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pediatrics > 18. Intrauterine infections of the newborn > Flashcards

18. Intrauterine infections of the newborn Flashcards

1
Q

what re the things to consider about congenital infections?

A

first trim usually the most dangerous time

infection of the mother might by trivial symptoms so the condition usually goes undiagnosed

infection in the motor does not always mean the baby is affected

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2
Q

some infection can be avoided by the mother through what

A

simple measures such as immunisation = rubella , varicella zoster virus during childhood or before pregnancy

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3
Q

some infections are treatable in intrauterine infections which are they ?

A

syphilus

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4
Q

what re the virus congenital infectious agents ?

A 
CMV *
HSV *
erythrovirus  B19 
enterovirus 
Hep B *
VZV *
HIV 
rubella *
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5
Q

what are the bacterial congenital infectious agent ?

A 
trepanoma pallidum *
mycobacterium tuberculosis 
salmonella typhus 
listeria monocytogenes 
campylobacter fetus 
borrelia burgfordi
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6
Q

what are the fungal agents for congenital infections ?

A

candida albicans

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7
Q

what re the parasitical agents for congenital infections ?

A

toxoplasma gondii *
plasmodium
trypanosome cruz

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8
Q

what Lethe most common organism giving infections ?

A

TORCH

one with the asterisk

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9
Q

pregnant women are exposed to these congenital infection through what ?

A

association with young children

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10
Q

congenital infection can result in ?

A

death and resorption

abortion and still birth

live birth of premature

term infant with abnormality

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11
Q

in survived congenital infection , the babies usually show which classical signs ?

A

low birth weight
developmental abnormalities
congenital infections persisting after even birth sometimes

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12
Q

what are the most common characteristics of rubella in born children ?

A

low birth weight and in utero growth retardation

cataracts , retinopathy ,

congenital malformation
cardiac - patent ductus arteriosus pulmonary stenosis

neurological - meningoencephalitis , mental retardation and behavioural changes motor change

liver associated - hepatosplenomegaly , early onset of jaundice , and

transitory
thrombocytopenia = purpuric skin lesions = blueberry muffin appearance from dermal erythropoeisi
and hepatitis

osteogenesis - radiolucent bones

later presenting features 
auditory - hearing loss 
diabetes mellitus 
glaucoma
mental retardation
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13
Q

why should infants with rubella be isolated ?

A

because they are still infectious for 1 year and shed live virus

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14
Q

what is the diagnosis of rubella

what is the treatment for congenital rubella ?

A

virus cultures from nasopahryengal swabs , urine , csf

csf examination - increased protein ratio
encephalitis

serological studies may be helpful - but disease itself can cause immunology aberration and delay in IgM and IgG production

radiological

no specific antiviral agent is currently available for rubella

vaccine should NOT be given to already pregnant women

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15
Q

are babies with rubella virus premature births ?

A

no

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16
Q

what is the most common pathogen of inutero infection

A

cytomegalovirus

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17
Q

rubella is most infectious at what stage of pregnancy

A

first trimester 1-12 weeks !

then third trimester = 60 percent
31-36 weeks

last month of pregnancy = 100 percent

however incidence of fetal effects is greater with earlier infections

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18
Q

in cmv the fetal damage is severe in ?

A

any stage of pregnancy the

but greatest risk at 22 weeks

earlier the mother contracts the infection the more severe the presentation

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19
Q

only 10 percent of babies born with CMV are symptomatic at birth , what are the symptoms ?

A

symptomatic at birth 10 percent

in utero growth retardation , low birth weight

hepaosplenomgealy , jaundice ,petechia

microcephaly
necrotic encephalitis
periventricular calcifications

chorioretinitis

developmental abnormalities

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20
Q

10 percent of babies born with cmv are asymptomatic and develop late complications such as

A

10 percent asymptomatic late complications :
deafness - [rogressive and can effect both ears
intellectual disability / mental retardation
seizures

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21
Q

what are the agents which are no perisirant postnatally ?

A

enterovirus

erythrovirus b19

listeria monocytogens

campylobacter fetus

salmonella typhus

b burgdoferi

trypansoma cruzi

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22
Q

CMV can be given to the baby after birth through what way ?

A

contact with genital secretion at delivery

through breast milk

however they result in no clinical manifestations

breast feeding is still advised as the benefits really outweigh the risk

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23
Q

is there reason to isolate cmv patients ?

A

no because there are really no clinical manifestations

they are really numerous in children - mother who is pregnant advised not to go near children in general

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24
Q

how is CMV infection tested and diagnosed ?

