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micro unit 6 > congenital and neonatal infections > Flashcards

congenital and neonatal infections Flashcards

1
Q

when is the fetus most susceptible to infections/toxins/mutagens, etc

A

the first trimester

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2
Q

what are the routes of infection to the fetus in congenital infections?

A

maternal blood, fallopian tubes, cervix, amniocentesis,

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3
Q

what are the barriers to infection for the fetus/

A

placenta and amniotic membrane.

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4
Q

what determines the severity of the infections to the fetus,

A

earlier the mother is infected more harm to organs.

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5
Q

what is more harmful to the fetus, acute or reactivation infections

A

acute because they typically have a higher infectious dose

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6
Q

what are the manifestations of congenital infections?

A

growth retardation/low birth weight, malformation, fetal loss/still births

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7
Q

what are the typical organisms of congenital infections

A

rubella, CMV, HIV, toxoplasmosis, T pallidum, parvovirus b19, HSV, VZV

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8
Q

what are the manifestations of perinatal infections

A

meningitis, septicemia, pneumonia, preterm labor.

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9
Q

what are the organisms involved in perinatal infectios

A

N. gonorrhea, C. trachomatous, strep agalactiae (group B), E. coli, listeria monocytogenes.

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10
Q

what are the manifestations of postnatal infections

A

meningitis, septicemia, conjunctivitis, pneumonitis.

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11
Q

what are the organisms involved in the postnatal infections

A

group B strep. listeria, E. coli.

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12
Q

what gives a high level of suspicion for infection

A

if the infant is born with abnormal head, eyes, blood, liver, spleen, jaundice or rash

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13
Q

does the mother usually show signs of infection>

A

no. nothing is usually suspected until the child is not normal.

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14
Q

what has the highest incidence of congenital infections?

A

CMV. 10X more than all the rest.

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15
Q

what are the other common congenital infections other than CMV

A

toxoplasmosis, syphilis, rubella.

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16
Q

torch infections>

A

toxoplasmosis, other, rubella, CMV, herpes,.

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17
Q

what comprises the other in TORCH

A

syphilis, hep b, VZV, parvovirus b19, HIV, HTLV-1

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18
Q

what are the presentations of torch at birth

A

rash, chorioretinitis, microcephaly, hepatosplenomegaly, intrauterine growth retardation.

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19
Q

where does toxoplasmosis come from

A

domestic animals, cats, mice, consumption of cystic bradyzoites.

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20
Q

what are the symptoms of congenital toxoplasmosis

A

most infants are asymptomatic. or fever, maculopapular rash hepatosplenomegaly, microcephaly, seizures, jaundice, thrombocytopenia,

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21
Q

what is the classic triad of toxoplasmosis

A

chorioretinitis, hydrocephalus, intracranial calcifications.

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22
Q

what laboratory tests daignose congenital toxoplasmosis

A

IgM+ on infant is diagnostic. PCR on the amniotic fluid, infant samples, or placenta. direct observation of the cysts.

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23
Q

what are treatment for toxoplasmosis

A

pyrimethamine (daraprima) + sulfadiazine + folinic acid (leucovorin) for 1 year.

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24
Q

what are the complications if not treated.

A

chorioretinitis vision loss. intellectual disability, deafness, seizures, spasticity,

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25
Q

congenital syphilis

A

crosses placenta and causes miscarriages/stillbirths/deaths in 40-50 of affected pregnancies.

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26
Q

what are symptoms of congenital syphilis at birth

A

66% are asymptom. they can appear at 3m months of age, mostly by 5 weeks. large puffy placenta, hepatomegaly, rhinitis, rash, LAD

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27
Q

diagnosis of syphilis

A

suspect in all mothers that are positive. VDRL or RPR titer. direct visualization on dark field or direct fluorescence antibody. examine the placenta and umbilical cord for fluorescence

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28
Q

when to test infants for syphilis

A

<1 month

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29
Q

how to treat syphilis

A

mother gets penicillin. infant gets 10 day course of aqueous penicillin every 12 hours if less than 7 days and every 8 hours if >7days.

