Congenital Infections Flashcards
note: the other cards are on quizlet because brainscape was being weird so this starts at HSV
What percent of pregnant women have evidence of past HSV infection?
30-60%
What type of HSV accounts for 70% or more of neonatal herpes infections or congenital cases
HSV 2
How is the majority of HSV passed to the newborn?
Through the birth canal and typically displayed within 28 days after birth
What is the risk of infecting the baby with primary genital herpes infection and vaginal birth?
25-50%
When is the highest risk of passing HSV to baby intrauterine?
3rd trimester
What type of transmission is more common: neonatal or congenital?
Neonatal
75% of infants who acquire HSV infections are born to mothers with what?
No previous history or clinical findings consistent with HSV infection
What is the process of infection of the infant with hsv?
- Fetus infected transplacentally or through retrograde spread through ruptured or seemingly intact membranes
- Enters human host via oral, genital, or conjunctival mucosa or break in skin
- Infects sensory nerve endings
- Transports via retrograde axonal flow to dorsal root ganglia where remains for life of host
When do symptoms of HSV usually develop?
5-10 days after birth
When should disseminated HSV infection be considered?
Any infant with symptoms of
* sepsis
* liver dysfunction
* negative bacteriologic cultures
* fever
* irritability
* abnormal csf findings and seizures
HSV infections are often what
- severe, delay in treatment can lead to significant morbidity and mortality
- Most benign outcome for morbidity and mortality in infants with disease limited to skin, eyes, and mouth
Clinical presentation of HSV
Congenital triad of symptoms:
* Skin vesicles
* Ulcerations
* Scarring eye damage
Other symptoms/signs:
* Organomegaly
* CNS abnormalities
* Prematurity (<36 weeks gestation)
* Localized infections of the skin, eyes and mouth usually first indication of infection
Diagnosis of HSV
- Specimen cultures: skin vesicle, eyes, urine, nasopharynx, blood, CSF, stool or rectum
- PCR sensitive for detecting HSV DNA in blood, urine, and CSF
Treatment of HSV
- Parenteral acyclovir = treatment of choice for neonatal HSV
- Administered to all infants suspected to have or have diagnosis of HSV
Who should be screened for HSV?
- USPSTF does not recommend screening asymptomatic mothers
Recommended method of delivery if mom has active genital lesions?
C-section
What percent of women have evidence of past HSV infection
30-60%
If primary infection is ath the time of birth (and untreated), what is the chance of transmission?
- 25-50%
What percent of HSV + babies had no history of HSV in mom?
75%
What CNS findings make you think about HSV?
- Fever
- Irritability
- Seizures
What areas of the body can you recover HSV from?
Any orifice
What medication is used for HSV in the newborn?
Acyclovir IV
When is a c-section indicated with HSV?
Active genital lesions
When do most cases of varicella zoster infection of infant occur in mothers who are infected?
8-20 weeks gestation
If infected in the first 20 weeks, what is the percent chance of transmission to the baby?
2%
When can varicella zoster be transmitted perinatally?
5 days before to 2 days after delivery, causing severe disseminated infection
Signs and symptoms of congenital varicella syndrome
- Cicatricial skin lesions (zig zag skin scarring and limb atrophy)
- Ocular defects- cataracts, retinitis
- CNS - hydrocephalus, microcephaly, seizures, mental retardation
- Death 20-30% for child of mother who develops varicella 5-7 days after delivery
Diagnosis of varicella
- characteristic appearance of skin lesion
- scraping of vesicle base and testing PCR for varicella
- IgM may be detected 3 days after symptoms appear
- IgG increased in serum confirms diagnosis and may be present as early as 7 days after symptoms appear
Treatment of varicella
- Varizig (varicella zoster immune globulin) prophylaxis given to any infant with perinatal exposure and all infants younger than 28 wks following postnatal exposure
- Isolation
- Acyclovir - 30 mg/kg per day TID IV
- Breastfeeding encouraged in exposed newborns d/t antibodies in breast milk
If mom is infected in teh first half of prengnacy, is there a good chance the baby will get it?
