Congenital Infections Flashcards
which is worse for the fetus, acute maternal infection, or reactivation of an old infection in the mother?
acute maternal infection! higher infectious dose causes more harm
when should you have a high index of suspicion that a baby has a congenital infection?
baby born with abnormal head, eyes, blood, liver, spleen. baby has jaundice or a rash. hearing loss. intercranial calcifications
what is the definitive diagnosis for congenital infection?
isolating the pathogen from the infant
what does TORCH stand for?
Toxoplasmosis, Other, Rubella, CMV, Herpes
symptoms of toxoplasmosis
chorioretinitis, hydrocephalus, intracranial calcifications
toxoplasmosis diagnosis and treatment
lab tests: serology on mother and infant: IgM infant is diagnostic. can do PCR. treat with pyrimethamine +sulfadiazine and folinic acid for 1 year!
congenital syphilis symptoms
large, puffy placenta. hepatomegaly. rhinitis. rash. lymphadenopathy
syphillis diagnosis and treatment
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
congenital rubella symptoms
hearing loss, heart defects (patent ductus arteriosis), opthalmic problems (cataracs)
neurological problems (microcephaly). hepato/splenomegaly, bone lesions, thrombocytopenia purpura, pneumonitis
risk factors for congenital CMV
no prior infection with CMV. pregnancy at young age. first pregnancy. new sex partner during pregnancy. frequent contact with babies and toddlers.
symptoms of CMV
90% are asymptomatic. chorioretinitis, jaundice, microcephaly, hepatosplenomegaly, small size, petichiae, purpura.
CMV treatment
ganciclovir or valganciclovir is the treatment
CMV diagnosis
PCR on urine or blood, culture the virus from the urine or saliva
congenital herpes infections, what is most severe?
in mother: HSV-2, primary infection, and visible lesions.
in child: intrauterine is worse than perinatal. disseminated infection is the worst
neonatal HSV treatment
acyclovir for infant. can prevent with c-section birth or antiviral prophylaxis
congenital varicella syndrome symptoms
limbs and brain development impaired, poor outcome
congenital varicella treatment
acyclovir for mother. can prevent with vaccination
parvovirus b19 symptoms
febrile illness without rash first, then turns to slapped cheek rash on the face. erythematous maculopapular rash, arthralgia, arthritis.
routes of transmission for perinatal infections
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
hepatitis B prevention and treatment
vaccinate all neonates. add HBIG immune globulin at birth if mother is hep B positive
antibiral treatment for pregnant women (HIV)
3-part zidovudine regimen: antenatal, intrapartum, and neonatal.
group B strep risk factors
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
symptoms of early onset group B strep infection
tachypnea, grunting, hypoxia. poor feeding, lethargic, irritable. hypotension and shock
symptoms of late onset group b strep
sepsis: fever, irritability, lethargy, poor feeding, grunting, apnea. meningitis: bulging fontanel, nuchal rigidity, focal neurologic findings
