ID and Immunization Flashcards
Which is false about Hep C:
- 5% of preg F w/ chronic transmit to infant
- no specific intervention to decrease vertical transmission
- primary dx test performed at 6 mo
- approximately 25% infant clear virus spontaneously
Primary dx test is HCV serology and done at 6 months of age.
** HCV serology not reliable in infancy because mother’s antibodies. Test at 12-18 month; repeat at 18 month if (+).
Note: testing at any age negative= don’t need to repeat.
If sero-(+) at 18 month= infected with HCV.
Recurrent HSV mom with lesions on labia at delivery. Delivered via C/S. Asymptomatic. When do you do surface swab:
- after 24 h
- immediately at birth
- within first 4 h
- < 12 h of age
24 h or later
What are the congenital infections?
CHEAP:
- chicken pox
- Hep B, C, E
- Enterovirus
- AIDS
- Parovirus B19
TORCHES:
- Toxoplasmosis (Big Cat/ C’s)
- Other (Zika)
- Rubella (Blue eyes + ears + heart)
- CMV (Draw the face+ Crown)
- HSV
- Every other STD
- Syphilis (the S’s)
What is the most common congenital infection?
CMV
What % of kids with CMV who are asymptomatic get permanent sequelae later?
15%
T or F: Most congenital CMV is symptomatic.
False (85%= asymp)
Describe key congenital CMV features:
CMV Draw a face with a crown. - C= chorioretinitis - C= ears= Deafness - M= Crown= MR and microcephalic - V= periventricular Ca2+
T or F: Congenital CMV treated w/ valganciclovir associated with improved hearing and neurocognitive skill at 24 months.
True
When do you treat congenital CMV? Tx with what? Monitoring?
- symptomatic w/ CNS, B/L sensorineural hearing loss or Chorioretinitis
- Tx: valganciclovir x 6 months
- Monitor toxicity:
CBC (neutrophil), Cr - Stop therapy if ANC < 0.5
- Long term F/U hearing + neurocognitive
Maculopapular rash on palm + sole. Chorioretinitis. Bony changes?
- Toxo
- Rubella
- CMV
- Syphilis
- HIV
Syphilis
List Syphilis Findings:
Syphilis= S’s
- snuffles
- salt + pepper chorio
- soles + palm rash
- stupid bones
Early:
- Snuffles
- Chorioretinitis “salt and pepper”
- Maculopapular palsm + soles
- HSM
- Bones: pseudo paralysis, osteochondritis, diaphysial periostitis
Late:
- GDD
- hydrocephalus
- chorioretinitis, glaucoma
- hearing loss
- saddle nose, frontal bossing, high arched palate
- Hutchinson’s teeth
- mulberry molars
- Linear Scars
Syphilis Preg F. RPR 1:128. Given 1 dose IM pen after RPR drop 1:64. Drop to RPR 1:32. Management for BB who has normal p?E:
- no tx as mom tx good
- full W/U = LP + 10d IV pen irregardless
- full W/U = LP + 10d IV penicillin if abN W/U
- full W/U= LP + single dose IM pen if abnormal
Goal: 4X RPR preg F drop
If not= W/U= LP
+ 10 d IV penicillin
When do you consider tx for a pt for congenital syphilis?
- Mother not treated
- Tx with non-pen regiment
- Tx within 30 d of child’s birth
- < 4X drop in mother’s non-treponema titre
- Infant has signs + symp of congenital syphilis
= TX FOR SYPHILIS (pen x 10d)
What is your W/U for congenital syphilis?
- **P/E
- **BW: CBC, LFTs
- **Syphilis serology (non treponemal and treponemal)
- Direct detection (dark field microscopy)
- **Skeletal Survey
- ** LP (even if asymp; test treponemal and non treponemal serology; if + repeat in 6 mo.)
What do you do if you have an asymptomatic pt whose mother’s RPR fell 4X or greater in preg?
If material RPR Fall 4X
** Check infant RPR!
= Non reactive or infant RPR < mother and asymptomatic
= No Tx
= clinical + serology F/U to 18 months
IF Infant RPR 4 fold or higher than maternal or symptomatic= full evaluation + Tx
What is Tx for Congenital Syphilis
IV pen G 10-14d
Macrocephaly/ Hydrocephalus + Cerebral Calcification + Chorioretinitis. Which TORCH?
“BIG Cat/ C’s”
- Big Brain= Hydrocephalus/ macrocephaly
- Cerebral calcifications
- Chorioretinitis
Note: LP= lymphocytic pleocytosis + high protein
How do you dx and treat congenital Toxo?
Dx: PCR (CSF, Blood, urine, tissue)
Tx: pyrimethamine + sufladiazine + leucovorin x 12 months
Monitor: Neutrophil
List Congenital Rubella Features?
BLUE EYES + EARS + HEART + BONES
- Blueberry rash
- Cataracts (blue eyes)
- Bony lesions
- Hearing (SNHL)
- PDA
Name congenital VZV (Varicella) features?
Microcephaly
Scars
Limb hypoplasia
GERD
Name congenital Zika features?
Microcephaly
Brain malformations
Macular scar
Contracture
Which TORCH infection has MACROcephaly?
BIG CAT/ C’s
- big head= hydrocephalus + macrocephaly
- chorioretinitis
- parenchymal Ca2+
T or F: highest risk period is during T3 for zika virus.
False.
affect brain
= T1 + T2
W/U: zika serology and PCR on mother + baby
If (+)= imaging (US and MRI)
Which TORCH infection has cataracts?
Rubella
Blue eyes
Blue ears
Blue heart
Blue bones