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Pediatrics > Congenital Infections > Flashcards

Congenital Infections Flashcards

1
Q

note: the other cards are on quizlet because brainscape was being weird so this starts at HSV

A
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2
Q

What percent of pregnant women have evidence of past HSV infection?

A

30-60%

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3
Q

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

A

HSV 2

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4
Q

How is the majority of HSV passed to the newborn?

A

Through the birth canal and typically displayed within 28 days after birth

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5
Q

What is the risk of infecting the baby with primary genital herpes infection and vaginal birth?

A

25-50%

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6
Q

When is the highest risk of passing HSV to baby intrauterine?

A

3rd trimester

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7
Q

What type of transmission is more common: neonatal or congenital?

A

Neonatal

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8
Q

75% of infants who acquire HSV infections are born to mothers with what?

A

No previous history or clinical findings consistent with HSV infection

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9
Q

What is the process of infection of the infant with hsv?

A
  • 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
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10
Q

When do symptoms of HSV usually develop?

A

5-10 days after birth

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11
Q

When should disseminated HSV infection be considered?

A

Any infant with symptoms of
* sepsis
* liver dysfunction
* negative bacteriologic cultures
* fever
* irritability
* abnormal csf findings and seizures

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12
Q

HSV infections are often what

A
  • 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
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13
Q

Clinical presentation of HSV

A

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

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14
Q

Diagnosis of HSV

A
  • Specimen cultures: skin vesicle, eyes, urine, nasopharynx, blood, CSF, stool or rectum
  • PCR sensitive for detecting HSV DNA in blood, urine, and CSF
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15
Q

Treatment of HSV

A
  • Parenteral acyclovir = treatment of choice for neonatal HSV
  • Administered to all infants suspected to have or have diagnosis of HSV
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16
Q

Who should be screened for HSV?

A
  • USPSTF does not recommend screening asymptomatic mothers
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17
Q

Recommended method of delivery if mom has active genital lesions?

A

C-section

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18
Q

What percent of women have evidence of past HSV infection

A

30-60%

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19
Q

If primary infection is ath the time of birth (and untreated), what is the chance of transmission?

A
  • 25-50%
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20
Q

What percent of HSV + babies had no history of HSV in mom?

A

75%

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21
Q

What CNS findings make you think about HSV?

A
  • Fever
  • Irritability
  • Seizures
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22
Q

What areas of the body can you recover HSV from?

A

Any orifice

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23
Q

What medication is used for HSV in the newborn?

A

Acyclovir IV

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24
Q

When is a c-section indicated with HSV?

A

Active genital lesions

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25
Q

When do most cases of varicella zoster infection of infant occur in mothers who are infected?

A

8-20 weeks gestation

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26
Q

If infected in the first 20 weeks, what is the percent chance of transmission to the baby?

A

2%

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27
Q

When can varicella zoster be transmitted perinatally?

A

5 days before to 2 days after delivery, causing severe disseminated infection

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28
Q

Signs and symptoms of congenital varicella syndrome

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 child of mother who develops varicella 5-7 days after delivery
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29
Q

Diagnosis of varicella

A
  • 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
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30
Q

Treatment of varicella

A
  • 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
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31
Q

If mom is infected in teh first half of prengnacy, is there a good chance the baby will get it?

A

No, closer to delivery has a higher chance

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32
Q

Can a newborn get chickenpox from it’s mom after birth? If so, what is the death rate?

A

yes, 20-30%

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33
Q

How do you isolate chicken pox in the newborn?

A

Scrape vesicle

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34
Q

What is the prophylactic medication for varicella?

A

Varizig

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35
Q

What is the medication for treatment of Varicella?

A

Acyclovir

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36
Q

What type of organism is parvo B19?

A

Single stranded DNA virus

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37
Q

Who has the highest infection rate with parvo B19?

A

Teachers and daycare workers

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38
Q

What are symptoms of mild parvo B19?

aka fifths disease, erythema infectiosum

A

Mild systemic symptoms: fever, lacy rash, slapped cheeks

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39
Q

Signs and symptoms of parvo in infant

A
  • 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
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40
Q

What is hydrops fetalis?

S

A

Serious fetal condition
* Abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema

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41
Q

Diagnosis of Parvo B19?

A
  • Pregnant women exposed serotype tested for IgG and IgM
  • Ultrasound
  • Percutaneous umbilical cord blood sampling of fetus
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42
Q

What does a positive IgM test result for Parvo indicate?

A

Infection probably occurred within the past 2-4 months

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43
Q

Treatment of Parvo B19?

A
  • 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
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44
Q

What else is parvo called?

A

Erythema infectiosum, fifth’s disease

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45
Q

What 2 occupations are most likely to be infected with parvo B19 while pregnant?

