Fetopathies Flashcards
(53 cards)
1
Q
Route of infection in Toxoplasmosis
A
- fecal-oral (from cat feces)
- contaminated water or soil, inadequatly cooked meat
- transmission to embryo via placenta or during birth
- mother can have acute infection or chronic if she is immunocompromised
- The older the fetus, the higher the risk of fetal transmission
2
Q
Clinical manifestations of congenital toxoplasmosis
A
FIRST TRIMESTER
- death, ophthalmologic and central nervous system consequences
SECOND TRIMESTER
- Classic triad (hydrocephalus, intracranial calcifications, chorioretinitis)
- rash (blueberry muffin)
- hepatosplenomegaly
- anemia
- lymphadenopathy
- microcephaly
- developmental delay
- visual problems and hearing loss
- seizures
THIRD TRIMESTER
- common, but often asymtpomatic at birth
3
Q
Diagnosis of toxoplasmosis
A
IN FETUS
- Amniocentesis –> PCR
- maternal ELISA
IN BORN CHILD
- ophthalmologic examination
- CT
- Examine CSF for elevated protein and pleocytosis
4
Q
Treatment of Toxoplasmosis
A
IN FETUS
- if mother is infected, but not fetus –> spiramycin to prevent infection
- when fetus is infected: give mother a combination of pyrimethamine, sulfadiazine, and folinic acid
BORN CHILD
- Pyrimethamine, sulfadiazine and folinic acid for at least 1 year
- if there is elevated protein concentration in CSF or severe chorioretinitis –> we can add corticosteroid like prednisolone
5
Q
Congenital syphilis
- general information
A
- caused by T. pallidum
- transmitted via placenta
- can lead to spontaneous abortion, stillborth or to congenital syphilis
- can be infected at any developmental age
6
Q
Classification of congenital syphilis
A
early congenital syphilis
–> develops in perinatal period, up to two years of age
Late congenital syphilis
–> develops after 2 years
7
Q
Early congenital syphilis presentation
A
- vesiculobulbous eruptions
- maculopapular rash on palms, soles, nose, mouth and in diaper area
- lymphadenopathy, hepatosplenomegaly
- failure to thrive, fever, pneumonia
- blood-stained nasal discharge
- meningitis, choroiditis, hydrocephalus, seizures
- ascites
- within first 8 months: osteochondritis of the long bones and ribs can occur
8
Q
Late congenital syphilis presentation
A
- gummatous ulcers (nose and septum)
- Hutchungton’s triad
1- Syphilitic keratosis
2- syphilitic conjunctivitis
3- Hutchington’s teeth - clutton’s joints, saddle nose, saber shins, high palate, palate perforation, frontal bone protusion, short maxilla, mandible protrusion
9
Q
Diagnosis of early congenital syphilis
A
- clinical examination
- dark-field microscope
- lumbar puncture for CSF analysis
- Long bone and cest X-ray –> wimberger sign (symmetric erosions of upper tibtia and long bones)
- serologic testing
- -> treponemal test
- -> non-treponemal test
If NTT antibody titer >4 times the maternal titer, it indicates in most cases syphilis
10
Q
Diagnosis of late congenital syphilis
A
- clinical history and examination
- positive serologic tests (same as in early CS)
- Hutchington’s triad is indicative
- poritive fluoroscent treponemal antibody absorption test
11
Q
Treatment in early CS
A
- benzathiene benzylpenicillin G (BPG)
- alternatives: doxycycline, ceftriaxone, azithromycin
12
Q
Treatment in late CS
A
- BPG
- if allergig: penicillin desensitization or doxycycline
13
Q
Neurosyphilis treatment
A
- Benzylpenicillin
- second choice: ceftriaxone, probenecid
14
Q
Treatment of CS in pregnancy
A
for early syphilis
- erythromycin
- azitromycin
- ceftriaxone
For late:
- erythromycin
DO NOT GIVE DOXYCYCLINE
15
Q
Herpes simplex virus
- route of infection
A
- direct contact with infected lesions or mucosa
- neonates most oft4en thorugh an infected vaginal canal during birth
- c-section reduces risk of infection if there is active maternal sheddign of HSV
16
Q
Herpes simplex virus
- clinical manifestations
A
- will present in firt 6 weeks of life
- presents in one of three ways:
- Neurological symptoms: meningoencephalitis (mostly after 10-14 days)
- Systemic symptoms: major overwhelming illnes including shock, respiratory failure and severe haptitis and coagulation disorders, sometimes meningoencephalitis
