Congenital infections Flashcards
What is the definition of a congential infection
Infection of the mother passed to fetus before OR after OR during the delivery
Even considered to be if by breastmilk
Congenital infection manifestation
DURING pregnancy
Growth retardation
What is perinatal infections
At the time of birth
meningitis
what are the two infections that can be transferred through the breast milk?
HIV
CMV
What is the TORCH infection mnemonic?
Toxoplasmosis
Other (HIV, enterovirus, etc)
Rubella
CMV
Herpes
What is toxoplasmosis caused by and how is it transmitted
A parasite
Transmitted vertically
More likely to get effected towards the delivery
often asymptomatic
Is it cost effective to screen for toxoplasmosis? When should you screen?
NO
screening is costly
Only screen if mom has symptoms and fetus has brain calcififations, lung problems, ascities, or fetal demise.
What are some RF of toxoplasmosis
Advanced gestational age
High parasite load
Uncooked meat
Immunocompromised
What is pathognomic for toxolasmosis
cataracts/retinitis
hearing
brain calcifications
+ systemic stuff
what are the s/s of toxoplasomsis
Can infect anything because it gets into the bone marrow
intracranial calcification
hydrocephalus
bone marrow
hearing loss
jaundice
hepatosplenomegaly
rash
fever
seizures
How to diagnose toxoplasmosis
IgG and IgM
CT shows diffuse cortical calcifications
How to spot toxoplasmosis prenatally
Abnormal prenatal US + mom s/s of lymphadenopathy then do
Amniocentesis
How to treat toxoplasmosis
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
What team needs to be involved with toxoplasomsis
Multidisciplinary d/t multiple organ systems
ophthalmology very important every 3 months until 18 months and then every year
Prevention of toxoplasmosis
Cook meat
wash fruits/veggies
avoid untreated drinking water
wear gloves while gathering
avoid changing cat litter
what type of organism is toxo?
parasite
should all mothers be screened
no incidence is small
MC eye finding of toxo
chorioretinitis
How often do you see rubella
Not often
what are the two reasons some1 can get fetal death
what is interesting about rubella
after 4 months is not worrying for fetus!
what are the s/s of rubella
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
what would mom feel
fever + rash
what do you do to diagnose rubella
IgM
CSF
blood cultures
What percentage of rubella are stillborn fetal demise
40%!
is rubella worse early or late
early
what type of organism is rubella
virus
vaccine preventable
what is the MC congenital infection in the US?
CMV
What type of organism is CMV
DS DNA herpes virus
is CMV screened
NOT screened in prenatal visits
when do CMV outcomes the worst?
In the beginning
Can CMV be transferred through breast milk?
YES
along with HIV
What mother history is MC for CMV
teenagers
how often is CMV symptomatic
only 10% of the time
what is CMV the MCC of?
Non-hereditary sensioneural hearing loss
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
what is the CT of CMV
Ventricular calcifications
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
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
does the mother have s/s of CMV?
Not usually, just a simple virus so maybe nasal congestion.
Most of us are immune
when you get CMV are you immune for life?
Yes
what does CMV do to bilirubin
elevated
what are the two ways CMV is best isolated
urine and saliva
when is the MC time HSV presents in baby
5-14 days after birth
3/4 of babies born with herpes have this mother history
mothers have no previous history or clinical findings consistent with HSV
How does HSV infect
oral/gential/conjenctival
sensory nerve endings
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