No, closer to delivery has a higher chance
Can a newborn get chickenpox from it’s mom after birth? If so, what is the death rate?
yes, 20-30%
How do you isolate chicken pox in the newborn?
Scrape vesicle
What is the prophylactic medication for varicella?
Varizig
What is the medication for treatment of Varicella?
Acyclovir
What type of organism is parvo B19?
Single stranded DNA virus
Who has the highest infection rate with parvo B19?
Teachers and daycare workers
What are symptoms of mild parvo B19?
aka fifths disease, erythema infectiosum
Mild systemic symptoms: fever, lacy rash, slapped cheeks
Signs and symptoms of parvo in infant
- Fetal anemia
- Myocarditis
- Hydrops fetalis
- Fetal demise
- Children:1-4 days of systemic symptoms prior to development of rash and arthropathy affection joints of hands, wrists, knees, and ankles lasting 1-2 weeks
What is hydrops fetalis?
S
Serious fetal condition
* Abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema
Diagnosis of Parvo B19?
- Pregnant women exposed serotype tested for IgG and IgM
- Ultrasound
- Percutaneous umbilical cord blood sampling of fetus
What does a positive IgM test result for Parvo indicate?
Infection probably occurred within the past 2-4 months
Treatment of Parvo B19?
- beyond 20 weeks gestation receive periodic ultrasounds looking for hydrops fetalis
- Infants who survive given supportive treatment to manage hydrops
- Aplastic crisis requires blood transfusions
What else is parvo called?
Erythema infectiosum, fifth’s disease
What 2 occupations are most likely to be infected with parvo B19 while pregnant?
Teacher and daycare worker
What is an abnormal collection of fluid in more than one body part of a fetus called?
Hydrops fetalis
What are symptoms of parvo B19 in infected kids?
- Runny nose
- Sore throat
- Slapped cheeks
- Joint pain
What does parvo do to your hemoglobin?
Aplastic anemia
What organism causes syphilis?
Spirochete Treponema pallidum
What is the most common method of transmission of syphilis?
Transplacental infection (nearly 100% chance of passage to fetus if active primary or secondary infection_
What percent of syphilis results in spontaneous abortion?
40%
Signs and symptoms of syphilis
- Asymptomatic at birth but will manifest symptoms by 3 months of age, but some not until after 2 years of age (2/3)
Before 2 y/o
* Hepatomegaly
* Nasal discharge “snuffles”-white and may be bloody
* Rash
* Generalized LAD
* Skeletal abnormalities
After 2 y/o
* CNS abnormalities
* Abnormalities to bones, teeth, eyes, skin
Late syphilis signs and symptoms
- Late effects after 2 years
- Hutchinson’s triad: interstitial keratitis, 8th cranial nerve deafness, and Hutchinson’s teeth (smaller and more widely spaced with notches on biting surface)
- 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
Diagnosis of syphilis
- Nontreponemal serum titer more than four x mother’s titer
- Direct visualization of T. pallidum by dark field exam from bodily fluids
- Diagnsois suspected in infants born to women who are postive without PCN and infants whose mothers treated less than 1 month prior to delivery
Treatment of syphilis
- Parenteral Penicillin: Aqueous Pen G for 10 days or Procaine Pen G for 10 days
- Repeat antibody titers at 3,6,12 months to document falling titers
What is the percent chance of transplacental infection with syphilis if mom has active disease?
100%
What % of kids born with syphilis will show symptoms in teh first 3 months?
2/3
What are some of the early syphilis symptoms (under 2)
Rash, snuffles, hepatomegaly
What are some of the late symptoms (over 2) of syphilis?
Keratitis, Hutchinson’s, Mulberry molars
What is the treatment for syphilis?
Pen G
What is the most common cause of sexually transmitted genital infections in the US?
Chlamydia
What organism causes chlamydia?
chlamydia trachomatis
How does chlamydia typically present?
