EXAM #2: PERINATALLY ACQUIRED INFECTIONS

Question 1

What are the TORCHES infections?

Answer 1

1) Toxoplasmosis
2) Other
3) Rubella
4) CMV
5) Herpes/Hepatitis
6) Syphilis

Question 2

How is Toxoplasmosis acquired?

Answer 2

CATS via cat feces AND:

• Undercooked meat
• Uncooked eggs
• Unpasteurized milk

Question 3

What should pregnant mothers be told not to do?

Answer 3

Change the litter box

Question 4

How does the risk of Toxoplasmosis change with gestational age? How does the severity of Toxoplasmosis change with gestational age?

Answer 4

• Increased RISK with gestational age

- Decreased SEVERITY with gestational age

Question 5

What is the classic triad of CNS findings in perinatal Toxoplasmosis?

Answer 5

1) Hydrocephalus
2) Chorioretinitis
3) Intracranial calcifications (diffuse or speckled)

Question 6

What is chorioretinitis?

Answer 6

Inflammation of the posterior portion of the uveal tract and retina

Question 7

What two TORHCES infections have intracranial calcifications? What is the mnemonic to remember the difference?

Answer 7

CMV and Toxoplasmosis

• CMV= periVentricular
• ToXoplasmosis= diffuse

Question 8

How is the diagnosis of Toxoplasmosis made?

Answer 8

1) Head CT
2) Ophthamology exam
3) IgM or persistent IgG titers

Question 9

How is Toxoplasmosis treated post-natally?

Answer 9

1) Pyrimethamine
2) Sulfadiazine
3) Leucovorin
4) Corticosteroids

Question 10

What are the major clinical outcomes of Toxoplasmosis?

Answer 10

1) Mental Retardation
2) Seizures
3) Cerebral Palsy
4) Deafness

Question 11

What type of virus is Rubella?

Answer 11

Togaviridae

Question 12

What are the only known source of Rubella infection?

Answer 12

Humans

Question 13

What is the alternate name for Rubella?

Answer 13

German Measles (in adults)

Question 14

What is the most common vaccine preventable disease in the world?

Answer 14

Congenital Rubella Syndrome (CRS)

Question 15

What are the classic symptoms of CRS?

Answer 15

1) Deafness
2) Cataracts
3) Congenital heart disease

Question 16

What is the most common isolated sequelae of CRS?

Answer 16

Deafness

Question 17

What are the two most common heart defects associated with CRS?

Answer 17

1) PDA

2) Pulmonary stenosis

Question 18

How is CRS diagnosed? When does diagnosis need to be made?

Answer 18

• Must be done in the first year of life*
  1) Culture
  2) Serum IgM titers
  3) PCR

Question 19

What is the treatment for CRS?

Answer 19

There is no treatment; only supportive care

*This is preventable with vaccination

Question 20

What finding in the neonate should make you think CMV?

Answer 20

Jaundice

Question 21

What type of virus is CMV?

Answer 21

DNA, part of the herpes virus family

Question 22

What is the most common congenital infection in developed countries?

Answer 22

CMV

Question 23

What is the classic triad of symptoms in neonatal CMV infections?

Answer 23

1) Petechia/ecchymosis (Blueberry muffin rash)
2) Jaundice at birth or within a few hours*
3) Hepatosplenomegally

Question 24

When should a physiologic jaundice develop?

Answer 24

Days 2,3,4,or 5

Question 25

Where are intracranial calcification seen in CMV?

Answer 25

PeriVentricular

Question 26

How is CMV diagnosed?

Answer 26

1) Urine CMV 2) Serum IgM 3) Head CT

Question 27

What is the treatment for congenital CMV infections?

Answer 27

Gancyclovir

Question 28

What is the leading cause of childhood sensorineural hearing loss in developed countries?

Answer 28

Congenital CMV

Question 29

What is the presentation of disseminated congenital HSV?

Answer 29

Febrile ill-appearing neonate

Question 30

When does disseminated congenital HSV occur?

Answer 30

Before week 2

Question 31

What is SEM congenital HSV infection?

Answer 31

Skin-Eye-Mouth Vesicles found in those locations without disseminated disease

Question 32

When does SEM HSV occur?

Answer 32

Before week 1

Question 33

asdf

Answer 33

asdf

Question 34

How is HSV diagnosed?

Answer 34

1) Tzanck smear | 2) PCR

Question 35

What is a clue to congenital HSV infection?

Answer 35

Elevated LFTs

Question 36

What is the treatment for HSV?

Answer 36

Acyclovir

Question 37

How is congenital HSV prevented?

Answer 37

1) C-section with active lesions 2) Obtain culture if born with active lesions 3) Treat with ayclovir empirically

Question 38

If a mother is positive for Hepatitis B, what do you do?

Answer 38

1) Give HepB immunoglobulin | 2) HepB vaccine

Question 39

What are the early classic symptoms for congenital syphillis?

Answer 39

1) Mucocutaneous lesions 2) Lymphadenopathy 3) Rash 4) Snuffles 5) Metaphyseal Dystrophy 6) Periositis

Question 40

What are the late stage congenital syphilis findings?

Answer 40

1) Hutchinson teeth 2) Saber shins 3) Frontal bossing

Question 41

If the mother has gotten proper treatment for syphillis, what do you need to do for the infant?

Answer 41

Nothing

Question 42

If the mother has NOT gotten proper treatment for syphillis, what do you need to do for the infant?

Answer 42

PCN

Question 43

What should mothers with HIV not do post-natally?

Answer 43

Breastfeed

Question 44

How is congenital HIV diagnosed?

Answer 44

PCR

Question 45

When are neonates tested for HIV? What is a positive test?

Answer 45

2 weeks, 2 months, 6 months - Positive= 2x - Negative= 3x negative

Question 46

Should women be tested for HIV during pregnancy?

Answer 46

Yes

Question 47

What drug is given to babies of HIV infected mothers?

Answer 47

AZT