HRR: congenital infections

Question 1

What is a congenital infection?

Answer 1

An infection vertically transmitted from mother to fetus or neonate during pregnancy, childbirth, or via breast milk

Question 2

What is perinatal transmission?

Answer 2

Transmission from mother to child between 22nd week of gestation and 1 week after birth

Question 3

What are outcomes of congenital infection?

Answer 3

Permanent developmental defect, fetal death, consequences apparent only after perinatal period

Question 4

What is the main factor leading to adverse outcome of congenital infection?

Answer 4

Mother is experiencing the pathogen for the first time; this will mean pathogen numbers are higher and she has not been able to give transplacental antibodies to the fetus or neonate

Question 5

What does the timing of exposure during gestation have to do with the outcome of congenital infection?

Answer 5

Different pathogens have different tropisms, and developmental stages of tissues are different at various times in the pregnancy. Depending on the developmental stage at time of infection, the outcome may change

Question 6

What timing has worse outcomes in terms of infection transferred perinatally?

Answer 6

Late in pregnancy leads to worse outcome; this is due to the likelihood of high levels of pathogen

Question 7

What congenital infections pose the greatest risk in the first trimester?

Answer 7

CMV, rubella, toxoplasma gondii, zika

Question 8

What is true of all the congenital infections that pose the most risk in the first trimester?

Answer 8

They have tropism for neural tissue; the nervous system is developing during the first trimester, hence why these are a risk

Question 9

Which of the congenital infections in the first trimester may cause post-natal consequences only?

Answer 9

CMV and toxo

Question 10

Which of the congenital infections in the first trimester may cause fetal or perinatal death?

Answer 10

All of them

Question 11

Which of the congenital infections in the first trimester may cause permanent developmental defect?

Answer 11

All of them

Question 12

What is unique about CMV in terms of congenital infection?

Answer 12

It can be primary or reactivated and transmit placentally either way

Question 13

What is the most common intrauterine infection?

Answer 13

CMV

Question 14

What symptoms may congenital CMV cause?

Answer 14

Sensorineural hearing loss, cognitive impairment, retinitis that develop over months to years

Question 15

What is the most common outcome of congenital CMV?

Answer 15

Asymptomatic

Question 16

What is the most common cause of congenital deafness?

Answer 16

CMV

Question 17

How do we diagnose CMV?

Answer 17

PCR of infant saliva or anti-CMV IgM

Question 18

How do we treat CMV?

Answer 18

Valganciclovir, but won’t change outcome

Question 19

How can we prevent congenital CMV?

Answer 19

We can’t

Question 20

What permanent symptoms may congenital rubella cause?

Answer 20

Cataracts, deafness, heart defects

Question 21

What transient symptoms may congenital rubella cause?

Answer 21

“Blueberry muffin rash”, low birth weight, pneumonitis, hepatosplenomegaly

Question 22

What is unique about congenital rubella?

Answer 22

If happens to one kid, it won’t happen to the next! There is lifelong immunity following infection

Question 23

What is the most common cause of congenital deaf blindness worldwide?

Answer 23

Rubella

Question 24

How can we prevent congenital rubella?

Answer 24

Vaccination! Completely prevents deaf blindness from rubella

Question 25

What are symptoms of congenital toxo?

Answer 25

Chorioretinitis, intracranial calcification, and hydrocephalus. May also be asymptomatic at birth with learning and developmental disabilities occurring later

Question 26

What is true of re-infection after congenital toxo?

Answer 26

It won’t happen; if you have it once, you’re immune

Question 27

How do we prevent toxo?

Answer 27

Avoid exposures (cat litter, undercooked meat)

Question 28

What are the symptoms of congenital zika?

Answer 28

Microcephaly, brain damage, blindness, seizures, swallowing issues. Symptoms may worsen after birth.

Question 29

What are some ways we get zika?

Answer 29

Mosquito bites, blood transfusion, sex

Question 30

How do we prevent zika?

Answer 30

Mosquito control

Question 31

How do we treat zika?

Answer 31

We can’t as of now

Question 32

Which congenital infections pose the most risk in the second and third trimesters?

Answer 32

HepC, listeria, parvo, treponema pallidum, HIV

Question 33

When does HCV transmission from mother to child occur?

Answer 33

Late pregnancy or during birth

Question 34

What are the symptoms of congenital HepC?

