33. Congenital & Perinatal Infections Flashcards
SGA or UGR, thrombocytopneia, rash, hepatosplenomegaly, jaundice, microcephaphy, growth and developmental anomalies
TORCH infection signs
HIV, hepatitis B, rubella IgG, syphilis, GC/chlamydia, GBS
prenatal screen for TORCH infections in mom
HSV, toxoplasmosis, CMV, parvovirus, varicella
no prenatal screen for mom for TORCH infections
intracellular protozoan parasite, severity of infection worse during first trimenters, acquired from cat feces, undercooked meat/eggs, milk, organ transplant, mother to child transmission, subclinical infection in 70-90%, mild or severe disease in the first few months of life, severe disease or death in the neonatal period or those infected in the 1st trimester, sequeale or relapse usually ocular or CNS of undiagnosed infection later in infancy, childhood, adolesence, causes fetal demise/stillborne, chorioretinitis, micropthalmia, hydrocephalus, intracranial calficiations, excessive volume of CSF in the skull, periaqua ductal and periventricular vasculitis followed by necrosis and obstruction of the ventricular system, inflammation of the posterior portion of the uveal tract and retina, diffuse or randomly distributed califications, test with toxoplasma IgM or IgA in infant CSF, PCR, ophtlamology exam, treat with antiparasitics, in infants with 12 months of active retinitis give pyrimethamine, sulfadiazine, leucovorin, +/-predisone , infants can be breastfed, complications include intellectual disability and severe vision impairment, treated infants may have late onset retinal lesions with loss of vision
toxoplasmosis
RNA virus, membrane of togaviridae family, humans are the only source, transmission vertically or by droplet, most common vaccine preventable disease, incidence and severity of disease is very high if acquired in the first semester, causes cataracts, cadiac disease, and deafness, including patent ductus arteriosus and ventricular septal defect, purpura, rash looking like blueberry muffin, hepatosplenomegaly, myocarditis, vasculitis, nephritis, lung inflammation, complications include sensorineural hearing loss, endocrine disorders, eye problems, vascular effects, immune defects, progressive panencephalitis similary to the SSPE of measles, review the maternal chart for maternal immunity, get PCR of nasopharyngeal swab, blood, urine, and CSF, also check serum IgM and IgG titers, opthalmology exam, hearing exam, no treatment but supportive care OT/PT, neurology, audiology, cardiology, and invasive monitoring
rubella
DNA virus, leading cause of non-hereditary sensorineural hearing loss, common, easy to catch with no vaccines, older kids and adults get it also with mono-like infection, transmitted from mother to child, direct contact with saliva, causes chorioretinitis, microcephaly and impaired mental ability, periventricular calfications, rash, jaundice, hepatosplenomegaly, seizures, periventricular calficiations on chest x-ray, no prenatal screening but symptomatic diagnosis is by exam and imaging, suspected maternal CMV infection, SNHL, immunocompromised newborns, check newborn saliva or urine PCR for CMV, if baby is asymptomatic infant saliva or urine CMV PCR will be negative after failiing hearing screen before 3 weeks of age, specific laws differ per state, treatment is with ganciclovir and valganciclovir
cytomegalovirus
DNA virus, HSV-1 orally transmitted, HSV-2 sexually transmitted, mother does not need to have lesions to be infectious, transmitted by intrauterine, perinatal, and postnatal, three types including localized skin,eye,mouth, and CNS with or without SEM, or disseminated disease
neonatal herpes simplex virus
clustering vesicles with erythematous base found in the skin, eyes, and mouth without evidence of disseminated disease +/- fever, excessive watery eyes, pain, conjunctival erythema, usually occurs in the 1st or 2nd week of life, must undergo CNS studies, if not treated will likely progress to other forms
skin/eye/mouth herpes
baby stops crying, lethargic, irritabile, lethargy, poor feeding, tremulousness, and seizures, usually seen in the 2nd or 3rd week of life, may be indistinguishable from other meningitis in the newborn`
CNS herpes
onset birth to 4 weeks, most common after DOL 3, presets like bacterial sepsis, fever or hypothermia, sepsis syndrome, hepatitis so elevated LFTs and direct bilirubin, liver transplant may be needed, diagnosis by culture or PCR of the vesicles, CSF sent for viral culture and PCR, send blood for PCR, CBC and LFTs are in disseminated disease where transaminases are usually elevated, prevention with c-section in the mother, maternal acyclovir IV acyclovir if history of genital lesions, IV acyclovir to newborns with HSV, mothers with HSV can be breastfed if no lesions on breast, to newborn with HIV , before treatment there is 85% mortality, disseminated disease has a bad prognosis, viruses continue to exist in latent form
disseminated herpes
DNA virus, transmitted by blood and body fluids, congenital infections are typically asymptomatic at birth, congenital symptomatic infections are most commonly chronic, can be asymptomatic but causes jaundice, lethargy, failure to thrive, abdominal distention, clay colored stools, infant should receive the hepatitis B vaccine and hepatitis B Ig at birth, serologic testing for infant should start at 9 months, baby can be breastfed, infection early in life increases risk of hepatocellular carcinoma
hepatitis B
serologic testing was developed in 1985, retrovirus, tranismitted by mother to child, sexual contact, neede stick, transfusion, breastfeeding, lymphadenopathy, hepatosplenomegaly, failure to thrive, oral candidiasis, recurrent diarrhea, recurrent opportunisitic infections, hepatitis, cardiomyopathy, CNS disease , diagnosis by maternal screening with HIV 1/2 immunoassays as early as possible and at 36 weeks for high risk patient, intrapartum maternal treatment, avoid AROM/scalp monitors/forceps, consider c-section if viral load is too high, prophylaxis for all mothers with antiretrovirals, treatment with zidovudine, antiretroviral therapy is also for all infected babies, transmission is low in treated mothers with low RNA counts on ART, prognosis is poor for infected infants, life expectancy is low
HIV
treponema pallidum, spirochete, all pregnant women should be tested during pregnancy with nontrepnoemal screens VDRL or RPR, transmission vertically or through contact with infected chancre, enters circulation through placenta and produces spirochetemia and dissemination to all organs, diagnose if physical/laboratory/or radiographic signs of congeintal syphyllis or if child was born to mother with untreated, inadequately, or suboptimally treated syphyllis, causes hepatomegaly, jaundice, rash, condyloma lata, snuffles, CNS involvement, pseudoparalysis, edema, intellectual disability, frontal bossing, saddle nose, hutchinson teeth, mulberry molars, rhagades, interstitial keratitis, sensorineural deafness, saber shins, clutton joints, nontreponal tests like VDRL and RPR are used to test mother and if RPR reactive 1:256 is positive, evaluation if results are concerning, treatment with IV or IM penicillin, prognosis involves eval for hearing loss, opthalmologic abnormalities, neurodevelopmental problems, serology or VDRL/RPR monitoring, interstitial keratitis and anterior tibial bowing may occur anyway despite treatment
congenital syphyllis
DNA virus, droplet spread, acquired in 1st trimester, causes hydrops/fetal demise, not a teratogen
parvovirus
herpesvirus, airbone spread, acquisition in first trimester can lead to congenital varicella syndrome, limb hypoplasia, skin lesions, neurologic abnormalities, and structural eye damage
varicella
