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RGU 2 > Congenital Infections > Flashcards

Congenital Infections Flashcards

1
Q

What are congenital infections?

A
  • infection of the fetus in utero following primary infection of mother, entrance of microorganisms into blood, establishment of infection in placenta, and invasion into the fetus.
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2
Q

What are the general consequences of congenital infections?

A
  • death leading to abortion.
  • malformations
  • low birth weight
  • failure to thrive
  • lesions after birth
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3
Q

Are infections mild or unnoticed often in the mother?

A

YES

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4
Q

Does a placental microbiome exist?

A

YES similar to our oral flora.

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5
Q

** What are the most common congenital infections?

A
  • CMV
  • Rubella
  • Toxoplasma gondii
  • Treponema pallidum (Syphilis)
  • HIV
  • Parvovirus B19
  • VZV
  • Listeria monocytogenes
  • Zika virus
  • ToRCHeS infections!
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6
Q

What routine antenatal (prenatal) screenings are performed?

A
  • Rubella antibody
  • Treponema antibody
  • Hepatitis B surface antigen
  • HIV antibody
  • Zika antibody (Flavivirus); IgM and RTPCR
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7
Q

When is the fetus most susceptible to Rubella

A
  • during the first 3 months of pregnancy

* affects brain, eyes, ears, and heart

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8
Q

Will an infected fetus with Rubella make IgM?

A
  • YES, found in cord and blood.
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9
Q

What maternal responses to Rubella will help control spread in infant?

A
  • maternal IgG and interferons
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10
Q

From where can you isolate Rubella in an infant?

A
  • throat or urine bc it will shed for a number of months.
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11
Q

What vaccine do we use for Rubella?

A
  • MMR= live attenuated virus during childhood.
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12
Q

Can you vaccinate a pregnant mother with MMR?

A

NO. Only safe immediately postpartum.

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13
Q

How likely is it for the fetus to acquire CMV if the mother gets a PRIMARY infection?

A
  • pretty likely but few show signs at birth.

* Most mothers will be asymptomatic.

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14
Q

Can CMV reactivation in the mother lead to transmission to the fetus?

A

YES, but fetal damage is uncommon.

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15
Q

What problem is most associated with prenatal CMV infection during the first trimester?

A
  • babies with SENSORINEURAL HEARING LOSS.
  • other clinical features include mental retardation, choroidoretinitis and optic atrophy, hearing defects, hepatosplenomegaly, thrombocytopenic purpura, or anemia
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16
Q

Is there a vaccine for CMV?

A

NO

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17
Q

How do we treat congenital CMV symptomatic babies?

A
  • ganciclovir or valganciclovir
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18
Q

Does HIV transmission to the neonate occur more during labor/delivery or via vertical transmission?

A
  • during labor deliver, but it still can occur vertically.
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19
Q

What is used to greatly reduce risk of vertical transmission to the neonate?

A
  • antiretrovirals

* avoid invasive fetal diagnostic procedures which would increase risk of transmission.

20
Q

What is the triad of symptoms that occurs in infants acquiring HSV in utero (RARE)?

A
  1. skin vesicles or scarring
  2. chorioretinitis and keratoconjunctivits
  3. microcephaly or hydranencephaly
    * more common to acquire HSV during delivery (intrapartum)
21
Q

Can varicella zoster virus transmit congenitally?

A
  • it can up to 20 weeks gestation
22
Q

How do you diagnose congenital varicella syndrome?

A
  • IgM + cord blood and clinical findings in newborn (limb hypoplasia, cutaneous scars, chorioretinitis, cataracts, cortical atrophy, microcephaly).
23
Q

What may you see with ultrasound of fetus with varicella syndrome?

A
  • hydrops, organ calcification, limb deformities, microcephaly
24
Q

Can you give the varicella vaccine during pregnancy?

A
  • NO bc it is a live attenuated vaccine
25
Q

Does herpes ZOSTER occur more frequently in pregnancy?

A

NO

26
Q

In what trimester is congenital fetal infection of hepatitis B, most likely to occur?

A
  • 3rd trimester
27
Q

Are most neonatal hep B infections asymptomatic?

A

YES and these are more likely to develop CHRONIC hepatitis and hepatocellular carcinoma.

28
Q

What will hepatitis B cause in the symptomatic infants?

A
  • hepatosplenomegaly, jaundice (icterus).
29
Q

With what disease does parvovirus B19 cause?

A
  • 5th’s disease (causes a slap cheek RASH on the face).
30
Q

What can parvovirus B19 do to the fetus?

A
  • nonimmune fetal HYDROPS (if acquired in first 2 trimesters) due to RBC destruction leading to anemia and increased fluid retention in body cavities.
  • birth defects (eyes and CNS)
  • prematurity
  • death (rare)
31
Q

Can Zika be passed from a pregnant woman to her fetus?

A

YES causing MICROCEPHALY, eye defects, hearing loss, and impaired growth.

32
Q

How does Zika spread?

A

through infected MOSQUITOS or SEX

33
Q

Is there a Zika vaccine?

A

NO nor medicine to treat.

34
Q

What are the clinical features of syphilis in the newborn?

A
  • abnormalities of bone, teeth (mulberry molars) and cartilage (saddle-shaped nose)
35
Q

What can be detected in fetal blood infected with syphyilis?

A
  • Treponemal IgM
36
Q

When does vertical transmission most often occur in syphilis?

A

after 4 months

37
Q

Can you prevent syphilis vertical transmission to the fetus?

A

YES if mother is treated before her 4th month of gestation.

38
Q

How is Listeria transmitted?

A
  • contact with infected animals and their feces or consumption of UNPASTEURIZED MILK or CHEESE or vegetables.
39
Q

What does Listeria do to the fetus when vertically transmitted?

A
  • spontaneous abortion
  • premature delivery
  • neonatal septicemia
  • pneumonia with abscesses or granulomas.
40
Q

How do you treat Listeriosis?

A

ampicillin + gentamicin.

41
Q

In what trimester is toxoplasmosis incidence highest?

A
  • 3rd trimester (but if infected early the outcomes are worse).
42
Q

What are the clinical features of congenital toxoplasmosis?

A
  • convulsions, microcephaly, chorioretinitis, hepatosplenomegaly, jaundice, hydrocephaly, mental retardation, defective vision.
  • Many of these will not appear until after a few years (aka there are no detectable abnormalities at birth).
43
Q

Can you detect toxo-specific IgM in the cord blood?

A

YES

44
Q

How do you treat toxoplasmosis?

A
  • treat pregnant woman or infected infant with spiramycin or sulphadiazine + pyrimethamine + folinic acid.
45
Q

Is there a vaccine for toxoplasmosis?

A

NO

46
Q

How do you prevent toxoplasmosis?

A
  • avoid ingesting cysts from cat feces (litter boxes) or lightly cooked meat

RGU 2 (24 decks)

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