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Pediatrics > Congenital infections > Flashcards

Congenital infections Flashcards

1
Q

An infection of the fetus typically caused by viruses, or less commonly other infections,that infect the pregnant mother and may be passed to the fetus.

A

Congenital infections

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2
Q

Congenital infections can be passed on when and how?

A

Can be before or after delivery
This can be via blood, vaginal secretions or even breast milk.

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3
Q

what are the 2 viruses that can be passed down via breast milk?

A
  • HIV
  • CMV
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4
Q

what are the 2 infections that can be passed down through the umbillicus?

A
  • staphlococci
  • tetanus
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5
Q

what is TORCH?

A
  • Toxoplasmosis
  • Others - HIV, enterovirus, parvovirus, varicella, hepatitis, syphilis
  • Rubella
  • Cytomegalovirus
  • Herpes
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6
Q

Toxoplasmosis is caused by?

A

Toxoplasma gondii - protozoan parasite (which is typically asymptomatic)

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7
Q

how is toxoplasmosis spread?

A

Vertical transmission of toxoplasma gondii, that occurs after acute maternal infection

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8
Q

Toxoplasmosis: Frequency of fetal infection increases with?

A

steeply with advancing gestational age

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9
Q

indications for toxoplasmosis screening

A
  1. High index of suspicion with significant cervical LAD, and high fever
  2. US findings of fetus
    - calcifications and or cerebral ventricular dilation - MC
    - Placental densities
    - Pericardial effusions
    - Ascites
    - Fetal demise
    - Hydrops fetalis

The US, UK, and Canada recommend against universal screening for toxoplasmosis in pregnancy

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10
Q

Toxoplasmosis: Risk Factors for maternal to fetal transmission

A
  1. Maternal infection at advanced gestational age
  2. High Parasite load
  3. Maternal parasite source
    - Higher risk of fetal infection when infected through cat feces than meat
  4. Maternal immunocompromise
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11
Q

s/s of toxoplasmosis

A
  • Cataracts / Chorioretinitis- MC
  • Abnormal CSF fluid
  • cerebral calcification = convulsion
  • Anemia
  • Microcephaly / Hydrocephalus
  • Hearing loss
  • Small for gestational age (SGA)
  • Early onset jaundice
  • HSM-hepatosplenomegaly
  • Generalized maculopapular rash
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12
Q

inflammation of the choroid (thin pigmented vascular coating of the eye) and retina of the eye.

A

Chorioretinitis

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13
Q

dx for toxoplasmosis

A
  • ELISA - detection of IgM and IgG antibodies
  • Skull films and CT head - diffuse cortical calcifications
  • acute infection - IgM Ab appear within 1 week - stay elevated for months
  • IgG appear in 2 wks, peak @ 8, then persist for life
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14
Q

Toxoplasmosis: How to spot prenatally

A
  • confirmed/strongly suspected primary maternal infection during pregnancy
  • abnml US findings
  • Testing via amniocentesis after 18 wks preferred
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15
Q

toxoplasmosis tx

A
  1. prevent transmission: Treat mom !!!
    - < 14 wks gestation - Spiramycin
    - > 14 wks - Pyrimethamine + Sulfadiazine + folinic acid until delivery
  2. Infants treated postnatally still - Pyrimethamine + Sulfadiazine + folinic acid until delivery x 1 year
  3. Repeated eye examinations x q3mo until 18 mo
    - Then q6-12mo
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16
Q

toxoplasmosis prevention

A
  • Cook meat until it’s well done
  • Peel and wash thoroughly all fruits and vegetables
  • Wash all surfaces after contact with raw meat
  • Avoid untreated drinking water
  • Wear gloves when gardening
  • Avoid changing cat litter
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17
Q

rubella: ?% lead to fetal death or premature stillborn delivery

A

40%

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18
Q

s/s rubella

A
  • “Blueberry Muffin Syndrome” - thrombocytopenia with petechiae or purpura
  • Ophthalmologic - cataracts, retinopathy, glaucoma
  • Cardiac - PDA and Peripheral pulmonary artery stenosis
  • Auditory - sensorineural hearing loss
  • Neurologic - behavior disorder, meningoencephalitis and mental retardation
  • Microcephaly
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19
Q

work up for rubella

A
  • IgM ab = recent infection
  • serial IgG over several months can be confirmation
  • CX - blood, urine and CSF are detectable as well
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20
Q

rubella: Tend to shed live virus in ___, ____, and ___ for up to 1 year

A

urine, stool, and respiratory secretions

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21
Q

Is Rubella worse if mom gets it early or late in pregnancy?

A

early

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22
Q

MC congenital infection?

A

CMV

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23
Q

what type of virus is CMV?

A

Double stranded DNA herpes virus

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24
Q

how is CMV transmitted?

A

Requires intimate contact: blood, saliva, etc.