- Cutaneous symptoms: rash, blisters and keratoconjunctivitis in second week of life
17
Q
Herpes simplex virus
- complications
A
- unctreated –> high morbidity and mortality
- recurrent skin outbreaks despite treatment
- neurologic outome for infants with CNS disease, even with treatment
18
Q
Herpes simplex virus
- diagnosis
A
- serum HSV IgM
- HSV PCR
- HSV culture of a lesion
19
Q
Herpes simplex virus
- treatment
A
- IV acyclovir
20
Q
Rubella
- route of infection
A
- contact wiht respiratory secretions and transplacentally
21
Q
Rubella
- clinical manifestations
A
- blueberry muffin rash
- lymphadenopathy
- hepatosplenomegaly
- thrombocytopenia
- interstitial pneumonitis
- intrauterine growth restriction
- infection after 12 weeks may have no clinical manifestations but is more likely to resilt in futre hearing loss and visual problems
- eye problems: microphthalmos, pigmentary retinopathy, cataracts and congenital glaucoma
- cardiac: pulmonic stenosis, patent ductus arteriosus
- Endocrine: DM
- Neurologic: developmental delay, encephalitis, hearing loss
22
Q
Rubella
- diagnosis
A
- virus can be isolated from blood, urine, CSF, oral and nasal secretions –> culture
- serologic tseting for rubella-specific IgM and IgG in pregnant woman
- rubella-specific IgG positive, considered immune
23
Q
Rubella
- treatment
A
- prevented by maternal vaccination, 2 doses of MMR vaccine
- no treatment of rubella outside of supportive measures
24
Q
Varizella-Zoster Virus (VZV)
- route of infection
A
- respiratory droplets
- direct contact with skin lesions
- congenital varicella: transplacentally
25
VZV clinical manifestations
- early symptoms: cold symptoms, fever, abdominal pain, headaches, general malaise
- infection transmitted under 20 weeks: risk of fetus developing congenital varicella syndrome --> skin scarring, eye abnormalities, limb hypoplasia, cortical atrophy and microcephaly
- infection a week beofre or up to 28 days: high risk of fatal varicella
- Zoster immunoglobulin should be given immediatly to infants at high risk of congenital varicella
26
VZV diagnosis
- should be suspected in mother who presents with typical signs
- in an infant who presnts with typical vesicular lesions --> PCR or direct fluoroscent antibody of the fluid
- serology-speficic IgM and IgG antibodies in blood
27
VZV treatment
- pregnant women --> acyclovir
- infants born with congenital varicella --> acyclovir and varizella-zoster immunoglobulin
- vaccine (but not in pregnant women)
- pregnant women who are exposed to VZV_ varizella-zoster immunoglobulin
28
Cytomegalovirus (CMV)
| - route of infection
- saliva
- genital secretions
- breast milk
- blood products
- transplacentally
29
CMV
| - clinical presentation
- most infants are asymptomatic at birth
- petechiae
- jaundice
- hepatosplenomegaly
- thrombocytopenia
- small size
- microcephaly
- intracranial calcifications
- sensironeural hearing loss
- chorioretinitis
- seizures
30
CMV
| - diagnosis
PRENATAL
- Ultrasound
- Amniocentesis
- Fetal blood sampling for IgM
POSTNATAL
- PCR or viral isolation in newborns under 3 weeks of age
- clinical signs
- liver panel: increased liver transaminases and bilirubin
- Blood count: thrombocytopneia and decreased platelets
- neuroimaging: calcifications, enlarged ventricles, polymicrogyria, lenticulostriate vasculopathy, white matter disease
31
Long term consequences of CMV
- hearing loss
- neurodevelopmental disablities
- cerebral palsy
- intellectual disability
- seizures
- ocular damage
32
CMV
| - prevention and treatment
- hygiene measures for mothers
- pregnancy titers to identify at risk mothers
- ganciclovir, valganciclovir (oral)
- IV ganciclovir
- no vaccine available
33
Diabetic embryopathy
| up to 9th week of gestation
- heart defects, skeletal defects, neuronal tube defects
| - can be improved with pre-conception glycemic control
34
Diabetic fetopathy
| from 9th week of gestation
- macrosomia in the 3rd semester
- birth weight over 4000g
- increased risk for labor complications: shoulder dystocia, asphyxia, birth injury
- transient hypoglycemia, congestive heart failure
35
late onset neonatal sepsis
| - diagnosis
- blood culture
- PCR
- serum inflammatory biomarkers
