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Pediatrics > Congenital infections > Flashcards

Congenital infections Flashcards

1
Q

What is the definition of a congential infection

A

Infection of the mother passed to fetus before OR after OR during the delivery

Even considered to be if by breastmilk

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2
Q

Congenital infection manifestation

A

DURING pregnancy

Growth retardation

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3
Q

What is perinatal infections

A

At the time of birth

meningitis

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4
Q

what are the two infections that can be transferred through the breast milk?

A

HIV
CMV

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5
Q

What is the TORCH infection mnemonic?

A

Toxoplasmosis
Other (HIV, enterovirus, etc)
Rubella
CMV
Herpes

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6
Q

What is toxoplasmosis caused by and how is it transmitted

A

A parasite
Transmitted vertically

More likely to get effected towards the delivery

often asymptomatic

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7
Q

Is it cost effective to screen for toxoplasmosis? When should you screen?

A

NO
screening is costly

Only screen if mom has symptoms and fetus has brain calcififations, lung problems, ascities, or fetal demise.

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8
Q

What are some RF of toxoplasmosis

A

Advanced gestational age
High parasite load
Uncooked meat
Immunocompromised

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9
Q

What is pathognomic for toxolasmosis

A

cataracts/retinitis
hearing
brain calcifications

+ systemic stuff

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10
Q

what are the s/s of toxoplasomsis

A

Can infect anything because it gets into the bone marrow

intracranial calcification
hydrocephalus
bone marrow
hearing loss
jaundice
hepatosplenomegaly
rash
fever
seizures

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11
Q

How to diagnose toxoplasmosis

A

IgG and IgM
CT shows diffuse cortical calcifications

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12
Q

How to spot toxoplasmosis prenatally

A

Abnormal prenatal US + mom s/s of lymphadenopathy then do

Amniocentesis

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13
Q

How to treat toxoplasmosis

A

if before 14: spiarmycin
if after 14: pyrimethamine and sulfadiazine with folinic acid

Mom gets treatment after 14 weeks
Baby gets treated for a year with pyrimethamine and sulfadiazine with folic acid

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14
Q

What team needs to be involved with toxoplasomsis

A

Multidisciplinary d/t multiple organ systems

ophthalmology very important every 3 months until 18 months and then every year

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15
Q

Prevention of toxoplasmosis

A

Cook meat
wash fruits/veggies
avoid untreated drinking water
wear gloves while gathering
avoid changing cat litter

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16
Q

what type of organism is toxo?

A

parasite

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17
Q

should all mothers be screened

A

no incidence is small

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18
Q

MC eye finding of toxo

A

chorioretinitis

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19
Q

How often do you see rubella

A

Not often

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20
Q

what are the two reasons some1 can get fetal death

A
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21
Q

what is interesting about rubella

A

after 4 months is not worrying for fetus!

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22
Q

what are the s/s of rubella

A

blueberry muffin syndrome
d/t virus affecting bone marrow causing thrombocytopenia causing
small head
CATARACTS

petechiae/purpura
have cataracts, retinopathy, glaucoma
cardiac: PDA and pulmonary artery stenosis
Auditory
small head
slow learning
CATARACTS
hepatosplenomegaly
bone disease

Almost everything

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23
Q

what would mom feel

A

fever + rash

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24
Q

what do you do to diagnose rubella

A

IgM
CSF
blood cultures

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25
Q

What percentage of rubella are stillborn fetal demise

A

40%!

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26
Q

is rubella worse early or late

A

early

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27
Q

what type of organism is rubella

A

virus
vaccine preventable

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28
Q

what is the MC congenital infection in the US?

A

CMV

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29
Q

What type of organism is CMV

A

DS DNA herpes virus

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30
Q

is CMV screened

A

NOT screened in prenatal visits

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31
Q

when do CMV outcomes the worst?

A

In the beginning

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32
Q

Can CMV be transferred through breast milk?

A

YES

along with HIV

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33
Q

What mother history is MC for CMV

A

teenagers

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34
Q

how often is CMV symptomatic

A

only 10% of the time

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35
Q

what is CMV the MCC of?

A

Non-hereditary sensioneural hearing loss

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36
Q

What are the s/s of CMV

A

hearing loss
microcephaly
big organs
thrombocytopenia
petechiae
appearance is
small head, petechiae, jaundiced, posture has hands close to the face

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37
Q

what is the CT of CMV

A

Ventricular calcifications

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38
Q

How to diagnose CMV

A

High index of symptons d/t no symptoms

elevated liver test
jaundice
platelet low
detectedf in urine w/in 3 weeks
blood of IgM IgG
PCR study for viral load

w/in 3 weeks = congential
after 3 weeks = perinatal

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39
Q

How to treat CMV

A

No approved medicine :(

if very asymptomatic, there are two antivrials that stop progression of symptoms (not approved (ganciclovir and valganciclovir) ask for Birth to Three to provide

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40
Q

does the mother have s/s of CMV?

