18. Intrauterine infections of the newborn Flashcards
what re the things to consider about congenital infections?
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
some infection can be avoided by the mother through what
simple measures such as immunisation = rubella , varicella zoster virus during childhood or before pregnancy
some infections are treatable in intrauterine infections which are they ?
syphilus
what re the virus congenital infectious agents ?
CMV * HSV * erythrovirus B19 enterovirus Hep B * VZV * HIV rubella *
what are the bacterial congenital infectious agent ?
trepanoma pallidum * mycobacterium tuberculosis salmonella typhus listeria monocytogenes campylobacter fetus borrelia burgfordi
what are the fungal agents for congenital infections ?
candida albicans
what re the parasitical agents for congenital infections ?
toxoplasma gondii *
plasmodium
trypanosome cruz
what Lethe most common organism giving infections ?
TORCH
one with the asterisk
pregnant women are exposed to these congenital infection through what ?
association with young children
congenital infection can result in ?
death and resorption
abortion and still birth
live birth of premature
term infant with abnormality
in survived congenital infection , the babies usually show which classical signs ?
low birth weight
developmental abnormalities
congenital infections persisting after even birth sometimes
what are the most common characteristics of rubella in born children ?
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
why should infants with rubella be isolated ?
because they are still infectious for 1 year and shed live virus
what is the diagnosis of rubella
what is the treatment for congenital rubella ?
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
are babies with rubella virus premature births ?
no
what is the most common pathogen of inutero infection
cytomegalovirus
rubella is most infectious at what stage of pregnancy
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
in cmv the fetal damage is severe in ?
any stage of pregnancy the
but greatest risk at 22 weeks
earlier the mother contracts the infection the more severe the presentation
only 10 percent of babies born with CMV are symptomatic at birth , what are the symptoms ?
symptomatic at birth 10 percent
in utero growth retardation , low birth weight
hepaosplenomgealy , jaundice ,petechia
microcephaly
necrotic encephalitis
periventricular calcifications
chorioretinitis
developmental abnormalities
10 percent of babies born with cmv are asymptomatic and develop late complications such as
10 percent asymptomatic late complications :
deafness - [rogressive and can effect both ears
intellectual disability / mental retardation
seizures
what are the agents which are no perisirant postnatally ?
enterovirus
erythrovirus b19
listeria monocytogens
campylobacter fetus
salmonella typhus
b burgdoferi
trypansoma cruzi
CMV can be given to the baby after birth through what way ?
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
is there reason to isolate cmv patients ?
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
how is CMV infection tested and diagnosed ?
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.
when women are infected with cmv they usually do not have any infections however what can be found int heir blood work ?
symptoms resembling mononucleosis = fever soar throat engaged lymph
what is the treatment of CMV in children who are tested positive
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
herpes simplex virus infection in utero is how common ?
they are very rare
what is the triad of symptoms in herpes simplex virus in utero ?
1) skin vescicles and scarring
2) eye disease - chorioretintis , keratoconjuctivitus
3) microcephaly and hydranenecphaly
what is the most common rout of infection in herpes simplex virus ?
intrapartum - most of the time
can also be intrauterine and postnatal!
what are the clinical signs and symptoms with infants affected postnatally or intrapartum of hsv ?
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
what is the treatment for HSV ?
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
pregnant women with active genital herpes lesions at the time of labor be delivered?
through c section
how is the diagnosis of hsv made ?
viral culture and isolation nasopharynx
immunological assay - HSV antigen testing
monoclonal anti HSV antibodies ELISA
lumbar punture - hemorrhagic CSF , white blood cells andportein high
does hsv have in utero growth retardation and associated with low birth weight ?
no
how rare is congenital varicella zoster virus
extremely rare
what are the clinical signs and symptoms of VZ
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
what is the period of risk for congenital varicella zoster ?
first 20 weeks of pregnancy
how is the diagnosis of congenital varicella syndrome
maternal varicella confirmation =
presence of IgG antibodies for vxv
ultrasound - LIMB malformations
what is the treatment of VZV ?
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
does varicella zoster virus cause premature infants ?
no
does herpes simplex visors congenital cause premature infants
yes
does enterovirus cause prematurity ?
no
does enetrovirsu case in utero growth retardation and low birth weight ?
no
what are the clinical signs and symptoms of enterovirus ?
developmental anomalies
does hepatitis b congenital infection cause prematurity ?
yes
does hep b cause in utero growth retardation and developmental anomalies
no
what is the route of transmission of hep b ?
in utero
through the vaginal delivery
what are the clinical signs and symptoms of hep b infections ?
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
babies born to mother with hepatitis b should beclincaly managed how ?
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 ,
how od ewe diagnose hep b in congenital ?
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
does hiv congenital infection cause prematurity ?
yes
what are the signs and symptoms of HIV congenital infection ?
