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Block G -- Infection > Dr. Rubin -- Congenital/Perinatal Infections > Flashcards

Dr. Rubin -- Congenital/Perinatal Infections Flashcards

1
Q

3 protective immunity mechanisms for fetus and neonate

A
  • Placenta (filter microorganisms)
  • Maternal Ab (mostly 3rd term)
  • Breast milk (secretory IgA)
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2
Q

Time of fetal infection that produces the most devastating effects

A

1st trimester

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3
Q

3 types of effects of fetal infection

A
  • Interference with normal development
  • Inflammatory reaction to the infection
  • Placental insufficiency leading to poor growth
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4
Q

How to recognize exposure of a pregnant woman

A
  • Usually asymptomatic
  • Detection of specific IgM Ab to an offending agent or rising titer of IgG helpful to assess risk
  • Baseline immunity will help to excluse dx (i.e. immunity against Rubella, CMV, parvo, etc)
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5
Q

Ig findings that indicate fetal infection

A

Presence of specific IgM or rising IgG titre

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6
Q

4 ways to isolate offending agents to diagnose infant

A
  • Viral cultures of urine and other body secretions for CMV, Rubella, HSV
  • PCR amplification if possible (i.e. Toxo)
  • Pathology of placenta
  • Darkfield microscopy from lesions for *T. pallidum *(syphillis)
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7
Q

4 fetal infections that you absolutely cannot miss (important to treat)

A
  • Toxoplasmosis
  • Syphilis
  • HSV
  • HIV
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8
Q

Fetal infection with no effective treatment

A

Rubella

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9
Q

Fetal infection with which there is only a possibility of treatment benefit

A

CMV (partial and transient improvement)

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10
Q

9 examples of organisms that are included in the O (other) of TORCH screen

A
  • Syphilis
  • TB
  • Listeria
  • Leptospirosis
  • Hepatitis B
  • Enteroviruses
  • Varicella
  • Parvovirus
  • HIV

etc

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11
Q

Common misconception about TORCH

A
  • There is no one test that will screen for congenital infections
  • Nothing replaces a good clinical accumen and directed specific testing
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12
Q

11 common features associated with TORCH agents

A
  • Prematurity
  • IUGR
  • Congenital defects
  • Abnormal head size
  • Intracranial Ca++
    • Periventricular
    • Diffuse
  • Eye abormalities
  • Earing loss
  • Hepatosplenomegaly
  • Hematologic AbN
  • Bone lesions
  • Inflammtion of CSF
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13
Q

2 conditions of adnormal head size associated with TORCH agents

A
  • Microcephaly
  • Hydrocephaly
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14
Q

3 eye abnormalities associated with TORCH agents

A
  • Chorioretinitis
  • Cataracts
  • Micophthalmia
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15
Q

Define TORCH

A
  • Toxoplasma
  • Other (covered in another card)
  • Rubella
  • Cytomegalovirus
  • Herpes
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16
Q

Classic triad of congenital toxoplasmosis

A
  • Hydrocephaly
  • Diffuse intracranial calcifications
  • Chorioretinitis
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17
Q

Approach to congenital toxoplasmosis

A
  1. Refer to maternal serology
  2. If not done, start with Toxo IgG and then Toxo IgM
    1. NEG
    2. POS
  3. Ophthalmology assessment for chorioretinitis
  4. Head imaging (CT vs. US vs Xray)
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18
Q

Use of NEG in congenital toxoplasmosis diagnosis

A
  • Toxo IgG = excludes Congenital Toxoplasmosis
  • Toxo IgM = does not totally exclude
19
Q

Describe the use of POS in congenital toxoplasmosis

A
  • Look at titre and avidity –> strong avidity = more remote infection
  • Toxo IgM = increases the likelihood, but + for >6 months
20
Q

Approach to toxoplasmosis during pregnancy

A
  • Seruconversion documents
  • Positive IgM
    • PCR on amniotic fluid
    • Serial ultrasounds, looking for ventricular dilatation
    • Placental histology
21
Q

Treatment for positive aminiotic fluid PCR in event of suspected toxoplasmosis during pregnancy

A

Pyramethamine and sulfadiazine and folinic acid supplements

22
Q

Treatment for negative amniotic fluid PCR in event of suspected toxoplasmosis

A

Spiramycin

23
Q

Approach to suspected congenital rubella (7)

