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LMCC Study - Peds > Congenital Infections > Flashcards

Congenital Infections Flashcards

1
Q

Define congenital infection

A
  • An infection acquired transplacentally during gestation
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2
Q

List as many common congenital infections as you can

A 
From TO note CHEAP TORCHES
C: Chicken pox/shingles
H: Hep B 
E: Epstein-Barr 
A: Aid (HIV) 
P: Parvovirus B19 
T: Toxicoplasmosis
O: Other (covered in longer acronym - so nothing else? Tuberculosis) 
R: Rubella virus 
C: CMV/Coxsackievirus 
H: HSV 
E: Every other STI (N. gonorhoeae, Chlamydia) 
S: Syphilis
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3
Q

Many clinical manifestions from congenitial infections are similar regardless of infection what are some common problems?

A
  • Intrauterine growth restriction
  • Non-immune hydrops fetalis
  • anemia
  • thrombocytopenia
  • jaundice
  • hepatosplenomegaly
  • chorioretinitis
  • congenital malformation
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4
Q

What is hydrops fetalis?

A

Abnormal accumulation of fluid in 2 or more fetal compartments:

  • Ascites
  • Pleural effusion
  • Pericardial effusion
  • Skin edema
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5
Q

Which pathogen causes toxoplasmosis?

A
  • Toxoplasma gondii
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6
Q

What classic triad would you expect to see in a patient with toxoplasmosis?

A

1) hydrocephalus
2) chorioretinitis
3) intracranial calcifications.

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7
Q

How is the diagnosis of toxoplasmosis confirmed?

A
  • Serum IgG antibody testing
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8
Q

How would you treat an infant with toxoplasmosis?

A

1) Pyrimethamine (with folic acid)
- Works by interfering with folic acid pathway

2) Sulfadiazine
- Also works by interfering with folic acid pathway at a different level
* Note therapy is prolonged often, sometimes up to a year

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9
Q

How is toxoplasmosis transmitted?

A
  • Contamination with cat feces

- Undercooked meat

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10
Q

How would you counsel a pregnant patient when discussing ways to prevent congenital toxoplasmosis infection?

A
  • Avoid cat litter box
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11
Q

What is the classic triad of clinical features associated with congenital rubella?
- What other features are common?

A

Eyes, Heart, Ears

1) Sensorineural deafness
2) Eye abnormalities
- cataracts
- retinopathy
- microphthalmia
3) Congenital heart disease
- PDA
- pulmonary artery stenosis

  • Other features
  • Blue berry muffin rash (due to dermal erythropoesis)
  • hepatosplenomegaly
  • encephalitis
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12
Q

How is rubella diagnosed?

A
  • IgM antibodies for recent infection
  • IgG antibodies over sever months can confirm
  • Rubella can be isolated from urine, blood, CSF and throat swabs
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13
Q

How long should a baby with congenital rubella stay away from pregnant women and why?

A
  • 1 year

- Infants are chronically and persistently infected and tend to shed the virus for 1 year

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14
Q

True or False: Children born to adolescents are 3-7 times more likely to be infected with CMV?

A

True

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15
Q

How is cytomegalovirus diagnosed?

A
  • Diagnosed by detection of virus in the urine or saliva by culture
  • Can take several weeks
  • Detection withing the first 3 weeks of life is considered proof of a congenital infection
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16
Q

What is the leading cause of non-hereditary sensorineural hearing loss in infants?

A
  • Cytomeglovirus
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17
Q

What are the most common sources of CMV occurring in the mother?

A
  • Sexual contacts
  • Contacts with young children
    • Daycare workers, school teachers, etc.. at increased risk
18
Q

How does a patient with congenital CMV most commonly present at birth?

A
  • 90% are asymptomatic!

- 10% are small for gestational age

19
Q

What symptoms can occur with congenital CMV?

A
    • Intracranial calcifications ** (TYPICALLY PARAVENTRICULAR in CMV)
    • Chorioretinitis
    • Hearing abnormality
  • small for gestational age
  • microcephaly
  • thrombocytopenia
  • hepatosplenomegaly
  • hepatitis
  • can also present with blueberry muffin rash
    • Children may not present until hearing loss, developmental delays are noted in early childhood
20
Q

What has been shown to decrease the progression of hearing loss in children with congenital CMV?

A
  • Ganciclovir
21
Q

What carries a higher risk of transmission of HSV from mother to fetus? Primary infection or reactivated secondary?

