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MSII Micro Unit 6 > Congenital and Perinatal Infections > Flashcards

Congenital and Perinatal Infections Flashcards

1
Q

What point in pregnancy is the most potentially dangerous for infection ?

A
  • early pregnancy
  • fetus is at highest risk from toxins, mutagens, and infections during 1st trimester
  • some women don’t know they’re pregnant
  • some women don’t act like they’re pregnant
  • mother may be exposed to harmful agents and not be aware
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2
Q

What are congenital infections?

A
  • acquired during gestation
  • severity: the earlier the mother is infected-> more harm to developing organs; acute maternal infection is worse than reactivation for the fetus-> higher infectious dose causes more harm
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3
Q

What are the manifestations of congenital infections?

A
  • growth retardation- low birth weight
  • congenital malformations
  • fetal loss- stillbirths
  • Rubella, CMV, Toxoplasma gondii, Treponema pallidum, Erythrovirus (parvovirus) B19, HSV, VZV
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4
Q

What are the manifestations of perinatal infections?

A
  • meningitis
  • septicemia
  • pneumonia
  • preterm labor
  • Neisseria gonorrhoeae, Chlamydia trachomatis, HSV, Streptococcus agalactiae (Group B Strep), E. coli, Listeria monocytogenes
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5
Q

What are the manifestations of postnatal infections?

A
  • meningitis
  • septicemia
  • conjunctivitis
  • pneumonitis
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6
Q

When do you have a high index of suspicion of congenital infections?

A

-an infant is born with abnormal head,eyes, blood, liver, spleen, jaundice and/or rash (blueberry muffins)

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7
Q

What are the signs of congenital infection?

A
  • prematurity worsens severity
  • intrauterine growth retardation
  • congenital defects
  • abnormal head size- microcephaly, hydrocephaly
  • intracranial calcifications
  • eye abnormalities
  • hearing loss
  • hepatosplenomegaly
  • hematologic abnormalities
  • bone lesions
  • inflammation of CSF
  • rash
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8
Q

How do you diagnose congenital infections?

A
  • recognize maternal exposures
  • mother often has no symptoms of infection, so few suspicions are raised until the infant is affected
  • detect IgM or rising IgG titer in maternal serum
  • other specific tests as warranted for mother, neonate, amniotic fluid or fetal blood
  • passive transfer of maternal IgG confounds serology on neonate!
  • definitive diagnosis: isolate pathogen from infant- sample urine, saliva, CSF, nasopharyngeal swabs
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9
Q

What are the most common congenital infections in the US?

A

1) CMV
2) Toxoplasmosis
3) Syphilis
4) Rubella

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10
Q

What are the TORCH infections?

A
  • Toxoplasmosis
  • Other- Syphilis, VZV, Parvovirus B19, Hep B, HIV, HTLV-1
  • Rubella
  • CMV
  • HSV

may have similar presentations at birth: Rash, Chorioretinitis, Microcephaly, Hepatosplenomegaly, IUGR

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11
Q

How is Toxoplasma gondii transmitted?

A
  • Domestic animals and mice theres encysted bradyzoites
  • theres sexual reproduction in the feline definitive host
  • there are oocysts in cat feces, and encysted bradyzoites (food and water borne) that infected human
  • congenital toxoplasmosis induced by tachyzoites
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12
Q

What are the symptoms of toxoplasmosis?

A
  • most affected infants are asymptomatic
  • if symptoms are apparent- classic triad of congenital toxoplasmosis- chorioretinitis, hydrocephalus, intracranial calcifications
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13
Q

How do you diagnose toxoplasmosis?

A
  • laboratory tests:
  • serology on mother and infant -> IgM+ infant is diagnostic
  • PCR on amniotic fluid, infant samples or placenta
  • direct observation of cyst
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14
Q

How do you treat toxoplasmosis?

A
  • Pyrimethamine (Daraprim) + Sulfadiazine + Folinic acid (Leucovorin)
  • treat for 1 year
  • delaying treatment worsens lon- term outcomes
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15
Q

What is congenital syphilis?

A
  • incidence of congenital reflects the rate in women
  • 384 congenital cases in 2013
  • Treponema pallidum crosses placenta and infects fetus
  • causes miscarriage/stillbirth/neonatal death 40-50%
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16
Q

What are the symptoms of congenital syphilis?

A
  • 2/3 affected infants are asymptomatic
  • symptoms usually appear by 5 weeks
  • common manifestations of early congenital syphilis- large puffy placenta, hepatomegaly, rhinitis (snuffles), rash, lymphadenopathy
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17
Q

How do you Diagnose and Treat T. pallidum?

A
  • if mother has positive test for syphilis, suspect congenital disease
  • test infants <1 month of age
  • VDRL or rapid plasma reagin titers
  • direct observation of bacteria or DFA staining
  • suspicious lesions (rash)
  • body fluids (snuffles)
  • placenta and umbilical cord
  • treat mother and infant with penicillin- IV or IM penicillin G for 10 days
18
Q

How does Congenital Rubella present?

A
  • infection of the fetus in early pregnancy results in severe disease in 80% of newborns
  • symptoms: hearing loss (most common), congenital heart defects, ophthalmic problems, intrauterine growth retardation, neurological problems- mental and psychomotor retardation, microcephaly
  • organs: hepatomegaly, splenomegaly, bone lesions, thrombocytopenia purpura, pneumonitis
19
Q

risk factors for congenital CMV?

