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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
What percentage of rubella are stillborn fetal demise
40%!
26
is rubella worse early or late
early
27
what type of organism is rubella
virus vaccine preventable
28
what is the MC congenital infection in the US?
CMV
29
What type of organism is CMV
DS DNA herpes virus
30
is CMV screened
NOT screened in prenatal visits
31
when do CMV outcomes the worst?
In the beginning
32
Can CMV be transferred through breast milk?
YES along with HIV
33
What mother history is MC for CMV
teenagers
34
how often is CMV symptomatic
only 10% of the time
35
what is CMV the MCC of?
Non-hereditary sensioneural hearing loss
36
What are the s/s of CMV
hearing loss microcephaly big organs thrombocytopenia petechiae appearance is small head, petechiae, jaundiced, posture has hands close to the face
37
what is the CT of CMV
Ventricular calcifications
38
How to diagnose CMV
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
39
How to treat CMV
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
40
does the mother have s/s of CMV?
Not usually, just a simple virus so maybe nasal congestion. Most of us are immune
41
when you get CMV are you immune for life?
Yes
42
what does CMV do to bilirubin
elevated
43
what are the two ways CMV is best isolated
urine and saliva
44
when is the MC time HSV presents in baby
5-14 days after birth
45
3/4 of babies born with herpes have this mother history
mothers have no previous history or clinical findings consistent with HSV
46
How does HSV infect
oral/gential/conjenctival sensory nerve endings
47
What is the s/s of baby with herpes?
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
48
What is the triad of HSV
skin vesicles (that can burst) ulceration scarring eye damage
49
what is the description of HSV lesions
flat on fluid filled
50
how to diagnose herpes
culture ANY orfice blood/urine/spinal fluid
51
treatment of neonatal HSV
ALWAYS Acyclovir if you have any worry and anyone who is septic only stop acylcovir if culture comes back negative
52
Do you screen for HSV?
NO only if you have symptoms at the time of history acyclovir 4 weeks prior to delivery
53
how should babies be delivered if mom has HSV
C section to avoid infection Acyclovir with mom
54
What percent of women hav past infection of herpes
30-60%
55
if primary infection is undetcted at time of tranmission
25%
56
what brain findings is HSV
seizures fever
57
Varicella zoster prevention
Vaccines!
58
what is VZV
herpes virus family
59
when is most cases of varicella
8-20 weeks
60
When is varicella most worrisome?
Later in delivery can be given if mom has shingles!
61
What is the s/s of shingles
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
how to diagnose varicella
burst vesicle and get fluid at base of the lesion and screen for HSV and varicella IgG will confirm the diagnose
63
What is the prophylactic med for varciella?
VariZIG (IV IG) to prevent baby from getting chicken pox
64
What is the treatment of active VZV
IV acyclovir breastfeeding is encouraged d/t breast milk having
65
if mom is infected in the first half of preggo is their a good chance the baby will get it?
if within 20 weeks, only a 2% chance
66
how do you isolate chicken pox in newborn?
scrape vesicle and send for culture
67
What is parvo aka
Human parovirus B19 fifth's disease erythema infectiosum
68
highest infection rates is for
teachers and daycare workers
69
what percent of adults are immune to B19
about half of pregnant women are already immune
70
what happens if you get parvo B19 while pregnant
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
prevention of parvo B19
masks if teacher
72
How to diagnose parvo B19
IgG and IgM
73
What is the management of a mom with parvo B19
US weekly if beyond 20 weeks Blood transfusions in baby
74
what does parvo B19 do to hemoglobin?
aplastic anemia
75
what is syphilis
spirochete
76
do they screen for sphyilis?
yes
77
when are s/s of syphilis seen
normally by 3 months sometimes until 2 years
78
what are the s/s of syphilis before 2 yo
snuffles white and bloody rash LAD skeletal problems
79
what are the s/s of syphilis after 2 yo
huthinsons triad: huthinsons teeth 8th CN defects interstial keratitis eyes, ears, mouth saddle nose synovial inflammation
80
how to diagnose syphilis
serum quantitiatve nontreponemal titre more than 4x the mother's direct visualization of T palladium
81
when should you suspect
mom did not get adequate treatment
82
What is the treatment of syphilis?
basically PEN G IM or IV repeat AB titers at 3,6, and 12 months
83
what is the percent of syphilis transmission?