A
  • Primary (33-50% risk)

- Secondary (under 5% risk)

22
Q

How long after birth does an infant present with signs of HSV infection?

A
  • Normal at birth in most cases

- day of life 5-10 is when symptoms tend to develop

23
Q

What are the clinical features of congenital HSV infection?

A

1) Disseminated disease
- multisystem organ disease most notably the lungs and liver

2) Localized CNS infection or localized infection to skin, eyes or mouth

In general:

  • HSV should be suspected in any infant with signs of sepsis or liver dysfunction with negative bacterial culture
  • Fever
  • Irritability
  • abnormal CSF findings
  • seizure
24
Q

How is a HSV diagnosis confirmed?

A

1) Culture obtained from any of:
- skin vesicle
- nasopharynx
- eyes
- urine
- CSF
- Stool
- Rectum

2) PCR from either blood, CSF or urine

25
Q

What is the treatment for congenital HSV infection?

A
  • Acyclovir I.V.
26
Q

Which pathogen causes syphilis?

A

Treponema pallidum

27
Q

What is the Hutchinson triad?

A

1) Interstitial keratitis
- Inflammation of the tissue of the cornea, the clear window of the eye
- Can lead to vision loss
2) Eighth cranial nerve palsay
- Vestibulocochlear nerve
- Hearing loss
- Vertigo
3) Hutchinson teeth
- Teeth are smaller and more widely spaced
- Have notches on the biting surface

28
Q

What type of abnormalities may be seen in the bones of a child born with congenital syphilis?

A
  • Osteochondritis (inflammation of the cartilage or bone in a joint)
  • Perichondritis (inflammation of connective tissue surrounding cartilage)
29
Q

What are snuffles?

A
  • Syphilitic rhinitis
  • More severe and persistent than the common cold and are often bloody
  • One of the earliest presenting signs of congenital syphilis
30
Q

How is congenital syphilis treated?

A
  • I.V. penicillin G (10-14 days) is the preferred drug and only documented effective treatment for congenital syphilis
31
Q

How do you follow-up on a patient treated for congenital syphilis?

A
  • Repeat nontreponemal titers at 3, 6, and 12 months to document falling tirers
  • In infants with neurosyphilis CSF must also be examined for at least 3 years or until CSF findings are normal.
32
Q

An infant with congenital N. gonorrheoeae typically has an infection where?

A

1) Eyes (ophthalmia neonatorum)

Other areas:

  • scalp abscess
  • vaginitis
  • diseminated disease
  • arthritis
  • meningitis
33
Q

When is an infant typically infected with N. gonorrheoeae?

A
  • During birth

- Mucous membranes come in contact with infected secretions of the mother

34
Q

Is congenital gonorrhea infection of the eye typically unilateral or bilateral?

A
  • Bilateral

- However, one eye may be clinically worse than the other

35
Q

How and when does a congenital gonorrhea infection typically present?

A
  • Within the first 5 days of life

- Initially a clear watery discharge which rapidly becomes purulent

36
Q

What complications to the eye can occur if congenital gonorrhea is left untreated?

A
  • Infection can spread to cornea (keratitis)
  • Can spread to anterior chamber of eye
  • Extention can result in corneal perforation and blindness
37
Q

How is ophthalmia neonatorum treated? Are these patient admitted?

A

1) Single intramuscular injection of ceftriaxone
- cefotaxime used if there is hyperbillirubinemia
- Eye irrigation with saline
* * Topical antibiotic therapy is inadequate alone and thus not recommended in patient treated with IM ceftriaxone **

2) Yes these patients are admitted and monitored for response to treatment and signs of disseminated disease

38
Q

What efforts are made to prevent congenital gonorrhea infection?

A
  • Pre-natal screening and treatment of gonorrhea
  • Prophylactic erythromycin, silver nitrate eye ointment or tetracycline at birth for gonorrheal and chlamydial conjunctivitis
39
Q

How is neonatal chlamydial conjunctivitis typically characterized?

A
  • bilateral ocularcongestion, edema, and discharge

- develops 5-14 days after birth

40
Q

Aside from ocular infection how else can a congenital chlamydial infection present?

A
  • Pneumonia
41
Q

How is chlamydial infection confirmed?

A
  • culture from conjunctival scraping

- Giemsa stain showing blue stain is also diagnostic

42
Q

How is congenital chlamydia treated?

A
  • 14 day course of oral erythromycin

- Topical treatment in known case, like in gonorrhea, is not effective and thus not recommended

LMCC Study - Peds (12 decks)

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