Congenital Infections

Question 1

which is worse for the fetus, acute maternal infection, or reactivation of an old infection in the mother?

Answer 1

acute maternal infection! higher infectious dose causes more harm

Question 2

when should you have a high index of suspicion that a baby has a congenital infection?

Answer 2

baby born with abnormal head, eyes, blood, liver, spleen. baby has jaundice or a rash. hearing loss. intercranial calcifications

Question 3

what is the definitive diagnosis for congenital infection?

Answer 3

isolating the pathogen from the infant

Question 4

what does TORCH stand for?

Answer 4

Toxoplasmosis, Other, Rubella, CMV, Herpes

Question 5

symptoms of toxoplasmosis

Answer 5

chorioretinitis, hydrocephalus, intracranial calcifications

Question 6

toxoplasmosis diagnosis and treatment

Answer 6

lab tests: serology on mother and infant: IgM infant is diagnostic. can do PCR. treat with pyrimethamine +sulfadiazine and folinic acid for 1 year!

Question 7

congenital syphilis symptoms

Answer 7

large, puffy placenta. hepatomegaly. rhinitis. rash. lymphadenopathy

Question 8

syphillis diagnosis and treatment

Answer 8

if mom has positive syphillis test, suspect congenital infection. VDRL can be used, or direct observation of bacteria or fluorescent staining. treat mom and infant with IV Penicillin G

Question 9

congenital rubella symptoms

Answer 9

hearing loss, heart defects (patent ductus arteriosis), opthalmic problems (cataracs)

neurological problems (microcephaly). hepato/splenomegaly, bone lesions, thrombocytopenia purpura, pneumonitis

Question 10

risk factors for congenital CMV

Answer 10

no prior infection with CMV. pregnancy at young age. first pregnancy. new sex partner during pregnancy. frequent contact with babies and toddlers.

Question 11

symptoms of CMV

Answer 11

90% are asymptomatic. chorioretinitis, jaundice, microcephaly, hepatosplenomegaly, small size, petichiae, purpura.

Question 12

CMV treatment

Answer 12

ganciclovir or valganciclovir is the treatment

Question 13

CMV diagnosis

Answer 13

PCR on urine or blood, culture the virus from the urine or saliva

Question 14

congenital herpes infections, what is most severe?

Answer 14

in mother: HSV-2, primary infection, and visible lesions.

in child: intrauterine is worse than perinatal. disseminated infection is the worst

Question 15

neonatal HSV treatment

Answer 15

acyclovir for infant. can prevent with c-section birth or antiviral prophylaxis

Question 16

congenital varicella syndrome symptoms

Answer 16

limbs and brain development impaired, poor outcome

Question 17

congenital varicella treatment

Answer 17

acyclovir for mother. can prevent with vaccination

Question 18

parvovirus b19 symptoms

Answer 18

febrile illness without rash first, then turns to slapped cheek rash on the face. erythematous maculopapular rash, arthralgia, arthritis.

Question 19

routes of transmission for perinatal infections

Answer 19

exchange of maternal and fetal blood, fetal monitors attached to scalp break the skin, vaginal and skin flora colonize baby during birth, many viruses secrete in breast milk, relatives/visitors infecting baby

Question 20

hepatitis B prevention and treatment

Answer 20

vaccinate all neonates. add HBIG immune globulin at birth if mother is hep B positive

Question 21

antibiral treatment for pregnant women (HIV)

Answer 21

3-part zidovudine regimen: antenatal, intrapartum, and neonatal.

Question 22

group B strep risk factors

Answer 22

previous baby with group b strep, group b strep in urine, fever during labor, heavy maternal colonization, delivery before 37 weeks of gestation, premature or prolonged rupture of membranes. intrapartum antibiotic prophylaxis reduces risk

Question 23

symptoms of early onset group B strep infection

Answer 23

tachypnea, grunting, hypoxia. poor feeding, lethargic, irritable. hypotension and shock

Question 24

symptoms of late onset group b strep

Answer 24

sepsis: fever, irritability, lethargy, poor feeding, grunting, apnea. meningitis: bulging fontanel, nuchal rigidity, focal neurologic findings

Question 25

symptoms of very late onset group b strep

Answer 25

sepsis with foci in CNS, soft tissues, bones, and joints

Question 26

group b strep diagnosis and management

Answer 26

culture from normally sterile site (CSF). for mother, give penicillin G. give vancomycin + penicillin G as empirical therapy. Penicillin G is the definitive treatment when it is confirmed group B strep