A

Teacher and daycare worker

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46
Q

What is an abnormal collection of fluid in more than one body part of a fetus called?

A

Hydrops fetalis

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47
Q

What are symptoms of parvo B19 in infected kids?

A
  • Runny nose
  • Sore throat
  • Slapped cheeks
  • Joint pain
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48
Q

What does parvo do to your hemoglobin?

A

Aplastic anemia

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49
Q

What organism causes syphilis?

A

Spirochete Treponema pallidum

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50
Q

What is the most common method of transmission of syphilis?

A

Transplacental infection (nearly 100% chance of passage to fetus if active primary or secondary infection_

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51
Q

What percent of syphilis results in spontaneous abortion?

A

40%

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52
Q

Signs and symptoms of syphilis

A
  • 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

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53
Q

Late syphilis signs and symptoms

A
  • 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
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54
Q

Diagnosis of syphilis

A
  • 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
55
Q

Treatment of syphilis

A
  • 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
56
Q

What is the percent chance of transplacental infection with syphilis if mom has active disease?

A

100%

57
Q

What % of kids born with syphilis will show symptoms in teh first 3 months?

A

2/3

58
Q

What are some of the early syphilis symptoms (under 2)

A

Rash, snuffles, hepatomegaly

59
Q

What are some of the late symptoms (over 2) of syphilis?

A

Keratitis, Hutchinson’s, Mulberry molars

60
Q

What is the treatment for syphilis?

A

Pen G

61
Q

What is the most common cause of sexually transmitted genital infections in the US?

A

Chlamydia

62
Q

What organism causes chlamydia?

A

chlamydia trachomatis

63
Q

How does chlamydia typically present?

A

Conjunctivitis or pneumonia in newborns

64
Q

How is chlamydia transmitted mother to baby?

A
  • Exposure to genital flora during vaginal birth
65
Q

How is mother screened for chlamydia?

A

vaginal swab or first pass urine specimen

66
Q

Signs and symptoms of chlamydia

A
  • Conjunctivitis - incubation 5-14 days post delivery in both eyes
  • Pneumonia
67
Q

Diagnosis of chlamydiain infant

A

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

68
Q

Treatment of chlamydia

A
  • Topical therapy not effective
  • Erythomycin
  • All pregnant women screened at first pregnancy visit
69
Q

What 2 parts of newborn is chlamydia likley to infect?

A

Eyes and lung

70
Q

If mom is + at delivery, what is the chance of transmission of chlamydia?

A

50-70%

71
Q

How is chlamydia treated in a newborn?

A

Oral erythromycin

72
Q

What organism causes gonorrhea?

A

Neisseria gonorrhoeae- gram negative diplococci

73
Q

Perinatal transmission of gonorrhea occurs in how many of the cases and how is it usually acquired?

A

30-40%, vaginal delivery or rupture of membranes
Usually within first 5 days

74
Q

Signs and symptoms of gonorrhea?

A
  • Eye most frequent with purulent discharge and conjuncivitis
  • Profuse exudate and swelling of eyelid
  • Scalp abscesses, vaginitis, and bacteremia
75
Q

Screening for gonorrhea

A

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

76
Q

Neonatal prophylaxis for gonorrhea?

A

Erythromycin ophthalmic ointment

77
Q

Gonorrhea diagnosis

A

Gram stain of conjunctival exudate

78
Q

Treatment of gonorrhea

A

Signle dose of ceftriaxone for symptomatic and asymptomatic infants

79
Q

What organism causes gonorrhea?

A

Neisseria gonorrhea gram - cocci

80
Q

What is the most frequent site of gonorrhea infection?

A

Eye

81
Q

What is used for prophylaxis against gonorrhea?

A

Erythromycin opthalmic

82
Q

What is the treatment for gonorrhea?

A

Ceftriaxone once

83
Q

How is HIV transmitted mother to baby?

A
  • Transplacentally in utero
  • During birth
  • By breastfeeding
84
Q

How can transmission of HIV to the baby be decreased?

A
  • Antiretroviral treatment of the mother before and during delivery
  • Treatment of infant during first 6 weeks of life
  • C-section delivery
  • Avoidance of breastfeeding
85
Q

How much does breastfeeding increase the risk of transmission of HIV?

A

30-50%

86
Q

What is the typical clinical presentation of newborns with HIV?

A

Asymptomatic

87
Q

How is HIV diagnosed in newborns?

A
  • 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
88
Q

What is treatment for HIV?

A

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

89
Q

What type of organism is hepatitis C?

A

Small, single stranded RNA virus

90
Q

What is the primary source of pediatric hepatitis C infection?

A

Vertical transmission

91
Q

What is the transmission rate from mother to baby in Hep C? What increases this risk?

A
  • 5%
  • HIV
92
Q

How do most children present with hepatitis C?