A

histopathology - focal necrosis , enlarged cells with intranuclaer incursions - cytomegalic cells
multinucleated gigantic cells

diagnosed through viral isolation

viral culture using blood , urine or saliva samples

serological testing IgM and IgG antibodies to CMV

A diagnosis of congenital CMV infection can be made if the virus is found in an infant’s urine, saliva, blood, or other body tissues during the FRST WEEK (vey important no later than that) after birth.

not recommend routine maternal screening for CMV infection during pregnancy because there is no test that can definitively rule out primary CMV infection during pregnancy.

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25
Q

when women are infected with cmv they usually do not have any infections however what can be found int heir blood work ?

A

symptoms resembling mononucleosis = fever soar throat engaged lymph

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26
Q

what is the treatment of CMV in children who are tested positive

A

should start at 1 month of age and should occur for 6 months. The options for treatment are intravenous ganciclovir (mutagenic carcinogenic) and oral valganciclovir

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27
Q

herpes simplex virus infection in utero is how common ?

A

they are very rare

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28
Q

what is the triad of symptoms in herpes simplex virus in utero ?

A

1) skin vescicles and scarring
2) eye disease - chorioretintis , keratoconjuctivitus
3) microcephaly and hydranenecphaly

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29
Q

what is the most common rout of infection in herpes simplex virus ?

A

intrapartum - most of the time

can also be intrauterine and postnatal!

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30
Q

what are the clinical signs and symptoms with infants affected postnatally or intrapartum of hsv ?

A

it is separated into three group

localised - skin , eye and mouth

CNS involvement - encephalitis = seizures ,
spastic tetraplegy

microcephaly / bulging fontanel
tremors , lethargy , poor feeding

with or without skin eye and mouth involvement

DIS herpes - affects multiple internal organs most especially the liver , lung , adrenal CNS etc

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31
Q

what is the treatment for HSV ?

A

antepartum - c section

isolation of infants
NO breast feeding
antiviral treatments such as acyclovir
second line vidarabine

However, morbidity and mortality still remain high due to diagnosis of DIS and CNS herpes coming too late for effective antiviral administration

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32
Q

pregnant women with active genital herpes lesions at the time of labor be delivered?

A

through c section

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33
Q

how is the diagnosis of hsv made ?

A

viral culture and isolation nasopharynx

immunological assay - HSV antigen testing
monoclonal anti HSV antibodies ELISA

lumbar punture - hemorrhagic CSF , white blood cells andportein high

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34
Q

does hsv have in utero growth retardation and associated with low birth weight ?

A

no

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35
Q

how rare is congenital varicella zoster virus

A

extremely rare

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36
Q

what are the clinical signs and symptoms of VZ

A

low birth weight , iugr

hypertroph and cicatrix skin , red and inflamed
hypo pigmentation

micropthalmia 
cataracts 
choioreteinitis 
optic atrophy 
anisoria 
horner syndrome

cortical atrophy
microcephaly
hydrocephaly
apslaia of brain

hypoplasia of extremities !!
motor and sensory defect
absent deep tendon

anal and urinary sphincter dysfunction

developmental anomalies

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37
Q

what is the period of risk for congenital varicella zoster ?

A

first 20 weeks of pregnancy

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38
Q

how is the diagnosis of congenital varicella syndrome

A

maternal varicella confirmation =
presence of IgG antibodies for vxv

ultrasound - LIMB malformations

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39
Q

what is the treatment of VZV ?

A

If a non-immune pregnant woman is exposed to chickenpox, varicella zoster immunoglobulin (VZIG) should be administered as soon as possible after exposure. VZIG is apparently most effective if used within 72 hours of exposure.
or acycovir

same fo the baby

40
Q

does varicella zoster virus cause premature infants ?

A

no

41
Q

does herpes simplex visors congenital cause premature infants

A

yes

42
Q

does enterovirus cause prematurity ?

A

no

43
Q

does enetrovirsu case in utero growth retardation and low birth weight ?

A

no

44
Q

what are the clinical signs and symptoms of enterovirus ?

A

developmental anomalies

45
Q

does hepatitis b congenital infection cause prematurity ?

A

yes

46
Q

does hep b cause in utero growth retardation and developmental anomalies

A

no

47
Q

what is the route of transmission of hep b ?

A

in utero

through the vaginal delivery

48
Q

what are the clinical signs and symptoms of hep b infections ?

A

asymptomatic individuals
however likely to develop chronic hepatitis and hepatocellular carcinoma this way !

symptomatic infants 
hepatosplenomegaly 
jaundice 
acute hepatitis - abdominal pain , dark urine ,
 loss of appetite
 , vomiting

chronic active hepatitis with or without cirrhosis
yes piecemeal necrosis or intralobular fibrosis

chronic persistant hepatitis - benign
no piecemeal necrosis or intralobular fibrosis

chronic asymptomatic HBcAG carrier

fulminant fatal hepatitis (liver failure) - rare

49
Q

babies born to mother with hepatitis b should beclincaly managed how ?

