5/5 Infections in Early Life (Ch 22/PPT) Flashcards
ToRCHHeS?
TOxoplasmosis Rubella (German Measles) CMV HIV Herpes Simplex Virus -2 Syphilis
Transmission of neonatal toxoplasmosis?
Cat feces or ingestion of undercooked meat
neonatal manifestations of toxoplasmosis?
Classic Triad:
Chorioretinitis
Hydrocephalus
Intracranial calcifications (basal ganglia)
Transmission of neonatal rubella?
Respiratory droplets
neonatal manifestations of rubella?
Classic Triad: PDA Cataracts Deafness \+ “blueberry muffin” rash
transmission of CMV?
Sexual contacts, organ transplants
neonatal manifestations of CMV?
Sensorineural hearing loss
seizures
petechial “blueberry muffin” rash
periventricular calcifications
transmission of neonatal Herpes Simplex Virus -2
Skin or mucous membrane contact (ie transplacental)
neonatal manifestations of Herpes Simplex Virus -2
Encephalitis (seizures)
Herpetic (vesicular) lesions
transmission of neonatal HIV
Risk of transmission during
- antenatal: 10-25%
- labor/delivery: 35-40%
- breast feeding: 35-40%
neonatal manifestations of HIV
Recurrent infections
Chronic diarrhea
transmission of neonatal syphilis
Sexual contact
neonatal manifestations of syphilis
Stillbirth, hydrops fetalis
If child survives, often presents with rhagades (linear scars at the angle of mouth), snuffles (nasal discharge) that is full of syphilis spirochetes, notched teeth, saddle nose, short maxilla, saber shins, CN8 deafness
etiologies of Meningitis in newborns (0-6mo)?
Group B streptococcus – Strep. agalactiae
Listeria Monocytogenes
E. Coli
how is Group B streptococcus – Strep. agalactiae acquired?
GPC – colonizes mom’s vajj, but can cause pneumonia, meningitis and sepsis in babies
Pregnant women are screened at 35-37wks, and those with (+) cultures receive penicillin prophylaxis
How is Listeria Monocytogenes acquired?
features of bug?
GPR – intracellular microbe with classic tumbling motility –allows evasion by antibody; ONLY GP to produce LPS!!
acquired by ingestion of unpasteurized dairy products, deli meats or transplacental transmission or vaginal transmission
4 causes of Meningitis in infants (6mo-6yr)?
What is unique about 3 of these bugs?
S. pneumoniae
N. meningitides
H. influenza Type B
Enterovirus (PicoRNAviruses)
top 3 secrete IgA protease in order to colonize respiratory mucosa
all of these are also encapsulated (antiphagocytic virulence factor)
Enterovirus (PicoRNAviruses)?
Poliovirus Echovirus Rhinovirus Coxsackievirus HAV
(PERCH)
All fecal-oral spread except Rhinovirus
etiologies of Respiratory Infections?
pathogenesis?
RSV
Parainfluenza Virus
both paramyxoviruses - both contain a surface F (fusion) protein, which causes respiratory epithelial cells to fuse and form multi-nucleated cells
sx of RSV?
trmt?
Bronchiolitis, pneumonia
Trmt: Palivizumab (mAb against F protein) – prevents pneumonia caused by RSV in premature infants
sx of parainfluenza virus?
Croup (seal-like barking cough)
otitis media is commonly caused by these 3 bugs
Strep Pneumoniae
Haemophilus influenza
Morazella catarrhalis
otitis media is commonly in what patient population?
<2 yo
what is Secretory Otitis Media occur?
trmt?
obstruction of auditory tube → accumulation of transudate with decreased pressure within middle ear and diminished mobility of tympanic membrane → diminished hearing
oral antibiotics
what is Acute Suppurative Otitis Media occur?
complications of this?
trmt?
obstruction of auditory tube due to recent colonization of nasopharynx with pathogenic bacteria → purulent exudate with increased pressure in middle ear with bulging of tympanic membrane
CN7 paralysis mastoiditis (→brain abscess) osteomyelitis “petrositis” venous sinus thrombosis “lateral sinus thrombosis” → otitic hydrocephalus
trmt:
- treatment: observation, antibiotics, myringotomy (incision made to relieve pressure caused by excess fluid buildup)
- 1st line: amoxicillin or if Strep. pnemo: amoxicillin clavulanate
- persistent : cefpodoxime
- recurrent: cefuroxime or ceftriaxone
- ß-lactam allergy: clindamycin or azithromycin
Strep Pneumoniae sx?
Meningitis
Otitis media
Pneumonia
Sinusitis
features of Strep Pneumoniae?
Most are OPtochin sensitive
Secretes IgA protease to colonize respiratory mucosa
Associated with
- “rusty colored sputum”
- sepsis in sickle cell anemia and splenectomy
Haemophilus influenza sx?
HaEMOPhilus
- Epiglottitis (cherry red in children)
- Menigitis
- Otitis media
- Pneumonia
Haemophilus influenza features?
GNR transmitted via aerosol droplets
Most invasive type: capsular type B (B for baby?!)
Produces IgA protease to colonize respiratory mucosa
Requires chocolate agar w/ Factor V (NAD) + X (hematin) or co-culture w. S. aureus, which provides factor V
trmt for Haemophilus influenza?
prophylaxis for close contacts?
vaccine?
- Mucosal infections: amoxicillin-clavulanate
- Meningitis: ceftriaxone
- Prophylaxis for close contacts: Rifampin
- Vaccine – contains type B capsular polyssacharide conjugated to diphtheria toxoid or other protein (given btwn 2-18mo)
what is Morazella catarrhalis?
GN diplococcus
Predilection for URT – cause otitis media, bronchitis, sinusitis, and laryngitis
How does the timing of the infection occurred during pregnancy affect the outcome?
early to mid-gestation:
- congenital defects in various organ systems: skin, CNS, blood, cardiovascular, musculoskeletal, pulmonary, etc
late pregnancy-birth (acute):
- no congenital defects
- manifestations range from mild-severe
- frequent reactivation during infancy and childhood (ie VZV, HSV, CMV)