A

Not usually, just a simple virus so maybe nasal congestion.

Most of us are immune

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41
Q

when you get CMV are you immune for life?

A

Yes

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42
Q

what does CMV do to bilirubin

A

elevated

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43
Q

what are the two ways CMV is best isolated

A

urine and saliva

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44
Q

when is the MC time HSV presents in baby

A

5-14 days after birth

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45
Q

3/4 of babies born with herpes have this mother history

A

mothers have no previous history or clinical findings consistent with HSV

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46
Q

How does HSV infect

A

oral/gential/conjenctival
sensory nerve endings

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47
Q

What is the s/s of baby with herpes?

A

triad of HSV +
SEVERE
look septic
fever
iritability
abnormal brain findings - think CNS for HSV
Some babies it is just nose eyes and mouth
Premature

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48
Q

What is the triad of HSV

A

skin vesicles (that can burst)
ulceration
scarring eye damage

49
Q

what is the description of HSV lesions

A

flat on fluid filled

50
Q

how to diagnose herpes

A

culture ANY orfice
blood/urine/spinal fluid

51
Q

treatment of neonatal HSV

A

ALWAYS Acyclovir if you have any worry and anyone who is septic

only stop acylcovir if culture comes back negative

52
Q

Do you screen for HSV?

A

NO
only if you have symptoms at the time of history
acyclovir 4 weeks prior to delivery

53
Q

how should babies be delivered if mom has HSV

A

C section to avoid infection
Acyclovir with mom

54
Q

What percent of women hav past infection of herpes

A

30-60%

55
Q

if primary infection is undetcted at time of tranmission

A

25%

56
Q

what brain findings is HSV

A

seizures
fever

57
Q

Varicella zoster prevention

A

Vaccines!

58
Q

what is VZV

A

herpes virus family

59
Q

when is most cases of varicella

A

8-20 weeks

60
Q

When is varicella most worrisome?

A

Later in delivery

can be given if mom has shingles!

61
Q

What is the s/s of shingles

A

zig zag scarring
ocular defects
hydrocephalus
difficulty
20-30% of children will pass away if mother gets infected 5-7 days prior to birth

62
Q

how to diagnose varicella

A

burst vesicle and get fluid at base of the lesion and screen for HSV and varicella
IgG will confirm the diagnose

63
Q

What is the prophylactic med for varciella?

A

VariZIG (IV IG) to prevent baby from getting chicken pox

64
Q

What is the treatment of active VZV

A

IV acyclovir
breastfeeding is encouraged d/t breast milk having

65
Q

if mom is infected in the first half of preggo is their a good chance the baby will get it?

A

if within 20 weeks, only a 2% chance

66
Q

how do you isolate chicken pox in newborn?

A

scrape vesicle and send for culture

67
Q

What is parvo aka

A

Human parovirus B19
fifth’s disease
erythema infectiosum

68
Q

highest infection rates is for

A

teachers and daycare workers

69
Q

what percent of adults are immune to B19

A

about half of pregnant women are already immune

70
Q

what happens if you get parvo B19 while pregnant

A

Hydops fetalis (big deal, classic finding) = fluid everywhere including hands and feet
fetal anemia
myocarditis

in kids it is just minor w/ slapped cheek look - runny nose

71
Q

prevention of parvo B19

A

masks if teacher

72
Q

How to diagnose parvo B19

A

IgG and IgM

73
Q

What is the management of a mom with parvo B19

A

US weekly if beyond 20 weeks
Blood transfusions in baby

74
Q

what does parvo B19 do to hemoglobin?

A

aplastic anemia

75
Q

what is syphilis

A

spirochete

76
Q

do they screen for sphyilis?

A

yes

77
Q

when are s/s of syphilis seen

A

normally by 3 months
sometimes until 2 years

78
Q

what are the s/s of syphilis before 2 yo

A

snuffles
white and bloody
rash
LAD
skeletal problems

79
Q

what are the s/s of syphilis after 2 yo

A

huthinsons triad:
huthinsons teeth
8th CN defects
interstial keratitis

eyes, ears, mouth

saddle nose
synovial inflammation

80
Q

how to diagnose syphilis

A

serum quantitiatve nontreponemal titre more than 4x the mother’s

direct visualization of T palladium

81
Q

when should you suspect

A

mom did not get adequate treatment

82
Q

What is the treatment of syphilis?