Conjunctivitis or pneumonia in newborns
How is chlamydia transmitted mother to baby?
- Exposure to genital flora during vaginal birth
How is mother screened for chlamydia?
vaginal swab or first pass urine specimen
Signs and symptoms of chlamydia
- Conjunctivitis - incubation 5-14 days post delivery in both eyes
- Pneumonia
Diagnosis of chlamydiain infant
SHould be suspected in any infant under a month of age with conjunctivitis if possibility of exposure
* Gold standard: isolation of C. trachomatis by culture
* Swabs of both conjunctival and nasopharyngeal samples
Treatment of chlamydia
- Topical therapy not effective
- Erythomycin
- All pregnant women screened at first pregnancy visit
What 2 parts of newborn is chlamydia likley to infect?
Eyes and lung
If mom is + at delivery, what is the chance of transmission of chlamydia?
50-70%
How is chlamydia treated in a newborn?
Oral erythromycin
What organism causes gonorrhea?
Neisseria gonorrhoeae- gram negative diplococci
Perinatal transmission of gonorrhea occurs in how many of the cases and how is it usually acquired?
30-40%, vaginal delivery or rupture of membranes
Usually within first 5 days
Signs and symptoms of gonorrhea?
- Eye most frequent with purulent discharge and conjuncivitis
- Profuse exudate and swelling of eyelid
- Scalp abscesses, vaginitis, and bacteremia
Screening for gonorrhea
Screen those at increased risk of infection:
* Previous STD infection
* Multiple sexual partners
* Inconsistent condom use
* Commercial sexual partners
* Drug use
* Those in communities with high prevalence of disease
Neonatal prophylaxis for gonorrhea?
Erythromycin ophthalmic ointment
Gonorrhea diagnosis
Gram stain of conjunctival exudate
Treatment of gonorrhea
Signle dose of ceftriaxone for symptomatic and asymptomatic infants
What organism causes gonorrhea?
Neisseria gonorrhea gram - cocci
What is the most frequent site of gonorrhea infection?
Eye
What is used for prophylaxis against gonorrhea?
Erythromycin opthalmic
What is the treatment for gonorrhea?
Ceftriaxone once
How is HIV transmitted mother to baby?
- Transplacentally in utero
- During birth
- By breastfeeding
How can transmission of HIV to the baby be decreased?
- Antiretroviral treatment of the mother before and during delivery
- Treatment of infant during first 6 weeks of life
- C-section delivery
- Avoidance of breastfeeding
How much does breastfeeding increase the risk of transmission of HIV?
30-50%
What is the typical clinical presentation of newborns with HIV?
Asymptomatic
How is HIV diagnosed in newborns?
- HIV DNA PCR <48 hours of age, 2 weeks, 1-2 months, and at 2-4 months
- If 4 months and older with a neg PCR - HIV excluded
What is treatment for HIV?
Antiretroviral prophylaxis (Zidovudine) for 6 weeks for infants born to HIV infected mothers
What type of organism is hepatitis C?
Small, single stranded RNA virus
What is the primary source of pediatric hepatitis C infection?
Vertical transmission
What is the transmission rate from mother to baby in Hep C? What increases this risk?
- 5%
- HIV
How do most children present with hepatitis C?
asymptomatic
What are risk factors for hepatitis C?
IV drug use, tattoos
Can you breastfeed with hepatitis C?
Yes
How is hepatitis C diagnosed?
- anti-HCV present in blood after 18 months of age
- COnfirmed with HCV RNA test
- HCV genotyping
- Testing after 18 months b/c test may reflect passive transfer of maternal antiboyd
Treatment for hepatitis C
Will be decided by GI - interferon and ribavirin
How can HPV present in children?
hoarseness in children later in life
How do you prevent HPV?
HPV or gardasil vaccine
What 3 ways can the baby get HIV from mom?
Across placenta
Birth
Breast
What is the chance of transmitting hep c to the baby?
5%
Where might you see HPV in the neonata in the first few months of life?