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25
Q

CMV: Severe problems can occur at any trimester but greater if exposed when?

A

first trimester

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26
Q

congenital CMV is 3-7x greater in what type of pregnancies

hint: age group

A

adolescent pregnancies

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27
Q

Leading cause of non-hereditary sensorineural hearing loss

A

CMV

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28
Q

presentation of CMV

A
  • sensorineural hearing loss
  • Microcephaly
  • Intracranial calcifications / periventricular
  • Hepatosplenomegaly / Jaundice
  • Mental Retardation
  • Retinal Disease
  • Cerebral Palsy
  • Thrombocytopenia / Petechiae
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29
Q

how to dx CMV?

A
  • DX: Clinically
  • Elevated liver transaminases, thrombocytopenia, bilirubin
  • CMV detection in urine or saliva (within first 3 wks of life)
  • CT: intracranial lesions - usually periventricular
  • IgM and IgG
  • PCR studies (check viral load)
  • Detection of CMV w/n first 3 wks after birth = congenital CMV infection; after first 3 wks = perinatal exposure
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30
Q

CMV tx

A
  • No antivirals currently approved
  • Very symptomatic - ganciclovir and valganciclovir - NEED APPROVAL
  • Long term tx - PT, Birth to Three, Children with Special Health Care Needs, Hospice.
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31
Q

?% pregnant women have evidence of past HSV infection

A

30-60%

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32
Q

which HSV type accounts for 70% or more of neonatal herpes infections or congenital cases

A

HSV 2

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33
Q

Primary genital herpes infection and vaginal birth: ?% risk of infecting baby

A

25-50

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34
Q

HSV: Highest risk intrauterine is during what trimester

A

3rd trimester

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35
Q

?% infants who acquire HSV infection are born to mothers with no previous hx or clinical findings consistent with HSV infection

A

75

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36
Q

HSV: Disseminated infection should be considered in any infant and neonatal with symptoms of ?

A

sepsis, liver dysfunction and negative bacteriologic cultures.
neonate - fever, irritability and / or abnml CSF findings and seizures

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37
Q

Congenital HSV - Triad of symptoms:

A
  1. Skin vesicles
  2. Ulcerations
  3. Scarring eye damage
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38
Q

additional HSV presentations

A
  • Organomegaly (usually liver and lungs)
  • CNS abnormalities
  • Prematurity (< 36 wks gestation)
  • Localized infections of skin, eyes and mouth is usually first indication of infection (45%)
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39
Q

how to DX HSV?

A
  • Specimen CX - vesicles, eyes, urine, nasopharynx, blood, CSF, stool or rectum
  • PCR - sensitive for detecting HSV DNA in blood, urine and CSF
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40
Q

HSV tx

A

**IV Acyclovir **

given to all infants suspected to have infection or dx of HSV.

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41
Q

recommendations for HSV

A
  • USPSTF does not recommend screening asx mothers
  • ACOG recommends c-section delivery for ALL mothers with active genital lesions
  • DO NOT KISS THE BABIES
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42
Q

if mom is infected with VZV during the first half of pregnancy, what are the chances for transmission?

A

low

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43
Q

Congenital Varicella syndrome s/s

A
  • Cicatricial skin lesions (zig zag skin scarring and limb atrophy)
  • Ocular defects - cataracts, retinitis
  • CNS - hydrocephalus, microcephaly, seizures, mental retardation
  • Death 20-30% for a child of a mother who develops varicella 5-7 days after delivery
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44
Q

how to dx varicella?

A
  • Usually based upon the characteristic appearance of skin lesions
  • Scraping of vesicle base and testing PCR for varicella
  • IgM may be detected 3 d after sx appear
  • IgG increased in serum confirms dx and may be present as early as 7 d after sx appear
45
Q

Varicella : treatment? can you breastfeed?

A
  1. VariZIG - varicella zoster immune globulin (IVIG)
    - Prophylaxis Exposure
    - Given to any infant with perinatal exposure
    - Given to all infants < 28 wks gestation following postnatal exposure
  2. Isolation
  3. Acyclovir - 30 mg/kg per day TID IV
  4. Breastfeeding encouraged in exposed newborns d/t antibodies in breast milk
46
Q

3 ways Parvo B19 is known as:

A
  • Human Parvovirus B19
  • Fifth’s Disease
  • Erythema Infectiosum
47
Q

what type of virus is Parvo B19

A

Single-stranded DNA virus

48
Q

Parvo B19 has highest infection rates in what professions?

A

teachers and daycare workers

49
Q

s/s of parvo B19?

A
  • Mild systemic sx - fever, lacy rash, slapped cheeks
  • Fetal anemia
  • Myocarditis
  • Hydrops fetalis
  • Children infected have 1-4 days of systemic sx before the appearance of rash.
  • Arthropathy - joints of hands, wrists, knees and ankles; lasts 1-2 wks.
50
Q

a serious fetal condition defined as abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema.