A

basically PEN G IM or IV

repeat AB titers at 3,6, and 12 months

83
Q

what is the percent of syphilis transmission?

A

100

84
Q

what is the MCC of sexually transmitted genital infection

A

chlamydia

vaginal birth transmission is 50-70%

85
Q

is chlamydia screened?

A

yes

along with gonorrhea

50-70%

86
Q

what are the s/s of chlamydia

A

Bilateral conjunctivitis (because both eyes go through the birth canal)
sometimes 5-14 days before symptoms
PNA d/t gulping

87
Q

How is chalmydia diagnosed

A

swab nose and eyes if conjunctivitis

88
Q

what is the treatment of chlamydia

A

erythrmoycin ORAL

89
Q

What is gonorrhea

A

gram negative diplococci

90
Q

When do you see s/s of gonnreha and what?

A

5-7 days post birth
bilateral eye infection
purulent conjunctivitis
profuse exudate and swellling
scalp abscesses, vaginitis

91
Q

what is the prophlyaxis for gonorrhea

A

previous STD. infection
multiple sexual partners

ALL babies get erythromycin of the eye

92
Q

What is the treatment of gonorrhea

A

ceftriaxone (rocephin)

test for other infections

93
Q

most frequent site of infection of gonorrhea

A

eyeball

94
Q

three transmission of HIV

A

placenta
birth
breast feeding

95
Q

what decreases HIV transmission to baby

A

avoid breastfeeding
treat mom

96
Q

how to dx HIV

A

HIV DNA PCR

97
Q

what is the treatment of HIV

A

antireoviral

98
Q

What is Hep C

A

RNA virus

vertical transmission

99
Q

what is a common RF of Hep C

A

tattoos (think needles)

100
Q

is BF CI in Hep C?

A

No

101
Q

why do yob test after 18 months to make sure Hep C is cleared?

A

because they still may have mom’s blood

102
Q

What is HPV transmitted

A

airway because baby gulps perineum - also scalp

decreased by HPV

103
Q

chance of transmitting Hep C to baby

A

only 5%

104
Q

what type of transmission is Zika

A

mosquito, flavovirus
goes through the placenta

105
Q

what are the s/s of zika

A

small heads
big ventricles
skull collapse
cardiofascial disproportion because the face is bigger than brain
Ocular issues (retinal scarring)
Sensioneural hearing loss
Arthrogryphosis (joints are stuck)
Cardiac abnormalities (ASD, VSD, PFO)
Neurogenic abnormalities from skull collapse (hypertonia, spasciticy)

106
Q

How do you diagnose Zika syndrome?

A

Head circumfrence
Blood studies
Cranial US (anterior fontanelle is not closed so you can probe their)
Hearing assessment
Radiologic

107
Q

What is the definitive diagnose

A

Serum + Urine positive for zika RNA = definitive

plausible if just one

108
Q

Primary screening tool of Zika

A

US (noninvasive)

can also use MRI and CT

see a lot of fluid in Zika baby

109
Q

treatment of Zika

A

goal is prevention with misquito

symptomatic
multidisciplinary team

110
Q

if infants born to zika positive mom with no s/s, what is done?

A

CT of head + hearing evaluation

111
Q

What is a newborn age?

A

28 days or less

112
Q

what are the 3 ways that a baby can get bacterial sepsis

A

Bloodborne transceptanal
ascending to the amniotic barrier
infection passing through the birth canal

113
Q

If a patient is septic at birth, when are s/s

A

w/in 24 hours

have low BP, acidotic

114
Q

What is the MC pathogen for bacterial sepsis?

A

Group B Strep

TREAT MOM when screened

115
Q

what are the s/s of sepsis

A

poor temp regulation (sometimes low)
low BP
Irritable
poor feeding
respiratory symptoms
tachycardic

116
Q

If a baby 7-90 days has this temp, you need a full sepsis work up

A

100.4 rectal temp

MEDICAL emergency

117
Q

what is the workup of sepsis

A

CBC
BMP
Urine cath and culture
CXR
CRP and Procalcitonin
Blood cultures
NP swab
LP cultures

118
Q

what is the treatment of newborn sepsis

A

admitted for r/o sepsis work up
IV AB until all cultures are negative

Ampicillin and Cefotaxime or Ampicillin and Gentamicin

+ acyclovir

119
Q

Give 4-5 signs of newborn sepsis .

A

lethargy
poor feeding
low BP
temp instability
agitation

Pediatrics (7 decks)

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