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Micro2 Unit 6 > Congenital and Neonatal Infections > Flashcards

Congenital and Neonatal Infections Flashcards

1
Q

what routs are congenital infectious acquired?

A

placenta, fallopian tubes, cervix and amniocentesis

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2
Q

what characteristics of maternal infection yield worse prognosis for the fetus?

A

infection earlier in pregnancy

acute infection vs reactivation (higher infectious dose)

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3
Q

what is the most common congenital infection?

A

CMV

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4
Q

what is the acronym for congenital infections and what does it stand for?

A

TORCH

Toxoplasmosis, Other (syphilis, HBV, VZV, Parvo B19, HIV and HTLV-1), Rubella, CMV, HSV

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5
Q

what are the most common presentations of congenital toxoplasmosis?

A

most are asymptomatic at birth

classic triad- chorioretinitis, hydrocephalus and intracranial calcifications

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6
Q

how is toxoplasmosis diagnosed?

A

infant IgM is diagnostic
can also do PCR on amniotic fluid, infant samples or placenta
cysts may be visible to ultrasonography

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7
Q

how do you treat congenital toxoplasmosis?

A

with pyrimethamine, sulfadiazine and folinic acid for one year

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8
Q

what can occur with untreated congenital toxoplasmosis?

A

increased risk of vision loss primarily

intellectual disability, deafness and seizures in minority

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9
Q

how does syphilis infect the fetus? what are the common results of congenital syphilis?

A

through the placenta
causes fetal/neonatal death in 40-50%
2/3 of live born are asymptomatic at birth with symptoms at about 5 wks of age

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10
Q

what are the symptoms of congenital syphilis?

A

large, puffy placenta, hepatomegaly, rhinitis (snuffles), rash and lymphadenopathy

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11
Q

how is congenital syphilis diagnosed?

A

VDRL or RPR titers are positive (test before 1 mo old)

may observe fluids or placenta with dark field or fluorescent antibodies

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12
Q

how is congenital syphilis treated?

A

aqueous or IM penicillin G for 10 days

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13
Q

how severe is the outcome of congenital rubella?

A

early pregnancy- severe disease in 80%

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14
Q

what are the symptoms of congenital rubella?

A

hearing loss (most common), congenital heart defects (PDA), microcephaly and cataracts

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15
Q

what are the risk factors for congenital CMV?

A

no prior maternal infection, younger mothers, first pregnancy, new sex partner during pregnancy, frequent contact with babies and toddlers- primary infection has worst prognosis

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16
Q

what is the percentage of neonates asymptomatic at birth? what percentage of them will develop late symptoms?

A

90%

15%

17
Q

what are the symptoms of congenital CMV?

A

IGR, hepatosplenomegaly, rash, jaundice, chorioretinitis and neuro involvement

18
Q

how is congenital CMV diagnosed?

A

PCR of urine or blood or culturing the virus from urine or saliva
serology not recommended because maternal IgG can confound

19
Q

what is the treatment for congenital CMV?

A

ganciclovir (taratogenic) IV or valganciclovir PO

20
Q

what maternal variables produce worse congenital HSV infection?

A

HSV2, primary infection, visible lesions and when transmitted during pregnancy (not perinatal)

21
Q

what is the most frequent scenario for neonatal HSV infection?

A

mother has recurrence of HSV2 at birth and the neonate acquires the virus at full term- prognosis is usually good

22
Q

what is the most severe scenario for neonatal HSV infection?

A

mother has primary HSV2 during pregnancy and the fetus is born with dissemination- usually severe mental impairment (encephalitis) or death

23
Q

how is neonatal HSV treated? how is it prevented?

A

acyclovir

c sections for women with frequent genital herpes outbreak and antiviral prophylaxis during pregnancy

24
Q

what is the outcome of congenital varicella?

A

primary maternal infection effects limb and brain development with poor outcome

25
Q

how is congenital varicella treated and prevented?

A

acyclovir with maternal infection

vaccination of all seronegative women of childbearing age or advise them to avoid chicken pox and shingles patients

26
Q

what is another name for parvovirus B19? what are the phases of diesease?

A

5th disease
children have febrile illness without a rash and then a rash on cheeks (erythematous and maculopapular) with possible arthralgia

27
Q

what is the risk of parvo B19 seronegative pregnant women?

A

disease causes fetal death with no treatment or prevention available

28
Q

what is a perinatal infection? how is it obtained?

A

acquired during or shortly after birth

exchange of maternal/fetal blood, fetal monitors, vaginal and skin flora, breast milk and relatives/visitors

29
Q

how is HBV transmitted to a neonate? what is the risk of initial symptoms? chronic infection?

A

blood transmission during childbirth

10% symptomatic, 90% risk of chronic infection

30
Q

how is HBV treated and prevented?

A

vaccinate all neonates (can prevent virus that has already entered) and add HBIg at birth if mother is HBV positive

31
Q

how is vertical HIV transmission prevented?

A

3 part zidovudine regimen (antenatal, intrapartum and neonatal)
drops transmission from 30% to 2%

32
Q

which antiretroviral is teratogenic? when should it be avoided?

A

efavirenz

during the first trimester

33
Q

what are risk factors for early onset group B strep disease?

A

previous baby with disease, GBS in urine, fever during labor, heavy maternal colonization, delivery before 37 weeks and premature/prolonged membrane rupture

34
Q

what reduces risk of neonatal group B strep?

A

intrapartum antibiotic prophylaxis of mother

35
Q

what are the symptoms of early onset group B strep infection? late?

A

pneumonia with temperature instability and possible shock

sepsis and meningitis

36
Q

what symptoms can be found in group b strep infections regardless of time frame?

A

generalized sepsis, possible foci in bones and CNS infection

37
Q

how is GBS diagnosed? how is it treated?

A

culture bacteria from normally sterile site

sensitive to penicillin

38
Q

in what cases is penicillin given for group B strep?

A

to mother with suspicion, to child if suspected or confirmed (if just suspected also give vancomycin)

39
Q

what are the most common spectrum of symptoms of congenital infection?

A

hearing loss, microcephaly, petechial rash and hepatosplenomegaly

Micro2 Unit 6 (6 decks)

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