Congenital Infections Flashcards
Define congenital infection
- An infection acquired transplacentally during gestation
List as many common congenital infections as you can
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
Many clinical manifestions from congenitial infections are similar regardless of infection what are some common problems?
- Intrauterine growth restriction
- Non-immune hydrops fetalis
- anemia
- thrombocytopenia
- jaundice
- hepatosplenomegaly
- chorioretinitis
- congenital malformation
What is hydrops fetalis?
Abnormal accumulation of fluid in 2 or more fetal compartments:
- Ascites
- Pleural effusion
- Pericardial effusion
- Skin edema
Which pathogen causes toxoplasmosis?
- Toxoplasma gondii
What classic triad would you expect to see in a patient with toxoplasmosis?
1) hydrocephalus
2) chorioretinitis
3) intracranial calcifications.
How is the diagnosis of toxoplasmosis confirmed?
- Serum IgG antibody testing
How would you treat an infant with toxoplasmosis?
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
How is toxoplasmosis transmitted?
- Contamination with cat feces
- Undercooked meat
How would you counsel a pregnant patient when discussing ways to prevent congenital toxoplasmosis infection?
- Avoid cat litter box
What is the classic triad of clinical features associated with congenital rubella?
- What other features are common?
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
How is rubella diagnosed?
- IgM antibodies for recent infection
- IgG antibodies over sever months can confirm
- Rubella can be isolated from urine, blood, CSF and throat swabs
How long should a baby with congenital rubella stay away from pregnant women and why?
- 1 year
- Infants are chronically and persistently infected and tend to shed the virus for 1 year
True or False: Children born to adolescents are 3-7 times more likely to be infected with CMV?
True
How is cytomegalovirus diagnosed?
- 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
What is the leading cause of non-hereditary sensorineural hearing loss in infants?
- Cytomeglovirus
What are the most common sources of CMV occurring in the mother?
- Sexual contacts
- Contacts with young children
- Daycare workers, school teachers, etc.. at increased risk
How does a patient with congenital CMV most commonly present at birth?
- 90% are asymptomatic!
- 10% are small for gestational age
What symptoms can occur with congenital CMV?
- 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
What has been shown to decrease the progression of hearing loss in children with congenital CMV?
- Ganciclovir
What carries a higher risk of transmission of HSV from mother to fetus? Primary infection or reactivated secondary?
- Primary (33-50% risk)
- Secondary (under 5% risk)
How long after birth does an infant present with signs of HSV infection?
- Normal at birth in most cases
- day of life 5-10 is when symptoms tend to develop
What are the clinical features of congenital HSV infection?
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
How is a HSV diagnosis confirmed?
1) Culture obtained from any of:
- skin vesicle
- nasopharynx
- eyes
- urine
- CSF
- Stool
- Rectum
2) PCR from either blood, CSF or urine
What is the treatment for congenital HSV infection?
- Acyclovir I.V.
Which pathogen causes syphilis?
Treponema pallidum
What is the Hutchinson triad?
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
What type of abnormalities may be seen in the bones of a child born with congenital syphilis?
- Osteochondritis (inflammation of the cartilage or bone in a joint)
- Perichondritis (inflammation of connective tissue surrounding cartilage)
What are snuffles?
- Syphilitic rhinitis
- More severe and persistent than the common cold and are often bloody
- One of the earliest presenting signs of congenital syphilis
How is congenital syphilis treated?
- I.V. penicillin G (10-14 days) is the preferred drug and only documented effective treatment for congenital syphilis
How do you follow-up on a patient treated for congenital syphilis?
- 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.
An infant with congenital N. gonorrheoeae typically has an infection where?
1) Eyes (ophthalmia neonatorum)
Other areas:
- scalp abscess
- vaginitis
- diseminated disease
- arthritis
- meningitis
When is an infant typically infected with N. gonorrheoeae?
- During birth
- Mucous membranes come in contact with infected secretions of the mother
Is congenital gonorrhea infection of the eye typically unilateral or bilateral?
- Bilateral
- However, one eye may be clinically worse than the other
How and when does a congenital gonorrhea infection typically present?
- Within the first 5 days of life
- Initially a clear watery discharge which rapidly becomes purulent
What complications to the eye can occur if congenital gonorrhea is left untreated?
- Infection can spread to cornea (keratitis)
- Can spread to anterior chamber of eye
- Extention can result in corneal perforation and blindness
How is ophthalmia neonatorum treated? Are these patient admitted?
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
What efforts are made to prevent congenital gonorrhea infection?
- Pre-natal screening and treatment of gonorrhea
- Prophylactic erythromycin, silver nitrate eye ointment or tetracycline at birth for gonorrheal and chlamydial conjunctivitis
How is neonatal chlamydial conjunctivitis typically characterized?
- bilateral ocularcongestion, edema, and discharge
- develops 5-14 days after birth
Aside from ocular infection how else can a congenital chlamydial infection present?
- Pneumonia
How is chlamydial infection confirmed?
- culture from conjunctival scraping
- Giemsa stain showing blue stain is also diagnostic
How is congenital chlamydia treated?
- 14 day course of oral erythromycin
- Topical treatment in known case, like in gonorrhea, is not effective and thus not recommended