100
84
what is the MCC of sexually transmitted genital infection
chlamydia vaginal birth transmission is 50-70%
85
is chlamydia screened?
yes along with gonorrhea 50-70%
86
what are the s/s of chlamydia
Bilateral conjunctivitis (because both eyes go through the birth canal) sometimes 5-14 days before symptoms PNA d/t gulping
87
How is chalmydia diagnosed
swab nose and eyes if conjunctivitis
88
what is the treatment of chlamydia
erythrmoycin ORAL
89
What is gonorrhea
gram negative diplococci
90
When do you see s/s of gonnreha and what?
5-7 days post birth bilateral eye infection purulent conjunctivitis profuse exudate and swellling scalp abscesses, vaginitis
91
what is the prophlyaxis for gonorrhea
previous STD. infection multiple sexual partners ALL babies get erythromycin of the eye
92
What is the treatment of gonorrhea
ceftriaxone (rocephin) test for other infections
93
most frequent site of infection of gonorrhea
eyeball
94
three transmission of HIV
placenta birth breast feeding
95
what decreases HIV transmission to baby
avoid breastfeeding treat mom
96
how to dx HIV
HIV DNA PCR
97
what is the treatment of HIV
antireoviral
98
What is Hep C
RNA virus vertical transmission
99
what is a common RF of Hep C
tattoos (think needles)
100
is BF CI in Hep C?
No
101
why do yob test after 18 months to make sure Hep C is cleared?
because they still may have mom's blood
102
What is HPV transmitted
airway because baby gulps perineum - also scalp decreased by HPV
103
chance of transmitting Hep C to baby
only 5%
104
what type of transmission is Zika
mosquito, flavovirus goes through the placenta
105
what are the s/s of zika
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
How do you diagnose Zika syndrome?
Head circumfrence Blood studies Cranial US (anterior fontanelle is not closed so you can probe their) Hearing assessment Radiologic
107
What is the definitive diagnose
Serum + Urine positive for zika RNA = definitive plausible if just one
108
Primary screening tool of Zika
US (noninvasive) can also use MRI and CT see a lot of fluid in Zika baby
109
treatment of Zika
goal is prevention with misquito symptomatic multidisciplinary team
110
if infants born to zika positive mom with no s/s, what is done?
CT of head + hearing evaluation
111
What is a newborn age?
28 days or less
112
what are the 3 ways that a baby can get bacterial sepsis
Bloodborne transceptanal ascending to the amniotic barrier infection passing through the birth canal
113
If a patient is septic at birth, when are s/s
w/in 24 hours have low BP, acidotic
114
What is the MC pathogen for bacterial sepsis?
Group B Strep TREAT MOM when screened
115
what are the s/s of sepsis
poor temp regulation (sometimes low) low BP Irritable poor feeding respiratory symptoms tachycardic
116
If a baby 7-90 days has this temp, you need a full sepsis work up
100.4 rectal temp MEDICAL emergency
117
what is the workup of sepsis
CBC BMP Urine cath and culture CXR CRP and Procalcitonin Blood cultures NP swab LP cultures
118
what is the treatment of newborn sepsis
admitted for r/o sepsis work up IV AB until all cultures are negative Ampicillin and Cefotaxime or Ampicillin and Gentamicin + acyclovir
119
Give 4-5 signs of newborn sepsis .
lethargy poor feeding low BP temp instability agitation

Pediatrics (7 decks)

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