A

HBsAG positive
with HBV vaccine
and hepatitis b immune globulin within 12 hour of birth = but not helpful when there is the onset of the acute infection

chronic hepatitis may benefit from
antiviral drugs - such as interferon alpha , lamivudine ,

50
Q

how od ewe diagnose hep b in congenital ?

A

transaminase levels increase before bilirubin

bilirubin levels increases

acute first antibody 
antiHBc IgM
HBcAG
disappear in weeks 
IgG antiHBc detected = maybe present for life 
and HBe antigen 
= acute 
low high hbv dna in blood

if vaccinated only anti HBs antibody
no hbv dna in blood

if chronic 
IgG antiHBc 
and HBs antigen 
with or without HBe antigen and anti HBe 
low high HBV dna in blood 
if cleared hep b 
IGg antiHBc
anti HBs
with or without anti HBe
no HBV dna in blood
51
Q

does hiv congenital infection cause prematurity ?

A

yes

52
Q

what are the signs and symptoms of HIV congenital infection ?

A

asymptomatic - many infants do not have symptoms till opportunistic infections start coming

or minor signs
in utero growth retardation and low birth weight

developmental anomalies

failure to thrive

fever persistent

heaptsplenomegaly

lymphadenopathy

oral thrush and other opportunistic infection

pneumonia -
recurrent resp infection

chronic diarrhea

CALCIFICATION OF BASAL GANGLIA

dermatitis

53
Q

if the mother has HIV the fetus has how many percentage change of being infected ?

A

25 percent

54
Q

when do the fetus get infected with HIV mostly ?

A

later in pregnancy and during delivery

55
Q

what is the treatment to lower the chances of the baby getting infected with HIV

A

c section

the last half of their pregnancy, during the birthing process, and treatment of the infant for 6 weeks following delivery can lower significantly the chances the baby will be infected

with retrovir with nevirapine

56
Q

is breast feeding recommend in HIV positive mothers

A

no

57
Q

how do you diagnose hiv ?

A

HIV culture PCR

children more than 18 months :
ELISA and western blot to confirm
anti HIV antibodies

58
Q

what is the clinical manifestation of erythrovirus ?

A

inter hydros fetalis

59
Q

does erythrovirus B9 have in utero growth retardation and low birth weight ?

A

no

60
Q

does erythrovirus case premature birth ?

A

no

61
Q

does erythrovirus b9 have developmental anomalies ?

A

no

62
Q

trepanoma pallidum gets infection through which way ?

A

transplacental or through vaginal birth

63
Q

do trepanomapallidum cause preterm birth

A

yes

64
Q

does trepanoma pallidus cause hydrops fetalis and still birth

A

yes

65
Q

what are the early symptoms of trepanoma palladium or congenital syphillus ?

A

can be asymptomatic

early - occurring between 0-2 years old

in utero growth retardation and low birth weight

developmental anomalies

hepatospenomegaly

snuffles/ runny nose - rhinitis , coryza luetica

lymphadenopathy

mucocutanoeus lesions of the palms , soles and around the mouth and anus

luetic pemphigus and vesicular bulle rash macular

osteochondrits

hemolytic anemia

thrombocytepnea

pneumonia alba

66
Q

if congenital syphillus is left untreated what are the clinical manifestation so late signs and symptoms ?

A

after 2 years

Hutchinson triad
interstitial keratitis
hutchinson teeth
cranial nerve deafness

frontal bossing
saddle nose
rhagades

neurosyhpilus

67
Q

what is the treatment of congenital syphillus ?

A

parenteral procaine penicillin or penicillin (G) for 10-14 days IM

treatment cannot reverse any deformities

if syphilus confirmed during pregnancy - start penicillin treatment

68
Q

how do you diagnose or green for congenital syphillus

A

VDRL - blood test for syphillus
basis of the test is that an antibody produced by a patient with syphilis reacts with an extract of ox heart (diphosphatidyl glycerol). It therefore detects anti-cardiolipin antibodies (IgG, IgM or IgA)

FTA-ABS test is used to detect antibodies to the bacteria Treponema pallidum and confirm the VDRL positivety
fluorescent treponemal antibody-absorption
T. pallidum hemagglutination assays

CSF pleocytosis, raised CSF protein level and positive CSF VDRL serology suggest neurosyphilis

microscopic dark field microscopy

blood count - hemolytic anemia

69
Q

medical conditions can produce false positive results vdrl?