A

Hydrops fetalis (fetal hydrops)

51
Q

how to dx parvo B19

A
  • Pregnant women exposed - IgG + IgM; US; percutaneous umbilical cord blood sampling
  • Positive IgM test result indicates that infection probably occurred within the past 2-4 mo
52
Q

tx for Parvo B19

A
  • acute infection > 20 wks gestation - US weekly looking for signs of fetal hydrops
  • Infants who survive - supp on management of hydrops.
  • Aplastic crisis - blood transfusions
53
Q

what is syphilis caused by?

A

Spirochete Treponema pallidum

54
Q

Syphilis is MC transmitted by ?

A

transplacental infection of fetus

  • nearly 100% chance of passage to fetus if active primary or secondary infection, but can be acquired by contact with chancre
55
Q

syphilis: ?% result in spontaneous abortion

A

40%

56
Q

how many infants are born with congenital syphilis asx at birth but will manifest sx by 3 months of age?

A

2/3

57
Q

s/s syphilis

A

not transferred through breast milk

  1. Before 2 y/o
    - Hepatomegaly
    - Nasal Discharge - “Snuffles” (persistent) - White and may be bloody
    - Rash
    - Generalized LAD
    - Skeletal abnormalities
  2. After 2 y/o
    - CNS abnormalities
    - Abnormalities to bones, teeth, eyes, skin
58
Q

late s/s of syphilis

A
  • Hutchinson’s Triad: interstitial keratitis, CNVIII deafness and Hutchinson’s teeth
  • Rhagades - cracks and fissures around mouth and chin
  • Bowing shins
  • Saddle nose
  • Mulberry molars: round cusps on enamel on permanent first molars
  • Clutton Joints: symmetrical joint edema/synovial inflammation
59
Q

What conditions would require further evaluation in regards to mom’s syphilis status?

A
  • Any child born to a mother with positive testing w/o adequate tx with PCN
  • infants whose mothers were treated < 1 mo prior to delivery
  • should not be DC w/o knowing mom’s syphilis status
59
Q

how to dx syphilis

A
  • Serum quantitative nontreponemal titer > fourfold mother’s titer
  • Direct visualization of T. Pallidum by dark field exam from bodily fluids
60
Q

syphilis tx

A
  1. Parenteral PCN
    - aq PCN G x 10 d - 50,000 U/kg q12h IV
    - Procaine PCN G x 10 d - 50,000 U/kg QD IM
  2. Repeat antibody titers at 3, 6, 12 mo to document falling titers
61
Q

MCC of sexually transmitted genital infections in the US

A

chlamydia

62
Q

chlamydia is transmitted to newborns via ?

A

exposure to an infected mother’s genital flora during vaginal birth

63
Q

how are mothers screened for chlamydia?

A

via vaginal swab or first pass urine specimen

64
Q

s/s chlamydia

A
  • Conjunctivitis - incubation 5-14 days post delivery - Both eyes
  • Pneumonia
65
Q

chlamydia should be suspected in any infant how old and with what sign?

A

under a month of age with conjunctivitis if possibility of exposure

66
Q

gold standard of dx chlamydia

A

isolation of C trachomatis by cx
Swabs of both conjunctival and nasopharyngeal samples

67
Q

tx chlamydia

A
  • Topical therapy not effective
  • Erythromycin PO x 14 d
  • All pregnant women should be screened at the first pregnancy visit
68
Q

what pathogen causes gonorrhea

A

Neisseria Gonorrhoeae - G- diplococci

69
Q

s/s gonorrhea

A
  • Eye MC frequent site of infection (BL)
  • Purulent conjunctivitis
  • Profuse exudate and swelling of eyelid
  • May also present as scalp abscesses, vaginitis and bacteremia
70
Q

who to screen for gonorrhea

A

Screening for those at increased risk for infection:
* previous STD infection
* multiple sexual partners
* inconsistent condom use
* commercial sexual partners
* drug use
* in communities with high prevalence of disease

71
Q

Neonatal prophylaxis gonorrha

A

Erythromycin ophthalmic ointment

72
Q

dx for gonorrhea

A

Gram stain of conjunctival exudate

73
Q

tx gonorrhea

A
  • Single dose of Ceftriaxone
  • asx infants whose mothers have untreated disease should receive the same tx
  • Test for the others
74
Q

how can HIV be transmitted?

A

from mother to baby transplacentally in utero, during birth or by breastfeeding

75
Q

ways to decrease the risk of HIV transmission

A
  • antiretroviral tx of mother before and during delivery
  • tx of infant first 6 wks of life
  • C-section
  • avoidance of breastfeeding
76
Q

what increases the risk of HIV transmission by 30-50%?