Answer 34

No symptoms during initial infection

Question 35

How do we prevent HepC?

Answer 35

No real method

Question 36

What are the symptoms of congenital listeria?

Answer 36

Miscarriage, stillbirth, serious fatal infection in newborn

Question 37

How do we prevent listeria?

Answer 37

Avoid unpasteurized dairy or deli meats during pregnancy

Question 38

How do we diagnose listeria?

Answer 38

Culture of blood, CSF, amniotic fluid

Question 39

What are the symptoms of congenital parvo?

Answer 39

Fetal anemia, cardiac failure, hydrops fetalis!!

Question 40

When is risk of transmission of parvo highest?

Answer 40

First or second trimester when P-antigen is high

Question 41

What are symptoms of congenital syphilis?

Answer 41

Stillbirth, prematurity, thick/pale placenta, hepatomegaly, maculopapular rash 2-3 weeks after birth, rhinitis

Question 42

How do we prevent congenital syphilis?

Answer 42

Penicillin G early in pregnancy

Question 43

When is risk of congenital syphilis transmission highest?

Answer 43

The last 4 months of pregnancy

Question 44

Describe risk of transmitting early syphilis in pregnancy.

Answer 44

If it is primary or secondary, there is a 60-90% chance. If it is latent, around 40% chance

Question 45

Describe risk of transmitting late syphilis in pregnancy.

Answer 45

Risk of transmitting late latent syphilis steadily decreases over time to less than 2% after 2 years

Question 46

What are symptoms of congenital HIV?

Answer 46

Poor weight gain and opportunistic infection

Question 47

Can we prevent congenital HIV?

Answer 47

Yes! Suppress maternal viral load, C section by 38 weeks if virus is detectable antiretroviral treatment of newborn, no breastfeeding if virus is detectable

Question 48

What infections pose risk during birth and perinatal period?

Answer 48

Group B strep, HSV, varicella, HBV, HIV, gonorrhea, trachomatis, HPV

Question 49

What are symptoms of group B strep in newborns?

Answer 49

third trimester stillbirth, neonatal infection

Question 50

How does neonatal infection with group B strep usually occur?

Answer 50

ascending infection from the vagina into the amniotic fluid after onset of labor

Question 51

When does group B strep show up after birth?

Answer 51

1-90 days following

Question 52

What are symptoms of HSV and varicella?

Answer 52

severe systemic infection and vesicular skin lesions

Question 53

When is transmission of HSV and VSV most likely?

Answer 53

If the mother is experiencing primary infection at the time of birthing process

Question 54

What are symptoms of congenital HBV?

Answer 54

asymptomatic, but super high risk of chronic HBV infection and lifetime risk of hepatocellular carcinoma

Question 55

Can c section prevent congenital HBV?

Answer 55

nope, due to blood exposure

Question 56

How can we prevent congenital HBV?

Answer 56

vaccination before conception, passive/active vaccination at birth, treatment of mothers with high viral loads in the third trimester

Question 57

What marker shows high viral HBV load?

Answer 57

E antigen

Question 58

At what point is congenital HBV transmitted?

Answer 58

almost exclusively at the time of parturition

Question 59

Describe prevention of perinatal gonorrhea.

Answer 59

babies get topical erythromycin in the eyes at birth to prevent associated neonatal conjunctivitis

Question 60

What are signs of disseminated gonorrhea in neonates?

Answer 60

sepsis, arthritis, meningitis

Question 61

Describe congenital chlamydia.

Answer 61

conjunctivitis 5-14 days after birth

Question 62

How do we treat congenital chlamydia?

Answer 62

azithromycin (ointment in the eyes won’t help unlike gonorrhea)

Question 63

Describe congenital trachomatis pneumonia.

Answer 63

may show symptoms 4 weeks post-birth, often preceded by conjunctivitis.

Question 64

What are lab findings in trachomatis?

Answer 64

Peripheral eosinophilia with normal total WBC

Question 65

What are symptoms of congenital HPV?

Answer 65

Symptomatic at birth, but hoarseness and warts of the larynx at age 2-5

Question 66

What are the most common serotypes of congenital HPV?

Answer 66

6 and 11

Question 67

What are rare manifestations of congenital HPV?

Answer 67

Spread to lungs and malignant transformation if it is an aggressive serotype

Question 68

How do we prevent congenital HPV?

Answer 68

Gardasil in the mom