A

rheumatic fever, rheumatoid arthritis, lupus, and leprosy

The syphilis anti-cardiolipin antibodies are beta-2 glycoprotein independent,[2] whereas those that occur in the antiphospholipid antibody syndrome (associated to lupus for example) are beta-2 glycoprotein dependent, and this can be used to tell them apart in an ELISA assay.[

70
Q

what re the signs and symptom for neurosyphilis ?

A

meningitis - early

cranial nerve palsy esp facial nerve

71
Q

a pregnant mother is identified as being infected with syphilis, treatment can effectively prevent congenital syphilis from developing in the fetus, especially if she is treated before the

A

26 th / sixteen week of pregnancy - with penicillin

72
Q

The fetus is at greatest risk of contracting syphilis when the mother is in which stage of infection

A

early stage

a women in the secondary stage decreases passing on syphillus by 98 percent

73
Q

toxoplasma gondi infection early in the trimester can cause what ?

A

death of th fetus and abortion is recommended

74
Q

toxoplasma gondi infection later in the trimester can cause what

A

still birth orr PREMATURITY
INTRAUTERINE GROWTH RESTRICTION LOW BIRTH WEIGHT

HEPATOSPLENOMEGAKY

MYOCARDITIS

classic triad - microcephaly hydrocephalus
intracranial calcification
chorioretnitis
SEIZURES

bone abnormality

75
Q

risk of fetal infection increases through

A

pregnancy lowest being the first trimester and highest being the third trimester

goes 15 , 45 , 70 percent

76
Q

toxoplasma gondiin pregnant women havee what ?

A

mild mononucleosis like syndrome
regional lymphadenopathy
ocasioanla chorioeretinits

77
Q

neurological and ophthalmological sequel in toxoplasma gondi may be delayed for ?

A

years and decades and may be born asymptotic

78
Q

how do we diagnose for cmv IN PREGNANCY?

A

serial IgG measurement for maternal

amniocentesis amniotic fluid PCR - for fetal

79
Q

what is the treatment for toxoplasma gondi in pregnant women ?

A

spiramycin maybe

appears to reduce vertical transmission by 60 percent

80
Q

what’s is the treatment for toxoplasma gondii in infants and neonates ?

A

pyrimethamine
leucovorin
sulfadiazine

begun after neonatal jaundice has resolved

regime is continued for 6 months

81
Q

what are the clinical manifestation for streptococcus agalactiae group b ore ecoli ?

A

hepatosplenomegalu
jaundice

pneumonitis

skin lesions petechia and puprura

CNS lesions - meningoencephalitis

82
Q

the severity or the clinical manifestation of these infections depends on ?

A

gestational age
virulence
primary or recurrent infection
newborn recieved

83
Q

the late in pregnancy the infection is required the more likely it is transmitted to the fetus ?

A

yes

84
Q

what is the diagnosis of toxoplasmosis condo

A

serological testing for toxplasmic specific IGM = ELISA ,
indirect fluorescent antibody immunosorbent agglutination assay - IgM -ISAGA

if IgM titres are high with specific IgG tigers aswell this suggests acute infection

CSF - mononuclear pleocytosisi , high protein level of csf , xantochromia

CT - intracranial calcifications

ophthalmic exam - chorioenteritis

85
Q

hw can toxoplasmosis be prevented ?

A

pregnant women should d avoid eating raw meat or raw eggs with exposure to cat feces

86
Q

describe rubella virus ?

A

RNA virus
spread through reps secretions , and stool and urine and cervical secretions

maternal antibodies to previous infection are protective for etus

87
Q

wh is at risk for rubella ?

A

women who have not recieved the mmr vaccinations

88
Q

what are risk factors for cmv ?

A

low socioeconomic status
drug abuse
sexual promiscuity

89
Q

has maternal hep b been associated with abortion , still birth or congenital malformations ?

A

no

90
Q

what is diff diagnosis of hep b ?

A

acute billary atresia

acute hepatitis secondary to CMV or rubella

91
Q

describe the transmission routes for hiv

A

in utero

intrapartum - contaminated blood

breast milk

92
Q

what is the most common agent for neonatal sepsis ?

A

vaginal flora - group b streptococci

followed by ecoli

93
Q

what are the alarm signs in neonatal sepsis ?

A 
change in behaviour 
weight loss 
feeding problems 
vomiting 
grunting flaring
94
Q

how do we prevent neonatal sepsis ?

A

4mg of ampicillin given during labour

95
Q

in case of sepsis suspicion what is the treatment ?

A

antibiotic broad spectrum
ampicillin
gentamyci

gram negative - cephalosporins

listeria - ampicillin

staph coagulase positive - oxacillin
coagulase negative - vancomycin

enter bacteria - aminogycogide and cephalosporin

anaerobes - clindamycin andmetronidazole

treatment varies fromm 10-21 days

pediatrics (19 decks)

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