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Perinatal Infections Flashcards

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1
Q

What are the ToRCHES infections?

A 
Toxoplasmosis
Other
Rubella
CMV
HSV/Hep/HIV
Syphilis
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2
Q

What are the common ssx of torches infx?

A
  • SGA or IUGR
  • Thrombocytopenia
  • Jaundice/HSM
  • Microcephaly
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3
Q

Where is Toxoplasma acquired from?

A
  • Cat feces
  • Undercooked meat
  • Uncooked eggs
  • Unpasteurized milk
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4
Q

What should women never do when pregnant?

A

Change the cat litter box

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5
Q

Is there a prenatal screen for toxoplasmosis?

A

No

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6
Q

Is there a risk of transmission of toxo for a secondary or primary infection?

A

Primarily only

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7
Q

When in pregnancy is the will toxo have the most severe effects?

A

1st trimester

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8
Q

What happens to the chances of transmitting toxo with increasing gestational age? What about severity?

A

Risk of transmission increases

Severity decreases

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9
Q

Vertical transmission of toxoplasmosis infection is most likely to occur in what trimester?

A

2nd and 3rd

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10
Q

True or false: the majority of newborns with congenital toxo lack clinical signs

A

True

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11
Q

What is the classic triad of congenital toxoplasmosis? (3)

A
  • Hydrocephalus
  • Chorioretinitis
  • Intracranial calcifications
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12
Q

What are the later signs of toxoplasmosis?

A

Seizures

Hearing loss

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13
Q

What is chorioretinitis? S/sx?

A

Inflammation of the posterior portion of the uveal tract and retina

Manifests as blurry vision, retinal detachment, or glaucoma

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14
Q

What are the characteristics of calcifications (CMV and toxo)?

A

V if periventricular, but this is CMV

X (diffuse) in toxo

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15
Q

How do you diagnose toxoplasmosis? (4)

A
  • Serum IgM or persistent IgG
  • Fundoscopic exam
  • Head CT
  • LP
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16
Q

What is the treatment for toxoplasmosis? (4)

A
  • Pyrimethamine
  • Sulfadiazine
  • Leucovorin
  • Corticosteroids
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17
Q

True or false: you should treat babies for ANY known or suspected toxoplasmosis infection, even if asymptomatic

A

True

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18
Q

Can you treat mothers in pregnancy for toxo?

A

Yes

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19
Q

What is the incidence of MR and seizures with toxoplasmosis? Deafness?

A 
MR = 87%
Seizures = 82%
Deafness = 15%
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20
Q

What percent of adults are susceptible to Rubella?

A

10%

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21
Q

What is the viral family of Rubella?

A

Togaviridae

+ssRNA

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22
Q

What are the ssx of Rubella infections in adults?

A

Mild cold

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23
Q

What is the colloquial name for rubella?

A

German measles

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24
Q

How does rubella spread?

