05-06 Infections in Early Life

Question 1

What congenital infections do you worry about?

Answer 1

Toxo, VZV, Rubella, CMV, HSV/HepB/C/HIV, Enteroviruses, Syphilis

Question 2

Complications of congenital rubella syndrome?

Answer 2

Hearing impairment, heart defect, PDA, microceph, low birth weight, MR, purpura (PIC), retinopathy (PIC) and on and on

Question 3

Risk of maternal to fetal transmission w/o breastfeeding w/o tx?

Answer 3

25%

Question 4

Risk of maternal to fetal transmission WITH breastfeeding w/o tx?

Answer 4

40-50%

Question 5

What peripartum infx should you worry about?

Answer 5

HSV, GBS, E. coli

Question 6

Neonatal HSV Complications

Answer 6

encephalitis: can lead to CP

Question 7

Bugs that cause resp tract infx (airways) in kids?

Answer 7

RSV, para-flu, flu, human metapneumovirus

Question 8

Types of otitis media

Answer 8

1. secretory (transudate build-up)
2. Acute Suppurative Otitis (purulent exudate)
   3.

Question 9

Most common bugs causing Acute Suppurative Otitis Media in kids?

Answer 9

35% Strep pneumo
20% H. flu
15% Moraxella catarrhalis
<5% S. aureus

25% no org found

Question 10

Acute Suppurative Otitis Media
—Tx
—Major Adverse Outcomes if not tx’d

Answer 10

Watchful Waiting or give Rx w/ instructions to fill in two days if not better if reasonable in older infants/children (per AAFP)
— > 75% of cases resolve without therapy within 5-10 days

Antibiotic Therapy
—First line: amoxicillin
—2nd line:  amoxicillin + clav OR
                  cefpodoxime
                  cefuroxime
                  ceftriaxone
—Beta-lact allergy: clinda or azithro

Major Adverse Outcomes w/o Tx
—CHRONIC develops in 10% of untreated pts which leads to:
—CN V palsy
—mastoiditis -> brain abscess
—osteomyelitis of the petrous ridge of temporal b
—venous sinus thrombosis

Question 11

Which Ig’s cross the placenta?

Answer 11

Only IgG for the most part

—IgM does not, so can be used in dx in infants

Question 12

Congenital CMV Infx

Answer 12

1% of babies have detectable CMV infx at birth
—90% asx
—can cause sensorineural hearing loss in infancy

Question 13

Congenital infx timing

Answer 13

Early-to-mid gestation is more risky and can cause all kinds of crazy problems:
—fetal demise
—cardiac defects
—pretty much any abnormality imaginable

Acute Infx in late pg or close to birth
—No defects
—mild-to-severe dz
—present days-weeks post-partum

Subsequent Reactivation: infancy and childhood
—VZ
—HSV
—CMV

Question 14

Do C-sections lower the rate of HIV transmission in infants of un- or under-treated mothers?

Answer 14

yes

Question 15

Herpes Simplex in infants
—When?
—Severity?
—Is Rx effective?
—Presentation(s)
—Tx

Answer 15

Newborns susceptible 4-8wks
—reactivates from latent states
—high mortality
—Rx effective if started early

Presentations
**Vesicles may appear only later or never
—SEM: skin, eyes, mouth vesicles
—Disseminated: 29% mortality
    —sepsis-like jaundice
    —coagulopathy
    —pneumonia
—CNS only: lethargy, szs (4% mort)
—Congenital: vesicles, brain damage, microcephaly

Tx
—IV acyclovir

Question 16

Group B Strep
—When to screen?/How to tx?
—Early onset neonate ( < 7days old) sx?
—Later onset neonate (7-89 days) sx?
—Prevention

Answer 16

When to screen?/How to tx?
—Screen at 35-37 wks; tx w/ intrapartum abx if +

Early onset neonate ( < 7days old) Sx
—PNEUMONIA, sepsis, meningitis

Later onset neonate (7-89 days) Sx
—sepsis, meningitis

Prevention
—there’s a vaccine in the pipeline