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30
Q

alternative infant treatment for syphilis

A

procaine penicillin as single dose for 10 days

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31
Q

is congenital rubella serious?

A

severe disease in 80%. rare in the us. first the virus infects the placenta, then the fetus.

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32
Q

what are the symptoms of congenital rubella

A

hearing loss, heart defects, opthalmic problems, intrauterine growth retardation, microcephaly and psychomotor retardation.

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33
Q

what organs are affected by congenital rubella

A

hepatosplenomagaly, boine lesions, thrombocytopenic purpura, pneumonitis

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34
Q

is there a vaccine for rubella

A

yes

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35
Q

what are the risk factors for CMV infection

A

no prior infection, pregnancy at younger age, first pregnancy, new sex partner when pregnant, frequent contact with babies and toddlers.

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36
Q

what is concerning about CMV

A

the mothers illness can be subclinical and she wont know. primary infection during pregnancy has the worst prognosis

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37
Q

intrauterine CMV transmission

A

CMV in maternal blood infects the placenta (primary infection carries more viral load), viral spread is slow through placenta and reaches the fetus causing damage to developing organs.

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38
Q

does CMV reactivation cross the placenta?

A

rarely

39
Q

what are the symptoms of congenitally infected neonates

A

asymp, only 10% have symptoms

small size, HSM, rash, jaundice, chorioretinitis, neurologic involvement, microcephaly, seizures, feeding difficulties.

40
Q

how to diagnose congenital CMV

A

PCR on urine or blood, culture virus from urine or saliva.

41
Q

why is serology not recommended for diagnosing CMV in the newborn

A

because the maternal IgG will confound results.

42
Q

treatment for CMV of the newborn

A

gancyclovir IV or valgancyclovir PO.

43
Q

prevention of congenital CMV

A

avoid kissing babies on the mouth. no sharing utensils, drinks or food. wash hands or use gloves when wiping noses, drool, diapers.

44
Q

congenital herpes infections presentations

A

there are many. some are serious

45
Q

what variables in the mother control the risk for herpes infection?

A

HSV-2&raquo_space; 1. primary&raquo_space;reactivation, visible lesions&raquo_space;subclinical

46
Q

what are the variables in the child that moderate disease transmission of herpes?

A

intrauterine&raquo_space; perinatal, disseminated infection» encephalitis»skin,

47
Q

what is the incidence of neonatal herpes infections

A

very rare.

48
Q

what is the most frequent scenario for neonatal herpes infection

A

mother has recurrence during time of birth neonate acquires the infection at full term,

49
Q

what is the prognosis for neonatal HSV

A

very good. rare severe infectios.

50
Q

most severe scenario for HSV infections of the newborn

A

mother has primary HSV-2 infection during pregnancy and the fetus is born with disseminated virus.

51
Q

what is the prognosis for the most severe cases of congenital herpes of the newborn

A

severe mental impairment or death

52
Q

how to treat congenital HSV of the newborn>

A

IV acyclovir is well tolerated.

53
Q

prevention of congenital herpes

A

c-section birth is indicated for frequent outbreaks. antiviral prophylaxis

54
Q

congenital varicella infections incidence

A

VERY RARE.

55
Q

what happens when VZV infection of the newborn occurs

A

primary infection in the mother damages the fetus. limbs and brain development are impaired, there is a poor prognosis.

56
Q

what is the treatment for congenital VZV

A

acyclovir

57
Q

prevention of VZV

A

vaccination. advise seronegative women to avoid children with chicken pox or anyone with shingles.

58
Q

parvovirus b19 (5th disease) presentation

A

erythema infectiosum lace like rash on extremities rash on face. slapped cheek face., erythematous maculopapular rash arthalgia and arthritis

59
Q

when is parvovirus b19 (5th disease) most common

A

school-age children during winter/spring.