A
  1. Check mom’s rubella status prior to the current pregnancy
    1. If positive = excludes rubella
    2. If negative or unknown, check Rubella IgG on Mom or baby
      1. If negative = excludes Rubella –> immunize Mom
      2. If positive –> rubella IgM
        1. If positive = Congenital Rubella
        2. If Negative –> Rubella Viral Cultures
24
Q

Approach to suspected congenital CMV

A
  • Urine viral culture for CMV
    • POSITIVE = if done within first 2 - 3 weeks of birth –> CMV
    • NEGATIVE = exclude CMV
  • No need for serology
25
Q

3 potential manifestations of congenital herpes

A
  • Skin, eye, mucous membrane (“SEM”)
  • Encephalitis
  • Disseminated
26
Q

Approach to suspected congenital herpes

A
  • Lesion –> viral cultures
    • POSITIVE = herpes
  • No lesions
    • Culture mouth, NP, eyes, urine ,rectum
      • POSITIVE > 48 hours after birth = viral replication vs. colonization after intrapartum exposure
    • CSF and blood HSV PCR
    • Tissue diagnosis

NOTE: HSV IgG and IgM not very helpful

27
Q

Approach to suspected congenital syphillis

A

Check naternal serology and recheck at time of delivery, or thereafter

  • NEGATIVE = exclude
  • POSITIVE = review history, prior treatment
28
Q

3 of the only congenital infections that are treatable

A
  • Syphillis
  • Toxoplasmosis
  • HSV
29
Q

2 sequelae of maternal primary CMV in pregnancy

A
  • Severe psychomotor delay (50 - 60%)
  • Hearing loss (30 - 60%)
30
Q

Primary etilogy of Fifth Disease (erythema infectiousum)

A

Parvovirus B19

31
Q

Effect of parvovirus in hemoglobinopathy patietns

A

Aplastic crisis

32
Q

Effects of parvovirus B19 in pregnancy

A
  • ?Spontaneous abortion in 1st trimester
  • Fetal anemia nad hydrops in 2nd and 3rd trimester
  • ?Stillbirth
33
Q

3 general effects of parvovirus B19

A

Bone marrow aplasia (hemolysis) –> severe anemia and CHF

34
Q

4 other infectious causes of nonimmune hydrops

A
  • Toxoplasmosis
  • Rubella
  • CMV
  • Syphillis
35
Q

Diagnosis of parvovirus B19

A

Serology on mom at time of exposure

  • If IgG positive = immune
  • If IgG negative = check and follow IgM and IgG
36
Q

Why is elevated alpha-fetoprotein a potential marker for adverse outcome

A

Produced in fetal liver, which is the major site for fetal erythropoiesis and major site of infection for B19

37
Q

Approach to a mother who is sAg and eAg positive for hepatitis B

A

High transmission and risk for infant to become chronic carrier = give HBIG and first dose of vaccine at birth (then at 1, 6 months)

38
Q

Describe perinatal HCV transmission

A
  • Low (<5%)
  • Increased if co-infected iwth HIV (18-20%)
39
Q

HCV diagnosis in infant

A

Follow serology at 6, 12, 18 months

PCR potentially

40
Q

When to give prophylactic antiviral to infants exposed to HSV at birth (4)

A
  • Eyes, NPA and urine cultures are positive
  • Primary infection in mother
  • Premature with limited transfer of maternal Ab
  • Instrumentation
41
Q

5 situations that cause higher risk of HSV to infant

A
  • First episode of maternal infection in pregnancy (i.e. versus recurrent)
  • Multiple cervial lesions
  • Rupture of membranes > 6 hours
  • Instrumentation, scalp electrodes
  • Prematurity, no maternal antibody
42
Q

4 manifestations of VZV embryopathy

A
  • Limb scarring and atrophy
  • Bony defects
  • CNS abnormalitis
  • Eye, chorioretinitis
43
Q

3 potential manifestations of Varicella Zoster infection in newborn

A
  • VZV embryopathy
  • Development of Zoster early in life
  • Congenital vericella syndrome
44
Q

Approach to suspected congenital varicella zoster infection

A
  • Unlikely that VZIG is protective in fetus
  • Give VZIG to newborn in maternal varicella 5 days before to 2 days after delivery

Block G -- Infection (23 decks)

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