EXAM #2: PERINATALLY ACQUIRED INFECTIONS Flashcards
What are the TORCHES infections?
1) Toxoplasmosis
2) Other
3) Rubella
4) CMV
5) Herpes/Hepatitis
6) Syphilis
How is Toxoplasmosis acquired?
CATS via cat feces AND:
- Undercooked meat
- Uncooked eggs
- Unpasteurized milk
What should pregnant mothers be told not to do?
Change the litter box
How does the risk of Toxoplasmosis change with gestational age? How does the severity of Toxoplasmosis change with gestational age?
- Increased RISK with gestational age
- Decreased SEVERITY with gestational age
What is the classic triad of CNS findings in perinatal Toxoplasmosis?
1) Hydrocephalus
2) Chorioretinitis
3) Intracranial calcifications (diffuse or speckled)
What is chorioretinitis?
Inflammation of the posterior portion of the uveal tract and retina
What two TORHCES infections have intracranial calcifications? What is the mnemonic to remember the difference?
CMV and Toxoplasmosis
- CMV= periVentricular
- ToXoplasmosis= diffuse
How is the diagnosis of Toxoplasmosis made?
1) Head CT
2) Ophthamology exam
3) IgM or persistent IgG titers
How is Toxoplasmosis treated post-natally?
1) Pyrimethamine
2) Sulfadiazine
3) Leucovorin
4) Corticosteroids
What are the major clinical outcomes of Toxoplasmosis?
1) Mental Retardation
2) Seizures
3) Cerebral Palsy
4) Deafness
What type of virus is Rubella?
Togaviridae
What are the only known source of Rubella infection?
Humans
What is the alternate name for Rubella?
German Measles (in adults)
What is the most common vaccine preventable disease in the world?
Congenital Rubella Syndrome (CRS)
What are the classic symptoms of CRS?
1) Deafness
2) Cataracts
3) Congenital heart disease
What is the most common isolated sequelae of CRS?
Deafness
What are the two most common heart defects associated with CRS?
1) PDA
2) Pulmonary stenosis
How is CRS diagnosed? When does diagnosis need to be made?
- Must be done in the first year of life*
1) Culture
2) Serum IgM titers
3) PCR
What is the treatment for CRS?
There is no treatment; only supportive care
*This is preventable with vaccination
What finding in the neonate should make you think CMV?
Jaundice
What type of virus is CMV?
DNA, part of the herpes virus family
What is the most common congenital infection in developed countries?
CMV
What is the classic triad of symptoms in neonatal CMV infections?
1) Petechia/ecchymosis (Blueberry muffin rash)
2) Jaundice at birth or within a few hours*
3) Hepatosplenomegally
When should a physiologic jaundice develop?
Days 2,3,4,or 5
Where are intracranial calcification seen in CMV?
PeriVentricular
How is CMV diagnosed?
1) Urine CMV
2) Serum IgM
3) Head CT
What is the treatment for congenital CMV infections?
Gancyclovir
What is the leading cause of childhood sensorineural hearing loss in developed countries?
Congenital CMV
What is the presentation of disseminated congenital HSV?
Febrile ill-appearing neonate
When does disseminated congenital HSV occur?
Before week 2
What is SEM congenital HSV infection?
Skin-Eye-Mouth
Vesicles found in those locations without disseminated disease
When does SEM HSV occur?
Before week 1
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How is HSV diagnosed?
1) Tzanck smear
2) PCR
What is a clue to congenital HSV infection?
Elevated LFTs
What is the treatment for HSV?
Acyclovir
How is congenital HSV prevented?
1) C-section with active lesions
2) Obtain culture if born with active lesions
3) Treat with ayclovir empirically
If a mother is positive for Hepatitis B, what do you do?
1) Give HepB immunoglobulin
2) HepB vaccine
What are the early classic symptoms for congenital syphillis?
1) Mucocutaneous lesions
2) Lymphadenopathy
3) Rash
4) Snuffles
5) Metaphyseal Dystrophy
6) Periositis
What are the late stage congenital syphilis findings?
1) Hutchinson teeth
2) Saber shins
3) Frontal bossing
If the mother has gotten proper treatment for syphillis, what do you need to do for the infant?
Nothing
If the mother has NOT gotten proper treatment for syphillis, what do you need to do for the infant?
PCN
What should mothers with HIV not do post-natally?
Breastfeed
How is congenital HIV diagnosed?
PCR
When are neonates tested for HIV? What is a positive test?
2 weeks, 2 months, 6 months
- Positive= 2x
- Negative= 3x negative
Should women be tested for HIV during pregnancy?
Yes
What drug is given to babies of HIV infected mothers?
AZT