A

asymptomatic

93
Q

What are risk factors for hepatitis C?

A

IV drug use, tattoos

94
Q

Can you breastfeed with hepatitis C?

A

Yes

95
Q

How is hepatitis C diagnosed?

A
  • 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
96
Q

Treatment for hepatitis C

A

Will be decided by GI - interferon and ribavirin

97
Q

How can HPV present in children?

A

hoarseness in children later in life

98
Q

How do you prevent HPV?

A

HPV or gardasil vaccine

99
Q

What 3 ways can the baby get HIV from mom?

A

Across placenta
Birth
Breast

100
Q

What is the chance of transmitting hep c to the baby?

A

5%

101
Q

Where might you see HPV in the neonata in the first few months of life?

A

Airway, scalp, face

102
Q

What is congenital zika syndrome?

A

Arthropod borne flavivirus transmitted by mosquitoes

103
Q

How is maternal infection spread?

A
  • Maternal infection –> placental transmission –> virus targets neural progenitor cells in fetal brain –> kills progenitor cells
104
Q

What are signs and symptoms of congenital zika syndrome?

A
  • Fetal growth restriction
  • Fetal demise - 5-10%
  • Ventriculomegaly
  • Microcephaly
  • Other congenital anomalies
105
Q

What is microcephaly?

A
  • Severe has partial skull collapse
  • Thin cerebral cortices with subcortical calcifications
  • Craniofacial disproportion
  • Craniosynostosis
106
Q

What are ocular symptoms of congenital zika syndrome?

A

Optic nerve and retinal pathology
retinal scarring

107
Q

What are hearing problems associated with congenital zika syndrome

A

sensorineural and delayed hearing

108
Q

What is a joint symptom of congenital zika syndrome?

A

Congenital joint contracture
Congenital club foot

109
Q

What are cardiac abnormalities due to zika

A

ASD
VSD
PFO

110
Q

What are neurogenic abnormalities due to zika

A

Hypertonia
Spasticity
Hyperreflexia
Seizures/epilepsy

also small for gestational age

111
Q

Evaluation of Zika

A
  • Head circumference/development
  • Lab studies
  • Cranial U/S
  • Hearing assessment
  • Radiologic findings
112
Q

Lab evaluation for zika

A
  • 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
113
Q

Imaging for zika

A

Head ultrasound = primary screening tool
CT scan: calcifications
MRI: structure

114
Q

Treatment plan for congenital zika

A
  • 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

115
Q

What organism causes zika and how do moms get it?

A

Flavavirus, mosquito

116
Q

What happens to skulls in zika

A

partial collapse

117
Q

What is the medical name for the limb anomalies in zika

A

arthrogriposis

118
Q

What labs for zika are definitive at birth

A

Serum and urine for zika RNA

119
Q

What is the preferred head study for Zika?

A

Head US

120
Q

What is considered a newborn?

A

Any child within first 28 days of life

121
Q

3 major routes of perinatal infection

A

Blood borne transplacental
Ascending with disruption of amniotic barrier: bacterial infections after 12-18 hours of ruptured membranes
Infection via passage through birth canal

122
Q

When do most with early-onset sepsis present?

A

<24 hours of age
Respiratory distress most commonly, then hypotension, acidemia, neutropenia

123
Q

Most common pathogen to cause neonatal sepsis

A

Group B strep

124
Q

Clinical symptoms of neonatal sepsis

A
  • Temperature instability
  • Irritability
  • Lethargy
  • Poor feeding
  • Respiratory symptoms
  • Tachycardia
  • Poor perfusion
  • Hypotension
125
Q

When is newborn sepsis work up?

A

7-90 days

126
Q

If a neonatal less than 60 days has a rectal temperature of 100.4, what do they require

A

Full work-up and hospital admission

127
Q

What does workup of newborn sepsis include

A
  • CBC
  • BMP
  • Urine cath and culture
  • CXR
  • CRP and procalcitonin
  • Blood cultures
  • NP swab
  • LP cultures
128
Q

How is newborn sepsis treated?

A
  • Sepsis work up
  • Ampicillin and cefotaxime or ampicillin and gentamicin
  • Questionable acyclovir
  • Close follow-up with PCP after discharge
129
Q

What is the most common organism to cause bacterial sepsis?

A

Group B strep

130
Q

4-5 signs of newborn spesis

A
  • Fever >100.4
  • lethargy
  • Hypotension
  • Agitaton
131
Q

What 3 ways can sepsis in the newborn happen?

A
  • Transplacental
  • Adcending infection during birth
  • Infection via birth canal
132
Q

What is the magic temp in a baby that would warrant a sepsis w/u?

A

100.4

133
Q

What antibiotics are used to treat presumed sepsis?

A

Amp + clarithrin ampicillin + gent, consider acyclovir

Pediatrics (12 decks)

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