Congenital and Neonatal Infections Flashcards
what routs are congenital infectious acquired?
placenta, fallopian tubes, cervix and amniocentesis
what characteristics of maternal infection yield worse prognosis for the fetus?
infection earlier in pregnancy
acute infection vs reactivation (higher infectious dose)
what is the most common congenital infection?
CMV
what is the acronym for congenital infections and what does it stand for?
TORCH
Toxoplasmosis, Other (syphilis, HBV, VZV, Parvo B19, HIV and HTLV-1), Rubella, CMV, HSV
what are the most common presentations of congenital toxoplasmosis?
most are asymptomatic at birth
classic triad- chorioretinitis, hydrocephalus and intracranial calcifications
how is toxoplasmosis diagnosed?
infant IgM is diagnostic
can also do PCR on amniotic fluid, infant samples or placenta
cysts may be visible to ultrasonography
how do you treat congenital toxoplasmosis?
with pyrimethamine, sulfadiazine and folinic acid for one year
what can occur with untreated congenital toxoplasmosis?
increased risk of vision loss primarily
intellectual disability, deafness and seizures in minority
how does syphilis infect the fetus? what are the common results of congenital syphilis?
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
what are the symptoms of congenital syphilis?
large, puffy placenta, hepatomegaly, rhinitis (snuffles), rash and lymphadenopathy
how is congenital syphilis diagnosed?
VDRL or RPR titers are positive (test before 1 mo old)
may observe fluids or placenta with dark field or fluorescent antibodies
how is congenital syphilis treated?
aqueous or IM penicillin G for 10 days
how severe is the outcome of congenital rubella?
early pregnancy- severe disease in 80%
what are the symptoms of congenital rubella?
hearing loss (most common), congenital heart defects (PDA), microcephaly and cataracts
what are the risk factors for congenital CMV?
no prior maternal infection, younger mothers, first pregnancy, new sex partner during pregnancy, frequent contact with babies and toddlers- primary infection has worst prognosis
what is the percentage of neonates asymptomatic at birth? what percentage of them will develop late symptoms?
90%
15%
what are the symptoms of congenital CMV?
IGR, hepatosplenomegaly, rash, jaundice, chorioretinitis and neuro involvement
how is congenital CMV diagnosed?
PCR of urine or blood or culturing the virus from urine or saliva
serology not recommended because maternal IgG can confound
what is the treatment for congenital CMV?
ganciclovir (taratogenic) IV or valganciclovir PO
what maternal variables produce worse congenital HSV infection?
HSV2, primary infection, visible lesions and when transmitted during pregnancy (not perinatal)
what is the most frequent scenario for neonatal HSV infection?
mother has recurrence of HSV2 at birth and the neonate acquires the virus at full term- prognosis is usually good
what is the most severe scenario for neonatal HSV infection?
mother has primary HSV2 during pregnancy and the fetus is born with dissemination- usually severe mental impairment (encephalitis) or death
how is neonatal HSV treated? how is it prevented?
acyclovir
c sections for women with frequent genital herpes outbreak and antiviral prophylaxis during pregnancy
what is the outcome of congenital varicella?
primary maternal infection effects limb and brain development with poor outcome
