neonatal infections

Question 1

which two microbes can cause intracranial calcifications in utero?

Answer 1

toxoplasmosis (diffuse; also hydrocephalus)

CMV (periventricular; also microcephaly)

Question 2

which two microbes can cause chorioretinitis?

Answer 2

toxo + CMV

Question 3

which two microbes can cause cataracts?

Answer 3

rubella + HSV2

Question 4

which microbe can cause congenital cardiac dz?

Answer 4

rubella (pda or pulm. vasculature hypoplasia)

Question 5

which two microbes can cause bone lesions?

Answer 5

syphilis (saber shins)

rubella

Question 6

which 3 microbes can cause vesicles in neonates?

Answer 6

HSV
VZV
Syphilis

Question 7

which microbes cause congenital infections which are not apparent?

Answer 7

HIV (>99%)
CMV (>90%)
Toxoplasmosis (75%)
Rubella (60-70%)
Syphilis (>50%)

Question 8

what is the mechanism explaining why moms with HIV have higher rate of fetal syphilis infection?

Answer 8

1. cellular immune dysfunction permits higher treponemal prolif.
2. HIV-infected women may not respond to therapy

Question 9

explain how untreated syphilis during pregnancy with an HIV can cause higher rates of fetal HIV infection?

Answer 9

1. placentitis causes increased transmission of virus from maternal to fetal circ.
2. direct induction of gene expression in mphages

Question 10

what is best way to evaluate and treat mothers who might have syphilis when pregnant?

Answer 10

test mother’s serological status prior to discharge

infant or cord serum is inadquate

Question 11

what is the mandatory screening test for syphilis in pregnant women?

Answer 11

mandatory serum RPR at least once during pregancy; twice in high risk populations

Question 12

what is the risk of transmission of HIV if mother’s viral load is undetectable at time of delivery?

Answer 12

<1%

Question 13

what is the most effective way to decrease perinatal transmission of HIV?

Answer 13

prenatal diagnosis and treatment (can decrease by ~75%)

Question 14

how do you diagnose HIV in neonates and infants?

Answer 14

use viral culture and PCR (serology doesnt work)

Question 15

which torch microbe: in neonate chorioretinitis, hydrocephalus and intracranial calcifications?

Answer 15

toxoplasma gondii

Question 16

which torch microbe: in neonate PDA ( or pulm. artery hypoplasia), cataracts, & deafness +/- blueberry muffin rash, and microcephaly

Answer 16

rubella

Question 17

name the torch microbe: in neonate hearing loss, seizures, petechial rash, blueberry muffin rash, periventricular calcifications

Answer 17

CMV

Question 18

name the torch microbe: in neonate-recurrent infections, chronic diarrhea

Answer 18

HIV

Question 19

name the TORCH microbe:encephalitis, vesicular lesions

Answer 19

HSV2

Question 20

name the TORCH microbe: in neonate-often stillbirth, hydrops fetalis; facial abnormalities (notched teeth, saddle nose, short maxilla), saber shins, CN VIII deafness

Answer 20

syphilis

Question 21

when is mom most likely to give baby CMV infection?

Answer 21

primary maternal infection

-leads to fetal infection 30-50% of cases (10-15% have overt clinical dz)

Question 22

what is the most common sequelae for congenital CMV infection?

Answer 22

neurological is MC

-note: a lot of newborns w/ asymptomatic congenital CMV infection develop neurological sequelae (HEARING LOSS)

Question 23

when do neonates typically acquire CMV infections?

Answer 23

POSTNATAL > natal > prenatal (frequency)

Question 24

which type of herpes causes genital herpes?

Answer 24

HSV2

Question 25

which pts have high incidence of HSV2?

Answer 25

lower SES

Question 26

when do neonates typically get perinatal HSV infections?

Answer 26

Intrapartum (natal) > 85% Postpartum (post-natal) 10% Intrauterine (prenatal) <5%

Question 27

neonates born to women with __________ genital HSV infection are at high risk of perinatal infection

Answer 27

primary genital HSV infection

Question 28

what is the greatest impact of therapy for perinatal HSV infections?

Answer 28

to prevent dissemination in neonates with skin-eye-mouth dz (w/ acyclovir)

Question 29

what happens if skin-eye-mouth dz of perinatal HSV infection is left untreated?

Answer 29

likely to disseminate to brain + viscera | note: dissemination has > 80% mortality

Question 30

if you see neonate with meningitis or evidence of encephalitis you must consider what diagnosis?

Answer 30

perinatal HSV infection

Question 31

describe the csf findings in a neonate with perinatal HSV infection?

Answer 31

``` lymphocytic pleocytosis (early) elevated Protein (later) occasionally hemorrhage ```

Question 32

__________ mothers may have mothers may have primary dz (perinatal HSV infection) and this is a great risk to baby

Answer 32

seronegative

Question 33

when is HepB transmitted to neonates?

Answer 33

at time of birth

Question 34

how do you treat HepB in pregnant moms?

Answer 34

give HBIG & vaccine to newborn as early as possible (~12-24 hrs)