
What percent of women have evidence of past HSV infection?
60%
43
Most cases of congenital Varicella Zoster disease occur in infants whose mothers were infected between ____ gestation. If infected in the first 20 weeks there is only a ____ chance of transmission
8-20 weeks 2%
44
Is it worse for the baby if mom has varicella zoster, early or late in pregnany?
worse outcomes for baby if mom had chickenpox LATE in pregnancy
45
Cicatricial skin lesions (zig zag skin scarring and limb atrophy) Ocular defects - cataracts, retinitis CNS - hydrocephalus, microcephaly, seizures, mental retardation What am I? What is a standout symptom?
congenital varicella syndrome limp atrophy
46
How is varicella zoster usually diagnosed? When can IgM be detected? IgG?
varicella is usually based upon the characteristic appearance of skin lesions and scraping of vesicle base is sent out for PCR testing IgM may be detected as soon as 3 days after symptoms appear IgG increased in serum confirms diagnosis and may be present as early as 7 days after symptoms appear
47
What is the prophylactic tx for varicella zoster? Who is it given to?
VariZIG - varicella zoster immune globulin (IVIG) Given to any infant with perinatal exposure and Given to all infants younger than 28 wks gestation following postnatal exposure
48
Is breastfeeding encouraged in varicella? why or why not? What is the tx for varicella?
breastfeeding is encouraged because it exposes the baby to antibodies in the breast milk acyclovir
49
What are 3 different names for Parvo B19? **Who has the highest infection rates?
Human Parvovirus B19 Fifth’s Disease Erythema Infectiosum **teachers and daycare workers
50
What is the structure of Parvo B19? **What are 3 symptoms associated with it?
single-stranded DNA virus fever, lacy rash and slapped cheeks **lacy rash on arms and "slapped cheeks" appearance
51
In parvo B19, how long do systemic symptoms tend to last prior to the rash? _______ is also common
infected kids have 1-4 days of systemic symptoms Arthropathy affecting joints of hands, wrists, knees and ankles
52
What is hydrops fetalis?
Hydrops fetalis (fetal hydrops) is a serious fetal condition defined as abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema.
53
What should you do if a pregnant women is exposed to Parvo B19? What does a positive IgM test result indicate?
regnant women exposed should have serologic testing for IgG and IgM; ultrasound; percutaneous umbilical cord blood sampling of the fetus infection probably occurred within the past 2-4 months
54
If mom is dx with parvo B19 and is further along than 20 weeks gestation, what should you do next?
receive periodic ultrasounds (weekly) looking for signs of fetal hydrops Infants who survive should be given supportive treatment centered on management of hydrops. Aplastic crisis would require blood transfusions
55
What are the symptoms of Parvo B19 in infected kids?
fever, lacy rash, slapped cheeks
56
What organism causes syphilis? What type? How likely is the fetus to get it? **______ result in spontaneous abortion
Treponema pallidum Spirochete nearly 100% chance of passage to fetus **40% result in spontaneous abortion
57
If a baby is born with syphilis is it likely to be picked up on at birth? Is it transferred through breast milk?
NO! 2/3rds are asymptomatic at birth but start showing symptoms by 3 months of age NOT transferred through breast milk
58
What are the s/s of syphilis before 2 years old? **What is the highlighted symptom?
hepatomegaly **Nasal Discharge - “Snuffles” (persistent): may be white and may be bloody Rash Generalized LAD-lymphadenopathy Skeletal abnormalities
59
How does syphilis present after 2 years of age?
CNS abnormalities Abnormalities to bones, teeth, eyes, skin hutchinson's triad rhagades bowing shins saddle nose mulberry molars clutton joints
60
**What is Hutchinson's triad? What dz is it associated with?
interstitial keratitis 8th cranial nerve deafness Hutchinson’s teeth (smaller and more widely spaced with notches on biting surface)
61
What are rhagades? What dz are they associated with?
cracks and fissures around mouth and chin syphilis after 2 years old
62
What are mulberry molars? What dz?
round cusps on enamel on permanent first molars syphilis after 2 years old
63
What are clutton joints? What dz?
symmetrical joint edema/synovial inflammation syphilis after 2 years old
64
What is this? What dz?
hutchinson's teeth associated with syphilis after 2 years old
65
**How is syphilis diagnosed?
Serum quantitative nontreponemal titer more than fourfold the mother’s titer **Direct visualization of T. Pallidum by dark field exam from bodily fluids
66
**What is the tx for syphilis? **When do you need to repeat testing?
IV PCN Repeat antibody titers at 3, 6, 12 months to document falling titers
67
What is your percent chance of transplacental infection with syphilis if mom has active disease? What % of kids born with syphilis will show symptoms in the first 3 months ?
nearly 100% 2/3rd will show symptoms by 3 months old
68
What organism is responsible for chlamydia? How does it present in newborns?