A

Respiratory droplets

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25
What is the most common vaccine-preventable disease in the world?
Rubella
26
Is prenatal screening for Rubella recommended?
Yes
27
What happens to the severity of congenital rubella infection as gestational age increases?
Decreases
28
Maternal infection with Rubella from how many months before may cause neonatal infection?
1 month before conception
29
What are the four major organ systems affected with congenital rubella syndrome?
Eyes Heart Brain Ears
30
What is the most common sequelae of congenital Rubella?
Hearing loss
31
What is the classic triad of congenital Rubella syndrome?
- Deafness - Cataracts - Congenital heart disease
32
What are the two common congenital heart defects that can occur with congenital Rubella syndrome?
PDA | Pulmonary stenosis
33
When can congenital Rubella infection be definitively diagnosed?
First year of life
34
What is the treatment for congenital Rubella?
There is none
35
How do you follow Rubella? (3 lab tests)
- Serum IgM - IgG - PCR
36
What is the most common presentation of congenital CMV?
Jaundice
37
What is the viral family of CMV?
Herpesviridae--dsDNA
38
What is the most common congenital infection in the Developed world?
CMV
39
Is transmission of CMV more common with primary or reactivations ?
Primary, but can be way of reactivations as well
40
Is there prenatal screening for CMV?
No
41
What percent of all newborns are infected with CMV?
1%
42
What percent of CMV infected infants will have severe involvement? A developmental delay? Die?
- 10% will have severe involvement - 4-30% with severe involvement with die - 75% have Neurologic problems
43
When should physiologic jaundice develop? When should it subside?
A few days after birth--NOT at birth or within 24 hours. Should subside after a week-ish
44
What is the classic rash associated with CMV?
Blueberry muffin rash
45
When in pregnancy will the infant have the most severe consequences?
1st
46
What percent of pregnant women with primary CMV remain asymptomatic?
90%
47
What are the three most common s/sx of CMV?
- Petechiae/ecchymosis - Jaundice at birth or within a few hours - HSM
48
What are the head CT findings with congenital CMV?
PeriVentricular calcifications
49
What is the treatment for CMV?
Ganciclovir
50
How do you diagnose CMV infections?
Urine culture
51
What is the leading cause of sensorineural hearing loss in developed countries?
CMV
52
What fraction of hearing loss from CMV is found at birth?
1/3
53
When is transmission of HSV more common from mother to fetus (primary/secondary? Symptomatic asymptomatic)?
Primary and symptomatic infections most common, but can occur with either
54
Can HSV be transmitted in mothers who have secondary asymptomatic infections?
Yes, but not as bad as primary symptomatic
55
What percent of congenital HSV is acquired from the maternal genital tract?
85%
56
Which is more important in the diagnosis of HSV infected infants: history or physical?
Physical, since most infections asymptomatic
57
What are the ssx of congenital herpes?
- Disseminated disease - skin s/sx followed by poor feeding, lethargy - Liver and lung involvement
58
When do most ssx present with congenital HSV?
3 days of age, but for sure before 4 weeks of age
59
What is the incidence of CNS disease with HSV? S/Sx?
1/3 of cases | Irritability, lethargy, poor feeding, seizures
60
How do you diagnose herpes?
Culture from vesicles, mucous membranes
61
What fraction of congenital herpes present with skin s/sx? CNS involvement? What is the significance of this?
20% SEM 30% CNS CNS does not have skin s/sx, so difficult to diagnose
62
Is there a treatment for HSV?
Acyclovir
63
Before what timeframe will congenital HSV present?
Within 4 weeks
64
What should be done if a mother is about to deliver, and has an active HSV-2 outbreak?
C-section
65
What is the mortality of congenital HSV with treatment? What are the sequelae if they survive?
20% | -Microcephaly, seizures, deafness, blindness etc
66
What presentation of HSV has the worst prognosis?
Disseminated
67
What is the viral family of Hep B?
dsDNA (Hepadnaviridae)
68
What is the viral family of Hep A?
Picornaviridae
69
What is the viral family of Hep C?
Flaviviridae
70
What is the viral family of Hep D?
Deltavirus--family remains unassigned
71
What is the viral family of Hep E?
Hepeviridae
72
True or false: transmission of syphilis can occur at any stage of the infection
True
73
What are the three stages of syphilis?
1. Painless ulcers 2. rash and fever 3. Gummas and CNS
74
True or false: neurosyphilis can occur at any stage of infection
True
75
Hutchinson teeth = ?
Congenital syphilis
76
What is the classic ssx of syphilis
Snuffles
77
What is the mortality of congenital syphilis?
40%
78
What are the nose findings of syphilis?
Saddle nose
79
What are the 3 major clinical s/sx of syphilis?
- Snuffles - Metaphyseal dystrophy - HSM/jaundice
80
What are the characteristics of x-ray findings of congenital syphilis?
Metaphyseal dystrophy
81
Is there prenatal screening for syphilis? Should you treat the baby even if the mother has a negative VDRL near birth?
Yes | No need to treat if mother was negative
82
How do you diagnose congenital syphilis?
VDRL RPR Confirm with treponemal test
83
What is the treatment for congenital syphilis in the neonate?
PCN
84
What is the viral family of HIV?
retroviridae
85
What are the three major infections in which PCN is still useful?
- GAS - GBS - Syphilis
86
What is the risk of HIV infection in seropositive mothers?
25-30%
87
When do symptoms present with congenital HIV? Are there sepsis like s/sx?
12-18 months | Does not present like sepsis
88
How do you diagnose HIV?
PCR
89
How many positive tests do you need to have with HIV?
2 positive tests or 3 negatives
90
What is the treatment for HIV?
Perinatal AZT

Infectious Disease (18 decks)

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