Airway, scalp, face
What is congenital zika syndrome?
Arthropod borne flavivirus transmitted by mosquitoes
How is maternal infection spread?
- Maternal infection –> placental transmission –> virus targets neural progenitor cells in fetal brain –> kills progenitor cells
What are signs and symptoms of congenital zika syndrome?
- Fetal growth restriction
- Fetal demise - 5-10%
- Ventriculomegaly
- Microcephaly
- Other congenital anomalies
What is microcephaly?
- Severe has partial skull collapse
- Thin cerebral cortices with subcortical calcifications
- Craniofacial disproportion
- Craniosynostosis
What are ocular symptoms of congenital zika syndrome?
Optic nerve and retinal pathology
retinal scarring
What are hearing problems associated with congenital zika syndrome
sensorineural and delayed hearing
What is a joint symptom of congenital zika syndrome?
Congenital joint contracture
Congenital club foot
What are cardiac abnormalities due to zika
ASD
VSD
PFO
What are neurogenic abnormalities due to zika
Hypertonia
Spasticity
Hyperreflexia
Seizures/epilepsy
also small for gestational age
Evaluation of Zika
- Head circumference/development
- Lab studies
- Cranial U/S
- Hearing assessment
- Radiologic findings
Lab evaluation for zika
- Serum + urine for zika RNA via PCR if + definite infection
- Serum Zike IgM, if positive probable infection
- CSF for RNA and IgM, if + probable
- Check mother for IgM
- Checked within first few days after birth
- If both Serum and CSF IgM are negative, likely negative
Imaging for zika
Head ultrasound = primary screening tool
CT scan: calcifications
MRI: structure
Treatment plan for congenital zika
- No specific treatment - multifaceted
- Referrals to opthalmology within 1 month of birth
- Hearing screen newborn
- Neurology, ID, genetics, devlopment
- Labs: zika detection, CBC, CMP, genetics
Infants born to zika positive mothers w/o clinical findings: head u/s and opthalmologic exam and ABR hearing test by 1 month of age
What organism causes zika and how do moms get it?
Flavavirus, mosquito
What happens to skulls in zika
partial collapse
What is the medical name for the limb anomalies in zika
arthrogriposis
What labs for zika are definitive at birth
Serum and urine for zika RNA
What is the preferred head study for Zika?
Head US
What is considered a newborn?
Any child within first 28 days of life
3 major routes of perinatal infection
Blood borne transplacental
Ascending with disruption of amniotic barrier: bacterial infections after 12-18 hours of ruptured membranes
Infection via passage through birth canal
When do most with early-onset sepsis present?
<24 hours of age
Respiratory distress most commonly, then hypotension, acidemia, neutropenia
Most common pathogen to cause neonatal sepsis
Group B strep
Clinical symptoms of neonatal sepsis
- Temperature instability
- Irritability
- Lethargy
- Poor feeding
- Respiratory symptoms
- Tachycardia
- Poor perfusion
- Hypotension
When is newborn sepsis work up?
7-90 days
If a neonatal less than 60 days has a rectal temperature of 100.4, what do they require
Full work-up and hospital admission
What does workup of newborn sepsis include
- CBC
- BMP
- Urine cath and culture
- CXR
- CRP and procalcitonin
- Blood cultures
- NP swab
- LP cultures
How is newborn sepsis treated?
- Sepsis work up
- Ampicillin and cefotaxime or ampicillin and gentamicin
- Questionable acyclovir
- Close follow-up with PCP after discharge
What is the most common organism to cause bacterial sepsis?
Group B strep
4-5 signs of newborn spesis
- Fever >100.4
- lethargy
- Hypotension
- Agitaton
What 3 ways can sepsis in the newborn happen?
- Transplacental
- Adcending infection during birth
- Infection via birth canal
What is the magic temp in a baby that would warrant a sepsis w/u?
100.4
What antibiotics are used to treat presumed sepsis?
Amp + clarithrin ampicillin + gent, consider acyclovir