60
Q

what type of disease is parvovirus b19 (5th disease)

A

biphasic

61
Q

what are seronegative pregnant women at risk for when infected with parvovirus b19 (5th disease)

A

fetal death

62
Q

what is the treatment for parvovirus b19 (5th disease)

A

none

63
Q

what is the prevention for rparvovirus b19 (5th disease)

A

none

64
Q

perinatal infections

A

acquired during or shortly after birth

65
Q

what are the routes of transmission of perinatal infections

A

exchange of maternal and fetal blood, fetal monitors attached to the scalp break the skin, vaginal and skin flora colonize the neonate, relatives that are visiting transmit, passage through the vaginal canal. r

66
Q

what are the risk factors for perinatal infections

A

extended delay between membrane rupture and delivery may allow the vaginal flora to ascend and then the fetus may aspirate.

67
Q

risks for neonatal sepsis

A

low birth weight, premature or prolonged rupture, septic or traumatic delivery, fetal anoxia, maternal peripartum infection

68
Q

neonatal hep b

A

easily transmitted through birth. infection is often asymptomatic in mother.

69
Q

what are the symptoms of neonatal infection of HBV and what is the risk for chronic infection of the newborn?

A

usually asymptomatic, 90% chance of chronic infection

70
Q

prevention of hep B of the new born

A

vaccinate all neonates, add HBIG immune globulin at birth if mom is HBV positive.

71
Q

how do we prevent maternal transmission of HIV

A

antiviral medications during pregnancy reduces the transmission. combined antepartum, intrapartum and infant antiretroviral prophylaxis

72
Q

what is antiviral treatment during pregnancy

A

3 parts zidovudine regime (antepartum, intrapartum, neonatal)

73
Q

what do we avoid giving for the prevention of HIV in the first trimester and why?

A

efavirenz because it is a known teratogen

74
Q

what is the rate of HIV transmission with and without treatment?

A

2% with treatment and 30% without

75
Q

streptococcus agalactiae morphology and stain

A

gram positive diplococcus that is encapsulated

76
Q

is streptococcus agalactiae common

A

25% of women are carriers

77
Q

risk factors for early onset GBS disease

A

previous baby with GBS, streptococcus agalactiae in urine, fever during delivery, heavy maternal colonization, delivery before 37 weeks gestation, premature or proloinged rupture.

78
Q

what reduces the risk of streptococcus agalactiae

A

intrapartum antibiotic prophylaxis

79
Q

early onset GBS symptoms

A

tachypnea, grunting, hypoxia, appears ill, poor feeding, lethargic, irritable, temperature instability, hypotension and shock.

80
Q

late onset GBS symptoms

A

sepsis, fever, irritability, lethargy, poor feeding, tachypnea, grunting, apnea, meningitis, bulging fontanel, nuchal rigidity, focal neurological findings.

81
Q

general GBS findings from early to late onset.

A

earlier is more of a pneumonia and later is more of a meningitis.

82
Q

late, late onset GBS symptoms

A

sepsis with foci in CNS, soft tissues, bone and joints.

83
Q

diagnosis of streptococcus agalactiae

A

culture from normally sterile site.

84
Q

treatment for streptococcus agalactiae

A

penicillin.

85
Q

maternal management of streptococcus agalactiae

A

intrapartum antibiotic prophylaxis, pencillin G IV

86
Q

empirical therapy for streptococcus agalactiae

A

give when GBS is suspected but not confirmed and if IAP was given, suspect resistance to pen. give vancomycin + penicillin G or ampicillin.

87
Q

definitive diagnosis of streptococcus agalactiae

A

give penicillin G. alone

88
Q

when are the prevention techniques most effective>

A

before pregnancy

89
Q

when is the worst time for infection during pregnancy

A

1st trimester

90
Q

is the maternal infection always diagnosed?

A

no. more often not

91
Q

are infections always transmitted to the baby>

A

no

92
Q

is the TORCH panel routine screening in the US

A

NO>

93
Q

are congenital infections treatable?

A

some. HSV (acyclovir), HIV (zidovudine), GBS (penicillin)

94
Q

are most babies born healthy>

A

yes.

micro unit 6 (7 decks)

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