A
  • no prior infection with CMV
  • pregnancy at a younger age
  • first pregnancy
  • new sex partner during pregnancy
  • frequent contact with babies and toddlers
  • mothers illness may be subclinical and she may be unaware that problems exist
  • primary infection during early pregnancy has the worst prognosis
  • spread through saliva
20
Q

symptoms of congenital CMV

A
  • chorioretinitis
  • small size for gestational age
  • microcephaly
  • petichiae, purpura, jaundice
  • hepatosplenomegaly
  • 15% develop progressive hearing loss
21
Q

incidence of congential CMV

A
  • 4 million/year of all pregnancies in the US
  • 99% of fetuses not affected
  • 1% affected-40,000
  • of those, 90% asymptomatic at birth and 85% of those remain normal, 15% develop late disabilities
  • 10% are symptomatic at birth, with the most severe neurologic complications
22
Q

diagnosis of congenital CMV

A
  • PCR on urine or blood
  • serology on infant not recommended because maternal IgG can confound results
  • culture virus from urine or saliva
23
Q

treatment of congenital CMV

A
  • ganciclovir IV

- valganciclovir PO

24
Q

congenital HSV infections

A

-many different presentations, ranging over all severities

25
Q

variables for HSV in mother

A
  • virus type, HSV2 worse than 1
  • primary infection is worse than reactivation
  • visible lesions worse than subclinical reactivation
26
Q

variables for HSV in child

A
  • intrauterine worse than perinatal

- disseminated worse than encephalitis, which is worse than skin lesions

27
Q

neonatal HSV infections

A
  • rare
  • most freq-mom has recurrent HSV2 during birth, neonate acquires virus at full term. prognosis is good, rare severe infections
  • most severe- mom has primary HSV 2 during pregnancy. fetus born with disseminated virus, prognosis poor- severe mental impairment, death
  • treatment is IV acyclovir
  • prevention- C section birth, antiviral prophylaxis during pregnancy
28
Q

congenital VZV

A
  • very rare
  • primary infection in mom damages fetus
  • limbs and brain development are impaired, outcome is poor
  • treatment- acyclovir and derivatives for mom
  • vaccinate all seronegative women
  • advise seronegative pregnant women to avoid children with chicken pox or anyone with shingles
29
Q

parvovirus B19

A

-5th disease
-most common in school age children during winter/spring
-biphasic disease
febrile illness without rash 1st,
then rash- slapped cheek on face. erythematous, maculopapular rash, arthralgia, arthritits
-seronegative pregnant women at risk for fetal death
-no treatment or prevention

30
Q

perinatal infections

A
  • acquired during or shortly after birth
  • many routes of transmission
  • exchange of maternal and fetal blood
  • fetal monitors attached to scalp break the skin
  • vaginal and skin flora colonize neonate during birth
  • many viruses secreted in breast milk
  • relatives and visitors can transmit infections to neonate- don’t kiss the baby!
31
Q

Hep B global distribution

A
  • up to 50% seropositive (?rebeccas lecture said 1/3)
  • HBV easily transmitted during birth
  • 15% of babies infected at birth without intervention
  • prevention- vaccinate all neonates, ad HBIG at birth if mom is HBV+
32
Q

perinatal transmission of retroviruses

A

-HTLV type 1 can cause adult T cell leukemia or tropical spastic paraparesis
-HIV can be transmitted
-transplacental passage of infected maternal lymphocytes, infected lymphocytes in breast milk
Risk groups:
-IVDA, sex with many people, prostitutes, newborns of virus positive mothers, people who aren’t vaccinated

33
Q

managing HIV mothers

A
  • combined ante/intrapartum and infant antiretroviral prophylaxis
  • recommendations updated frequently
  • 3 part zidovudine regimen- before, during, after birth
  • with treatment, only 2% transmission rate to neonate, without rate is 30%
34
Q

GBS

A
  • encapsulated gram positive
  • strep agalactiae
  • 25% of women are asymptomatic carriers
  • risk factors for early onset disease:
  • previous baby with GBS, GBS in urine
  • fever during labor
  • heavy maternal colonization
  • delivery before 37 weeks
  • premature or prolonged ROM
  • intrapartum antibiotics reduce risk
35
Q

early onset GBS

A

-0-7 days
-sepsis, possible bone foci, CNS involvement
-pneumonia
tachypnea, grunting, hypoxia
-appears ill
-poor feeding, lethargic, irritable
-temperature instability, HoTN, shock

36
Q

late onset GBS

A
  • 7-89 days
  • sepsis, bone, CNS
  • pneumonia or meningitis
  • sepsis-fever, irritability, lethargy, poor feeding, tachypnea, grunting, apnea
  • meningitis-bulging fontanel, nuchal rigidity, focal neuro findings
37
Q

late late onset GBS

A
  • > 3 mo
  • sepsis, bones, CNS
  • meningitis
38
Q

diagnosis of GBS

A
  • culture bacteria from normally sterile site

- GBS sensitive to penicillin

39
Q

maternal management of GBS

A
  • intrapartum antibiotic prophylaxis (IAP)

- penicillin G, IV

40
Q

empirical therapy for GBS

A
  • give when GBS is suspected but not confirmed
  • if IAP was given, suspect resistance
  • vanco + penicillin G or ampicillin
41
Q

important points about congenital/perinatal infections

A
  • prevention measures are most effective before pregnancy
  • vaccination and antimicrobials
  • 1st trimester is worst time for infections
  • maternal infection is often asymptomatic or missed
  • infections are not always transmitted to baby
  • TORCH panel not a routine screen in US

MSII Micro Unit 6 (8 decks)

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