- monitoring of physiological data, heart rate
36
Hematologic scoring system (HSS)
Based on follwing severn criteria:
- high values of total leukocyte count
- high PMN level
- elevated immature PMN count
- Elevated immature to total PMN ratio
- Immature to mature PMN ratio > 0.3
- platelet count > 150.000/mm3
- pronounced degenerative changes in PMNs
score > 2 --> likelyhood of sepsis
37
IL6 and IL8 in late neonatal sepsis
- they can be detected in blood early
| - short half life
38
CRP in late neonatal sepsis
- best diagnostic marker
39
Pro-calcitonin and presepson in late neonatal sepsis
- more specific than CRP in bacterial infections
40
Additional investigations in late neonatal sepsis
- chest x-ray
- blood gas
- renal function test
- liver function test
- coagulation profile
41
late neonatal sepsis
| - clinical presentation
- depends on virulence of pathogens
- body temperature may be elevated or depressed
- mtoro functions are reduced
- delayed weight gain
- pale skin
- reduction of activity
- cyanosis, apnea, tachycardia, bradycardia, hypotension
- jaundice sometimes only symptom
- CNS: drowsiness, irritability, lethargy, conculsions, increased tension at fontanelles
- GI: vomiting, diarrhea, anorexia, abdominal distension
- Cardiac: bradycardia, tachycardia, poor perfusion
- oliguria and anuria
42
late neonatal sepsis
| - treatment
- empiric therapy until identification of the casative therapy
- usually vancomycin and an Aminoglycoside
- duration from 7 to 21 days
- supoortive therapy
43
late neonatal sepsis
| - prevention
- universal GBS screening of all pregnant wimen at 35-37 weeks of gestation
- penicillin, ampicillin, cezazolin or clindamycin at least 4 hours before delivery
- breastfeeding
- administration of lactoferrin
- probiotics
44
late neonatal sepsis
| - definition
- onset of manifestation after 72 hours of life
- during first 3 months: innate immune system provides defence against pahtogens
- Decreased function of neutrophils and lower concentration of immunoglobulins increase
susceptibility of infections.
45
late neonatal sepsis
| - transmission
- horizontla: postnatally from hospital environment or from community
- hand contamination is most common
- parturition
46
late neonatal sepsis
| - risk factors
- poor hygiene
- low birth weight
- prematurity
- invaisve ventilation
- prolonged use of antibiotics
- breakage of natural barriers
- H2 receptor antagonists
47
late neonatal sepsis
| - microorganisms
```
Group B streptococcus and coagulase negative staphylococcus (S.aureus, especially in
neonates with vascular access catheters)
• Gram negative organisms
• Gram positive organisms
• Acinetobacter spp
• Klebsiella
• E. coli
• Candida spp. (Candida parapsilosis)
• Herpes simplex virus
• Enterovirus
```
```
Infrequent
• Streptococcus pyogenes
• Neisseria gonorrhoeae
• Enterococcus faecalis
• Streptococcus pneumoniae
```
48
Early onset neonatal sepsis
| - definition
- day 0-3
- most present in first 24 hours
- most rapid onset is in premature neonates
49
Early onset neonatal sepsis
| - route of infection
- blood, placenta, ascending cervical infection
- neonate bay be exposed to mother's Genitourinary tract during birth (Group B streptococci, E. coli, coagulase negative staphylococci, H. influenza, L. monocytogenes)
50
Early onset neonatal sepsis
| - prophylaxis
- intrapartum prophylactic antibiotic treatment in mothers
- GBS screening in weeks 35 and 37
- culture obtained with vaginal and anal swabs
- delivering baby wihtin 12 to 24 hours of then membrane breaks
51
Early onset neonatal sepsis
| - treatment
- combination of IV glycosides with expanded spectrum penicillin
- specific antibiotics are chosen based on mothers history and trends of organism colonization and susceptibility
52
Early onset neonatal sepsis
| - diagnosis
- blood tests: CBC, CPR, blood culture
- skin and stool cultures
- lumbar puncture (CSF)
53
Early onset neonatal sepsis
| - clinical presentatio
- general: lethary, hypothermia, poor feeding
- non-specific signs: anuria and acidosis
- Respiratory symptoms: apnea, tachypnea, nasal flaring
- Cardiac symtpoms: cyanosis, desaturation, bradycardia
preterm infants: apnea, bradycradia, cyanosis as first signs