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
if the mother has HIV the fetus has how many percentage change of being infected ?
25 percent
when do the fetus get infected with HIV mostly ?
later in pregnancy and during delivery
what is the treatment to lower the chances of the baby getting infected with HIV
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
is breast feeding recommend in HIV positive mothers
no
how do you diagnose hiv ?
HIV culture PCR
children more than 18 months :
ELISA and western blot to confirm
anti HIV antibodies
what is the clinical manifestation of erythrovirus ?
inter hydros fetalis
does erythrovirus B9 have in utero growth retardation and low birth weight ?
no
does erythrovirus case premature birth ?
no
does erythrovirus b9 have developmental anomalies ?
no
trepanoma pallidum gets infection through which way ?
transplacental or through vaginal birth
do trepanomapallidum cause preterm birth
yes
does trepanoma pallidus cause hydrops fetalis and still birth
yes
what are the early symptoms of trepanoma palladium or congenital syphillus ?
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
if congenital syphillus is left untreated what are the clinical manifestation so late signs and symptoms ?
after 2 years
Hutchinson triad
interstitial keratitis
hutchinson teeth
cranial nerve deafness
frontal bossing
saddle nose
rhagades
neurosyhpilus
what is the treatment of congenital syphillus ?
parenteral procaine penicillin or penicillin (G) for 10-14 days IM
treatment cannot reverse any deformities
if syphilus confirmed during pregnancy - start penicillin treatment
how do you diagnose or green for congenital syphillus
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
medical conditions can produce false positive results vdrl?
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.[
what re the signs and symptom for neurosyphilis ?
meningitis - early
cranial nerve palsy esp facial nerve
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
26 th / sixteen week of pregnancy - with penicillin
The fetus is at greatest risk of contracting syphilis when the mother is in which stage of infection
early stage
a women in the secondary stage decreases passing on syphillus by 98 percent
toxoplasma gondi infection early in the trimester can cause what ?
death of th fetus and abortion is recommended
toxoplasma gondi infection later in the trimester can cause what
still birth orr PREMATURITY
INTRAUTERINE GROWTH RESTRICTION LOW BIRTH WEIGHT
HEPATOSPLENOMEGAKY
MYOCARDITIS
classic triad - microcephaly hydrocephalus
intracranial calcification
chorioretnitis
SEIZURES
bone abnormality
risk of fetal infection increases through
pregnancy lowest being the first trimester and highest being the third trimester
goes 15 , 45 , 70 percent
toxoplasma gondiin pregnant women havee what ?
mild mononucleosis like syndrome
regional lymphadenopathy
ocasioanla chorioeretinits
neurological and ophthalmological sequel in toxoplasma gondi may be delayed for ?
years and decades and may be born asymptotic
how do we diagnose for cmv IN PREGNANCY?
serial IgG measurement for maternal
amniocentesis amniotic fluid PCR - for fetal
what is the treatment for toxoplasma gondi in pregnant women ?
spiramycin maybe
appears to reduce vertical transmission by 60 percent
what’s is the treatment for toxoplasma gondii in infants and neonates ?
pyrimethamine
leucovorin
sulfadiazine
begun after neonatal jaundice has resolved
regime is continued for 6 months
what are the clinical manifestation for streptococcus agalactiae group b ore ecoli ?
hepatosplenomegalu
jaundice
pneumonitis
skin lesions petechia and puprura
CNS lesions - meningoencephalitis
the severity or the clinical manifestation of these infections depends on ?
gestational age
virulence
primary or recurrent infection
newborn recieved
the late in pregnancy the infection is required the more likely it is transmitted to the fetus ?
yes
what is the diagnosis of toxoplasmosis condo
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
hw can toxoplasmosis be prevented ?
pregnant women should d avoid eating raw meat or raw eggs with exposure to cat feces
describe rubella virus ?
RNA virus
spread through reps secretions , and stool and urine and cervical secretions
maternal antibodies to previous infection are protective for etus
wh is at risk for rubella ?
women who have not recieved the mmr vaccinations
what are risk factors for cmv ?
low socioeconomic status
drug abuse
sexual promiscuity
has maternal hep b been associated with abortion , still birth or congenital malformations ?
no
what is diff diagnosis of hep b ?
acute billary atresia
acute hepatitis secondary to CMV or rubella
describe the transmission routes for hiv
in utero
intrapartum - contaminated blood
breast milk
what is the most common agent for neonatal sepsis ?
vaginal flora - group b streptococci
followed by ecoli
what are the alarm signs in neonatal sepsis ?
change in behaviour weight loss feeding problems vomiting grunting flaring
how do we prevent neonatal sepsis ?
4mg of ampicillin given during labour
in case of sepsis suspicion what is the treatment ?
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