A

Breastfeeding

77
Q

HIV presentation

A

Newborns are typically asx

78
Q

HIV dx

A

HIV DNA PCR

< 48 hrs of age, 2 wks, 1-2 mo, and at 2-4 mo

If 4 months and older with a neg PCR - HIV excluded

79
Q

tx HIV

A

Antiretroviral prophylaxis (Zidovudine) for 6 wks for infants born to HIV-infected mothers

80
Q

type of virus Hep C

A

HCV - small, single stranded RNA virus

81
Q

primary source of pediatric infection of Hep C

A

Vertical transmission

82
Q

Hep C: 5% transmission rate from mother to baby; what other condition increases risk?

A

HIV

83
Q

RF for Hep C

A
  • IV drug use
  • tattoos (of the at-home or prison variety)
84
Q

can you breastfeed while having Hep C?

A

yes, not CI

85
Q

how to dx Hep C

A
  • Anti-HCV (HCV antibody testing) present in blood after 18 mo of age is indicator
  • confirmed with HCV RNA test, then HCV Genotyping
86
Q

tx Hep C

A

decided by GI- interferon and ribavirin

87
Q

presentation of Hep C

A

MC asx

88
Q

presentation HPV

A

hoarseness in children later on in life

89
Q

prevention of HPV

A

HPV or Gardasil vaccine

90
Q

Congenital Zika Syndrome is caused by what

A

Arthropod-borne flavivirus transmitted by mosquitoes

91
Q

pathway of infection of Zika

A
  1. Maternal infection
  2. placental transmission
  3. virus targets neural progenitor cells in fetal brain
  4. kills progenitor cells
92
Q

presentation Zika syndrome

A

asx or sx
* Fetal growth restriction
* Fetal demise - 5-10%
* Ventriculomegaly
* Microcephaly
* Ocular - Optic nerve and retinal pathology; Retinal scarring
* Hearing loss - sensorineural, possibly delayed
* Arthrogryposis - Congenital joint contracture; Congenital club foot
* Cardiac - ASD, VSD, PFO
* Neurogenic - Hypertonia; Spasticity; Hyperreflexia; Seizures / Epilepsy
* SGA

93
Q

describe the microcephaly in Zika

A
  • Severe with partial skull collapse
  • Thin cerebral cortices with subcortical calcifications
  • Craniofacial disproportion
  • Craniosynostosis
94
Q

how to eval Zika

A
  • H&P - Head circumference / development
  • Lab studies
  • Cranial U/S (primary screening tool)
  • Hearing Assessment
  • Radiologic findings
95
Q

what lab shows definitive infection of Zika

A

(+) Serum + Urine for Zika RNA via PCR

96
Q

what two labs show probable Zika infection

A
  1. Serum Zika IgM
  2. CSF for RNA and IgM

If both of these negative = Likely negative

97
Q

tx Zika syndrome

A
  1. No specific tx - multifaceted
  2. Referrals
    - Ophthalmology w/in 1 month of birth
    - Hearing screen - newborn (ABR preferred)
    - Neurology, ID, Genetics, Development
    - Labs - Zika detection, CBC, CMP, genetics
  3. Infants born to Zika (+) mothers w/o clinical findings
    - Head US and ophthalmologic exam and ABR hearing test by 1 mo of age
98
Q

Newborn is considered any child within the first ? days of life

A

28

99
Q

Three major routes of perinatal infection

A
  1. Bloodborne transplacental - CMV, etc.
  2. Ascending with disruption of the amniotic barrier (PRM) - Bacterial infections after 12-18 hrs of ruptured membranes
  3. Infection via passage through birth canal - HSV, HIV, GBS, etc.
100
Q

Most with early-onset sepsis will present at what age

A

< 24 hrs of age

101
Q

presentation of sepsis

A
  • Resp distress MC
  • hypotension, acidemia, and neutropenia
  • Range from subtle to profound septic shock
  • Temperature instability
  • Irritability
  • Lethargy
  • Poor feeding
  • Respiratory sx
  • Tachycardia
  • Poor perfusion
  • hypotension
102
Q

MC pathogen to cause sepsis

A

group B strep

103
Q

newborn sepsis w/u for how long?

(__ days of age)

A

7-90 days of age

104
Q

rectal temp considered sepsis

A

100.4

105
Q

Medical emergency, specifically ? days or under requiring a full work-up and hospital admission

A

60

106
Q

work-up for newborn sepsis

A
  • CBC
  • BMP
  • Urine cath and culture
  • CXR
  • CRP and Procalcitonin
  • Blood cultures
  • NP swab
  • LP cultures
107
Q

tx for newborn sepsis

A
  • hospital admission with empiric abx until all cultures return
  • Ampicillin + Cefotaxime/Gentamicin
  • Questionable Acyclovir
  • Close follow-up by PCP after discharge

Pediatrics (23 decks)

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