Chlamydia Trachomatis conjunctivitis or pneumonia in newborns
69
______ is the most common cause of sexually transmitted genital infections in the US. What is the risk of passing it to the baby during vaginal birth?
chlamydia 50-70%
70
How does chlamydia present in a newborn?
bilateral conjunctivitis 5-14 days post delivery or pneumonia
71
**What is the gold standard dx for chlamydia?
isolation of C trachomatis by culture and need to swab both conjunctival and nasopharyngeal areas
72
What is the tx for chlamydia? Should you screen pregnant women for it?
oral (NOT TOPICAL) Erythromycin ALL preg pts should be screened for it at their first pregnancy visit
73
What organism is responsible for gonorrhea? What is the structure? What is the likelihood of transmission? When does the infection occur?
Neisseria Gonorrhoeae Gram negative diplococci 30-40% cases usually due to vaginal delivery usually within the first 5 days
74
How does gonorrhea present in the newborn? give 3 additional presentations
bilateral PURULENT conjunctivitis scalp abscesses, vaginitis and bacteremia
75
**What pt populations need to be screened for gonorrhea?
previous STD infection multiple sexual partners inconsistent condom use commercial sexual partners drug use those in communities with high prevalence of disease
76
_____ is used as neonatal gonorrhea prophylaxis. **What is the tx?
Erythromycin ophthalmic ointment **Single dose of Ceftriaxone (25-50 mg/kg, not to exceed 125 mg IM or IV)
77
How do you dx gonorrhea?
Gram stain of conjunctival exudate
78
What 3 ways can HIV pass from mother to baby? ______ can help decrease the rate of transmission.** ______ increases the rate of transmission
in utero, during birth or by breastfeeding antiretroviral tx breastfeeding increases the risk of transmission
79
**What is the screening/diagnosis pathway for HIV in a newborn? When is HIV considered excluded?
HIV DNA PCR <48 hrs of age, 2 weeks, 1-2 months, and at 2-4 months If 4 months and older with a neg PCR - HIV excluded
80
What is the tx for HIV infected newborn?
Antiretroviral prophylaxis (Zidovudine) for 6 weeks for infants born to HIV-infected mothers
81
What is the structure of Hep C? _____ is the primary source of ped infections. What is the rate?
small, single stranded RNA virus Vertical transmission **5% transmission rate from mother to baby; HIV increases risk
82
______ present in blood after 18 months of age is indicator for Hep C; confirmed with HCV RNA test. What is the tx?
Anti-HCV (HCV antibody testing) interferon and ribavirin
83
How does HPV present in children? What is the prevention?
May present as hoarseness in children later on in life Gardasil vaccine
84
What is the chance of transmitting Hep C to the baby ? ____ increases risk of transfer
5% transmission rate from mother to baby; HIV increases risk HIV
85
How is Zika syndrome transmitted? Why is it so detrimental to the fetus?
Arthropod-borne flavivirus transmitted by mosquitoes Maternal infection -> placental transmission -> virus targets neural progenitor cells in fetal brain - > kills progenitor cells
86
Microcephaly: severe with partial skull collapse Ventriculomegaly Thin cerebral cortices with subcortical calcifications Craniofacial disproportion Craniosynostosis optic nerve and retinal pathology retinal scarring sensorineural hearing loss Arthrogryposis Cardiac Abnormalities neurogenic abnormalities (hypertonia, spasticity, hyperreflexia, seizures/epilepsy) What am I?
Zika syndrome
87
What is Craniosynostosis? What dz?
skull sutures close too early and brain cannot grow Zika
88
What is Arthrogryposis? What dz?
congenital joint contracture or club foot
89
if _____ is positive then the baby has Zika
Serum + Urine for Zika RNA via PCR
90
if _______ and _______ are both negative then likely the baby does NOT have Zika. But if either are positive than it is probable
Serum Zika IgM CSF for RNA and IgM
91
______ is the primary screening tool for Congenital Zika Syndrome. What will a CT show?
head US is primary screening tool CT: calcifications
92
What is the tx for Zika?
no specific tx outline refer to: Ophthalmology w/in 1 month of birth Hearing screen - newborn (ABR preferred) Neurology, ID, Genetics, Development Labs - Zika detection, CBC, CMP, genetics
93
What is the protocol for infants born to Zika positive mother w/o clinical findings?
Head U/S and ophthalmologic exam and ABR hearing test by 1 month of age
94
What are the 3 major routes of perinatal infection that can lead to bacterial sepsis in the newborn? How will it present?
Bloodborne transplacental Ascending with disruption of the amniotic barrier (PRM) Infection via passage through birth canal Resp distress most commonly, then hypotension, acidemia, and neutropenia usually at LESS than 24 hours old
95
What is the MC pathogen for bacterial sepsis in the newborn?
group B strep
96
If the baby is under 10 weeks of age, _____ is the best way to assess temperature. What is considered a fever?
rectal temp Rectal temperature **100.4 degrees
97
**What is the tx for bacterial sepsis in the newborn? What part of the medication regimen is considered nephrotoxic?
Ampicillin and Cefotaxime (Claforan) OR Ampicillin and Gentamicin +/- acyclovir gentamicin is nephrotoxic!!
98

Pediatrics (24 decks)

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